A history of medicine in Chinese culture Volume 1 2019020532, 9789813237971, 9789813237988, 9789813237964, 981323797X

Table of contents :
VOLUME 1
Contents
Part One The Cultural Background to the Origins of Chinese Medicine
Chapter 1 Primitive Human Beings, Their Health, Culture and Ecological Environment in China
A. Primitive Culture and Ecological Environment
1. The Origin of Human Beings in China
2. Chinese Culture and Its Natural Ecological Distribution During the Paleolithic Period
3. Neolithic Culture and Its Natural Environment in China
B. The Physique and Diseases of Primitive Human Beings in China
4. The Evolution of the Physical Constitution of the Ancient Chinese
5. Discoveries of Archaeological Pathology
C. The Culture and Conditions of Hygiene Among Primitive Humans in China
6. The Residential Culture of “Nest-Living & Cave-Dwelling” and Its Significance for Health
7. Striking Flints or Drilling a Log to Get Fire & the Significance of Cooked Food to Health
8. The Culture of Dietary Hygiene and Its Influence on Other Things
9. The Culture of Hygiene in Clothing
10. Primitive Dance, Music and Sports
11. “Cannibalism” and Funeral Sanitation
Chapter 2 Primitive Thought, Worship and Medical Culture
A. Primitive Thought and Medical Culture
12. The “Collective Unconsciousness” and Mysterious Feelings
13. The Concept of “Soul”
14. The Experience of Using Objects as Tools and Cumulative Thinking
B. Primitive Worship and Its Association with Medicine
15. The Worship of Nature
16. The Worship of Totems
17. The Worship of Reproduction
18. Ancestor Worship
19. The Worship of Ghosts and Gods
Chapter 3 The Primitive View of Life, Getting Old, Illness and Death: The Pursuit of Longevity
A. The Earliest View of Life and Death
20. The Original Understanding of Human Life
21. The Origins of Birth
22. The Meaning of Death
23. Primitive Knowledge of the Human Body and Its Anatomy
B. The Earliest View of Illness and Etiology
24. What Is Illness?
25. Diseases Involving Gods, Spirits, and Others
C. The Pursuit of Immortality
26. Longevity Involving Gods and Spirits
27. The Immortal Regions and Their Medicines
Chapter 4 Treatment in a World of Wizardry
A. The World of Wizardry
28. The “Blocked Way Between Heaven and Earth” and the Wizard
29. The Behavioral Characteristics of Sorcery and Its Psychological Foundations
30. Sorcery, Religion and Science
B. Sorcerous Doctors and Sorcerous Medicine
31. Sorcerous Doctors in Ancient Times
32. Zhu Taboo, Divination and Medicine
33. Horoscopes, Divination by Dreams and the Yarrow Stalks
34. The Great Exorcism and Fu Xi Sacrifice
35. Massage? Moxibustion? Herbal Medicine?
36. The Medicine of Witchcraft in the Mountain and Seas Classic
Chapter 5 The Origin of Medicine
A. A Definition of the Origin of Medicine and Other Relative Factors
37. To Identify the Conception of Medicine’s Origin
38. Animal Instinct and Human Love
39. Primitive Thinking and the Functions of the Witch
40. The Relationship of Life and Labour to the Origins of Medicine
B. The Beginnings of Early Medicine and Health Care
41. Massage, Daoyin, Hot Compresses, Moxibustion and the Discovery of the Meridian
42. From Stone Needling to Acupuncture
43. The Growth of Medical Knowledge
44. The Bud of Prevention
45. The Famous Doctor Bianque: A Step Up from Witch-Doctoring
Conclusion of Part One
Part Two Chinese Medicine Under the Influence and Permeation of Philosophy, Religion and Politics
Chapter 6 The Heavenly Law (Tao) of Nature and Medicine in Deference to Nature
A. “Tao Qi” Theory and Medicine
46. From Ji Zi to Lao Zi, Zhuang Zi and the Jixia
47. Qi as the Root of Medical Theoretics
B. The Medical Theories of the Yin–Yang and Five Elements
48. The Formation of the Yin–Yang and Five-Element Theories
49. The Golden Mean, the Three Talents, Image and Number, and the Correspondence Between the Human and Natural
50. From the Mawangdui Medical Books to Huangdi’s Inner Classic (黄帝内经)
Chapter 7 Occultist Culture and Medicine Under the Impact of the Confucian Classics and Chenwei Philosophy
A. The Fangshi2 Culture and Some Secret Medical Groups
51. Research on the Date of the Composition of Huangdi Neijing (黄帝内经)
52. Medical Schools, Lord Cang, His Masters and Apprentices
53. The Huangdi Neijing (黄帝内经) and Secret Medical Schools
B. Another Side to Taoist Medical Science
54. The Occultist’s Art of Well-Being
55. Occultists in Search of Elixirs and the Immortal Alchemy of the Yellow (Gold) and White (Silver)
56. The Compositional Background to Shen Nong’s Classic of Materia Medica (神农本草经)
57. The Calamity Due to Witchcraft Gu, Chunyu Yan Killing the Queen and Their Involvement with Occult Physicians
C. The Impact on Medicine of the Study of the Confucian Classics, Chenwei Theology and Anti-Chenwei Philosophy
58. Studies of Two Types of “Ancient” and “Present” Confucian Classics and Chenwei Theology
59. Anti-Chenwei Philosophy and Thoughts of a Primordial Qi
D. The Background for the Medical Achievements of Zhang Zhongjing and Hua Tuo
60. The Confucian Tradition of Zhang Zhongjing, a Medical Sage
61. Hua Tuo, a Miraculous Doctor, His Occult Elements and Demeanour
Chapter 8 Religious Taoism and Medical Culture
A. The Inherited Relationship Between Religious Taoism and Medicine
62. The Role of Occult Medicine During the Establishment of Religious Taoism
63. The Origins of Alchemy and Medicine
64. The Development of Internal dan and Its Influence on Medicine
B. A Taoist’s Magic and Medical Skills
65. The Taoists Holding Some Medical Skills
66. The Taoist’s Magical Arts of Forbidding or Incantation
67. The Art of Taoist Talismans
68. The Taoist’s Magic or “Supernatural Power”
C. Taoist Doctors and Their Grand Contribution
69. How Ge Hong Dabbled in Medicine
70. The Taoist Naturalist and Leader Tao Hongjing
71. The Great Sun Simiao in Medicine and Taoism
72. Contributions from Other Taoist Doctors
Chapter 9 Neo-Taoism and Medicine During the Wei, Jin, Southern and Northern Dynasties
A. Neo-Taoist “Idle Talk” and the Fashion of Taking Stone Powders
73. Neo-Taoist Idle Talk and a Comprehensive View of an Undisciplined Life
74. The Prevailing Fashion of Taking Medicines such as Wushi San
B. The Prospering of the Medicine During the Wei and Jin Dynasties
75. Huangfu Mi and The Classic ABC of Acupuncture and Moxibustion (针灸甲乙经)
76. On Material Things (物理论), The Theory of Spiritual Perishability (神灭论) and Views on Life and Death
77. Medicine Prospers in the Wei, Jin, Southern and Northern Dynasties
Chapter 10 Confucianism and Medicine
A. A Medicine Dominated by Feudal Ethics
78. From Licking Piles and Sucking Carbuncles to “Cutting the Flesh of His Thigh to Cure His Parents”
79. The Monarch’s Medicine Tasted by Officials, Understanding Medicine as Filial Piety and Feeling the Woman’s Pulse Through a Gauze
B. Neo-Confucianism, “Down-to-Earth” Learning and Medicine
80. From the Taiji Diagram to the Innate Root — The “Kidney’s Life-Gate”
81. Zhang Jiebin’s Taoist Medical Theories
82. Medical Reflections on Acquiring Knowledge by Probing into Things
83. The Medical Tradition of Abiding in the Classics
C. The Rise of the Confucian Doctors
84. To Be a Good Prime Minister or Excellent Doctor
85. Various Yongyi (Quacks)
86. Kindness in Medicine
Chapter 11 The Emperors, Their Government and Medicine
A. The Emperors and Their Medicine
88. The Emperors of the Han and Tang Dynasties and Their Dealings with Medicine
89. Emperors and Medicine During the Song Dynasty
90. Emperor Kangxi and Medicine
B. The Governmental System and Organization of Medicine and Health
91. The Governmental Medical Organizations and a Doctor’s Social Position
92. Supporting the Disabled, Visiting the Sick and Policies of Medicine and Health
93. The Imperial Medical Agency and Official Medical Education
C. Governmental Materia Medica, Medical Books and Bronze Acupuncture Figures
94. National Pharmacopoeias Issued by the Government
95. Officials Emending Medical Books
96. Casting Acupuncture Figures in Bronze
D. The Formulation of Medical Law and Progress in Forensic Medicine
97. The General Situation of Medical Law
98. Medical Jurisprudence and Legal Forensic Examination
Conclusion of Part Two
VOLUME 2
Content
Part Three Medicine in Social Life, Epidemics and the Invention of Variolation
Chapter 12 Medicine in Different Social Environments
A. Medicine in War and Turmoil
99. Medical Conditions During War and Periods of Historical Turmoil
100. Health Organization in the Army
101. Surgery in the Army
B. Medicine in the Heyday of Peace
102. Peaceful Eras and the Conservation of Medicine
103. Concerning the Books: Treatise on the Causes and Origins, and Manifestations of Various Diseases, Important Prescriptions Worth a Thousand Gold Pieces and Arcane Essentials from the Imperial Library
104. Compilations, Compendia, Medical Cases and Rudimentary Verses
C. The Relationship Between Population Statistics, Natural Ecology and Diseases in History
105. Geography and Diseases of the Five Directions
106. The Theory of the Five Circuits and Six Qi
107. The Relationship Between Population Statistics and Diseases in Ancient China
108. Diseases in Relation to Social Ecology
Chapter 13 Epidemics and the Triggering Mechanism of Disaster
A. Ancient Epidemic Diseases and Epidemiological Factors
109. The Historical Background to Epidemics
110. Major Epidemics During the Zhou and Qin Dynasties, and at the Beginning of the Han
111. The Main Epidemics of the Han, Wei, Jin, Northern and Southern Dynasties
112. Epidemics During and After the Sui and Tang Dynasties
113. Conducting Textual Research on the Epidemicity of the Plague and Cholera
B. The Evolution of a Theory of Epidemics
114. The Evolution of the Etiology of Seasonal Qi, Pestilent Qi and Other Qi
115. The Impracticality of Ancient Prescriptions for Curing New Diseases, the Theory of the Fire and Heat Mechanism, and the Theory of Attacking the Pathogenic Qi
116. The Theory of Internal Injury and Yin Syndrome Theory
117. The Theory of Epidemic Febrile Disease Put Forward by Ye Tianshi and Others
Chapter 14 Smallpox Remedies and Variolation in Ancient China
A. Outbreaks of Smallpox and TCM Treatment in Ancient China
118. Textual Research on Outbreaks of Smallpox in China
119. Smallpox Treated by Chinese Medicine
(1) Origins of the Theories and Treatments for Smallpox: A Summary
(2) Comparatively Mature Treatments for Smallpox
(3) Curative Efficacy
B. The Invention of Variolation and Its Promotion by Emperor Kangxi
120. The Origins of Variolation
(1) Ideas of Prevention and Initial Therapies
(2) Legends of Variolation’s Origin
(3) A Literature Review of Variolation Therapy
(4) Stories on Variolation’s Origin
(5) Research into the Beginnings of Variolation in the Regions South of the Yangtze River in the Middle and Late Ming Dynasty
121. Views on the Popularization of Variolation by Emperor Kangxi
C. The Theory, Technology and Success of Variolation
122. The Theory and Technique of Variolation
(1) Foetal Toxin and the Theory of Variolation Being Used to Discharge Foetal Toxin
(2) The Variolation Method and Its Improvement
(3) Efficacy and Safeguarding Measures During Variolation
(a) Selecting the Seedlings
(b) Seedlings, Their Storage and Management
(c) The Timing of the Variolation
(d) Suitable and Unsuitable Constitutions for Variolation
(4) Observation and Recuperation with Herbal Medicines After Variolation
123. The Success Rate of Variolation
Chapter 15 Science, Technology and Medicine: Ancient Occupational Disease, Its Prevention and Treatment
A. The Development of Science and Technology and the Progress Made by Medicine During Ancient Times
124. Time Medicine, Biological Rhythm and the Theory of the Midnight-Midday Ebb and Flow
125. Simple Systems Theory and Experimental Thought in Traditional Chinese Medicine
126. The Identification, Processing and Refining of Medicines
127. Other Effects of Scientific and Technological Progress on Medicine
B. The Prevention and Treatment of Ancient Occupational Diseases
128. Occupational Poisoning and Damage
129. Occupational Diseases
Chapter 16 The Culture of Reproduction and Medical Science
A. Pregnancy and Delivery
130. Conception and the Pursuit of a Boy
131. Antenatal Training and Eugenics
132. Delivery and Midwifery
133. Spontaneous Abortion and Aborticides
B. The Culture of Child-Rearing and Science of Medicine
134. Premature Infant Death and Baby Care
135. The Theory of Congenital Foetal Toxin and Diagnosis Through Pediatric Finger Veins
Chapter 17 Sexual Culture in Medicine
A. Ancient Sexology
136. Sexology in Books and Paintings
137. The Growth of Knowledge of the Sexual Organs and Sexual Skills
138. The Initial Theory of Sexology and the Method of Storing Essence and Promoting Qi
139. “Picking and Fighting” and the Inner Alchemy of Chinese Sexology
B. Sexual Perversions and Disease
140. “Lovesickness” and Various Sexual Perversions
141. Diseases of the Sexual Organs and Functional Disorders
142. A Study of Venereal Disease in Ancient China
Chapter 18 Medical Science, the Culture of Food and Other Things
A. The Culture of Food and Medical Science
143. Fine Foods in Health and Nutrition
144. Medicated Foods Based on the Homology of Medicine and Food
B. Cases in Literature, Art, the Physical and Medical Sciences
145. The Relationship Between Music, Poetry and Medical Science
146. Kongfu and Medical Science
Chapter 19 A Glance at Altar Medicine
A. Sacrificing to the Three Sovereigns, the Specialty of Supplication and Divination Prescriptions
147. Sacrifices to the Three Sovereigns and the Deification of Famous Doctors
148. Supplication as a Specialty
149. Holy Water, Bringing Down the Gods and Divination Prescriptions
B. Gu Insect Witchcraft, Physiognomy and Taisu Pulse Necromancy
150. Gu Insect Witchcraft
151. The Taisu Pulse and Art of Physiognomy
Chapter 20 The Mentality and Behaviour of Physicians and Patients in the Tradition
A. The Cultural Psychology of Chinese Medicine
152. The Medical Expert’s Pursuit of Personality — “A Superior Physician Treats a Country”
153. “Medicine, It Is Mental”: The Physician’s Logic and Way of Thinking
154. “Using Medicine Is Like Deploying the Army” — The Behavioural Psychology of the Clinical Physician
B. The Psychology of Behaviour During the Pursuit of Medical Help
155. “Seeking No Treatment Is Equal to Seeing an Averagely Skilled Physician”
156. The Patient Seeking Medical Help and Selecting a Physician
Conclusion of Part Three
Part Four The Cultural Process of Chinese Medicine in History and Its Crystallization
Chapter 21 The Essential Stream of Chinese Medicine and Its Outcomes
A. The Main Developments and Characteristics of Chinese Medicine Through the Ages
157. The Beginning of the Basic Theory of Traditional Chinese Medicine in the Pre-Qin Period
158. The Medical Classics and Classical Prescriptions as They Formed and Fell into Disuse Among the People
159. The Foundation of a System of Treatment According to Syndrome Differentiation in the Late Han Dynasty
160. How Chinese Medicine Bloomed During the Wars
161. Great Achievements Made During the Prosperous Sui and Tang
162. Chinese Medicine Takes on an Organizational Structure During the Northern and Southern Song Dynasties
163. Chinese Medicine in Contention During the Jin and Yuan Dynasties and Its Superstable Formation During the Ming and Qing
B. Important Works and Famous Doctors from the History of Chinese Medicine
164. Three Shi Chinese Medicine and the Four Classics
165. The Works Extant in Chinese Medicine Worth Reading
A. Works of Etiology and Pathology
B. Diagnostic Works
C. Works on Acupuncture and Moxibustion
D. Works on Chinese Materia Medica
E. Works on Prescriptions
F. Comprehensive Medical Works
G. Works of Annotation and Research on the Neijing and Nanjing
H. Annotated Works on the Treatise on Febrile Diseases and the Synopsis of the Golden Chamber
I. Works on Epidemic Febrile Diseases
J. Works on a Special Subject or Special Topic
K. Popular Medical Works and Medical Songs and Rhymes
166. Famous Doctors in Chinese Medical History
A. Famous Doctors in the pre-Qin Period (before 221 BCE)
B. Famous Doctors during the Qin (221–207 BCE), Han (206 BCE–220 CE) and Three Kingdoms (220–265 CE) Periods
C. Famous Medical Workers During the Jin Dynasties (265–420) and the Northern and Southern Dynasties (420–589)
D. Famous Doctors during the Sui (581–618), Tang (618–907) and Five Dynasties (907–960)
E. Famous Chinese Medical Masters during the Song Dynasties (960–1127, –1279)
F. Famous Doctors and Pharmacologists from the Jin (1115–1234) and Yuan (1271–1368) Dynasties
G. Famous Physicians of Chinese Medicine During the Ming Dynasty (1368–1644)
H. Famous Doctors of Chinese Medicine in the Qing Dynasty (1644–1911)
I. Famous Doctors in the First Half of the 20th Century (the Late Qing Dynasty and Early Republican China)
C. Eight Major Contributions and Mysteries Concerning Traditional Chinese Medicine
167. The Five Elements, Yin–Yang & Qi and Blood — A Basis for Theory
168. The Four Examinations and Eight Principles — Keys to Pattern Identification
169. The Toxicity-Relieving and Property-Enhancing Qualities of TCM
170. The Magic of Compound Prescriptions
171. The Undetectable Nature of the Acupuncture Meridians
172. The Endotherapy of Exogenous Disease Without an Operation
173. Variolation — A Way of Keeping Well
174. Turning to TCM When Western Medicine Fails
Chapter 22 The Root of Life and the Future of Chinese Medicine
A. The Essence of Chinese Medicine: A High-Quality Ecological Medicine
175. Chinese Medicine, Is It Scientific or Not?
176. Comments on the Transforming Modes of Biomedicine and Evidence-Based Medicine
177. The Ecological Medical Theory of Chinese Medicine
B. The Vital Source of Chinese Medicine
178. The Cultural Soil of Chinese Medicine
179. Die-Hard Chinese Medical Practitioners Providing Effective Treatment, with Less Toxicity and Fewer Side Effects
180. Theoretical Advancement and Foresight: “Creativity” as the Motive Force Within TCM
C. Puzzles and the Future
181. Puzzles: Turmoil and Swirls
182. Research Methodologies and Research into Methodologies
183. An Evergreen Life
Conclusion of Part Four
General Conclusions
About the Author

Citation preview

中 国 医 A History of 学 Medicine in 文 Chinese Culture 化 VO L U M E 1 史

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中 国 医 学 文 化 史

A History of Medicine in Chinese Culture VO LU M E 1

Boying Ma Federation of Traditional Chinese Medicine Practitioners, UK; Life Fellow, Royal Society of Medicine, UK

World Scientific NEW JERSEY

10932_9789813237971 tp.indd 2

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LONDON

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HONG KONG

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TAIPEI

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CHENNAI

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TOKYO

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Published by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE

Library of Congress Cataloging-in-Publication Data Names: Ma, Boying, 1943– author. Title: A history of medicine in Chinese culture / Boying Ma. Other titles: Zhongguo yi xue wen hua shi. English Description: New Jersey : World Scientific, 2019. Identifiers: LCCN 2019020532| ISBN 9789813237971 (hardcover) | ISBN 9789813237988 (hardcover) | ISBN 9789813237964 (hardcover) Subjects: | MESH: History of Medicine | China Classification: LCC R601 | NLM WZ 70 JC6 | DDC 610.951--dc23 LC record available at https://lccn.loc.gov/2019020532 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library.

《中国医学文化史》 Originally published in Chinese by Shanghai People’s Publishing House Copyright © 2010 by Shanghai People’s Publishing House English rights arranged with Shanghai People’s Publishing House

Copyright © 2020 by World Scientific Publishing Co. Pte. Ltd. All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. ISBN 9789813237964 (set) ISBN 9789813237971 (vol. 1) ISBN 9789813237988 (vol. 2) For any available supplementary material, please visit https://www.worldscientific.com/worldscibooks/10.1142/10932#t=suppl Typeset by Stallion Press Email: [email protected] Printed in Singapore

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Contents Volume I Part One The Cultural Background to the Origins of Chinese Medicine  rimitive Human Beings, Their Health, Culture P and Ecological Environment in China A.  Primitive Culture and Ecological Environment    1.  The Origin of Human Beings in China   2. Chinese Culture and Its Natural Ecological Distribution During the Paleolithic Period   3.  Neolithic Culture and Its Natural Environment in China B. The Physique and Diseases of Primitive Human Beings in China   4. The Evolution of the Physical Constitution of the Ancient Chinese    5.  Discoveries of Archaeological Pathology C. The Culture and Conditions of Hygiene Among Primitive Humans in China   6. The Residential Culture of “Nest-Living & Cave-Dwelling” and Its Significance for Health    7. Striking Flints or Drilling a Log to Get Fire & the Significance of Cooked Food to Health    8. The Culture of Dietary Hygiene and Its Influence on Other Things   9.  The Culture of Hygiene in Clothing  10.  Primitive Dance, Music and Sports 11.  “Cannibalism” and Funeral Sanitation

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Chapter 1

3 3 3 6 13 19 20 24 28 29 33 35 39 41 43

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Chapter 2

Primitive Thought, Worship and Medical Culture

47

A.  Primitive Thought and Medical Culture 47 12. The “Collective Unconsciousness” and Mysterious Feelings48 13.  The Concept of “Soul” 56 14. The Experience of Using Objects as Tools and Cumulative Thinking 62 B.  Primitive Worship and Its Association with Medicine  66 15.  The Worship of Nature 66 16.  The Worship of Totems  76 17.  The Worship of Reproduction 84 18.  Ancestor Worship 88 19.  The Worship of Ghosts and Gods 92 Chapter 3

 he Primitive View of Life, Getting Old, Illness T and Death: The Pursuit of Longevity

A.  The Earliest View of Life and Death 20.  The Original Understanding of Human Life  21.  The Origins of Birth 22.  The Meaning of Death 23. Primitive Knowledge of the Human Body and Its Anatomy B.  The Earliest View of Illness and Etiology 24.  What Is Illness? 25.  Diseases Involving Gods, Spirits, and Others C.  The Pursuit of Immortality 26.  Longevity Involving Gods and Spirits 27.  The Immortal Regions and Their Medicines Chapter 4

Treatment in a World of Wizardry 

A.  The World of Wizardry 28. The “Blocked Way Between Heaven and Earth” and the Wizard 29. The Behavioral Characteristics of Sorcery and Its Psychological Foundations 30.  Sorcery, Religion and Science B.  Sorcerous Doctors and Sorcerous Medicine 31.  Sorcerous Doctors in Ancient Times 32.  Zhu Taboo, Divination and Medicine

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33.  Horoscopes, Divination by Dreams and the Yarrow Stalks 34.  The Great Exorcism and Fu Xi Sacrifice 35.  Massage? Moxibustion? Herbal Medicine? 36. The Medicine of Witchcraft in the Mountain and Seas Classic Chapter 5

The Origin of Medicine 

189 195 201 209 213

A. A Definition of the Origin of Medicine and Other Relative Factors 213 37.  To Identify the Conception of Medicine’s Origin 213 38.  Animal Instinct and Human Love 214 39.  Primitive Thinking and the Functions of the Witch 218 40. The Relationship of Life and Labour to the Origins of Medicine  221 B.  The Beginnings of Early Medicine and Health Care  225 41. Massage, Daoyin, Hot Compresses, Moxibustion and the Discovery of the Meridian 225 42.  From Stone Needling to Acupuncture 228 43.  The Growth of Medical Knowledge 235 44.  The Bud of Prevention 243 45. The Famous Doctor Bianque: A Step Up from Witch-Doctoring250 Conclusion of Part One 260 Part Two  Chinese Medicine Under the Influence and Permeation of Philosophy, Religion and Politics Chapter 6

 he Heavenly Law (Tao) of Nature T and Medicine in Deference to Nature

261 263

A.  “Tao Qi” Theory and Medicine 263 46.  From Ji Zi to Lao Zi, Zhuang Zi and the Jixia 263 47.  Qi as the Root of Medical Theoretics 274 B.  The Medical Theories of the Yin–Yang and Five Elements  279 48. The Formation of the Yin–Yang and Five-Element Theories279 49. The Golden Mean, the Three Talents, Image and Number, and the Correspondence Between the Human and Natural 290 50. From the Mawangdui Medical Books to Huangdi’s Inner Classic (黄帝内经)296

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Chapter 7

 ccultist Culture and Medicine Under the Impact O of the Confucian Classics and Chenwei Philosophy

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A.  The Fangshi Culture and Some Secret Medical Groups 305 51. Research on the Date of the Composition of Huangdi Neijing (黄帝内经)306 52. Medical Schools, Lord Cang, His Masters and Apprentices311 53. The Huangdi Neijing (黄帝内经) and Secret Medical Schools 317 B.  Another Side to Taoist Medical Science 324 54.  The Occultist’s Art of Well-Being  324 55. Occultists in Search of Elixirs and the Immortal Alchemy of the Yellow (Gold) and White (Silver)  331 56. The Compositional Background to Shen Nong’s Classic of Materia Medica (神农本草经)340 57. The Calamity Due to Witchcraft Gu, Chunyu Yan Killing the Queen and Their Involvement with Occult Physicians 345 C. The Impact on Medicine of the Study of the Confucian Classics, Chenwei Theology and Anti-Chenwei Philosophy 349 58. Studies of Two Types of “Ancient” and “Present” Confucian Classics and Chenwei Theology 349 59. Anti-Chenwei Philosophy and Thoughts of a Primordial Qi 355 D. The Background for the Medical Achievements of Zhang Zhongjing and Hua Tuo 362 60. The Confucian Tradition of Zhang Zhongjing, a Medical Sage 362 61. Hua Tuo, a Miraculous Doctor, His Occult Elements and Demeanour  366 Chapter 8

Religious Taoism and Medical Culture 

A. The Inherited Relationship Between Religious Taoism and Medicine 62. The Role of Occult Medicine During the Establishment of Religious Taoism 63.  The Origins of Alchemy and Medicine 64. The Development of Internal dan and Its Influence on Medicine

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B.  A Taoist’s Magic and Medical Skills  65.  The Taoists Holding Some Medical Skills  66.  The Taoist’s Magical Arts of Forbidding or Incantation 67.  The Art of Taoist Talismans 68.  The Taoist’s Magic or “Supernatural Power” C.  Taoist Doctors and Their Grand Contribution 69.  How Ge Hong Dabbled in Medicine 70.  The Taoist Naturalist and Leader Tao Hongjing 71.  The Great Sun Simiao in Medicine and Taoism 72.  Contributions from Other Taoist Doctors Chapter 9

 eo-Taoism and Medicine During the Wei, N Jin, Southern and Northern Dynasties

407 408 411 418 422 426 426 432 437 444 451

A. Neo-Taoist “Idle Talk” and the Fashion of Taking Stone Powders 451 73. Neo-Taoist Idle Talk and a Comprehensive View of an Undisciplined Life 451 74. The Prevailing Fashion of Taking Medicines such as Wushi San 461 B. The Prospering of the Medicine During the Wei and Jin Dynasties 472 75. Huangfu Mi and The Classic ABC of Acupuncture and Moxibustion (针灸甲乙经)472 76. On Material Things (物理论), The Theory of Spiritual Perishability (神灭论) and Views on Life and Death 475 77. Medicine Prospers in the Wei, Jin, Southern and Northern Dynasties 481 Chapter 10 Confucianism and Medicine A.  A Medicine Dominated by Feudal Ethics 78. From Licking Piles and Sucking Carbuncles to “Cutting the Flesh of His Thigh to Cure His Parents” Not Daring to Damage Any Part of the Body 79. The Monarch’s Medicine Tasted by Officials, Understanding Medicine as Filial Piety and Feeling the Woman’s Pulse Through a Gauze B. Neo-Confucianism, “Down-to-Earth” Learning and Medicine 80. From the Taiji Diagram to the Innate Root — The “Kidney’s Life-Gate”  81.  Zhang Jiebin’s Taoist Medical Theories 

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82. Medical Reflections on Acquiring Knowledge by Probing into Things 83.  The Medical Tradition of Abiding in the Classics C.  The Rise of the Confucian Doctors 84.  To Be a Good Prime Minister or Excellent Doctor 85.  Various Yongyi (Quacks)  86.  Kindness in Medicine

521 526 532 532 540 547

Chapter 11 The Emperors, Their Government and Medicine

553

A.  The Emperors and Their Medicine 88. The Emperors of the Han and Tang Dynasties and Their Dealings with Medicine 89.  Emperors and Medicine During the Song Dynasty  90.  Emperor Kangxi and Medicine B. The Governmental System and Organization of Medicine and Health  91. The Governmental Medical Organizations and a Doctor’s Social Position 92. Supporting the Disabled, Visiting the Sick and Policies of Medical and Health  93. The Imperial Medical Agency and Official Medical Education C. Governmental Materia Medica, Medical Books and Bronze Acupuncture Figures 94.  National Pharmacopoeias Issued by the Government 95.  Officials Emending Medical Books 96.  Casting Acupuncture Figures in Bronze D. The Formulation of Medical Law and Progress in Forensic Medicine  97.  The General Situation of Medical Law 98.  Medical Jurisprudence and Legal Forensic Examination Conclusion of Part Two

553 553 558 561 565 565 568 573 577 577 581 586 589 589 592 597

Volume II Part Three Medicine in Social Life, Epidemics and the Invention of Variolation

599

Chapter 12 Medicine in Different Social Environments

601

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Contents  xi

A.  Medicine in War and Turmoil 601 99. Medical Conditions During War and Periods of Historical Turmoil  601 100.  Health Organization in the Army 603 101.  Surgery in the Army 608 B.  Medicine in the Heyday of Peace 623 102.  Peaceful Eras and the Conservation of Medicine 623 103. Concerning the Books: Treatise on the Causes and Origins, and Manifestations of Various Diseases, Important Prescriptions Worth a Thousand Gold Pieces and Arcane Essentials from the Imperial Library626 104. Compilations, Compendia, Medical Cases and Rudimentary Verses 632 C. The Relationship Between Population Statistics, Natural Ecology and Diseases in History 639 105.  Geography and Diseases of the Five Directions 639 106.  The Theory of the Five Circuits and Six Qi 644 107. The Relationship Between Population Statistics and Diseases in Ancient China 652 108.  Diseases in Relation to Social Ecology 655 Chapter 13 Epidemics and the Triggering Mechanism of Disaster

661

A.  Ancient Epidemic Diseases and Epidemiological Factors 109.  The Historical Background to Epidemics 110. Major Epidemics During the Zhou and Qin Dynasties, and at the Beginning of the Han  111. The Main Epidemics of the Han, Wei, Jin, Northern and Southern Dynasties 112.  Epidemics During and After the Sui and Tang Dynasties 113. Conducting Textual Research on the Epidemicity of the Plague and Cholera B.  The Evolution of a Theory of Epidemics  114. The Evolution of the Etiology of Seasonal Qi, Pestilent Qi and Other Qi 115. The Impracticality of Ancient Prescriptions for Curing New Diseases, the Theory of the Fire and Heat Mechanism, and the Theory of Attacking the Pathogenic Qi 

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116.  The Theory of Internal Injury and Yin Syndrome Theory 117. The Theory of Epidemic Febrile Disease Put Forward by Ye Tianshi and Others

710

Chapter 14 Smallpox Remedies and Variolation in Ancient China

717

A. Outbreaks of Smallpox and TCM Treatment in Ancient China 118.  Textual Research on Outbreaks of Smallpox in China 119.  Smallpox Treated by Chinese Medicine (1) Origins of the Theories and Treatments for Smallpox: A Summary (2)  Comparatively Mature Treatments for Smallpox (3)  Curative Efficacy B. The Invention of Variolation and Its Promotion by Emperor Kangxi  120.  The Origins of Variolation (1)  Ideas of Prevention and Initial Therapies (2)  Legends of Variolation’s Origin  (3)  A Literature Review of Variolation Therapy  (4)  Stories on Variolation’s Origin (5) Research into the Beginnings of Variolation in the Regions South of the Yangtze River in the Middle and Late Ming Dynasty 121. Views on the Popularization of Variolation by Emperor Kangxi C.  The Theory, Technology and Success of Variolation  122.  The Theory and Technique of Variolation (1) Foetal Toxin and the Theory of Variolation Being Used to Discharge Foetal Toxin  (2)  The Variolation Method and Its Improvement (3) Efficacy and Safeguarding Measures During Variolation (a)  Selecting the Seedlings (b)  Seedlings, Their Storage and Management (c)  The Timing of the Variolation (d) Suitable and Unsuitable Constitutions for Variolation (4) Observation and Recuperation with Herbal Medicines After Variolation 123.  The Success Rate of Variolation

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Chapter 15 S cience, Technology and Medicine: Ancient Occupational Disease, Its Prevention and Treatment A. The Development of Science and Technology and the Progress Made by Medicine During Ancient Times 124. Time Medicine, Biological Rhythm and the Theory of the Midnight-Midday Ebb and Flow  125. Simple Systems Theory and Experimental Thought in Traditional Chinese Medicine 126. The Identification, Processing and Refining of Medicines 127. Other Effects of Scientific and Technological Progress on Medicine  B. The Prevention and Treatment of Ancient Occupational Diseases 128.  Occupational Poisoning and Damage 129.  Occupational Diseases Chapter 16 The Culture of Reproduction and Medical Science A.  Pregnancy and Delivery 130.  Conception and the Pursuit of a Boy 131.  Antenatal Training and Eugenics  132.  Delivery and Midwifery 133.  Spontaneous Abortion and Aborticides B.  The Culture of Child-Rearing and Science of Medicine 134.  Premature Infant Death and Baby Care 135. The Theory of Congenital Foetal Toxin and Diagnosis Through Pediatric Finger Veins  Chapter 17 Sexual Culture in Medicine A.  Ancient Sexology 136.  Sexology in Books and Paintings 137. The Growth of Knowledge of the Sexual Organs and Sexual Skills 138. The Initial Theory of Sexology and the Method of Storing Essence and Promoting Qi 139. “Picking and Fighting” and the Inner Alchemy of Chinese Sexology B.  Sexual Perversions and Disease 140.  “Lovesickness” and Various Sexual Perversions

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141.  Diseases of the Sexual Organs and Functional Disorders  142.  A Study of Venereal Disease in Ancient China 

956 968

Chapter 18  Medical Science, the Culture of Food and Other Things

975

A.  The Culture of Food and Medical Science 143.  Fine Foods in Health and Nutrition  144. Medicated Foods Based on the Homology of Medicine and Food B.  Cases in Literature, Art, the Physical and Medical Sciences 145. The Relationship Between Music, Poetry and Medical Science 146.  Kongfu and Medical Science

975 975

Chapter 19 A Glance at Altar Medicine

990 1001 1001 1009 1015

A. Sacrificing to the Three Sovereigns, the Specialty of Supplication and Divination Prescriptions  1015 147. Sacrifices to the Three Sovereigns and the Deification of Famous Doctors 1015 148.  Supplication as a Specialty 1025 149. Holy Water, Bringing Down the Gods and Divination Prescriptions 1031 B. Gu Insect Witchcraft, Physiognomy and Taisu Pulse Necromancy1038 150.  Gu Insect Witchcraft 1038 151.  The Taisu Pulse and Art of Physiognomy  1045 Chapter 20  The Mentality and Behaviour of Physicians and Patients in the Tradition A.  The Cultural Psychology of Chinese Medicine 152. The Medical Expert’s Pursuit of Personality — “A Superior Physician Treats a Country” 153. “Medicine, It Is Mental”: The Physician’s Logic and Way of Thinking  154. “Using Medicine Is Like Deploying the Army” — The Behavioural Psychology of the Clinical Physician B. The Psychology of Behaviour During the Pursuit of Medical Help 155. “Seeking No Treatment Is Equal to Seeing an Averagely Skilled Physician”

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156. The Patient Seeking Medical Help and Selecting a Physician 1091 Conclusion of Part Three1103 Part Four The Cultural Process of Chinese Medicine in History and Its Crystallization

1105

Chapter 21 T  he Essential Stream of Chinese Medicine and Its Outcomes

1107

A. The Main Developments and Characteristics of Chinese Medicine Through the Ages 157. The Beginning of the Basic Theory of Traditional Chinese Medicine in the Pre-Qin Period 158. The Medical Classics and Classical Prescriptions as They Formed and Fell into Disuse Among the People 159. The Foundation of a System of Treatment According to Syndrome Differentiation in the Late Han Dynasty 160.  How Chinese Medicine Bloomed During the Wars  161. Great Achievements Made During the Prosperous Sui and Tang 162. Chinese Medicine Takes on an Organizational Structure During the Northern and Southern Song Dynasties  163. Chinese Medicine in Contention During the Jin and Yuan Dynasties and Its Superstable Formation During the Ming and Qing B. Important Works and Famous Doctors from the History of Chinese Medicine  164.  Three Shi Chinese Medicine and the Four Classics 165. The Works Extant in Chinese Medicine Worth Reading 166.  Famous Doctors in Chinese Medical History  C. Eight Major Contributions and Mysteries Concerning Traditional Chinese Medicine 167. The Five Elements, Yin–Yang & Qi and Blood — A Basis for Theory  168. The Four Examinations and Eight Principles — Keys to Pattern Identification 169. The Toxicity-Relieving and Property-Enhancing Qualities of TCM

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170.  The Magic of Compound Prescriptions 1217 171. The Undetectable Nature of the Acupuncture Meridians1220 172. The Endotherapy of Exogenous Disease Without an Operation  1222 173.  Variolation — A Way of Keeping Well 1223 174.  Turning to TCM When Western Medicine Fails 1226 Chapter 22 The Root of Life and the Future of Chinese Medicine 1229 A. The Essence of Chinese Medicine: A High-Quality Ecological Medicine 1229 175.  Chinese Medicine, Is It Scientific or Not? 1229 176. Comments on the Transforming Modes of Biomedicine and Evidence-Based Medicine 1236 177.  The Ecological Medical Theory of Chinese Medicine 1242 B.  The Vital Source of Chinese Medicine 1257 178.  The Cultural Soil of Chinese Medicine 1257 179. Die-Hard Chinese Medical Practitioners Providing Effective Treatment, with Less Toxicity and Fewer Side Effects 1259 180. Theoretical Advancement and Foresight: “Creativity” as the Motive Force Within TCM 1264 C.  Puzzles and the Future 1266 181.  Puzzles: Turmoil and Swirls 1266 182. Research Methodologies and Research into Methodologies1269 183.  An Evergreen Life 1275 Conclusion of Part Four1277 General Conclusions1279 About the Author1285

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b3657   A History of Medicine in Chinese Culture

PART ONE

The Cultural Background to the Origins of Chinese Medicine The main task of this book is to reveal how culture and civilisation provide both an intrinsic and extrinsic source of motivation, driving the development of Chinese medicine throughout all history. Western medicine branched out of both the general culture of Europe and the whole of Western society since the Renaissance — especially the arrival of experimental medicine. On the other hand the branching of Chinese medicine may be just at its beginning — or it may not yet have even begun. In a sense, Chinese medicine and culture always intertwine, are closely related as somewhat chaotic, and difficult to divide. This is a feature of Chinese medical culture and we are devoted to studying this feature in order to clarify how Chinese medicine and culture interact and entangle, the generation of their driving force, their reactive forces, and lastly their future. These problems have never before been deliberately studied and great strength is required now to explore them. We will begin with a discussion and analysis of the cultural background to the origins of Chinese medicine. The origins of Chinese medicine are the result of a human cultural development, involving various comprehensive factors. It has been a lengthy journey from the medical pursuits exerted by primitive humans, struggling for survival, to the emergence of a witchcraft based upon a medicine under mystique, to an independence from the bondage of witchcraft and superstition.

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CHAPTER 1

Primitive Human Beings, Their Health, Culture and Ecological Environment in China A.  Primitive Culture and Ecological Environment 1.  The Origin of Human Beings in China It is getting harder and harder to draw an absolute boundary line between human beings and animals. What is the fundamental difference between them, the timing of their qualitative change and ultimately their eventual evolution from ape to mankind? In recent years, some scientists have even proposed that the closest ancestor of all human beings is the dolphin, an aquatic primate.1 Generally, the following features can differentiate the human from the ape: (1) Humans stand upright; (2) Humans are omnivorous (the ape is regarded as a vegetarian — at most eating insects and ants, etc.); (3) Humans can work; 1

 For instance, Michel Odent, a famous French Doctor, put forward seven points to prove that human beings are more like dolphins than apes. In that apes dislike water, have no tears, have hair, but no subcutaneous fat, do not like eating fish or shrimps, perform sexual intercourse in a back-to-abdomen posture, and do not use “hands” to deliver a baby, and in addition there are many creation myths among humans related to water. However, he overlooked certain aspects of morphology and genetics. For instance see www.hinews.cn/ocean/ system/2007/01/23/010070987.stml and also www.mil.eastday.com/epublish/gb/paper451/1/ class045100002/ 3

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(4) Humans can make and use tools; (5) Humans have the ability of speaking and thinking; (6) Humans can utilize and eventually produce fire. These latter three points signify the beginning of human culture and civilisation. Therefore, human culture and civilisation is the radical mark that differentiates human beings from animals. However, since especially the publication of The Ape Society papers written by Jenny Gudoll and Stella Brewer, two British girls who spent nearly 20 years with extraordinary courage and persistence among gorilla and ape groups during the 1960s to 1970s, observing and recording their lives,2 people began to feel that the above differentiating features were relative, obscure, and only partially correct. This is because the gorilla can sometimes stand upright, become involved in work, use and even make simple tools, has its own simple language including body posture and sound production, and displays simple thinking ability, though it has failed to master fire and the visual arts. Perhaps for these reasons, Joseph Leone has said, “With respect to humans developing from animals, the features that differentiate them are the use of tools, fire, language and art.”3 This suggests that culture, including the arts, is the most important differentiating feature. The core difference between the human and the animal is the quantitative and scalar. In other words, an accumulation of the quantitative contributes to a qualitative difference. The origins of society and culture will be far from our grasp unless we are able to understand this. In addition, we will be confused, comparing ape society with primitive human social organization, and so on. It will also be difficult to comprehend the relation between animal medicine and the origin of human medicine, mentioned later. It is worth noting that paleoanthropologists consider the place for the origin of mankind to be global. For example, people generally think Peking Man stands for a primitive human group discovered in the Beijing Zhoukoudian as fossil-primitive man, but paleoanthropologists regard it as standing for a period. Peking Man did not only live in Beijing Zhoukoudian, but all over Asia, Europe and Eastern Africa. His age is also not limited to the 500,000 years ago revealed by the Zhoukoudian fossil, but can be traced 2

 Zheng Kaiqi, Wei Dunyong. The Ape Society, 1992, p.2.  Zhu Di. Primitive Culture, Sanlian Bookstore Press, 1988, p.298.

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Primitive Human Beings in China  5

back 1,000,000 years. In the 1930s (Peking Man fossils were discovered in 1927) and long thereafter, Peking Man was universally acknowledged as the earliest ancestor of humans in the world.4 According to paleoanthropology, to limit the significance of human fossils to the discovery area makes it incapable to retrieve their actual intensity. In 1959, much earlier primitive human fossils were discovered in Eastern Africa, termed by some people “African Man” —  who existed about 1,750,000 years ago. Paleoanthropologists naturally shifted their interest to Africa. In 1965, a Yuanmo fossil man was discovered in Yunnan, dating back 1.5±0.1 million years to 3.1 ± 0.1 years ago (determined by the palaeomagnetic method). The age of the Yuanmou fossil man is approximately 170 million years. At the same time, there have been many other human fossils discovered, in other regions, especially the Ramapithecus fossil dating back 8 to 14 million years discovered in India, Pakistan, Kenya, the surrounding regions of the Mediterranean, and Yunnan Province (Kaiyuan and Lufeng Cities) in China. Judging by this, Professor Jia Lanpo proposed the earliest origin of humans to lie in the non-equilateral triangle outlined by the three points of Fort Terran in Kenya, Hari Talyangar of Simla in India, and Xiaolongtan of Yunan Kaiyuan Town in China, with South Asia right at its heartland.5 People once believed that the Chinese moved from Africa, because the Australopithecus fossil which exists in the evolutionary period from Ramapithecus to Homo Erectus, has been found in Africa but not in Asia. In 1989, the Australopithecus fossil was accidentally discovered in Yunyang County, Hubei Province, China. It was confirmed by Jia Lanpo and other paleoanthropologists later.6 In 1980, the first intact Ramapithecus skull in the world was discovered in Lufeng county, Yunan Province, China. This revealed China as one of the original places of human origin and evolution.7 As the history of human beings began, so did the history of human culture. The primitive human culture of China plays an indispensable part in the origin and history of world culture. 4

 Zheng Kaiqi, Wei Dunyong. Ape and Monkey Society, 1982, p.200.  Jia Lanpo. Ancient Inhabitants in the Chinese Mainland, Tianjin People Press, 1978, p.5. 6  Overseas Version of Oriental Outlook, 1990, Period 1. 7  Some professors, in recent years, suggest that Peking Man emerged and perished of itself long ago and was not related to the subsequent development of Chinese people. They said this is proven by DNA testing and the gene of the Chinese people corresponding to that of the African ape man. I (the author of this book) do not believe this. Is there any way of getting the DNA of an ape man who existed several million years ago? Does it exist in the fossil? 5

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2. Chinese Culture and Its Natural Ecological Distribution During the Paleolithic Period The evolution of mankind is closely related to the natural environment and the formation of a culture, including a primitive culture of hygiene. The cultural heritage of China during the Paleolithic is illustrated in Table 1.1. Generally, Yuanmou Man is considered the first Homo erectus to live in China. Some scholars actually believe Lantian Man displays the earliest and most reliable fossil record of human beings.8 But I (the author of this book) would prefer to adopt the theory of Jia Lanpo. Thereafter, Lantian Man and Peking Man are representative. Xujiayao Man, Maba Man, Changyang Man and Dingcun Man have fallen into the category of Early Homo sapiens. Homo sapiens novus or modern man begins with Liujiang Man (40,000 years ago), which includes Hetao Man and Upper Cave Man. Glaciation boosted the evolution of humans during the Paleolithic. Beneath the find of Yuanmou Man, the earliest remnant of Homo sapiens to be found in China, has been discovered. The paleomagnetic method has determined a local moraine, dated back to 3 million years ago, to be of the Longchuan Glacial Stage. The fossils of primitive humans, earlier than Homo sapiens, listed in Table 1.1 are almost all belonging to the interglacial period. Professor Jia Lanpo stated that the vastness of its influence, the intensity of its impact on the living world, and its fierce pressure upon our human ancestors place Glacial Theory in a dominant position — so much so, that only species that can make excellent adaptation to the changes caused by glaciation can survive and be impelled to develop themselves in brand new ways.9 Therefore, it was during the interglacial period that the fittest survived and that there appeared variations in the ape-men that seized the opportunity to reproduce and thrive. In China’s Paleolithic cultural sites, distributed predominately along the transitional zones between the two steps of China’s topographical conditions, the climate was moderate and moist with abundant rainfall, but no flooding. The land was covered by a variety of topography, but the terrain sloped gently. The mountains were high but not precipitous, and rivers and lakes extensive, but not deep. Even the Himalayas with their height of only 1,000 meters in the Pliocene epoch could not function as 8

  Zhou Mingzhen, Wang Yuanqing. Ancient Environmental Background of Human Evolution in China: Explorations into Great Nature, 1990, Period 2. 9  Jia Lanpo. Ancient Residents in Chinese Land, Tianjin People’s Publishing House, 1978, p.13.

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Ice Age China

Holocene

Post Glacial

Post Glacial

Middle Early

Pleistocene

Riss glacial

Lushan glacial

Holstein interglacial

Zhoukoudian period

Mindel glacial

Taku glacial

Cromerian interglacial

Gongwang Mountain period

Gunz glacial

Boyang glacial

Lantian man (Gongwang Mountain)

Terglen interglacial

Xihoudu period

Yuanmou man (Yunnan)

Donau glacial Lungchuan glacial

Peking man

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Primitive Human Beings in China  7

Eemian glacial

Old Stone Age

Tali glacial

New Stone Age

Early

Wurm glacial

Culture Age

Middle

Upper Cave man (Zhoukoudian), Ziyang man (Sichuan), Zhiyu man (Shanxi), Hetao man (Inner Mongolia), Liujiang man (Guangxi), Dingcun man (Shanxi), Xujiayao man (Shanxi), Dali man (Shaanxi), Maba man (Guangdong), Changyang man (Hubei)

Types of Human Beings

Late

Late

Europe

Main Human Fossils

Homo sapiens      Homo erectus     Australopithecus

Geologic Age

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Table 1.1   Human Cultural Relics of the Old Stone Age in China

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8  Chapter 1

a barrier to the climate as they do today. They yielded to the warm, wet monsoon from the Indian Ocean on their northern side as well as on their southern slope. Altogether, compared to the present, the paleoclimate was cool and pleasant, but by no means cold. Such a climate, together with a particular landform, offers an explanation for the discovery of early Paleolithic humans such as Ramapithecus (14 million to 7 million years ago), Australopithecus (4.5 million to 1.5 million years ago), Yuanmou Man (1.7 million years ago) and others, without exception, around the south of China and the IndiaPakistan area. Catastrophic as they are, glaciations provide powerful catalysts which bring challenges to the generation and development of the human. It is these changes in paleogeography and the harsh pressure of glaciation that possibly might have driven Lantian Man (about 1.7 million years ago) and Peking Man (about 700,000 years to 200,000 years ago) to places when and where the climate was warm and humid (proven by a paleogeographic study).10 The paleolatitude of Lantian in the Lantian Age was 30 degrees 36 points, which is nearly 4 degrees off where it is today at a latitude of 34 degrees 12 points (in present China’s northwestern Shaanxi province, approximately 50 km southeast of the city of Xian). Thus the vegetation in these places bore the typical features of temperate zones. For Peking Man (at Zhoukoudian, near Beijing, in China), there were bubbling streams, flowing brooks, luxuriant undergrowth, forested with trees not too thickly, and unbounded grassland, all of which made for a more favorable life, ecologically speaking, than even today in Zhoukoudian. It was the same for other ancient peoples such as Dingcun Man, Maba Man, Changyang Man, even Liujiang Man and Upper Cave Man. Such an ecological environment helped the ancient humans in China form a unique system of culture, continuous in both time and space. However, the vastness of the land and diversity of habitats also stimulated the formation of multi- and poly-centric cultures. About 40,000 to 10,000 years ago, one tribe of the ancient Chinese, during their hunting trip for the giant mammoth to the north, crossed the Bering Strait via a land bridge which became visible when the sea level dropped. These people, the earliest inhabitants of America, were the ancestors of Indians. It has been found by research that a specific genetic expression on the hemoglobin molecule chain of Yunnan people (descendents of Yuanmou Man) is identical to that of the American Indians.11 10

 ibid. Jia Lanpo p.109.  ibid. Jia Lanpo p.112.

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Primitive Human Beings in China  9

The primitive Chinese were the earliest people in the world to know the use of fire. Residues of charcoal, and burnt animal bones have been discovered in almost all the ancient sites of Yuanmou Man, Lantian Man, Peking Man and others. In some of the Yuanmou and Lantian Sites, carbon dust was found in the outline of a nest. In Xihoudu (located in Shanxi Province) and Peking Man Site, marks of burning can be found on mammal ribs, deer horn, horse’s teeth and even stones. The layers of ash at the Peking Man Site piled upto 6 meters high. All these are evidence of man’s control over fire. Made mainly of quartz, the stone artifacts percussed by the primitive Chinese in the early and middle Paleolithic, were crude and simple. The earlier the artifacts, the simpler they were. The types of artifacts, such as those of Yuanmou Man, are only a few so far, include scrapers, pointed and chopping tools. These are “tools-for-making-tools”. Scientists like Jenny Goodall (b. 1934) in Britain and the Japanese Toshisada Nishida (1941–2011) investigated the behavior of wild chimpanzees and proposed that they could certainly use tools, though quite primitively. They would place stalks of grass into holes to “fish” for termites, use leaves to wipe off water and clean their own bodies, and make stones or twigs into weapons for fighting. But although they could process simple materials — for example, take twigs from trees and strip off the leaves and branches — it was beyond their ability to make “tools-for-making-tools” (cf.“the first tool”12). Obviously, this is the difference between primitive human beings and apes. Stone artifacts could function as “tools for making tools”. In the sites of Xihoudu, Gongwangling and Dingcun, three-edged pointed tools have been found, which in Professor Jia Lanpo’s opinion may be tools for digging.13 Functioning as hunting tools, stone balls have also been discovered in Gongwangling Site, thought to be the earliest of their kind in China; and also in the sites at Kehe and Dingcun. From a later age, tons of stone balls have come to light at Xujiayao Site, of all sizes — some more delicate. At the site of Peking Man, among thousands of stone artifacts, delicate pointed stones, used to cut and strip skins, dig out worms from trees and scrape muscles and tendons from bones, definitely tell us of the hunting and feeding habits of primitive humans, among which stone hammers, with which they could make stone artifacts, make up just a small part. From the 12

 The Ape Society, p.103.  Ancient Residents in Chinese Land, p.27.

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conditions of these artifacts, it is thought that Peking Man used his right hand more than the left in labour.14 It is amazing that there were even bone artifacts, made of animal horn, limbs and bones, fashioned into points and blades. In the Kehe and Dingcun sites, the faint outline of primitive artifacts can also be seen. The situation at Dragon Bone Hill in Zhoukoudian, Beijing, Upper Cave Man Site is typical. Among the fine bone artifacts found here, the most special is a needle 82 mm in length, as thick as a match, with one tip pointed and a pinhole at the other. As Jia Lanpo pointed out, “the clothes of Xujiayao Man and Maba Man, in their time, were no more than a hide for covering….The ability to sew did not come in until the appearance of bone needles”.15 In addition, Upper Cave Man had an abundance of ornaments, such as perforated animal teeth, clam shells, stone beads, gravel, the upper eye-bones of grass carp — seafood was available, as the sea then was near Beijing — grooved bone canals, and similar items, marking their heroic activity as well as craftsmanship. Furthermore, hematite powder, sprinkled around the bones of Upper Cave Man, definitely signifies burial. “Red objects, symbolizing blood dried up after death, were sprinkled on the body wishing to give immortality to the dead in the other world.”16 Presumably, the hematite mine, situated 1 km, to the east of Dragon Bone Hill today, was exploited as early as 18,000 years ago. The primitive Chinese roamed, settled and migrated around this area for 1.5 to 2 million years. They managed to survive in the critical natural environment which occurred during the Glacial Period and revived in the Interglacial. The most primitive of humans could not have been tree inhabitants, for the ape would never have evolved into Homo erectus by jumping from tree to tree during environmental hardship. Homo erectus grouped together to search for better living conditions and survival. They mainly earned a living by foraging and also hunting to supplement their diet. Their initial food was similar to that of the modern gorilla, but they were also able to make stone tools, which made it easier to gain food and hunt down much larger animals, such as the deer, boar, antelope and wild horse. Moreover, they were capable of utilizing natural fire and conserving fire to cook and roast food. Thus they can be defined as human beings because of this ability to use fire. 14

 ibid, p.77.  ibid, p.121. 16  ibid, p.124. 15

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If we follow through from Yuanmou Man to Lantian Man and on to Peking Man, although they had separated from the more primitive Ramapithecus and Australopithecus, their groupings still pertained to the “family community” stage, although no clan system had as yet emerged. They formed groups of several dozens and carried out seemingly organized activities. For instance, the women and elderly were left to look after the young and do foraging, while the young adults went further to collect food or hunt animals. When all the food in one place had been collected, they would move on to another — not far away. They were never migratory, but were equivalent to the Youchao Clan of Chinese legend, in that they “inhabited caves or built dwellings on the ground and in trees”. They performed family-group marriage, in which sexual intercourse among the same generation was allowed, but between different generations was avoided. This state was typical during the Peking Man period, and later on gradually evolved into marriage between different family groups. It is supposed that Peking Man retained the custom of cannibalism, because there were lots more skulls discovered among Peking Man fossils than there were bones of the trunk and limbs. In sixteen years of excavation around the time of the liberation of the People’s Republic of China, many skulls or skull parts were unearthed — including 6 intact or almost intact skulls, 9 skull relics, 6 pieces of facial bone, 15 pieces of lower jawbone, 152 teeth, along with several broken limb bones. These unearthed bones belong to about 40 people, of all ages. Most of the skulls had scars, seemingly caused by hitting with sharp edges, round stones or clubs. Some scholars hold the custom of cannibalism to be due to hunger, while others believe “though cannibalism is regarded as barbarous and brutal behavior in modern times, it is quite natural for primitive people because it allows the disabled, old or weak to escape their terror of waiting to die; so then eating them is ethical.”17 Engels also wrote in his History of Ireland that “Modern science has confirmed that cannibalism, including eating the parents is an indispensable stage in the process of peoples’ development.”18 Among the relics of Hetao Man, there have been found also ashes and burnt bone, but unlike the ash in the Peking Man cave, this ash zone is not thick. Therefore, we can speculate that Hetao Man was able to make fire instead of conserving fire. It is similar to the Sui-Ren Shi age when people 17

 Huang Shupin, et al. Historical Narrative of Primitive Society in China, Beijing Publishing House, 1982, p.26 and Song Zhaoling, et al. History of Primitive Society in China, Cultural Relics Publishing House, 1983, p.32. 18  Engels. History of Ireland. People’s Press. p.125, 1972.

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were capable of producing fire by striking flint, wood or sawing bamboo. Ethnological data has proven this point.19 Upper Cave Man could both “sew clothes and knot nets”,20 so this is equivalent to the legendary time of the Fu Xi Age. The marriage of Homo sapiens pertained to group marriage out of the family, as in a matriarchal society. This implies that marriage was allowed only among different families and clans, instead of within the same family or clan. These were between the so-called “chief wife” and “chief husband”. The man went to sleep in the woman’s family in the evening and came back in the morning. The children were the possession of the matriarchal family. The Azhu Marriage recorded in the ethnography of China,21 is such a marriage. Mister Lu’s Spring and Autumn Annals – Monarch Lists (吕氏春秋·恃 君览) records that “In remote ancient times, there was no monarch and the people grouped together. They knew who their mother was but not their father. None of the relatives or partners were regarded, none of the elders or children were respected, there was no courtesy, no clothes or living goods preserved for convenience, and no instruments, vessels, vehicles or towns prepared for the marriage.” This was just as it was during this period. Apart from decoration or during funerals, engraving probably also began. In the Zhiyu site, many bone sheets with engraved traces were discovered. These could be primitive notes. Some people speculate that the earliest totems appeared around that time. Human society has three major types, namely the yellow race, black race and white race. The difference among the races is the outcome of an evolution in appearance and heredity — due to long-term adaptation to differing geographical conditions.22 These racial differences began at an early-stage of 19

 Wang Minge History of the Pre-Qin Period, Heilongjiang People’s Publishing House, 1983, p.47. 20  ibid. p.48. 21  Song Zhaoling, et al. History of Primitive Society in China, Culture Relics Publishing House, 1983, p.102. 22  When the author was in Cambridge University, a British friend asked him whether the following legend stemmed from China. That is, “The Supreme Being used mud to make humans. The first mud-man was over baked, becoming the black man. The second mud-man was not baked for enough time, becoming the white man. The third mud-man was baked right, becoming the yellow man.” The author answered “no”, because Chinese people didn’t use ovens. Another legend was of three people bathing, “When the first person had a bath, the water was clear, so this person became white. At the time the second took the bath, the water was a little turbid, so he could only wash and become yellow. When the third had a bath, the water had almost gone, so he could only wash his palms and soles, becoming a black person

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Homo sapiens and basically were formed by late-stage Homo sapiens. The head and face of Dali Man, Mapa Man, Dingcun Man and Changyang Man have some morphological characteristics of the yellow people. Liujiang Man, whose appearance and stature are similar to modern yellow people, especially the Southeast Asian, is the earliest primitive yellow person discovered so far. Ziyang Man and Lijiang Man also possess significant features of primitive yellow people.23 In short, following on the 1 to 2 million years of the Old Stone Age, the Chinese race came into being — within a harsh environment. They progressed constantly, by resisting and protecting themselves from hostile changes in the environment. A primitive culture also began to evolve and move forward in this fashion. This was not only a stage of racial development and reproduction, but also the origin of a culture. Surely, the primitive hygiene and physique of these human beings, in this land, are in no way to be separated from their culture?

3.  Neolithic Culture and Its Natural Environment in China Generally speaking, the Middle Stone Age follows on the Old Stone Age and its salient feature is a microlithic culture. It was 12,000 years ago, during the late Pleistocene, that the glaciers faded away and the world climate became warmer. Representative relics of microlithic culture have been found in Shayuan, Dali City in Shaanxi Province and Lingjin, Xuchang City, in the Henan Province of China. At that time, dogs had been domesticated and stone tools were becoming refined. However, this period did not last long as it occurred sometime between the ice age and the interglacial period. As soon as the warm interglacial period arrived, a New Stone Age Culture quickly flourished to replace the former age. Microlithic culture relics discovered in China are only a few at present. The New Stone Age rose up abruptly more than eight-thousand years ago. More than seven-thousand New Stone Age relics have been discovered in China. Table 1.2 shows the representative cultural relics of the New Stone Age in comparison to the Old Stone Stage and Legendary Era. The main features that differentiate the New Stone Age from the Old Stone Age are polished stone implements, pottery and agriculture. This with white palms and soles.” This legend may start from the black people. Both legends imply the influence of an external environment. 23  Huang Shupin et al. Historical Narrative of Primitive Society in China, p.46.

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Middle Stone Age Pleistocene

1.2

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1000

Pleiocene

1500

Miocene

Hongshan culture Dawenkou culture Liangzhu culture Yangshao culture Songze culture Peiligang culture Hemudu culture Dadiwan culture Lingjing culture Shayuan culture

Old Late Liujiang man, Upper Cave man Stone Middle Dingcun man Age Dali man Early

Use of natural wood and stone

Patrilineal society

Majiayao culture Qujialing culture

Early

0.8 1

100 300

New Late Stone Age Middle

Marriage

Legends

Monogamy

Yao, Shun, Yu Emperors

Yellow Emperor

Shen Nong Shi Matrilineal society

0.6

10

Yueshi culture Qijia culture Longshan culture

Social Organization

Clan community

0.4

Combined use of metal and stone age

Holocene

0.2

Culture Relics

Pairing marriage

Group marriage out of the clan

Peking man Lantian man Yuanmou man

Family community

Group marriage within the clan

Australopithecine

Primitive group

Hybridization of marriage

Ramapithecus

Fu Xi Shi Nu Wa Shi

Sui Ren Shi You Cao Shi

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14  Chapter 1

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Table 1.2   Cultural Relics & Comparisons between the Old Stone Age and Legendary Era

stone

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indicates that primitive humans were able to transform nature instead of accommodating and taking advantage of nature. It was then that people begin to settle down in different and relatively safe places. For instance, archaeological discoveries show that the Banpo Village Remains were once a place with hundreds of inhabitants and more than a hundred houses; Hemudu Site had wooden buildings involving pile-dwelling architecture, such as dovetail joints and dowel-bearing tenons, which indicate a high technological level. At that time, people in northern China had been able to plant millet and grains and people in the south to grow rice and cultivate silkworms. Fishing and hunting had developed and there were boats, bows, javelins, harpoons and the like. They began to keep animals, and stock farming emerged. The feeding of pigs, cattle, chicken and the like thrived. Fire was utilized not only to cook food, but also to make pottery. Starting from sandy-ware, they built pottery kilns and, as their manipulation of fire improved, their pottery was much more refined. They were able to polish stone implements and many fine and practical items were produced, such as stone shovels, axes, stone adzes, sickles, knives, plates, all made out of stone, and spade-shaped, bone made farm-tools. These tools were used in farming, fishing, hunting and pottery, propelling civilization forward. In the Caoxieshan relics, Wu county, Jiangshu Province, the earliest remains of textile fabrics have been found with the raw material probably being wild kudzu; at Hemudu Site, silkworm cocoon carvings have been discovered; and in the Liangzhu culture, there was silk and linen fabric in common use. It is marvelous to see the source of silk industry in China dating back so early. Moreover, in the Liangzhu culture, there are quite a number of items of lacquer ware, jade ware and bamboo ware. Jade ware, especially, is abundant and exquisite; which indicates a well-developed handicraft. Both Songze and Liangzhu culture have water-well relics, and it denotes that the use of water was not limited to natural sources. Cultural growth in the abstract sense during the New Stone Age was very different from that of the Old Stone Age. The first feature was that group marriage — out of the family and clan — had been transformed into “pairing marriage”, which happened some time since the Middle Stone Age. This is a symbol of a flourishing period of matriarchy. It can be confirmed by the “Son-in-law house” record in the History of Three Kingdoms – Wei Dynasty – Wuhuan Xianbei Dongyi Records (三国志·魏书·乌桓鲜卑东夷传), as well as by ethnographic research, that marriage among the ongoing Yongning Naxi and Lancang Lahu was also a “pairing marriage”. In the Banpo Village Remains, there are groups of round or square-shaped houses surrounding a large square house: a scene

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that is regarded to be similar to the house pattern in the Naxi matriarchal society. The large house is for public residence and gathering, while the small houses are for the pairing family.24 In the Banpo graves, there are single burials of a man or woman, multi-burials of two men or four women, but no multiburials of a couple, or father and son. This implies marriage at that time was a pairing marriage, not the marriage of husband and wife. The pairing marriage generated some differences between relatives, siblings and husband and wife. The Er Ya (Close to Standard Dictionary) – Explanation on Relatives (尔雅· 释亲) states: “A male calls his sister’s child a chu, and a female calls her cousin’s child a nephew. The child of a chu is called a li grandchild, while the nephew’s child is called a gui grandchild.” This is a surviving record of such a case. The marriage of husband and wife emerged soon after and was an outcome of the emergence of private property. At this time, people understood pregnancy was related to the male and the male wanted his own children to inherit the property. Pairing marriage was gradually abandoned and replaced by the far stronger marriage of husband and wife, entering the period of a patrilineal society. In the Songze culture, there had been multiburials of male and female, and in the Liangzhu culture, there were occasional secondary burials and multi-burials of one man with two women. Burial accessories to the male were abundant, which was different from the previous situation when the female had more burial accessories. In the clan cemetery of Dawenkou, Liuwan and Wuwei Huangniang-niangtai, there had been multi-burials of male and female of a similar age, evidently reflecting the burial customs of husband and wife. In the Dawenkou No. 35 tomb a man is buried on the right, a woman on the left and a young child at their side, apparently as a family. The building was oblong, separated into single rooms, each room with daily life-items, production tools, warming and cooking benches; so evidently designed for a husband-wife family. Youle, Dulong and Lahu people in Yunnan province still live in this kind of building, reflecting the state of a primitive patrilineal society. The second feature of tomb burial customs embodies cultural consciousness. There was no tomb burial in the early-stage of the Old Stone Age. It is stated also in the Copulative Explanations (系辞) that “In ancient times, the dead wore thick clothing for burial then were burnt with firewood, and the ashes left in the open without a mound, without a tree being planted: there was no stipulated period for keeping vigil for the dead.”

24

 History of Pre-Qin Period, p.54.

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The Spring and Autumn Annals of Wu and Yue (吴越春秋) also record that, “The ancient people were unsophisticated and unadorned. After they were dead, they were wrapped with cogon cloth and cast into the wild. As some dutiful younger generations could not bear to see their dead parents eaten by birds or beasts, sling shots were used to keep them away.” During the time of Upper Cave Man, people were also able to bury their dead in the earth consciously and hematite powder was spread around the burial place. In a matrilineal society, people lived and were buried together, so the clan cemetery came into existence. For example, in the Banpo graves, skeletons were arranged in lines, and there were more than 250 graves. In addition, there were more than 400 such graves in Beishouling, Baoji city, 240 in Jiangzai, 60 in Yuanjunmiao, and 800 in the early Dawenkou Culture. Most of the graves contained a single body, some were multi-burials of the same sex or man and woman, and secondary burials also appeared. Take Hengchen Village relics in Hua County, for example. Here there were large burial pits for collecting bodies and in one large pit, there were 5 to 7 secondary small burial pits while in each small pit, several bodies were set in layers. There were no child burials at this cemetery — such as at the public cemetery in Banpo, where children’s bodies were put into an urn which had small pores, for the so-called “exiting and entering of the spirit of the dead”. Children’s bodies were not buried in the clan cemetery as children did not have the social rights of an adult. In a patrilineal society, there were multi-burials of men and woman of a similar age, which could possibly be multi-burials of husband and wife. Of such graves, there are four in Dawenkou, two in Liulin and two in Caoxieshan. In a grave at Caoxieshan, the male body lies supine with stretched out limbs, while the female body lies on its side with bent limbs, indicating the subordinate position of the woman. This phenomenon was also discovered generally in Qijia culture, Huangniang-niangtai, and so on. At this time, the custom of being buried alive along with the dead emerged. This phenomenon does not just occur among slaves. Just as the female body lying on the side with bent limbs in a multi-burial is the body of the wife, this also happens in being buried alive with the dead. In the Liuwan multi-burial of five people, the bodies belong to a wife and children being buried alive, and an old female skeleton in the fill stratum pertains to a maidservant being buried along with the dead. Burial accessories at an early stage of human history are rare, and most were ornaments and instruments used by the dead while they were alive. A pig’s lower jawbone was one of the burial accessories in a matrilineal society

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but was a far more wealthy cachet in a patrilineal society. Thereafter, many more burial accessories have been discovered. For example, among the Dawenkou graves, one single rich tomb has more than 180 burial accessories, all luxuries of the time, such as ivory combs, engraved ivory tusks, jade cups, and calcite neckwear and headwear. The burial accessories can either be exquisite pottery (especially colored pottery, white pottery, and thin black pottery), or jade ornaments, or instruments — all things in daily use at the time. But they are in such large numbers that they are more than one person could use. The change of burial pattern and accessories denotes the accumulation of private property, an enlarged gap between the rich and poor, and even an early form of class system. It also shows the progress and development of a culture. Mystical concepts in the primitive consciousness grew rapidly. A third feature lies in its primitive art. The art in Europe during the Old Stone Age was mainly reflected in sculpture and rock painting. However, in China, few paintings have been confirmed with exact dates. Judging from the uncomplicated style and antiquity of such paintings, they should embody the mystical world which lies at the heart of primitive man. Such examples include the Group A rock paintings at Jiangjun Rock in Lianyungang city and Cangyuan rock paintings in Yunnan province. There have been about 70 locations where rock paintings have been discovered in China and further research is required. At the Jiangzai site, a painter’s grave was surprisingly discovered and a set of painting articles unearthed, including ink stone, stone pestle, water glass, along with several pieces of red pigment. Primitive artists at this time may have been considerably mature. Many unearthed articles have also appeared, including sculptures, pottery and coloured drawings all dating to the New Stone Age. These drawings and sculptures are abundant in their imagery and symbolic content — although not totally realistic. Such admirable masterpieces include the Banpo picture of a human face on a fish-body shape as a basin design; the Qinghai Minghe concentric circles painted on some colorful pottery; a Ganshu Yongjing swirl-painted colorful pottery cup; some jade dragons unearthed at Jianping, Liaoning province, on the Ongniud Banner, Inner Mongolia Autonomous Region; and the dragon-tiger sculptures on both sides of the dead in Puyang Tomb, Henan province. These cause one to ponder “in reverie”. The arts of primitive people will surely also include music and dance. At Ningming Flower Mountain in Guangxi province, rock paintings of dancing and dance-designed coloured pottery basins in Datong, Qinghai province,

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are both evidence of primitive dance. The use of music is proven by an unearthed Wenxi stone resonator in Shanxi province and a Minhe coloured pottery drum in Qinghai province. Earlier evidence is a xun (egg-shaped, holed wind instrument) and a bone whistle among the Hemudu relics, and a Miaodigou pottery bell, all of which are the earliest recorded musical instruments to be found and used by humans. The Great History (路史) records, “The Paoxi clan baked earth to make their xun”; “Fu Xi chopped down the tung tree to make a lyre”; and “Ling Lun made a resonator”. The Generation Records (世本) also writes, “Yi made drums”. All these are evidence that our ancestors were able to make musical instruments. In the rock paintings at Flower Mountain, there is a dancer above and a bronze drumshape below, showing dancing accompanied by music. Dancing was sometimes utilized to defeat the enemy. The Han Feizi – The Five Vermins (韩非子·五蠹) records, “At the time of Shun Emperor, the Miao clan refused to obey, so Yu wanted to send armed force to suppress them. Shun did not agree and said it was immoral to apply force without great virtue. Therefore, virtue was cultivated for three years and arms — an ax and shield — were used as instruments for dancing, instead of force. At last, the Miao clan were subdued.” The dancing with arms must have been quite majestic. Where there is music, there is also song. Mister Lu’s Spring and Autumn Annals – Ancient Music (吕氏春秋·古乐) records, “Previously in the Getian clan period, there was a dance to music in which three people held oxtails and stepped out along to the music, singing eight special songs. The first was For the People (载民), the second Black Bird (i.e. swallow 玄鸟), the third Chasing River Weed (逐水草), the fourth For Five Cereals (奋五谷), the fifth Respect the Celestial (敬天神), the sixth Achievements of the Great Emperor (达帝功), the seventh The Virtue in Following the Earth (依地德), and the eighth A Marvel of All Things (总万物之极).” The names of the eight songs might have been given afterwards, but it is truly imaginable that work was accompanied by rhythmic singing, while dancing accompanied songs; sacrificial ritual was accompanied by music.

B. The Physique and Diseases of Primitive Human Beings in China It is extremely difficult to do research on the physique and possible diseases of primitive people in China. There are two reasons. The first is lack of fossils. Take Yuanmou Man for example, only two teeth have been discovered

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up to now. It is reasonable to infer a primitive nature for Yuanmou Man, but extremely difficult to uncover his physique or health status. The second reason is lack of research. Paleoanthropologists usually do research on the bodily and facial appearance, but seldom on physique and pathology. Anatomists and pathologists are also rarely involved in paleoanthropology. Despite all this, the physique and pathology of the primitive human in China can be revealed through the collection of the particular materials that remain.

4. The Evolution of the Physical Constitution of the Ancient Chinese Shovel-shaped incisors, of the maxillary type, whose lingual surfaces are grooved in the middle, with its edges puckered up, thus shaped like a shovel, are a significant feature of the yellow race, as well as the Chinese. According to American anthropologists Ales Hardlicka and Franz Weidenreich, among contemporary Chinese women, those who have typical shovel incisors account for 82.7%; those with semi-shovel incisors 12.5%; those with slight shovel incisors 1%; and those who have no shovel incisors at all make up only 3.8% of the total. On the contrary, among contemporary white women, those who have shovel incisors are only 2.6%; semi-shovel ones 5.2%; slight shovel ones 21.8%; while those who have non-shovel incisors reach up to 70.4%. Carbonell’s statistics in 1963 suggested that among Chinese who had typical shovel incisors, those whose maxillary central incisors were shovel-like accounted for 92.7%, while those whose maxillary lateral incisors were shovel-like took up 91.3%. However, among other races, there are people who have no shovel-shaped incisors at all; and even for the few races with shovel incisors, the maximum figure is no more than 5%.25 Such features have been discovered in research work on Peking Man fossils around that time and was later confirmed by the fact that almost all fossils of Chinese primitive human beings had one or more shovel-shaped incisors — as long as they were found with their maxillary incisors intact. Yunxian Man, Tongzi Man, Dingcun Man, Hetao Man, Liujiang Man, Upper Cave Man and even Yuanmou Man, without exception, take up the same feature of shovel-shaped incisors. However, a satisfactory explanation is still needed why the yellow race alone has shovel-shaped incisors. 25

 All the above from Song Zhaolin et al. China’s Primitive Society, Cultural Relics Press, 1983, p.113.

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The evolution of limbs, bones and joints precedes that of skulls within the evolutionary record of the ancient Chinese. This is prominently reflected in the fossils of Peking Man. The limbs, arms and legs were so well-developed compared to skulls that they could work with their hands quite freely, walk independently on their feet, and even were capable of running, although they still stood with bent knees. One explanation for the “assembled-Peking-Man” is that the development of the hands goes prior to the brain and skull due to physical labour. This can be proved further by the fact that looking at the minimum diameter of Peking Man’s thigh-bones, the transverse part of the bone is bigger than the anteroposterior, which is similar to the apes but contrary to contemporary man. Meanwhile, the size, shape, proportion of bones and their muscle attachments are all similar to those of modern man. The fossils of Maba Man’s metacarpal joints provide more proof that these people were dexterous with their fingers — which made it easier for them to work. However, their skulls were still close to being spherical. Lantian Man’s skull, with a height of 87 mm, clearly bears the marks of an ape with prominent brow ridges, extremely low jawbones, a flat nose bridge and a broad nose. The skull wall is as thick as 16 mm. The fusion of skull suture takes place around the age of forty — earlier than in modern man. The angle of lower jaw is tipped 55 degrees forward. But no information about Lantian Man’s limbs and bones has been collected, owing to a deficiency of such fossils. As for Peking Man, his head, hemispheric in shape, is big on its lower side and small on its upper side. The skull has a height of 97.4 mm (in the range of from 93.5 to 105 mm), a figure which is prominently bigger than that of Lantian Man. The skull wall is much thinner — about 7 to 9.9 mm. The angle of lower jaw is in the range of 58 to 63 degrees, more retracted than that of Lantian Man. Later in their development, Peking Man had chins. But they still had protruding superciliary bones like a ridge, so much so as to even cover the eyes, flat noses, prominent cheek-bones, and forward pointed mouths with small chins, all of which made them superior to Lantian Man but slightly inferior to Maba Man and Changyang Man, who were a little later in the evolutionary scale, due to their closer-to-hemispherical head and thinner skull wall. Dingcun Man was much closer to modern man although he was a defined primitive human “between Peking Man and modern man”. The primitiveness left over from the ape-man had faded from Ziyang Man, Liujiang Man, Laibin Man, Hetao Man and others whose brow ridges were not so protrusive, frontal bones more plumped up, mouths retruded and chins more prominent. Meanwhile

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the parietal boss had become the broadest part of the skull. When it comes to Upper Cave Man, they appeared much more akin to modern man — with short faces, square eye-sockets, high cheekbones, and broad chins. The cranial capacity of the ancient anthropoid is generally in the range of 430 to 470 ml, with an average capacity of 450 ml. In Peking Man, the range is from 850 to 1225 ml, with an average of 1059 ml. Juveniles excluded, this capacity is from 1015 to 1225 ml, with an average of 1088 ml. It can be seen from this that Peking Man had a not-so-big brain, with a capacity equal to about 80% of that of modern man. But his brain was much bigger than that of other ancient anthropoids, whose capacity amounts to only 40% of modern man. The capacity of the brain of Lantian Man, with an average of 780 ml, falls in-between. However, when it comes to Upper Cave Man, the cranial capacity of the male reaches 1500 ml while the female has 1380 ml, with an average capacity of 1440 ml. This is almost the same as that of modern man — who has a cranial capacity lying between 1300 and 1500 ml and an average capacity of 1400 ml. This reflects the brain development of Upper Cave Man. Without doubt, cranial capacity cannot be considered an absolute criterion for intelligence. There are guri, sulci, brain cells and other detail structures which must be taken into consideration. But one thing is quite clear, based on the evolution of primitive humans’ cranial capacity, there is a stepped model for the development of the brain. Denying such a model will bring us nowhere in any further discussion on the evolution of these detailed structures. The thick limb-bone wall of Peking Man leaves small room for the medullary canal, which takes up about one-third of the bone pipe diameter, the proportion of which is about half for modern man. When it comes to Ziyang Man, Liujiang Man and others, the limb-bone wall becomes thinner and its cavity enlarged to contain more marrow. From what has been measured so far, it can be deduced that with a height of 162 cm for the male, 152 cm for the female and 156 cm for the average individual, Peking Man is shorter than a modern Chinese, whose height is 168 cm for the male and about 160 cm for the female respectively. Upper Cave Man seems taller, with a height of 174 cm for the male and 159 cm for the female. In the Neolithic Age, the average height of a Banpo male is 169.5 cm; and 172.26 cm for a Dawenkou male. This reveals contrarily that the ancient Chinese were not short. The assertion based on Peking Man’s relics that modern men are tall while ancient people were short seemed ungrounded and needs more analysis. People usually think it is incorrect that ancient people were described as

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tall and strong in writings and stories. But it is a fact that the terracotta soldiers, generally believed to be modeled on the size of real soldiers, have an average height of 1.8 m, among whom the tallest was 1.95 m which equals to 8 Chi in ancient times (when 1 Chi of Qin Dynasty was proximately 23.1 cm ). It might be true that the common people were shorter, but not by much. The figures of 1.579 m and 1.64 m respectively are the heights of the two tomb owners whose bodies were found intact and whose tombs, two out of the three, were unearthed between the summer of 1953 and the autumn of 1954 on the outskirts of Changsha, Human province. The height of the female corpse in the Mawangdui Han Tomb in Changsha was 1.544 m; 1.657 m is the height of the male corpse in No. 168 Han Tomb, Phoenix Mountain in Jiangling, Hubei province; and 1.7 m for the No. 11 Tomb owner named “Xi” in Shuihudi Qin Tomb in Yunmeng County, Hubei province. However, in the above, corpse shrinkage must be taken into account. It is presumably from the facial muscle attachment-points together with the skull that Peking Man got his language.26 Professor Jia Lanpo points out, “Anyone who oversimplifies Peking Man’s language, or merely takes it as a cluster of a few simple syllables, will be wrong.”27 Peking Man was called Peking Ape-man in former times because of the resemblances of their looks. It can be seen from a comparison of dental formations that there was a long history of Peking Man cooking food as well as using and controlling fire, indicating a reasonable development of intelligence, thinking and competence in language. It is equally difficult to deduce the life-span of primitive human beings. Some believe it to be short — because of the unsmooth, chewing surface and slight abrasion of the two teeth of Yuanmou Man’s relics. But it is questionable: why should a short life be apparent only in this individual in Yuanmou? By determining 38 out of more than 40 individual fossils of Peking Man, we found 15 persons who died at the age of under 14 years old accounting for 39.5% of the total; 3 persons who died at the age of around 30 taking up 7%; 3 persons were between 40 and 50 years old representing 7%; and only 1 person who died was between 50 and 60 years old (2.6%); while there were 16 persons whose ages could not be determined (definitely adults) representing 43%. Judging from the above figures, the average life-span was short indeed, which also tells us about the harshness of the primitive humans’ 26

 Jia Lanpo. Peking Man, Chinese Publishing House, 1988, p.28.  Jia Lanpo. Ibid, 1984, p.56.

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struggle for survival. It must be pointed out that the average life-span was not the maximum life-span. Such an assertion as “every hominid suffered a short life” appears to be indefensible. Also out of a total of seven Upper Cave Men, men and women, old and young, there is one person whose age is above 60 years old taking up 14% of the total; two young women between 20 and 40 years old taking up 29%; two children and one teenager occupying 43%; and lastly one adult whose sex is unknown. During the Neolithic, the general statistics of age of death are as follows: aged 7–14, 10.8%; 15–23, 18.7%; 24–35, 31.3%; 56 plus, 6.6%,28 according to Wu Xinzhi.29 Of the 8 or 10 individuals of Upper Cave Man found, there is one old man, one middle-aged or prime-aged person, one prime-age person, one 5-year-old child and one new-born baby or foetus. In Banpo Man’s Site, most of the adult dead are around 30 years old, and lots of child urn coffins have been found. It is undoubtedly true that the average life-span then was quite short, but still the maximum life-span remains unknown and further evidence is needed. A harsh living environment, unpredictable natural conditions, brutal fighting against animals, ruthless war between men and men, and even cannibalism — all explain the short average life-span of the primitive human. However, this does not mean a poor physical constitution. All in all, those who go naked into the world can in no way keep themselves safe from natural disaster — only culture and civilization can do this, and keep us from perishing.

5.  Discoveries of Archaeological Pathology Archaebacteria, one of the lowest forms of probiogenesis occurring in the sequence of life, appeared during the Archaeozoic era about 10 billion years ago. Archaeologists have found traces of archaebacteria and fungi in fossils. Whether these microbes could cause disease still awaits proof. But some discoveries have found that shellfish-mollusk fossils 350 million years ago bore the marks of damage caused by parasites; traces of osteitis and osteoma were left on dinosaur fossil bones some 150 years ago. There were bone tumors on the thighbones of Java Man; and Neanderthal Man has been found to have suffered from arthritis. It is a fact that spinal tuberculosis, 28

 He Zhaoxiong. History of Chinese Medical Ethics, Shanghai Medical University Press, 1988, p.5. 29  Wu Xinzhi. A Study on Zhoukoudian Upper Cave Man’s Relics, from Vertebrate Paleontology And Paleoanthropology, 1961, No.3.

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osteomyelitis, congenital hip dislocation and other diseases have also been detected on human fossils.30 Disease held its existence not only among primitive humans but also long before they came into existence. Lately some anthropologists from Germany discovered that among 80 skeletal remains unearthed from an ancient Stone Age tomb about 7000 years ago, about one-fifth bore the marks of malignant tumors, some were breast cancers and some from lung or prostate cancers. Clearly this was a tomb for men dying from serious diseases.31 These cases also suggest that diseases (such as tumors) not only appeared after the development of civilization; and also that their expansion did not simply accompany the progress of civilization. Similar discoveries have been made among hominid fossils in China. For example, there are marks of arthritis on the bone-fossils of deer, bear, local Chinese dogs etc. On the fossils of Megaloceros pachyosteus, the lower jaw is humped near the molar teeth into almost the same height and breadth, in the shape of a ball. And it is the same on the upper jaw. Malunion caused by injuries before death appears on the antlers of many Megaloceros pachyosteuses.32 Such cases among animals would definitely also happen among humans. It has been found that marks of hitting were left on the skull of Peking Man; and trauma and fractures were common in Upper Cave Man. According to the information provided by Professor Jia Lanpo, a female skull, although severely broken, was closely jointed together with its parts overlapping in adhesion, arousing speculation that such overlapping must have formed when the woman was still alive when there was flesh and skin on the skull, which made it possible for the healing to occur in this overlapping shape. Besides, on the tempus line between the woman’s left frontal and parietal bone, there was a hole 15.5 mm on the anteroposterior side 10 mm in diameter inferred to be a wound made by thumping not by damage to a dead body. A longitudinal groove 1.5 mm in breadth and 12.4 mm in length on the tempus line between the left frontal and parietal bone of another elderly man’s skull has also been discovered and arouses speculation that the groove was caused by a sharp object, when flesh and skin still covered the skull.33 Tooth-biting was discovered both on the brow bones and the upper frontal bones of Maba Man of Qujiang, Guangdong Province — indicating 30

 Gerhard Venzmer. Five Thousand Years of Medicine, Macdonald & Company (Publishers) 1972, pp.16–17, London. Translated into Chinese by Ma Bo-Ying, 1984. 31  Xinmin Evening News, Shanghai, 3rd January 1996. 32  Song Daren. Health Culture of Primitive Society, Chinese Journal of Medical History, 1955, Vol. 3. 33  ibid.

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that gnawing by animals was one of the causes of hominid disease. Among Neolithic hominid bone-fossils, about 4000 years ago, from Xixiahou in Qufu, Shangdong Province, arm-bone fractures and their healing have been detected. The left femur of No. 316 Tomb owner in Dadunzi Site, Pixian County, Jiangsu Province was injured by a bone arrowhead. Stone arrowheads were left in the chest and abdomen and lumbosacral parts of eight corpses, each of whom had four arrowheads at least and more than 10 at most, among the 15 Neolithic tombs in Dadunzi Site, Yuanmou, Yunnan Province. It can be concluded that external wounds and war injuries were other major causes of the hominid’s death. Bone diseases were quite common for primitive human beings, such as hyperosteogeny, osteoarthritis, bone tuberculosis, sacral and lumbar variations, curving and swelling of the thighbones and so on.34 There were lots of fine ostioles and tiny wrinkles on the outer side of the occipital bone of Xujiayao Man and clumps of ostioles were also found on the parietal bone, which according to Lin Yipiao, a paleoanthropologist, were cribriform bone diseases caused by the lack of certain vitamins.35 The fact that two out of five men suffered from this testifies to a high incidence rate. Severe dental diseases were also discovered among Ziyang Man. Among 1,035 lower teeth of Dadunzi Site in Pixian, Jiangsu Province, 66 were decayed, accounting for 6.38%; among 113 lower jawbones, 46 suffered from periodontal disease, accounting for 40.7%. Some suffered from alveolus abscesses and among nine specimens of such diseases, six had radicular fistula abscesses and three bore clear marks of ulcers.36 In the Xixiahou Man of Qufu, a radicular cyst was also discovered. Research on Dadunzi hominid bones in Pixian also testifies that maternal diseases might pose a major threat to women’s lives. Among 199 human bodies, 21 died between the age of 14 to 23, of which 8 were male and 13 were female. That the death rate of the women is higher than that of the male is probably because some died during pregnancy and childbirth or had deaths associated with gynecological diseases. In other sites, related information reveals that there were women who died during a difficult labour Among 34

 Yan Yin. Research on Neolithic Hominid Bones of Xixiahou Relic, Acta Archaeologica Sinica, 1973, Vol. 2; Xi’an Banpo Museum, The Shi’s Neolithic Age Site in Weinan, Shangxi Province, Kaogu (Archaeology), 1978, Vol.1. 35  Jia Lanpo. Ancient Residents in Chinese Land, Tianjin People’s Publishing House, 1978, p.95. 36  Han Kangxin. Research on Human Bones of the New Stone Age in Dadunzi, Pei County, Jiangshu Province, Acta Archaeologica Sinica, 1973, Vol. 2.

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seven human bone-fossils unearthed in Upper Cave Man Site, one had a foetus still in the womb. In Dahezhuang Site in Yongjing, Gansu Province, there was a joint burial tomb for an adult and a baby who, though decayed, lay between the legs of the adult with its head down, which was most likely the result of death for both mother and baby during a difficult labour.37 The death-rate for children was also not low. Among 73 urn-coffins out of 76 child tombs, only two corpse bones were well-preserved (the others were decayed) and their age was around one year old. It is presumed that all these were deaths of new-borns as it is easy for new-borns to perish. Among 82 tombs in Dahezhuang Site in Yongjing, Gansu Province, 55 were for little children aged from 1 to 8, accounting for 60%; the rest of the 27 tombs were for adults. It can be inferred from this that the death-rate for children was fairly high — which gives a high probability that it was associated with disease. It is difficult to find marks of diseases on bone-fossils as they usually affect the flesh. There were also some bone injuries not caused by disease. In Dawenkou, Xixiahou and Dadunzi Neolithic Sites, artificial deformation of the occipital bone of the head and maxillary incisor teeth pulled out during adolescence was discovered, which was associated with folk customs or primitive worship. For example, a “flatten-head-as-in-sleeping” appearance, a traditional custom of Manchu Nationality in the northeast of China, originally referred to pressing the head flat with stones. In Dawenkou culture, according to the data collected from Dadunzi, Dawenkou and Xixiahou Sites, among 115 measurable corpse fossils, 74, aged between 15 and 22, had teeth extracted, making the rate of tooth-extraction approaching 64.4%. This might relate to the Chengding ceremony — the ancient rite for boys when they were about to become adults, or else immolated burials through coercion from a husband, for decoration, disease prevention38 or in the pursuit of beauty. According to the Mountain and Sea Classics (山海经), “Among the 36 countries abroad, from the southwest to the east, there were a people named the Zaochi who extracted their own teeth.” Also it is said in the Huai Nan Tzu (淮南子): “Yao ordered Yi to kill Zaochi in the Chouhua lake area.” “Yi fought with Zaochi and shot an arrow to kill him in the Chouhua 37

 Fu Weikang. Chinese Medical History, Shanghai College of Traditional Chinese Medicine Press 1990, p.6. 38  According to the New Book of Tang – Biography of Nanman (新唐书 • 南蛮传), “Where people suffered from a miasma and found it difficult to take medicines, they chiseled out their own teeth to make it easier.” However Zaochi — meaning ‘dug out teeth’ in Chinese — might also have been the name of a particular peoples.

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lake area, east of Kunlun Ruins: Yi held bows and arrows but Zaochi held a shield, which ended up with Zaochi shot dead by Yi.” According to the ethnographic records, tooth-extraction remains a traditional custom for the Gelao and Gaoshan nationalities.39 On the forehead of the female skull of the No.102 Upper Cave Man fossil, there is a groove-like deformation, which, according to Professor Jia Lanpo, was caused by ropes tightly tied on the forehead over a long period of time.40 Similar deformations, associated with carrying loads on the forehead, also appear on the skulls of people in the southwest of China, where cliff-burying is still popular.41 These all belong to the category of strained physical mutation. Another fact which requires our attention is the rare occurrence of marks of trepanning (i.e. the operation of cranial sawing etc.) found on the skull-fossils of Chinese primitive humans. These are quite common in foreign countries almost all around the world, and most common in the western Mediterranean, South and North America, and South Pacific islands. The earliest discovery of such marks was made in France in 1685 and three cases have been reported in Japan as well. It is thought that sharp stone artifacts were used to effect a trepanning (which occasionally appeared among American Indians also more recently), aiming to expel the evil spirits out of the head and cure such diseases as refractory headache, lethargy, neuralgia, epilepsy, idiocy, insanity, convulsions. Primitive humans from the Malay Archipelago used to make palm leaves into a small figure with spices and food in order to lure a ghost out through the hole in the head. South American natives prepared narcotic drugs (made by coco leaves, stramonium leaves and the like) and used anticorrosive drugs before trepanning. Though popular in the ancient world, trepanning left no trace on Chinese primitive human fossils, which leaves behind a mystery for the students of paleoanthropology as well as for cultural analysis.

C. The Culture and Conditions of Hygiene Among Primitive Humans in China Primitive humans might have not known where life came from, but they understood the harshness of their own lives. Their primitive conditions of 39

 Yan Wenming. On Tooth-extraction of Dawenkou People and its Ethnicity, see Chinese Ancient Culture History compiled by Xiang Rendan, Peking University Press, 1986, p.285. 40  Jia Lanpo. Upper Cave Man, Longmen Joint Publishing Company, 1951. 41  Song Zhaolin et al. China’s Primitive Society, Cultural Site Press, 1983, p.376.

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hygiene came through striving for survival, and gradually a culture of health and hygiene was formed.

6. The Residential Culture of “Nest-Living & Cave-Dwelling” and Its Significance for Health All animals live in hideouts such as dens or nests. Needless to say, so do human beings. On the hygiene front, hideouts are for rest, protection, and ultimately survival. However, human beings differ from animals in their ability to develop and perfect their hideouts. This creates what is known as a “culture”. If this is not an instinct among animals, living in nests or caves, at least, it originated along with the age of animals. Collecting wood to build hideouts like nests as well as digging caves for dwelling characterizes Chinese hominids’ conditions of hygiene — which symbolize the creation of a collective intelligence. Peking Man lived in natural caves. No information is as yet available telling us where or how Yuanmou Man and Lantian Man lived. According to Zhang Hua’s Natural History, “the southern people lived in nests on trees, while in the north people lived in caves.” Volume 78 of the Tai Ping Imperial Encyclopedia (太平御览) quoted Xiang Jun’s words from his Starting to Learn (始学篇): “Ancient peoples all lived in natural caves at the beginning. Later a sage named Dachao Shi taught them to build nests in trees. Hence southern people lived in nests on trees and northern people dwelt in caves, both of which became ancient custom.” It seems that hominids began with cave-dwelling and later changed to nest-living. However, most likely, hominids used natural caves or hollow trees for shelter and turned to collecting wood to build nests in trees when there were no such hideouts available. Gradually the earliest building, the earliest human habitation, came into being. Ethnologists believed that the Dulong Nationality made tree-houses or used stone caves not so long ago.42 The Sui Book – Biography of Nanman (隋书·南蛮传) records, “The people who lived in natural caves in ancient times were called Baiyue, and were accustomed to cutting their own hair and tattooing their bodies.” Vol. 78 in the Tai Ping Imperial Encyclopedia (太平御览) says that the Dong Xie Man Nationality during the Tang Dynasty “were scattered between caves and living in layers of nests on different levels in trees”, which proved that there was no fixed way of living in caves or nests for the southern and northern people. 42

 Tao Yunkui. Jiang Ji Cheng, Southwest Frontier, 1941, Vol. 12, Vol. 14, Vol. 15.

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Reflecting early Neolithic Culture, ancient human habitation is mainly pit-dwellings in the north and stilt housings, typically tree-nest-housings, in the south. Western anthropologists have found that many primitive houses among ancient tribes in South Asia and Europe were “wind breaks”.43 With their simple structures, and branch-plugged fences, covered with twigs or straw, these seem cruder than the primitive houses of the ancient Chinese. Take the primitive houses of the Yangshao Culture for example. These were mainly semi-pit-dwellings with a pit in the lower part and a formation of wood and clay in the upper part, surrounded by low walls and supported by a roof structure. The walls, fences and roof were all mudded. Most noticeable is the use of soil which, in an earlier period was a daub of grass mixed with mud, but in the later period was a plaster made from a mixture of fine sand, small stones and clay, which turned out quite hard after it dried. Sometimes rammed earth was used and might have been roasted with fire; sometimes a layer of wooden slabs would be placed on the land before it was pargeted. The wooden stilt houses of the Hemudu Cultural Site in the south, earlier than those of Yangshao, whilst more advanced, had two storey — with the first storey wood-staked in an empty space and on which a base of wooden slabs was placed with columns projecting out and stacked with wooden plugs connecting them, making quite a sturdy structure. Houses in Qi’s Cultural Site four-thousand years ago were famous for their “white lime construction”, i.e. the ground and lower part of the walls was whitelimed, similar to today’s whitewashing — which made the house bright, beautiful and clean. Most of the houses were surrounded by cellars with the base and walls plastered with grassed mud, red clay and flat large gravels and tiny stones, indicating clearly a use for storage. This goes beyond total passivity in adapting to the environment, and not only in architecture. A ditch, 5 or 6 meters in depth as well as width, was dug around Banpo Village, not only for the purpose of keeping away wild animals and defending against armed attacks from other tribes, but also to drain off water and keep the area dry — which bears a noticeable hygienic significance. Agreeing with later Fengshui geomancy, houses in Hemudu Site, with their fronts facing lakes and backs to slopes, can shield against the wind, keep you warm and drain off flood-water. The transparent space in the lower part of a stilt house means the upper rooms are kept dry and ventilated, which seems most important in humid areas to the south. More significantly such construction can buffer the occasional floods which occur after heavy rains and keep away miasmas, as well as poisonous insects and weeds. The Biography 43

 Zhong Fulan. Origin of Chinese Customs, Knowledge Publishing House, 1986, p.116.

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of Nanpingliao (南平僚传) in the old and new Book of Tang (唐书) records, “People lived in stilt houses because there was too many miasmas on the ground, and many poisonous chiggers and deadly vipers living in the hills”. More proof comes from the Geography of Peaceful China (太平寰宇记) which records that “people usually collect wood to build their houses on trees to keep away miasmas.” Living high makes it easier to smoke out low-flying insects like mosquitoes which are quite common in southern areas. Piles of acorns, left-over shells of water-caltrops together with bones of birds, fishes and animals have been unearthed, and might have been dropped by the inhabitants through cracks in the overhead wooden slabs after they finished eating. This helped to keep the upper room healthy and also fed the livestock, like dogs and pigs, which were usually reared in pens separate from human beings in the south. From the fact that pig remains are found quite commonly in the Hemudu Site, we can know that such a healthy construction began at quite an early stage. Even today, the style of stilt housing remains in the wooden or bamboo towers of some minority people. In the section on buildings in Volume 8 of The Origin of Things in the World (事物纪原), it is said that “The ancient people used to live in wild caves and later a sage taught them to build houses with a structure, the upper part made into rooms and the lower part empty in order to keep them from the rain and wind.” Bai Hu Tong (白虎通) recorded that “The origin of houses came with the Yellow Emperor who built houses to avoid the cold and damp.” Such constructions were already called houses because they were high-ranking and associated with the healthy significance of avoiding the wind, rain and cold and damp. However, the appearance and construction of these houses built by the Yellow Emperor remains a mystery to us. Mo Zi (墨子) said, “With a height of 3 chi and three steps at the front, the house built by Yao was assembled with thatch and rafters both untrimmed.” Simple as it is, both the steps and the house being high can protect against the damp and make it well-ventilated. Another description from Mo Zi says: “People, in ancient times, before they knew how to build houses, lived in caves in nearby hills, but found the damp on the ground often caused illness and injured them. Thereby the sage-king built houses. The principles of building were said to build high to avoid damp, build sides for keeping out the wind and the cold, and a top roof for keeping out the snow or frost, rain or dew. High walls can also maintain good etiquette between man and woman.”44 Thus more stress was placed on health than on other aspects of life like ritual, pleasure and so on. 44

 Chapter Ci Guo from the Mo Zi.

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In the Book of Rites – Introduction of Rites (礼记·礼运), it is said that “In ancient times, there were no palaces and houses, so people lived in dug-outs or natural caves in winter and wood-formed nests on trees in summer. …later a sage taught them to use fire, which made life easier. From then on, they learned to build pavilions with terraces, doors, windows and houses using metal artifacts which they forged using moulds and fire-utensils made from a mixture of clays and mud.” Such descriptions reveal clearly that the living conditions of ancient people were improved after they learned to use fire. Vents on the roofs of most houses in ancient sites, in northern areas, also conform with these descriptions. Comparatively, ancient houses in western countries usually piled up stones to make walls and both windows and doors were narrow and small — which helped keep them warm but less well-ventilated than in Chinese houses. In the houses of the Longshan Cultural Site, there is usually a kind of fireplace dug out the ground in the middle, or to one side of the room. Some houses had a fire-bed, with a space underneath for burning material to keep warm, avoid the humidity and improve safety. It is healthier to live separately rather than live all together — or to live with livestock and household odds and ends. Reed screens in Hemudu houses and ceramic bowls with mat patterns at the Banpo Site both show that mats were used to keep healthy and for decoration. This is progress compared to what is recorded in A Brief Biography of Yunnan (滇略) as the Luogan Man people “lived in houses where there were no beds, and lay pine leaves on the ground to lie on”. The Chinese idiom “sitting on the mat”, and the story of “never sitting on a slanting mat” from the Zhou Li (周礼), and the saying “Yan Zi sat solemnly on his mat when his guest withdrew” from Yan Zi’s Spring and Autumn Annals (晏子春秋), all reveal that, on one hand, the Chinese put mats on the ground for health; while on the other hand, that how the mat was placed was closely connected with etiquette. The migration of villagers and the abandonment of houses has also been discovered during archaeological excavations. Some believe this was because of fire, while others connect it with continual migrations owing to the fire tillage operation of agriculture. However, hygienic considerations must be taken into account, which can be proven by the ethnographical records which show that the houses of Gaoshan Nationality were divided along a line through the central pillar into two parts — an eastern part for living and a western part for the dead. When the western part was full, the house was abandoned and they would move on to another one. The Lahu Nationalities respond to such a circumstance once and for all as they “simply leave the

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dead in the house without any burial and move to another house when someone dies.”(Chuxiong Prefecture Annals, Vol. 1) For the Yi Nationalities in Liangshan region and Hezhe Nationalities in Northeast China, whole villages will migrate as quarantine when there is a plague.45 In the West, houses of lepers would be burned down ever since there have been Jewish people.46 It can be deduced from this that the abandonment, migration and relocation of the ancient Chinese became totally conceivable because of health considerations.

7. Striking Flints or Drilling a Log to Get Fire & the Significance of Cooked Food to Health Getting fire through friction made an enormous contribution to the evolution of mankind. It was the first time man could take control of a natural force and, in doing so, eventually distinguish himself from animals. Such an ability played an equally important part in health and safety, firstly protecting him from animal attacks, secondly keeping him warm and avoiding the damp; and more importantly, in preventing gastrointestinal diseases by using cooked food — which at the same time stimulated the evolution of the human physiology. Natural fire is mainly caused by the explosion of volcanoes, burning vegetation sparked by lightning, spontaneous combustion under the sun or other physiochemical factors etc. During the eras of Yuanmou Man, Lantian Man, and Peking Man, people predominantly used natural fire. It was difficult as well as significant to keep the fire going. According to ethnographic records, there were different ways of preserving fire, such as a combination of bonfire keeping and no-flare burning, which was adopted by the Luoba Nationality of Tibet, who would dispatch an old man to watch the fire; and also the mobile preservation of no-flare burning, which used fungus, rotten wood and sparking ropes adopted by the Erlunchun Nationality, Yi Nationality and others — particularly as it suited their nomadic lifestyle. Gradually, as fire was used more and more, the ways of preserving fire could not meet the needs of production, life, survival and health. Consequently during the striking process of making stone artifacts, ancient people learnt to strike a flint to get fire. 45

 China’s Primitive Society, p.366.  see the Bible.

46

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In Han Feizi – Five Vermins (韩非子·五蠹), the ancient period is described as “a time when people ate wild fruits and clams fetid with rankness and damaged their stomachs and health through disease. Then a sage appeared and taught them to strike flint to get fire and cook food. People loved him and made him king, and called him Suiren Shi.” These words lay bare the hygienic significance of cooking food — it not only helps digestion but also functions as sterilization and disinfection. It bears enormous significance that cooked meat is easier to digest and provides sufficient animal protein — necessary for physical and brain development. The invention of pottery was also another vital progression. Pottery artifacts made it possible to preserve food and this changed the life-style of “eating when hungry and discarding the rest”. Surely this made life more stable. On the other hand, pottery artifacts with ventilated holes were used as cooking utensils and they were usually made of sandy clay and therefore resisted cracking, due to their high heat conductivity. It can be seen from this that the methods of cooking food became more sophisticated, step by step. A variety of cooking methods were associated with differing shapes of pottery and cooking-ware. It is commonly believed that the pottery artifacts, about nine-thousand years old, unearthed in areas like Fairy Cave in Dayuan, Wannian County of Jiangxi Province, and Zhenpiyan in Guilin, are the earliest of their kind. Recently a possible earlier site has been discovered. During the Neolithic Age, pottery artifacts were quite common. Five hundred-thousand pieces were unearthed in Banpo Site — most of them for cooking, eating, preserving and containing water. In sites like Peiligang, Yangshao, Hemudu and others, a variety of pottery utensils were discovered: pots, kettles, dings (vessels), stoves, bowls, dishes, cups, bottles, basins and so on. A triangular-shaped stone knife used to cut up large pieces of meat for cooking was also found on a board. A pottery zeng (an ancient Chinese steamer), unearthed in Miaodigou, Shangxi Province, had tiny holes at the bottom and was used for cooking food. Cooking utensils like the ding, li and jia (all types of ancient Chinese vessels) occurred in especially large numbers and were used to erect cookers. Checks on Ancient Classics (古史考) said that “the Yellow Emperor made kettles and zeng and cooked grain into rice and porridge”. The development of the Chinese culture of cooking was basically contributed to by cooked food and pottery artifacts. Containers used for cooking, serving and preserving food made the absorption of nutrition more thorough, and also reduced pollution.

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8. The Culture of Dietary Hygiene and Its Influence on Other Things The dietary change of primitive humans was also significant for nutrition and hygiene. Primitive agriculture in China originated about 10,000 years ago. The Chinese people usually call proso millet (黍), millet (稷), wheat (麦), bean (菽) and sesame (麻) the five cereals; and together with rice (谷), the six cereals. These are still the main food for the Chinese. These foods contain much vegetable protein but little animal protein, and they have deeply influenced the Chinese constitution, physique — even their endurance, intelligence and facial shape (chewing affects the facial shape), etc. Originating on the loess plateau area in the Northwest, millet and proso millet were the main food of the northerner. Rice was believed to originate in the north of Thailand, India, etc. However, the discovery of wild rice in Jiangxi, Yunnan and much unearthed rice, rice husk and rice straw at the Hemudu site, in recent years, all prove that rice undoubtedly originated in China. Today, rice is still the main food of the Southerner. It is said in Mo-zi – The Wrong (墨子·辞过) that: “The people in ancient times did not know how to make food, they only ate vegetables and lived singly. So the sages taught them to grow crops to supply food for increasing qi and supplement weakness, strengthen the body and satisfy the stomach.” Being digestible and nourishing, rice could increase qi, supplement weakness, and satisfy the stomach, but it was not enough to strengthen the body. Vegetables played an important role as a subsidiary food. From wild vegetables and fruits to “plantable cereal and vegetables,” there are more than twenty kinds mentioned in The Book of Songs (诗经), including melon, pepo, leek, cluster mallow, turnip, celery, cress. Seeds of mustard were found in Banpo; coix seed and bottle gourd in Hemudu. Some seeds of plants, e.g. broad bean, sesame, musk melon, etc. were also unearthed in sites of late primitive society in the South. Peach, tangerine (originating in China), kiwi, etc. and all those above supplied enough vitamins for the people. Animal protein was obtained by hunting, fishing and the raising of the “six domestic animals” — pig, cattle, horse, chicken, duck and dog. Pig bones are most prevalent, which evidences that meat has been mainly porcine since ancient times. But there was no large-scale cultivation of domestic animals for meat. From harvesting the nests of the wild bee to raising domestic bees, the Southerner could eat bee pupa and honey very long ago, and these are very nutritive.

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Seasoning included the salty, spicy, bitter, sweet and sour (five kinds), which became the sour, bitter, sweet, acrid and salty (five tastes). The salty taste comes from salt, the others from cereal, fruit and vegetable. Salt is an indispensable inorganic mineral for the body. People around the sea used salt from the sea while those inland used rock salt and well salt. The Generation Records (世本) says that “Susha’s people boiled sea water to make salt.” It is said in the Huai Nan Tzu (淮南子) that “The people of Susha rebelled against their ruler and submitted to Shennong,” from which we can learn that Susha was a tribe. The Great History (路史) notes that, “There is a salt ancestor’s temple ten miles southeast of An’ County today. Lu Chen said Susha is the god making salt and ‘salt ancestor’ is an honorific title for him.” It is said in the Shantang Sikao that, “A people named Susha boiled sea water to make salt, whose color was blue-green, red, white, black and purple.” From all the above, we know salt-making began very early. A Book about Royalty – On Fate (尚书·说命) says, “Salty or sour seasoning is the key to a delicious soup!” It is said in the Nei Jing (内经) that: “In the Eastern area there are many varieties of fish and salt. At the seaside, the people live peacefully and eat fish and like the salty taste.” From this we know that people knew about seasoning with salt long ago. Along with salt being taken, so was sodium (Na+). The earliest method of making salt is said to be splashing salty water on burning charcoal so that the salt would be crystallized, although its production was limited. The health of drinking water was recognised by the invention of the well. The Book of Changes (易经) says, “The Yi (county) can be changed but not the well.” “It is noted that the people in ancient times dug into the ground to draw out water with a bottle, which was called a well.” Huai Nan Tzu (淮南子) says, “Boyi made a well and was enthroned.” Boyi lived in the time of Yao and Shun. But in reality, the well was created earlier. Wells can be seen in the primitive culture of the north in Jiangou village of Handan City in Hebei Province and in the Longshan Culture in Luoyang, Tangyin etc. It is believed that these wells were shallow and could not be used for irrigation. Many broken drawing-pots found at the bottom of these wells suggest they were used for supplying drinking water. Some wells earlier than the Northern Culture were found in primitive sites to the south of the Yangtze River, for instance, Hemudu, Songze, Liangzhu. They are all lined with a wooded shelf shaped like a “井”. Shaped like a barrel, Liangzhu’s shelf consists of a few planks, each one with a hole in the middle. In a pool stands a well, which is believed to be for drawing water when the pool dries up. But anyway, the water from the well, especially after it had been percolated, was cleaner and healthier.

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Along with cooking with crockery, drinking boiled water became possible. It isn’t actually recorded when the Chinese began to drink boiled water, one of their unique and healthy traditions. Many unearthed pots, pottery cups, bowls, etc. can be seen as drinking utensils. Drinking boiled water further developed into the drinking of tea. The Book of Tea (茶经) by Lu Yu in the Tang Dynasty says that, “Tea drinking began from Shennong, being popularized in the period of Zhou Lugong”. There is another saying that, “Shennong tasted a variety of herbs daily and he met seventy-two poisons — but they were all detoxified by tea.” Today people speak highly of “tea culture” and tea’s functions, which include sterilization, detoxification, relieving diarrhea, cleansing the stomach and bowels and having an anti-cancer effect. Undoubtedly, drinking tea began very long ago, though not from Shennong. The saying “drinking tea developed from drinking boiled water” is tenable, beginning in late primitive times. Drinking wine was also hygienic, at least at the beginning. Alcohol not only has the function of disinfection and sterilization, but also can excite the mind and strengthen the body. Wine at an early stage of its development was low-alcohol, so it is generally thought that the earliest wine was fruit wine, made from wild fruit containing sugar after spontaneous fermentation. At first the ancient people found it accidently — later they brewed wine purposely. Dr. Joseph Needham believes that the earliest wine made by Chinese was beer.47 The wine that he refers to is the wine made from grain. It is believed that Assyrians (about two-thousand years ago) was the earliest nation to make wine with barley. A set of wine-making utensils and many brewing and drinking utensils were found in the early primitive ruins about ten miles north of Ju County, Shandong Province in 1987, from which we can infer that Chinese could make wine as early as three-thousand years ago, during the New Stone Age. Some further conclude that the Chinese culture of drinking possibly dates back to the Cishan Culture, more than 5000 years ago.48 This brewing technology was seemingly wine-making out of grain. The Wine Prohibition (酒诰) written by Jiang Tong in the Jin Dynasty says, “Wine originated from the ancient emperors (including Fu Xi, Shen Nong, and Sui-jen Shih)… leftovers of cooked rice were put in the area of mulberry trees and then together with leaven, acquired a good flavor and smell which was the beginning of natural wine and not artificial.” This text clearly points 47

 Robert Temple. China: Land of Discovery and Invention, Multimedia Publication (UK) 1986, p.77. 48  A History of Chinese Civilization, p.258.

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out that people discovered the brewing process of rice-wine and then learnt from there. There might be some substance acting as leavening in the mulberry. The European Hop Flower used today also belongs to the category of moraceae. It is recorded that the racial minorities chewed rice to make wine in The Book of Wei (魏书), The Book of Sui (隋书), The Geography of Ming Dynasty (大明一统志), etc. It is also described in detail in Travelling Notes of Taiwan (稗海纪游) and Chorography of Taiwan (台湾纪略) that the Gaoshan nationality in Taiwan chewed rice to make wine. It goes as following, “Get men and women, old and young together to chew rice and then put it in a section of thick bamboo — it will become wine after a few days. Add clear spring water before drinking it.” “People like drinking, they take rice in the mouth to chew and then put it into a bamboo holder. After a few days, wine is made. When there is a guest, they must taste the wine before entertaining the guest.” This method uses salivary amylase as leaven, but there were other materials used in the Stone Age. There is the inscription of the words “chang, the wine” found on tortoise shells during the Shang Dynasty. Baihu General Sense (白虎通义) explains that “chang, the wine” means wine brewed and flavored with hundreds of grasses and tulips — from which we know that fragrant herbs were used as materials for fermentation. The Nei Jing (内经) stresses the medicinal function of wine. There is a saying “The sages in ancient times made laoli.” Laoli is a kind of rice wine. The making of rice wine using smartweed flower to ferment it is now still popular in southern rural areas. We don’t know whether the word “lao” in the ancient term “laoli” is related to “liao” (smartweed).49 Making wine with distiller’s yeast was also a great invention of the Chinese. A Book about Royalty – On Fate (尚书·说命) says, “Only using yeast, can one make wine.” At first, wine might be made for enjoyment, or for relieving grief. For instance, a Prime Minister during the Han Dynasty says in Cao Cao’s poem: “While greatly impassioned, great grief and brooding are never 49

 Some believe that “lao” is mellow wine and “li” is rice wine, which personally I doubt. See A Book on Geography of Wu and Yue (吴越山海经) by Zhong Weijin (Shanghai People Publishing House, 1990). The article on Dayu and Rice Wine records that the earliest wine was rice wine made by Yidi. He accidently put the flower of Polygonum hydropiper L. onto glutinous rice, which became wine after a few days. According to this, we know that both lao and li are rice wine. Under the item of polygonum in Compendium of Materia Medica, there is a saying, “People use its juice to make distiller’s yeast.” Making wine with polygonum has a long history.

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forgotten; what can relieve it? Only drinking Dukang.” Or it may be used for strengthening the body, or dispelling cold and avoiding the damp, or for treating illness. Every one of these incidences has a hygienic inference. Since this age, Chinese medicine sees wine as the oldest and most important medicine, as can be seen in Neijing: “Even a serious illness can be cured with wine after a hundred days,” and also the word yi (醫) meaning ‘medicine’ is also made with the radical “酉” (wine). Who on earth did make wine? It does not matter.

9.  The Culture of Hygiene in Clothing Clothing is not only cultural but also a token of hygiene for humankind. Since the evolution of ape to human, people without fur have to face the challenge of the cold. A Book of Rituals – Rituals Development (礼记·礼运) says, “There was no flax or silk but the plumes and fur of animals were used as clothing,” from which we know primitive man used the plumes and fur of animals to keep warm. But “only covering the front,” as written in Baihu General Sense (白虎通义), these clothes could not solve this problem very well. A caveman’s bone needle could enable sewing during the Upper Cave Man era and a bone awl unearthed in Huangshanxi, Ziyang County in Sichuan could sew hides. People could make presentable furs for themselves. From ethnodynamics, we presume people might have used hardened wooden or bamboo needles earlier, such as the Ewenki nationality using wooded needles, the Derung nationality using bamboo needles. At first people wrapped a large hide around the body, later they made a few holes in the hide, or put together a few smaller hides to make clothes. During the earliest times, people wore skirts made from hide, or tree leaves, which developed into pants, viz. shang. The saying in the Changes of Zhou – Attributed Sayings (易·系辞) is that “Huangdi, Yao and Shun showed clothes to the people with reverence and the world was well ruled.” This shows that clothes played an ever important role in the course of civilization. From textile technology, peoples might well learn the braiding of reed mats, the fishing net and basket made with the tegument of kudzu vine and ramie bark. Relics of kudzu cloth were found at Straw Sandal Mountain Site, a potter’s wheel at Dadiwan, a wooden wheel and a bone shuttle at Hemudu. Seeds of flax at Dahecun Remains prove that the people of that time could plant flax and weave clothes. This agrees with the saying in the Han Feizi – Five Vermins (韩非子·五蠹) “fur coat in winter and kudzu clothes in summer.” The north and the south of China also produced silk. It

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is said that Lei Zu, the wife of Huangdi and daughter of Xi Ling Shi invented sericulture. Archaeological discoveries such as the silkworm pupa of Yangshao Culture in Ruicheng town in Shanxi Province and a half-cut cocoon in Xia County, Shanxi Province prove that sericulture appeared even earlier. Sericulture and silk weaving in Liangzhu Culture have improved greatly. While the clothes in the north were mainly for keeping out the cold, the clothes in the south were mainly for protection from mosquitoes. The ornamentation of clothes was not much stressed. It is said in Mo-zi – The Wrong (墨子·辞过) that, “ The ancients didn’t know how to make clothes, so they wore hides and wrapped around straw ropes, which were neither light nor warm in winter, neither light nor cool in summer. The Sage King thought that this did not accord with the aspirations of human nature, so he taught women to treat silk and flax and weave cloth to make clothes for people. They made underclothes with silk linen for winter and with fine kudzu cloth for summer. The former were light and warm; the latter were light and cool, but not much more. The sage made clothes for comfort and to protect the body, not for the enjoyment of the eyes or extravagant display.” The function of sanitation and protection was much more important than ornamentation. It was hot in the south. The skirt was cool and more convenient, especially for people working under the sun, so it was used over long periods. In the north, people wore “Hu dress for horsemanship and archery” during the period of King Zhao Wuling of the Warring States. People in the South wore short skirts “for wading, clothes with short sleeves for rowing boat, both for convenience”, as is written in the Huai Nan Tzu – Teaching Dao (淮南子·原道训). It is said that the miniskirt was still the main dress in the Jin Dynasty, which is not in accord with the saying “Huangdi displayed clothing and trousers with reverence”. Maybe there were skirts and trousers at the same time, whichever was popular. That was proven by Goujian, the King of Yue in Zhejiang and Sima Xiangru in Sichuan both wearing dubi pants. Man didn’t wear skirts any more in Sui Dynasty. Being cool to wear and keeping away mosquitoes and flies, skirts were good in the south. We presume that there were coir raincoats in primitive society, which later developed into rain gear made from silkworm cocoons and oiled paper, and wooden implements such as clogs, rain-shoes, etc. Today the bamboo leaf hat and coir raincoat are still seen keeping off rain and wind in southern villages. They have the value of being naturally healthy. Originally people wore horns as a hat on the head to beguile animals, when out hunting. The Origin Of Things (事物纪原) says: “The hat

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appeared in ancient times”. On Ancient Laws and Regulations (通典) mentions: “In ancient times people dressed and wore fur as their apparel and made hats — later the sage learnt from the crests of birds and horns of beasts and they made formal hats. Huangdi started to make clothes and hats from cloth and silk.” Hats had the function of sanitation and keeping warm. The Yunnan Records – Barbarian Customs (云南志略·诸夷风俗) says, “The Ancient Liao used birch bark as a hat,” which might mean a rain hat. Baihu General Sense (白虎通) says, “The hat is a headband to band up the hair,” meaning it is being used for banding up the hair and keeping it tidy. From this we can presume that many unearthed bone ji’s and zan’s (both are hairpins) could keep the hair tidy, as well as act as embellishment. We can further presume that they often shampooed and took a bath to keep themselves clean. No matter what they were used for, combing or embellishment, the beautiful hollowed-out four-whirling-stria ivory combs unearthed at Dawenkou Site could in no way have belonged to a scruffy and unkempt person. Many artifacts such as clay pots were probably used for washing. Bare feet are easily hurt and bitten by snakes and insects, so shoes were important in sanitation. Firstly they were of hide, then they used the foot binding cloth and straw sandals, finally this developed into socks and shoes. The saying in Generation Records (世本) is that, “Yuze, a minister of Huangdi, made fei shoes, out of leather.” The Book of Songs (诗经) says, “Wearing shoes made of kudzu vine, people can step on frost,” from which we can understand their obvious function of keeping the feet warm. As a symbol or totem, tattooing could help people avoid evil spirits and keep them from hurting, though this was not clothing. The History of Later Han Dynasty – On Southern Barbarian (后汉书·南蛮传) says, “The Ailao people tattooed their bodies, in shapes as dragons.” Ornamenting clothing with flower designs might be derived from tattooing.

10.  Primitive Dance, Music and Sports Primitive sports such as running, jumping, riding, martial arts, throwing, wrestling, climbing, shooting, Wushu (martial arts), skiing, rowing, swimming, developed from foraging, hunting, fishing, etc. This was good for physical and mental health. Ethnography proves that some minorities have their own special festive sports up to the present day, whose function is of strengthening the body and obtaining more energy — so this is not difficult to understand. But obviously sports were not created for strengthening the body initially.

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Sports were also connected to dance. Besides their use in the rituals such as making the sacrifice, dance also could amuse the body and mind. The Spring and Autumn Annals of Wu and Yue (吴越春秋) records that in the prehistoric era “There were torrents — the four rivers and other rivers in China were blocked, and everything on the earth was flooded in the prehistoric age.” It was difficult to survive a great calamity, if the people did not exercise. The survivors also used sports and dance to dispel the damage done to the body and the soul by the calamity. What is said in Mister Lu’s Spring and Autumn Annals (吕氏春秋) is factually correct, “The Yin qi has stagnated and accumulated since the beginning of Tao Tang-shi. The waterways are all blocked and water departed from its way. Depressed and stagnated qi leads to infirm bones and muscles, so the people danced to free up the stagnant qi.” The Great History (路史) also says, “During Yin Kang-shi’s times, the waters did not flow and the rivers departed from their usual routes. Stagnant yin qi leads easily to depression. If it stagnates in the striae and interstitial spaces of the skin and muscle, it causes swellings and heaviness of the body. For benefiting the action of the joints, a dance was created and taught to people, to strengthen their joints; this was the Great Dance.” Daoyin arts followed after this, such as Hua Tuo’s five-animal exercises, bear climbing and bird stretching — all dances performed to imitate animals. Dance, music and sports can please people psychologically and physically; they can dispel grief and vexation, create comfort and make people wholesome. The battling dance from the petrogram on the Huashan Mountain spirits away the dancer and audience; the celebratory dance from Yin Mountain’s petrogram and the rigadoon from Wulanchabu’s petrogram all make the people carefree and happy! Singing may originate from work-songs or folk-songs, imitating the sounds of the hills and valleys to express emotions such as sadness, compassion and happiness. The oldest song is Fuxi’s Jia Bian, which is referred to in the saying “Fu Xi made a Se (a twenty-five-stringed plucked instrument, somewhat similar to the zither) and composed the song Jia Bian (驾辩)” from The Songs of Chu (楚辞) annotated by Wang Yi in Eastern Han Dynasty. Xingtian during the time of the Yan Emperor composed the Xia Mou (下谋) to extol the plowing and harvest. Kui wrote the Xiaoshao (箫韶), which was heard by Confucius even 2,000 years later. Confucius was so moved that he said he even forgot the delicious taste of meat for three months. Bafeng (the “Eight Winds”) in Mister Lu’s Spring and Autumn Annals (吕氏春秋) also belongs to dance music. The Book of Songs is the

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record of the ancient folk songs in China. There are even some earlier records. Poems express a poet’s ambition; thoughts are innocent. They are both acts of mental health. Unearthed musical instruments include pottery chimes, pottery bells, ring balls, pottery xuns, bone flutes, etc. What is particularly impressive is that playing the sixteen heptachord bone flutes unearthed from Wu Yang County of Henan Province, still makes an accurate, pleasing sound: they can even make a tune today. From all these, we know the range, tone quality and rhythm at that time was rich enough to express great happiness and great sadness.

11.  “Cannibalism” and Funeral Sanitation As mentioned earlier, cannibalism perhaps still remained during the time of Peking Man. Eating humans is itself against sanitation. But if a human was threatened by hunger or death due to food shortage and had to do it, cannibalism might be a “chivalrous deed”. Engels said: “Eating humans, even eating one’s parents, was a phase during the development of all peoples.” “Food supply was difficult to guarantee sometimes, so cannibalism happened and remained over a very long period.”50 According to a study of foreign anthropologists, the evidence for cannibalism is not difficult to see. Cannibalism can be observed in some tribes even in recent years. A market in human flesh was even found in Africa several decades ago.51 Cannibalism due to famine is also recorded in Chinese history. It was said in Bai Juyi’s poem (Tang Dynasty) that: “A disastrous drought happened to the south of the River that year, and hunger drove the people in Quzhou to eat themselves!” Cannibalism as an individual phenomenon also happened among modern anthropoids. Jane Goodall witnessed three new-born chimpanzees eaten by another group of chimpanzees. She also saw two groups of chimpanzees struggling until one group were dead — but they were not eaten by the winners.52 Animals do not in general eat their own kind. Non-famine cannibalism may be a morbid sign of disease. The number of the skulls found of Peking Man is in disproportion to that of other bones. The former are more and the latter less. Skulls like scoops occur more than other skulls, which is believed to be the result of 50

 Engels. The Origin of Family, Private Ownership and Nation, People’s Publishing House, 1972, p.18. 51  The History of China’s Primitive Society, Cultural Site Press, 1983, p.361. 52  Society of the Ape, p.9.

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them being used as containers.53 Song Zhao-lin, quoting from a secondary source says, “The Tibetan nationality, and Naxi nationality still used the skull as bowl until not long ago. ‘There was a cannibalistic nation in the ancient era, where the first-born son was killed and eaten. It was believed that eating him would be good for his brothers born later. If the flesh tasted good, it would be sent to the ruler. If the ruler liked it, he would give it to his father.’ In the legends of the Yao nationality, there was a cannibalism stage, then people changed to eating beef, which corresponds to the development of production capability.”54 Besides production capability, cultural customs were another important factor in cannibalism. Primitive man did not regard life as sacred as we do today; they did not know even how much difference there was between life and death. Peking Man had no funeral; Upper Cave Man buried bodies in the earth. Burial is popular in China and has its own origin. It is much more hygienic than leaving the body in a wild field. Burial grounds in matriarchal societies were centralized in one place and separate from the living area, which was more hygienic, but coffins were not found. Only in Banpo Site was a baby’s body put in an urn. This was not a conscious activity, but it could prevent the stench escaping and bacteria spreading. Coffins after that had the same hygienic significance. Certainly, the funeral itself had more cultural significance. Being buried alive with the dead was found in many places from Dawenkou Site onwards. Like cannibalism, it was also unsanitary. It was not due to famine, but more to primitive worship, and primitive belief, etc. They did not really understand life’s real implication — they trusted that death follows life or believed that death is only another form of life. From the above, we know that primitive peoples in China have more than 1,700,000 years of history. Compared to this, human literate civilization is only few-thousand years old. After surviving the glaciers and experiencing all kinds of hardships and destitution, they finally settled down in a much better eco-friendly environment. They were able to lay the foundation for a brilliant and splendid culture. Their constitution evolved over a long period and enabled them to adapt to their environment, to carry on a tenacious struggle to preserve life, using natural water and fire, and developing fishing, hunting, agriculture and grazing to defend themselves and provide the basic necessities of life, such as clothing, food, and shelter. With 53

 Jia Lanpo. Cannibalism in Remote Antiquity, Fossil, No.1, 1979.  Song Zhao-lin, et al. The history of Chinese Primitive Society, p.361.

54

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these results they were provided with a preliminary culture and condition of hygiene. Illness and injury would always strike, and even engulf their lives. But they fought back, by instinct. However, mainly due to having a natural constitution, they survived by following their natural options. This was not a real triumph over illness. But then, after a very long time, conscious sanitation and medicine began to emerge.

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Primitive Thought, Worship and Medical Culture During primitive times, humans were dominated by primitive thought and primitive worship became the earliest mode of culture. Myths and legends together with artistic images survive from ancient times, and today’s folk customs along with investigations of aboriginal peoples, have given us rich information connected to these ancient times, which can boost our introspection and speculation on medical culture.

A.  Primitive Thought and Medical Culture According to the science of modern thinking, modes of thought can be divided into: imaginative — such as that of a writer or an artist, logical — which is the major style of theoretical thinking, and intuitive — insight, for instance. “Primitive thought” here is somewhat different to the so-called “primitive thought” referred to by sociologists and anthropologists in general, and is being used to refer to the major thinking mode of the primitive human. The study of “primitive thinking” by sociologists and anthropologists can be valuable for revealing particular features of primitive or “wild” thinking — specifically pre-logical thinking, collective representation and mystic permeation etc. — but such studies seem to leave the impression that this was the only thinking mode that primitive humans had, despite their acknowledgement that some primitive thinking can still be found in modern man. Lucien Levy-Bruhl in his book Primitive Mentality devoted much space to discussing the pre-logical thinking of the primitive and said, “there do exist two thinking modes in humans, not completely separate — one is pre-logical thinking and the other — logical thinking. However, it is a common, and probably a from-beginning-to-end thing for the co-existence of 47

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different thinking structures in one conscience.”1 Such an opinion was also held by Claude Lévi-Strauss, another famous French anthropologist, who said in his book The Savage Mind, “Early humans in history were successors to a long scientific tradition….there were two different modes of scientific thinking, both of which function simultaneously, of course not at different stages of the so-called development of the human mind, but on two strategic planes of scientific research into nature respectively — the one roughly corresponding towards, and the other away from perception and imagination. It seems that both can lead to the essential scientific connections between objects either in the New Stone Age or in the modern age with one way close to perceptual intuition and the other far away from it.”2 Both these writings, however, cannot cover up the fact that these anthropologists kept silent on the matter of whether Homo sapiens had logical thought or not. Thus the concept of “primitive thinking” in this book differs from that which is discussed in their writings. It should be made clear that the author by no means disagrees on the general use of the term “primitive thinking” to refer to collective representation, mystical permeation, animism etc., — all of which characterize pre-logical thought. He believes that such modes were a major feature of early human thought.

12.  The “Collective Unconsciousness” and Mysterious Feelings What kind of scene, can we imagine, when Homo sapiens first began to look at the surrounding world different to the animals — just after they separated and moved down from trees to the earth? Faced with a complete chaos, without doubt they had no idea about their own self or surroundings. Such big issues as life and death, which ran their utterly natural course, didn’t affect them. In a word, life had no value. These people had no individuality, no independent cognition of the world. Their thinking still featured collectivity with a tendency to follow and conform, and was mainly emotional as a kind of consciousness of motion. Such features corresponded to the activity patterns and simple thinking mode of their near kin — the orangutans, 1

 Ding Youzhi, Primitive Mentality, The Commercial Press, 1985. Lucien Levy-Bruhl, the author of How Natives Think (1926), Primitive Mentality, The “Soul” of the Primitive (1928) etc., whose preface to Primitive Mentality in the Soviet Union in 1930 was a compilation of the above three works. This was the basis for Ding’s 1980 translation published by Commercial Press in 1985. 2  The Savage Mind, translated into Chinese by Li Youzheng and published by The Commercial Press in 1987.

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and to the primitive constitutional features of human beings and their gregarious lifestyle. This type of thinking, characterized by a collective unconsciousness and feelings of mystery, was named a “collective representative idea” and defined by Lucien Levy-Bruhl to be a mental phenomenon shared by all members of the social group, and passed on, generation to generation — so much so that it left a deep imprint on every one of them. In different circumstances it could cause every gregarious member to feel respect, dread or worship to a relative object. Yet the existence of a collective representation did not depend on every individual, and hence its characteristics cannot be explained through research on individuals; no logical feature can be discovered; the feelings of Homo sapiens were mysterious but real, etc.3 The author agrees with this opinion. This earliest type of human thinking marks an unprecedented progress compared with non-thinking in the animal realm. Suppose, in a primeval forest, there was a habitation isolated from the human world for more than two thousand years. One day these people suddenly “come into the world”. Their first feelings must have been fear and mystery, sweeping the whole community — much as if they had confronted the cars, trains and planes of modern civilization. Such a fear and mystery would have been kept down for long, as part of their collective representation, if they had not been able to get involved in the modern world without proper guidance and instruction. In a similar way, it can be speculated that Homo sapiens, opening his eyes to the world, must have had the same feelings of strangeness, mystery and fear — just like those primitive forest people at their first sight of planes in the sky: a mysterious sense of reality. The perceptional difference between primitive and modern man is probably similar to that between the subconscious and conscious. Its core is the quality of being mysterious and strange — mysterious because of being strange. The mystery of some particular object or matter is first sensed by one or two — but it infects everybody. Thus it becomes collective behavior. Over the years, it could grow into a common feeling or behavior — for instance, a sense of respect, fear or worship, passed down from generation to generation. The phenomena of people believing in superstitions, devoutly worshipping gods, etc., in civilized society, cannot escape the speculative and collective representative ideas of primitive humans and the history of their psychological formation. There are typical cases in the Western history of medicine like the “laying on of hands” during the Middle Ages recorded 3

 Primitive Mentality, p.5 & p.25.

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in the history of Western medicine,4 as the king being asked to lay his hand on the head or neck of patients, with his mouth muttering, “I touch you and God heal you”; also mass panic, mass hysteria and mass frenzy,5 for instance, occurrences of “self-flagellation” and madly-unstoppable dancing; as well as the appearance of a “Children’s Crusade” in France and Germany in 1212, when thousands of children believed in the ravings of a nine-yearold boy and wanted to be Christ’s guards — some of whom ended up being sold into slavery while the rest were starved or frozen to death in the Alps. Lately an example of “collective representation” and emotional and flexible, unconscious behavior along with contagious mysterious feeling has been seen in some who practice modern qigong, after they have became totally obsessed with the moves made as a group, following the qigong instructions. Such a contagious permeation between humans suggests quite naturally the idea of a permeation between objects, as well as between humans and objects, i.e. the transference of properties. This is what Lucien Levy-Bruhl proposed in “the law of mutual permeation”, although he did not state how mystic permeation arose in ancient people. However, the author believes that the transmission of information between humans led him mistakenly to the idea that there was a similar transference between everything. The examples Lucien Levy-Bruhl used, some of which were quoted from The Religious System of China by J J M de Groot, can partly provide a key — although some were mistakenly used or quoted. For example, the idea of a “portrait-man” (a portrait turning into a living person), the ability to conceive and give birth of young widows if they live together with the mud statue of their dead husband, the custom of presenting paper-made animals and burning paper money when attending a funeral or visiting the graves of the dead, and so on. These were relics of mystical permeation and collective representation in primitive thinking. These even lingered into modern times. In the past, some of the elders of the country, including Empress Dowager Cixi refused to have their photo taken, as they thought that the soul would be gripped and transferred away to others. In presentday Xi’an, paper notes released by Orcus Bank can be found on the black-market as people believe the dead still need money underground. Actually paper money has quite a long history, traceable back to the 4

 See Gerhard Venzmer. Five Thousand Years of Medicine, Macdonald, London, pp. 1972, pp. 105, 249. Translated by Ma Boying translated in Chinese. World Medical History of Five Thousand Years, People’s Medical Publishing House, 1984, pp. 51, 134 5  ibid. Five Thousant Years of Medicine, p.130. World Medical History of Five Thousand Years, p.66

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Ting Yu Congtan (听雨丛谈) written by Fuge during the Qing dynasty. In this compilation he records that “people in the capital cut yellow paper into the shapes of coins to replace cotton and silk to burn for the gods; and when visiting the graves of the dead, they cut white paper into coins three or four cun6 in diameter to take the place of funerary objects. However such paper coins were not used in temples. The records in Tang Lin’s Ming Bao Ji (冥报记), state that ‘they made paper in the shape of coins to take the place of money to be sacrifices to gods and ghosts’, which indicates that paper money had been in existence since Tang.” All these primitive collective representations have something in common — that “the image can take on the status as well as the properties of the prototype”, while the dead under the ground keep their status and properties just as when they were alive. According to one of the folk customs in Shanxi province, wax-made boy-figures, played with in the water during the Double Seventh Festival (Chinese Valentine’s Day), can make women give birth to a boy, which is called “Huasheng”. In this case, the properties of the boy-figures were thought to be transferred in a mystical way. Portraits and figures bear the symbol of, or function as a intermediary for the inherent properties of all living things, just by the perspective of primitive thought, and it is the same even for names. In the rural countryside, people have a custom of naming children “doggy”, “kitty” etc., putting on old clothes immediately after the baby is born and placing it in the doghouse hoping the new-born will feed easily and grow up healthy, just like the dog or cat. This is because they believe that such names carry the property of strong vitality, and transfer it from the dog or cat to the child. In Lucien Levy-Bruhl’s research, this kind of thinking is called ‘mystical thinking’ from the perspective of its contents or pre-logical thinking, taking its relevance into account. He points out that pre-logical thinking is neither anti-logical nor illogical, and can never be temporally perceived as a stage preceding logical thinking7 — as it is essentially compliant with “the law of mutual permeation”. The law of mutual permeation initially reflects the existence of a relationship between individuals who together make up the whole collective society — which is itself considered and perceived simultaneously as a kind of mutual permeation, a kind of set of relationships, or several mutual permeations and relationships. Among differing objects, and between different objects and people, there exists a certain kind of natural and mystical 6

 A cun is a unit of length in China, equal to 1/3 of a decimeter.  Primitive Mentality, p.71.

7

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relationship — through which, one thing possesses the properties of another. This is what is meant by “mutual permeation”, or “me-in-you and you-in-me”, or even “I-am-you and you-are-me” or else some third party. In some Australian aboriginal tribes, the Barbaram tribe insist on them being macaws and macaws being them; the Talandiji proclaim that they are water-dwelling aquatilia; the Aranda people believe that every single individual is the direct embodiment of their ancestor or else a small part elf or fairy, living among the animals. All these ideas suggest the mutually-permeating and inter-connecting. Chinese Emperors were considered to be the sons of Heaven, the embodiments of dragons, and dragons themselves — just as the Chinese themselves, being descendants of dragons, mutually inter-connect with dragons. The story of Lord Ye who professed to love dragons (if its allegorical meaning is cast aside) can be counter-evidence for this point — because when Lord Ye unconsciously considered himself to be a dragon, it was done out of the law of mutual permeation. Therefore whatever was painted on his walls or carved on his furniture was all dragons to him. However, when the “real dragon” came to pay him a visit, his mutuallypermeated unconscious collapsed and the truth that he was not a dragon was revealed and it frightened him. Pre-logical thinking does not consider any contradictions because mutual permeation comes above everything else, which explains Lord Ye’s unconscious behavior. But when his logical thinking came first — when he “woke up” — the law of contradiction drove mutual permeation away. So how could Lord Ye avoid trembling when the real dragon appeared? In addition, Chinese ancestral tablets initially served as something like a Churinga8 and later turned into a symbol for the ritual of ancestor-worship. These tablets were attachments for an individual’s in vitro soul; that is, they become an intermediary for the ancestor and were probably considered as the ancestor himself or herself. Dominated by the law of mutual permeation, causal associations between things and phenomena become mystical, accidental and individualistic; then they evolve into the ordinary and overall. This purely came about by the transference of properties. Such transference was achieved by various kinds of means, such as teaching, touching, distance-working, infecting, profaning, colonizing and so on, and it is needless to search for any further internal association through logic. 8

 Primitive Mentality, p.87. The use of the Churinga occurs in Aranda’s myth which is used by Lucien Levy-Bruhl to analyze the mutual permeation of pre-logical thinking.

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The myth of Sui Ren Shi’s “drilling-wood-to-make-fire” is further evidence of mutual permeation. People in the Sui Ming kingdom knew neither the seasons, nor day and night. In the country there was a fire tree named Suimu which covered an area as broad as ten-thousand qing (a Chinese unit of area, equals to 6.6667 hectares ) with its branches twisted and twined up. Then there came a sage who wandered into this kingdom which the sun and the moon could not reach. Resting under the giant tree. there were owl-like birds pecking the tree. The firelight sparking at each pecking enlightened the sage — who then tried to drill into a branch with a small twig. Fire was made. Thus the sage was called Sui Ren (燧人).9 The Ren Zi Nian Shi Yi Ji, quoted by Volume 869 in the Tai Ping Yu Lan (太平 御览) recorded this in more detail: “Once upon a time there was a kingdom named Sui Ming where the people knew neither the seasons, nor day and night. These people were immortal and when they got tired of living they went to heaven. In the country there was a fire tree named Suimu which covered as broad as ten thousand qing with its branches twisted and clouds twined within. The tree’s branches could be used to make fire if drilled. Later a sage, who wanted to make efforts to change the habit of eating fetid or raw food so as to save the world, wandered alone till the southern frontier where the sun and the moon could not reach. When he saw sparks were made by an owl-like bird pecking the tree, he was then enlightened by the branch drilling the tree and made fire. Thus he was called Sui Ren Shi.” This myth is probably associated with the later sun-firebird totem worship. What is to be stressed here is the enlightenment of the sage — which has something in common with the habit of Jaluit people in Claude Lévi-Strauss’s The Savage Mind who were accustomed to touch the beak of wood-peckers in order to cure the toothache. What can be seen is that it is not because the ancient people understood by their logic the heat-generating-friction principle of rubbing-wood-to-make-fire; nor did they know that trees can avoid disease because wood-peckers take away the bugs. It is simply because they perceived both that the owl-like birds and the wood-peckers possessed some mystical power which can be mutually permeated through pecking and transferred to trees and teeth and thus could be transferred to man. In the Huai Nan Zi (淮南子), such records as “when Cang Jie (仓颉) created (Chinese) characters, it rained crops and ghosts cried out at night” also reflect the permeation of a mystical power. Another tale described this more clearly, using the analogies of mystical permeation. “Emperor Cang, 9

 Lu Shi quoted from Shi Yi Ji.

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whose clan was Shihuang and name was Jie, with the initial family name Hougang, had a dragon face with uplifted eyebrows and a big mouth, his four eyes sparkling with wisdom. He surely had divine wisdom and virtue, being able to write as soon as he was born. He studied thoroughly the changes of heaven and earth, looked upwards around the twisted orbits of the stars in the sky, and examined below the patterns of tortoise shells, birds’ feathers, rivers and lakes, lines on the palms and fingers and such. Finally as he created the characters, Heaven made it rain crops, ghosts howled in the night and dragons lurked thereafter.”10 This is a similar case to the story of Da Yu (大禹) acquiring the image of Bagua (八卦, Eight Diagrams) and square from Fu Xi. Fu Xi lay down on the ground, and “pointed around his belly button, and drew Eight Diagrams; then he leaned over and twisted his body into the form of a square”. At the sight of Eight Diagrams, Da Yu began to understand not only the four directions of south and east, north and west, but also the heavens and earth, Yin and Yang. Then the square enlightened him on how to measure a river’s width and depth, and how narrow or shallow it was. Then he ran to Kuaiji Mountain and there he began to control the flood.”11 This story seems to explain how knowledge was passed on, but in fact it reveals how Fu Xi, as a sage, put mystically mutual permeation into practice, through his physical movements. Many more typical expressions can be found among folk customs. In the northeast of China, when a woman goes into labour, the midwife will, to her face, modestly open all that can be opened — for instance closets, drawers, doors etc. in the belief that this can help open her pubis and facilitate a smooth delivery. This is called kaifeng (开缝) or “pubis-opening”. Here this former fairy story can be seen as a process of “learning” or imitative mechanism; yet whether the pubis can be opened or not is totally irrelevant to the subject. Furthermore, the view that there are seams linking the pubic bones is typical of the Chinese. In reality, there are no clear seams in the pubic symphysis. Not to mention “opening and closing the pubis”. But in primitive thought, the opening of closets and doors can, in a mystical way, mutually permeate the opening of the pubis in women and result in a smooth delivery. Some folk customs West of Zhejiang Province also demonstrate this. When a child suffers a stomach-ache, the mother will whisk over the belly, 10

 From the Chunqiu Yuanming Bao春秋元命苞, compiled in the Hanxue Tang Congshu 汉学堂丛书 11  Zhong Weijin, Wuyue Shanghaijing, Shanghai People’s Publishing House, 1990, p.23

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counting continuously seven times, from one to seven. On the count of seven, she will immediately throw the sweeper out of the house and shout, “Seven go, go out!”12 Here numbers, together with movements, are mutually permeated by sounds. In another custom, before a baby sucks its first milk, a spoon of coptis root-juice will be fed; and juices of meat, pastries, wine and fish will be used to wet the baby’s lips. All these actions are accompanied by singing good words such as, “taste the bitterness of coptis on the third day after born, then it will have honey in the future every day.” “Have meat and become stout.” “Have pastry and grow tall.” “Drink wine and have happiness, high rank and longevity.” All these demonstrate the mutual permeation of homophonic sounds. In Sichuan Province, when someone has just given birth to a boy, people will give a duck (Yazi, 鸭子 in Chinese) as a gift to the mother’s mother; for the character for duck in Chinese is homophonic to yazi (押子), meaning holding the son away from any misfortune. During the Lantern Festival in Guangzhou province, people will qingdeng (请灯, meaning ‘invite lanterns’) hoping to qingding (请丁) meaning “inviting people” to have more family members. People eat longevity noodles because the character for long noodle in Chinese is “chang mian” (长麺) similar with “chang ming” (长命) meaning long life. All these are affected by an awareness of mystically mutual permeation. In a word, mystical mutual permeation is the most prevalent characteristic of primitive thought — not only for the primitive, but also for modern man. Among primitive people, when they first came into this world, everything was a myth and unfamiliar. Their surroundings combined the contingency of unknown myth, along with stunning fear. Thus they moved in groups, perceived collectively, and emotion and movement became their main mode of communication. Hence mutual permeation became their major way of thought — for emotion and movement themselves are apt to mutual infection and permeation. The people of that time could not differentiate between the accidental and the inevitable, between contradiction and non-contradiction, despite their good memories and keen observation. They did not avoid contradiction or, to be precise, they did not care about contradiction. Without the ability to generalize, or accumulate experience, they preferred to take the relation between the un-real cause and effect as the starting-point for their reasoning. In their minds, everything seemed just the same — and intelligence resided in both living and non-living things. The 12

 The number “seven” in Chinese is homophonic to “出chu” which in “出去chuqu” means going out.

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whole world was full of ambiguity and there was no “this one or that one”. To them, an association between things rested on mystical properties. It only needs a discovery, not a demonstration. In other words, there was no necessity to repeat experiences or to certify different cases, nor was there any necessity to consider the rationality of logical reasoning.

13.  The Concept of “Soul” At an initial stage, collective representation and the law of mutual permeation dominated primitive thought. Myth flooded the whole world and primitive people, who believed in a ubiquitous “intelligence”, tended to take common natural phenomena and natural things as supernatural. In fact, there was no concept of a real ubiquitous “intelligence” — they just felt intuitively. When, during later stages, “intelligence” crystallized out of primitive thinking, it turned out the concept of a “soul”, which was applied to everything, hence the notion of “animism”. Then, whatever frightened primitive people or made them afraid were just a few particularly extraordinary occurrences. Their somewhat everyday feelings had been piled up into experience and only those that could not be explained through such experience would result in the concept of “intelligence”. In some way, the vague concept of animism is an accumulated mystical experience. What primitive people felt strongly was a kind of supernatural mystical power which dominated everything. They began to realize that there was a gap between life and death — and that only the soul was immortal. The soul would attach itself to something and thereafter gave life to it, through transference. During the later Paleolithic, and after, animism began to become fully formed and probably was the main trend of primitive thought. Undoubtedly, this represented an awakening of human nature. Primitive people stepped out of the shadows of collective representation, away from their style of group living, although this was still their major lifestyle. Collective representation still controlled their thinking, but they began eventually to reflect on their independent existence, as individuals. This change might have corresponded with their own physical growth and linguistic differentiation. The physical constitution of Peking Man could only permit very simple languages. When we come to Upper Cave Man, the cranial capacity and structure of the lower jaw is similar to that of modern man; and the linguistic differentiation and degree of manageable complexity, were both improved, which made it easier for them to reflect on their own existence. Such a kind of retrospection must have appeared initially in several

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individuals whose talent excelled. The trigger for these insights agrees with what Tyler believed: “It looks like that people who could think but still were in their lower cultural development stage were deeply interested in two kinds of biological questions: first, what causes the difference between living body and corpse? And what are the causes of soberness, sleeping, dreams, diseases, and deaths? Second, what are those human shapes which appear in dreams and illusions?”13 As for these questions, Tyler believed that primitive people would find their first answers to “life” and “illusion”, and then life and illusion became combined together into one — which gave them the concept of a “soul”. A soul must bear the following features: it must be thin and in a human shape but without substance; it must be like a breath, a thin membrane or shadow; it is the essence of life or thinking which solely controls the conscience and will of an individual; it is separated from the body, either near or faraway, so that it can appear in different places all of a sudden; it is untouchable and beyond sight, but meanwhile it can express itself as some material force which can, taking a similar shape as someone, emerge before them, either in his/her dreams or when they are awake; it can maintain its existence and keep appearing again and again, even after the body has died; it can penetrate into other people, animals or even things, control them and even move about inside them….. There is no need for reticence in holding the view that the formation of the Chinese concept of a soul proceeded in just the same way — and was passed down, generation to generation until the present-day. The cognition of souls by primitive people initially was associated with shadows, breaths, dreams, illusions and so on. The aboriginal peoples of Africa always feared treading on their own shadows, when walking under the sun, because shadows were considered the image of the soul. The Chinese do not fear treading on their shadow under the sun, but it is true that showing your shadow to another was a taboo in ancient China. There is an example in the You Yang Za Zu (酉阳杂俎): “In the year of Baoli (825–826 AD) … it was said that a person’s shadow should be deeply dark which may be elitist but it encouraged longevity ... shadows do not lie on water, a well or bathing-basin. This is also the reason why the ancient Chinese avoided showing their shadow to others. The three animals, the earwig, the Duanhu (a legendary creature like a soft-shelled turtle with three legs), and the Tayinggu (another legendary creature, or worm) can harm people by stepping on their shadows. Lately there have been people who 13

 Tylor, Primitive Culture, 4th ed. London, 1903, p.428.

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cure their patients by roasting their human shadow.” The famous Chinese proverb “han sha she ying” (含沙射影，idiom literally “spitting sand on a shadow”) meant making an insinuation. It is mentioned here as some people are afraid of catching disease after a ghost or evil spirit has sprayed sand onto their shadow (meaning soul). In the folk circle, there always are stories — like the one about a man walking out at night. Finding himself chased by a shadow, he was frightened to run as the shadow followed him closely. Another saying states that “ghosts have no shadows”, which means that the “ghost” is a shadow itself, and therefore has no shadow any more. “Ghosts” have no feet either, which also means that “ghosts” are shadows. Ghosts are transformations of souls. Shadows are more likely to be associated with mirrors in China. Before the invention of mirrors, people saw their own shadow or reflection in water. The “wajian” (瓦鉴) in that era, an earthenware pot holding water, was anciently used to give a reflection; during the Shang Dynasty, bronze vessels took over the job and then bronze mirrors were eventually used, after the Qin Dynasty. To the Chinese, mirrors were marvelous things — they reflected the special attention given, by the ancients, to the association of shadows and souls, together with spirits. Therefore, the processing of mirrors became more and more exquisite, so that every pattern and decoration on them bore a special significance. According to the records in the Tian Gong Kai Wu (天工开物), Qin mirrors were usually polished on one side and decorated with patterns of flowers, birds and beasts, as well as inscriptions, on the other. The myth was that the human reflection in the mirror was the soul or spirit, and needed decent treatment. Another aspect of the marvelous function of mirrors can be best revealed from the concept of the “zhao yao jing” (照妖镜, “monster-revealing mirror”). In the Dong Ming Ji – Deng She Pian (洞冥记·登涉篇) written by Guo Xian during the Han Dynasty, it is recorded that “Diaoying Mountain was thirty thousand li away from Zhao River….on the top of its twelve-zhang-high14 Wangchan Pavilion hangs a golden mirror, four chi (about 1.3 metres) in diameter. It was in the midyear of Yuanfeng (110–105 BCE) that Youdi kingdom presented this mirror which reflected ghosts and monsters, and they were no longer able to hide their form.” Ge Hong (葛洪) in his Bao Puzi (抱朴子) says, “The eldest of each species, whose spirit could transform into a human shape, often liked to test people by deceiving them, except that they could not transform their own reflection in a mirror.” It was also written in this same book that an inn at the foot of Linlu Mountain was haunted by ghosts. 14

 a zhang was a unit of length, equal to 3.33 metres.

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Anyone who lodged there would either become sick or die. Later a Taoist arrived and sought lodging here. As night fell, he lit candles and sat chanting Taoist classics. When midnight came, he found more than ten people, men and women, dressed in red, white and black, sitting around in a circle and having fun — but they turned out to be a pack of dogs, when reflected in the Taoist’s mirror. So the Taoist made a plan and killed all of them, and they eventually transformed back into their original shape and became dogs. According to the You Yang Za Zu (酉阳杂俎), high on a mesa in Jinan County, there was once a mirror-cliff, three zhang high (about 10 metres), which was said to “clearly reflect the movements and shapes of all ghosts and monsters”. Some time later, “mountain ghosts, sick of the reflective power of the mirror”, painted over the cliff. In all these stories, mirrors worked to reflect the shape — which was considered as the soul or spirit of the animal. Their shape could change, while their soul or spirit could not. Trees, the glass and even animals; everything had a soul. It was simply mountain ghosts and monsters which could not hide their shapes in a mirror. No wonder Li Shizhen’s famous Compendium of Materia Medica (李时 珍: 本草纲目) recorded that: “Mirrors combine the spirits of gold and water; they are bright within and dark without. Ancient mirrors were like ancient swords, which could evade evil and eliminate wickedness, if there was an enlightened spirit around. Families should have hung up big mirrors to drive away evils and monsters.” It seems a good explanation — except it does not explain that these evils and monsters were the spirits of things in the near locality. So peasants in the countryside, when building new houses, would usually implant a little round or diamond-shaped mirror centrally right above the door — aiming to “expel ghosts, suppress evil, and ensure safety.” This also reveals the Chinese understanding of the association between shadows and souls, which has been since ancient times and which grew later into a taboo. Some of these mirrors acted just like today’s X-ray fluoroscopic machines. The records in the Ying Yun Stories (殷芸小说), and the Xi Jing Za Ji (西京杂记) tell us, “When Liu Bang (刘邦), the first Emperor of the Han Dynasty, entered Xianyang Palace, he marveled speechlessly at the countless treasures found in its storehouses, where the most amazing thing was a sapphire-made nine-branch lantern….there was a rectangular mirror, four chi wide (about 1.2 m) and five chi nine cun high (about 2 m), both sides of which could reflect things. When someone stood plainly before it, the figure reflected in the mirror would be inverted. Yet if the man in front of the mirror covered his heart with his hands, any diseases, if there were any, could be detected because in the mirror his internal organs became visible, every

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part becoming quite clear. If a woman harboured disloyal thoughts, her gallbladder would enlarge and heart vibrate irregularly. So Qin Shi Huang (秦始皇), the first Emperor of the Qin Dynasty, often took maids of the palace out to stand before the mirror to see whether their gallbladders or heart moved irregularly. If they did, he would execute them. Liu Bang (刘邦) sealed up everything and left it for Xiang Yu (项羽), who took the mirror to the east and later no one knew where to find it.” Obviously this is an expansion of the idea of the soul or spirit, extending it even to the power of seeing into people’s mental activity. The breath was associated with the soul — as “qi” (气) was the carrier of souls. The requirement of souls being thin and without substance could find its best expression in the breath. The clinical criteria for the diagnosis of death in ancient China15 was “to place a slight piece of silk under the nose and wait for the moment of the last breath”(see the Li Ji – Sang Da Li 礼记·丧大礼). Modern medicine judges whether the breathing has stopped; yet ancient people would probably try to detect whether the soul has left the body, as it was clearly associated with breath. The Li Ji – Ji Yi (礼记·祭义) defined “ghost” in the phrase “everyone is mortal and will go back to the earth after death, and then becomes a ghost”. Interestingly “gui” 归 (going back) is homonymic to “gui” 鬼 (ghost). Skeletons return to the earth, while simultaneously souls return to the air. “Bones and flesh under the ground turn into plain soil while their “qi” goes up above and drifts into the air, even giving out a sparkling light. The whole process brings about an air of bleak sorrow. Such an air is the essence of every living thing. Based on this process, rules for naming were made and hence the names for ghosts and spirits.” These descriptions tell us that ghosts and spirits were a kind of “qi”, which would not return with the bones and flesh to the earth, but “go up above and drift into the air or sky”. Dreaming is a physiological phenomenon whose nature has been kept mythical — not only to primitive and ancient people, but also to the modern. It has been proven by modern research that there is nobody who does not dream. The dreams of primitive people came as often as those of modern man and were the direct source of the raw material and their method of thought and imagination. No matter whether the objects in the dreams were what the dreamers had already experienced or not, these untouchable phenomena or a shadow of a human figure appeared in dreams right “before 15

 Ma Boying, The Earliest Diagnostic Methods of Death in China, Chinese Journal of Medical History, Vol. 1, 1982.

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their eyes”, which was mysterious to these people. The formation of the character “meng (梦 dream)” in oracle inscriptions depicts a man sleeping in a bed with his fingers pointing to his eyes — meaning that his eyes catch sight of something while he is asleep. Quite naturally, what was seen in dreams, since it evaporates when they awake, was different from what was real; therefore primitive people imagined that dreams were activities of the soul or spirit. It can be seen from the “buci” (卜辞) or oracle bones16 that the people of Yin (殷)17 often dreamt of their ancestors. So they believed that it was their ancestors’ souls that came into their dream. Such was quite a natural association. Chinese character “魂 hun (soul)” was the side-by-side combination of two characters “鬼 gui (ghost)” and “云 yun (cloud)” which indicated that the “hun (soul)” was adrift like clouds in the sky. It is similar in the words like “dreams are what’s imagined, are the movements of essences; when the souls and spirits break away from the bodies, it is complying with an order from the deities.”18 Dreams were usually associated with essences and with the activities of souls. In Chu Ci (楚辞), there are words like “Once I dreamt to touch the sky, but in vain, my soul was halfway there but there was no river to cross.”19 Sima Xiangru (司马相如) wrote in his Changmen Fu (长门赋), “when all of a sudden I fell onto my bed asleep, dreaming that your soul was just at my side.” All these, without any doubt, revealed that dreams were associated with souls — just like the Chinese idiom meng hun xiang qian (梦魂相牵 dreams and souls often twined together). Illusions are often considered symptoms of mental diseases, such as hallucinations, auditory illusions and the like, and this suggests the folk saying “meeting ghosts in the broad light”. Initially patients with such mental disorders were taken as someone with the unusual ability to see what mortals could not see and talk with those who were invisible. When they talked to them, people believed that they were speaking to a soul. It can be thought, looking at some ethnographic records, that sorcerers in many tribes had some 16

 Oracle inscriptions on tortoise shells or animal bones by the Shang (1600–1046 BC) people who used to make inscriptions related to their divination, for example recording the date, the event, the consequence and so on. 17  Ying is the name of a clan who could be from the period of Emperor Huangdi. Ying people took Emperor Huangdi as their remote ancestor while Xie was their first ancestor. They were feoffed to the land of Shang and later migrated to Bo. The famous Emperor Ying Zhou was the last king of the Shang. 18  Tai Ping Yu Lan, Vol. 397. 19  From Nine Chapters 九章.

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connection with this mental disorder. Sometimes these mentally disordered people would even be elected chieftain, because in the eyes of the primitive, what appeared in illusions was real — and it was the soul which appeared in illusions. In particular, the illusions did not come to every one. In a word, “animism” ruled the world of primitive thought in China; mainly during the Paleolithic, but also afterwards, it particularly deeply affected the primitive Chinese concept of life, old-age, disease and death.

14. The Experience of Using Objects as Tools and Cumulative Thinking Experts at home and abroad rarely notice or make a study of another form of primitive thinking that directly and simply emerged from the usage of common tools in daily life. In fact, ordinary tools only bear the value of direct use, and only those special ones were given a particular intelligence or soul. Such specialties might be that this tool occurred in quite a mystical way; or on the other hand, that its usage was complicated. However, tools like grass stalks used by chimpanzees to fish for termites, or the earliest stone utensils, were used in direct and quite simple ways. Therefore, it is incorrect to conclude that primitive people had only mystical thinking. In fact, there must have coexisted another thinking mode which featured direct cognition and use. Such a kind of thinking was not mystical at all, but still served as a general way of primitive thinking. Herein lies the distinction between the concept and content of “primitive thinking” mentioned previously in this book. During the Paleolithic and Neolithic periods, the creation of a primitive material culture depended mostly on the experience of the direct use of objects as tools (or to put it simply “tool-thinking”). Imitating the use of and comparing similar objects was its basic type. That chimpanzees and gorillas can drink water from a cup or use tableware when groomed, is the result of imitation. The Yi – Xici (易·系辞) records that “Looking up to observe the heavenly bodies, down to determine the principles from the terrain; perceiving the patterns of birds and animals whether they were harmonious to the surroundings. From as near as the self to as far away as everything”. Such a record reflects the analogous (or “imitative-thinking”) of ancient people, which eventually led to the creative use of tools like tying knots to make a net, cutting wood to make ploughs or carving wood into the handle of a plough; teaching people wear to clothes, then rule the country in order; scooping out a log to make a boat or sharpening wood into oars; cutting

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open a tree to make into a pestle and digging the ground with mortars; bending battens into bows and sharpening branches into arrows; building houses and palaces to shelter from the wind and rain; coffining the corpses; writing with a twig, and so on. The above bear some feature of mutual permeation with a deity or soul — although not much. It is mainly a case of “following the analogy to achieve direct use”. This can be seen from the technology of pottery production in archaeological records and ethnographic research. Peking Man used skulls as ladle goblets; gourd seeds have been found in Hemudu (河姆渡) Site and its shells used as drinking vessels; the earliest pottery might be used gourds as models, vividly shown by the Chinese idiom “drawing a goblet in the shape of a gourd”. In Liangshan, Sichuan Province, Ersu people primitively drew water using bamboo baskets which were later filled with mud as the bottom and turned into water-containers. When they found that these containers were much more durable after being fired, they began making pottery.20 The creation of pottery production was inspired through such analogies. At the beginning, people used manual mudded-battens to weave into plates or linked up segments of mudded-battens. They would, with their fingers, mould or pat mud into pots directly when making small ones. Usually they would imitate the shape of a gourd, coconut-shells, bamboo-basket, etc. Later on the slow-pottery-wheel was invented and then the fast-potterywheel. It is possible that the pots in Banpo (半坡) Site were made by the technique of the wheel — they are of such great quantity and variety. Meanwhile the technique of open-air burning evolved into that of kilning. The shaping, pattering and decoration all improved. It was possible that the “tool-thinking” at the time began to be enriched by mystical thinking. The evolution of pottery mainly matched the needs of living and production, and technology, and through imitation, thinking by analogy and the accumulation of experience, this all gradually developed. During this whole process, the idea of taking objects as tools, directly through analogy, won a main position. At the same time as this, quite more simply and directly, there must have been going on a certain mode of thinking closely connected to the growth of the primitive individual and their experience of production. Otherwise, it would be beyond explanation why primitive people ever found caves or build nests or houses to live in, and why they discovered the use of animal hides, or knitted clothes to protect themselves from the cold. Behind the Chinese 20

 History of Chinese Primitive Society, p.171.

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idiom of “doing without thinking (不假思索)”, there lies the experience of using tools and a continuous accumulative process. The thinking process of collective representation and mystical mutual permeation still held control, but not all natural objects and natural forces were mystical to such an extent, especially when these primitive people expanded their knowledge day by day, their intelligence was gradually civilized and their mode of thought accumulated more and more experience, so that, as a result, a systematic mode of logical thinking finally came into being. On the other hand, the idea of directly using objects as tools — together with experience, producing a basically simple kind of thinking — might produce a foundation on which mutually permeated thinking could grow. In other words, there were two possible directions. Take the story of the silkworm–horse for example. According to the Mountain and Seas Classics (山海经), “In the wild land of Ousi, which was east of Fanzhong, a woman was kneeling and spinning under a tree.” Sou Shen Ji (搜神记) recorded this story as “when in the ancient time, there was a family, only father and a daughter. The father was recruited into the army and went far away, leaving nobody except the daughter at home with a stallion and feeding it herself. Living in an impoverished and secluded state, she missed her father so much that she teased the horse and said, ‘I will marry you if you bring my father back to me.’” The horse broke the rope and ran away to carry her father back. Later the daughter broke her promise and her father shot the horse, exposing its hide in the yard. While the daughter was playing, “suddenly the horse-hide rose up, rolled her up and went away…. When her father returned to seek her she could not be found. Days later, the daughter still rolled up in the hide was found hanging between the branches of a tree. She had turned into a silkworm, spinning on the branch …. Thus the tree was named Sang (桑). Sang (桑) is homophonic to Sang (丧, meaning death). From then on, people actively planted Sang trees — which are still planted.” The Tai Ping Guang Ji (太平广记) records also that this happened during the reign of Gaoxin (高辛), “the hide came to rest on the Sang tree and the woman within it turned into a silkworm, spinning to cover the people with her warmth.” Her parents missed her so much — when suddenly they spotted her riding on the same horse, surrounded by iridescent clouds and followed by tens of guards coming down from the heavens. She said to her parents, “The Supreme Lord awarded me the position of Ninth Palace Fairy Wife as the lord was out of gratitude for my kindness, and so I’m immortal now and living in heaven.” Considering this story, the usage of silk came first, and the mutual permeation of the beautification of the silk-woman and the steed secondly.

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The idea of directly using objects and accumulated experience has been in existence for a long while, although it was often mixed with mystically mutual permeation. We can even find it in the ancient Chinese records, which show cognitive thinking happening through physical experiment. Primitive thinking was the co-contribution of human feeling, along with physical motion; within this process cognitive thinking deriving from physical experiment might get mixed up — together with hand or body, an experimental subject (human or animal, etc.) and an “apparatus”. In China, there is the legend of “Shennong creating Chinese medicine”. The Huai Nan Zi – Xiu Wu Xun (淮南子·修务训) states that, “Shennong tasted a variety of herbs and came across seventy poisons a day.” The tasting of a variety of herbs and judging from their toxic reactions whether they were edible or could be used as a medicine is clearly a reflection of a thinking process (also an operational process) of reaching a conclusion after experimenting on itself (on one’s own body) and understanding the herbs. The Kai Pi Yan Shi (开辟衍释) by Zhou You of the Ming Dynasty also described and commentated on this story: “It was said that Shennong had an exquisitely translucent body whose five internal organs, like the liver and lung were visible. This must be true, otherwise how could he survive when poisoned by twelve toxic herbs a day? It is also said that Emperor Yandi (炎帝 i.e. Shennong) tasted medicinal herbs and could detoxify himself whenever he got poisoned — until he ate a centipede with hundred legs and every leg turned into a worm in his stomach. Emperor Yandi could not detoxify it this time and he died.” Such a description concerning Shennong’s “exquisitely translucent body whose five internal organs were visible” can even be considered as implying anatomical experimentation and research — which at least explains how the examiner could judge whether the medicine was toxic or not, by the reactions and changes of his viscera. The so-mentioned “centipede with hundred legs” would probably refer to a case of death by high toxicity. Shennong Shi, by legend, was an ancient sage. However, according to some studies, Shennong Shi was the name of an ancient tribe. It may be that the whole tribe of Emperor Yandi participated in the experiment and some of them died from poisoning. Another legend implies that animals might have been used as experimental subjects. The knowledge was probably achieved by examining the reactions of the subjects’ internal organs (including what was examined anatomically after death) or by their death caused by poisoning. The Shuo Fu (说郛) recorded that Chen Fen during the Yuan Dynasty said, in his Yun Chuang Si Zhi (芸窗私志), that Shennong tasted a variety of herbs with the aid of a “medicinal beast” which held the medicinal herbs in its mouth and passed them to him. “Shennong would pat his animal when

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someone was ill … the animal then went to the wild and returned with the herb in its mouth. The patient pounded the herb, took the juice and later was healed. Later Emperor Huangdi … recorded which kind of herb it was and for which kind of illness it was. As time passed, if someone got this disease, he could be treated according to the prescription. It worked every time.” It was even said in the Shu Yi Ji (述异记) that “in Shenfugang, Taiyuan, there is preserved an acient tripod vessel which was used by Shennong to taste herbs. In Chengyang Mountain, there was a place where Shennong picked herbs. This place was named Shennong Plain and its other name was Yaocao Shan (Medicinal Herb Mountain). On the mountain, there is a place Ziyang Guan where it was said Shennong identified a variety of herbs, and where a thousand-year-old borneol tree grows.” From this description, it can be concluded that Shennong Shi also used some experimental apparatus — a vessel. Taken all together, these legends can be wholly considered a case of primitive people executing cognitive thinking through physical experiment. What we are trying to explain here is how and by what mode primitive people began thinking and asking questions. We hold that the earliest medical conceptions must have been condensed and deposited through conclusions gradually reached after a process of primitive thought or a relatively fixed point of view. Yet, there still is a long, long way to go.

B.  Primitive Worship and Its Association with Medicine China is a country of polytheism. It’s probably because there are just too many deities that devout believers are few. They adopt a pragmatic attitude to their worship so that in general they can only be said to be “half-believinghalf-not” in their worship. They “would rather believe something than nothing.” They can seem to believe, yet at the same time show an indifference. Such a dilemma can be traced back to primitive worship — being both ordinary and complicated at the same time. Howsoever, such a “halfbelieving-half-not” character has affected both the living habits of the Chinese and the direction of their medicine. .

15.  The Worship of Nature The Li Ji – Ji Fa (礼记·祭法 The Rule of Sacrifice) said, “Mountains, hills and forests, rivers and valleys, where the clouds, wind and rain are formed and even monsters appear, all are our gods.” This shows that everything, owing to the uncontrollability and unpredictability of natural phenomena, is

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considered respectable as a deity, which is a reflection of “mystically mutual permeation”. Therefore thereafter there arose the awe and worship of the unpredictably changing natural phenomena or the forces of such objects as the sun, moon, the stars, mountains and rivers, the earth, wind and rain, water and fire. Thus the origin of nature worship can be traced. To primitive people, there must be some supernatural force controlling everything — initially “gods” did not appear in their minds. The Li Ji (礼记) set the standard that the Emperor worships heaven and earth, while his feudal lords worship mountains and rivers. All this was the worship of nature. “Worshipping the sun on altars and the moon in pits”, “worshipping the sun to the east and the moon the west”. It is recorded in the Fengshan Book of Historical Records (史记·封禅书) that the ancient State of Qi worshipped eight Gods, namely the God of Heaven, of Earth, of War, of Yin, of Yang, of the Moon, of the Sun and of Seasons (among these, the God of War referred to a planet or star); and this also reflected the worship of nature. Among the natural gods and spirits, the most famous were the Sun God Xihe, Moon God Wangshu, River God Hebo, the Wind God Feilian, the Fire God Zhurong, and Cloud God Fenglong — although these names were attached later. There was a division of work among them, one was in charge of heaven, of earth, of the directions (south, north, east, west, and centre) and four seasons, etc. respectively. So there were distinctions in the rituals. The Zhou Li – Chun Guan (周礼·春官) records that the ritual of Yin Si was to worship God of Heaven; the ritual of Shi Chai to worship Gods of Sun, Moon, and Stars; the ritual of You Liao to worship Gods of Life, Death, Wind and Rain; the ritual of Blood Sacrifice to worship Gods of Land and Grain, Gods of the Five Elements, and Gods of Five Mountains; the ritual of Li Chen to worship Gods of Mountains, Forests, Rivers and Lakes; the ritual of Pi Gu to worship everything in the world. The Guo Yu – Lu Yu (国语·鲁语) also records: “Besides, we worship the spirits of the earth, grains and mountains because they have given merit to the people; the ancient sages and virtuous men because people trust and admire them; the spirits of the sun, moon and the stars in the sky, because people pay respect to them; the spirits of the Five Elements from the ground such as gold, wood, water, fire and earth, because people depend on them for life and reproduction; and the most famous mountains and rivers across the land, because they provide a source of natural wealth for people to use.” Although late in the record, the above reveals the continuity of ritual and worship during these times. They even go into detail: for each land had a Lord of the Land (the spirit of the land); the spirit of Mountains for mountains, the God of Trees for trees, the spirit of flowers for flowers, the spirit

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of Goats for goats, the spirit of Oxen for oxen, etc… Each was doing their job respectively. According to differences of local folk customs, every god might take major or sole charge of a certain natural deity. The initial condition of primitive nature worship must have been similar as well. Archaeological discoveries have found that there is much similarity between the pictures carved of the sun, moon and mountains on the pottery vessels unearthed at Dawenkou Cultural Site in Lingyanghe, Ju (莒) County, Shandong Province, and the Gods of the Sun and Moon of the Pumi Nationality in Yongning, recorded in the ethnographies. On the pottery from the Neolithic Age, a great number of sun patterns have been discovered, showing that sun worship was once quite popular. The Sun God played a vital role in some nationalities, such as the Erlunchun, Hezhe, and Naxi. From the pictures of Sun Salutations found on the Yinshan Rocks (Inner Mongolia) to pictures of sun worship in other places, all reflect the people’s worship of the sun. There is an interesting folk custom among the Naxi in Yunnan: early on the third morning after a birth, a ritual of sun salutations should be carried out at the moment of sunrise — for the Sun God, being head of all gods, nurtures everything and protects the health of each of us. What is more, a banquet should be provided and the new mother uncover her breasts to ask the elders for blessings, such as “a strong body and plump breasts, to make for a healthy baby”. Herein lies the close association of nature worship with life and health. The Han nationality’s worship of the sun is also shown in the beautifying feelings reflected in their fairy tales. The poem God of the Sun (from the Nine Songs) worships the spirit of the Sun: Before my light, oh! dawns in the east, The light over my balustrade and the Fusang.* I stroke my steed, oh! Give it a free rein to run; The night brightens, oh! the daybreak set out. Driving my dragon cart, oh! drawn by thunder; My cloud-flags wave, oh! they are meanderingly in sky. The blue cloud clothing me, oh! With white and purplish red, My long arrow to shoot, oh! the Sirius. Then I downward sink, oh! carying my Bow I go; I grasp the Big Dipper, oh! to ladle out the bay flower wine. I hold my reins, oh! galloping to the east again, Leaving the vast and darkened heavens behind me. (*Fusang tree is another name for the Sun)

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The imposing manner of a chief God dwelling in the heavens, solemn, grand and magnificently mighty, is revealed in the lines of this poem. Xihe, the wife of Emperor Jun who was the Chinese legendary God of Heaven, gave birth to ten suns and bathed them at Ganyuan. In Tanggu, also, where the ten suns were bathed, there was a giant tree called Fusang which was north of Heichi and planted in the waters. Each day, one sun would hang on the upper part of the tree while the other nine suns lay on the lower part. “No matter whether the sun came up or down, it was carried in a chariot driven by a Wu (a type of crow, a legendary three-legged black bird).” This is a tale from the Mountains and Seas Classic (山海经). All was done in a peaceful and orderly fashion. Yet there was a grass named Diri in the northeast and Chunsheng grass in the southwest. The three-legged Wu had come down to earth to eat this grass several times. Xihe covered the eyes of the bird because she wanted to ride on it, but the Wu did not listen and went on its way, as eating this grass could make it immortal. However, other birds or animals would feel wonderful and listless and could not move at all if they ate this grass.21 This is not only a tale of fancy, but it also symbolizes health. However, “during the time of Yao (尧), the ten suns all appeared together. The blazing suns burned the crops, dried up the trees and grasses and caused the people to starve. Wild animals like the Yayu, Zaochi, Jiuying, Dafeng, Fengxi, and Xiushe often harmed the people. So Yao ordered Yi (羿) to kill the Zaochi in the Chouhua lake area; to kill the Jiuying above Xiong waters; to capture the Dafeng at Qingqiu lake; to go up above to shoot the ten suns and to kill the Yayu down below; to cut down the Xiushe at Dongting, and to catch the Fengxi at Sang forest. People were so happy they made Yao their Emperor. Then they knew that in the world, there were broad and narrow places: those dangerous and plain; those faraway and nearby. Hence roads and villages were built”.22 Extreme disasters were closely associated with the blazing heat of the sun and Yi became the hero “who had subdued the sun”, the main mischiefmaker. This might be another representative form of sun worship. In any case, the hero who had conquered supernatural forces was extolled. Another aspect can be seen in such descriptions as … “in ancient times, ten suns hung together in the sky, illuminating every corner of the world, and moreover your grand virtue excels the sun’s brightness.” Here the ten suns together in the sky do not fashion a disaster, but are used as an image 21

 from the Dong Ming Ji 洞冥记.  from the Huai Nan Zi 淮南子.

22

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of the ubiquity of virtue. The “ten suns together in the sky”, which “burned crops and dried the trees and grasses”, could be considered as there being “something wrong” with the “healthy” sun; and made Yi, the hero, a god of healing. But this last example shows that people in their nature worship gradually acquired an ability to tell between the normal and abnormal. The records of moon worship are comparatively few in myth. Yet everyone is familiar with the story of Chang’E (嫦娥) flying to the moon. The lines of a poem made famous by Li Shangying: “Chang’E must regret having stolen the magic elixir — She is now in the blue sky as in the green ocean, missing the human world, night after night”.23 It is enough to make people drop tears of fellow feeling. Chang’E, the wife of Hou Yi (后羿，not “Yi 羿” as in the previous texts) “stole the elixir bestowed by the Queen Mother of the West and was about to fly to the moon after taking it. Prior to leaving, she sought a divination from You Huang who told her, ‘it is revealed — good omen. This divinatory symbol Guimei means you will fly lightly alone, fluttering along to the west, don’t be panic-stricken when falling into the dark. Everything will be greatly prosperous.’ So later Chang’E lived in the moon as a gold toad, a moon spirit”.24 That a pretty woman turned into a moon spirit has always stirred special feelings of beauty, even when we look at the moon today. However, people never thought the spirit turned out to be a toad. And yet toads make excellent ingredients in Chinese medicine. Chang’E just took the elixir and let herself rise to the moon and turn into a toad — from this also the story gradually evolved into a jade rabbit who, with a pestle, pounded herbs into a medicine. So in this story, the key factors are interwoven with medicine. The You Yang Za Zu (酉阳杂俎) also recorded that on the moon, there was an osmanthus tree, “five hundred zhang high, with a man named Wu Gang (吴刚) under that tree all the time chopping at it — however, the wound heals by itself, the instant it occurs. Wu Gang because he once overstepped the rule in learning immortal magic, was ordered to exile and chop down the osmanthus tree.” Laurel (or “moon cassia” tree) is also named “the king of medicines”. It is also said that “there are eight Trees, and anyone who eats its leaves will become an immortal and be called a Yuxian (jade spirit)”.25 There was also a story derived from that of Chang’E about the Yue Xia Lao Ren (月下老人, old man under the tree on the moon) who became a matchmaker in charge of people’s marriages. 23

 translated by Zhang Tingchen & Wilson.  from the Chuang Tze – Qi Wu Lun 庄子·齐物论. 25  According to the Yun Ji Qi Qian 云笈七签. 24

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All in all, the moon spirit was fairly benign and acted as a god of health, hygiene and healing. Therefore during an eclipse of the moon which was imagined to be “the heavenly dog eating the moon” in the folk circle, the whole village would turn out, striking gongs and beating drums, to force the dog to spit out what it had eaten — so as to return bright and clear peace to the world. Such a tradition has existed since ancient times, for it is said that: “to rescue the sun or the moon from eclipses, the king must order drumbeating.”26 Fire worship in the folk circle mainly concerned the God of the Kitchen for “Emperor Yan (炎帝) created fire, but when he died, he transformed himself into a kitchen god”. This might possibly show the association between cooking food, fire and the creation of the kitchen. Emperor Yan Shennong (炎帝神农) always cared deeply about the health-aspects of cooking. In The Analects of Confucius – Ba Yi (论语·八佾), there were words like “currying favor with the gods of the house and kitchen” indicating that the tradition of worshipping the Kitchen God had a long history. Fan Chengda in Song Dynasty wrote the following among his Lines on Worshipping the Kitchen God: It was said since ancient times that on twenty-fourth of the twelfth month, The Kitchen God heads to the heavens to report on the passing year. … Sending the Kitchen God, drunken and full, through the Heavenly Door, Don’t mention quarrels and disputes in the world any more, Just hope the Kitchen God return with profits, oh! In folk custom, malt sugar is used to worship the Kitchen God, reflecting people’s wishes that the God at least would not report “bad things” — even if he would not “speak sweet words in heaven”. In the reign of Emperor Wu (汉武帝) of the Han Dynasty, Li Shaojun (李少君) performed alchemy to create the dieting utensils of immortality. These stories show the associations of the Kitchen God — a God of Fire, along with diet and longevity. Another legend says that the Fire God (also named the Fire Lord) was Zhu Rong (祝融), descendant of Emperor Yan (or some say a descendant of 26

 From the Zhou Li 周礼.

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Emperor Huangdi), with a human face and an animal body, riding on two dragons.27 Yet another view is that the Fire God was Wu Hui, Zhu Rong’s younger brother, also known as Hui Lu. Up to the present, a fire disaster is also called “a disaster of Hui Lu”. Hence, the Fire God becomes the God of Disaster. As for worshipping the God of Water, his subject could be a big fish, a mythical flood-dragon, Gonggong, the Dragon King, the Kui (a mythical onelegged monster), even snakes, carps, Shuibo, Hebo and more. Quite a few worshipped the Water Immortals, even Qu Yuan, Feng Yi, Wu Zixu and the like. Gonggong (共工), said to be a son of Zhu Rong, was the earliest and most famous subject of worship. He had a human face, a snake-like body and red hair. The Huai Nan Zi (淮南子) records that, “in the time of Shun (舜), Gonggong raised water and made rivers flood which approached Kongsang.” And “in the ancient times, Gonggong competed with Zhuan Xu to be the Emperor and bumped his head on the Buzhou Mountain (不周山) out of rage. The vehemence of the force caused the pile which supported heaven to be broken, and the rope tying up the four ends of the Earth pulled apart. Then the sky begun to slant towards the northwest making the sun, moon and stars move to the northwest; and the land sank down towards the southeast making waters flow and dust subside to the southeast.” Surely Gonggong was a hero of calamities. Also there was the goddess Luoshen (洛神also known as Princess Mi) who could touch the hearts of everybody, all the time, with her romantic love story. She was “the daughter of Fuxi (伏羲) and later drowned in the River Luo, transformed into a goddess”. She was so beautiful like a startled swan tripping along; so graceful as a swimming dragon”.28 She was married to Hebo, but lost her heart to Houyi (后羿). It might be due to this, that Chang’E envied her. Hebo ( 河伯), the Yellow River Water Spirit named Feng Yi was, according to Chu Ci (楚辞) a dissolute villain, full of malice and greed. The poem Hebo (河伯) or God of the River describes him: On rivers nine, oh! with you I roam; The whirlwinds rise, oh! and billows foam. My water chariot, oh! lotus-canopied, Two dragon-steeds, oh! run side by side. On Mount Kunlun, oh! I look around; My heart surges up, oh! beyond the bounds. … 27

 This comes from the Mountain and Sea Classic 山海经.  from the Luo Shen Fu 洛神赋.

28

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I’d chase spotted fish, oh! on turtle white, And roam with you, oh! on sands in delight, While melted ice, oh! drifts left and right. Let us go eastward, oh! hand in hand! I’ll see you off, oh! My beauty, to southern lands. Waves on waves rise, oh! to welcome you; Fishes’ scales flash, I leap, oh! to bid you adieu.   (based on a translation by Xu Yuanchong) It is generally believed that these lines show Hebo’s complacency and vain-glorious wish to make all the women of the world his concubines. Another view is that the Chu (楚) people’s worship of the rivers is due to them praying to a god to cure disease.29 This is different from the time when Hebo married a woman during the period of Ximen Bao ruling Ye county (西门豹治邺), who wished to avoid a flood. It seems there were rich emotions when Hebo married this woman according to the folk customs of the Chu. However, the common point for both was appeasing the god. Another aspect was that attention should be paid to the problems that accompany sexual relations between male and female, and the confusion and disaster brought about by them. Anyway, in those legends there were many heroes like Dayu, Ximen Bao, and Li Bing and his son. All of whom were capable of preventing floods by controlling the waters, but none was heroic enough to defeat the deities of deluding emotions. The stories about mountain Gods seem to be more pleasant, like the various mountain Gods and Spirits who helped Dayu (大禹) control the waters and the mountain Gods mentioned in the Mountains and Seas Classic (山海经) and other sources. This might relate to the copious output of mountains and forests, which provide humans with the necessities of life and yet bring no harm to life — unlike water and fire. The Di Jing Tu (地镜图) describes a fifty days fast “which must be taken before entering a prominent mountain, then leading a white dog and holding a white cock enter the hills, accompanied by a litre of pure salt. This is in order to pay your respects to the mountain spirits who are then so pleased as to return to you ganoderma mushrooms, magic herbs and precious jade. At one hundred steps away from the mountain, call out ‘lin lin! yang yang!’. This is the mountain god’s name; being aware of this can dispel

29

 Cheng Jiazhe, New Annotations to Nine Songs, Sichuan People’s Press, 1981, p.92.

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all evils.” Such is the magic of herbs! They are powerful enough to dispel all devils! The Mountain Goddess described in the poem Chu Ci (楚辞) is quite beautiful: In mountains deep, oh! looms a fair lass, In ivy leaves, oh! girt with sweet grass. Amorous looks, oh! and smiling eyes, For such a beauty, oh! There’s none but sighs. (translated by Xu Yuanchong) Some experts believe the goddess here is the Wushan Mountain Goddess30 (巫山神女), daughter of Emperor Yan (炎帝), who died unmarried and was buried on the south side of Wushan (巫山). King Huaiwang of Chu (楚怀王) dreamt of her during his tour of Gaotang. In his dream she volunteered to be his bed companion. She said, “My name is Yaoji. I died without knowing sexual relations and was buried under the mesa of Wushan. My soul has turned into a ganoderma mushroom. If you like me, pick it, and I’ll meet you in your dreams”. As she departed, she told him, “In the morning I’m a cloud, and at dusk I turn to rain in the sky. Every morning and night, I’ll be in the place under the mesa on the south side of Wushan.” This story was recorded also in the Gaotang Fu (高唐赋) and Shennu Fu (神女赋), both odes by Song Yu (宋玉). In the Mountain and Seas Classic (山海经) is the following passage, “on Guyao Mountain, the Emperor’s daughter died. Her name was Nushi and she turned into a Yaocao (瑶草) plant. When all its leaves were out, its flowers were yellow, and its grain like that of the cuscuta seeds. They could make one who took them become charming to others.” So, this herb plant was an Emperor’s daughter who became the Goddess of Wushan, i.e. the spirit of the Mountain. While Yaocao, or the ganoderma mushroom, is a top-grade medicine, it is also exactly the same magical plant which later the White Madam (白娘子) and Xiaoqing (小青) stole in the story Madam White Snake,31 to bring Xu Xian back to life. The property of “being charming to 30

 Yuan Ke, Dictionary of Chinese Myths and Legends, Shanghai Lexicographical Publishing House, 1985, p.30. 31  Madam White Snake is a famous ancient legendary story in China. White Lady was a white snake who transformed into a lady named Bai Suzhen, after one thousand years’ magical practice, in order to look for the man named Xu Xian who was reincarnated from the shepherd who saved her life a thousand years previously. However, on discovering that White

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others” indicates the beautifying and libido-boosting functions of Yaocao. Whether it is a Mountain Goddess, a Yao Fairy or one of the Flora, all are associated with the production of medicines which benefit humans. According to ethnographic records, families from the She (畲) Nationality would worship a camphor tree as the baby’s godmother, when a baby was born; in the south of Zhejiang province, there was a folk custom of saluting “rocks-fathers”, kowtowing to the rocks as godfathers, depicted in the song: Rock-fathers, gods’ delegates. A baby was born into the family, a genius, Afraid of being envied for its brightness. Willing to bring my children to follow your horse, They shall call you the rocks’ godfathers. [Qie Ou Ge (且瓯歌) by Shi Fangluo in Qing Dynasty] This ritual was carried out every first and fifteenth day of the month until the baby reached adult­hood. In other words, the Gods of trees and the Gods of rocks both become guardians to protect the baby’s health. The Wind God and Rain God were both initially officials of Emperor Huangdi himself. The Mountain and Seas Classic (山海经) records, “When Chiyou (蚩尤) waged war against Huangdi, Huangdi ordered Yinglong to attack him in the wild lands outside Jizhou. In response Yinglong stored up the waters — while Chiyou asked the Wind God and Rain God to make strong winds and heavy rain.” It is said in the Fengsu Tongyi (风俗通义) that “the Wind God in the Zhou Li (周礼) lay in the constellation of Ji (one of twenty-eight Chinese constellations). Ji was in charge of winnowing and tossing, and therefore could produce wind. Ji nurtured everything and did good to the people, and so Kings would worship Ji to express their thanks.” Also in this book there appear the words “the Wind God named Yi” where the Wind God has been transformed into a female. In the Records of Emperors and Kings (帝王世纪), it was said that “Emperor Huangdi…appointed Fenghou in coastal areas, who rose to be his Prime Minister.” And the Zhi Lin (志林) recorded that “Emperor Huangdi battled against Chiyou in the wild lands of Zhuolu. Chiyou made thick fog for three days, causing the soldiers and generals to Lady was a giant white snake, Xu Xian was so frightened he died. To save his life, White Lady and Xiaoqing, her maid, who was a green snake, stole a magical plant, the ganoderma mushroom. As punishment, she was buried under Leifeng Tower, now in Hangzhou, Zhejiang Province.

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lose their direction. So then Emperor Huangdi ordered Fenghou to make a machine imitating the Douji (the Big Dipper or Beidou in China), i.e. the south-pointing chariot which could tell the direction. As a result Chiyou was captured.” Later medical theories held “wind to be the primary pathogen”32 and that fog was also a factor in causing disease. This can readily be deduced from primitive nature worship. The medicinal animal mentioned above can also be taken as reflecting the worship of animals in their natural surroundings. The Yunchuang Private Records (芸窗私志) claim that “in the time of Shennong, white people presented him with a medicinal animal… Shennong spoke to it just as the white people had, but others could not understand what was said. After this, the animal just ran out into the wild and returned holding a herb in its mouth… The ancient legend which tells us that Emperor Huangdi tasted a variety of herbs is actually incorrect. This is why Yuqin33 said that, ‘Emperor Huangdi learned from a medicinal animal and then knew how to cure disease.’” So on and so forth. There are numerous other cases. Nature worship came about as the result of mystical mutual permeation. Primitive people took natural forces as having some kind of supernatural power. As this supernatural power, unveiled, was found to be the knowledge of ordinary natural and common forces, people would create other theories, like a later natural philosophy and, based upon this, the theories of Traditional Chinese Medicine. This is a “process reborn”, but we have been able to show how to extract out this process with its most primitive factors through our analysis of nature worship.

16.  The Worship of Totems The worship of totems was also mainly due to nature worship. Its growing form, especially the worship of animals and plants, was connected with combining ancestor worship along with social forms and organizations. There were rigid taboos for totems and the complex of research into incesttotem taboos in particular has attracted a number of famous scholars.34 This corresponded with a transition from the system of the blood-clan commune based on consanguineous group marriages — such as Peking Man and those 32

  According to the Huangdi Neijing 黄帝内经.  A reputed scholar in the Warring States Period, who wrote Mr. Yu’s Spring and Autumn Annals 虞氏春秋. 34  Sigmund Freud, Totem Worship, and other related views. 33

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before — to the matriarchal commune system, based on non-consanguineous group marriages. The human-faced and fish-patterned drawings found on the painted pottery at Banpo (半坡) might signify a fish totem; the discovery of dragonshaped jades at Hongshan (红山) Cultural Site indicates that dragon totems have been in existence since primitive times; the phoenix totems, in their earliest use might have grown out of those of birds (including cockerels, crows, magpies, ospreys, swallows); the Kirin (麒麟 Chilin or Chinese “unicorn”) was probably associated with totems of the tiger, leopard, deer, ox, dog and the like. The earliest totems — which were animals and plants in their original shape — then gradually transformed into a combination of poly-animals or some half-human-half-gods shapes, beautifully enriched by the richness of the imagination. It is the same for the Four Benevolent Animals of the Chinese: the dragon, phoenix, turtle, and Kirin. The twelve animals which denote the years: the rat, ox, tiger, rabbit, dragon, snake, horse, sheep, monkey, cock, dog, and pig, also reflect early totems. Some surnames came from totems, such as Si (姒) from a snake totem; Gui (妫) from the elephant; Jiang (姜) from the goat; and Mei (梅), Li (李), Hua (花), Ye (叶), and Lin (林) from plant totems. Tattoos might be symbols of totems. The Han Shu – Geographic Records (汉书·地理志) state that “the people in Yue (粤) tattooed their bodies and cut their hair in order to avoid the harm brought on by the Jiaolong (蛟龙), a legendary Chinese dragon which often caused flooding.” In the Huai Nan Zi (淮南子), it is said that “People on the south side of Jiuyi (九嶷) Mountain laboured more on water than on land, so they cut their hair and tattooed their bodies to imitate the dragon fish. (The intention was to avoid the harm from the flood dragon, whilst they were in the water”.) The You Yang Za Zu (酉阳杂俎) mentioned, “the Yue (越) people learned to swim and insisted on tattooing their bodies to avoid any disaster befalling them from the flood dragon. Today in the southern regions, the Xiumian people use the custom of tattooing.” People believe that tattoos form an internal aspect of the totem group, and enable one to be free from attacks and hurts. Tattoos are considered a form of mystical mutual permeation and possess magical power. The author believes that there was indeed, in primitive people, an inclination towards the earliest form of classification using a deeply unconscious structure created by totems. Originally, there was no inclination towards classification — not in collective representation, nor in mystical mutual permeation — for they both belonged to the same internal thinking and assemblage which occurs in primitive groups. But along with the enlargement

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of these groups, interaction and contact arose and as contact with the outer world increased, a first step towards classification was slowly taken. This was also associated with the relative immobilization of the subjects of mystically mutual permeation. For example, a clan who depended for their livelihood on fishing took the fish as their totems and mutually permeated with fish; while a hunting clan took an animal as their totem and mutually permeated with animals. But as production increased, in time the fishing clan and hunting clan probably intermarried and became integrated with each other, while meanwhile a matriarchal clan-society grew up into a patriarchal clan-society; so then the development of people’s thinking and imagination helped the fusion of totems and enriched them by the power of imagination and decoration. For instance, the image of the dragon was synthesized from images of the alligator, snake, pig and the lightning dragon; and the image of phoenix from a variety of birds. There were totems in the medical world too. At least the author believes this to be the case. The West generally takes the snake as the embodiment of the physician and healing, and therefore the snake can be considered a totem of medicine. Even today, the emblem of the World Health Organization is still a snake coiled round a staff. In Greek mythology, among the gods of Mount Olympus, there was Aesculapius, the God of Medicine, an illegitimate child of Apollo, God of the Sun, and Cornis, daughter of Prince Thessly. Both Apollo, the creator of healing and doctor to all the gods, and Artemis, Apollo’s sister, guardian of women and children, passed on their healing arts to Chiron who then taught Aesculapius, the so-called “flawless physician” mentioned in the epic poem, The Iliad. Once when Aesculapius was sitting out on the grassland, meditating on healing, a poisonous snake crawled up and coiled around his staff. He beat it to death. After a while, another snake came up, holding a herb in its mouth and brought the dead snake back to life. This scene taught Aesculapius a lesson: disease was a kind of venom and venomous snakes carry venom too. One kind of venom could be healed by another kind of venom. All creatures that could produce venom and cause disease possessed the power to kill or to heal. From thenceforth, every time he went out to practice, he always carried a staff with a venomous snake coiled around it. Aesculapius was later killed with a thunderbolt by Zeus, the chief god. In honor of Aesculapius, people built temples and erected statues depicting his staff entwined by a snake. His temples later became the “lands of promise” for healing. Snakes became the embodiment of the God of healing and a totemic symbol for medicine. Snakes are cunning as well as wise and bear

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both venom and medicine within themselves, which is a reflection of mutual permeation. In Chinese medicine, the author holds the view that the Hu Lu (葫芦 or bottle gourd), the sign of medicine in China, is also a totem; and the Wu Que (乌鹊 or crow-magpie), the symbol of a physician, is also a totem for physicians. However, there is no snake totem, and even supposing that we accept that dragon totems originated from snake totems, the dragon has relatively little connection with medicine. Gourds were quite commonly unearthed at Hemudu (河姆渡) Site. They could have been used as food, a vegetable, or a ladle or utensil for drinking. The worship of reproduction is associated with the gourd because the gourd produces numerous seeds when dried. Among the traditions of the Yao (瑶) nationality of Guangxi province in China, the gourd played a part in saving the lives of Fuxi (伏羲) and Nuwa (女娲), brother and sister, during the great flood.35 In fact, the gourd has been a totem for many southern nationalities in China. Mr. Wen Yiduo (闻一多) once said, “Fuxi and Nuwa by name are two people, but in reality just one. Both of them were incarnations of gourds of different gender.”36 Fuxi (伏羲) could also be written “Paoxi 庖羲” which was homophonic in ancient times to “匏邂”37; Nuwa (女娲) was also called “Quanwa 棬娲”, homophonic in ancient times to “匏瓜”. In modern folk customs, in many places, “drawings of thousands of generations of offspring”, sometimes carved on jade, are very popular — showing a picture of a big round gourd accompanied by two tiny gourds, one each side, roots and tendrils intertwined. The living of big and tiny gourds together suggests generation after generation, continuously; the intertwined roots and tendrils connote “perpetual posterity” — just as the saying “Guadie 瓜瓞” to people means “to wish for longevity”. All in all, the gourd is associated with life and health. Thus gourd totems have been in existence since ancient times and have lasted until today, except there is little evidence on records. The relationship of the gourd to medicine might have come from the mysterious properties of the gourd mentioned above. Both the Hou Han Shu (后汉书) and Ge Hong’s Shen Xian Zhuan (葛洪神仙传) describe the following story. Lord Hu (壶/葫 公) was unknown to the world. Fei Changfang (费长房), a market administrator, saw him coming from afar and enter a 35

 Wang Xiaodun, Primitive Beliefs and Chinese Ancient Gods, Shanghai: Shanghai Chinese Classics Publishing House, 1989, p.104. 36  Wen Yiduo, The Collection of Wen Yiduo, Vol. 1, p.60. 37  pao 匏 means a bottle gourd.

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market to sell his medicines. Nobody knew him. Yet although his prices were non-negotiable, the medicines healed. The man often hung an empty gourd on the beam in a house and jumped into it, visible to none, each day after sunset. Only Changfang could see this, from an upper floor, and began to understand that this man was not common. Changfang himself swept his floor and presented him with food and useful things, and the man took all without any hesitation. Each day, Changfang did the same. At last, after a long time, the man was assured of Changfang’s trust and told him, “Come at dusk when nobody’s around.” Changfang went as he had been instructed. Then the man said, “When I jump into the gourd, follow me immediately.” Changfang followed and was in before he knew it. Before him lay a grand jade-hall together with numerous buildings and towers, intertwining doors and corridors. More than ten servants were waiting on Lord Hu. Then Changfang and the Lord Hu enjoyed a feast. The drinking cup was as big as a man’s fist and would never run dry till deep into the night. Later Changfang asked the man to teach him Taoist magic and followed him deep into the mountains. As a result, Changfang learned to heal diseases and even could lash out at ghosts. However, eventually he was killed by ghosts, after his magic talisman went missing. Whatever disease it was, Changfang could heal it. Each time he would tell the patient the medicine would make him vomit something up, and then the disease would be healed, in a few prophetical days. His words always came true. As this story is well-known to the Chinese people, a medicine seller by tradition puts his medicine in a gourd; and a Taoist alchemist hides his magic pills in a gourd at all times. Outside herbal shops, gourds are used as a sign there are medicines for sale. Therefore, if you see a gourd, you know a herbal-medicine shop or physician is around. Another Chinese saying goes “you don’t know what kind of medicine he is selling in his gourd”. All these stories indicate that gourds are intertwined with medicine in primitive thinking and function as the totems through the occurrence of mutual permeation. Now let us turn to “crow-magpies”, i.e. crows and magpies. The Chinese usually take crows as a taboo although the ancient people did not. Cao Cao38 (曹操) once made the famous lines “A clear moon, a few stars in the sky, the crows and magpies fly south.” The silk painting unearthed from Ma Wang Dui Han Tomb in Changsha presents a sun with a fire crow within it, 38

 Cao Cao (155–220), also known as Mengde, was a famous statesman, militarist, one of the literati and calligraphist during the Period of the Three-Kingdoms in China.

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signifying the sun i.e. a Jin Wu (金乌 a “golden crow”) or three-legged crow. It was the totem of sun worship. In the Mountains and Seas Classics (山海 经), it says: “There was a tree named Fu, (i.e. Fusang tree), in Tanggu. No matter whether the sun rises up or falls down the tree, it is carried by a Wu (or crow).” In the picture A Flying Crow Carrying The Sun painted on the color pottery found in Hua county, Shang’xi Province, the sun and the crow are integrated into one. The sun gives light and warmth to the world, and health to the people. Furthermore, the God of Life, assistant to Taihao Fuxi (the God of the Sun), was also known as Jumang, and appeared in the shape of a bird just as in the phrase — “the oriental Jumang, who was humanfaced and bird-bodied, riding two dragons.”39 This God of life was in charge of life and health. There is also a mention in the Hai Nei Bei Jing (海内北 经) that “to the north of Kunlun Ruins, the Queen Mother of the West sits beside a table, wearing decoration in her hair. From the south, three bluebirds come, bringing her food.” The three blue-birds, according to the You Yang Za Zu (酉阳杂俎), acted as messengers for the Queen Mother. The text says: “there were crows, dark-legged, orange-beaked, white-winged, crimson on the forehead, messengers of the Queen Mother… legends also have it that on the mountain there were medicine caskets belonging to the Queen Mother, who ordered blue-birds to protect them.” Blue-birds became the messengers of medicine. Blue-birds suggest Luan, which belong to the category of phoenixes: “there were five phoenix-like birds….the one with more blue on it, than other colors, was a Luan.”40 In the Guang Ya (广雅) it states: “The Luan is a category of phoenix”. The power of blue-birds is also described in the Mountains and Seas Classic (山海经): “A five-colored bird, which had three names: a Huang, a Luan, or a Feng.” “A five-colored bird, whose stretched wings could cover the county when flying, was named a Yi (翳).” “Appearing like a pheasant, with five-colored feathers, the bird was named a Luan and it could bring peace to the world, if anyone caught sight of it.” “The character Yi (鹥)” in the poet Chu Ci (楚辞)’s line “to ride on a jade dragon and a Yi (鹥)” was explained by Wang Yi as “another name for a phoenix.” Thenceforth, the Yi (鹥) bird referred to the Yi (翳) bird, which was synonymous to a blue-bird (or phoenix), messenger of medicine, protector of world peace. Lots of folk-tales claim connections with magpies. The Guang Yi Ji (广异记) describes how: “The daughter of Emperor Chi (Emperor Yan) in 39 40

 from the Mountains and Seas Classics 山海经.  Cited from the Jue Yi Zhu by Yi Wen Lei Ju.

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South China took up residence on a Sang tree (mulberry tree) on Mount E in Nanyang, after she attained the Tao, and became a deity. On the first day of each year, she would collect twigs to make a nest. Sometimes she would transform into a white magpie, sometimes a woman. The sight of her made Emperor Chi so sorrowful that he wanted to capture her. But after his efforts of trapping her were in vain, he tried to force her out by burning the tree. Yet she rose up to heaven instantly. Hence the name Di Nu Sang (‘the Emperor’s daughter Sang’). Today, on the fifteenth day of each month, people burn magpie nests to make a cleaning lye which they use to cover the silkworm’s eggs, so as to make them produce silk. There is something in this myth.” So a fairy story was associated with silkworms. However what should not escape our attention is the connection between the act of covering silkworm eggs with a lye produced by burning magpie nests, and the prevention of disease in silkworms. The Emperor’s daughter Yao Ji was also an embodiment of the Yao Cao or ganoderma mushroom previously mentioned and here she transforms into a magpie, also associated with medicines. Take another story, for example — the well-known legend of Niulang and Zhinu (牛郎织女 the herdboy and spinning maid). “On the seventh night of the seventh month, Zhinu made the magpies construct a bridge when she wanted to cross the Milky Way.”41 “On the seventh day of autumn, the heads of magpies became bald, for no reason. It was said that on that day Hegu (the name of the star of Niulang) and Zhinu had a tryst on the eastern bank of the Milky Way and he instructed the magpies to set up a bridge with their bodies for him to cross the Milky Way and meet her. So the magpies were all bald.”42 The kindness and self-sacrifice of magpies is reflected here. Yet Cui Baozhi of the Jin Dynasty wrote in his Gu Jin Zhu (古今注), “the magpie is a goddess.” Shuo Fu (说郛) cited the Xi Nang Ju You (奚囊橘柚) as saying that “Yuan Bowen passed Gaotang and lodged with a family in the mountains, on the sixth day of July. At night, he dreamt of a beautiful woman who claimed to be herself a goddess. Bowen asked her to stay the night with him, but she refused, ‘I have a bridge to build for Zhinu tomorrow and it would be quite a humiliation if I failed her.’ Bowen woke up with a start, when he saw glittering in the sky the morning star. He opened the window and saw a flock of magpies flying east, which joined with a smaller flock flying out of his window. Thence he named magpies as goddesses.” In brief, connections always exist between magpies and stories of goddesses. 41

 according to the Feng Su Tong 风俗通.  from the Er Ya Yi 尔雅翼.

42

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Some might say it is far-fetched to record these tales of animal totems. In reality, more direct evidence comes from sayings such as these. “When someone dies, ghosts may scratch rashes on his skin, making it uncomfortable for him. So to avoid this, kill a cock and put it on his heart.” “If a person suffered an illness, to dispel it, use chicken.” “The head of a cock hung at the east city gate can treat the disease caused by a Gu (a legendary venomous insect)”. In conclusion, it seems that cocks must possess a power mainly to do with the prevention of death and the expelling of evil. Cocks here demonstrate one type of mutual permeation by a bird totem. If traced back further, might this not apply also to crows? It is worthy of our attention. At least the totems of lucky birds which contain primitive meanings such as the above, and are taken as guardians of life and health are more acceptable. In the Historical Records, the Han Feizi (韩非子) and other classics, stories of Bianque (扁鹊), the physician, are quite common. Yet the stories cover a time-span of some four-hundred years. So they definitely do not refer to the same person. A doctor whose name was Qin Yueren (秦越人) was also known as Bianque because Que, a bird name, suggested the totem of physicians and was therefore a synonym for a physician. According to records in the Zuo Zhuan – Zhao’s Seventeenth Year (左传·昭十七年), Tanzi, when asked “Why did Shaohao43 name the titles of his officials after birds?”, answered, “When our great ancestor, known as Zhi, claimed the throne, a phoenix happened to appear. So he made rules and disciplines according to the birds, learned from them, named the official titles after them, and set up an administrative mechanism. For example, the official titled Fengniao (phoenix), i.e. Lizheng in later generations, was in charge of astronomy and the Chinese calendar; the official titled Xuanniao (Black birds) was in charge of marking the spring and autumn equinoxes; the official titled Bozhao was in charge of marking the summer and the winter solstices; the official titled Qingniao (Green birds) was in charge of marking the beginnings of spring and summer; the official titled Danniao (Red birds) was in charge of marking the beginnings of autumn and winter; the official titled Zhujiu was in charge of the land and the enlightenment of the people; the official titled Shijiu was minister of war; the official titled Jiu was minister of public 43

 Shaohao (2598–2525 BCE), son of Emperor Huangdi, chief of the five Emperors of ancient China, the co-ancestor of Chinese people according to legend. The country of Shaohao prospered especially as a result of the culture of the phoenix which, together with the culture of dragon, made up the twin pillars of Chinese culture. Chinese people are not only descendants of the dragon, but also of the phoenix, the king of birds.

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works; the official titled Shuangjiu was minister of justice; the official titled Gujiu was handler of miscellaneous affairs.” So the division of works used the totems of birds. The title of the official Qingniao, in charge of the beginnings of spring and summer, suggests the beginnings of life and health. Chances are that the official titled Queniao in charge of medicine, was simply not mentioned above. The God of Life, Jumang, who was bird-headed and human-bodied, might be conceived of by the folk people as Bianque. According to a scientific investigation into a stone inscription found in Shandong Province, from the time of Emperor Hanwu, two Queniaos (magpies) curing a disease with needles tallies well with the story of Bianque. Thus there is strong evidence for Queniao (magpies) being the totem of physicians.

17.  The Worship of Reproduction The worship of reproduction, that is “genital worship”, began with the change from the worship of nature to the worship of human beings themselves. In a strict sense, this is different from ancestor worship which however surely involved the worship of both female and male ancestors. The worship of reproduction was the result of the veneration of a mystical power in the genitals being transferred to natural objects or products, or painted images — and eventually these becoming the objects of worship, through mutual permeation. Hegel expressed similar opinions when he said “oriental people usually laid stress on the common vital force in nature and placed their worship onto, not the spirituality and power of human thinking, but the creative power of reproduction….more specifically, their perspective was of the common and natural reproductive forces, represented by their worship of the outer appearance of male and female genitals.”44 Primitive people might not care about how to increase their population — they just grew and died in the most natural way. The so-called “hybridization of marriage” or consanguineous group marriage was, by nature, nothing but sexual behavior, that is an animal instinct, conducive to happiness in life. It was quite uncertain whether the earliest people, just evolved from apes, ever had an oestrum, or period of sexual readiness like animals. Was the seventh day of the seventh month, when according to legend Niulang and Zhinu met once a year, really a remnant of a primitive 44

 Georg Wilhelm Friedrich Hegel, Aesthetics, 3rd Volume (upper part), p.40.

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people’s oestrum? Was the abhorrence towards the Queen Mother, in reality, a censure of her yearly oestrum? Otherwise, it would be quite difficult to explain the significance of such a regularly, yearly date — the seventh day of the seventh month. Sexual behavior between parents and their children had been taken as unacceptable in consanguineous group marriages, but it does not seem that they had a clear understanding of the reproductive function of the genitals. Recognition of the distinction between generations brought about the myth of reproduction. They were not able to fully understand the inherent mystical power of the female genitals. So to primitive people, the female genitals were great for reproduction; breasts were also great for feeding babies. As a result a greatness of and respectability due to females was elicited and hence emerged the beginnings of a matriarchal society. Similarly, the recognition of the reproductive function of the male genitals and later their mystification resulted in the replacement of a matriarchal society by a patriarchal one. The opposite opinion that male worship appeared after patriarchy was established is unacceptable. On the contrary, such a replacement happened as it accompanied the productive development of society — which helped raise the status of the male in the economic production (and probably demonstrated the importance of the male genitals in “self reproduction”). An indispensable relationship between the male genitals and reproduction was gradually acknowledged, and it became clear for primitive people that no intercourse between male and female meant no reproduction. If the female genitals were important and mystical, then the male genitals must be also. Male genitals became a source and symbol of the mystical power of reproduction. Thus the worship of male genitals came into existence. Till then, sexual intercourse was not only a thing done during “oestrum” which had disappeared long ago in the process of evolution, but a physical need which brought about physical pleasure, and more importantly, the reproduction and prosperity of their clan. Therefore, the relationship between parents and children must be clear and definite. Hence the real beginnings of a marriage with husbands, wives and family patterns appeared, with females in a relatively subordinate position. It must be made clear that the worship of female genitals was still preserved in cultural form, except it was not on the top list. There is a reasonable explanation available for these unearthed materials and ethnographic records. The pottery statue of a pregnant woman unearthed in the Hongshan Cultural Site located in Dongshanzui, Kazuo county, west of Liaoning Province, reflects the worship of the female

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genitals, for it has the features of being naked, the breasts protruding and there being marks on the genitals. The kettle-shaped human figure found at Liuwan, Qinghai Province is considered hermap­hrodite by some and male by others, but in fact it should be seen as female because her pudenda is quite prominent — the middle part bulging upwards being her labia with the mouth of vagina below, and the swollen kettle-like body signifying pregnancy. According to ethnographic investigations, the Churen Cave (“human delivery” cave) of the Wa people stands for the female pudenda through which humans are delivered; there is a stone cave in Yanyuan, Sichuan Province, where Naxi people will “strike the offspring cave” by throwing stones into a cave to ask for a child; both the Miao and Bai nationalities have a Nuyin Stone or an Ayang Stone, which women if infertile will go and salute; there is a “Child-conceiving Stone” in Huqiu (虎丘) of Suzhou, Jiangsu Province and it is said that a woman can conceive if she throws a small stone on the top of Child-conceiving Stone. All these are cases of living stone-worship, and also the worship of the female genitals. The Mosuo people in Yongning, Yunnan Province take the valley on the mountainside of Mount Gemu as representing woman’s pudenda; while the Mosuo people in Zuosuo take the stretch of water to the west of Lugu Lake and Mosuo people in Wujiao the stalactite pit in the Lazi grotto as the same. All these stones and rocks taken as genitals are called “stone ancestors”.45 Yet stone ancestors, if male, usually bulge out and are prominent. For example, the Mosuo people in Yongning take a hill as a penis; the Naxi people in Muli Eya take a stalactite in a certain cave as a penis; the Naxi people in Zuosuo Dazi take the long naturally occurring feldspar outcrop with the two round rocks beside it in an open grotto behind their village as a penis and testicles. Women, asking for a child, will burn incense, light candles, present sacrifices and drink the spring water (child-conceiving juice) in front of the male stone ancestor; or take a bath in the pond beside it; or lift up their skirts and let the pudenda touch the stone ancestor several times, if there is no water to bathe in or to drink. The stone ancestor before the Tomb at Dayu (大禹) in Shangxing, Zhejiang Province is said to be a male symbol. Also among the hills of the Dai nationality in Xishuangbanna there are stone ancestors; the Menba Nationality in Tibet enshrine wood ancestors; 45

 All the ethnographic materials cited here are from Chinese Primitive Society, Primitive Worships and Chinese Gods and other books. Similarly, hereinafter, no reference will be provided.

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there is a “penis cave” at Daba village in Muli, Sichuan province, in which male genitals are enshrined and if a woman is infertile, she will burn incense, present sacrifices and sit down on them for a while; at Kawa village in the same county, stone ancestors are also worshipped by women asking for a child. They will bathe in the pond and drink the holy water, while sitting on the stone ancestors. Relics of stone and pottery ancestors have been unearthed — quite a few in cultural sites such as Yangshao Cultural Site in Jiangzhai, Majiayao Cultural Site, Qi Cultural Site, Dawenkou Cultural Site, Qujialing Cultural Site, and Longshan Cultural Site, etc. Some people think that the Huabiao columns (ornamental columns erected in front of palaces, tombs, etc.) and the ancestral memorial tablets (“wood” ancestors) also derive from penis worship. The Chinese characters “Mu (牝)” and “Mu (牡)”, for female and male respectively, have been analyzed to be originally pictographs of the female and male genitals, and the character “Zhu (祝)” is pictograph of a man kowtowing to and worshipping genitals.46 The worship of genitals naturally led to the worship of the form of sexual intercourse. In the rock paintings at Renmudong, Ritu County, Tibet, there are prominent female and male genitals, signifying sexual intercourse. The Miao nationality in Guizhou Province will perform a dance representing sexual intercourse during the Gucang festival and the accompaniments to the dance are said to represent the male and female genitals.47 Sexual intercourse is even mimed during the grand sacrificial ceremony “Gusheji”, where there occur naked images of male Yanggong and female Yangpo and also clay sculptures of their genitals beside a barrel containing sugary vinasse, symbolizing semen. The climax of the ceremony is when a painted-face man symbolizing a male ancestor holds a branch, as thick as a bowl, of cedar or maple both of which trees have thriving roots, beside his underbelly and symbolically chases the young women. The one chased should give her consent implicitly. Another form taken is when a man dressed as a warrior holds a gourd filled with sweet wine (or a bamboo tube carved like a penis) in his hand, beside the lower part of his body and places it at the foot of women’s lappets. Then the women climb up onto low tables and lift up their aprons, symbolizing receiving the ejaculation. Up until late primitive times, genital worship evolved into the reproduction-related worship of male and female gods and ancestor-worship, among which the worship of Fuxi and Nuwa was the most famous. Fuxi held the 46

 Primitive Worships and Chinese Gods, pp.118 & 123.  History of Chinese Primitive Society, p.485.

47

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sun and Nuwa the moon, symbolizing the sun and moon respectively. Such a connection laid the foundation sub-consciously for a view of life and death as well as a view of nature as combining Yin and Yang, and therefore exerted a far-reaching influence. A view of male worship was reserved implicitly in the case of families preferring boys to girls. Cases of drowning new-born girl-babies had long been known since the pre-Qin period, as recorded in the Han Feizi (韩非子): “Parents, after the delivery of a child, would congratulate each other if it was a boy and kill it if a girl. Although both were born from the same parents, a boy would be congratulated and a girl killed. The reason for the difference was that parents considered the future profit and did it out of long-term interest.” (Chapter Liufan) This simply explains the financial interest lying in having males, unaware as they were of the impact of this exclusive worship of the male genitals.

18.  Ancestor Worship In a strict sense, ancestor worship came into being after the appearance of the family. According to the Li Ji – Jiao Te Sheng (礼记·郊特牲), “everything originated from heaven, while humans originated from ancestors.” Ancestors could refer to our first ancestors, or the meritorious ones among whom the heroic would usually be categorized as gods and worshipped; while the most recent were mostly seen as ghosts or souls. Yet ancestor worship, a prominent feature of Chinese people, frames the basic structure of their ethical life. Therefore such worship can be disconnected from the general idea of souls and spirits. Even though connected, they are slightly aloof from each other. The Chinese prefer to stress that everything of their bodies comes from their parents — rather than believe that life is created by some other divine being. Yet at the same time they also believe that, if their ancestors were gods, in that case they would act from the underworld, to protect their offspring somehow. However, such a belief came about later, while the Yin (殷) people (i.e. the people roughly contemporary with the Shang Dynasty) believed that most of their ancestors were trouble-makers. After the dominance of Confucianism, ancestor worship became mainly a form of gratitude and ceremonial respect — which more belonged to the category of ethics which, as a hinge, adhered to and lubricated the whole country, society and interpersonal relations. This was really what the Yi – Xu Gua (易·序卦) meant when it said: “Heaven and Earth nurture nature which raises men and women; men and women combine into families which raise fathers and sons; the relationship between

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fathers and sons helps the relationship between the king and his people which boosts the different ranks — high and low, and so the etiquette of discrimination is raised. The Five Ethics — “righteousness between king and officials, affection between fathers and sons, distinction between husbands and wives, order between seniors and juniors, and trustworthiness amongst friends” — they all find their origin here. Therefore the author does not agree simply that ancestor worship is just a crude form of worshipping gods and ghosts.48 Actually there were common ancestors worshipped by our forefathers, as explained in the Li Ji – Ji Fa (礼记·祭法): “the principle of worship set forth by the wise Kings of old was to use sacrificial rituals to worship those who had exerted laws and created justice among the people, those who died on duty, those who laboured for the peace of the country, those who prevented invasion by powerful countries, and those who prevented the country from great calamities.” These ancestors were held as heroes in the hearts of people. Because of their accumulated merit, the king, ministers and the common people together worshipped their ancestors — and this was called the “country’s great worship”. Yet there was “family worship” too. Nowadays, people will hold a sacrificial ceremony whenever a family member dies. On Tomb-sweeping Day, 5th April (清明节) they go to sweep the graves and burn paper money to express their mourning of the dead. Of course this is also a form of ancestor worship. People rarely believe in ghosts and gods, but they still perform the ceremonies. They cannot hold to the belief that there is no connection between ancestor worship and the worship of ghosts and gods. The forms which ancestor worship takes are quite varied — they may follow the pedigree of a clan, a particular ancestor or a particular family. Also various ancestors’ tablets, pictures and sculptures may be part of it. Even during the ceremonial worship in some folk circles, courtesy is paid to the still-living seniors and filial behavior can be considered part of this too. As for the early conditions of worship, it can be speculated that ancestor worship, for quite a long period of time, was not deified, but simply a mystical mutual permeation with the deceased ancestor; thereby forming a collective representation, with all its corresponding forms, of the so-called sacrificial ceremony to the living offspring. From the discovered oracle bones, quite a few scholars question whether the ancestors have given protection to their own offspring or else brought them trouble or diseases. They 48

 Zhu Tianshun, Initial Study on Chinese Ancient Religions, Shanghai People’s Publishing House, 1982, p.206.

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question whether there was a connection between their ancestors and the real, contemporary world. A unified concept of a God of ancestors controlling everything had not yet been achieved. So the God who controlled the sun, the moon, the wind and rain was a “Supreme God” — quite a common term on the Oracle bones. The ancestors only “obeyed” the supreme god and served as an intermediary, a messenger between King Yin or the sorcerers, and the supreme god. If the ancestors did not “obey” the supreme god, they were untitled — with such a qualification as a “medium”, which was probably unavailable to the ancestors of the common people. So in most cases, ancestor worship during that time was basically worship of the dead which lasted at most to the third generation and had nothing to do with other family-lines, which explains why an ancestor only protected or punished his or her own offspring. The reason why traditional Chinese home-ownership was exceptionally strong is closely related to the idea of worship of ancestors, and the family-line. The appearance of the deification of ancestor worship was the result of combining the worship of natural gods and the worship of heroes, both of which bore an intimate association with the worship of reproduction and totems. Since a natural god possessed the most powerful supernatural forces, he could become a remote ancestor to humans once integrated with the “creation heroes”. Once a natural god had been totemized and his totem connected with the birth and reproduction of the clan, the totem thenceforth also became a God of ancestors. Besides, the goddess of reproduction and the later male gods were without doubt associated with the God of ancestors. Human civilized heroes were remote ancestors, or more recent ones — but being extremely outstanding in talent or possessing magical powers, they were apt to be deified by the process of mutual permeation. Thus almost all gods were ancestral gods as well as appearing in ancestor worship, especially as they became the major object of sacrificial ceremonies or even something larger. The opportunity for the historization of Chinese mythology found its origin here. The creation heroes who later became the earliest ancestors and the object of worship were Pangu (盘古) and Nuwa (女娲). The San Wang Li Ji (三王 历纪 The history of three greatest kings) writes that “Before the world was created, heaven and earth were a chaos, like an egg, out of which Pangu was born. Eighteen thousand years passed, and heaven and earth departed — with the clear, light air of Yang rising to be the heavens and the turbid, heavy air of Yin descending to fashion the earth. Pangu stood between them, transforming one hundred and nine times. His wisdom was superior to

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the heavens and his abilities more powerful than the earth. The heavens became higher one zhang (丈) a day, the earth became deeper one zhang a day, and Pangu was growing taller one zhang a day. Another eighteen thousand years, and the heavens were very high, the earth very deep and Pangu very tall. Then did the three Emperors come into being.” According to the ethnographic record, some nationalities in the southwest of China still worship Pangu (or Panhu) today. The Wu Yun Li Nian Ji (五运历年纪) contains more mysterious descriptions, such as “the first born when the world was created was Pangu, whose body went through tremendous changes as he died: his breath turned into wind and cloud; his voice, loud thunder; his left eye, the sun and right eye, the moon; his arms and legs, four pillars supporting the sky; his five body constituents (tendon, vessel, muscle, hair and skin, and bone), five mountains; his blood, rivers and lakes; his tendons and vessels, mountain ranges and roads; his muscles, the soil; the hair on his head and moustaches, the stars; his skin and hair, trees and grasses; his teeth and bones, metallic minerals and stones; his semen and marrow, pearls and jade; his sweat, rain to nurture everything; even the worms on his body, catalyzed by the wind, turned into people on the earth.” So not only humans, but also nature, were a transformation of Pangu. Metaphorizing nature through the human body was the thinking mode already present in ancestor worship. Nuwa was well-described in the Huai Nan Zi (淮南子): “In the ancient time, the four pillars which supported the heavens at the four directions collapsed, and the earth cracked open, so that the heavens could not cover all and the earth could not hold all. Fire spread everywhere and could not be quenched; the prevailing floods could not be halted. Ferocious animals ate the gentle and kind people, and fierce birds snatched the aged and children with their claws. So Nuwa smelted five-colored stones to fix the heavens, cut down the legs of the giant turtle to be used as the supporting pillars of the four directions, killed the black dragon to save the central land and used reed-ash to block up the floods. In this way the heavens were fixed, the pillars at the four directions erected again, the flood subsided, tranquility was regained in the central lands, ferocious birds and animals were subdued or killed and the gentle and kind people survived.” Nuwa was not only the creator of all human beings, but also a heroine who fixed the heavens and saved the people from disaster. Obviously this legend shows an aggregation of the gods of nature, the first ancestor of reproduction, and hero worship. But nevertheless, ancestor worship was truly the basic framework which held Chinese primitive worship together, from beginning to end. It needed

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the enrichment of gods, souls and ghosts to be complete, so as to turn it into something more substantial and relevant to mortal life. It was in this framework and system that later Confucian ethics (and morality) became a major carrier. The same goes for Chinese medicine which could never escape from its shadow.

19.  The Worship of Ghosts and Gods As has been explained above, the worship of ghosts and gods, together with ancestor worship, formed the mainstay of Chinese primitive worship. In a comparative sense, this worship — nature worship, totem worship, the worship of reproduction, etc. — took backstage as time went by, or blended into the formation of the worships of ghosts and gods, and ancestor worship, both of whom reveal themselves as pervading almost the whole of Chinese ideology and custom, up to the present day. It is likely that at the earliest times, primitive people believed in the coexistence of humans and ghosts, without distinction. Therefore there was no need either to differentiate in their burials. Time passed, and with the appearance of nature and totem worship, a world of gods was created. Yet these deities were restricted to the circle of nature surrounding them, the heavens and the earth, mountains and rivers, animals and plants, and so on. Mutual permeation was mainly reflected in mystical feelings toward natural forces. Then there appeared the worship of reproduction, which must have been accompanied by the worships of ghosts and gods because — when primitive people began to think about the problems of their own reproduction and death — naturally the mystical concept of mutual permeation with the dead, is formed. Hence ceremonial burial came into existence. That mystical feeling towards the special talents possessed by our first ancestors and their meritorious heroes, our forefathers, promoted ghosts and souls to the status of gods. They were called “human gods”. Thus, a ternary worldscheme of “gods — humans — ghosts” was established. Gods were up in the heavens while ghosts gathered under the ground. Some ghosts, wandering between, had nowhere to go and were called “wandering souls” or “wild ghosts”. Those objects of nature which possessed great mystical power were categorized into the world of gods, like the God of heaven, of earth, of the mountain, water, fire, the flowers, trees and so on. While those which possessed some mystical power, too weak to impact and make a difference, like foxes, rats, fishes, shrimps, etc. were taken as spirits, at a similar level to that of wandering souls and wild ghosts. All these gods, spirits, souls and ghosts

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had something in common — they were intangible and thus invisible; they were unobvious because they could change form; and by some superior capability or secret power acted silently on humans, who could not escape. By comparison, the human souls of the living were fragile and did not possess special features; so people were not afraid of them, but only scared of being hurt. Mo-zi (墨子) was a ghost-believer. In his book Mo-zi – Ming Gui (墨子·明鬼) he listed various stories to prove the existence of ghosts and their superior power. One of them went, “King Xuan of Zhou killed Du Bo, one of his courtiers, who was innocent. Before his death, Du Bo said, ‘If my majesty kills me without reason, the dead may not know, well that’s it. However, on the other hand, I will avenge myself on him, within three years.’ Three years later, King Xuan of Zhou brought the dukes of his vassal states together and went hunting in his hunting grounds. Crowds swept the hills and plains, with hundreds of chariots and thousands of escorts. Then at noon, Du Bo appeared, in a white horse and cart, wearing a red coat, a red bow and arrow in his hand, then he chased King Xuan of Zhou. From his cart, he shot the king in the heart and broke his spine. Then the king fell, bent down over his arrow box and died. At that time, none of the escorts witnessed the killing and none of those far away heard it.” A similar story tells how Lord Jian of Yan killed his officer Zhuang Ziyi, who was also innocent of any crime. Both stories revealed that ghosts would take revenge if they were treated with injustice when alive. This is what Zichan (子产)49 said: “the souls of common men and women, if they were forced to die, would append to a person and they became cursed.”50 Such a stern ghosts’ penalty for revenge could be unstoppable: “Facing punishment from ghosts and gods, people could not obstruct them by wealth, popularity, ferocity or an army. The ghosts’ penalty must win.” What is more, “what the ghosts and gods award would be awarded to that person — no matter how low their status in the world; while whom the ghosts and gods punish would be punished — no matter how high their status in the world.”51 In another state of affairs, one also believed that ghosts would be good or evil depending on how they behaved in life. It is reported that Zigao said, “I’ve heard that a person, if he benefited people when alive, would do no harm after death. All my life 49

 Another name for Ji Qiao (?–522 BCE), a prominent statesman and ideologist during the Spring and Autumn Period, also respected by Confucius. 50  from the Zuo Zhuan – Seventh Year of Lord Zhao (左传·昭七年). 51  from the Mo-zi – Ming Gui (墨子·明鬼).

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I’ve done no good to others, why shall I harm others after I die?”52 Another circumstance would be that “ghosts would do no harm if they had a home to return to”. Therefore, we can see some place here for normal human feelings — for whether a ghost was good or evil was partly related to the good or evil they did in the human world, and partly to the hierarchy of profits in the human world. The You Yang Za Zu (酉阳杂俎) said, “the man who does five thousand evil things when alive, will become a ghost remaining in five prisons, one after another; the man who does six thousand evil things when alive, will become a ghost staying in twenty-eight prisons; the man who does ten thousand evil things when alive, will fall into the prison of hungry ghosts in the wild.” Thus it can be seen that ghosts were restrained, and even graded in hell. It was believed that in matriarchal society, the popularity of group burial, twice burial, and burial with artifacts was because primitive people wished the dead (the soul) to live a life the same as they lived when alive. The same direction of the heads and the small holes on the children’s burial urns was for the soul to pass through, or “go west” in order to return to its old home. A group burial with those of the same surname was a reflection of marriages with those outside the clan. Flexed burial, dismembered burial, prone burial and adult urn-burial were used because the dead, dying of unusual causes, were considered in danger of becoming ferocious ghosts — and therefore these unusual burials would exorcize them. In patriarchal society, it was quite popular for female and male to be buried together, the male above and the female below, and there were quite a number of living female sacrifices; also the burial objects differed in amount, according to the grade of the dead. Many ornaments, or else just the daily necessities, or even livestock such as pigs were discovered. All these reflected the different attitude toward ghost worship, before and after a social transformation resultant from the progress of production. The ghosts of those who occupied a high social status in the human world, were still to live the same life of luxury underground. The living sacrifices of wives and concubines might be considered a form of undifferentiating life from death. In the binary concept of body and soul, primitive people probably tended to stress the latter — that is, the soul transcending the body. Because in their opinion, ghosts were also “alive”, so therefore the death of the body did not matter so much. While modern people usually take the burial of living sacrifices as an act of cruelty, it was probably not in these people’s eyes. In some Indian tribes people are 52

 from the Li Ji – Tan Gong (Upper Part) (礼记·檀弓上).

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willing to burn themselves because of the piety of their religious beliefs; there is no life or death here, as the obliteration of the body does not mean the death of the soul. On the contrary, the sacrifice of the body lifted the soul up higher. To the primitive, being a servant or wife when alive and leaving with their dead master did not mean a separation of two worlds, but a transformation of their life-form and a means of communication. This point was probably different from that of the living slave-sacrifices since the times of the Yin and Shang. Traces of obvious struggle on the relics of many living sacrifices unearthed at Yinxu Ruins in Anyang, Henan Province seem to show the results of physiological stress, and reveal that wives and servants had been unhappy about dying, and thus appealed through their lust for life. The ternary world of “gods–humans–ghosts”, in reality, still took the human world as its mainstay. Primitive people gradually realized that something miserable was associated with the world of ghosts (or hell), while something happy with the world of deities (heaven). Yet most people could only become ghosts after death and only a few heroes turn out to be gods. What’s more, it would be a long and tortuous process to become a god. There were no cases of turning into a god immediately after the death (except in the later “deity stories” of Taoism). Appealing for blessings from the gods was rather appealing to the ancestors for protection — or at least for them not to make trouble. Such was the most basic wish of the living, who hoped that real life, although not full of happiness, was at least tolerably better than life in the ghost world, and could possibly last longer. This concept became the reason for the core status of ancestral worship among all worship, as longevity became the basic pursuit from the perspective of medicine. Therefore, in the worships of ghosts and gods, the worship of gods became more distant while the worship of ghosts was more relevant. At the same time, both gods and ghosts were gradually graded and positioned, which came naturally to a human society evolving slowly the concept of class. The deity who occupied the highest position was the Supreme God-onHigh, yet whose real appearance was never described in detail. His match with Queen Mother of the West was something that happened later. Gradually the Queen Mother became the chief god of all gods — Queen Mother Niangniang. The Supreme God Xuanyuan — Yu Huang Dadi — was created by Taoism to rule over all gods, together with the Queen Mother. The Queen Mother was most probably the embodiment of the sun and moon. Among the oracle bones found in Yinxu Ruins, there are many items

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which take Eastern Mother or Western Mother as the object of the sacrifice. In ancient classics, evidence could lie in the words “sacrificing to the sun in the east and the moon to the west”, “sacrificing to the sun with oxen and the moon with ghosts, pigs and oxen”, and “convention believes Yin and Yang come in and go out in the East and West and they were worshipped as gods — the King Father and Queen Mother” etc. Yet Queen Mother of the West, in the Mountains and Seas Classic (山海经), was described as “leopard-tailed, tiger-toothed and good at roaring” and became a symbol of the tiger or leopard totems. In some later classical texts, the Queen Mother was also said to be “the daughter of the Emperor” and keep an immortal medicine, appearing as the figure of the god of reproduction. The natural gods and gods of reproduction were represented by Xihe, the Sun God, and Wangshu, the Moon God, led by a group of human gods of the earliest ancestors, including Fuxi, Nuwa, Shennong, Emperor Huangdi, Pangu, Houji, Cangjie and so on. Then there appeared the deities of heroes, like Gonggong, Yi, Yao, Shun, and Yu etc. who had won victories; and Chiyou, Kuafu, Xingtian, and Gun etc. who mainly featured through rebellion and their failures. At a level lower were gathered Jingwei, the Goddess of Wu mountain, the Goddess of Luo River, Chang’E, Niulang and Zhinu and the like who were enriched by human affections; or the hero-gods transformed from humans directly like Libing and his son, Master Jiang Taigong, Guangong and other meritorious courtiers and generals. Godlings of mountains, land, flowers, trees and grasses were graded even lower. Even “Bed Mother and Bed Father” were deities. According to Han customs, Bed Mother and Bed Father were worshipped during the ritual of a baby’s bathing, on the third day after birth, aiming to thank them for the peace of the deliverance and asking them for their blessings on the baby’s health. The most venerable of all ghosts was Yanluo (阎罗, Yama), a term adopted later. Originally he was the deity Houtu (后土) who ruled the ghost world. Kuafu, also the god, was born out of Houtu. The real ghosts, all of whom were direct ancestors of humans, real figures, could not be enlisted in the roll of gods after death, nor could they “transfer” to the same official rank in the hell. They would, according to their good or evil deeds in human world, either rise to be town gods or fall into hell going through all disasters for eternity, like becoming devils in animal form, having legs sawed off or bodies split apart, fried and burnt, and so on. All these ideas were made up by later generations, but might also be inherent in the sense of ghosts taken by primitive people.

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The most famous name in the ghost world was Zhong Kui (钟馗), who was a talented scholar of Zhongnan Mountain in Tang Dynasty, who died of some unusual unjust cause in the human world. After he made quite a bit of trouble in the underworld, he was entitled by the Jade Emperor as Exorcism and Devil-beheading General taking sole charge of evil demons in the human world. Demon-Beheading Sword in hand, he chopped up numerous evil ghosts and brought peace to the human world. Besides, he was full of love when he appeared in a dream to arrange the marriage of his younger sister. Such an ugly but loved figure in the ghost world may be coincidental — but it had its source. Zhong Kui, is homophonic with “Zhongkui (钟葵)” — as recorded in the Kaogong Ji (考工记). Yet “Zhongkui (钟葵)” is also related to the sound for “zhui (椎)” which could be a tool, a weapon, or even the earliest apparatus to treat diseases. The phrase in Nei Jing (内经): “Isn’t it too late to forge arms when the war has began?” relates to medicine. Accordingly, Zhong Kui was a figure mystically mutually permeated from “zhui (椎)” to control all ghosts, to repress devils and expel demons, and became the most powerful among ghosts. Another view relates to “zongbu”. It says in the Huai Nan Zi 淮南子: “Yi became Zongbu after eliminating all dangers.” Zongbu was annotated by Gao You53 as “what today people worship in their houses”. “Zongbu” is homophonic with “Zhongkui”. The ghosts most despised by the people were evil devils, demons and monsters, the like of which had been transformed mostly from animals or plants, not from ancestors. Yet some humans could also become ferocious ghosts or even devils. All these goblins and gremlins were considered especially to associate with those which cause disease and disaster. To deal with them, some power gained through mystical mutual permeation was needed. That was peach wood. In Wang Chong’s Lunhen – Dinggui Chapter (论衡·订鬼篇) which was cited in the Mountain and Seas Classic (山海经) (unavailable today) the words “in the vast tracts of ocean, there was a mountain named Dushuo on which a giant peach tree grew, winding and stretching as far as three-thousand li. Among its flourishing branches, on the northeast part, there was a gate named ‘ghost gate’ where ghosts used to go in and out. On the peach tree, two deities, one Shentu, the other Yulei, were in charge of all the ghosts. If a ghost had done something evil, they would bind him with reed ropes, to feed to a tiger. Therefore, Emperor Huangdi laid down rules of etiquette to exorcize them — according to the changes of 53

 A scholar in East Han Dynasty, who once made annotations for Huai Nan Zi, Mister Lu’s Spring and Autumn Annals, and Intrigues of the Warring States etc.

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seasons — and giant figures carved from peach wood were erected, images of Shentu, Yulei and the tiger were painted on the door and reed ropes hung to keep ferocious ghosts away.” In the Sou Shen Ji (搜神记), some chapters are missing, but still sayings can be found, like “according to today’s customs, at the end of every year, on New Year’s Eve, human-shaped figures of peach wood would be used to decorate the door, reed ropes hung on the door, and a tiger painted on the door with two lanterns hung on either side, to signify the eyes of the tiger. All these were to expel misfortune.” The Chinese habit of decorating their door-knocker with the pattern of a tiger’s head is probably related to this. Also a peach charm was made with “some thin, peach wood-plate, two or three chi long, four or five cun wide, painted on the upper side, with images of the gods, Suanni54, Baize55 and the like, written on the lower side with Yulei on the left and Shentu on the right, or else written with words of welcome to the spring, or congratulatory speeches. On the next morning, the peach charm would be replaced.”56 Some variation of this custom was “on the first day of the new year, …a painted chicken picture is glued on the door of the house, hung with reed ropes and stuck with a peach charm beside it so as to frighten away ghosts.”57 Some ghosts were associated with the He Tu Kuo Di Tu (河图括 地图): “on the Taodu Mountain, there was a giant peach tree, winding and stretching three thousand li, on which a golden cock rested, crowing as the sun shone; below which two gods, one named Yu and the other Lei, held reed ropes waiting for evil ghosts to kill.” Shentu and Yulei were later replaced by Qin Qiong (秦琼) and Yuchi Gong (尉迟恭) during the Tang Dynasty. In a word, either cross-replacement or mystical mutual permeation remain essentially the same, despite all apparent changes — using the power of mutual permeation to bring evil ghosts under control. Since what was harbored in the hearts of the living toward ghosts was basically fear, either the worship of ancestors or burying the dead was needed to please them. This was probably one of the psychological causes behind elaborate funerals. They might have been to provide the ghosts underground with everything they enjoyed in the human world. Kneelingdown burial, converse burial, prone burial, flexed burial etc. made sure they did not return to the human world to do harm, after they became ghosts. Living sacrifice was either made to accompany the dead so they enjoyed 54

 A mythical animal in the shape of lions.  A mythical animal. 56  from the Huangchao Suishi Zaji 皇朝岁时杂记. 57  from the Jingchu Suishi Ji 荆楚岁时记. 55

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their life in the underworld, or else to suffer the torture and atone for their crimes, because they might have caused the death of the dead person. People believed that a death penalty together with some special form of the burial could restrain a ferocious sinner. It was unimaginable that they would penalize the murderer — for people believed ghosts were stronger than humans. Hence the attitudes toward ghosts were divided into two, i.e. to worship your ancestors’ ghosts; and to expel ferocious and evil ones. This was different from the respectful attitude toward the worship of gods. Accordingly, humans got closer with ghosts and understand them more; while the relationship with gods was farther away and humans knew little of their mysterious power. They could only please and respect them, they could not resist them. But regardless of this, the worship of ghosts and gods which begun in the ancient times and lingered till today, stealthily keeps up its popularity. Therefore we can make generalizations when we discuss it. However, in the West people do not fear dead bodies, nor much believe in ghosts. Their tombs are placed in the churchyard, quite near their houses. This differs from the Chinese concept of ancestor worship and the worship of ghosts and gods. It is this concept of worship — ancestor worship and the worship of ghosts and gods — which from beginning to end has impacted the Chinese concept of life and death. The concept of ghosts and gods changed with the prospering of natural philosophy in later years. But the concept of ghosts and gods by no means withdrew from the historical stage. The entirety of what has been described above centers on major aspects of Chinese primitive worship — but while maybe one thing has been cited, ten-thousand have been left out, and some views of the author have also been presented. The list is far from complete. The modes of Chinese primitive worship can never be crystal-clear. Nevertheless, they played a major part in the Chinese concept of life and death, the concept of disease and much else during the ancient era.

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The Primitive View of Life, Getting Old, Illness and Death: The Pursuit of Longevity The primitive view of life, getting old, illness and death appeared under the framework of the primitive mentality of China. The pursuit of longevity became an aim which has never been given up by the Chinese people.

A.  The Earliest View of Life and Death 20.  The Original Understanding of Human Life Primitive people were originally unable to distinguish between life and death, as a mystical mutual permeation and animism gave meaning to all life for them in differing forms — and all things in the world were thought to have life. Before the period of animism, all things were believed to be alive, in the so-called “theory of living things”. However, during the period of animism, the essence of life was believed to lie in the soul, which drifted around and possessed things, giving them so-called “life”. In the first place, some lifeless objects were considered to be alive. A common example is the Oath of Alliance between Wood and Stone which shows such an indication, as recorded in the novel The Dream of the Red Mansion (红楼梦). In this novel, a magical Spirit Gem is the dwelling-place of Jia Baoyu’s soul and if he loses it, he will pass out. The myth of Kua Fu Chasing the Sun (夸父追日) in remote times tells how Kua Fa wanted to catch the Sun by running after it (which also shows that the Sun was alive as are humans). The Huai Nan Tzu (淮南子) records, “Yi shot an arrow at the Big Wind and killed him at Qingqiu Lake”, so here the wind is considered to be alive. The Records of Things Bizarre (述异记) states “At the time 101

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of the Jie tyranny, Mount Tai walked and the stones wept”, which is not just a case of personification, but a real idea in the minds of primitive people. The You Yang Za Zu (酉阳杂俎) state, “There was a Stone Man in the sea of Laizi country, 1 zhang 5 chi in height and with a waistline 10 times that of an ordinary man. The First Emperor of Qin sent him to chase after Laoshan Mountain, but he failed and thus has stood here ever since.” In this tale a stone can chase after a mountain. Sui Chaozi (随巢子) records, “Yu the Great and Qi were both born from stone”, which indicates stone has the ability to reproduce just as Sun Wukong, the stone monkey, jumped out of a stone in the novel Pilgrimage to the West (西游记). The Classic of Mountains and Seas (山海经) records, “Rainbows reside in the North, each having two heads”. According to Notes on Maoshi (毛诗正义), there are both male and female rainbows and each time they appear as a couple. Both the Bizarre Collections (异苑) and Talks at Maoting (茆亭客话) tell the story that the rainbow drank wine on the ground, from the air. In the epic belonging to the Bai Nationality, is described the very first age of chaos, when trees and stones were able to walk. Many common sayings indicate the same. For instance, the stones can talk; a dog in Heaven eats up the moon; the sun was shy when getting married to the moon, so he cast a pack of golden needles over his face to hide himself from the other’s sight. These descriptions may well be regarded as literary personifications, but this only became the case after the age of primitives. People originally thought these were facts — and that all things in the world were alive just the same as humans. As for animals and plants, primitive people believed that although they were not human, their life was equal to that of humans. Modern people may not be too surprised to hear that “the gorillas knew our name”, as recorded in the Classic of Mountains and Seas (山海经) and that “the apes can talk”, as recorded in the Book of Rites (礼记) — but fables such as “the struggle between a snipe and a clam”, “the fox taking advantage of the awfulness of a tiger”, “the frog at the well-bottom” and “snakes in a dried-up lake”, are regarded only as imaginary. Yet primitive people didn’t doubt that there was a similar spirituality between animals, plants and human beings. The aged apricot tree, the locust tree, the wolf and the turtle recorded in books such as Zhongshan Wolf (中山狼), Goddess Marriage (天仙配) and Bizarre Collections (异苑), can all speak, communicate and even make a good match or deceive other beings. The History of the Han Dynasty (汉书) records that, “Bo Yi knew the language of birds and beasts” and “Bo Yi was able to understand a variety of bird languages”. Many other ancient books have

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records of people understanding the language of the birds, beasts, snakes and so on. In a primitive age, such an ability was not regarded as exceptional but ordinary — and knowing nothing about the language of animals and plants was seen as quite inconceivable. Actually, this understanding is only thinly disguised self-approbation — as they simply deemed animals and plants to be equal to humans. This shows that primitive people were unable to realize the implication of their own lives — as being different to those of animals or plants. They didn’t know that things such as the mountain, the stones, the wind, fire, water and earth were lifeless, but mystical mutual permeation made them believe they all were just as alive as humans. We should not instantly draw the conclusion that their view of the world was absurd. It may just be that it shows us the extreme origin of the natural and philosophical foundation of Chinese medicine. Just as animism was a common way of thinking for primitive people, so they regarded the soul as the distinguishing feature of life. If there was no soul, there was no life. In a sense, for them there existed a distinction between life and death. Lifeless or dead things suddenly becoming alive was seen as the special endowment of having a soul. But they thought that although animals and plants had life, that life was feeble as their feeble soul. The life of humans undoubtedly depended on the existence of the soul, which could exist either independently, or re-vitalize something by possessing it. As a result, the death of the body together with the immortality of the soul (without a body) became recognized. This gave existence to the idea of the “immortal soul although the body can be rotten”, as mentioned in the section on primitive worship. So then, does human life or the having of a soul make people superior to other creatures? Hierarchical recognition came into being a little later, at least after the recession of the nature and totem worship, and the rise of ancestor worship. The Book of Rites – Sacrificial Ways (礼记·祭法) states, “All things in the world are destined. The death of humans is called a 鬼, while the death of other creatures is called a 折”. It is noted that “折” means being destroyed. Plants and animals are all utilized by the humans, so their death usually results from damage. 鬼 means a return. So then human death is seen as a total return to nature. This evidences that all other creatures are inferior to humans because they are utilized by humans. Later, Wang Chong recorded in his Discussion on Balance (论衡) that “The essential qi forms the human form, while the turbid qi forms the animals”. This provides us with a further understanding of hierarchical recognition.

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Since the existence of the soul was considered both an entity and a possession in the world of animism, it represented the essence of life, and consequently must possess substance to have any reality. Surely, the coexistence of both soul and body was what gave significance to life. The greatness of human daily life, its labour and pleasure gave substantial meaning to the coexistence of the soul and body, leading to an increasingly high value being given to the body. Probably, due to this, even when the soul was separated from the body, people might also be extremely unwilling to admit death — until the body decayed. They wished it to be just a temporary absence of the soul, just as in dreams and unconsciousness, and they wished that it would come back a while later. A common explanation given of primitive people’s “secondary burial” is that it involved moving the body to a cemetery to let the soul live together with other souls of the clan. However, Xia Nei holds that “There is a belief that the body belongs to the land of living and the last formal burial can only be carried out after the body decays. Only at this moment can the dead enter into the soul world”.1 The author thinks this might not be enough to explain the practice, and there is possibly another explanation. At the first burial, primitive people believed the soul was not far away from the body and there was chance of revival. With time, the body rotted and as there was no hope of revival, the dead body was then moved to the clan cemetery. This can be proved by the evolution from “secondary burial” to the encoffining of the body and keeping vigil beside the coffin for 3 × 7 days to 7 × 7 days after the death. And afterwards, this practice evolved into a sacrifice being made each seven days, namely on the 7th day, 14th day, 21st day… until the 49th day, to express good wishes to the departing soul. Customs or rituals for calling back the soul of the dead definitely relate to the idea that the soul was still around nearby — or on the wrong path, so could be called back into the body. For example, the Book of Rites (礼记) notes, “Stand on the roof to call back the soul” and “There are soul-callers to call back the soul”. The Book of the Later Han (后汉书) records, “There are rituals for calling back the soul and for establishing the time for holding the funeral and burying the dead”. One custom is as follows: The soul-caller gets on the roof of the house at the front and by holding the shroud, calls the name of the dead 3 times making a long sound to let the soul come back into the shroud. Then, he gets down at the back of the house and puts the shroud back over the body. The funeral begins only if the dead person does 1

 Xia Nei. Excavation Records in Washann, Lingtao Temple published in the 4th volume of Acta Archaeologica Sinica in 1949.

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not come back to life 1 or 3 days after the rite. For those who die in foreign lands, the rite of calling back the soul was carried out on the vehicle travelling to the site. There are also the customs of hanging Soul Recalling Streamers beside the coffin or outside the house, during the time of the funeral. For the Southwestern Yi people, they even have a custom of erecting a puppet of the dead to call back the soul — it takes place during the month before the funeral. The puppet is then placed in a quiet or a deep cavern, in a high hill close by. During the period of the poet Qu Yuan (343–278 BC), there was a differentiation made between heaven and hell and he was the earliest poet to record this in the literature of China. He wrote in Calling Back the Soul (招魂) that heaven was not a paradise and that hell only gloomy and frightening, so it can’t be better than living in the human world. The poem is as follows: Soul, please don’t go straight to the heaven! Please come back! There are tigers and leopards at the heaven gate! They bite and injure humans on earth. There is another monster with nine heads. It can pull out nine thousand big trees. There are wolves with vertical eyes. They run to and fro in groups, And toss humans for games, Until the human is thrown into the bottomless abyss. Then they will report it to the Supreme Being, Before you breathe your last and close eyes. For all these misfortunes, Soul, please come back! Soul, please don’t go straight to the hell! Please come back! Tubo guards there with nine ropes. His horn on the head is sharp as knife, His back thick and burly and thumbs with blood. He chases humans as fast as flying. There are also tiger-head monsters with three eyes each. Their body is as strong as a bull. All of them like eating humans. For all these disasters, Soul, please come back!

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In short, the poem tells us quite clearly that it is better to live in the present than to go to heaven or hell. Therefore, people then had learnt the profound value and pleasure of having a living body. Tales such as the Weaving Girl in Heaven “thinking of worldly pleasures” and the Goddess of Marriage with a common man, which came later, are all rational demonstrations of celestial beings clinging to immortality. Primitive people felt depressed and fearful if the life of the body came to an end. Soul immortality is a concept, while the dead body is a reality. From a few pottery figurines buried with the dead unearthed from late Yin (Shang) Dynasty tombs, we can see that people were unwilling to be buried with the dead — nor did they want to let their bodies die. It proves the two worlds of the living and the ghostly had, by then, tended to separate and the real value of life was being emphasized. Henceforth, the idea of pursuing the nurturing of life when alive, and resurrection after death would soon begin to emerge.

21.  The Origins of Birth Since the life of the body was so precious, the origins of birth were destined to be of great concern to primitive people. This can also be regarded as an issue of phallic worship and its evolution. The genital organ is surely great — because the body is created by it. However, the body could not come to life without the soul, so how did the soul integrate with a new body? This was a concern for primitive people. Nu Wa (女娲), a goddess in Chinese mythology, is seen as picking up a pinch of loess to create a human being, which is no different from Jehovah making humans from the earth, as recorded in the Bible. The loess stands for the earth, a place that creates everything. Therefore, it was originally thought that the human body came from the earth and this had a lasting influence on nature worship. However, Jehovah only made Adam from the earth — Eve was made from Adam’s rib. They were tempted by the snake to eat the forbidden apple and thus expelled from the Garden of Eden. Human beings have reproduced ever since. As for Nu Wa’s tale, Customs Comprehension (风俗通义) records, “Folklore tells us there were no humans when the sky and earth separated. Hence Nu Wa picked up a pinch of loess to create a human, but the human was never created even she toiled. So she then put ropes down into the mud and threw them in the air. As the drops of mud fell down, they became humans. Those rich and honoured were created by the loess, while the poor, humble and common people came from the drops of the mud.” In a sense, Nu Wa’s method was an improvement

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because she created humans in batches, which is different from the Bible’s legend. In addition, there are legends of help coming from Deities for Nu Wa during the time she was creating humans. The Huai Nan Tzu (淮南子) states, “Huang Di determined the gender, Shang Pian determined the ears and eyes, and Sang Lin determined the hands and arms. That’s generally why Nu Wa was able to create so many people.” The Classic of Mountains and Seas (山海经) records, “There are 10 Deities, who were transformed from out of Nu Wa’s intestines. They lived in the wild fields and lay on the pathway to rest.” Judging from the above, the idea of Nu Wa as reproduction goddess is probable, but it seems that the soul derives from another source — being endowed by a deity. How does the human generation continue? Customs Comprehension (风俗通义) records, “Nu Wa prayed to be appointed as matchmaker in the shrine and became the one who arranged the marriages.” Nu Wa became the earliest matchmaker. The Long History (路史) states, “As Nu Wa was matchmaker, people from other countries afterwards offered a sacrifice to her as the Goddess of Marriage.” “The second month of spring, people offered a sacrifice of cattle, sheep, pigs and so on to the great matchmaker” — this is recorded in The Book of Rites (礼记), and is just the kind of sacrifice made to her. However, the relation of marriage to reproduction and life was not discovered until later on. For example, The Classic of Mountains and Seas (山海经) records, “The Female Country was on the north of Wuxian, surrounded by water and where each house was occupied by two women.” Guo Pu further remarked, “There was a yellow pool at that place and women got pregnant after having bath in it. If the baby delivered was male, he died before 3 years old.” Such is the belief in monogenesis! Nevertheless, the marriages enabled by Nu Wa are the earliest recorded, and they reflect a transition from consanguineous marriage to pairing marriage — at an early stage of primitive society. The time of Nu Wa creating humans by “picking up a pinch of loess” is equivalent to the initial age of making pottery, while the time of Nu Wa and Fu Xi’s marriage and reproduction fits the age of the appearance of pairing marriage. Both these periods occur during the stage of matriarchal clan society. Records of Peculiar and Foreign Things (独异志) states, “At the beginning of the universe, there were no people other than Nu Wa and her brother in the world. They lived in the Kunlun mountains and discussed becoming a couple, but they felt ashamed. But her brother instantly took Nu Wa to the top of Kunlun mountains and swore ‘if the heaven agrees with us being a couple,

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please gather the clouds together; if not, please dissipate them.’ The clouds gathered together at once and they became a couple.” Among the ethnographic records, there are similar stories in many southern minorities, such as the Miao, Dong, Yao, Li Su, and Yi.2 For instance, Fu Xi (伏羲) and Nu Wa released the imprisoned Thunder God, who hinted to them about planting a kind of bottle gourd in order to escape from the continual floods. The Thunder God induced a tremendous flood later on and only Fu Xi’s siblings were able to escape — by riding on the ladle of the gourd. They then made a fire on top of two different mountains to produce smoke, trying to see whether they should become a couple and reproduce as humans. Since the smoke from the two mountains merged, Fu Xi and Nu Wa became a couple and gave birth to a geek shaped something like a “flesh roll”. This “flesh roll” was chopped up and scattered over the plains and mountains. Humans came into being in all these places, including the races of the Han, Yao, Zhuang and so on. Legends of Fu Xi and Nu Wa coupling in order to give birth to humans are many and have long been in existence. The image of their coitus as first ancestors can be found in many portraits and stone carvings of Han Dynasty. Xu Xusheng, during modern times reviewed both field-visits conducted by Rui Yifu (an anthropologist) and analyses of legends in districts of the Miao nationality. He noted that the Miao sacrificed both to Fu Xi and Nu Wa — as in some of their legends, the honoured female was called Ku-eh, similar to the ancient pronunciation of Nu Wa, while the male was called Bu-i, similar sounding to Fu Xi. The original meaning of “Bu” was ancestor and “I” means the first, so in combination, they mean “the earliest ancestor”. The appearance of these two names is not a coincidence along with the legend of Han nationality, but it may actually show a spread from south to north. Traces of this idea can be found in Zhuangzi (庄子) and the Songs of Chu (楚辞).3 All the above show where the body came from — namely from sexual intercourse. So where did the soul came from — to endow the body with life? Further investigation is required. Judging from stone-relief images, Fu Xi was the sun god and Nu Wa was the moon goddess, who are lifting up the solar disk with a golden crow and the lunar disk with a gold striped toad respectively. Does this depiction of yin–yang simply imply the source of the soul during the course of reproduction? Probably not. The Genealogy of the Spring and Autumn Period (春秋世谱) records, “Hua Xu gave birth to a boy called Fu Xi, and a girl called Nu Wa”. The Celestial Foggy Poem Weft (诗纬含神雾) 2

 See Xu Xusheng. Primitive Worship and Chinese Ancient Gods p.97.  Refer to Xu Xusheng. Legend Era of Chinese Ancient History, Science Press, 1960, p.237.

3

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states, “There were giant footprints (of the Thunder God) in Leize. One day, Hua Xu stepped on them, they interacted together and Fu Xi was born”. Hua Xu was the mother of Fu Xi. Lieh Tzu (列子) records, “Hua Xu’s country … is millions of miles away from Qi State, so it can never be reached by means of transportation except through the wandering of the mind.” There are many descriptions of this wonderful country, such as “water never drowns people, fire never burns people, and cutting and whipping cause no pain or injury”, and “they ride on the air like walking on the land, and rest in empty space like lying on a bed, clouds and fog never blind the vision, thunder never deafens the hearing, and neither good nor bitter words disturb the heart”. The Biographical Sketches of Xuan Yuan (轩辕本纪) states, “Huang Di visited Hua Xu’s country and said this is a celestial country.” Accordingly, Fu Xi is the son of a celestial country, and his father is the Thunder God because his footprints interacted together with Hua Xu, and Fu Xi was born. Hou Ji’s birth was similar. The Book of Songs — Birth of a People (诗· 生民) states, “At the beginning, our ancestor was born and his mother was Jiang Yuan. How was our ancestor born? Because Jiang Yuan prayed as she was without children. As she stepped on the footprints of the celestial god, she felt her thumbs tremble and was blessed to conceive a baby. The foetus was sometimes quiet and sometimes active. Then she delivered the baby and took good care of him. That baby was named Hou Ji.” Contrary-wise, if there is only intercourse between man and woman without the interaction together with a god, no baby will be conceived. “Interaction” thus became the key to the source of life. The above section shows the effect of the rule of mystical mutual permeation — in that new life can only come from sexual intercourse and interaction together with a celestial god. This “interaction” means the conveyance and endowment of a soul. Similar tales about birth through interaction are numerous, and prove this view. For instance: Hetu’s Search for Life Signs (河图稽命征) records, “Fubao, Huangdi’s mother, saw a giant flash of light encircle the Big Dipper and lightening the whole area. She then conceived due to its interaction and gave birth to Huangdi, surnamed Xuan Yuan, in Shouqiu.” The Spring–Autumn Primordial Life Bud (春秋元命苞) records, “An’deng, Shaodian’s concubine one day visited Huayang and suddenly a fairy dragon-head emerged from Changyang to interact together with her. She thus gave birth to Shen Nong, who had a human face with the luster of a dragon. He was good at farming, so he was called the Patron of Agriculture and became known as the son of heaven.”

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Biographical Sketches of the Three Emperors (三皇本纪) records, “Yandi is just another name for Shen Nong. His family name is Jiang, and his mother was Nudeng, the daughter of Youshi and concubine of emperor Shaodian. His mother conceived him after she interacted together with a fairy dragon.” The Spring–Autumn Primordial Life Bud (春秋元命苞) records, “In the period of Huangdi, there came a star moving like the rainbow. It fell down at Huazhu and Nujie caught it in her dream. Their mental interaction together resulted in the birth of the White Emperor, Zhuxuan, also named Shaohao.” The Celestial Foggy Poem Weft (诗纬含神雾) records, “Yaoguang, one of the stars of the Big Dipper, shone like a rainbow and travelled in front of the moon to interact together with Nushu, giving birth to Zhuanxu.” The Spring–Autumn Combined Honesty Drawings (春秋合诚图) record, “Qingdu was Yao’s mother. When she was aged 20, she lodged in Yichangru’s house. She had no husband and at one time, she went to watch the source of the Three Rivers when suddenly the rain poured down around her. She interacted together with a red dragon and got pregnant, afterwards giving birth to Yao.” The Book of Songs (诗经) states, “The gods sent a heavenly blackbird to earth and the Shang Dynasty’s ancestor was born.” This is similar to the record in The History Records — Biographical Sketches of Yin (史记·殷本纪) that: “Qi was the ancestor of the Shang Dynasty. His mother was named Jiandi, the daughter of Youkushi and second wife to Diku. One day, Jiandi went outside to have bath with two others. She saw a heavenly black bird drop its egg, so she picked it up and swallowed it. She thus got pregnant and gave birth to Qi.” Biographical Sketches of the Zhou (周本纪) records: “Hou Ji was the ancestor of the Zhou Dynasty and his childhood name was Qi. His mother was named Jiang Yuan, daughter of Youshaoshi and queen of Diku. One day, Jiang Yuan saw a giant footprint out in the wild fields and felt quite excited, so she stepped on it and suddenly her body trembled. She thus got pregnant and gave birth to Hou Ji some time later.” Biographical Sketches of the Qin (秦本纪) records that Nuxiu gave birth to Daye after she swallowed an egg of a heavenly blackbird. Biographical Sketches of the First Han Emperor (高祖本纪) records that Liu Bang was born thus: “His mother, Liu Ao, who once rested on the bank of the Daze and dreamed of interacting together with a god. At that time, it was dark all around and Taigong, Liubang’s father went to have a check on her. He found a dragon entwined around her and consequently she got pregnant. She then gave birth to Liu Bang.”

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These records show lots of ancient emperors and great people are related to the lightning, the rainbow, the Big Dipper, fairy dragons and such things, endowing them with extraordinary and strange souls. The effects of sexual intercourse became secondary. The text Explaining Characters (说文) states, “Of all the saints born through interacting together with heaven, none had a father”; and “the sons of ancient saints were born through heavenly interactions, so they are called celestial sons”. However, there are still traces of sexual intercourse in fairy legends. For example, why should Taigong, Liubang’s father go to check on Liu Ao? We can infer that at this time of mystical permeation, life was associated with sexual intercourse because of the idea of contact and transmission. As for the common people, the effect of sexual intercourse on reproduction was quite clear, but if infertility occurred, praying for the god’s endowment was also common, probably associated with the soul interacting with fairy beings. “The kylin (unicorn) sent me a baby” is a most commonly held belief. It is the continuation of the totemic myth and wish to possess a healthy, superior soul as well. In the areas around Zhejiang Province, if a married woman is unable to get pregnant for 1 to 2 years, the husband’s relatives will make a paper baby on the 16th night of the first month of the lunar year, and draw pictures of “a kylin sending a baby” on glass lamps, and then send them along with drums and gongs to the woman’s home with prayers for the baby. There was an old custom in Wenzhou city that an unfertilized woman should kneel in front of the town god’s temple with her shoulders exposed. Female companions would use fine bamboo branches to lightly strike the exposed shoulders, calling it “inducing pregnancy”. Meanwhile, the woman would mutter “I hope the god will feel my sincerity and send me a jade kylin”. Hu Puan recorded in Records of Chinese Customs (中华全国风俗志) that “the kylin is a shrunken dragon with a child riding on it — it circles in front of the hall of the house, calling ‘kylin, send me a baby’”! In addition, people in Anhui province have a custom of “taking away the mud baby”. They would take away a mud baby from the mountain god temple in Siding Mountain on the 15th March of the lunar calendar, generally calling it “stealing the baby”. After a real baby had been born, they had to give back the mud baby gaily dressed, calling it “giving back the baby”. In Beijing and some other areas, the custom of “tying the baby” is also similar. “Candling the dragon” is a custom where a woman praying for a baby exchanges a new candle for an old one after the dragon lantern parade. Just as the Poems of Custom Records in She County (歙县 纪俗诗) records:

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Lantern lights at the festival of lanterns, The long bank lined with the long dragon! The dragon dancing and drums make a noise; Struggling, people beg for a candle before the dragon head. Candle’s been got, and it’s a good time for going back to the bedroom. There are also customs such as “stealing a gourd to send for a baby” and “sending a taro baby” for pregnancy, which are both in the realm of taking advantage of mutual permeation for transferring a soul. After giving birth to a baby, they would “thank the god for sending a baby”. In some areas of Anhui and Shandong provinces, people offered a sacrifice of wine and burnt pilgrim paper outside the delivery room on the 3rd or 8th day after giving birth, for “the goddess for sending a baby”. They were afraid the the soul of baby would be taken away. In central China, some children even have to wear blue and purple trousers with one trouser leg blue (lan) and the other leg purple (zi), homophonic to “lan zi” (getting a baby) in Chinese. There is a Han custom performed on the 20th March of the lunar calendar. It is to offer sacrifice to the “Birth Goddess”, who governs pregnancy, delivery, and keeping healthy for a baby. Women would offer a sacrifice and pray to conceive or for the healthy growth of children. Those who have no child would consecrate flowers to the goddess and insert a hairpin in their braid; those with sick children would beg the small embroidery shoes off the altar then, with a red thread, hang the shoes by the side of a sick child. Some people would entwine some kind of lock, plate or thread along with the smoke of joss sticks, and then hang it by a red thread in front of the child’s chest for longevity. This can only be removed at 16 years old and after thanking the goddess for her protection. This “thanking” just means giving thanks for the sending of the soul. Much later came the recognition that the soul could transform the life of the body. The second chapter mentioned how the Chinese people’s worship of ghosts and gods was differentiated by the partition “god–human–ghost” — which was connective as well as partitive. The soul wandered among them in differing forms. The god-soul is supreme, so most fairy-tales which tell of the interactions of birth accord with this and describe humans as emperors or heroes. The human soul or life-soul stands for the thoughts and mental activities which control all behavior. The life-soul leaves the body and changes into a ghost-soul when the human dies. The human body is thus deprived of its mental activities and life behavior. In the West’s “Anima

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Theory”, the soul is categorized into a plant-soul, which controls nutrition, an animal-soul, which manages feelings, and a life-soul, which governs reasoning. This is a distinction between plant, animal and human. In Chinese custom, the soul is generally an ethereal soul, a corporeal soul, a consciousness, a will, thought, consideration and wisdom, which make up the seven differing functions of the soul along with the life-soul which governs reasoning. Therefore any living body must have a soul. Having dreams or being in a coma is regarded as a temporary departure of the soul from the body, but it will not leave forever, or death will be the result. Kong Yinda noted in The Spring and Autumn Annals – Zhao 7th Year (左传·昭七年), “The soul is called Po (魄)，a corporeal soul when it possesses bodily form; and an ethereal soul when it possesses bodily qi is called Hun (魂). The former comes into being when the baby is born, and is reflected in the senses of the ears, eyes, heart, movements of the hands and feet, and sound of crying. The latter comes into form as mental activities and recognition gradually matures.” This is the traditional understanding of the corporeal and ethereal souls. In comparison, the ethereal soul is more important, because it represents mental activities and consciousness. Of Immortals (仙纵) records Li Tieguai (李铁拐), one of the eight immortals: “his family name was Li, his body sturdy, and he comprehended the Dao at an early age and practiced cultivation himself in a grotto. … One day, he went out to make an appointment with Lord Lao Zi on Huashan Mountain, so he told his apprentice, ‘My corporeal soul will remain here and if my ethereal soul doesn’t come back, you can deal with my corporeal soul.’ However, after six days, the apprentice had to go back home suddenly as his mother fell ill. Therefore, he dealt with the corporeal soul (the body). When Li came back on the seventh day, he found his corporeal soul gone and his ethereal soul had nothing to possess. He could do nothing but possess a body which had died from starvation. As a result, his appearance became lame and ugly.” If the corporeal soul existed without an ethereal soul, it had nothing else to do but die. According to folk custom, the seven days after birth are known as one “la”, during which one’s corporeal soul comes into being. After seven periods of la, seven corporeal souls are formed. People initially are born with a corporeal soul, while the ethereal soul comes in later and its tempo and firmness are not the same. Even in modern times, folk will reprimand their children as having a “lagging residence of the soul” if they cannot remember grown-up’s words, the contents of a book or don’t use their head. People of the Dulong nationality carry out a sacrifice when the baby reaches one week old, calling it “Pulalu”. It is presided over by the wizard Nanmusa and is for

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the safety of the child’s soul. It implies an intention to tranquilize the soul, which verifies that people don’t think the soul in children to be stable. People of the Buyi nationality take frightened children who have perhaps experienced falling into water, falling down from a tree or rock as a soul which has been lost, so they then will sacrifice a goose or duck egg, or burn joss-sticks or pilgrim paper until the egg rights itself or an insect climbs up a ladder, indicating that the soul has found its way back. In the evening, family members will shout loudly out the child’s name whilst eating eggs, rice and so on. This is called “ganwen”, namely “calling the soul”. In villages of the Han nationality, people have a similar custom, but it is relatively simple. They place the frightened child at the area where the accident happened and then shout out “frightened Jack has come back” first, with “has come back” as the refrain or response. This is performed along the whole route, from the place back to the family house. Then the adult will pull child’s ear and call lightly several times, meaning the soul has come back. People of the She nationality also have a custom of calling the soul. The child’s grandmother will cast tea leaves and rice outdoors and call “Come back! Don’t be scared by the chickens crowing and dogs barking. Please come back from the east if you are frightened in the east, from the west if you are frightened in the west”. The child’s mother will lie on the bed and reply “has come back”. In places like Shaanxi province, when the baby is born, they pray for protection from the gods and hang a red-cloth necklace holding a silver plate with the writing “longevity” on it, over the child’s neck. Another layer of red-cloth is added to the necklace on the next birthday. This continues until at the age of 12, during which, when the sacrifice is held before the god, the necklace is removed, calling it to “dajia”. This means the soul has stabilized and the child has become an adult. In areas around Taiwan and Fujian province, the necklace is removed at the age of 16. There is another custom that any boy should be fostered as a girl by giving him long hairs and wearing colorful clothes — because they think a male soul is more valuable and fragile. These folk customs show that a child’s soul is different to an adult’s: that their ethereal soul stabilizes gradually and that the corporeal soul gives us only a preliminary existence in this life. This is, of course, associated with reincarnation. The new birth of a baby means the reincarnation of a soul. But the soul has to follow a set course to gradually possess the body. The soul is not so steadily integrated with the body until 12 years old. This is actually related to the child’s susceptibility to early death among primitive people — but they thought it was due to the unfixed possession of a soul. People of the Dai nationality will check

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footprints around the fire pit at home, after a funeral. If there are the footprints of a cat or dog, it is thought the soul has incarnated in the cat or dog; if there are footprints of a human, the soul has incarnated in a human; and if there are no footprints, the soul has gone to heaven. People of the Kelao and Naxi nationalities will invite wizards to cast spells for preventing the dead from cruel torture and let them have a smooth re-incarnation. People of the Naxi and Mengba nationalities believe “incarnation will be easy if the shape at death is the same as the shape at birth”, so they hold to squat burials where the dead body is bound into a squatting shape, is similar to the baby before delivery. People of the Hezhe nationality think women over 30 years old who have no pregnancy have a lack of “fayangku”or soul for incarnation. The souls of a dead child finds it much easier to be incarnated — and some believe it changes into a sparrow before the incarnation, while some will invite the Shaman to find the soul and rituals are held to catch it in a “soul-catching bag” for the parents, who will then conceive another child later. A custom among the Han Nationality is that the dead should wear swaddling clothes once for the purpose of incarnation. In areas of Sichuan province, “incarnation divining” is popular. After the straw and towels of the dead have been burnt, wizards are invited to forecast the duration of the incarnation by observing the pattern of straw and towel ash. Common people are not born from interaction with a god like emperors, but directly from the soul of other common people, or even from animals. People of the Bulang nationality in Yunnan province will eat food mixed with a pig’s liver, heart and rice when they get married, because it is said that a soul resides in a pig’s liver and heart and having them inside one can help one get pregnant. In areas of Qinghai province, if the newborn is in shock, they need to cut a cock’s head off at the doorsill of the delivery room, coat the chicken blood on the lips of the baby and then call out the name of the child’s father. After the baby recovers from the shock, “jiai” (chicken suffering) is used as the baby’s pet name, because they think it is a trade-off of life — and that the soul came from the cock. These examples indicate that the success and tranquilization of the incarnating soul requires a real process. Besides this, there is another view. That is, that the mother gives the body and the father endows the soul. This has appeared indistinctly among some primitive people. The Book of Songs – Xiaoya (诗经·小雅) records, “My father gave birth to my soul and my mother gave me my body and cared for me”. Fairy-tales of birth interaction also imply the sense of a god’s soul being transmitted from the husband. For example, in the case of Jiang

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Yuan giving birth to Hou Ji, she had sexual intercourse with her husband before “she stepped on the footprint of the celestial god”. The celestial god may also refer to her husband and because “she felt her thumbs interact with trembling”, it may be a kind of sexual pleasure felt after ejaculation. The soul may be actually transmitted by the sperm. This is illustrated more clearly in the tale of Bao Si’s birth, recorded in Stories About Famous Women (列女传): “Two dragons entered the imperial court and had sexual intercourse. Divination suggested it would be favorable to store their sperm in a box. … During the period of the Zhou Dynasty Li Emperor, the emperor was curious and opened the box to look inside. He was so careless the dragon sperm spilled out into the imperial court and could not be removed by any means. The emperor then asked his maids in the imperial palace to shout out with their naked bodies. The dragon sperm then changed into a big soft-shelled turtle and entered the imperial harem, where it encountered a girl who got pregnant without a husband at the age 15. The baby was namely the enchantress Bao Si.” This is no less than the “cold storage of sperm” and “artificial insemination” of modern times. Though the story is ridiculous, the sense that the soul is transmitted by the sperm is clear. According to ethnographic records, pregnant women of the Pumi nationality in Yongning, Yunnan province will use a man’s pants to rub their abdomen with if they have a difficult labour and meanwhile, say “please come out, my baby — your father is waiting”. In a ceremony of worshipping the ancestors, the people of the Miao nationality in Taijiang, Guizhou province have a procedure of “crossing the bridge”, during which five wives of “guzangtou” will dress in man’s clothes and go across a low stool that stands for bridge. After they cross the “bridge”, it means they have been fertilized and they can take off the male clothes. Mr. Song Zhaolin, among others believes that although it is the women being disguised as men, it still tends to stress that women will not get pregnant without the help of a man.4 The author holds that a further meaning is that it is the ritual of birth interaction among the common people, which tends to tell of the soul possession of children only after men offer insemination or shout. People of the Mosuo nationality have a similar ceremony of reproduction. They put up an 80-cm high and about 90-cm wide stone with a dent on top of its flat surface, representing a female genital stone and calling it a “jiu mu lu”, in a cavern. Above the stone, they hammer in a penis-like stalactite, from which water drips down into the stone dent below. The 4

 Song Zhaolin, History of Chinese Primitive Society, pp. 489, 490.

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accumulated water is called “ha ji”, indicating male semen. At the time of praying for pregnancy, a woman is accompanied by a wizard, husband and bridesmaid to the cavern. The wizard burns joss sticks on the flat surface of the stone and the couple begin to kowtow. At the same time, the wizard chants, “The heaven, the earth, the people on the right, the people on the left, the people of West Fan nationality, and the people of Mosuo nationality, may you all get pregnant. Under a god’s protection, we hope you get a strong body and the more children, the more the blessings”. The woman praying for pregnancy should then have a bath in the pool of the cavern and suck the “ha ji” from the “jiu mu lu” three times using a bamboo straw — which implies the semen and soul have entered into the woman’s body. People thus recognized that new life was due to sexual intercourse. As it is known to all that the baby’s body is delivered from the female vagina and the body and soul are considered as the two layers of life, people naturally guessed that the other layer — the soul — came from the male. This recognition was an advancement on previously held views. The above passages show the primitive views of life in China — as well as their understanding of the source of human life. But what is their opinion on the pregnancy and delivery that constitute the essential and natural course of new life? Judging from oracle inscriptions, people’s curiosity about pregnancy lay in the pregnancy itself and the gender of the baby. For example, “辛丑 卜，殼贞：帚 (妇) 好 (有) 子？三月。辛丑卜，亘贞，王占曰：好其 (有) 子？ (《匮》620)” and “壬辰卜，殼贞：帚 (妇) 良 (有) 子？贞：帚 (妇) 良亡其子？ (《乙》2510)” are two oracle inscriptions; both are about predicting pregnancy, in which “妇好 (Fuhao)” and “妇良 (Fuliang)” were wives of Wu Ding, a great emperor during the Shang Dynasty. Take“丙午卜，争贞：黄尹兄(祝)不 (死)？才(在)丁家， (有)子。(《明》287)” as another example. Here the woman mentioned seemingly suffered from a serious disease, but after praying to the god and casting the oracle, they found it was due to pregnancy. Her disease was actually a reaction to the pregnancy. The following two oracle inscriptions, “戊子卜，贞：帚 (妇) 衍又 (有) 子？ 戊子，贞：帚 (妇) 壴又 (有) 子？戊子，贞：帚 (妇) 束又 (有) 子？ (《乙》4504)” and “贞：帚 (妇) 康又 (有) 子？今六月。 (《乙》617)” are also much the same. In the latter, it says if “妇康 (Fukang)” has got pregnant, she should have been pregnant for 6 months. The oracle inscription was not only used for predicting pregnancy, but also for predicting the gender of the baby. Such oracle inscriptions were for instance

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“… 不 (男孩), 隹女。 (《遗》526)” and “戊午卜： 小臣 (男孩) ？十月。戊午卜,   小 臣 (男孩) ？戊午卜：小臣不其 (男孩) ？癸酉 ，甲戌，［隹］女。 《丙》83)”. ( The meaning of the latter is: “Divination was repeatedly performed for the purpose of having a boy, but on that day the sky was covered with dark clouds and a girl was delivered.” In the oracular inscription of “癸亥卜，殼贞：帚 (妇) 好冥，其 (男孩) ？隹, (死) 。 (《存》 2.45)”, “冥” means “delivery” and this inscription says that “妇好” suffered from a difficult labour and the baby was delivered dead. There are also oracle inscriptions predicting the expected date of childbirth, which are quite accurate. For example, “辛未卜，殼贞：帚 (妇) 奻冥 (娩), ？王占曰，其隹庚冥 (娩), ？三月庚戌冥 (娩)。 (《合》94)” tells “Divination on the date Xin Wei (Chinese ancient calendar) showed that Wu Ding’s wife would deliver a boy on the date Geng. Forty days later, on the date Geng Xu, during the third month, she exactly delivered spontaneously a boy.” In the oracular inscription “甲申卜，殼贞：帚 (妇) 好冥 (娩)，不其 ？三 旬 (又) 一日，甲寅冥 (娩)，其不 。甲申［卜，殼贞］：帚 (妇) 好冥 (娩), ？王占曰：其隹丁冥 (娩)， ；其隹庚寅冥 (娩)，引吉。三旬 (又) 一日， 甲寅冥 (娩)，不 ，隹女。 (《乙》7731)”, it illustrates that “Wu Ding performed divination for his wife Fuhao, and predicted that if the delivery occurred 31 days later the baby would not be a boy, but if it occurred on the date Ding, the baby would be a boy. As a result, she gave birth to a baby 31 days later on the date Jia Yin, and the baby was a girl.” So it seems the prediction was totally accurate and that the date plays a crucial role in determining the baby’s gender. The oracle inscription “丁酉卜，宾贞：帚 (妇) 好冥 (娩), ？王占曰， 其隹甲冥 (娩), (有) (祟) 。 … (《续》 4.29.3)” predicts “the baby delivered would be born a girl on the date Jia Yin”, which was accurate. The following oracle inscription, “壬寅卜，殼贞：帚 (妇) ［好］冥 (娩), ？王占曰：其隹［戊］申冥 (娩),吉, 。其甲寅冥 (娩), 不吉。 。隹 女？壬寅卜，殼贞：帚 (妇) 好冥 (娩), 不其 ？王占曰：……不 ？其 ？不 吉。若 (兹) 迺 (死) 。 (《乙》4729)” was a divination 12 days before delivery and it turns out that the predicted date was not exact. It is an inauspicious divination and the baby died due to a difficult labour.5 The prediction of baby gender existed not only in China, but also in other countries. The ancient Egypt papyrus (Great Berlin Papyrus), more 5

 Wang Yuxin, et al. Discussion on Yin Dynasty Ruins Tomb 5 of Fu Hao, Acta Archaeologica Sinica, 1977, 2

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than 1300 years earlier, recorded a method of prediction. That is, that the supposedly pregnant woman should urinate over some barley and if nothing happens, pregnancy is excluded; if the barley grows very fast, the baby would be a girl; if it grows slowly, the baby would be a boy.6 From these texts, we can sense how ancient people felt about the mystery of pregnancy and labour, and see how they applied divination to predicting the delivery date. Divination is a kind of witchcraft, based on mutual permeation. Delivery is usually performed through the vagina, which is simply expressed as the “冥” or “生” in ancient Chinese. But there are also records of caesarean birth in ancient times, especially common among some great persons with magic power. For example, The Classic of Mountains and Seas (山海经) records, “Gun’s body didn’t get rotten after death for 3 years and it was cut open with a Wu knife, the sharpest knife in the world.” Gui Cang (归藏) records, “The Wu knife was used to cut the abdomen open and Yu (禹) was born.” According to folk legends in Zhejiang province, the one who held the Wu knife was a courageous shepherd. As he cut lightly into the abdomen of Gun’s dead body, Gun’s wife Xiu Ji arrived just at that moment and threw herself onto Gun’s body. Just then, a baby jumped from the abdomen and came into his mother’s arms.7 Though the baby jumped from Gun’s body, Gun’s wife Xiu Ji was there, which indicates that the baby was still delivered from the mother. “Gun’s body didn’t rot after death for 3 years” meaning it was a kind of posthumous birth — while the baby being born from the cut abdomen shows it was a caesarean birth. As for another example, The Spring and Autumn Annals of Wu and Yue (吴越春秋) records, “Nu Xi couldn’t get pregnant while she was young. One day, as she played on the Di Mountain she ate some yi yi ren (coix seed). It tasted just like being interacted with and she got pregnant. Her ribs were cut open at the side, delivering Gao Mi.” Gao Mi was the leader of Yu’s feud and probably came from Xiu Ji’s caesarean birth. The Generation Book (世本) illustrated this more directly, “Xiu Ji swallowed a soul — like taking yi yi ren — and delivered Yu by cutting her chest open.” This tells that Yu was not delivered by Gun, but by Xiu Ji through caesarean. The Book of Songs – Birth of People 6

 Gerhard Venzmer (translated from German to English by Marion Koenig): Five Thousand Years of Medicine, Macdonald & Company Ltd, p.40, 1972. 7  Wu-Yue Classic of Mountains and Seas, p.5

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(诗·生民) records, “Hou Ji was not delivered either by caesarean, or by difficult labour”, which proves there were difficult labours and caesareans at that time. It is said that Sakyamuni Buddha was also delivered by cutting open his mother’s rib-side region, and his age was close to the formative age of The Book of Songs (诗经), but in Nepal. Peng Zu (彭祖) was also delivered by caesarean. The History Records – Chu Family (史记·楚世家) record that Lu Zhong’s wife gave birth to six babies by caesarean. The Generation Book (世本) states, “Zhuanxu gave birth to Laotong and Laotong gave birth to Chong Li and Wu Hui. Wu Hui gave birth to Lu Zhong. Lu Zhong got married with Gui Fang’s sister, who gave birth to six babies by cutting open her rib-side region. Among the six babies, the third was Qian Keng, namely Peng Zu.” Biography of Immortals (神仙传) even stated that Laozi was also “delivered by cutting open his mother’s left armpit”. I’m afraid this is some kind of strained interpretation. The author wants to point out that the occurrence of a caesarean not only has special significance in medical history (the surgical history of gynecology and obstetrics), but also makes reproduction more mysterious, in terms of cultural history. Phallic worship transforming into soul worship may possibly result from this — because the baby is not necessarily delivered through the female vagina, and it reduces the influence of the more primitive phallic worship. In the West, the caesarean is said to have first appeared in the case of Julius Caesar’s mother. This must be why the word “caesarean” is derived from the name Caesar. Besides this, primitive people have some records remaining which describe the relation between the earliest human beings and oviparity. For example, Jian Di swallowed an egg to give birth to Qi; Yu and Hou Ji were egg-shaped after being delivered. About Balance – Auspicious Experience (论衡·吉验篇) states, “A lady’s maid of Tuo Li country in Northern Yi region got pregnant, so the king wanted to kill her. The maid responded ‘A mass of qi the size of a chicken egg fell down from the sky and thus I got pregnant’. She delivered a baby later.” The Natural History Records (博物 志) also recorded, “Xu king’s maid got pregnant and delivered an egg. It was considered as ominous, so the egg was discarded at the beach of the river. … The lonely mother thought it was strange and got the egg back. She warmed it and it then hatched into a baby.” In the legend of the Man nationality, Fokulun, the fairy younger sister, got pregnant after she swallowed a red fruit provided by a magpie. She then gave birth to Aisin

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Giorothe Bukuuri, the ancestor of the Man nationality. Some believe the folk custom of offering red eggs after giving birth to a baby, in modern times, is a lasting custom of worshiping oviparity.8 In Shaanxi province, they will offer red eggs when a pregnancy has lasted for three months, and they say “By holding golden eggs in the room, the Queen of Heaven descends to earth. She sends a precious baby to you so calm down, calm down.” Then the pregnant woman takes the eggs and answers “Thanks be for the Queen’s graciousness”. This also implies that the soul may be delivered by way of an egg. Philosophers often debate the issue of life’s origin — “whether the chicken or the egg came first”. According to the order of biological evolution, it is possible that the mutation of the species comes after the mutation of the egg, which makes oviparity superior. But primitive people sensed this by the permeation of mystical reasoning and through watching the hatching process of eggs, which explain the traces in fairy-tales and folk customs. In conclusion, no matter how numerous and jumbled primitive people’s recognition of life is, the coming of a fleshy body and the possession of a soul are its two essentials, while the delivery of a child is its most realistic feature.

22.  The Meaning of Death As the soul was seen to be immortal, talking about death must supposedly be meaningless. However, the rule of mystical mutual permeation in primitive thought doesn’t repel contradiction — and not considering contradiction has a negative effect on logic. Therefore, primitive people considered the soul to be immortal on one hand as well as paying close attention to the reality and significance of death on the other. No matter how long a person can survive, the soul departs the body eventually and leaves a lifeless body. This is namely “the death of body”, a kind of realistic death. The Book of History – Records of Yao (书·尧典) records, “Twenty eight years after Yao Emperor passed the throne to Shun, he became deceased (zu luo)”. Yao lived for 118 years, the “殂  zu”means the soul returned to Heaven and “落 luo” means it went back to earth, but he died in the end. Tao Yuanming’s poem has the line, “Birth ensures death, 8

 Gong Weiying. Turtle Tip and Totem Worship, referring to Scripts of Chinese Ancient Cultural History compiled by Xiang Rendan, Peking University Press, p.271

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so an early death doesn’t mean a short life-span”. Perhaps this might seem a rather unaffected view. But primitive people and those following them would inevitably feel afraid and be reluctant to leave when death approached. They hoped the lifeless body could revive before it rotted. The Book of Rites (礼记) records: “Remove the bed and underwear, and add new clothes”, which meant to move the dead person to the ground from the bed, implying resurrection — as people derive their being from the earth. Cases of embalming burial in China, the storage of mummies in Egyptian pyramids, and keeping a coffin in a temporary shelter before burial, of calling back the soul and the folk custom of being buried alive with the dead are all intended to retrieve the soul and revive life before the body began to go bad. Some even believed somebody could revive if even one body-organ was preserved from decay. The Natural History Records (博物志) record, “The Xi man’s liver was immortal and it turned into somebody 100 years later”; “a Liu man’s lung was immortal and he revived 100 years later”. Map Records (括地图) states, “a Wuxian man’s heart was immortal and he revived 100 years later”. Guo Pu noted that in Wu Qi Country, as recorded in The Classic of Mountains and Seas (山海经), “Wuqi’s people lived in caves and ate earth — after they died, their hearts were immortal and they could revive 120 years later”. However, some were afraid of resurrection as the soul went back to the body. There is a mention of “sending away the soul” in many funeral customs. For example, in the New Stone Culture at the Yangshao, Daxi, Dawenkou and Miaodigou sites, the head of the body is buried in a certain direction, such as west, north, northeast and south. Some believe the direction the head face was the same to its birthplace, which is to make it convenient for the soul to go back to its hometown. According to ethnographical studies, the people of the Yao nationality also have such a custom, but on the contrary, the people of the Miao nationality in Guizhou province hold that the direction of the feet should face the birthplace.9 Funeral methods vary greatly, especially in cases of sudden death, when there is possibly a tendency to expel the soul from the body as soon as possible. For instance, the people of the She nationality will invite wizards to use magic and chant spells. The wizard will carefully cut 36 straw ropes to hang over and give colour to the door outside the village. Cutting one rope means killing one kind of ghost that could hurt the soul. In areas like Qinghai, for those who commit suicide by hanging from a beam, that 9

 History of Chinese Primitive Society, p.479

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beam and its connected stringers and rafters should all be removed for fear of letting the suicidal soul linger on searching for possession in a living body. Just as the common saying goes, “for suicide by hanging from the beam, the beam is greatly ominous; burning it totally ensures peace forever.” According to the custom in Zhejiang province, people make “Mengpo soup”. Mengpo, a netherworld goddess, is specialized in making wine-like but non-alcoholic soup, which can confuse the soul and make it forget its previous life. If there is no “Mengpo soup”, people put dewy leaves in the mouth and a pack of tea in the hand instead. In the meanwhile, they will sing, “If you are thirsty, drink the dew in the mouth and the tea in the hand”, hoping the soul will forget its previous life and leave as soon as possible. People of the Li nationality in Hainan province will ask “Palao” to read the ancestor’s name of the dead constantly, imploring the ancestor to take away the soul of the dead. At the same time, they will use a bush-hook to cut into a tree several times, intending to cut off the relation between the dead person and the village as well as to prevent the soul from coming back. Those who attend the funeral should wash their feet in the river when they go back and place a small branch in the house-roof of the dead, thus stopping the ghost-soul following and coming back. As for the customs in Shanghai, after people accompany the funeral to the crematorium, they should not go back the same way, but take a detour in case the soul follows them back. People will also receive a “turn-round pastry” (or a white handkerchief, instead) from the family of the dead and yellow and white flowers on their clothes will be removed, to keep the ghost-soul away. In the customs of Taiwan and Fujian province, before putting the corpse into the coffin, relatives tie themselves to the dead person with a hempen thread — and then the threads are cut off, one by one. Each person burns a thread in silver paper to break off his or her relation with the ghost-soul. This is also the reason that the people of the Blang nationality burn or cut hairs for the dead. People of the Miao nationality believe sudden death is caused by a wild ghost, so a ceremony must be held to expel the ghost. The ceremony is as follows: First the ghost master will lead a yellow dog to circle the room three times, and chant, “Wild ghost who has killed this person and I as well, use this dog to drive you away. I kill the dog for you to eat, so please go away!” Then the yellow dog will be hung outside the door and killed by beating it with a stick and stabbed with a bamboo. The dead dog will be thrown into the river or pond, being tied to a stone. The burial place of the person suffering a sudden death will be moved after 3 years. People

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will also move the coffin from a burial place when misfortunes occur after the first burial, because they think it lies in an unfavourable position and the ghost-soul is making trouble. All the above customs reflect people’s deep fear of ghost-souls in their hearts. Meanwhile, people often mix the soul and wild ghost together, considering both as ominous. Therefore, they intend to send away or cut off their relation with the soul of the dead as quickly as possible. However, sometimes people hope the soul can return and revive the body. As primitive thought doesn’t repel contradictions, intentions to retain or get rid of the soul exist at the same time. What is the ultimate destination of the soul? Generally, there are five. The first way is to go back home, which has been stated before above. The people of the Jingpo nationality will send off the soul and build a corpse rack. With the corpse on the rack, it is covered with colored ribbons to show the possession of a soul. Then, following the wizard’s appointed route, the people will deliver the rack to a burial place. People of the Nu nationality in Yunnan province will send off the soul by the wizard “Yugushu” to the east bank of Lantsang river. In the Naxi nationality, the soul of the dead will be sent back to its hometown of 6 different “Er”. Modern Chinese people also have the idea of “fallen leaves returning to the roots” — and the idea is that they want their body to be sent back to their hometown for burial, when they die. Secondly, the way is to ascend into the heavens. The National Martyr (国殇) records, “after the body dies, the spirit becomes omniscient and the soul becomes a hero among the ghosts.” To rise into heaven in a spiritual transformation is the patent aim of all emperors, heroes and sages. The Huai Nan Tzu (淮南子) records, “Yu laboured for the people in the world, so he became an earth god after he died; Hou Ji worked for farming, so he became a cereal god after he died.” The silk-cloth painting discovered in the Mawangdui Han Dynasty tomb may reflect an idealized course in showing the soul “going up to heaven”. The History of Three Kingdoms – Records of Barbaroi (三国志·东夷传) recorded that the people of Bianchen in Barbaroi region during the Han dynasty believed that, “a big bird will come down to a suicide, intending to bring the soul up to the heaven”. Notes on the Ancient and Modern (古今注) recorded that King Huaiwang of Chu State “changed into a bird representing the Chu soul”. These two cases take advantage of a bird to help the soul ascend. Fu Shuo, a minister during the Shang Dynasty, changed into a star after he died, which is rare in Chinese fairy-tales. It is just as Zhuangzi (庄子) records, “After Wu Ding got Fu Shuo to be minister, he won over the world. When Fu Shuo died, he flied to

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the eastern sky and became a star.” Therefore, the Songs of Chu (楚辞) state, “It is strange that Fu Shuo turned into a star and we envy Han Zhong as an immortal.” The Kunlun mountains are regarded as the ladder to the heavens to become an immortal, but it is only a road for saints and great ones, not necessarily for the common souls of the dead. The Classic of Mountains and Seas (山海经) records, “The Kunlun mountains are the great capital of the kings”; “(Kunlun) is the shape of an enormous square and high as the sky, wherein is the dwelling of gods.” The Huai Nan Tzu (淮南子) records, “On Kunlun mountains, if you climb up more mountains above, you will arrive at the mount of cool breezes, where you are able to stay alive forever; if you climb up more mountains above again, you will arrive at the mount of Xuanpu, where you can be a spirit and maneuver magic; if you climb up more mountains above again, you arrive at the heavens, the dwelling of the heavenly gods and where you can become a god.” Common people can sometimes also become immortal. For example, the couple Han Ping committed suicide as they didn’t want to yield to King Song Kang and their tombs were built face to face. In Search of the Supernatural (搜神记) records, “The King said, ‘This couple are in love with each other and if these two tombs can join, I will not stand in their way again.’ Just that night, a big catalpa tree grew between the two tombs and in a single day the tree’s branches embraced each other, trunk to trunk, bending down, with their roots crossed underneath the ground. Moreover two mandarin ducks, one male and one female, perched on the tree from dawn to dusk and their lamenting song was very touching. The Song People had great compassion for them, so they called the tree the ‘Lovesick Tree’.” The Dongba people of the Naxi nationality will “guide the road” for the dead and unfold a “Road Map to the Gods” depicting 33 layers to the heavens. They will also perform a Dongba dance to send the soul of the dead up to the heavens and prevent it from losing its way into hell. The third way is to rest down in the underworld. Just as the saying goes, “There is no difference between old and young in the underworld”. Most people will follow this road after death and become ghosts. In some good cases, people can hold onto a certain post in the underworld, but for those evil ones, they will be tortured in hell. A fourth method is to reincarnate in a new body, which has already been mentioned before. Fifthly, the last way is to wander around, still occupying the human world. These are the souls of people who die a sudden death, people who die under persecution and also the kind-hearted. They have either run away from the underworld, or been released by bribing a hell-guard, or are wandering temporarily looking

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for reincarnation. Kind ghosts will also help living people, or accomplish a long-cherished wish, or get married to commoners, while evil ghosts haunt us in order to cause disasters and diseases. There are lots of wonderful narratives in the Strange Tales of Liao-Zhai (聊斋志异) as well as many other strange fairy-tales. There can be seen two aspects to death: the soul on the one hand causing endless thoughts and fears among the primitive people, while the body on the other hand relates to our very existence, and at the same time deserves our concern. Therefore the causes of bodily death and the arrangement and disposal of the dead body must now be discussed. Generally, there are four reasons for death. The first is death due to natural factors, such as flood, fire, drought, hunger and accident. For example, The Classic of Mountains and Seas (山海经) records, “The daughter of Yandi (炎帝) was Nu Wa (女娃). One day, she swam in the East Ocean and didn’t come back, as she was drowned. She turned into a mystical bird, the Jingwei (精卫), which often carried trees and branches, or stones from Western Hill to fill up the East Ocean.” In this fairy-tale, Nu Wa died from drowning and Jingwei’s act of filling up the sea implies a sense of rebelling against her death — a kind of mystical permeation. In another example, Shu Taowu (蜀梼杌) stated that, “Zhen Meng’s daughter stole Huangdi’s pearl and was drowned in the river.” The Commentary on the Waterways Classic (水经注) records that, “Emperor Shun died when two wives accompanied him on an expedition. They were so sad at his death that they drowned themselves in the Xiang river. Their souls often wandered down to Dongting lake.” These examples show death by drowning. It is recorded that, “Chi You (蚩尤) assembled an army to do battle with Huangdi. Huangdi sent a Ying dragon to assault Chi You’s army in the Ji Zhou wilderness. The Ying dragon was good at maneuvering the waters, while the wizard invited by Chi You was better at summoning gales and rain. So Huangdi asked the drought goddess Nu Ba to help, and she stopped the rain and had Chi You killed.” In this case, draught was applied as a weapon (mystical permeation) to kill the enemy. Kua Fu (夸父) died of thirst while chasing the Sun; Bo Yi (伯夷) and Shu Qi (叔齐) died of hunger at the foot of Shouyang Mountain as they would not eat the rice of the Zhou clan, because it was not right. The History of Ancient Countries (国语) records, “Gun disobeyed the emperor’s order and was killed in the Yu mountains by a thunder-clap.” The Huai Nan Tzu (淮南子) states, “fierce beasts ate people and predatory birds took the weak and old away”, which is the disaster meted out by birds and beasts.

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The second reason is man-made death, such as war, torture, murder and cannibalism. The Classic of Mountains and Seas (山海经) records, “Gu and Qinhongi joined together to kill Bao Jiang south of the Kunlun mountain. The heavenly emperor was angry and killed them both at Yao cliff to the east of Zhong mountain.” Other records of such a kind are, “Er Fu and minister Wei joined together to have Ya Yu killed”; “Xing Tian contested with the heavenly emperor to be the god, but the emperor cut off his head and buried him in the Changyang mountains”; “As for the corpse of Wang Zihai, the hands, legs, chest and head were all scattered in different places”; “Emperor Jie of the Xia dynasty built a wine pool, and asked three-thousand famous drunkards to drink there and to push their heads into wine to get drunk, to the sound of drums. Some of them went on drinking until they died, but the Moxi was laughing and just took it as fun”, which is recorded in Stories about Famous Women (列女传); “there were very many beautiful women in the palace of Emperor Jie of Xia dynasty, and they ate people”, which is recorded the Records of Bizarre Things (述异记). The third reason for death is illness, which will be illustrated later. The fourth reason is aging, such as Peng Zu, Huangdi, Hou Ji, Pan Gu, Yao, Shun and Yu. The Laozi (老子) states, “Even to those never in contact with each other, death comes due to aging”, which shows that aging is the way to death. The Book of Rites (礼记) records, “The age between 80 and 90 is called mao (耄)”. The Songs of Chu (楚辞) states, “With there is a sorrowful heart, the mind is disturbed in mao age”. Confucian Legends (孔传) states, “One hundred years old is called a Qiyi (期颐).” The Explanation on Book of Songs (毛传) records, “Die (耋) means old. Eighty years old is Die.” The Spring and Autumn Annals – Xi Nine Years (左传·僖九年) records: “For seniors who are more than seventy years old and still have obligations, upgrade them by one rank so that they don’t need to kneel before the emperor.” The Book of Jin (晋书) records: “People under 12 and above 66 constitute the children and the old. They don’t need to work.” People over 60 or 70 may become weak and their minds befuddled, approaching death. As people become old, death is inevitable. The analyses and conclusions above have been carefully drawn from ancient materials. Behind these four causes of death, the actual dominant factor is of mystical mutual permeation. This has been clear in the first two cases. The third and fourth cases will be discussed later in detail. Firstly, let’s take a look at how people deal with the dead body. After death, the “corporeal soul” dissipates gradually and the “ethereal soul” also goes away, about which people are usually concerned. The time after death

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is counted by periods of seven days. One period of seven days is regarded as the dissipation of one corporeal soul — so that, after forty-nine days, all seven corporeal souls have disappeared. Therefore, family members hold sacrifices to the dead seven times during these seven periods. “Seven” in Chinese sounds the same as “auspicious”. For example, in Hangzhou the custom is to make a sacrifice each seven days after death — which is called “hitting seven”…. “the first time hitting seven, the ghost is beaten to complain of being wronged; the second time hitting seven, the bier is provided next door; the third time hitting seven, the grieving family find good fortune; at the fourth hitting seven, a wall collapses; at the fifth hitting seven, their offspring will not suffer hunger; at the sixth hitting seven, their children find good fortune; and at the seventh hitting seven, their eyes protrude.” This custom gives the ghost-soul a different encounter every seven days so that any sacrifice can avoid impending trouble and seek out good fortune. In the folk customs at Hehuang, Qinghai province, people should lift the coffin and circle the tomb three times, left to right. And meanwhile, they should chant “The first circle opens the heavenly gate, the second circle opens the nether gate, the third circle shows our ancestors a welcome to the soul. With three souls and seven corporeal souls going to the tomb, the city will be secure forever and the dead rest at peace.” Then the coffin is buried. In ancient times, as sometimes the dead could not accept any sacrifice, a living person, calling a “corpse”, was assigned to receive the sacrifice instead. The identity of the representative person is determined by the dead. He Xiu noted in The Commentary of Gongyang (公羊传) that “If the dead was an emperor, the corpse’s identity was a minister; if the dead was a senior, the corpse’s identity was a scholar official; if the dead was with a rank below a senior official, the corpse’s identity was a grandchild.” The Book of Songs – Chu (诗·楚) records: “The gods are drunken, and the emperor’s corpse is lifted! With drums and bells to send off the corpse, the holy one returns!” Etiquette (仪礼) states “Good wishes to send off the corpse”. Both record this custom. Later, the living person standing in for the “corpse” was replaced by a holy statue or tablet. We can see that the disposal of the dead requires the granting of a great posthumous honor. At first, a “Xiao Lian” (small encoffining) was carried out. The Book of Rites (礼记) records, “the Xiao Lian is held in the house”; “xiao lian means putting two or more cloths or quilts on the corpse regardless of their rank — monarch, senior official, or gentry”. Generally, the dead were dressed in several sets of clothes. If the dead was a rich person, more than ten sets of clothes were put on; if the dead was an imperial official, court

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dress was put on; if the dead was an official’s wife, a phoenix coronet and robes of rank were put on. Moreover, new silk-balls were stuffed in the ears, jade or rice-balls filled the mouth. It is said that a dead body containing jade, gold or silver will be preserved. But there are also other sayings. For example, Jia Gongyan noted commentating on the Rites of Zhou (周礼) that “the big funeral of an emperor meant that he held a small jade-piece in his mouth to fill it up”. The Commentary of Gongyang (公羊传) writes “What’s the reason for the dead to have something in their mouth? To make it full!” It is noted that “when the living make arrangements for the dead, they cannot stand an empty mouth. Therefore, a dead emperor may contain pearl, jade, senior-official green stone, and soldier-shell. This is a custom during the Spring and Autumn Period.” Judging from this, such a behavior prevents the cheeks collapsing, namely a kind of beautifying of the corpse. To the Zhou, it had been common for the dead to hold rice in their mouth, meaning that they would not suffer hunger in other lands. As for the school of “pursuing immortal”, gold and jade were put in the mouth to aid in preservation and to turn them into immortals. This was a different idea.10 Silk towels covered the face, and a large scarf covered the neck to the feet, not to expose the dead body. Then, many bed-sheets were put over the body, and all tightly bound up by cloth strips. Nowadays, sending a sheet cover for the dead is popular among Shanghai people, which reflects this. In different areas, the dead body is either placed in the bed or on the ground. A “soul guiding lamp” (or “eternal lamp”) is lit in front of the head and behind the feet respectively, as in the underworld everywhere is dark and so that the dead can see the way clearly in the light. In the evening, it became necessary to accompany the leaving soul. Sometimes, paper-made children were made to accompany them, lest the dead should feel lonely. The next step was for a “Da Lian” (encoffining) to be performed. The dead were encoffined in the east side of the room and then moved to the west side to make a sacrifice. This is generally carried out 3 to 7 days after death. If it occurs on the first day, it is called a “hurried encoffining”. The Book of Rites (礼记) records, “To encoffin the dead 3 days after is to wait for the possibility of resurrection. If the dead cannot come alive again in 3 days, it will never occur.” Before the encoffining, the coffin’s inner walls were covered with yellow paper and its bottom stuffed with pie-marker straws before being covered with yellow paper or directly stuffed with 10

 In his book Primitive Thinking (p.1415), Levy-Bruhl criticized Frazer for giving a Chinese example. Actually, Frazer was not wrong, Levy-Bruhl was.

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packing-paper, wood ash, pine-charcoal, dry aquatic-grass, lime-packs, and so on to absorb the moisture. Then a cotton sheet was covered below. The head of the coffin was pasted with the sun, moon and Big Dipper cut out of golden or silvery paper. A shoe-shaped silver ingot was placed by the head and feet respectively. The top of the corpse’s head was enclosed by a piece of red cloth and held by the eldest son, while 4 to 6 other people carry the body. A shed should be built outside the room to shelter it from the sun. The corpse’s feet should be moved and put into the coffin first. And then the body was laid flat. At both sides of the dead, daily necessities were provided for the way to the underworld, such as things that the person liked during their lifetime, living goods, golden and silvery paper, white candles and cereal bottles or bags. The next step is to cover the corpse with layers of sheets sent by relatives. The last sheet is the “offspring’s sheet” sent by one of the dutiful offsprings. Afterwards, the coffin is covered up and nailed down, and meanwhile, people shout out “hide from the nail!” loudly. At last, the seams of the coffin are stuffed with silk and raw lacquer. During this process, family members, relatives, and friends bid farewell to the dead on bent knees, in succession. They also call out to the soul of the dead to prevent it from being scared. The funeral is held that day or some other selected day. The “celestial burial” of the Tibetan nationality and “wild burial” of the Mongolians are not included on this list. The corpse being prepared for celestial burial is naked and carried to the platform made especially for celestial burial. The body is laid on its stomach with the head to the west. While Lamas chant sutras and burn incense, the body is cut up. Internal organs are thrown around and the bones smashed and mixed up with roast highland barley flour. After cypress branches are burnt sending smoke into the sky, eagles come to feed. If the body parts are completely eaten up, it is regarded as auspicious because the soul has ascended to the heaven along with the birds. As for a “wild burial”, the body is wrapped in white clothes and carried by a vehicle or a horse. The place where the corpse falls down becomes the burial place, or else a burial place is arranged especially. The body is laid on the ground to be eaten by eagles or wild animals. People visit the burial place 3 days after, and if it has been eaten completely, it is auspicious, indicating the soul has ascended to heaven. Family members and relatives should show their grief by not having a haircut, not drinking alcohol, or having any recreation or greeting friends up to 49 or 100 days afterwards. Cremation has long been in existence among the ancient Di and Qiang people. Laozi – Supplementary Chapter (老子·逸篇) states, “When the

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Qiang people die, they have the dead body burnt and its ashes scattered.” They build racks in the wild to burn up the corpse as well as the tools and living implements of the dead. There are also water burials, tree burials, suspending coffin burials, hanging burials and jar burials in some individual areas. These burial patterns and ways of disposing of the corpse are all different. Lieh Tzu (列子) records, “There is a Yanren country in the south. When their parents die, they will scrape the flesh off the dead body and bury the bone. It is regarded as dutiful only if you do this. There is Yiqu country to the west of Qin state. When parents die there, they collect wood to burn the dead body, and it is called ‘ascending to the heavens’.” The inhumation practiced by the Han nationality is much more complicated. After the body has been encoffined, a funeral would be carried out. In front of the coffin, there is put a “road guide ghost”, which is a dummy pasted up in paper. The dummy’s body is more than three meters high, its head one meter wide, its beard more than one meter long, its head red, face blue, left hand holding a seal and right hand holding a spear. This is especially popular in Shaanxi province. In the western Zhejiang province, people would tap on water bowls before the funeral. They think the dead are in a trance-like dream and don’t know they have died until they hear the tapping on the water bowl. At this moment, the family members burst into tears. There is also a custom of “kicking over the stool”. When the coffin has been lifted, someone would intentionally kick over a stool, meaning the backbone of the family has gone. However, family members would pick the stool up as it was going down, indicating that it doesn’t fall down because there are qualified successors. This applies to the funerals of senile people. The people who carry the coffin are full-time professionals. They are called the “Jingang” who mainly are strong men from among the poor. According to the wealth of the dead, the coffin is carried by 8, 16, 24, or 32 men. The eldest son kneels down with a pot used for burning imitation paper-money by the head. When the coffin is lifted up, he smashes the pot, which implies that the paper money cannot be grabbed by other ghosts. Then the son will shoulder the “soul guiding streamer” and connect himself to the coffin by a filial white band. This is called “zhifu”. The daughter follows by holding on to a “soul-guiding chicken” (“chicken” in Chinese sounds like “auspicious”). The men responsible for carrying the coffin are in two groups. They cannot rest or let the coffin down on the road even accidently, in any circumstance; it is regarded as greatly disrespectful and ominous. After the coffin follow the drum corps and then the relatives and friends. Those in deep mourning wear sackcloth and mourning dress, while those in general mourning wear a mourning hat or white winding-cloth.

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Such mourning dress is known as “disaster-free cloth”, which can get rid of ominous incidences. A close relative must cry with sad singing all the way to the burial place, the louder, the better, as this can ward off bad luck. Then they will also throw joss paper money in the way to dispatch ghosts and ask for a smooth passing. This is “money buying the way”. In some places, people set lamps in the way to bribe the ghosts by giving them the oil. When the coffin passes a bridge, people will stand still until someone has offered a sacrifice to the river god — the sons kneel down beside the coffin and the relatives shout loudly, “Be careful! Be careful!” to prevent the soul from being frightened. Afterwards, the way to the burial continues. When they arrive at the burial ground, the eldest son will dig for the first time and then relatives and friends will open the tomb. Sometimes, the tomb has been dug in advance. People will buy a “ground certificate” beforehand, which is worth 99,999.9 of the old coin and on it is written “the ground east to the green dragon, west to white tiger, north to the sinking tortoise, and south to the rose-finch. East and western queen mothers bear witness!”. People scatter cereals at the base of tomb or cave, or put steamed buns at the four corners of the coffin. When the relatives lay the coffin in the tomb, they shout out “Be careful! Be careful!” again to prevent the soul from being frightened. Burial objects are placed at both sides of the coffin. People pray again. Then the eldest son first scoops up the soil and others follow — to shovel soil on top of the coffin. After the coffin has been buried, the “soul-guiding streamer” is placed at the tomb and the “soul-guiding chicken” is set free, which can be caught by anyone. After this is complete, the eldest son uses soil to block up the place and puts yellow joss paper on the top of the tomb. The Jinuo people from Yunnan province have a “soul-seducing” ceremony at this moment. It is held by a wizard, called a “Youka”, for the purpose of preventing the dead soul from capturing the soul of the living. People of the Li nationality in Hainan province will sweep out the tomb with the purpose of clearing the souls of the living from the tomb. All the people who have attended the funeral should drink a drop of wine and wash their hands before the funeral feast. The eldest son is responsible for proposing a toast. People in Shanghai and Zhejiang province always have a dish called “bean-curd cooked with rice”, which may be because it sounds similar to “begin to decay” in Chinese. It is similar to the record in Custom Records of West Stone City (西石城风俗志) which states that, “On the day of the funeral, a feast is held. The rice is cooked with peas, and called ‘rice soup’. Vegetable dishes vary from 11 to 13. If the family of the dead is poor, only four bowls of vegetable and four bowls of

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bean-curd may be offered to each person.” The custom in the north of Jiangshu province and for the Zhuang nationality is that, if the dead are over 80 years old, people take away a small cup of wine or bowl of food, meaning “getting longevity” — a wish to live longer. In addition, a sacrificial ceremony is held in the house, which involves Taoist rites or Buddhist ceremony. A memorial tablet or portrait of the dead is placed prominently and family members and friends perform acts of worship. In ancient times, the son has to resign from government and lived in a small house nearby to guard the tomb for three years. There were even intricately over-elaborate formalities — more than 50 of these writings are recorded in The Book of Rites (礼记) and 25 in the Ceremonies (节仪) written by Sima Guang, but they will not be listed here. In all these courses of events, each and every detail was mutually permeated by a mystery, the fear of the soul as well as the loss of the dead person. If the dead ever knew this, they would surely be unable to decide whether to leave or to stay. This is the notion of death among the primitive. However, the death of children is an exception. According to most customs, their body is deserted in a children’s pagoda or valley, and allowed to be eaten by wild animals.

23.  Primitive Knowledge of the Human Body and Its Anatomy Judging from the funeral processes and people’s notion of the soul and ghosts mentioned above, primitive people had mixed feelings of fear, myth and honor when confronting a dead body. Therefore, a dissected burial was quite a rare occurrence and there are only a few examples, including the celestial burials of the Tibetan nationality, the pregnant burials of the Bulang nationality where the abdomen requires to be cut open to get out the foetus (and the corpse, foetus and placenta buried respectively), and the burials of high-ranking people of the Qidan nationality where the inside of the body is stuffed with salt after the organs have been removed and a golden or silver mask, or copper wire gauze is put over the face. These are exceptional circumstances — because the dissection of the corpse was extremely problematic, especially for the Han nationality. The corpse was the ghost, it could be god or ancestor, and was not allowed to be interfered with. Despite this, primitive people’s knowledge of the body accumulated over time. The earliest knowledge of the body was not as objective as that of present times. Mythical permeation played quite a major role. Totem worship provides the best evidence. Anthropologists repeatedly mention the example of the Bororo people, who stubbornly insist they are scarlet macaws since

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they take the scarlet macaw as their own image. Modern or ancient Chinese people since the primitive age often liked using animal terms to describe someone’s shape, such as tiger-backed and bear-waisted, rat-eyed and buckheaded, and “looking like a pig, but very wise at heart”. Though this is a kind of literary thing, it couldn’t come about through the use of characters or literary technique. For primitive people, this was not due to their imagination, but was a very real feeling — based upon the significance of a collective image. The twelve Chinese zodiacal signs may also derive from this and it has been argued in About Balance (论衡) written by Wang Chong, that these signs might have been in existence earlier. Historical records, unofficial records, and folklore, all have descriptions of emperors from remote times, many of which mention the “scarlet macaw”. For example, the History of the Han Dynasty – People List (汉书·人表考) written by Liang Yusheng has the following: Fu Xi: A snake’s body, bull headed, wide shoulders connecting to the armpit, forehead protruding like the sun and beaded, dragon lips and turtle teeth, a long beard drooping to the ground, and standing 9 chi 1 cun high. Nu Wa: A human body, a cow’s head, tiger’s nose, and able to change into 70 kinds of animal within a single day. Shennong: Able to speak at 3 days old, to walk at 5 days, to have a full of teeth at 7 days, a bull’s neck, dragon’s face, and standing 8 chi 7 cun high. Huangdi: Eloquent from childhood, eyes like a river, a dragon’s face, a beautiful beard and standing more than 9 chi high. Gong Gong: A snake’s body and red hair. Zhuanxu: A wide head, lined ribs, protruding brows, and dragonshaped striae across both hands. Diku: Able to speak his name when he was born, lines of teeth, and protruding brows. Yao: Standing 7 chi high, a face sharp above and full below, the eyebrows having eight colors, having two pupils to the eye, his hair 7 chi 2 cun long, and thin like dried meat due to worry and fatigue. Shun: Standing 6 chi high, a bulky body, round head, four pupils to the eye, dragon’s face, big mouth, thin and arrogant, a black complexion, no beard on the face.

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Yu: Standing 9 chi 9cun high, each ear with 3 holes, a long neck, black mouth, eyes like a river, lined teeth, a tiger’s nose, a big mouth, the head as if stamped crooked, the chest hanging down like a drinking-vessel, bare feet, lame, bumping and swaying to the left when walking fast. Tang: Standing 9 chi high, light in complexion, tall, the face with a beard and sharp above while full below, arrogant, loud-speaking, with slim arms, a turtle’s back, having two elbows each side, a weakness in half of the body, the left foot flat and the right foot full. King Wen of Zhou: Standing 10 chi high, a dragon’s face and tiger’s eyes, the forehead protruding like the sun, a bird’s nose, high shoulders, a gaze which looks up, four nipples, and large feet. King Wu of Zhou: Lined teeth, and a gaze which looks up. Duke of Zhou: Hunchbacked like a broken, withered tree. Confucius: A head like Niqiu mountain, sunken in the centre, the face square and ugly, the eyes a river, a protruding forehead like Huangdi, slim arms and a turtle’s back like Tang, a neck like Gao Tao (a wise official of ancient times), shoulders like Zi Chan (a politician during the Spring and Autumn period), the length of his body below his waist being 3 cun shorter than Yu, standing 9 chi 6 cun high, people called him “tall person”. The above descriptions are both imaginary and real, showing the signs of totemic permeation. In the hearts of primitive people, images act in the same way. We can believe that according to their knowledge that they were unable to distinguish very clearly between humans, animals and gods. They were actually governed by mystical or mythical permeation, and thus mixed all up together. Later, this permeation faded away and a relatively objective understanding became dominant. Oracular characters from the Shang dynasty show a few simple records. They are emblematic, and not a totally faithful representation. For example, the following characters collected from inscriptions on bones or tortoise shells of the Shang Dynasty describe body parts, some physiological functions and diseases.11

11

 This is the view of experts of the inscriptions on bones or tortoise shells. see Zhang Baochang, Knowledge of the Human Body in Oracle Characters; Chinese Journal of Medical History, 1981 (4)

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: Head. : Head. : Sky; the top of the head; beheaded by axe. : There are hairs in all these characters, pinning the hair or catching another’s hair. : Skull. : Face. : Eyebrow. : Eye; see; tears; strabismus or shifty eyes; blindness. : Ear; hear; cutting an enemy’s ear. : Nose, smell; to blow one’s nose; nasal discharge; cutting the nose with a knife. : Mouth; speak; sweet. : Tongue; images of stretching the tongue, pronouncing, having food and marks on the tongue. : Teeth; decayed tooth; moustache. : Neck; shell decoration in the neck; cutting the neck with a knife. : To stretch out the two arms, armpit; arrow under the armpit; elbow; left and right hands; hammering; flattening a field; drawing characters; manacled by hand; holding a pen; hand manacles. : Body. : Heart; blood in the heart; worry. : Blood in the container; bleeding as if the forearm cut off; bleeding due to delivery. : Backbone. : Chest. : Abdomen; a sharp object stabbing the abdomen, exposing the abdomen, an abdominal lump, pregnancy; abdominal dissection and dismemberment. : Male genital organ; castration.

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: Leg, foot, toe; footstep, foot manacle, saw-cutting off the leg, farming with a spade-shaped stool. : Dream. : Female, mother, breast-feeding. : Corpse; death (living people kneel before the bones of the dead), the image, from the front, of a person resting. : Death. : Wise. : Illness. : Illness. : Venomous insect. : Pain. : Head illness？ : (Hu Houxuan believes it is a kind of disease.) There was definitely no real knowledge of anatomy around or before the Shang dynasty. However, as trauma and death were often caused by war and punishment, there grew some understanding and record of the human body. In the above oracular characters, some are just forms of punishment with hacking, saw-cutting etc... Records solely due to observation may be partly distorted — and this is reflected in the descriptions of human shape given in such as ancient books as The Classic of Mountains and Seas (山海经), in which many factors are mixed together. In all these oracle characters, it is strange that among the inner organs, only the heart character is present. King Zhou (纣王) of Shang’s tyranny and brutality are mentioned repeatedly in the ancient literature. For example, Mister Lu’s Spring and Autumn Annals (吕氏春秋) records that King Zhou cut off the leg of a person who was wading effortlessly, just to see what was the difference in his marrow, as he could endure the cold; the king cut open the uterus of a pregnant woman to observe the development of the fetus; his minister Bi Gan remonstrated with the king’s cruelty, regardless of the danger he put himself in, and the king was angry. He said, “I heard the sage’s heart has 7 orifices”, so the king killed him to inspect his heart. These historical facts show that King Zhou was a ruthless tyrant and also show the practice of vivisection. In ancient China, most cases of anatomical dissection derive from vivisection. This will be discussed later. Anatomy and the physiology of the human body,

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its inner organs and pregnant state surely have a connection here. People probably recognized more than the heart, but as the heart was regarded as the monarch of the body, it is recorded in the oracular inscriptions. After King Zhou died, “people nearby all came to kick his body, his abdomen, kidneys, lungs and liver, never wanting to desist.” This was recorded in the New Book – Running Words (新书·连语). We can see that since the people at that time dismembered his corpse, they must surely have known something about the anatomy of the inner organs. Lieh Tzu – Tang’s Questions (列子·汤问) has a story, in which it describes a robot-like “changzhe”, probably some kind of puppet. Most experts think the book Lieh Tzu (列子) to be a forgery of an older book put together by Zhang Zhan during the Eastern Jin Dynasty, but regardless, its ideas are very vivid. At least it had some better understanding about anatomy. The story goes: One day, King Mu of Zhou (周穆王) came back from Queen Mother of the West and on the way back, encountered a skillful craftsman, called “Yan Shi”. Yan Shi presented the king with a robot-like “changzhe”, that could sing and dance well. The robot was so vivid the king thought it was a real man. He and his wife, Sheng Ji watched the performance in the palace. At the end, the robot winked at the maidservants standing near the king. The king fell into a rage and wanted to kill the Yan Shi. He was afraid and tore the “changzhe” to pieces, at once. It consisted of leather, wood, paste, and lacquer, white, black, red and green sections. The king looked carefully and found out it had a liver, heart, spleen, kidney, intestines and stomach within, while the tendons, bones, joints, skin, hairs, and teeth were all on the outside, and artificially constructed. All the parts of the body were there. If these parts were put together, it turned into the initial robot. The king tried to remove the heart, and the mouth was unable to speak; he removed the liver, and the eyes failed to see; to remove the kidney, and the feet were unable to walk. The king smiled and praised Yan Shi, saying, “Your human skill can compete with natural creation!” Then he arranged for two vehicles to take the robot home. Let’s put aside this “robot” and judging from the naming of the internal organs — we can see that the people of that age had a relatively good understanding of the body. For physiological functioning, the five elements match with the five Zang organs and five orifices; which accords with the theory

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stated in Huangdi’s Inner Classic (内经). However, there is no record in the Inner Classic that removing one organ can disable its function. It actually implies some experimentation. Nevertheless, knowledge of the human body forms the basis of any medicine.

B.  The Earliest View of Illness and Etiology 24.  What Is Illness? Among the four causes of death mentioned above, the third is illness and the fourth ageing. However, even if someone can live a long while, he or she will die with more or less some kind of disease. It is the view of modern medicine that ageing inevitably leads to decreased or disordered functions in the body. Organ aging or degeneration is a morbid state in itself. Therefore, ageing can be seen also a kind of “disease” in the broad sense. However generally, illness occurs in a more serious form, not as ageing. None of ancient literature in China defines disease. Generally people consider discomfort, being unable to freely move or to work as an illness. It is the same in other countries. At present, there are three notions to disease mentioned by Chalfant, et al.12 (1) Disease: A medical term which refers to a biological abnormality of body. It can be determined by physical exam, chemical tests or other special means. (2) Illness: This is an individual feeling and judged by discomfort. In some circumstances, disease can be confirmed by exam, but in most cases, it is probably a kind of psychological or sociological disorder. (3) Sickness: This is a description of one’s role within society. That is to say, other people (society) know or acknowledge that this person is in an unhealthy state. The author has doubts on all these three notions. They are not in accord with the practical experience of people in the West, but some kind of irrational argument put together by medical sociologists. They haven’t been adopted by recently published dictionaries, such as the popular Medical Dictionary or Concise Oxford English Dictionary.13 Judging from clinical 12

 H. Paul Chalfant, et al. Medical Sociology, Shanghai People’s Publishing House, 1987, p.14  Black’s Medical Dictionary, 1999; The Concise English Dictionary, 1990; Collins English Dictionary, 2007 13

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practice in the United Kingdom, disease mainly refers to a definitely diagnosed medical abnormality; illness presents as a patient’s subjective symptoms, their uneasiness or weakness, but without definite evidence of pathology or lab tests which confirm a diagnosis; sickness is an uncomfortable feeling, especially symptoms of nausea or regurgitation, including motion sickness. From the historical perspective, the meaning of these three terms varies semantically according to the period. And when they are used by those in different walks of life, such as doctors, intellectuals, and common patients, the implication may also be different. The Cambridge Illustrated History of Medicine (1996) has illustrations which are much clearer. But more generally, these three terms are often mixed together by non-medical people, who don’t care about a precise definition. This being so, a so-called disease actually refers to pain or a diagnosed disorder, in most cases. The Inner Classic (内经) states, “Huangdi said, ‘Why do some people feel uncomfortable lying in bed?’ Qibo (岐伯) answered: ‘This is due to an impairment of the internal organs. People can only find rest once their essence has again found its place. Hence, a patient cannot support himself during his disease’”. This explains how some people become bedridden and uncomfortable, which describes an illness. Explaining Characters (说文) states “疒” means “lying, that is when a person suffers from a disease, he or she lies down at home”, indicating pain or illness so that the person cannot have normal action or labour. Mencius (孟子) states, “In a former day, when the emperor’s order came, I was feeling ill and was unable to ‘cut any tree branch’ (do any work) or go to the court. Later, I felt a little better and I wanted to attend the court, but I was not sure that I were able to get there or not.” In Chinese language “unable to cut any tree branch” means the illness causes you to be unable to do any labour; “unable to go to the court” means “cannot walk”. “Unable to cut a tree branch” is illness of a physical labourer and “unable to walk to court” is an illness of officials. A common point made in these records is that people from different walks of life all may experience an unhealthy state. It seems that in the eyes of primitive people the ill state of a person was difficult to determine. In the oracle inscriptions, it is reflected by a series of puzzles and answers gained from divining: 贞，其 (有) 疒？ (Yi, 2141) 不其 (有) 疒？ (Yi, 1772) 丙申卜：其疒？丙申卜：弗疒？ (Ye San, 38.1)

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All these questions are asking whether disease is there or not, indicating unclarity about its state. There are also divinations about whether the disease is in its initial stage, such as: 疒民 (萌) ？ (Ming, 1633) 王役 (疫), 民 (萌) ？ (Hou, 2nd vol. 32.8) The following divinations are about the transmission of disease or it lingering on.  申卜，争贞：帚 (妇) 好不 (延) (有) 疒？［贞］：帚 (妇) 好其 (延) 戊 (有) 疒？ (He, 275) (有) 疒目，其 (延) (有) 疒目，不？ (He, 210) 甲子卜，殼贞，疒役 (疫),不 (延) ？贞：疒役 (疫),其 (延) ？ (Yi, 7310) These are an advancement on the previous questions, but we can see people at that period were still unclear about any disease condition. There is another kind of divination, which is about prognosis. If the patient was in a critical condition, divination was performed to predict whether they would die or not, such as: 贞： (有) 疒差，其 (死) ？ (Qian, 6.1.5) 丙午［卜］贞：…… (有) 疒，不 (死) ？ (Ren, 446) 庚子卜，耳贞：疛，不 (死) ？ (Zong, 23.4) …… (疟),不隹嶭？ (Cun, 1.817) By analyzing these character forms, we know that for people in remote antiquity, their understanding of visible morbidity was quite well defined. For example, “疒”, written in the small seal style (小篆) in Explaining Characters (说文), must be a collective term of that time for disease. It is derived from Chinese bronze inscriptions (金文 ) and further from oracle character (甲骨文 ). (Yi, 6849). It is also written as or in the oracular characters. According to Hu Houxuan’s explanations, the character is shaped like someone lying on a bed with blood on one side.14 This author thinks it plausible that it also may be explained as “to sweat profusely”. Overall, it shows a person lying in bed either sweating or bleeding, no doubt from an internal disease. 14

 Hu Houxuan. Investigations on Diseases of People in Shang Dynasty, firstly published in Study Thoughts, 1943, vol. 2 and later in Symposium of Business History, being the initial research on diseases in oracle characters.

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Another character (Yi, 29), or (Yi, 35), or (Yi, 383). Lin Qianliang explains it as an arrow inserted in the chest or abdomen.15 This explanation is better than the previous attempt — “an arrow in the armpit”. It suggests an arrow injury or incised trauma. During that period, the two Chinese characters of disease, (疾- ) and (病- )，illustrated two separate notions. In English, external injury does not pertain to the realm of disease, but is called a trauma or wound. According to the Chinese ancient characters, a external injury is equivalent to rapidity. Both these terms appear as oracular characters. This is probably because an incised injury progresses very quickly and death is usually rapid — or if the injury is not serious, recovery is quick. The character “疾” found in Chinese bronze inscriptions is written as “ ”, and as “ ” which is on the Mao Gong Ding (an ancient cooking vessel with two loop handles and three or four legs), and is made up from a combination of both characters. Therefore, the use of “疾” as a collective term for diseases must have begun around this time. The “疾” found on the Qin Shi Huang Tuo Sheng (an ancient oval measuring vessel), which is stored in the Museum of Chinese History, is written as “ ”, and as “ ” in a Yi Mountain Stele, being more similar to “疾”. As for the character “病”, it came about quite late. It is absent from the oracle characters, from the ancient calligraphy of the Zhou dynasty, and from Chinese bronzes. It is occasionally seen in royal seal characters and had been more common during the Qin and Han dynasties with a tendency to gradually replace “疒” and “疾”. Afterwards, it evolves into the alliterative terms “疾疫” and “疾病” (Chinese characters of disease), and along with the single words “疾” and “病”, eventually become the collective terms for an unhealthy state in the Chinese language. Now, let’s take a look at the character “疫”. Explaining Characters (说文) explains it as “all people suffer from illness”. This is the clue to the earliest record of epidemic disease. In the oracle bones, it is written as (Yi, 8873) or (Jia, 2040). Another character, “ ”, in the oracle bones, is believed to be “ ”. Moreover, “役” and “疫” are interchangeable in oracular inscriptions. Diseases of pregnant women may be “ ” (Cun, 733) or “ ” (Hou, 11.8). The character “ ” (Chen, 102) is possibly referring to common female diseases. There are characters shaped like holding the breast in some 15

 Lin Qianliang. Discussion on the Origin and Development of Medical Characters 1 — About Disease. Chinese Journal of Medical History, 1984 (4)

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oracular inscriptions, which may refer to a breast carbuncle or the like (see footnote 15). The character “龋” is written as “ ” and “蛊” as “ ”, meaning a worm in the tooth and a worm in the abdomen respectively. But the former is shaped like the disease — in that the hole caused by the worm entering the tooth is shown, so the V shape is used. In the latter, the “虫” (worm) part is given special consideration as cause, which is mysterious and suggests that the disease is caused by a ghost. The characters “ ” and “ ” are equal to “恙”, just meaning worry. In this character, the lower part represents the heart and the upper part the horns of a ram. The character “恙” surely depicts a psychological disease as it occurs vividly in the oracles. It is said primitive people regarded mutton as delicious, so it is possible they took the shape of the ram’s horns as decoration, which is why “美” (beauty) derives from it. Therefore, its original intention might just be “wish”, wishing beautiful future without worry. Hence, the meaning of worry is added later. The character “ ” means obliquity of the eye, which is a pictographic character. “ ” means blindness, which is an associative compound. “ ” is probably a head disease or headache, which is an associative compound. For “ ”, Prof. Hu Houxuan thought it as a disease name. And the disease “ ” may refer to roundworm, which is a pictographic character. The Chinese character system is pictographic, and the pictograph and associative compounds are the two most basic word forms out of the six categories of Chinese characters. Therefore, it is not difficult to deduce a conclusion. Here, the author only wants to point out that this pictograph suggests mystical permeation and has something in common with totemic evolvement. Therefore, mystical permeation also involves a recognition of disease and the causes of disease. For the structure of terms in relation to diseases in oracle inscriptions, most of them consist of “疒” and a body part, and a few of them are a combination of “疒” and a disease cause. Examples of the former case are 疒首, 疒天, 疒目, 疒耳, 疒自, 疒口, 疒舌, 疒言, 疒齿, 疒乳, 疒腹, 疒孕, 疒身, 疒臀, 疒肘, 疒膝, 疒足, 疒趾, 疒骨, 疒软, 疒心, 疒子, 疒旋. Examples of the latter case are 疒蛊, 疒蛔, 疒疟, 疒疫. “疒” in combination with the body part shows people at that time lack definite recognition on the disease state, while its combination with the disease cause indicates people had had some understanding on some directly seen disease causes. However, all these appear in the questions of oracle inscriptions, still under the influence of the myth permeation.

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Though the age of The Classic of Mountains and Seas (山海经) text is much later than that of the time of the oracle characters, the record of diseases is similar. Generally, there are about 27 diseases mentioned of internal medicine, including unconsciousness, abdominal mass, fear, worms in the abdomen, insect infestation, puzzle, heart-pain, swollen ankles, mania, jaundice, cai, wind invasion, rabies, heatstroke, abdominal pain, diarrhea, dementia, gui, worry, dian, malaria, choking, fainting, foolishness, jealousy, abdominal disease, and chest-and -abdomen disease. There are 15 skin or surgical diseases, including calluses, swelling, scabies, hemorrhoids, chapped skin, leprosy, goiter, wart, flat abscesses, carbuncle, itching, ou, fistula, white lichen, and acne. There are 5 diseases of the ENT type, including deafness, frightened eyes, sore throat, blurred vision and declining vision. Altogether, 47 kinds of disease are recorded. Lu Xun, a great Chinese writer, once said that the Classic of Mountains and Seas (山海经) was a book of witchcraft from ancient times. We shouldn’t simply extract the above terms and understand them through our modern languages — instead we should put them back into the wizarding world described in the book. It will not be difficult to understand them then, when they are studied together with the sacrifices, gods and spirits described in that book. Behind the recognition of these diseases, there is a common point — the idea of “myth”, which becomes integrated into a whole, along with the diseases involving gods and spirits discussed immediately below. We can say that mystical mutual permeation would have been present throughout the life of primitive people.

25.  Diseases Involving Gods, Spirits, and Others We can easily understand this single point by taking a look at the explanation of “疫” (epidemic disease). Explanation to Names (释名) records, “疫 means there are ghosts spreading disease to every body”. Collective presentation and animism, both working mysteriously, are involved here. Now, let’s make a study of the way gods and spirits present themselves, when involved in disease. Among the primitive gods of China, the goddess that governs disease is Queen Mother of the West (西王母). The Classic of Mountains and Seas (山海经) records, “The Queen Mother of the West has a human figure, a panther’s tail, tiger teeth, fluffy hair, wears jade ornaments, is good at howling, and governs epidemic diseases and tortures by the five punishments.” Guan Tzu (管子) has a record of five epidemic diseases, “In the period of Emperor Yao, his five officials had nothing to eat. The king set up a sacrifice

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for five officials who were in charge disease.” In later times, the five officials evolved into the five gods of the plague. The Collection of Gods in Three Religions (三教搜神大全) states, “The warriors of the five directions made up the ghosts in the heavens and the plagues on the earth. They were the five gods of the plague. The god of the spring plague was Zhang Yuanbo, the god of the summer plague Liu Yuanda, the god of the autumn plague Zhao Gongming, the god of the winter plague was Zhong Shigui, and the manager and god of all middling plagues Shi Wenye.” They were also called the “five envoys” of the plague. Chi You (蚩尤) was also something like a manager of the plague gods. In the General Dictionary – Music Dictionary (通典·乐典) it says, “Chi You led the Chi Mei (evil spirits) to fight against Huangdi in Zhuolu. Huangdi ordered him to blow horns as a roar of a dragon to resist Chi Mei”. The Historical Records’ Suoyin (史记索隐) explains, “Chi Mei have human faces, a beast’s body, four legs and are good at tricking people”. The Long History (路史) states, “Chi You drove on the Wang Liang (demons and monsters) to stir up the clouds, fog, wind and rain, willing them to conquer the dukes”. The Spring and Autumn Annals (左传) states, “Thereafter, when people entered the mountain forests, they avoided encountering ominous things. The Chi Mei and Wang Liang could not catch them.” It is noted that “Wang Liang are water gods”. The Annotation (释文) records, “Wang Liang are mountain monsters.” The Record of Countries (国语) states, “Monsters of wood and stone are called Kui and Wang.” It is noted that “Wang are spirits of the hills. They are good at imitating people’s voices and perplexing them.” These sayings do not all agree. But generally, all the monsters and demons that could cause illness were led on by Chi You. Records of Bizarre Things (述异记) states, “In the villages of Tai Yuan, people don’t offer a bull head as a sacrifice to Chi You. At present, there is a place called Chi You plain in Ji Prefecture, namely the field of Zhuolu. During the time of Emperor Wu of the Han dynasty, people saw the god Chi You in broad daylight near Taiyuan. He had turtle feet and a snake’s head and caused a serious plague. So then, people built a temple for him following the custom.” In later times, Zhuan Xu is sometimes regarded as an emperor, ruling over the plague god, as is recorded in the Du Duan (独断), written by Cai Yong. This is because “he had three sons, who became the ghosts of disease after their deaths. One lived in the river and was the malaria ghost; one lived in the Ruo water and was the Wang Liang ghost; and one lived in the palace or in the people’s rooms and was a child ghost.” This is recorded in A Search for the Supernatural (搜神记). Here, the child ghost may be equal to the “Guhuo bird” mentioned in the Mysterious Records (玄中记). It is also

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called the “daughter of the heavenly emperor”, or “ghost bird”, or “ghost cart”. It is recorded that “People never want to expose a child’s clothes in the evening, because the ghost bird is in favor of leaving blood on the clothes to signify that the child has been taken away.” It is also said to be a “nine-head bird”. Records of the Ridge: Bizarre Things (岭表录异) states, “The ghost cart flies around when the weather is a little dull in the spring or summer. It is especially common outside of the South Ridge. It likes entering houses and consuming people’s soul qi. It is also said to have nine heads with one of them showing a dog-bite, so it bleeds quite readily. It is regarded as ominous if its blood is found in the house.” However, the Yawyang Essays (You Yang Za Zu, 酉阳杂俎) state, “The wandering female in the evening is also called the Heavenly Emperor’s daughter or ‘fishing star’. She flies in the evening and hides at day, like a ghost. When she has her feathers on, she becomes a bird; when she takes off her feathers, she becomes a woman. She has no children, so she is fond of taking away other people’s children. She shows her breasts openly. People who have children, they should hide their breasts. People should not even dry children’s clothes in the sun because if a feather drops on the clothes, it transforms into a ‘bird evil’ or a drop of blood will be left on the clothes as a mark. Another saying is she was a woman who died after a difficult labour.” The so-called “Gu’e bird” is the same thing. Shu Shi (苏轼) noted in his Words for Five Birds – Chant Gu’e (五禽言·咏姑恶) that “the Gu’e is a water bird. It is said the woman had been tortured to death by the aunt (Gu, 姑), that is evil (E, 恶) so the character Gu-E is used as it has the same Chinese pronunciation of aunt and evil.” Lu You (陆游) wrote these lines in the poem Hearing a Water Bird on a Summer Evening (夏夜舟中闻水鸟声), “We hear the sound of Gu’e bird; it is no way to ask the rancorous soul of a murdered woman to leave.” According to folk-customs in Henan Province, people bind up a sesame stalk into a long bamboo stick during the Lantern Festival on the 15th day of the first month of the lunar year. Hanging up a lantern made of oiled paper as well, they place the stick with it on the tip of a tree in the house, calling it “clearing away bad luck”, or “brightening heaven’s light”, or “our heaven-cleaning broom”, just to avoid misfortunes caused by the nine-headed bird’s blood being left in the room. The name Yu Qiang generally refers to the wind god. Guo Pu noted, “Yu Qiang’s alternative name was Xuan Ming.” But Customs Comprehensive (风俗通义) records, “Xuan Ming is master of the rain.” The Book of Rites (礼记) also states, “The first month of winter, … the emperor is Zhuanxu and the god is Xuan Ming.” Huai Nan Tzu (淮南子) records, “In the utmost

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north that is where the rivers end, and at the end of summer, there is Northern Lingzheng valley, where it is freezing cold, filled with ice blocks, rain, hail, frost and sleet area. There is a field of drifting water. Zhuanxu and Xuan Ming are governors there over an area twelve thousand miles wide.” Judging from this, Yu Qiang was also called Xuan Ming, and the latter was the god of ice and wind. The Classic of Mountains and Seas (山海经) states, “Yu Qiang in the north has a human face and bird’s body, as earrings he has two green snakes and under his feet is stepping on two red snakes.” It is also said “He was delivered by Buzhou Wind”, in the Huai Nan Zi (淮南子). The Historical Records – Law Book (史记·律书) states, “Buzhou Wind lived in the north-west and governed executioners”. Mister Lu’s Spring and Autumn Annals (吕氏春秋) states, “The northern west prevails as an epidemic wind.” Therefore, Yu Qiang was also the god of diseases caused by wind. For the “misfortune wind” in the oracle inscriptions, we should never simply understand it as diseases resulting from the natural wind, but something in relation to a wind god like Yu Qiang. The Songs of Chu (楚辞) states, “Where is Bo Qiang?” Wang Yi noted, “Bo Qiang is the ghost of epidemics. Where he goes, he causes damage to people.” Bo Qiang is the same as Yu Qiang. Su Shuang, one of the five kinds of phoenix, was also present as a god of epidemics. The Music Discussions – Ye Tu Zheng (乐纬·叶图征) records, “The five kinds of phoenix are all different colors. One of them is good, while four of them are evil”; “The four which appear similar to a phoenix are all demons. One is called Su Shuang, which has turtle-dove beak and round eyes … when he comes, people suffer from the plague; one is called Fa Ming … when he comes, death is the result; one is called Jiao Ming, … when he comes, floods are induced; one is called You Jun, … when he comes, droughts ensue”. The demon of the year star is called the “White Tiger”, the so-called White Tiger star of later times. People’s Primary Secret Pivot Classic (人元秘枢经) states, “The White Tiger is the demon of the year. He often resides in the year’s following four periods. If his residence is violated, people will encounter the misfortune of death.” Hence, he is the demon who can cause diseases and death. The Classic of Mountains and Seas (山海经) mentions a monster that “when people see it, there will be an epidemic”. It is also of the same kind. Other records include, “birds like an owl with one leg and a hog’s tail in the Fou Zhou mountains. They are called Chi Zhong. If they appear, the country suffers a plague”; “beasts something like a hedgehog and as red as fire,

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in the Lema mountains. They are called Lie. If they appear, the country will suffer a plague”; “birds like wild ducks with a mouse’s tail in the Yin mountains. They are good at climbing trees and called Xie Gou. If they appear, that country will often suffer from the plague”; “Tai mountain is abundant in gold, jade and lucidum trees. There is also a beast like a bull with white head, one eye and a snake’s tail. They are called Fei. When it wades through water, the water drains away; when it trudges across grass, the grass dies. When it appears, a serious plague will occur”. All these birds and beasts that can cause disease are ghosts and demons. There are also records from other books. The Classic of Gods and Spirits (神异经) records, “Shan Sao… If he is offended, people will suffer cold and fever”. Though he has a human body, he is a ghost. The Luoyang Poem (东京赋) writes, “Kill Ye Zhong, and eliminate You Guang”. Xue Zhong notes, “Ye Zhong and You Guang were both evil spirits. They had altogether 8 brothers and harm humans as ghosts”. It is recorded, “They are human-size, living in the western wild. They wear rags tied up in a hundred knots. Their hands are like tiger-claws. They are called Mo Gui. Someone who walks out alone could have his brain eaten. Sometimes they can stretch out their tongue, three metres long on the ground. If people hear the sound of this happening, they can throw a large heated stone onto the tongue to stop it and kill it. Otherwise it will eat the person’s brain.” Records of South Yue (南越志) states, “The Pan dragon is 4 zhang long, and greenish-dark with golden-red striae. It often travels in water to enter the sea. It is poisonous and can hurt and kill people.” The Extant Collection of Customs (风俗 通逸文) states, “In remote times, when people lived in the grassy wilderness, there were worms that could eat a human heart. They were called Yang. However, nowadays, when we greet people and say ‘no Yang’, this is not referring to a specific disease, but means ‘are you well?’”. The Mysterious Records (玄中记) recorded, “A fox at the age of 50 can turn into a woman, at the age of 100 it can turn into a beautiful girl, and become a wizard. It can change into a man and have sexual intercourse with a woman. It can know things a thousand miles distant and is good at tricking people. At the age of 1000, it can communicate with heaven, and become a heavenly fox.” Even the Goddess of Li mountain can cause diseases. The Records of Xin’s Three Qin Areas (辛氏三秦记) recorded, “According to folklore, the first emperor of Qin once played with a goddess without being courteous. The goddess spat at him and he developed sores. The emperor was afraid and begged for help. The goddess showed him how to bathe in a warm spring. People in later times thus use baths.” This is recorded as well in the Records of the Dark and Bright (幽明录), “Emperor Wu of Han lived in the Sweet

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Spring Palace. A goddess often descended to play chess with him. The goddess had a good figure and was beautiful. The emperor was happy in heart and wanted to have sexual intercourse with her. She spat at him and left. The emperor henceforth suffered from sores for many years.” The spirits of gold and silver can also cause diseases. A Search for the Supernatural (搜神 记) has a story as follows: A person bought an old house and after his family moved in, all of them fell ill. Therefore, he wanted to sell it again. Meanwhile, another one bought it and held a big knife and hid under the roof alone at night to see whether there were ghosts or not. To his surprise, there arrived three spirits dressed in yellow, white and green respectively and another spirit with a thin waist. He thus knew it was true and in the next day, burrowed down into the ground under the house and found 250 kg of gold and silver, and 40 thousand copper cash. The spirit with a thin waist was just a pestle also buried under the house, so they were burnt. They lived peacefully from then on. From the above, we can see that nearly every kind of spirit or god, including the ghosts of dead people, can cause disease. According to ethnography, the Bai nationality in Yunan province have a “Great Dark Lord”, the god of plague. The legend is as follows: The emperor of heaven disliked human beings, so he sent a god to spread plague and tried to kill all the people on the earth. However, when his god came down to the earth, he found the men working the farms and women weaving at home, and they were all simple and honest. Therefore, he was not hardhearted enough to use the plague to kill them. But on the other hand, he was also unable to disobey the emperor’s order, so he opened the bottle filled with plague, and took the plague on himself, swallowing all the plague spells. After that, his body and face turned black. Hence, people call him the “Great Dark Lord”. People were grateful to him and consecrated him as a major god.16 This “plague god” (god of “Black Death”) thus becomes a good god. Sacrificial ceremonies or rituals occur in folk customs, for driving away ghosts and overwhelming demons — and these are relics of the concept of disease coming about through ghosts, from remote times. For example, the “压岁钱” (gift money), which is given to children in the spring festival, literally means “overwhelming ghosts” as “岁” (year of age) has the same pronunciation as “祟” (haunting ghosts to cause disease). The Yanjing Year Time Records (燕京岁时记) state that when using gift money, one way is to 16

 See the Dictionary of Chinese Myths and Legends, p.460; the present author thinks the plague is related to Black Death in that the affected person became black due to subcutaneous bleeding.

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hang it on a child’s chest to overwhelm and drive away the ghosts, while another is to string the gift money (coins in ancient times) up like a long dragon and put it by the bed leg. According to the Xuanhe Antique Catalog of Conversations with Things Past (宣和博古图录) written by Wang Fu, long and square money with carvings of dragons and horses could be used to expel evils and overwhelm ghosts. At the present time, gift money has turned into paper money given to children to pass over into the new year on New Year’s Eve. This is a great change from ancient times. In areas of Henan province, it is said the king of hell releases ghosts on the 1st day of October of the lunar calendar, so people who live there always kill a chicken on that day, because “ghosts are afraid of chicken blood” and “chicken blood can turn away evil”. As the saying goes, “On October the first, a little chicken is killed”, which is also to get rid of diseases caused by ghosts. Another custom is “walking or riding off a hundred diseases”, or alternatively, “walking three bridges”, “eliminating or riding off a hundred diseases” or “wandering to get rid off a hundred diseases” — the name is different in different areas. The Synopsis of Scenes and Things in the Capital (帝京景物略) records, “On the evening of the Lantern Festival, women walk one after the other, up and down to keep away disease.” In the areas of Jiangsu and Anhui, women carry a pottery jar and when they walk over a bridge, they drop the jar at the side of the bridge. In the areas around Jilin province, women walk out putting their sleeves together and roll on the ground to dispel bad luck. There are also customs of throwing big stones and discarding clothing. There are poems written in Some Poems of Walking off Diseases (走百病诗) by Zhou Yong, “Tongcheng is a good place to be. People walk up and down, and diseases flee. Lanterns are lit and pots rolled around, they have been burnt and sound out cracks”; “Lantern fair is popular in the capital, with all the people enjoying it. Aunts and newly married women and sisters-inlaw meet together in dress, and make-up and walking about to keep the disease at bay. It is said the ghosts are everywhere this night, and diseases all over the earth. If this is not done, diseases will prevail all the year through, such as limb paralysis, declining vision and headaches.” In areas of the author’s own hometown, Dongyang, Zhejiang province, people have a custom of “catching the year ghost” from the 1st day to the 15th day of the first lunar month or during the winter solstice. A beggar or vagrant living in the temple is disguised as the god by wearing a pasted black paper or scholar’s cap, a blue robe, a red beard on the face, an iron cord round the waist and exposing one arm. He shakes a copper bell with the left hand and holds a sword in his right. Other beggars follow behind. They ask

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for money and drive away ghosts, from door to door. In the meantime, they shout “Drive! Drive! Let’s drive away the ghosts. If they are caught in the front door, kill them — and if they are caught in the back door, boil them alive.” It is said all diseases are caused by ghosts, so a peaceful year can only be ensured by driving away them. This custom may derive from Zhong Kui (钟馗) catching ghosts. There are many ghost stories or folk customs like this. Take “tai sui (太岁) “ for example. The saying goes, “Who dare disturb the soil on the head of tai sui?” “Tai sui” is the name of the duty god that year. The Classic of God’s Pivot (神枢经) states, “Tai sui has an emperor’s image and commands all the gods, governing their individual locations and time order. He has a duty for the whole year”; “If a country’s army go hunting outside, or are sent away to seize an area or to open up a new territory, they never go in the direction of the Tai sui. If the country’s common people build houses and walls, they try to avoid the place of the tai sui”. If the tai sui is offended, disaster or disease will arise. There are stones carved with the inscription “Brave Stone of Mount Taishan” in alleyways and bridges, used for suppressing ghosts and disasters. The earliest stone tablet known at present is one carved in the 5th year of Emperor Dali of the Tang dynasty (700 CE) at Pu Tian, Fujian Province. There are also stone tablets carved with “Master Jiang great-grandfather (姜太公) is here; no disease can approach” or “Master Jiang great-grandfather is here, so there is nothing to be afraid in heaven, the underworld, yin-yang disorders or anything else”. These are often set on the wall or over a door. According to legend, Master Jiang great-grandfather has great magic powers and can expel and frighten away ghosts and devils. There is an idiom which goes, “wei hu zuo chang” (为虎作伥, helping a tiger do evil), the chang is a ghost. The Kui Che Records (睽车志) records, “When the tiger arrives, the chang ghost comes first”. Understanding of Characters (正字通) states, “People down the generations say that when a tiger eats someone when he is dead, his ghost has no way out, but just serves the tiger, being called a chang ghost.” It is said the chang ghost is in favor of tart flavors, and can be tempted away by dark plums, red bayberries, and the like. “Bie lai wu yang?” (Are you well since our last meeting?) is also used as a greeting. But “yang” has a different explanation in common sayings compared to the previous one. The Classic of Myths – the Classic of the Middle Wild (神异经·中荒经) states, “There are beasts in the north. Their body-shape is like lion and they eat people. They blew air on the person to cause illness. They are called yang. In the past, they approached villages,

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entered rooms and made people suffer a lot. Therefore, the god of heaven moved them to the northern wilderness.” The character “huan” of “huan bing” (患病，suffer from an illness) also refers to a ghost. A Search for the Supernatural (搜神记) records, “The Emperor Wu of Han once travelled east and before going over the Hangu pass, found he was blocked by something. It was several zhang in height and shaped like a bull. It had green and shining eyes, four legs, and was able to enter the earth, it could move but wouldn’t move away. All the attendant officials were shocked and frightened. Dong Fangshuo (东方朔) asked to feed it with wine. Then the thing disappeared after tens of buckets of wine were provided. The emperor asked the reason. He answered ‘This thing is called huan (患), and it has been formed by grief. This was definitely the area of jails during the Qin dynasty, or a gathering area for sinners. As wine can make people forget their grief, so it takes effect.’” Later, a magical medicine called “wu huan” (无患，no suffering) was developed. For example, Ancient and Modern Notes (古今注) states, “the Lu wood, was also called wu huan. There was a wizard in the ancient times who could write runes which would expose ghosts and use a stick of this wood to kill them. This legend was passed down generation to generation. The wood can frighten away ghosts, so people strove to make tools out of this wood to ward off ghosts. Therefore, it was called a ‘wu huan’.” Secret Records of Wu’s Family (吴门表隐) records, “King Wu’s sword lay in the depths of Dantai Lake and had a length of about a meter. It bore Wu Zixu’s name on it. It often floated on the surface and if people picked it up, disease would immediately set in, but if people threw it away, health would be restored instantly.” The sword of Wu Zixu is described here like a ghost that can cause disease. As such, only if mystical permeation existed in the thoughts of people unconsciously during later times, could animism control people’s brains in certain occasions and aspects, and create the many ghosts and gods and their relation to disease or disasters. Hence, it is not strange to have so many mysterious records. As far as ancient times were concerned, primitive people attached very great importance to the concept of disease involving gods and spirits. The Songs of Chu (楚辞) records, “There is a kind of mysterious wasp shaped like a kettle.” Wang Yi noted, “There is a kind of flying wasp with an abdomen as large as a kettle. It contains a wasp poison, which can kill someone.” The same thing is recorded in the Classic of Mountains and Seas (山海经) that “the big wasp is shaped like a bee”. It seems not to be the

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business of gods and spirits that a big wasp can kill someone. But in the minds of primitive people, this kind of wasp could also be an incarnation of some ghost, or empowered with special magical power. It is also necessary to emphasize the Shang dynasty’s idea of being haunted by their ancestors. People in the Shang dynasty believed in ghosts very much and it seems they were especially afraid of the ghosts of their ancestors. They suspected that wars, disasters and punishments were probably caused by ancestral ghosts. For them, a dead ancestor could be deliberately against them instead of protecting them. Maybe at that time, when people’s recognition of the difference between life and death had just been established, their fear of death was relatively strong. They enjoyed the happiness of life and were disgusted by the toll of death, and they imagined that their ancestors hated the living. In turn, the living were afraid of the revenge of the dead. It is different nowadays — people believe their ancestors are there to protect them, and not destroy them. There are many oracular inscriptions about suspected diseases caused by ancestors. For example: 疒 ， 于妣己眔妣庚？ 贞王疾身，隹 (唯) 妣己 (祟) ？ 贞：疒，不隹 (唯) 匕 (妣) 己 (祟) ？ 午卜，殼贞： (有) 疒隹 (唯) 黄尹 (祟) ？ According to Guo Moruo’s explanation, “黄尹” is named Aheng Yiyi. “妣己” means those deceased mothers, who were actually regarded as ghosts causing diseases. This view of disease caused by ancestors can still be traced in the Dai and Achang nationalities. They think their ancestors can ensure happiness and longevity for their offspring, but one soul of them may come to bite the offspring and cause a disease. In addition, the disease caused is similar to the one that the ancestor died of. For example, if the ancestor died of an abdominal pain, the living person will also suffer from abdominal pain caused by that ancestor.17 The people of the Shang dynasty also believed in heavenly God. There are many oracle inscriptions which record diseases caused by heavenly God, such as: 贞，隹帝 王疒？ (Yi, 7304) … 不隹上下 王疒？ (Yi, 8069) 17

 See Dictionary of Chinese Customs, Shanghai Lexicographical Publishing House, 1990, p.736

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“ ” is a figure using a dagger-axe to break a window, indicating hit or harm. It is explained as “肇” (zhao). Explaining Characters (说文) says, “肇 means to hit”. “上” (up) refers to the god of heaven, and “下” (down) refers to the god of earth. 丁巳卜，贞：亡降疒？ (Lin, 2.21.8) 卜，贞：亡降疒？ (Lin, 2.21.12) “降疒” means diseases befallen one by the gods of heaven. In short, diseases involving gods and spirits pervaded the people in remote times. In recent antiquity or even nowadays, there are also relics of this, which are the evidence.

C.  The Pursuit of Immortality 26.  Longevity Involving Gods and Spirits Earlier on, we understood how primitive people gradually formed the three worlds concept of “god–human–ghost”, deep within their subconscious. The ghost world is fearful, a place the living never want to be. The world of gods is remote and far beyond reach — only a few of our initial ancestors and heroes have a chance to enter it. Therefore, what is most real is our human life world in which it is only a living body which can enjoy reality. However, the thoughts of primitive people are often multiple and in our eyes, some of them contradictory. Hence, the world of the gods and spirits is often mixed up with the stubborn pursuit of longevity. It is better that the body never dies, but even when the body dies, we wish that we can enter the world of the gods and achieve immortality, or follow the way of the spirits — and be promoted to being a god. Whichever it is, it generally reflects people’s unwillingness to leave the present world. Judging from some viewpoints formed at that time, primitive people held that the span of our lives was determined by a heavenly god. The god who governed the lifespan was probably Ju Mang. The Classic of Mountains and Seas (山海经) states, “Ju Mang lives in the east. He has a bird’s body and human face. He rides two dragons.” Mister Lu’s Spring and Autumn Annals (吕氏春秋) states, “The emperor is Tai Hao, and the god is Ju Mang.” Gao You noted, “Tai Hao, namely Fu Xi, governed China by the virtue of wood. He was buried in the east after he died. He is emperor of the virtue of wood. … Ju Mang, a descendant of Shao Hao, is also called Chong. He assisted the emperor of wood virtue and became the god of wood official.”

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It seems plausible that as an assistant of the sun god (Fu Xi), Ju Mang governs the lifespan of humans. Mo Tzu – Under Bright Ghosts (墨子·明鬼下) has made it very clear that “In the past, when emperor Zheng Mugong was in his temple in the afternoon, a god entered the gate and walked to the left. The god had a bird’s body, square face, was dressed in white clothes. Zheng Mugong was afraid and ran away… The god said ‘Don’t be afraid. The heavenly god knows your virtue and asked me to give you 19 more years of life. You can make your country prosperous, have plenty of descendants, and never lose the country of Zheng.’” Sui Chaozi (随巢子) also records, “In the past, the Sanmiao (三苗) clan caused great turmoil. The heavenly emperor ordered to kill them. But Xiahou (Yu) received the order at the Yuan palace and a great god with a human face and bird’s body descended in order to bless them. The god of emoluments helped to increase food production, so people were not hungry; the god of gold helped them to make the economy fitter, so the country became rich; the god of life helped to prolong their lives, so people didn’t die early. Therefore, all sides of the world submitted themselves to be governed. Yu thus conquered the Sanmiao clan, accomplished heaven’s order, spread their territories far and wide and became an emperor.” The god with a human face and bird’s body was probably Ju Mang, who was a prototype of Bian Que. The Songs of Chu (楚辞), however, regards Da Siming (大司命) as the god of longevity and Shao Siming (少司命) as the god of reproduction. Da Siming is recorded as saying “The world is so wide and wild, the population is so large, why am I the one who governs their lifespan and death?” Shao Siming is recorded as saying: “People naturally have lovely sons and daughters, why should you be so worried?” A god named Chun also governs the lifespan. Chuang Tzu (庄子) records, “Da Chun in remote antiquity lived 8 thousand years as his spring and 8 thousand years as his autumn.” Later, a “Chun Year” is given to bless longevity on the elder. A “Chun” is actually a kind of tree. In the area around Changjiang and Huaihe, people have the custom to go on an outing carrying the Chun god on the 15th of the first lunar month, which is called to “Pan Chun”. The “old star of longevity” is offered to most in folk custom by people — and this is still the case at present. The Historical Records – Book of Offering Sacrifices to Heaven (史记·封禅书) has a record of the “Temple of Longevity God”, noting “The god of longevity is named the Antarctic, the aged star Canopus. If he appears, the world will be peaceful, so people build temples of him to pray for blessings and longevity.” The stars Spica and Virgo are regarded as “gods of longevity” in Close to the Right – Heavenly

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Explanation (尔雅·释天). Qin Shi Huang (秦始皇，the First Emperor) built a “temple of longevity” in Du County, Chang’an (西安). Folklore states that Laozi (老子) was the god of longevity, because “he was born with white hair before heaven and earth, and so was immortal”. Another legend states that the Great White Planet (Venus) is considered the god of longevity. However, it is also possible that the Queen Mother of the West manages life and longevity; because she controls “the five epidemics and five disabilities”, which are important factors concerning our life span. At the same time, she is in charge of the “medicine of immortality”, just as recorded in the Huai Nan Tzu (淮南子): “Archer Yi got the medicine of immortality from the Queen Mother of the West, but his wife, Chang’E (嫦娥) stole it and fled to the moon.” People do believe that longevity does exist in the human world — and the legendary Peng Zu (彭祖) is just a typical representative. There are many arguments about him in the history. Some said Peng Zu lived for 1800 years. The Xia dynasty survived 400 years, the Shang dynasty some 600 years, and the Zhou dynasty 800 years, while he was a senior official during the contemporary Yin. Some argue that Peng Zu was a monarch of “Dapeng Country” and that during the Xia and Shang, he was the head of older senior lords, being one of the five ancient over-lords. He established a prosperous country, which lasted tens of generations and then when he was aged 800, his country was destroyed by the Shang. Ge Hong said in his Biography of the Immortals (神仙传) that “Peng Zu’s family name is Qian and honorific name Keng. He is the great-great-grandson of Emperor Zhuan Xu. He had been 767 years old at the end of Shang without any sign of ageing. The king of the Shang ordered a female official to go by cart to ask Peng Zu for the secret of his longevity. Peng Zu said: ‘I was born after my father died and my mother perished when I was 3 years old. Then I encountered the turmoil of war and was forced to wander in the western lands for more than a hundred years. Forty-nine wives and 54 children have died before me. I have suffered a lot, so at this moment, my qi has been consumed, my rong qi (nutrient) and wei qi (defensive) are withering, and I’m afraid I will not live long. My knowledge is superficial and not worth learning.’ So the female official left without the secret. He left but nobody knew where he was going. More than 70 years later, some people said they saw him west of Liusha country.” Qu Yuan wrote in Questions for Heaven (天问), “Why does emperor like pheasant cooked by Peng Zu so much? What can let you feel upset when you live so long?” From the period of the Spring and Autumn, and Warring States up to the Jin dynasty, it is true that Peng Zu was passed on as a model of longevity. However, as for whether he lived for more than

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700 years, this is surely an exaggeration. At long last, he died. Wang Yi noted, “When Peng Zu was dying, it was regretful that his pillow was too high for him to sleep and he spat saliva too far, which impaired his primary qi and made him unable to live out his full lifespan. He lived so long because he often drank a delicious pheasant soup cooked by himself. Chuang Tzu (庄子) records, “Peng Zu is still well known for his longevity in the present day”, which also is proof of his longevity. Legends of Immortals (列仙传) records, “Peng Zu was a senior official during the Shang Dynasty. His family name was Qian and his given name Keng. He was the grandson of emperor Zhuanxu and the second son of Lu Zhong. He lived for more than 800 years from the Xia to the Yin Dynasty. He often ate osmanthus flowers and ganoderma mushroom and was good at guiding the qi flow through the body.” From so many legends, we can see at least that Peng Zu was a real person who lived a long life. Recent reports show there are many long lived elders living in Xinjiang province (probably the same area as the old ‘western region’, and Liusha country). A 109-year-old man even married a young girl and had a baby. Sun Jiande, an associate research professor of the Xinjiang Health Ministry, once visited them in person. There are really some surprising points to be made about the human lifespan. Peng Zu was a legendary person who occupied the space between the immortal and the common world, so he was entrusted with people’s wish for longevity and embraced the characters of ordinary people. Records of Heaven (天中记) states, “Wuyi mountain is the place where Qian Keng refined Chinese alchemy as mentioned in Legends of Immortals (列仙传). Qian Keng made pheasant soup for Yao, and Yao rewarded him with Peng city. He was thus called Peng Zu. He died at an age of 777. He had two sons. One was called Wu, and the other Yi, so the mountain was named Wuyi after them.” It is said he had a daughter in Sichuan province, with excellent health and lived for several thousand years. The Biography of the Immortals (神仙传) has another story: “Mr. Bai Shi was a disciple of Zhonghuang Zhangren. At the time of Peng Zu, he was more than 2000 years old. He was unwilling to practice to become an immortal. He only tried not to die. At first, he was poor and was unable to buy medicine. He thus raised sheep and pigs and lived a simple life. Decades later, he became very wealthy and bought lots of medicines of immortality. He often cooked Bai Shi (‘white stone’) as food. As he always lived in the Baishi mountains, people called him Mr. White Stone. Peng Zu once asked him, ‘Why don’t you have medicine that can make you become a deity to Heaven?’ He answered, ‘Can you be happier in heaven than in the human world? I only hope I do not die. There are so many gods in the

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heaven that you have to do things under their orders; it must be more bitter than the human world.’ Therefore, people often called him Mr. Reclusion Immortal for his unwillingness to be a celestial official and become famous.” By peeling away the veil of mythical permeation from these legends, we can see that the essence lies in a willingness to live long in the human world — rather than a wish to become an immortal deity. This has definite practical significance. The original meaning of “仙” (xian, immortal, deity) is not the one living in the heavens. The Explanation on Nouns (释名) states, “Being old without dying is called a 仙”; “仙 means to move into the mountains, so its composition is 人 (human) on the side of 山 (mountain).” In Explaining Characters (说文), it is written as 僊 and 仚. It explains, “僊 means immortality becoming 僊”. The Chinese character “迁” (move) at present is written as “遷” in the complex font, from which we can see partly similar meaning. “仚” is explained as 人 (human) on the 山 (mountain), which is same as the meaning of “仙” in Explanation on Nouns (释名). However, “仙” often is the combined with or comes close to “神” (god). It is the case in Chuang Tzu (庄子), “In the remote west, there was Miaogushe mountain. A god-like man dwelt there. His skin was white and tender like ice and snow, his body slim and graceful like teenager. He didn’t eat cereals, but inhaled the winds and drank the dew”; “he could summon clouds and rode on dragons to travel around the world; his mind was focused and where he stood, there were no mild or serious diseases, just a harvest of cereals”. About Balance (论衡) recorded a story of Man Du learning celestial acts, “When I was hungry and thirsty, the deity asked me to have a cup of Liu Xia (moving rosy clouds). One cup could make you full for several months.” Li Shangyin wrote a famous poem that “If you can get a cup of Liu Xia wine, you would hear the sound of flute and drum in the air with the deity coming.” Deity and god were mixed together. Later Taoism had the Eight Immortals and various deities ‘of the celestial peach’ who were spoken of as gathering together in the novel Pilgrimage to the West (西游记). They are also evidence of this idea that the concept of the permeation of myth was still around even at that time. According to the statistics of archaeological excavation, the average lifespan of primitive people was not very long, but neither did quite a few people during those times live only a short life. Surely, it is impossible that Peng Zu lived several hundred years as recorded in the legend. However, scientific studies in recent years have shown that the natural lifespan of humans can reach about 100 years. According to records, in remote times, the lifespan was much greater — which is mostly not fact. In nearer times, the recorded lifespans are probably closer to the truth. The lifespan of some

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emperors and sages is listed as the following: Fu Xi 194, Shennong 168, Huangdi 117, Shaohao 100, Zhuanxu 98, Diku 105, Yao 118, Shun 100, Yu 100, Emperor Tang of Shang dynasty 100, King Wen of Zhou 97, King Wu of Zhou 54, Zhou Gong 99, and Confucius 73. The average lifespan of these emperors and sages is 108 years. This seems approximately correct, just as the Inner Classic (内经) writes, “People in remote times, they all exceeded one hundred years. … People lived to a natural lifespan and died at about a hundred years old.”18 We can see people’s wish for longevity during these remote times is integrating both realism and the myths of gods and spirits. Therefore, their investigations into immortal medicines surely show that there is as far as possible a way to gain longevity.

27.  The Immortal Regions and Their Medicines The immortal regions were places in which the holy immortals lived. In these places, there were undying trees, ever-flowing springs and holy medicines for longevity. Ordinary people believed that if they could ever go there, they would naturally become immortal. There is the so-called “immortal country”. The Classic of Mountains and Seas (山海经) records, “There was an immortal country. People there had the family name of ‘A’. Their food was from the Gan tree (sweet tree).” Guo Pu noted, “Gan wood was namely the tree of the immortals. People would become immortal if they ate it.” It also records that, “people from Xuanyuan country, …could live at least for 800 years”; “There was a mountain called Immortal mountain to the east of Liusha and within Heishui (黑 水, black river) area”; “The immortal people lived to the east of it. They were black and lived for ever. Another record states that they lived to the east of Chuanxiong country.” This last place is probably the same as that recorded in the Records of Foreign Areas (异域志), “The country of longevity was to the east of Chuanxiong. … people there turned black when they grew up. Some of them were able to live for several hundred years, but still with a teenage complexion. There were undying trees growing there and people could live longer if they had it. There were also red-springs and if people drank from them they would not become old.” Moreover, the Classic of Mountains and Seas (山海经) mentions a virtuous gentlemen’s land, which was also an immortal country. Explaining Characters (说文) states, “夷 has the part of 大 in it, meaning a big person; the folkways of the state 18

 Liang Yusheng. History of the Han Dynasty – People List, Commercial Press, 1937, Vol. 1, p.13

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of 夷 are kind-hearted and such kind gentlemen are always long-lived, belonging to this virtuous land.” Mister Lu’s Spring and Autumn Annals (吕氏春秋) records, “There was a country in which the people wore no clothes, it was a region of immortals.” There is another land, a land of longevity. The Yingzhou (瀛洲), Records of States (十洲记) states, “There was an area which covered a square 4 thousand miles across, in the Eastern sea. … the glossy ganoderma and celestial grasses grew across the land, an area of jade stones as high as a thousand zhang, that leaked sweet spring-like wine, which were called the Yuli Springs. If people drank a few liters from the spring, they would get drunk and became immortal. There were many immortals living on the land and their customs were similar to those of the Wu people. The landform was like that of central China.” This was apparently a land of idyllic beauty. This is just one of the three holy mountains (the other two are Penglai and Fangzhang) across the sea, mentioned by Xu Fu in the Historical Records (史记). They are all “lands of deities, with sacred medicines”. Lieh Tzu (列 子) has a list of five holy mountains: Daiyu, Yuanqiao, Fanghu, Yingzhou, and Penglai. He records, “They were situated away to the east of Bohai sea, it is not known how many thousands of miles”; “Zhugan trees grew thickly there and their fruit was delicious. If someone ate it, he would never grow old but become immortal”. Another land of longevity was called “Zhongbei Country”. It is recorded that “There were hills in that country. … at the top of the hills, water welled up, and it was ‘Shengfen, holy water’. This water was stronger smelling than peppers or orchids, and sweeter than sweet wine. … the land was fertile, and the people lived near the waters. They didn’t do farm-work and died at about 100 years old, without young death and disease. … When they felt hungry and tired, they drank from the holy water, which made them feel their strength and be peaceful. If the dead drunk, they would go into a daze and wake up after ten days.” Records of Bizarre Things (述异记) recorded about Rilin Country, “where there were several thousand kinds of medicines. There was a stone mirror in the southwest, the area covered a square several hundred miles across. The mirror was quite shiny and people could see their internal organs in it. It was also called a ‘celestial mirror’. If people of that country fell ill, they would know the disordered organ by looking into the mirror. Then they could collect celestial medicines to take in orally. No disease was incurable there. People of that country could live for 3000 years, and some of them became immortal.” This Rilin Country is also a country of immortals. This magic mirror appears in several records and its effects seem unexpectedly better than today’s X-rays or CT examinations.

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The facts reflected in the above records about people in some areas having a very long lifespan, have been permeated by myth. The ever-lasting springs, the undying trees, and holy medicines in the land of the never-dying are all factors of immortality. The holy medicines come from the undying trees and grasses. The Classic of Mountains and Seas (山海经) states, “To the south of Heishui, there were black moose-eating snakes. There was a Wushan (巫山) mountain and to the west of it, where the ‘yellow birds’ resided. The heavenly emperor stored holy medicines in eight rooms there. The ‘yellow birds’ of Wushan mountain ruled over these black snakes”. This is a record of storing holy medicines. It also records, “In the vast wilderness, … there is a Yunyu mountain. A kind of tree called a luan grew there. Yu attacked this mountain and found that this tree grew out of reddish-type rocks. The tree had a yellow trunk, red branches and green leaves. Emperors came to collect medicines from this tree.” The Bao Pu Zi (抱朴子) states, “In the past, there existed Yuanqiu mountain. Many large snakes lived there and many effective medicines grew there too.” Mister Lu’s Spring and Autumn Annals (吕氏春 秋) states, “These delicious vegetables are the ferns of Kunlun mountain and are the flower of the ‘longevity tree’.” Gao You notes, “The ‘longevity tree’ grew on Kunlun mountain. … people could become immortal if they ate the fruit of that tree.” Elm was also once regarded as a kind of tree which produced holy medicines. The Records of Self-Cultivation (修真录) states, “In the past, there were female deities who liked eating various leaves and grasses, and never slept. One day, they ate a kind of leaf and fell asleep soundly. Then they felt very happy. Thus, this tree was called a ‘Yu tree’ (yu — 愉, happiness). Later, its radical character was changed, becoming 榆 (elm)”. It is said that this is the tree “some people ate leaves of”, as told in the Classic of Mountains and Seas (山海经). In Mister Lu’s Spring and Autumn Annals (吕氏春秋), Gao You noted, “Its leaves could be taken as food and if people ate it, they became immortal.” In addition, the Classic of Gods and Spirits (神异经) records, “There were trees in the vast wilderness. … which had flowers after 3 thousand years and fruited at 9 thousand years. The fruit was 9 chi in length and width. It had no kernel and hard shell and looked like congealed honey when cut by bamboo knife. People who ate it could live for 12 thousand years.” The Records of Bizarre Things (述异记) states, “There were 7-chi sized dates in the north and 3-chi sized pears in the south. Ordinary people could not see them. If people once saw them and ate them, they became terrestrial deities at once”; and “there were jade peaches which grew on Kunlun mountain. They were bright, transparent and hard. People could only soften and eat them after they had been washed by the water of a jade-lined well”.

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The Classic of our Agriculture Patron (神农经) states, “If people ate these jade peaches, they could become immortal.” The Classic of Gods and Spirits (神异经) records, “There were trees in the vast south. …the fruit of which had a core and was shaped like a date. …If people ate it, they became terrestrial deities, not afraid of being hurt by water, fire or knife.” The Records of the Dark Cave (洞冥记) state, “There was a kind of dragon-liver gourd. Xia Qiuzhong, one of the gods, found this gourd while he was out collecting herbs. After he ate this gourd, he didn’t feel thirsty for a thousand years.” These are all records of holy fruits. The highest category of holy medicine was Yao cao (瑶草), i.e. the glossy ganoderma. The Natural History Records (博物志) state, “The glossy ganoderma was a kind of holy plant. The highest-graded looked like a horse carriage, the medium-graded looked like a human, the inferior-graded looked like one of the common six domestic animals.” The ‘horse carriage’ glossy ganoderma was the most precious. The Taiping Imperial Encyclopeadia (太平御览) writes, “Carthorse-like glossy ganoderma grew in some of the most famous mountains. They became transformed by a seven-horse carriage during Yao’s reign. People could fly by riding the clouds if they found it and ate it, or even move through the cloud cover.” Shi Zi (尸子), describing Yuhong grass, says that “The shenzhou of Ci county (赤县神州, the Dvine Land) were actually relics of Kunlun mountain. Yuhong grass grew there. If people ate some of it, they would fall into a daze and wake up 300 years later.” This probably belongs to the category of glossy ganodermas. The God Star of Longevity often holds up this plant in pictures. Jade-like stones or liquid can also be used as a holy medicine. The Classic of Mountains and Seas (山海经) states, “The Taihua mountains were steep and squarely shaped. They were as high as 5000 ren19 and 10 miles wide. Birds and beasts were unable to live there.” Guo Pu noted, “There was a ‘Shining Star’ Jade woman on that mountain, who held jade liquid. People could become deities at once after drinking it.” It also records, “Mi mountain was abundant with Dan trees (‘red trees’). This tree had round leaves, red branches, yellow flowers, and red and sweet fruits. If people ate them, they would not be hungry again. Dan water emerged from them.” The Dan water is holy water as Huai Nan Zi (淮南子) states, “People became immortal if they drank Dan water.” The Dan water is actually derived from that of “jade cream”. It is recorded that “jade cream emerged to irrigate the Dan tree. When the Dan tree was five years old, the five colors of the cream became lucid and the five tastes of it delicious”; and “jade cream originally 19

 仞, the ren, an ancient measure of varying length, 1 ren = 185 cm.

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bubbled up. Huangdi drank it and ate it”. This suggests that this “jade cream” can be eaten directly. The Jade Plate of the River Map (河图玉版) records, “There was a white jade cream found in Shaoshi mountain. People could become gods at once if they ate it.” The Records of the Ten States (十洲记) states, “There was a jade cream like the wine in Yingzhou, which was called jade wine. If people drank several liters of it, they would go into daze and become immortal.” The Map Records (括地图) state, “There was a heroic spring at the celestial palace. If people drank from it, they would sleep for 300 years and then wake up as immortals.” Wine is also regarded as a holy medicine. The mountain spring-like wine mentioned above is just such a case. The Classic of Gods and Spirits (神异 经) records, “There was a wine-spring in the wilds of the Northwest. The wine was delicious as meat and clear as a mirror. People would become immortal if they drank it.” Pine nuts can also be a holy medicine. The Legends of the Immortals (列仙传) states, “Wo Quan was the originator of a herbal collection at Huaishan mountain. He was in favor of eating pine nuts. He had hairs several cun in length all over his body. His eyes were able to look out in all directions. He could run so fast even a horse could not keep up with him. He once gave some pine nuts to Yao, but Yao had no time to eat them. These pine nuts were not ordinary nuts. If people ate them often, they could live 200 to 300 hundred years.” The Songs of Chu (楚辞) states, “I’m envious of Han Zhong’s realization of immortality.” It is said Han Zhong “collected herbs for the emperor, but the emperor refused to eat them. So he ate them himself and became immortal”. Mounted animals can also make people immortal. The Classic of Mountains and Seas (山海经) states, “There was a wen horse, …which was also called a Jiliang. People who had chance to ride on it could live for a thousand years”; “There was a chenghuan horse, which looked like a fox. It had horns on its back. People who had chance to ride on it could live for two thousand years”. The holy animal’s longevity was transferred to people through the permeation of myth. Grasses could often become holy medicines. The Supplements to Immortal Legends (仙传拾遗) records, “In the period of Qin Shi Huang (秦始皇), many people died of a false charge in Dawan (大宛) country. Quite often birds placed grass on the face of the dead and the dead came back to life. Mr. Guigu (鬼谷先生) said the grass was a holy grass from Zuzhou, which grew at Qiong (琼, jade) field and was also called the Yangshenzhi (养神芝).” In Search of the Supernatural (搜神记) records, “During the period of Gaoyang (Zhuanxu), a sister and brother got married. Gao

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Yangshi exiled them to the field of Kongtong. The couple died embracing each other. A divine bird carried up some holy grass, and place it over them. Seven years later, the couple revived as one body, with two heads and four hands and feet, called a Mengshuang Shi.” The Records of the Ten States (十洲记) states, “Jukuzhou was in the west sea. …there was Renniao mountain there. Many big trees like maples grew there. The fragrance of their flowers and leaves could be scented several hundred miles away. These trees were called ‘soul-returning’ trees. … If the tree’s roots were boiled in a jade pot and the decoction was gathered up, or made into pills, Jingjing Fragrance was produced. … The dead on the ground would come back to life when its fragrance entered their nose.” The following two records show some medicines can even prevent death and eliminate toxins. The Classic of Mountains and Seas (山海经) states, “In the east of Kaiming, there were six wizard doctors, including Wu Peng, … They surrounded the corpse of Yayu holding holy medicines to resist his death.” Guo Pu noted, “Their purpose was to resist his death qi and seek resurrection.” In the past, Shun’s father, Gu Sou, wanted to kill Shun (舜) when drunk. “Shun told this to his wife, Er’nu. She thus gave some medicine to Shun for him to wash himself all over with, before he went. Shun kept the appointment, but he never became drunk even though he drank all day.” This is recorded in Stories about Famous Women (列女传). The story of the “white rabbit pounding herbs” has also been told for a long time. The poet Li Bai (李白) wrote a poem, “The white rabbit pounds herbs, year after year, but who is neighbour to Chang’E (嫦娥), the goddess living on the moon longingly?” Fu Xuan also wrote in Try to Ask the God (拟天问): “Who lives on the moon? The white rabbit pounding herbs.” The herbs pounded down by the rabbit are surely holy medicines. The potteryware that holds the herbs is probably the one recorded as being found “in the ruins at Kunlun mountain, … where there were 9 wells at one side and many jade hengs piled up in the northwest corner.” Gao Xiu noted, “Heng equals peng, which is a potteryware used for holding holy medicines.” It is just the Big Dipper. All the above records are brimming with beautiful imagination. These curious and holy medicines motivated people in their pursuit of immortality, and this occupied them much during these remote times. But eventually such pursuit in some way directed them to find medicines that really could treat diseases. It is worth noting that the described lands of the immortals were surely places which had an especially good ecological environment — while “holy medicines” were only medicines made from superior natural substances. These products laid the foundation for Chinese medicine’s later emphasis on an immediate and natural ecology.

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Treatment in a World of Wizardry A.  The World of Wizardry 28. The “Blocked Way Between Heaven and Earth” and the Wizard The world of primitive man was filled with a mysterious atmosphere, mysterious and mystical in its feelings. In this sense, it was the world of the shaman and wizard. Human thinking, social structure, action, culture, etc. — nothing could escape the imprint of sorcery — not only in ancient times, but also still today, as people have been controlled by sorcery for nearly a hundred-thousand years. But there was a gradual phasing in and development of this wizarding world. The earliest collective representations such as fear, worship, mystery and actions similar to the ritual worship of primitive hordes were subconscious, and fundamentally spontaneous. Later, these collective actions cohered together into more regular primitive worship. The thinking of the primitives was dominated by animism. In China sorcery was more popular in the late Old Stone Age, manifested in the belief that almost anyone could be sorcerer and sorceress; anyone could communicate with the ghosts and spirits. Ghosts, spirits and human beings were believed to live in the same world, so the History of Chu – Nation (国语•楚语) records that “the people and the spirits lived side by side, nobody could differentiate them apart. Everyone could perform sacrificial rituals; every family had its own sorcerer”. A ground painting in the ruined foundations of a building in the Dadiwan Site at Qin’an County, Gansu Province supports this. The ruins belong to the late Dadiwan Culture, and are at least 4,900–5,500 years old, corresponding to the late Yangshao (仰韶) Culture. This was the period

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between a matriarchal and a patriarchal society. In the center of the painting, there is a robust figure of a man dancing, with a sharp, clubbed instrument in his hand. On his left there is a smaller, slim-waisted and largebreasted woman, in the same posture of the man. She also holds a sharp, clubbed instrument in her hand. In the lower part of the painting, there is a long pane shaped like a wooden coffin, with two people (some suggest they represent animals) lying within. There is something shaped like an inverse character “丁” in front of the pane. One opinion is that this represents the worship of ancestral spirits, while others consider it to be a record of primitive witchcraft.1 The latter opinion is nearer to the truth. With the instruments of a shaman, a man and woman are dancing to help the spirits descend and exorcise the dead (killed either by their own hand or someone else’s) and to render blessings to the living. The object shaped like an inverse “丁” must be an instrument of witchcraft. It embodies the combining together of homoeopathic and contagious magic. The situation of “immortals and human beings living side by side, every family having its sorcerer” must have brought about some social problems. If everyone could communicate with the immortals, the head of tribe would have difficulty in dealing with the situation. Reorganization was necessary and it brought about the recorded “jue di tian tong” (绝地天通) of Zhuanxu, which blocked the way between heaven and earth and made it impossible for everyone to communicate with the immortals. It is said in the Book of History – Lu’s Law (书经•吕刑) that “The Jade Emperor took compassion on his innocent victims, punishing them with torture, and checking the people of Miao, so that they had no offspring. He therefore commanded Zhong (重) and Li (黎) to block any way of communication between humans and immortals”. Zhong and Li were grandsons of Zhuanxu. The Mountain and Seas Classic (山海经) says: “Zhuanxu gave birth to Laotong, Laotong to Zhong and Li. Zhuanxu ordered Zhong to hold gods up to the heavens — Li to hold the common people down on the earth.” Or as the History of Nations – Chu (国语：楚语) goes: “Zhuanxu accepted the commandment and appointed Zhong as nan zheng (an official title) to be in charge of the heaven of the immortals; Li as huozheng (a position name) to be in charge of the earth of the people, thus order was restored and humans and immortals did not bother each other any longer — and this was called ‘blocking the road between humans and immortals’.” It was said that Li gave birth to “Ye” (噎), the god 1

 The History of Chinese Civilization, Vol.1, p.308

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of time. “Li came to the earth and gave birth to Ye, who lived in the furthest west and took the control of the movement of the sun, the moon and stars.” Ye might be the Yeming (噎鸣) in the Mountain and Seas Classic, who gave birth to twelve sons and named them after the twelve months of a year. Basically Li had so much power. The author agrees with Mr. Xu Xusheng’s view.2 Zhong and Li were senior sorcerers, one assisting Zhuanxu and in charge of the heaven; another in charge of the earth. Apart from them, none could ascend to heaven and pass on the commandments of the immortals. Obviously, there was a great reshuffle and adjustment in the wizard world, and a great reform of primitive religion. The wizarding world became orderly after that. But we can’t think that the road to the heaven had been blocked totally and that it was “impassable.” The Dengbao Mountain (“Spirits” Mountain), the Qingyao Mountain, the Zhaoshan Mountain, etc. in Kunlunxu were not only places to become an immortal, but also passages through to heaven for the sorcerers. They were the mountains of the immortals and under the charge of sorcerers. Blocking the road between heaven and earth purged the confusing situation of “every family having its own sorcerer”, and changed “immortals and humans living side by side”. Now they “lived separately”, centering the power of communicating between heaven and earth in order to make a hierarchy of wizards: that is, lord sorcerer, senior sorcerer, sorcerer and minor sorcerer. Apart for them, nobody could communicate with the immortals. This period approximately corresponded with that of the separation of immortals, humans and ghosts mentioned before (see Chapter 2). Zhuanxu was the grandson of Huangdi and son of Changyi. According to the sequence of the kings — Fuxi, Shennong, Huangdi, Shaohao, Zhuanxu, Diku, Yao, Shun and Yu — Zhuanxu reigned exactly between Huangdi and Yao. It was the period of late primitivism, during which productivity had improved, society developed, and hierarchy were stricter. So it was reasonable for Zhuanxu to reform and re-order the witches and wizards. Strictly speaking, it is incorrect to say that sorcery appeared at the end of primitive society. But it is true that there was the establishment of an orderly wizarding world and a great religious reform at the end of this society of primitivism. As it were, this religious reform first sowed the seeds for Chinese primitive society, where all was held in common to transform into a class society. Zhuanxu was an outstanding person. The appearance of “Ye”, the god of 2

 Xu Xusheng. The Legendary Era of Chinese Ancient History, p.83

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time, also reflects the order at that time. It is not unreasonable that the Chinese calendar is said to date back to Zhong and Li. This is also proved by the speech of Zhengzi (郑子) in Zuo’s Spring and Autumn Annals (左传). The famous clans before Zhuanxu were named after natural things, such as the “cloud record”, “fire record”, “water record”, “dragon record” and “bird record”; but Zhuanxu changed the tradition, and “named civil officers according to whatever they managed” and also after their positions: such as the situ (司徒 in charge of the earth, etc.) the sima (司马in charge of the military), the sikong (司空 in charge of water, engineering, etc.), which was a more accurate, orderly hierarchal system of administrative management. The people in these positions later became the governing class — and slave owners. The actions of Zhuanxu agree with Fraser’s general analysis concerning magical systems. The name “wu (巫)” (sorcerer, witch, shaman) might have first appeared during or after this period. The Analytical Dictionary of Characters (说文) annotates: “wu (巫)” has the same meaning as “gong (工)”. Duan Yucai says “Being good at something is gong (工).” I think “wu (巫)” should not be annotated as “gong (工)”, but as “communicating between heaven and the earth”. The “一” above was the heavens, below it was the earth, and inbetween were two people watching the road between heaven and earth. These two people were Zhong and Li, who danced to bring down the immortals from heaven. So the original meaning of “wu (巫)” refers to a person who can communicate with heaven and earth, which includes Zhong, Li and other sorcerers. The Analytical Dictionary of Characters says that “An ancient person named Wuxian (巫咸) was the first sorcerer”, which might imply that “wu (巫)” didn’t become an official title until after the time of Wuxian. Wuxian was a senior sorcerer, and a central character in tales concerning sorcerers. Volume 79 of Taiping Imperial Encyclopedia (太平御览) quotes from Guizang (归藏, one of three ancient books of “changes”) “Long long ago, Huangdi had a war with Yandi in the wildness of Zhuolu. Before the battle, Huangdi had gone to Wuxian for divination. Wuxian said, ‘You will win but there will be a great disaster.’ But the Great History (路史) says it was Shennong that asked Wuxian for divination. Song Zhong annotates the Generation Records (世本) that “Wuxian’s dates were unknown”. Volume 721 of the Taiping Imperial Encyclopedia (太平御览) also quotes from the Generation Records (世本): “Wuxian, a minister of Yao, also became a famous doctor because of his great skill.” Volume 790 also quotes again from Foreign Pictures (外国图) saying that, “In days of

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yore, Taiwu during the Yin Dynasty ordered Wuxian to pray at mountain and river.” Wang Yi annotates the Songs of Chu (楚辞) by saying that “Wuxian was an ancient wizard who lived during the Zhongzong period of the Yin Dynasty.” According to the above, Wuxian was different people living separately during the times of Shennong, Huangdi, Yao and Yin. There were also the people of Wu Zhi mentioned in the Mountain and Seas Classic (山海经): “Shun (舜) gave birth to Wuyin, who was banished to Zhi, and whose offspring were called the Wuzhi people. Their surname was fen. They had clothes to wear, though they did not spin; they had grain to eat, though they did not plough”. Thus they were the offspring of Wufen. Wuxian was also said to have settled at mount Dengbao, where later we hear of the “Wuxian nation”. Wuxian, Wuxiang, Wufen, Wupeng, etc. — these could be the ten sorcerers mentioned in the Mountains and Seas Classic who were all living at the same time. They were the names of powerful sorcerers who lived after Zhong and Li. Therefore Xu Xusheng’s view that “the ten sorcerers and Bogao might have lived before Zhuanxu, though their times were unknown” is questionable. The ten sorcerers along with Bai Zigao, etc. all had the privilege of being able to ascend to heaven, or gather medical plants, or communicate with the immortals, etc. and to perform their sacred duties in the Kunlunxu Mountains. Under the ten sorcerers, there were also some minor characters. It is said in the History of Nations – Chu (国语•楚语下) that “Male sorcerers were called xi (觋), female sorcerers wu (巫).” The Analytical Dictionary of Characters (说文) says “A wu (sorcerer) is a zhu (a person performing the sacrificial rite). Woman sorcerers are able to communicate with the immortals by dancing. The ancient character wu is like a person dancing, with two waving sleeves.” “A xi shows a person who can seriously devise a sacrifice to the immortals. A male is called xi; a female is called a wu.” These were the descriptions of the main role of the wu and xi — that they danced to help the immortals descend to take part in wizarding rituals. Mister Lu’s Spring and Autumn Annals (吕氏春秋) says “After Yao was crowned, he ordered his minister Zhi to create music. Zhi created music by imitating the sound of the hills, the forests, the valleys, etc., by making a drum with moose-hide, by striking a stone to imitate the Jade Emperor’s bell in attracting animals to dance”, which is a telling comment on a wizard. Confucius commented on his disciple Yu (禹) in the Analects of Confucius – Taibo (论语•泰伯) that “Yu ate simply and tried his best to sacrifice to the immortals and ghosts. He usually wore simple clothes, but wore fancy clothes when making the

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sacrifice.” He praised Yu for living frugally but wearing fancy clothes and a hat when making a sumptuous sacrifice, from which, we get the idea how solemn the sacrificial ceremony was, and how much people valued it. There is a saying like this in Han Feizi – Five Vermins (韩非子·五蠹). The importance of the wizard at that time can be deduced from the above. Wizardry declined in the Zhou Dynasty. Even so, there were still grand-scale wizarding rites. Besides, various other wizards accounted for a considerable proportion of the work in Zhou’s Rituals (周礼). For example, there was a woman zhu, senior zhu, minor zhu, funeral zhu, field zhu, cursing zhu, master sorcerer, male sorcerer, female sorcerer, dream diviner, religious devotee, feng xiangshi (astronomical official), astrological diviner, hu benshi (official to escort the ruler), lu benshi (official to hold the spear and shield), jie fushi (official in charge of the king’s clothing), fang xiangshi (official wearing a mask made out of gold and bearskin), senior servant (official in charge of the place for the king’s ritual clothing), minor servant (delivering the ruler’s everyday commands), sacrificing servant (servant in charge of the sacrifice), qi shi (official in charge of the sacrifice), shu shi (official in charge of things witchy and venomous), yi qishi (official supplying old ministers with walking sticks) etc. All these wizarding officials had their own duties and there was a delicate division of labour. These senior royal officials also acted as sorcerers in some important sacrificial ceremonies. From the above analysis, we know that after Zhong and Li blocked the road between heaven and earth, the wizarding world developed a strict wizarding/political constitution, a real form of theocracy. This might be one of the great contributions made to Shamanic Culture during human history. After reaching its peak, theocracy will tend to decline. And a feudal system came into being and emerged from this theocracy, as society developed a new stage of civilization. The period of the “spring and autumn” Warring States was indeed a revolutionary age. The evolution of a political constitution did not wipe out sorcery. As a primary cultural form in history, sorcery would not disappear that easily, and it did not step off the historical stage completely, which is why a culture of witches and wizards can commonly be seen around us, still now. Sorcery was based on mystery — and as long as there is something inexplicable in the world, there will be the soil for sorcery. The earliest senior sorcerers in ancient times were even made into heroes by history. They were known generation after generation, and no less outstanding than the officials of the later more orderly wizarding world. Although as a social phenomenon and

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individual psychology, the regime of witches and wizards disappeared, the influence of sorcery still remains.

29. The Behavioral Characteristics of Sorcery and Its Psychological Foundations If we say that the collective presentation of primitive humans as sorcerers was subconscious, mysterious and mutual permeation was involuntary in their thinking; but when sorcery became a school — and subsequently famous — any wizarding actions also became conscious and intended, and the result was that mysterious permeation became regarded as the guiding principle of all thought. Sorcery became an exclusive skill, which belonged to sorcerers — and they made great efforts to carry it out, and keep it long-lasting. They considered that the nature of all was mysterious mutual permeation — interacting and movable, and that it could be attained through the witchcraft of sorcery. At the same time, it was beneficial for people to be fearful so that they could understand “evil” and enjoy merriment that they could be brought to seek out the “good”. Everything in nature was labeled as either evil or good. Sorcery aimed to control these two: with evil pitted against evil, and blessings descending for the good. This was the psychological foundation of sorcery. “Yan Yan” (厌殃 to exorcise evil spirits) and “Yan Sheng” (厌胜 to bring bad luck to your enemy) were two typical examples in Chinese sorcery. Make an idol of your enemy (or their name) out of mud, wood, dough, etc. If you prick the eye of the idol, your enemy would become blind; if you stab its heart, your enemy would suffer a “heartache”; if you stab his foot, your enemy would be lame; if you bury it and write his birth-date and the word “he is dying”, your enemy would die soon after; if you slash the idol into pieces and bury it outside, your enemy would be wounded, or ill, or even die, and your bad luck would be erased. Mr. Tie’an (铁庵) has collected a few typical examples of Yan Sheng.3 A person named Gongsun Chao became an official. A few months later, he suddenly suffered from a serious illness and died. Before he was buried, someone found a candlenut idol wrapped in a cloth in the seventh tile-bar of the eaves of his house. After the idol had been destroyed, Gongsun Chao unexpectedly came back to life. There are a few other examples. Someone was childless, and a wooden 3

 Tie’an. Essays on Personage, Custom and Institution, Shanghai Book Store, 1986, pp. 6–9

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eunuch was found on the beam later. The sound of wrestling and fighting was heard in a house every night. After the roof-beam had been taken down, two naked wooden statues were found there. They were fighting and with their hair-disheveled. Someone’s female offspring had been adulterous for three generations. Later, the wooden idol of a woman was found in the rafters, who had been violated by several men. It was quickly taken away and the bedroom became quiet. There was someone who had unusual good luck. They had the surname Sheng (盛) and the taboo-name wannian (万年). They purchased a big house. When the house was taken down, four silver bars with the words “fu sheng wan nian” (富盛万年) cast on them were found on the roof-beam. The four silver bars were originally used for setting the foundation of the building. Sheng Wannian (盛万年) became rich accidently as his name contained the last three words on the four silver bars. Also the first word “sheng” can be explained as “made rich”. This could be a term for mysterious mutual permeation. Li Anzhai explains the saying in Zhou Rituals (周礼) “The meishi (an official) commanded the man and woman to marry in the second month of spring. Elopement was also not forbidden at this time. If the man and woman reached marriageable age and were still not married, the meishi would help them meet together.” Li Anzhai thinks the second month of spring was the time for sowing the crops, and marriage between a young man and woman might influence the harvest. People without children were forbidden to step into any orchard or field to avoid a poor harvest. Yet those childless people were also commanded to trample an enemy’s field to bring a poor harvest.4 Sometimes yellow papers might be seen in the streets and lanes. On the paper was written “Great Heaven, Great Earth, I have a night-time crying baby. I beg you good passerby, please read this out loud three times. Then my baby will have sweet dreams.” This was used to cure babies’ nocturnal crying. Sometimes on the paper was written “If you have a bad dream, please write it on the western wall. When the sun rises, everything will come good.” This was used to exorcise a nightmare. And so sorcery had a clear aim: to win over the enemy or to bring him bad luck; or to exorcise evils or to protect oneself. The former is called yan sheng, the latter yan yang in China, which is the same as the difference between black sorcery (bad luck sorcery) and white sorcery (good luck sorcery) in the West. 4

 Li Anzhai. Sorcery and Language, 1988, p.56

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Sorcery includes “positive” sorcery and “passive” sorcery. The examples above belong to positive sorcery, which means using measures of witchcraft (theurgy) to control or attain an aim. Passive sorcery is mainly to do with taboo, i.e. the prohibition of or avoidance of anything harmful, but excluding prohibition using talismans. Prohibition using talismans refers to the use of special water-talismans and spells to prohibit a hostile action or avoid some kind of hostile object: this belongs to positive sorcery. Many things need to be avoided even today. For example, fire is avoided on Cold Food day, drawing water is not allowed during the Dragon Boat Festival day, and the taboo that a name cannot be the same as the Emperor or elder member of the family, etc. A child is forbidden to point at the new moon with their hand, because it is believed the moon will cut the child’s ear as the crescent moon is shaped like a razor; the child is also forbidden to point at a rainbow, otherwise a malignant sore will grow on their finger. There are also taboos around sneezing — for a sneeze is a token of bad luck. So if one sneezes, another will say “hundred years old to you!” Just as we say “God bless you!” in the West. There is also a taboo about the dog’s howl in the Shanghai outskirts. One who hears a dog howl will say “dying dog!” to drive away the bad luck. Stepping on the threshold is also another taboo. It is said that the threshold is the neck of the family, and that stepping on the threshold will choke the family and bring about disaster. It is also forbidden to point the mouth of a pot at people, because a pot is used as altar-ware, and pointing with its mouth at someone implies using them in a sacrifice for a living person. Totem taboos can be stricter. For instance, the people of the Yao nationality are forbidden to eat dog-meat, because the dog is their ancestral totem. Bringing down the immortals by dancing and through divination were the most commonly seen sorceries practiced in ancient times. Being positive sorceries, bringing down the immortals involved praying to the immortals to get rid of evil and bring blessings to the people. Being passive sorcery, divination forecast good or bad fortune and then aided us in thinking our way out of misfortune. Divination with tortoise shells, horoscopes, dream interpretation, etc., these were often seen. Physiognomy and palmistry, fortune-telling and glyphomancy were also popular. People had a psychological disposition — “I cannot win but I can evade” — an attitude which became more obvious later. No matter whether it was bringing down the immortals or divination, they were all the processes and forms of sorcery and of “communicating with the immortals”. It seems there is a great defect in the research of sorcery theory in the West. Maybe Westerners had not studied ancient Chinese sorcery enough,

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but they did not take the wizardry and witchcraft of “communicating with the immortals” seriously into consideration. Today, the study of sorcery theory in the West is still based on that of famous English anthropologist J.G. Frazer (1854–1941).5 The following shows a classification from Frazer’s book: A classification of sorcery: sympathetic magic (sympathetic law): (1) imitative magic (similarity law), (2) contagious magic (contagious law). However, I propose that sorcery theory should also include “transforming” magic to make a threefold classification: sympathetic magic (sympathetic law): (1) imitative magic (similarity law), (2) contagious magic (contagious law), (3) transforming magic (transforming law). Sympathetic law refers to common imagination: that people in the wizarding world thought “objects at a far distance could influence each other through some kind of mysterious interaction”. This interaction could be through imitation, so “if two things were in the same category they could mutually promote each other” and “the same result must come from the same cause”, which describes well the work of “similarity law”. Another belief is that “once two objects have contacted each other, they will still interact even they have been separated far from each other,” which is the work of “contagious law”. Sorcerers enable one object (or person) to influence another, through imitation or contact. They have no misgivings about the time, the distance or that it is not part of the whole. This was the transformation of mysterious mutual permeation from people to sorcerers: all mysteries could interact with each other in primitive thinking, and sorcerers could master this power of interaction, thus to make it serve their purpose. Transforming law or magic refers to the theory that the messages are gained from the world of immortals and ghosts then manifest themselves to instruct people how to act and achieve their wizarding goal, but not through 5

 His great work, The Golden Bough, has been republished quite a few times since 1890. Xu Yuxin et al. translated the fourth edition of 1922 into Chinese in 1987, when it was published by the Chinese Folk Art Publishing House.

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imitation or contact. Such sorcerious actions often appeared in China as tortoise-shell divination, horoscopes, dream divination, palmistry and fortune-telling — all aiming to gain information from the immortals and explain it. Planchette writing evolved later as prayer for the direct incarnation of immortals who would then deliver their instructions, and tell of a particular way to achieve good fortune and avoid misfortune. As in witchcraft, this action is the giving of information to make an effect. This does not happen through imitation or contact. It is generally still as Frazer says: “The earliest sorcerers never analyzed the psychological process of witchcraft or thought of the abstract principles involved in their actions. Just like most people, they could not do logical reasoning. Their reasoning did not follow any understanding process or intellectual pursuits… in brief, witchcraft was just artistry, and never a science. There was no concept of science in their uncivilized brain.”6 However, transforming magic was more advanced in its thinking than both imitation and contagious magic. The principles behind some of the theories of prediction in China originated from transforming magic. Yan sheng and yan yang (mentioned before) are typical examples of making magic through imitation. Examples of contagious magic are as follows: When a child’s milk-teeth fell off, in order to make the permanent teeth grew out smoothly, the parents threw the lost upper teeth under the bed and the lower teeth on top of the bed, saying “big mouse, little mouse, receive my teeth and return me bronze teeth!” In the imagination the lost teeth and the new teeth will keep a lasting relation to each other — because they have contact with each other. Throwing the lost teeth under the bed or on top of the bed maintained consistency in the growing direction of the new teeth. Chinese people set store by the ties of blood. Blood out of the body should be hidden or dealt with as soon as possible — to avoid it being touched by an enemy or the ‘essence of the sun and moon’, which could cause trouble or create demons. Menses, hair and nail, etc. also are not allowed to be discarded randomly. Mr. Jiang Shaoyuan, the famous Chinese religious expert, wrote a book, Hair, Beard and Nails – Customs about Them.7 There are many examples of contagious magic in this book. There are more in the Dictionary of Chinese Customs (中国风俗辞典) published recently. For instance, the custom of burying of the placenta was often seen 6

 The Golden Bough, p.20  Jiang Shaoyuan, Hair, Beard and Nails: Customs about Them (发须爪: 关于它们的风俗), Shanghai art publishing house, 1987 7

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in Jiangnan Region, that is to say the placenta is put in a big pot and buried under the bed or at cross-roads etc. The placenta is buried under the bed to avoid contact and keep away illness and bad luck; the placenta is buried at cross-roads to be trampled on by people, as such contact can drive away disease and disaster. One story mentioned a thief who fled but left his clothes, the owner was so angry that he beat and hit the clothes. Unexpectedly, the thief ached all over and could not get up, which was because the thief had a close contact with the clothes. This is brought about by sympathetic law. Drive a nail into an enemy’s footprint and it can make his feet produce boils. Calling an enemy’s name can make him fall off his horse and get hurt. “One needs to respect and cherish one’s writing paper”, otherwise the person’s knowledge and future will be influenced unduly. Burying a dead body in a good location chosen by a geomancer will bring good luck to the offspring through physical contact with a lucky location and so on. From the above, we know that mysterious mutual permeation still provided the psychological foundation for sorcery, but sorcerers could actively use it to try to control nature. The sorcerers’ main behavioral characteristic was the sorcerers’ artifice formed by the wrong association of ideas with their magical aim.

30.  Sorcery, Religion and Science As it occupied a very long and important phase in human cultural history, the culture of sorcery and witchcraft acted, at the very least, as mother culture in three respects: institutions, religion and science. Frazer discussed this very early on. After reading the following careful analysis of it all, readers may find that there is some difference between my standpoint and Frazer’s. He says: “When a tribe’s welfare depended on fulfilling the rites of sorcery, sorcerers were promoted to a position which was more influential and reputable, and they easily could become chieftain or king, holding a high position and power. So, such a profession perhaps easily promoted the most competent and ambitious people into illustrious positions.” “One official path that sorcery had was to push the ablest person into the highest authority. Sorcery in this way did make a contribution to liberating people from traditional manacles, broadening their world-outlook and enabling them to live more freely. The benefit to people was not too trivial to mention. When we further consider that sorcery paved the way for science, we have to admit that

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although sorcery did a lot of bad things, it also was the source of a lot of good; although it was the child of fallacy, it was also the mother of freedom and truth.”8 Frazer even summarized the general developmental process of human thinking: sorcery → religion → science. The institutionalization and development of theocracy have been mentioned before. However, in a sense there was no true religion in ancient China. Buddhism began at the beginning of the East Han Dynasty and came in from India. Then, triggered by Buddhism, Taoism was founded, with a flavour of being a refurbished Buddhism. Taoism is different from the three great religions of the world in that they had spontaneous foundations and an independent form. The difference between religion and sorcery lies in the following: “Sorcery’s form, in fact, treated the spirits as if they were inanimate, that is to say, sorcery coerced and suppressed immortals and spirits; while religion pleased and flattered them.”9 The priests in ancient Greece and among the Brahmans of ancient India, etc. appeared to be taking part in a primitive religion. They developed it from wizards’ rituals, from which natural philosophy later divided off. But in China, this process was not obvious. Religious gods with a human personality, which already mentioned by Frazer, had been in China long ago. A mysterious feeling towards natural or supernatural powers, and due to such mysterious feelings a worship of the supernatural, and a belief in, and reverence and love for this feeling etc. revealed a firm belief in primitive worship, and was also evident in the concrete behaviour used for flattering gods. This manifested itself in all kinds of rites, sacrificing to heaven and the ancestors. But it did not reach the final stage of becoming an independent religion. At most, it only exhibited signs of a religion. In addition, wizarding beliefs were as obvious as wizarding behaviour. Sorcery drove, blasphemed, burnt, and paid off the immortals and ghosts. In some cases, it coerced and suppressed the immortals and spirits instead of pleasing or flattering them. Sympathetic sorcery played its role everywhere. Frazer points out that “similarity association” and “contagious association” are two basic ways of thinking. These also appeared together in China’s ancient times. They resulted from the obscure but mysterious certainty of the law of mutual permeation, casually relating cause and effect, paying too much attention to accidental and occasional affairs, disdaining contradiction, thinking little of experience, until step by step, it eventually 8

 The Golden Bough, pp.75–91.  The Golden Bough, p.79.

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evolved into sympathetic magic. This tended towards an affirmation of the invariance of the natural order, the eliminating of uncertain, casual or accidental factors, and starting to notice, collect and confirm through the use of experience, whilst paying attention to some factual contradictions. From an angle of thinking, primitive logic thus developed gradually into logical reasoning. This was the greatest contribution made by sorcery. Here sorcery, in a way came near science and became its close relation. During the stage of animism, the separation into Gods–human–ghost began to affirm a world order and the necessity of world development. This was believed to be mastered by the will of the immortals and ghosts. It was invaluable that sorcery started to confirm the rule of change and transformation in nature. Sorcery tried to predict it by divination, dream interpretation, horoscopes, etc. and find out how the immortals controlled the world. Sorcery also tried to maintain control over the spirits by yan sheng, yan yang, contagion, etc. and change the developing direction and course of events. If we ignore the spiritual and some specific sorcerer’s artifices, we may only see that the principle affirmed and pursued here was the same as that pursued in science. Sorcery and science achieved the same thing, through travelling separately down different roads. Someone might possibly say: “All sorceries are useless and absurd, they have nothing in common with science”, which is a platitude often heard. But Frazer is right; he says: “If sorcery were true and effective, it would not be sorcery but science.” So we should not criticize sorcery in a hollow way without any research, but do some earnest and down-to-earth explorative work concerning its essence and external form. Sorcery tried to control the process of natural development just as science defines laws in nature. But travelling a different road made sorcery deviate from the truth and never be able to realize its aim. Finally it was vetoed by long-term accumulated experience, which ensured that it declined. The immortals became less important and so natural philosophy grew up in its background. Thus early Chinese science directly sprouted from sorcery without moving through a religious stage. In another respect sorcery developed out of primitive religion through the activity of “flattering the immortals” which transformed and became one with human ethics. Chinese ancestral worship was specially related to ethics, and so they united quite easily. In the West, sorcery turned into religion, by virtue of having a deified ethics. But there was no religion in ancient China, and one of the reasons for this could be that there was a strong custom of ancestral worship.

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B.  Sorcerous Doctors and Sorcerous Medicine 31.  Sorcerous Doctors in Ancient Times As described above, the term wu for “sorcery” may well have appeared at approximately the time of Zhuanxu. The period before that was the time of the early stage of animism, during which sorcery had not yet fully divided and there were not professional wu. The period after that was the time of the later stage of animism, viz. the period of sorcery. The most famous and obvious sorcerers were the fourteen senior ones. There is a text concerning them in the Mountains and Seas Classic – The West Jing of Great Wilderness (山海经•海 内西经): “On the eastern side of the enlightened beast, stood Wu Peng, Wu Di, Wu Yang, Wu Lu, Wu Fan and Wu Xiang around the dead Ya Yu with ‘living’ medicine in their hands to resist the dead qi and bring him back to life.” The West Jing of Great Wilderness (海内西经) also says “In the wilderness…there was a mountain named Mount Soul, where ten great witches, namely Wu Xian, Wu Ji, Wu Fen, Wu Peng, Wu Gu, Wu Zhen, Wu Li, Wu Di, Wu Xie and Wu Luo rose up, came down and gathered various medicines.” In the above quotations, Wu Peng and Wu Di describe the same person, the different names making fourteen in all. Wu Xian and Wu Peng were the most famous. Mister Lu’s Spring and Autumn Annals – Don’t Do Everything Yourself (吕氏春秋•勿躬) says: “Wu Peng practiced medicine, Wu Xian divined.” But in fact, there was no exact division of labour among witches. All wu practiced medicine, and so were the fourteen. They gathered medicines, or used “living” medicines to “resist the dead qi and revive the dead”. Wu Peng might perhaps have been more proficient in medicine. But the Generation Records (世本) says: “Wu Xian was a doctor of Yao times and became Yao’s doctor with his sorcerious skill. He could practice zhu (祝 a kind of witchcraft) to bring blessings and treat illness. If he zhu before a tree, the tree withers; and if he zhu to birds, the bird will fall down.” From this, we know that Wu Xian also practiced sorcerious medicine. He was more likely to be the head or most proficient of those mentioned above. Also there was the grand meeting and greeting of him mentioned in the Songs of Chu (楚辞): Wu Xian will descend the immortals at evening, I’ll greet them with pepper and fine rice, So many immortals descend that the heavens cannot be seen, Oh, the spirits on the mountain Jiuyi all meet them. (Li Sao)

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As one of the characteristics of Chinese wizards, zhu stands for homoeopathic magic, performed using words, language and other objects. For example, there was a witch doctor named Miao Fu mentioned in the Tradition of the Book of Han Songs (韩诗外传) and the Anecdotes in the Garden (说苑): “I have heard of an ancient doctor named Miao Fu (also ‘Mao Fu’). When he treated illness, he made a mat out of themeda and a dog out of hay, and then practiced zhu northwards. After Miao Fu recited some ten sentences, all his patients recovered well, even those supported by others.” Making and displaying a themeda model, a dog idol out of straw to imitate the spirits causing the illness, and then cursing (zhu) with words later developed into something like magic spells and curses. This and the folk custom of reciting “Great Earth, Great Heaven, I have a crying baby”, mentioned earlier, are both examples of sympathetic magic. Another famous witch was Shu Fu. The Tradition of the Book of Han Songs (韩诗外传) says: “There was an ancient doctor named Shu Fu. He did not use medicines to treat illness, but made a head out of wood and a body out of aristate grass, blew air into the orifices of the head to calm the brain of the model and the dead revived”. There is another saying in Anecdotes in Garden – Identification (说苑•辨物): “There was a famous doctor named Shu Fu. When treating patients, he held the brain and marrow, strung the huangmu (the fatty tissue in life center between the heart and diaphragm), fumigated the nine orifices to settle the meridians and collaterals, and the dead came back to life. So he was called Shu Fu”. This is also homoeopathic magic. It first made a hay idol, then treated the idol, and the true patient recovered simultaneously. Witch rabbis on Liangshan Mountain in China now still use a similar method to perform witchcraft. The sorcerer is called Bimo. To exorcise evil, he has to firstly make a straw idol representing a scapegoat for all the sinners who want to reincarnate. Then the Bimo chants the scriptures of Bimo and all the disasters and the causes in their family and lets the straw idol be the “fall guy”. When someone suffers from a serious disaster, his soul is believed to be buried under the ground and needs to be called back. So he sets up two pieces of corn tsamba and an egg in front of the door — then pulls on some of the red strings by the door (called “pulling soul string”) from inside. Two men stand outside, holding a wooden ladle with some mud and ashes from the grass inside it. After the Bimo has chanted an incantation, the family cry out loudly and throw the mud and ashes out the door to exorcise the ghost, and then turn round back facing the house and shout: “Come back, soul!” If it is believed there is ghost haunting them or a plague, the people then curse the ghost. They have a goat or pig, a

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chicken, thirty poplar branches, thirty willow branches, and drive the pig, goat, and chicken into the Bimo. Then they thrust the willow branches in front of the kitchen. After the Bimo has chanted the scriptures, the animals will be killed to eat. If someone suffers from a dry illness, he is believed to be hunted by a dry ghost. The wizard binds a straw idol on the back of a monkey and brings the monkey to the mountain to free it. The sorcerer Suni can also seize the ghost in a pot. He moves the ghost and pot to the hillside, takes the lid off the pot, then puts it back on again, thus the ghost is caught in the pot. Then they can kill the sacrificial animals and eat them. Then he takes the pot back to the door, while another person shovels a handful of fiery ash into the pot. He chants: “Evil ghost, burn to death today!” If cursing a person, a handful of straw is bound up with a chicken and held by the Bimo. At the same time, he chants a scripture cursing the thief or enemy to death, and then the chicken is killed and cooked and eaten. Lastly chopping the straw idol into pieces, he binds the chicken’s head, wings and legs on to a bamboo rod and thrusts it into the place where it has been cursed.10 “Binding the goblin” is also popular in Zhejiang Province. If someone is ill and cannot get up, a sorceress is then invited to chant scriptures before the bedside. After making her wizardry, the sorceress catches a small animal living with the family and flings it hard on the ground, then steps on it and binds it with a hemp rope to hang it from a tree in a wild area. If the animal dies, the evil ghost causing the illness also dies. The patient will recover.11 An example is taken from folklore to prove that the witchcraft methods used by Miao Fu and Shu Fu still remain. The ancient record is brief, but modern investigation of folk-customs is quite detailed. Frazer says, in humor, that “One great advantage of homoeopathic magic is that the treatment is not necessarily done and finished on the patient himself.” There are similar examples in many countries. For instance, when a Dayak woman in Borneo finds childbirth difficult at the time of labour, a wizard is invited to act as the pregnant woman outside the house. He holds a big stone pretending it to be the foetus and acts out the pain, moving restlessly until the child is delivered. The Indians treat jaundice by transferring yellow to yellow animals such as the thrush, parrot, etc. Only if patients stare at a yellow bird, will they recover. The methods used by Shu Fu in treating illness are a good example of this in ancient China. 10

 A Dictionary of Chinese Customs, p.710 Zhang Zichen. Chinese Folk Customs and Folklore, Zhejiang People’s Publishing House, 1985, pp.120–121. 11  A Dictionary of Chinese Customs, p.810

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In view of the above, we can make a new interpretation of the text in the Historical Records (史记). It goes as follows: “Zhongshuzi (an official) says: I learnt that there was a famous doctor named Shu Fu in ancient times. He treated patients without decoctions, wine medicine, needling, daoyin (movement), massage, tuina (manipulation) or drug patches. He could as soon as possible find the problem in the patient. According to the appearance of the five Zang-organs, he cut the skin, separated the muscles, dredged the vascular channels and scoured out the choroids, held the brain, settled the diaphragm and omentum, washed the stomach and intestines, cleansed the organs, refined the essence and qi, and changed the body’s shape.” Scholars thought previously that Shu Fu had practiced a treatment, or even operated on the patient’s body. It seems that anatomy already had very high level in ancient China.12 But this interpretation is questionable. As a witch doctor, Shu Fu simulated all these operations on a straw idol, cleansed the organs of the idol to make the patient refine his essence and qi and change his countenance in order to cure him. This text from the Historical Records (史记) should be in The Tradition of the Book of Han Songs (韩诗外传), but the original text in this work is different to the quotation in the Historical Records (史记). This is probably because Sima Qian rewrote or inserted some missing sentence. The texts of The Tradition of the Book of Han Songs (韩诗外传) and the Anecdotes of the Garden (说苑) agree that as they were witch doctors, Miao Fu and Shu Fu treated illness with homoeopathic magic. Some scholars think Shu Fu lived in the time of King Chu Wu (740– 690 BCE). A Person with Pheasant Plume (鹖冠子) records that Pang Nuan answered Dao Xiang Wang of Chu: “Did you not hear how Shu Fu treated illness? He could treat every illness — and even gods and spirits hid from him. When the king of Chu took the throne, he appointed Shu Fu as chief physician. Just as Yao appointed a sage, the king of Chu appointed a competent person instead of one of his own relatives. When he was ill, he summoned not his favorite but an old doctor to treat him. One day while he was listening to a story, he fell sick. However he waited until Shu Fu came back.” According to that, Shu Fu should have been witch doctor to the Chu king. But there is only this one single testimony. We can also make a new interpretation of the saying, mentioned above, concerning “Wu Peng, etc. standing around dead Ya Yu with the ‘living’ medicine in their hands, to resist the dead qi and bring him back to life.” 12

 Kong Jianming. Outline of Chinese Medicine History, People’s Medical Publishing House, 1989, p.26

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The old view was based on Guo Pu’s annotation of “resisting the dead qi and reviving him”. The Western Jing Within the Seas (海内西经) records that “Ya Yu with a snake’s body and human face was killed by one of Er Fu’s ministers.” “Er Fu’s minister was named Wei, so he and Er Fu killed Ya Yu.” But there is no record of the resurrection of Ya Yu even mentioned in the Normal Language (尔雅), the Huainanzi (淮南子) or any other book about him. So the “living” medicine was not for bringing the dead back to life. I think it might have been a witch medicine for preventing infection, keeping the ghosts from doing evil and saving either the family or others. Wu Fan (朌) of the ten witches might refer to Wu Fan (凡). “Fan” could be a mistake for “fang” (肪) or the characters could have been interchangeable in ancient times. Wu Fan (朌) is written Wu Fang (方) later on by Chao Yuanfang in a Treatise on Causes and Manifestations of Various Diseases (诸病源候论) and as Wu Fang (妨) by Sun Simiao in Invaluable Prescriptions (千金方) where it says that “Wu Fang wrote the Canon of Cranial Fontanels of Children (小儿 颅囟经) to divine their life span and predict illness. This book passed down from generation to generation and contained many prescriptions for children.” From the above, we know that Wu Fan was a witch doctor. The apothecary Tong Jun was also known to later generations. It is said in the Great History (路史): “Huangdi commanded Wu Peng and Tong Jun to prescribe, boil decoctions, wash and needle people so to make them live as long as their natural span of life.” Like Wu Peng, Tong Jun was also a witch doctor. Tao Hongjing says in his preface of An Annotated Shen Nong’s Herbal (本草经集注) that, “Tong Jun’s Record of Gathering Herbs (采药录) describes the flower, the leaf, shape and color of herbs; His fourvolume Couplet of Medicine (药对) discusses the assistant, the guide and how they work together (mutual reinforcement).” Those texts were obviously forged by later generations, but Tong Jun has undoubtedly been regarded as the ancestor of apothecary for a long time. A few famous doctors mentioned in the Huangdi Neijing (黄帝内经) must also have been witches or wizards, for instance, Bo Gao (伯高). It is said in the Mountains and Seas Classic: “East of Qingshui River by Huashan Mountain, there is a hill called Zhaoshan where someone called Bo Gao practiced, and could ascend to the heavens.” People who could ascend to the heavens were senior wizards. The Lie Zi (列子) says: “Lie Zi took Laoshangshi as his teacher, and befriended Bo Gao. He learned their methods and could ride on the wind to return.” He became an immortal. There is also the example of Wei Yuqu (鬼臾区). It is recorded in the History of the Han Dynasty – a Record of Sacrificing to Heaven and Earth

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(汉书•郊祀志) that “Wei Yuqu was also known as Da Hong. After he died, he was buried at Yong, which was later named Hong Grave”. This book also records that Huangdi once asked Wei Yuqu some question. Wei Yuqu answered: “You will acquire the Treasure Tripod and Divining Yarrow in the year when the ji you day is exactly the first day of the lunar month — and at the Winter Solstice, in the morning. This moment agrees with the record of the skies of heaven, from ending to beginning again, round and round.” Wei Yuqu was an astrologer and discussed the “original source” of the heavens in the Neijing (内经). His talk with Huangdi is probably fictional, because the time god appeared in Zhuanxu at a time later than Huangdi. According to the quotation (see above), Wu Xian “became Yao’s doctor and gained his Hong shu (鸿术, great skill)”, Wei Yuqu was the head practitioner of Hongshu, so he must also have been a great witch. Some people later regarded Wei Yuqu to be Guang Chengzi (广成子). It is said that Shao Shu was the little brother of Shu Fu, and he certainly belonged to a family of witch doctors and wizards. There is record concerning Qi Bo (岐伯) in the Book of History – A Record of Sacrificing to Heaven and Earth (史记•封禅书) where it says “Gong Yudai said: Though Huangdi sacrificed at mount Tai, Feng Hou, Feng Ju and Qi Bo commanded Huangdi to sacrifice at East Tai Mountain and Fan Mountain. If there was an auspicious sign, he would become an immortal.” Qi Bo was regarded as a deity or wizard by some people at least. Most ministers of the Shang Dynasty were senior witches. Yi Yin (伊尹), i.e. E Hen (阿衡) was a prime wizarding minister, and Yi Zhi in Tai Wu times, Fu Yue in Wu Ding times and Jiang Taigong were also great witches. It is just as it states in the Zhou Rites (周礼) that “the duties of witches were clear”, and Yi Yin, etc. not only performed witchcraft, but also medicine, and their primary duty was to administer to the whole nation. Medicine might be the charge of minor witches. For instance, the Great Gathering of Lost Zhou Books (逸周书•大聚) says: “Each county provided witch doctors and various drugs to prepare for disease and disaster.” The Zhou Rites – Spring Officers (周礼•春官) says: “The wizards were in charge of the Wangsi (a sacrifice), the Wangyan (a sacrifice), conferring names on the immortals, inviting the immortals to attend with cogon-grass, performing the Tanzeng sacrifice to dispel misfortune and nightmares ‘of unknown directions and distance’ at the end of year, and praying for happiness to dispel misfortune and illness during the spring. When the king went to mourn his favorite minister, wizards went before him accompanied by the funeral witch to clear away the evil for the king.” But sorceresses seemed not be in charge of medicine any more.

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There is a word “ ” among the bone inscriptions. Hu Houxuan (胡厚宣) explains it as a minor disease-official13 — else it might by a minor ji-official (in charge of the royal country-estate), a minor qiu-official (qiu is the basic level of regional organization), a minor servant-official (in charge of the royal servants), or a senior horse-official (in charge of the royal horses). A minor disease-official was in charge of disease. There are also oracle inscriptions as follows: Divining: Suffer from disease? Divining: Not suffer from disease? (Cun 1.832) Suffer from disease? (Jing 2235) Such divinations were made by professional witches in charge of medicine. So there was a division of labour among witches. At first the witch performed the witchcraft and medicine simultaneously, then the senior witches became chiefly in charge of government affairs. While some minor witches became proficient doctors. This division of labour prepared the way for the breaking away of medicine from witchcraft.

32.  Zhu Taboo, Divination and Medicine Wu Xian and Miao Fu, among others, also treated patients with zhu — later called “zhu taboo” or “zhu you”. It is recorded in the Book of Rites – Sacrificing with Cattle (礼记•郊特牲) that: “Soils return to the place where they were dug! Rivers flow back into their big pool! Insects do no harm to grass and trees, and grass and trees return to their marsh.” These are “Yi Qi’s sacrificial words for the winter sacrifice” and they are the words of the zhu taboo. The Huangdi Neijing (黄帝内经) also mentions the ancient zhu you. “Huangdi asked: I have heard that in the ancient times, a patient could be cured just by zhu you through ‘shifting essence and transforming qi’. But today medicine is used to treat the inner, needling is used to treat the outer, and some diseases can be cured, but some diseases still cannot be cured. Why? Qi Bo answered: Ancient people lived with the animals. They exercised to avoid the cold and lived in the cool to avoid the summer heat. They were not hurt by love and envy inside or by rushing overworked into official 13

 Hu Houxuan, A Study of the Diseases of Yin People

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duties outside. They lived peacefully and relelaxedly. The evil qi could not invade them deeply. So they needed neither medicine within, nor needling without, but ‘shifted essence’ by using zhu you. But nowadays, people are not only hurt by sorrow and worry inside and but also injure the body by over-toil outside. Besides that, they do not follow the changing cold and heat of the four seasons, so they are easily hurt by weakening pathogens and evil winds. Firstly they injure the skin and orifices outside and then the five Zang-organs and marrow inside the body. Any ailment must become a serious disease; any serious disease must make the patient die. Zhu you can do nothing for this.” Su Wen – Shifting Essence and Transforming Qi (素问·移精变气论) “Huangdi asks: What you said now has been known by the patients themselves. But why are there some people suffering diseases suddenly — neither from invasion of evil qi, nor emotional overstrain? Is it just because of a ghost? Qi Bo answered: There are also some reasons for this. If the evil qi remains in the body from before but does not appear in the symptoms, the emotions will be oppressed and overstrained at times, the qi and blood will counter-flow and bring internal disorder, the two kinds of qi inter-clashing. These factors are invisible and in-audible, it is as if there was a ghost within. Huangdi asked again: But how could such disease be cured by zhu you? Qi Bo answered: Because the ancient witch doctors knew what would win over the disease, they mastered the cause of disease so then just so, some diseases could be cured by zhu you.” Ling Shu – Evil Winds (灵枢·贼风). According to the notion of Wang Bing during the Tang Dynasty, “zhu you” means “cursing the cause of the illness”. The above quotations from the Huangdi Neijing (黄帝内经) indicate that: I. zhu you was the basic method of treating illness in ancient times; II. zhu you was performed by a witch; III. zhu you was based on the belief that a ghost or immortal caused disease; IV. Qi Bo explained the reason the patient recovered was because the evil was not deep in the body, and that the disorder of vitality and qi could be cured through “shifting essence and transforming qi” — equal to today’s psychotherapy; V. Medicine before the Neijing virtually belonged to witchcraft. Analyzing these two quotations and because the doctors of medicines mentioned above all are the witches and wizards, we must admit that the medicine of Neijing emerged from the womb of witchcraft as it then existed. Taboo was similar to zhu you, but differed in method. Bao Puzi (抱朴子) says: “Taboos in the Wu and Yue regions could make use of qi to drive off disaster and ghosts, protect the body from injury by snakes, insects, tigers, leopards and other fierce animals, knives and arrows. Taboos also could

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make water counter-flow, stop bleeding and make embedded nails come out automatically.” This was a relic of ancient witchcraft. In fact, the animal emblazonry known as the tao tie (饕餮, a mythical ferocious animal face) popular in the Shang Dynasty, might also have acted as a taboo. Taboo was developed from totem taboos. Mr. Zhang Guangzhi (张光直) has a new opinion — that the bronze altar-ware showing animal imagery as emblazonry, such as that on big caldrons and pots, were a necessity for the witches as thus they could “communicate with heaven and earth”. He disagrees with Luo Zhenyu (罗振玉) and Rong Geng (荣庚) that those animals on the emblazonry “opened their mouths to eat humans”. He also disagrees that the “tao tie you” was sometimes called the “eating-humans tao tie you”. He thinks the animal’s open mouth was a first symbol of separating this side of the world (the world of the living) from that side of the world (the world of the dead). All animals “open their mouths to breathe”, to make “wind” which was “the right and basic instrument to communicate with heaven and earth”.14 I basically agree with Zhang Guangzhi and further extend his idea, asserting that this emblazonry was possibly also for frightening off ghosts and spirits, especially the epidemical ghosts causing disease. It was as in ancient Babylon, where every family inlaid their doors and windows with a strange eagle image made out of clay or metal. It was said that this “strange eagle” was the epidemic god of the “south-west wind”, which brought about disease. The god of epidemics was afraid to see his own ugly image, so the Babylonians inlaid the image on doors to frighten him away. This was acting just like a taboo in sorcery. Those bronze altar wares with the tao tie emblazonry from the Shang Dynasty also frightened away or ate up evil spirits — which can be proved circumstantially by the still remaining custom of hanging up a symbol at the door to drive away disease, in the Li Su nationality.15 Taboo almost never disappeared. Taoism helped it develop — and there was a “department for taboos” in the government medical division following after the Sui and Tang dynasties. Divination was the most common form of sorcery. The Historical Records – On Tortoise Shell and Yarrow (史记•龟策列传) say: “It was an unalterable tradition that when the king had to make a decision concerning a dilemma, he would divine with the turtle and yarrow-stalks in order to 14

 Zhang Guangzhi. Arts on Fairy Tale and Sacrifice, Liaoning Educational Publishing House, 1988, p. 49, 57 15  Guo Chengxu, et al. Preliminary Investigation of Lisu medicine in Jinsha village of Dechang County in Sichuan Province, Chinese Journal of Medical History, No. 3, 1987

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make a choice.” Divination was especially popular during the Shang Dynasty, but the earliest oracle bones have been seen in Xiawanggang Site during the late Yangshao Culture in Xichuan County, Henan Province, and then next in Chengziya Site during the Longshan Culture, Shandong Province. These oracle bones are cattle or deer scapulae with fissures on their upper surface, which indicated a direction, possibly they were made by burning with a point, or some might have been drilled. The oracle bones at Jiangou Site, Handan County are the scapulae of pig, sheep, deer and cattle, all showing vestiges of burning. The fourteen sheep-scapulae in Dahezhuang Site, Gansu Province from the Qijia Culture have vestige of burning instead of drilling. Divination with tortoise shells was an everyday routine during the Shang. As long as there was something to question, people divined. The drilled oracle bones among the Yin Ruins in Anyang (安阳殷墟) amount to more than 150,000. Tortoise plastrons also became material for divination. There was also divination with scapulae during the Zhou. There have been more than 20,000 discovered since the 1950s. The southern racial minorities during the Han Dynasty used chicken bones to divine. The Book of the Former Han – A Record of Outskirts Sacrifice (汉书•郊祀志) records, “The Yue witch built Yue Zhu temple, which had a platform but no altar. They also sacrificed to immortals and ghosts. They divined using a chicken and the king believed it. Yue sacrifice and chicken divination have been popular since this time.” The General Yunnan Records (云南通志) says that the method of chicken divination is as follows: “Get a young female chicken, cut its hip-joints and bind it up while still living, then carefully dissect its skin and bone, prick through its openings with bamboo sticks. According to the number, direction and shape of bamboo sticks, people divine good or bad luck”. These well-known oracular bone inscriptions from the Shang Dynasty have been universally acknowledged to be the earliest and most comprehensive writing system with formed characters found in China to present. The aim of divination was to forecast good or bad luck. People basically divined by asking celestial immortals such as the God, Sun, God Mother, Western Queen Mother, Cloud, Wind, Rain and Thunder; or earthly immortals such as gnomes, immortals of the four direction, the four spirits, the four witches, Mountain, River or spirit-ghosts such as a deceased father, deceased emperor, or deceased mother, a deceased philosopher, a deceased aunt or deceased minister, etc. Also they divined to ask about disease. Sacrifice was mainly used to treat illness but how to sacrifice was decided by divination. For instance, “Divining on a geng xu day, I (the king) suffer from tinnitus,

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and sacrifice one hundred sheep to ancestor Zhugeng.” This oracle inscription means that Wuding King suffered from tinnitus, he divined and was told that he had to sacrifice to his ancestor Zhugeng with one hundred sheep in order to treat his illness. There is another example in Zuo’s Spring and Autumn Annals – The 6th Year of Ai Times (左传•哀六年): “King Zhao of Chu was ill. The diviner said King Zhao was ill because of the evil spirit of the Huanghe Spirits. But King Zhao made no sacrifice, so his daifu (an official) requested him to make a sacrifice in the suburbs of the city.” Divination is still seen in the Yi nationality (among the Talu people) in Yongsheng County, Yunnan Province recently. The process is as follows: Firstly they prayed, a witch extolled the efficaciousness of sheep bones and spoke out about the thing to be divined; then the sacrifice: invite the sheep bones to “eat” the rice (burnt highland barley among the Qiang nationality; scattered wheat among the Naxi); next burn the bone: light small grains of wormwood-leaves or fireweed on the bone surface until fissures were seen. Sometimes bones needed to be burnt a few times and in a few places; finally examine the fissures on the bone, explain what they presage — and judge good or bad luck, this is done by the witch and then bury or burn the sheep bones to show how sacred they are.16 So we surmise that divination during the Shang Dynasty might have followed a similar process. Burning fissures mainly on the back of a tortoise shell or scapulae was used. Words carved on them after divination, were called oracle inscriptions. Boring was also used, or burning, or drilling and boring together. The instrument was a little bronze knife or jade engraving knife. Divination had no direct effect on the illness, but influenced greatly the patient’s psychology. It was as effective as zhu you. Besides this, drilling, burning and the resultant fissures might work by influencing the establishment of meridian theory of acupuncture, about which we will talk in detail later.

33.  Horoscopes, Divination by Dreams and the Yarrow Stalks Though horoscopes appeared long ago, horoscopes predicting illness are not seen much among the documentary remains. Zuo’s Spring and Autumn Annals – The 10th Year of Zhao Times (左传•昭十年) says: “A star appeared in the Wunu Constellation in the spring (the first month of the Zhou calendar). Bizao of Zheng nation said to Zichan: ‘The Jin king will be dead on 16

 Wang Yuxin. Research on Inscriptions of Bones since the Founding of the P.R.C, China Social Sciences Press, 1981, p.64

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the 3th day of July.’” Zuo’s Spring and Autumn Annals – The 17th Year of Zhao Times (昭十七年) say: “A comet appeared beside the Big Fire star at winter. Its brilliant rays went westward to the Milky Way. Shenxu said: a comet means replacing the old with the new. Everything happening in the sky often forebodes good or bad luck. Today we drive away the Big Fire star, but it will appear again. Will there be a disastrous fire somewhere in the country?” The Huainan Zi – On Military Affairs (淮南子•兵略训) says: “King Wu of Zhou (周武王) sent a punitive expedition against King Zhou of Shang (商纣王). They marched eastwards and performed sacrificial rites for the spring. When they got to Sishui River (in Henan Province), there was a deluge; when they got to the Gongshan Mountain, there was a landslide. Then a comet appeared, and its handle pointing towards Yin seemed to lend Yin a helping hand.” All these examples had nothing to do with illness except for the king of Jin’s death. Popular Chinese chess is mentioned in the Songs of Chu (楚辞): “With jade counters and ivory pieces, they play the six-bo game. Two players step up, playing harder and harder. If there is a xiao piece, the player can capture two! Five Whites! Every player cries out for it!” Continuing the Tripitaka (续藏经) says: “Shennong used the sun, moon, stars and other celestial bodies as chess pieces. Niu Sengru, prime minister of the Tang, used carriages, horses, a general, warriors, soldiers and cannons as chess-pieces.” The earliest chessmen were like the sun, moon and stars — it might have been a horoscopy. The comets (“sweeping stars” in Chinese), Jupiter, Mars, etc. were later regarded as evil stars. There are also old sayings such as “the blue star kills people”, “a shooting star brings prosperity”, “a lucky star brings good luck”, “lucky stars, high and bright, bring to the world happiness”, which all relate to the practice of horoscopes and may have some involvement with medicine. Dream divination must have always played an important role during the age of animism. Being known as “dream foreboding”, dream divination also had a great influence on the Chinese. A Pedigree of Monarchs (帝王世纪) describes: “Huangdi dreamed that a strong wind blew away all the dust; and a man held a very heavy crossbow and drove on hundreds-of-thousands of sheep.” The Book of History – About Five Monarchs (史记•五帝本纪) records that Huangdi interpreted the dreams himself: “Wind is the commander, it means the ruler; the character ‘gou’ (垢) has lost the radical ‘tu’ (土) and become ‘hou’ (后). Is there someone with the surname wind and first name hou? A strong crossbow means strength; herding hundreds-ofthousands sheep is what a competent herdsman is good at. Is there someone with surname li (力strength) and first name mu (牧 herd)?” According to the story, Huangdi divined and prayed to the immortals and arrived Feng Hou

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and Li Mu, two famous ministers. But there were no written characters during Huangdi times. It was impossible to interpret dreams by taking apart Chinese characters. The above-mentioned might be a strained interpretation made by later generations. But there are many records of dreams in the Pedigree of Monarchs (帝王世纪). For instance, Yao dreamt he ascended the heavens on a dragon, Shun dreamt about growing eyebrows and drumming; Yu dreamt about a book called Mountains, about taking a bath in Huanghe River and about travelling to the moon by boat etc. Those examples at least prove that dream divination was once popular. There is a saying in Zhanghen’s Thoughts on Life (思玄赋) that “It made Wu Xian interpret my dream and he said it was an auspicious omen.” There is also a saying in Han Yu’s On Luo Pond (享罗池) that “I dreamed that I got an animal like a leopard cat,… Wu Xian has ascended to the heaven, who knows him now?” It seems that Wu Xian was the earlier dream diviner from these two sayings. Dream divination was also sorcery. Dream divination had a set of theories outlined in the popular On Dream Explanation (解梦书) put together during the Wei, Jin and the Southern and Northern Dynasties. It says: “Dreams consist of imagery. They result from the movement of the essential qi. When one dreams, his soul departs the body to communicate with the immortals. Dreams are an interaction of Yin and Yang and predict good or bad luck. They can predict faults, so a virtuous person can behave himself well and so avoid the fault. Dreams mean speaking to the dreamer, they speak in their own form, while you as dreamer cannot see, hear, smell or speak out. The soul is away and the body left behind. The dreamer is so absorbed in things, he forgets the body. The soul accepts the warning from the heavenly immortals and informs the dreamer. If the dreamer is not full of essential qi, he will forget the warning. After the dreamer has woken up, he relates the warning from his dream. There have been dream officers since ancient times, generation after generation.” There are many theories on dreaming like this one, which gives a proper foundation for interpreting a dream. The study of dreams and dream theories also has never declined in the West. The modern book The Interpretation of Dreams by Freud (1856–1939) written in 1900 has had a far-reaching influence. Gustav Carl Jung (1875–1961) and his school described their view in People and Their Representations.17 Relatively speaking there is little research on dreams in China except for the recently 17

 Sigmund Freud. The Interpretation of Dreams, translated by Lai Qiwan, Fu Chuanxiao, Chinese Folk Art Publishing House, 1986. People and Their Representation (人及其表象), translated by Zhang Yue,. Chinese International Broadcasting Publishing House

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published book: Superstition and Exploration of Dreams (梦的迷信与梦的 探索).18 From these studies, we know that no matter whether we are talking about dream divination in the past or dream interpretation in the present, dream analysis reflects to some extent an intangible reality; it is not totally superstitious or anti-scientific. There are also some records of dream divination in oracle inscriptions. There were some about illness as follows: Divination on a geng chen day, divining: dreaming about ghosts often, will it bring bad luck? (Hou Xia 3.18) Divination on a geng chen day, divining: dreaming about ghosts often, will it be a disease appearing? (Fu • Za 65) Divining: Ya dreams about ghosts often, will I be ill or not? Yes, in April. (Qian 4.18.3) …the King dreamt, will his children be ill or not? (Jing 1660) Officials divining dreams are recorded in Zhou’s Rituals – Spring Offices (周礼·春官): “Dream diviners need to master the four seasons and the meeting together of the sky and earth, to judge Yin qi and Yang qi, and to divine the ‘six dreams lucky or not’ by the sun, moon and stars”. Dreams were classified into six types: peaceful dreams, astounding dreams, musingover dreams, awakening dreams, happy dreams and frightening dreams. There is the record of “inviting a senior advisor to interpret a dream” in the Book of Songs (诗经). It is a text about the dream of the sex of a fetus: “The diviner interprets that if I dream about bear or brown bear, I will bear a boy; if I dream about a small dragon without a horn or a snake, I will bear a girl.” Zuo’s Spring and Autumn Annals – The 9th Year of Cheng Times (左 传·成九年) records: “The lord of Jin dreamed of a large ghost with long hair which could touch the ground. Beating his breast, the ghost says: ‘It is unrighteous for you to kill my offspring. I have got the Emperor’s permission to revenge myself on you.’ Then he smashed up the entrance door and interior door and stepped in. The lord was afraid and hid in an inner room. The ghost smashed up the room door again. After waking up, the lord gave audience to the witch Sangtian Wu. What the witch said was just the same as the dream. The lord said: ‘But what is it about?’ The witch said: ‘You 18

 Liu Wenying. Superstition and Exploration of Dreams, Chinese Social Science Press, 1989

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would not taste the new rice!’ It came out just as the witch said.” This was an example in which dream divination was testified to be correct. There is also a saying about dream divination in Chapter 6 of The Life of Yanzi (晏子春秋): “Lord Jing suffered from edema and dreamed about fighting with the sun. Yanzi taught the diviner how to answer Lord Jing.” Yanzi said: “The Lord’s illness is Yin, the sun is Yang. One Yin cannot win over two Yangs. You will recover.” “After three days, Lord Jing recovered”. Yanzi used the theory of Yin and Yang to interpret the dream, which worked just like psychotherapy. There is the same record of dream interpretation in the Huangdi Neijing (黄帝内经) and in the Lie Zi (列子): “If Yin qi is excessive, the patient will dream about crossing rivers and be frightened; if Yang qi is excessive, the patient will dream about fires and feel burning; if Yin and Yang are both excessive, the patient will dream about close fighting. If evil qi in the upper body is excessive, the patient will dream about flying in the sky; if evil qi in the lower body is excessive, the patient will dream about falling; if the patient is hungry, he will dream about getting food; if the patient is too full, he will dream about rendering something to others…” (Ling Shu – Excessive Evils Causing Dream) There are some changes in the Lie Zi (列子), “strong” instead of “excessive”, “fierce fighting” instead of “close fighting”. There is not the fourth sentence beginning with “upper”, but there are also added some other sentences: “So if the original pulse is floating and deficient, the patient will dream about floating; if the pulse is excessive and downwards, the patient will dream about drowning; if one sleeps with a belt, he will dream about snakes; if one’s hair is held by a bird, he will dream about flying; if it will be cloudy, people dream about fire; if one will be ill, he will dream about dining; if one dreams of drinking wine, he will be feeling sad; if one dreams of singing and dancing, he will be crying. Dream of meeting an imaginary lady in effect is the affair of making love. So, what you think in the day causes dreaming at night. This is because the spirits and body form a combination with things. So when one’s spirit is centering on something, the dreams disappeared. Trust your waking sense without doubt; believing in the dream will not be realized…” The records in these two books testify that ancient dream divination has had a long history. The Ling Shu – Excessive Evils Causing Dreams (灵枢·淫邪发梦) has more on it, as Table 4.1 shows:

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Illness

Being angry

liver-qi exuberance

Being frightened, crying, flying

lung-qi exuberance

Easily laughing, being fearful

heart-qi exuberance

Singing, the body heavy and cannot rise up

spleen-qi exuberance

The loins being separated from the spine

kidney-qi exuberance

Mountains and hills, flame

chaotic qi in the heart

Flying, strange metal things

chaotic qi in the lung

Mountains, forests

chaotic qi in the liver

Hills, a lake, a broken house in the wind and rain

chaotic qi in the spleen

On the edge of abyss, in the water

chaotic qi in the kidney

Food and drink

chaotic qi in the stomach

A field

chaotic qi in the large intestine

Many people in s square or main road

chaotic qi in the small intestine

Fighting, legal action and killing oneself

chaotic qi in the gallbladder

Love-making

chaotic qi in the genital organ

Be beheaded

chaotic qi in the neck

Wanting to go but cannot, trapped in a pit under the ground

chaotic qi in the legs

Bending on your knees as in rituals

chaotic qi in the thigh

Defecating or urinating

chaotic qi in the urethra and rectum

Something tragic, being killed and bleeding, war

lung-qi deficiency

Be drowned from a boat or trapped in water

kidney-qi deficiency

White mushrooms, green grass, crouching under tree and cannot stand up

kidney-qi deficiency

Fire-fighting, thunder, scorching

heart-qi deficiency

Deficient food and water, building walls or houses

spleen-qi deficiency

From this table, it is clear that dreaming connects directly with the bodily organs (zangfu) according to the theories of Yin and Yang and Five Phases, which is the transformative interpretation of dream divination, and reflects the medical usage of ancient dream divination. Divination by yarrow was also as important as divination by tortoise shell during the Shang (Yin) Dynasty. The Flood Codes (洪范) says: “Set up officials to carry out the yarrow divination. If there are three diviners, defer to two of them. If you are in supreme doubt but it needs a decision, you should firstly consider yourself, then consult with ministers, next with the

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plebeians, finally with the divination officials. If you agree, the diviners agree, the ministers agree, the plebeians agree, this is called Great Unity.” This case was seen at the end of the Yin Dynasty and the beginning of the Zhou. If Wu Xian were a senior witch in the Yin Dynasty, the tale that “Wu Xian created yarrow divination” could not be true because yarrow divination is known to be created by the Zhou people. However, we may regard Wu Xian as one of the senior witches at Kunlun Xu, near Zhouyuan. Yarrow divination means dividing up the yarrow-stalks into piles and divining good or bad luck according to the number of stalks in each pile. Because the divination instrument is the yarrow stalk, it is impossible to find remnants in archaeological excavations. The historical record of yarrow divination is written into three later books. Zhou’s Ritual – Spring Official (周礼·春官) records that “the divination method was written into the three books of change: the Lianshan (连山), the Storing (归藏); and the Book of Changes (周易). They all have eight Trigrams and sixty-four double Trigrams”. Gao Heng considers that “the Lianshan (连山) and the Storing (归藏) are also books on yarrow divination, the writer of Zhou’s Ritual (周礼) arranged them according to their age, but their specific period cannot be verified.”19 The former two books might have existed during the Han. The three books were all about divination. They were written at different times and were always being rewritten. Yarrow divination must have been popular in the Zhou Dynasty. The Book of Changes (周易) greatly influenced Chinese culture and is the original source of the theory of Yin and Yang, as well as influencing medicine. Couch grass and bamboo might also have been used for yarrow divination. Li Sao (离骚) says: “I brought couch grass and bamboo to the diviner and asked Lingfen to divine for me.” Wang Yi annotates: “qiong mao (琼茅), is couch grass used as a spiritual grass. Yan (筳), means little splinters of bamboo. Chu people named divination with couch grass and bamboo ‘splinter zhuan’ (篿).” But it is a pity there are not more documents or definite objects to testify to these sayings. It is also a pity that nothing proves the connection between this divination and medicine.

34.  The Great Exorcism and Fu Xi Sacrifice The term fu xi means “to cleanse”. The Great Elegance – About Heaven (广雅·释天) says: “the fu xi, the sacrifice.” The Nations – Chu (国语·楚语上) says: “cleansing one’s heart, one’s being refined.” Wei Zhao annotates: 19

 Gao Heng. A Modern Annotation of the Book of Changes, Qilu publishing house, 1979, p.665.

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“being refined, means being clean.” Fu means “removing evil”, xi means “cleaning the body”. To fu xi is to clean the body, and remove evil qi and sick qi, eliminate dangerous illness and to get wellbeing. Mo Tzu – The Law in the World (墨子·尚同) states: “If people suffer an illness or disaster, they must fast and take a bath, and prepare wine and rice to sacrifice to the immortals and ghosts, then the heavenly immortals can remove the illness or disaster.” This is an example of fu xi. In folk custom, the fu xi sacrifice was usually held in ancestral temples or she (places where one sacrificed to the spirits of the land) at the beginning of the year. It was especially popular to perform the fu xi by the side of a river on the third day of the third month in the lunar calendar, March. There was also making a bonfire, using incense or bath at home, or taking a bath by the waterside, and daubing animal blood on the body. Besides this, people held a xi drinking party or feast. In Zhou’s Ritual – Spring Official – Sorceress (周礼·春官·女巫) it says: “The sorceress was in charge of the yearly bath of the fu xi.” Zheng Xuan annotates: “The ‘yearly bath of the fu xi’ just means the Shangsi Festival on the river in the lunar calendar March. The bath refers to bathing with fragrant herbs.” The fu xi became an occasion for men and women to enjoy the spring scenery and romance, just as it says in the Book of Songs – Songs of Zheng – Zhen River and Wei River (诗经·郑风·溱洧): “The Zhen and Wei Rivers, their water just melted from freeze! Young men and women, with sweet orchids in their hands! The woman said: ‘shall we go to have a look?’ The men answered: ‘We just have been! Shall we go again!’ They reach the river — an immense place, so many happy people! Men and women, talking and laughing. presenting peonies.” The Book of Jin – About Ritual (晋书·礼志) says:”According to the rituals of the Han, officials and the common people all sacrificed in a river in which the water flowed towards the east, cleansed and bathed themselves to eliminate dirt and bad luck at the time of the Shangsi Festival, in the spring.” Wang Xizhi (王羲之) and his friends performed the fu xi at the Orchid Pavilion, playing the game of “cups following on the curved Brooklet” (a game where cups filled with wine were put on the water to drift along in the stream, and people catch up the cups for drinking). Du Fu’s (杜 甫) poem goes: “The third day of the third month there was brilliant weather, there are many beauties by the river in Chang’an.” There is also Du Mu’s (杜牧) poem: “It rains and rains at the Qingming Festival. The people on the road are so sad they feel they have lost their souls — as if missing their dead ancestors.” Such examples shown the changes in custom. But the sanitary aim of the ancient fu xi and of dispelling evil qi was kept up. For

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example, in the Yearly Record of Customs in Hubei Province (荆楚岁时记) it says: “Jingchu people wove various grasses together and made an idol out of Chinese mugwort to put by the door to remove evil qi on the fifth day of the fifth month, May.” Another example: “Make a tiger out of Chinese mugwort, some even as small as a black bean. Or cut out a tiger from colorful paper and stick some mugwort on it to be worn.” These two examples may be related to the fu xi performed at the Shangsi Festival in the spring. The book also states that red-bean porridge was used to remove evil, because the son of Gong Gong (共工), who turned into an evil ghost, was afraid of red beans. The Nine Odes – Madam Xiang (九歌·湘夫人) states: “Artocarpus as the ridge beam, magnolia as the rafter; magnolia flowers around to decorate the door lintel, angelica dahurica around to decorate the medicine room.” The Book of Jin – About Ritual (晋书·礼志) says: “Reed rope, callamus, peach wood and a killed chicken were put on the doors of the palace and all temples — normally on the first day of the year to remove any evil qi. According to the Han rituals, it was in midsummer but only a peach-wood seal was used and no killed chicken. Emperor Ming of the Wei Dynasty changed greatly the ceremony of exorcism. He Yan (何晏) drew up the rituals of the ‘exorcism sacrifice’, and debated over whether a chicken and other animals should be used …” All those customs could date back to the ancient fu xi and were performed with the function of treatment and sanitation. The Da Nuo (Great Sacrificial Rite) used to exorcise pestilence was similar. The witch or wizard danced to bring down the immortals and to exorcise the ghosts causing the illness — along with some altarware and animals used for sacrifice. Wang Yi says, in the Annotation of the Songs of Chu (楚辞章 句): “Long ago, people in Nanzheng County and the place between Yuan River and Xiang River believed in sorcery and liked to perform the sacrifice. They drummed, sang and danced to please the immortals.” They pleased the immortals so that the immortals would not harm the people. The Great Exorcism is recorded, as a formal ritual, in almost all the official histories. It is specifically described in the History of the Later Han – About Rituals (后汉书·礼仪志): The Great Exorcism is performed on the day before the La Ba Festival and was for dispelling the plague. The ritual was as follows: Select children of the yellow gate (eunuchs) between ten and twelve years old and one hundred and twenty chenzi (youthful wizards). They all wear a red scarf, black clothing and hold large drums. The fangxiangshi (main official) wears a mask with four golden eyes and is dressed in a bearskin, black garments, vermilion pants, with a dagger-axe and shield in his hands. The twelve

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animals wear hide and horn. The chief royal-bodyguards lead the eunuchs to drive off evil ghosts from the palace. At the time of adding water to the water clock after its night-leakage, officials including the shizhong (an official appointed directly by the ruler), the shangshu (a high official), the yushi (an official for recording), the yezhe (an official in charge of passing on information, etc.), a warrior, an armed escort, a langjiang (a military officer), a deacon, etc. all wore red headscarves and guarded the ruler to escort the royal carriage to the Royal Hall. The head of the eunuchs reports to the king: “the chenzi are ready to exorcise, shall we start?” And then the eunuchs sing, the chenzi joining in the singing, saying: “Jia Zuo eats up evils; Fei Wei eats up tigers; Xiong Bo eats up ghosts; Teng Jian eats up bad luck; Lan Zhu eats up disaster; Bo Qi eats up nightmares; Qiang Liang and Zu Ming eat up dismembering and killing at the same time; Wei Sui eats up Guan ghost; Cuo Duan eats up monsters; Qiong Qi and Teng Gen both eat up venomous insects. We make the twelve immortals trace around the evil, split apart your body, sever your limbs, divide your flesh, cut out your lungs and bowels. If you do not hasten to flee, you will be eaten up.” The fangxiangshi and the twelve animals then dance and chant around the palace three times, then held up torches to send out the evil through the Duan door. Mounted men then drive in a carriage at the door, carrying torches to the sima (in charge of the southern palace-gate), then they ride off to camp, and finally after they have passed everyone at last throws their torches into the Luo River. Every official following the exorcism wears an animal mask made of peach wood. Then the deacon finishes the sacrifice. A halberd made of reeds and a stick of peach wood is then granted to senior officers, generals and vassals. How majestic, how splendid, and with what sincerity was the wizarding ceremony performed! From the monarch to his officials, they trusted their health and life, for the whole year, to this ritual. Such was the strength of sympathetic magic. Some people think the Master of Life (大司命) poem in the Nine Odes (九歌) is an ode to the Great Exorcism.20 Widely open is the gate of Heavenly Palace, I ride a black cloud, A whirlwind is my forerunner, A rainstorm clears the air. 20

 Chen Jiazhe. New Annotation of Nine Odes, Sichuan people’s Publishing House, 1982, p.55

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The above describes the arrogance of pestilence spirit when he descends. Cloud clothes float freely, The jade plate at his waist tinkles. Yin and Yang do everything on earth, Nobody knows what I have done! This describes what the pestilent spirit wears and his evil intent. But next an old dean appears, he holds a Cimicifuga foetida medicine, and sneers at the pestilent spirit, warning him: My dragon carriage rumbling, Rushes up into the sky, … What can the sad person do? Wish every day was like today without loss. Everyone has his own fate, Nobody can control divergence or coming together! This was the Great Exorcism for eliminating the plague among the ordinary people. The Customs in Jingchu (荆楚岁时记) records: “A group of people wore hu helmets (or masks) and played waist-drums to act as the god Vajra. They swarmed around like bees and danced to drive away the pestilence and it fled like a frightened rat. The people finally won.” There is a paragraph describing the Great Exorcism in Prose about Luoyang (东京赋): “Drive away demons and monsters, chop down devils, cut up the snakes, and behead the Fangliang (方良) spirits. Imprison the Gengfu (耕父) ghost in a cold area, drown the Nu Ba (女魃) in the Shenhuang River, cripple the one-legged monster and the wangxiang (a water or wood-stone monster), kill the mao zhong and you guang (evil ghosts).” People performing exorcism had great power; they could wipe out the spirits of the mountain and marsh, evil ghosts, the wei yi (a snake as big the boss of a roof-nave), swamp spirits, the drought ghost, monsters of wood and stone, the red ghost of disease, etc. Dances following the Great Exorcism later became the principal ritual in Shamanism. (They are still popular in Northeast China, Siberia, and among Eskimos.) The Record about Jilin Province (鸡林·旧闻录) states: “Shamanism is a religion of the Dongyi, a people of Manchuria who

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believed it since long ago. Now Shamanism has travelled to the lower reaches of the Songhuajiang River, Heilongjiang River, and Majiang River. It has reached Hamgyong, etc. in Korea. If someone is ill, a wizard or witch is invited to the house. Dozens of strings of cash, strung on iron wire, are fastened horizontally to the two ears of a drum held in the left hand of the wizard … they hunch up their shoulders and walk, using a drum stick to beat the drum. The strings of coins do not come together but they make a noise. With a full-length apron around his waist, the wizard chants an incantation, then makes the noise of the evil. He can perform operations, use a knife to prick the affected part of the patient and even cut it into two. That custom can also be seen at Linjiang City in Jilin Province.” This is the model where one wizard performs the exorcism. There was also the dance of exorcism made by a few wizards in the Qing Dynasty palace, Yunnan and Guizhou Provinces, years ago. They wore a ghost mask and armor, held a spear and musical instruments, took a brave posture of do-or-die, and fought with the ghosts and demons. There are some variants of this dance for eliminating pestilence among the southern minorities, for instance, the “washing the ghosts”, “funeral entertainment”, “making trouble with the dead”, “shelving the dead”, and “funeral dancing with a drum” etc. The Nanmu Sa among the Dulong nationality means a folk wizard. He was a “lifelong friend sent from the heaven to treat illness”. He has four to ten other Nanmu as his assistants, to treat illness, save souls, kill ghosts and divine, etc. Nanmu Sa has “intelligent eyes” to see the root of the illness. He “drops heavenly medicine” on the head of patient, takes out little black stones, ropes etc. from the patient without touching him; or sucks out black sandy-water which is believed to cause illness. As they perform these rites, they shake bells, beat on a onesided drum, and tie a belt embedded with seashells around the waist, dance and sing. This is the exorcism of the shamans. Professor Xu Weilian (徐维廉) and others made some research into Shamanism used by witches and wizards to treat illness among the Oroqen nationalities. The shaman chose the following people to train: somebody whose placenta had not separated off when he was born; someone who suffered from a serious illness and recovered after the shaman’s treatment, who then promised to train as a shaman; someone who had suffered convulsions and then been cured. It was not hereditary. As The Annals of Aihui County (瑷珲县志) records: “being a skilled doctor is like having fun or playing a game”; “Someone who did not understand medicine suffered from illness. He invited in a witch. The witch wore a five-flower crest and eight-trigram clothes. Two big bronze glasses were on her breast and back, bells tied

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around her waist and knees. She beat a one-side drum, jumped round, acted frenziedly, and made strange noises like singing or crying but without an even temperament. The witch often called out, or spoke like a bird in the trees, and the people did not understand her meaning. Suddenly she made a big jump up into the air. The people were astounded. Then she turns back and says: Here comes the immortal! It was a ‘dance for the immortals’.” This was a Shamanic exorcism dance developed into “jumping immortals” (跳神). Professor Xu recorded live a song of a Shaman praying to the immortals on location21:

There was somebody suffering from a serious illness. The shaman made him lie naked on his back, sprinkled boiled water on him and said “biqindalan (必沁达兰)”! At the climax of the jumping immortals, “the immortal infuses him”, the Shaman shows an expression of being fevered and having chills, stupor and then loses consciousness. It is said that the Shaman has seen the immortal who the patient offended. After a while, the Shaman draws an image of the immortal on paper and gives it to the patient to enshrine at home. The whole process lasts from about ten minutes to a few hours.21 This is a general description about how the Great Exorcism developed into “the jumping immortals treatment”.

35.  Massage? Moxibustion? Herbal Medicine? The quotations in this section are cited in the following: Yu shengwu (于省 吾) Annotation of Inscriptions on Bones (甲骨文字释林); Hu Houxuan (胡 厚宣) A Study of Yin People’s Disease (殷人疾病考); Meng Shikai (孟世凯) A Sketch of Inscriptions on Bones at Yinxu Site (殷墟甲骨文简述); Xiao Ai (萧艾) The History of Inscriptions of Bones (甲骨文史话); Kang Yin (康殷) The Origin of Words (文字源流浅说); also About Inscriptions of Bones (甲骨文编) and Union of Inscriptions of Bones (甲骨合集); Wen Shaofeng (温少锋) and Yuan Tingdong (袁庭栋) The Study of Oracle Inscriptions of 21

 Xu Weilian, et al. A Study of Oroqen Medicine. Chinese Journal of Medical History, Vol. 1, 1989

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Yinxu Site, Science and Technology Series (殷墟卜辞研究, 科学技术编); Wang Yuxin (王宇信) A Study of Inscriptions on Bones Since the Founding of the PRC (建国以来甲骨文研究); and Peng Jian’s, Zhan Yinxin’s, and Lin Qianliang’s (彭坚、詹鄞鑫、林乾良) papers from the Chinese Journal of Medical History, etc. The “ ” inscription on tortoise shells and bones, explained by Meng Shikai as someone lying in bed, with a hand massaging him, is generally thought to have the same meaning, as an inscription from an ancient bronze “ ”. Yu Shengwu explains it as “the ancient character ‘Yin (殷)’. People suffered from illness of the internal organs and used a massage utensil to treat it”. It refers to a particular massage skill. It also has variants …etc. on other bone inscriptions. Kang Yin explains it as the original writing of the character for “yi (medicine)”: “It is like someone holding an instrument shaped as if to pierce the belly.” Wen Shaofeng thinks these explanations are inter-changeable and complementary. Ren Yingqiu (任应秋) considers that “殹” was the original character for medicine, meaning the guard for an arrow. 殳 is the character for knife. “Knife” is thought to have been used for medicine, but the reason is unknown. Combining the above, we think that “殹” and “殷” are two variants with similar meanings. (“殹” can also be written “也”, a third variant.) Wen Shaofeng and others also explained that the “ ” as “付” as an original script for “拊”, which popularizes Xia Lu’s idea of it being “like a hand massaging a belly, being the original character for 抚 and 摸 (touch, massage)”. The Analytical Dictionary of Characters (说文) says: “拊 means ‘stroke’, with the sound of 付 (fu) and the radical 手 (hand).” It also says: “ 揗 means massage.” This explanation is nearly correct. But it is inappropriate to say that “Shu Fu was the earliest master of massage.” We have met Shu Fu before. As with most simple treatment, massage comes close to instinctive behavior. It had been developed by that time. So there are oracle inscriptions about massage as follows: Divining: Bellyache to give massage, ok? Be blessed? ( Yi 234) Should we not massage for this illness? (Yi 8075) Divination on a jia shen day, Zheng divining: Yin, should he come massage the children? Divining: Yin, should he not come to massage the children? (Qian 7.43.1) Divination on a xin hai day, Bin divining: Should I not take an aromatherapy bath and massage? (Ming 2354)

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These all refer to massage used to treat illness. The word “疛” is equal to an inscription on bone “ ”, and refers to stomach-ache. It is also used as a verb, meaning a “massage to treat stomach-ache”. Massage (on the bone)? ( Yi 4714) Divination on a ding you day, Zheng divining：Call for massage, ok? ( Yi 2244) The two characters above, “尹” and “ ”, might mean a professional masseur. “臭” is explained as an aromatherapy bath, the ritual before treatment. It is more appropriate to explain “臭暨拊” as aromatherapy bath and massage. Similarly, Yin (殷) is also explained as needling to treat illness. The instrument was shaped just like a stone needle. The Analytical Dictionary of Characters (说文) states: “Bian (砭) refers to using a stone to prick the affected part.” The Mountain and Seas Classic (山海经): “There was a hill called Gaoshi Hill. There were some jades on top of the hill and needling stones at its foot.” Guo Pu (郭璞) annotates bian (砭) saying: “It means a small stone needle used to treat carbuncles.” Hao Yixing (郝懿行) says in Annotations to the Mountains and Seas Classic (山海经笺疏): “‘砥’ should be written ‘砭’, it is mis-written.” A Southern History – A Biography of Wang Sengru (南史·王僧孺传) annotates, “Bian (砭) means using a stone needle’.” The Book of Former Han – Yiwenzhi (汉书·艺文志) says: “In the Canons of Medicine… there were treatment methods such as the stone needle, decoctions, and moxibustion.” Yan Shigu (颜师古) of the Tang Dynasty annotates: “Stone means the needling stone, viz. a stone needle. People in ancient times used it to treat illness, which is not seen today.” The Suwen (素问) says: “In the Eastern regions…carbuncles are mostly seen and treated suitably by the needling stone.” Wang Bing (王冰) annotates: “Needling stone means to use a stone as a needle.” The Lingshu (灵 枢) says: “So if the sick part has pus and blood, it can only be treated by the stone needle, stiletto needle or lance needle to drain pus.” The Nanjing (难经) says: “If pathogens invade the eight extraordinary channels, they accumulate in the body and cause swelling and fever. They should be pricked and drained by a stone needle.” These quotations all testify that bian (砭) was an instrument used to prick abscesses. Ma Jixing (马继兴) and Zhou Shirong (周世荣) think that the ancient needling stone had four functions: I. to press or medical ironing, II. to massage, III. to cut abscesses and pricking, to drain stuck blood, IV. to tap.22 Objects like needling 22

 Ma Jixing, et al. Preliminary Study on Stone Needle in Archaeological Excavation. Antiques, Vol. 11, 1978

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stones from the Yin Dynasty have been unearthed at Taixi Village in Gaocheng County, Hebei Province. It is acceptable that bian (砭) is seen as meaning “needling”: that is to say, bian (砭) is an instrument used for surgical operations. But it is not right to regard bian (砭) as the needle used today (described in detail later). The Elegance – About Words (尔雅·释言) says that one of the extended meanings of the word Yin (殷) is “appropriate, correct”, referring to correct treatment. The meaning is similar to that of Yin (殷) in the following sentences: “to correct midspring” in the History of Ancient Royalty – About Yao (书·尧典); and “the waters centered at Jiu Jiang” in History of Ancient Royalty – Yu Gong (禹贡) and “if the breath is not vigorous, it is not due to our natural endowments” in Chuang Tzu – Things in the World (庄子·外物). Again, pus with blood after needling is dark red, so Yin (殷) is also noted as “dark red” in the Great Rhyme (广韵). For example, “the left wheel is black red” in Zuo’s Spring and Autumn Annals – The 2th Year of Cheng Times (左传·成二年). Du notes: “Blood becomes Yin (殷) after a while; Yin (殷) is pronounced yan (烟). Today people call dark red a Yin (殷) colour.” “Yin red” is related to the original meaning of the character. Yin is also explained as “pain” in Great Elegance – About Ancient Words (广雅·释诂) because people ache when being needled. A patient is treated by needling, so there is the saying “Yin Yin means worry”, a saying from Elegance – About Dao (尔雅·释训); needling needs a lot of care, so we say “a lot of care is called hospitality”, as mentioned in the Kangxi Dictionary (康熙字典), and so on. Those examples are enough to prove that the original meaning of “Yin” was “needling”. The word “xu” (叙) is used as / / / in the inscription on bone. This is a variant of “yu” (余) and the original meaning is an instrument with a sharp head and handle.23 This also mentions using a stone needle to treat illness. See the Source of Name – Ancient Books and Arts (释名·释典义): Xu (叙) is zhu (cutting). Cutting the excess means draining the excess. Oracle inscription: It is not getting worse, needling? (Qian 6.10.3) 23

 See for example Wen Yiduo, New Meaning of Classics — About Yu; and Xia Lu. Study Notes on Ancient Writing. They quote from a secondary source: Wen Xiaofeng, Yuan Tingdong. The Study of Oracle Inscriptions at Yinxu Site, Science and Technology Series, Sichuan Social Science Institute Press, 1983, p.335.

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It means: “It did not get worse, does it still need needling?” There is a tortoise shell inscription on a wenkui you (a kind of vessel) of the Shang Dynasty. Mr. Yu Xingwu describes it as: “like somebody in bed at home and massaging his belly with an instrument, with a fire under him to make him warm”. But Xia Lu says：“It is a pictographic and ideographic word ‘liao’ (疗, meaning treatment) with someone indoors using an instrument for needling and fire treatment.” Either explanation is acceptable, if we relate it to the above and other characters possibly meaning fire-therapy. Kang Yin considers the following characters meaning fire-therapy: ( ) seems like two fires under a person’s left and right armpits. It is perhaps fire-therapy. ( ) and ( ) seem like a hand holding a burning needle, heated. It is a fire needle. ( ) and ( ) are explained as ironing flat, like a hand holding an instrument to heat a patient’s back, viz. medical ironing. The instrument is like a stone, perhaps a stone needle. ( ) is explained as “xiu” (修), a simple character meaning to iron, then changed to mean “to decorate” (修饰). ( ) — ( ) ( ) ( ) are explained as “攸”, simplifying the same character above. (

) means jiu (灸, moxibustion), like using light fire to do moxibustion.

Zhan Yinxin explains ( ) as ( ) on Tortoise Shell Inscriptions in Xiaotunnandi (小屯南地甲骨) 2219. by saying that ( ) is a simple script for “re” (热 hot). The character is like a hand holding a grass cone to heat the abdomen. It is the same as the “ruo” (焫 moxibustion) of 灸焫 (moxibustion) in the Nei Jing (内经). Wang Bing notes, “Cauterizing with burning moxa is called moxibustion.” The above explanations are all acceptable. Like massage, medical ironing was almost the earliest and simplest form of treatment. It was instinctive and developed into an early healing technique, just as cooking with fire and protection against damp also evolved. I personally think all these treatments can be comprehensively called “acupuncture therapy with Bian stone”.

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Accordingly, we have to consider the views of Wen Shaofeng and others who think that “moxibustion was popular at that time”. He says: There is a tortoise shell inscription which shows two hands holding up a pair of scissors. The inscription is explained as “乂” by Ding Shan and Li Xiaoding, as seen in the Explanation of Tortoise Shell Inscriptions (甲骨文字集释). And “乂” is pronounced “ai” (艾). In ancient times, if the words had the same pronunciation, they had the same meaning moxa. There are also oracle inscriptions: Should Wumei (a sorceress) treat the children with moxibustion? (shi 11.10) Divination on a chou day: The child is to be treated with moxibustion? (Jin 556) ) Divination on a wu wu day, divining: Should the wife be treated with moxibustion? This evening？… On a wu wu day, the wife made a sacrifice to father Wu. It is a good omen. Do we moxa again? (He 470) Do moxibustion? This evening？… Do moxibustion this evening? (zong 2458) These oracle inscriptions are all to divine whether to treat children or a wife with moxibustion. … Do we invite Aimu to do moxa？ (jia 2287) Aimu and Wumei were possibly professional moxibustion therapists. There is also an inscription “ ”, which can be written as “ ”. Meng Shikai explains that shows somebody lying in bed and treated by herbs or moxibustion. Wen Shaofeng and others think the character means treating a patient with herbs, and could be an original writing of “yao” (药 medicines, herbs), viz. “藥”. The Analytical Dictionary of Characters (说文) says: “medicines (药) mean herbs used to treat illness, using the radical herb and the pronunciation yue (乐).” The word with the radical illness and “wood” is in accord with the meaning of using “greenery to treat illness”. 藥 is the new phonogram for ( ). This saying is to the point. There are also these oracle inscriptions: Divining: Treat with herbal medicine, is this blessed？ (yi 6412) Don’t use herbal medicine? ( yi 632)

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These are all records about treating illness with herbal medicine. There are also specific records about treating illness with fish or dates. Divination on a bing xu day, divining: Abdominal pain, should we use fish? (Ku1212) Divination, Bing divining … is ill, will king make use of dates? (Ji 6.23.10) Divination on a jia xu day, divining: Suffer from malaria, should we use dates? (Ming 105) Treating malaria with dates can also be seen in the Minor Bupleurum Decoction mentioned in the Treatise on Febrile Diseases (伤寒论) by Zhang Zhongjing (张仲景) of the Han Dynasty. The decoction consists of twelve dates given to treat alternate attacks of chills and fever, as in malaria. This Minor Bupleurum Decoration was revised by removing Pinellia Tuber and adding Trichosanthes Fruit and dates in the book Medical Essences (外台秘要). The Compendium of Materia Medica (本草纲目) also quote a text from the Supernatural Feats (岣嵝神书), “Spell a date to treat malaria. Hold a date and recite: ‘I have a date, with great piety towards the Great Dao. Are you willing to descend, are you willing to do good deeds to others. It also can be burnt.’ Recite the spell seven times and blow on the date, then give it to the patient to eat and the patient recovers.” This shows that later records also accord with the bone inscriptions. Wine was also used as medicine. Divination on a bing chen day, divining: Make a sacrifice to Ding for Wu’s illness, Should we use with new wine? (Xu 1.44.6) “New chang” means new wine, which was customary to use to treat illness. “Bi has been addicted to drink, so he is ill” is also an example about wine. (Jia 2121) These are explanations by experts concerning tortoise shell inscriptions. But the specific explanations about acupuncture and moxibustion, massage and herbs are still in dispute. There are some other tortoise-shell inscriptions about treatment. For instance, people used tooth extraction to treat tooth problems: Divination on a jia zi day, Ke divining: The King has a sick tooth, should we use awl to extract it? (Qian 4.4.1)

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Divination on jia zi day, Ke divining: The King has a sick tooth, Should we extract it? (Qian 6.32.1) Divining: Is this

a sick tooth? (Tong Ⅲ7)

Divining: Pray for the sick tooth to come out, will this be blessed? The sick tooth, would this course be blessed? (Bing 11) “Yi”(易) means to remove, to extract the sick tooth; “ ” means to fasten, to fasten the sick tooth with a fine thread to extract it, which was a method often used by people to extract a tooth. “ ” is explained as “blessed”, “di” (氐) here means “send”, “zhi” (之) here means “out”. The meaning of the whole sentence is “Pray for sending out the sick tooth, be blessed?” This is also about tooth extraction, but the tooth here is a sick tooth. It is different from the custom of teeth extraction mentioned before, though the former possibly followed on from the latter. There is also bone-setting to treat dislocation: The Kings elbow is dislocated? Should we reduce it? (He 211) “ ” is the original writing of elbow. “ ” means to “rectify”, that is “correct”, “unity”, “tangle”, etc. We can conclude that this is reducing therapy for an elbow dislocation, viz. resetting the joint. There are tortoise-shell inscriptions about other aspects also: ( ) is also written as ( ), as if somebody was sweeping the floor with a broom in one hand and a dustpan in the other. ( ) means guan (盥), or washing the hands. (

) means mei (沬), or washing the face.

(

) means mu (沐), or washing the hair.

( ) means 湔 (jian), washing, or washing the feet.。 ( ) is wen (温), or taking a bath in a tub. Zhan Yinxin also thinks that there was a rather strict distinction between using water to wash the face and the hair, and water to wash the feet during the Yin and Shang Dynasties. The former was “pan”, viz. the water left after washing rice; the latter was “tang”, viz. hot water. The Origins of Things (物原) says, “Gao Xinshi began to build a bi (湢 bathroom)”. A Book of Rituals (礼记) says: “The husband and wife are not allowed to use the same dwelling, nor take a bath in the same bathroom”.

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Inscriptions about praying for treatment have been mentioned before.

36.  The Medicine of Witchcraft in the Mountain and Seas Classic The Mountain and Seas Classic (山海经) is an encyclopedia put together during the time of witchcraft in China. It records the primary gods such as Huangdi, Zhuanxu, Dijun, and some others such as Chiyou, Zhurong, Gonggong, Nuwa, Gun, also with slight mention of Yao, Shun, Yu, Qi, Wanhai (the 7th forefather of Chengtang), up to Chengtang, the first king of the Yin and Shang Dynasty, but it does not record any people after Chengtang. So I consider that the Mountains and Seas Classic was written after the time of Chengtang. But the book was not written too long after Chengtang, otherwise it would mention Yiyin and the other kings who followed Chengtang. It does not praise Wanghai and Chengtang, so Yuan Ke’s (袁珂) view is that it is most likely that the book was made up of legends of the Chu, and not written down by the Yin nation.24 The book was possibly written by other people trodden down by the Yin, who had to leave the Central Plains. This means it is necessary to make an especial description of the medicine written about in the Mountains and Seas Classic. Firstly, it is certain that all writing on medicine in this work has been coloured by witchcraft. In other words, their medicine was entirely carried out by witches and wizards. When outlining every mountain and river, it firstly describes the particular sacrificial ceremony, then describes the medicine. For example: “Taking Bo Mountain from Goulin Mount to Yangxu Mount, there are sixteen mountains in the Boshan Mountain Chain, a total distance of 2,982 li. The Sheng Mountain was the ancient tomb. Its sacrifice: a calf, a sheep, a pig, and an auspicious piece of jade. The Shou Mountain is the place where the spirits show their presence. Its sacrifice: some rice, a black pig, a black calf, a black sheep, some fine wine, dancing with shield, branches, a bi (a round flat piece of jade with a hole in its center). The Shishui River goes to the heavens. Its sacrifice: an auspicious piece of jade, fat animals, a black dog on top, over which is bound a chicken. Kill a ewe and sacrifice her blood. Use a colorful silk to wrap up all the sacrifices and invite the spirit to enjoy them.” Reading this text, we feel a strong witchwind blowing against our face. It records various strange animals, plants, minerals, stones and springs, etc. from every mountain and river. There are 121 objects in all, which are described clearly in relation to health or disease. 24

 Yuan Ke. Symposium on Myth, Shanghai Ancient Books Press, 1982, p.1225.

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There are fourteen medicines mentioned in total in the Nanshan Jing (南 山经), such as the zhuyu (a grass which grew on Zhaoyao Mountain; if people ate it, they would never be hungry.), the migu (a tree which grew on Zhaoyao Mountain, whose flowers could give out a bright light and prevent travelers losing their way), the xingxing (an ape-like animal, whose meat could make people walk with vigorous strides), beeswax, xuan turtles (people who ate them were never deaf), the “trout” (a fish like a calf, people eating its meat did not suffer from carbuncles), the lei (an animal like a cat, which was monoecious; people eating its meat were never jealous.), the boyi (an animal like a sheep, people wearing its fur did not feel fear), the shangfu (a waxbill-like chicken, people eating its meat did not feel sleepy), the “ninetailed fox” (people eating its meat were not invaded by evil spirits), the guanguan (a waxbill-like turtledove, its plumes could make you clearheaded), the chiru (like a fish, its meat could prevent scabies), the hujiao (with a fish-like body and a snake’s tail, its meat could prevent swelling and hemorrhoids), the baijiu (a tree, of which the juice was sweet, people drinking it did not feel hungry and sad). There are twenty-eight medicines in all in the Xishan Jing (西山经), such as the xianyang (an animal like a sheep, whose grease could cure chapped skin), the bili (a grass, which cures heart disease), water with sulphur and sienna (red earth), the feiyi (a waxbill, curing leprosy and killing parasites in the body), the huangguan (a grass, curing scabies and edema), the gurong (like a vanilla-bean, causing infertility), the fan (a mineral used to kill mice), the jiaguo (its fruit like a peach, people eating it are never tired), the wenyao (a fish like a carp, curing mania), the shatang (people eating it could float on water). There are twenty-one in all in the Beishan Jing (北山经), such as the “slippery fish” (a fish like a finless eel, curing swellings), the “merman” (an aquatic creature, makes a sound like a baby, it could cure abdominal lumps and kill parasites), the ershu (an animal like a mouse, its meat could cure abdominal distension), the “yellow bird” (a bird, people eating it would not become jealous). These are all animals, most of them fishes. There are six in all in the Dongshan Jing (东山经), such as the zhubie fish (curing pestilence), the xiegou (its appearance means pestilence), the fei (a strange beast, its appearance means pestilence). Some cured pestilence, warts, blindness, etc. But some appeared and brought pestilence, and so on. There are fifty-one in all in the Zhongshan Jing (中山经), such as the li tree (its fruits could improve memory), the hao fish (used to cure favus on the scalp), rong grass (a grass used to cure arthralgia), the mangcao (awned grass — for poisoning fish), the xun grass (beautifying the skin), the yao

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grass (beautifying grass), the tripodia turtle (people eating it did not suffer from serious illness, it also was used to cure swellings), the zhuyu (a yam), ditai water (curing heartache), the bamboo, the ba snake (curing heart and abdominal disease). Some of these medicines were used to cure goiter, favus, fistula sores, acne, wind-arthralgia, prolapses, diseases caused by poisonous insect; some were used to poison fish; some were used to seduce another person; some were used to make people sterile or unsleepy, some to prevent people from being attacked by poisonous insects, etc. Here I just name a few. Those used to cure disease come to forty-six, those used to keep away disease come to forty-five, those used to strengthen the body are nineteen, those which are good for producing offspring are two, those causing sterility are two, those pitted against evil spirits are two, those used for beautifying are two, those poisoning mice are two, those poisoning fish are four, other poisonous medicines are three, those that bring pestilence when they appear come to four. Those medicines were all bewitched and used by witches and wizards. This is proven in the following text. “There was Taiqi Mountain, from which the Guan River flowed out … where there were many wen yao fish (flying fish). They were like carp, but had a fish’s body with bird-like wings, a green streak, white head and red beak. They are often in the four seas. They often swam in the eastern sea and would fly at night. Their sound was like that of a luan (a mythical bird like a phoenix), their meat tasted sour and sweet. If people ate them, the crazy would be cured. Their appearance brought a bumper harvest.” In Lu’s Spring and Autumn – Original Flavors (吕氏春秋·本味) it says: “Those that taste delicious are the fish in the Guan River, called yao.” Comparing these two texts, the fish in Lu’s Spring and Autumn are the true fish; but the fish in the Mountains and Seas Classic were deified fish, which could fly at night, had a fish’s body and bird’s wings … sounded like a luan ...cured the crazy … brought a bumper harvest. They not only cured the crazy, but also brought a bumper harvest! They had magical power. “There was a kind of bird like a crow, but it had three heads and six tails and kept on laughing, it was called a qi tu. People eating its meat did not have nightmares anymore and could keep away evil spirits”. It was also bewitched. “There was a mountain called the Guyao Mountain where Nu shi, the daughter of the Emperor of Heaven, died and turned into yao grass. This grass had many layers of leaves, and yellow flowers. Its fruits were like those of the dodder and could make people beautiful.” Yao grass became the

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incarnation of the Emperor’s daughter. It was a medicine deified through contagious magic. “There are little stones on the Xiuyu Mountain, which are used as chesspieces by Ditai. They have five-colored stripes on them, like a quail’s egg. Ditai’s stones were used to sacrifice to the immortals, with them people are not invaded by evil spirits.” Because the stones were used for the sacrifice, they obtained magical power and became a magical medicine. “There was a mountain called Mi Mountain, four-hundred and twenty miles to the northwest. … Here are produced black jades. Huangdi often enjoyed an ointment made from these jades. If red wood was soaked with this jade ointment, it would blossom out with five-colored flowers and then produce five-colored fruits after five years. Huangdi collected the quintessence of this jade from Mi Mountain and threw it onto the southern side of Bell Mountain, facing the sun. A five-color light was given out, flickering and very beautiful, reflecting the harmony of the hard and soft. No matter whoever they were, immortal or ghost, they all ate it. An upright man ate it could keep away bad luck.” This is also contagious magic. Everything that Huangdi touched had magical power. These medicines described above are all of the same kind. Strange animals, strange birds and strange fish all appear in a collective representation. They left and moved away from their actual form to produce a magical power. “Wearing it and not losing your way” played its part through contagious magic. The Mountain and Seas Classic records even more animals and plants such as the papaya, sweet dew, wolfberry, peony, Lovage Rhizome, realgar, wu (a grass), mustard, cudrania, oak, the trifoliate orange, the cypress, willow, lettuce, floating weeds, the leek, jujube, paprika, laurel, peach, vitex, chestnut, mulberry, plum, deer musk, the rhinoceros, the tree of heaven, tangerine, hazel, pomegranate grain, the alpine yarrow, a type of bean, sophora japonica, the elm, sunflower, the ahurian angelica, chrysanthemum, Chinese ligusticum, miwu (a fragrant herb), insects, “dragon-bones”, and dwarf lilyturf, coming to forty-five in all. According to the Compendium of Materia Medica, by Li Liangsong and others, a statistical count says the number of animals and plants in the Mountain and Seas Classic comes to 227. I declare that his book was presented to me after I had finished writing this passage and I did not compare it with my Compendium of Materia Medica. Some of those he recorded were mainly foodstuffs, vegetables and fruits. Almost all of them could be used as medicines, but were not named “medicine”, so I have not listed them as witch medicines. Even so, they could still have been used in sorcery, as their connotations were not the same as their connotations today.

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The Origin of Medicine A. A Definition of the Origin of Medicine and Other Relative Factors 37.  To Identify the Conception of Medicine’s Origin The origins of medicine are as unclear as the origins of human and human cultural activity. The reasons are that: I. The non-clarity of the earliest human existence; II. There is no universally acknowledged definition of “medicine” and “culture” for discussion. There is a viewpoint that since modern medicine is a scientific system, naturally, in tracing medicine’s origins, only scientific activity should be allowed as a formal source. This totally excludes all wizarding and superstitious factors, and negates at once an important phase in the origins of medicine. It should be understood that even though, generally speaking, “the nearer the source, the clearer the water”, in the case of medicine and culture the reverse is true. Certainly we cannot say that the original phase of “medicine’s origins” lies in the implications of the scientific age.1 Otherwise, we will be cutting out its historical chain of development, and the substantial existence of many cultural ties, let alone discussing its origins. Also, people cannot regard some specific medical treatise such as the collected works of Hippocrates or the Huangdi Neijing in China as the sole origin of medicine — because medical activities had been around for millions of years before these books were written. From a historical point of view, we realize that we cannot totally exclude witchcraft and superstition from the field of medicine. The medicine of witches and wizards was an important 1

 Chen Guang, The Social Recognition of the Scientist, Science, No.3, 1990. 213

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phenomenon in medical culture. Especially during its original stage, witchcraft and wizardry played an important role and lasted a long time. As for medicine’s initial origins, I think we must come back to a more accurate definition, for instance — Medicine may be defined as follows: Medicine is a scientific system of knowledge with regard to a recognition that forms and continues to form within our own culture, as the practical activity and theory of scientific knowledge that historically gradually develops to maintain and enhance human health, prevent and treat disease and prompt the rehabilitation of the body. — So all the earliest human activities in accord with this definition lie within our scope. That is to say: When exploring the origins of medicine, on one side, we should certainly seek out any indistinctly appearing but essential medical factors within primitive human activities; while on the other side, we should examine how these essential factors came together, step by step, finally to turn into an independent professional knowledge, namely, a system. This is the process of the development of medicine and its civilization. Therefore, curative activity is not medicine itself but has formed the basis for medicine’s origins. The origins of medicine embrace a curative activity which had its own conscious aim and began to move forward systematically and rationally.

38.  Animal Instinct and Human Love Evolving from the animals, the earliest human beings more or less retained some animal characteristics. The origins of medicine also firstly involved instinct. The study of instinct is very complex. The general view is that since human beings evolved from animals, animal behavior or animal instincts must also be transferable to humans (for instance “survival”). There is a point of view in the field of medicine that medicine originated from the instincts of animals. For instance some older works such as the English version of Chinese History by Wang Jimin and Wu Liande state: “To seek and apply remedies for it (pain) is the most primitive of primeval instincts”2; also The Outline of Medical History by Li Tao considers “The origin of human medicine… was roughly similar to that of animal medicine”.3 Some more recent works such as Difference, 2

 K. Chimin Wong and Wu Lien-the, Chinese History, p.2, National Quarantine Service, Shanghai, China. 1936. 3  Li Tao, The Outline of Medical History, Chinese Medical Association, 1940.

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Puzzlement and Choice, chiefly edited by He Yumin, also mention that “In a sense, medicine started from instinct”.4 They give many examples to prove this, such as: Bees and ants have “medical organizations”, even acting like professional doctors, nurses or midwives. A wounded ant is dragged back by its mates; a drowned bee is saved and nursed by its companions until it recovers. In India, an elephant was wounded in the head, and its mother dressed it every day until it recovered; bears eat grass, or sweet flag leaves to treat gastric disease, and eat wild fruit to cure dyspepsia; When apes in the tropical forests start shivering, they will gnaw Peruvian bark; when cats suffer from diarrhea, they take in a kind of fresh grass until they vomit extremely which stops the diarrhea; if suffering from thrush, gibbons will chew a kind of grass and then recover; wounded hares look for cobwebs to dress a wound; wild boars wallow in a quagmire to dress a wound with mud; hippos use the sharp tip of a reed to prick open a vein to let blood; stags use the leaves of the dictamni bush to treat a wound. Tortoises eat mint to detoxify snake venom; when adders fight and get wounded, they will hurry to a stream to drink as much water as they can and the head swelling will disappear within two hours, which is similar to “hydrotherapy”; sea cucumbers “discard the chariots to save the commander in chief”: that is, if the stomach and bowels become poisoned, they discharge them out the anus and produce a new set. It is recorded in Chinese ancient books that “sick deer eat asaraceae leaves”, “overfeeding dogs look for rice leaves”, “cats seek out the fimbriata to treat bee stings”, “tigers shot by poisonous arrows will eat clean mud”, “boars shot by poisonous arrows root around in the earth to find adenophora trachelioides to eat”, “mice bitten by snake drink mud water”, “spiders stung by bees dress their wound with worm-casts”, “pheasants hurt by an eagle dress the wound with adhesive rehmannia leaves”, “storks rub a broken egg with sticky herbs” etc. There are many examples like this in China and abroad. Professor Li Tao concludes that “Animals know they have to enter deep water to bathe in hot weather, to go in the sun to warm themselves when it is cold, to kill lice, fleas, mosquitoes, flies etc. to remove the irritation to the skin. It is common for cats and dogs to lick to clean a wound, dogs eat grass to vomit, monkeys stop bleeding and remove foreign matter with the hand 4

 Difference, Puzzlement and Choice chiefly edited by He Yumin, Shenyang Publishing House, 1990.

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etc. All of these are following their instincts to overcome pain. They also indicate the origin of medicine.”5 Some have criticized the term “origin of medicines” as “medicines” implies a natural drug, whose origin people need not work hard to explore. In fact, the term is conventional, meaning “the origin of the application of medicines” condensed into the “origin of medicines”. It is undeniable that this medical behavior in animals could also have been done by primitive man, or the most uncivilized and uneducated of people, even those who were mentally simple or did not learn from their activity. The earliest human treatment could not do without such activities as cleansing a wound, pressing to stop bleeding and removing foreign matter, etc. The problem is whether these most primitive activities were instinctive or not? Why was man able to develop his base “instincts” into a medicine, while animals were not? Social anthropologist Agnes Heller (born 1929), Hungarian by descent, and a senior research fellow of sociology at Latuobao University in Melbourne, Australia, has written a book Human Instinct.6 She considers there are four views on “instinct”. I. The scholars of traditional behaviorism who deny that man and animals possess instinct; II. It is wrong to differentiate between man and animals, instincts are various (more than 6,000 according to some statistics); III. Basic instincts. Some consider that there are a few basic instincts that control animals’ and man’s behaviour. Later, some scholars believe there are four basic instincts: starvation, sexual desire, aggressiveness and fear; IV. Some people consider that many types of instincts are simply animal instincts and not important for humans, else they only admit that man retains a basic survival instinct, but not true animal instincts. Heller herself holds the fourth opinion. She studied instinct within the discipline of social anthropology and found it an all-important principle. This principle may be applied both to modern and primitive humans, which may perhaps be called the process or mechanism of “the erosion of instinct”. And this process and mechanism only lies in human and their history. She says: “Humans are not guided by instinct. More than that, humans do not have instincts at all, only a survival instinct. Such a survival instinct is manifested in some small coordinated actions which only need the minimum 5

 Li Tao, ibid.  Agnes Heller, Human Instinct translated by Shao Xiaoguang and Sun Wenxi, Liaoning University Press, 1988. 6

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of intelligence. And just as Darwin has already said, these survival instincts are also under a process of erosion.”7 So, we can easily explain the role that animal instinct or human’s “survival instinct” has played in medicines’ origin. The remaining of an instinct of “self-preservation” for most primitive people did later become the foundation stone for medicine. But the role of this “foundation” was limited. If human thinking, emotion and individuality had not unceasingly improved along with cultural progress, human medicine would not have attained its true origin. Thereby the above animal curative behavior by instinct can be differentiated from the primitive curative behavior of humans. Though animals such as monkeys can delouse, pick out thorns, take care of their babies, and do simple treatments, even through “study” (simulation) — their instincts can never progress, let alone develop into or create animal medicine. Animals always rest in an instinctive state and this proves that instinct is not the true source of medicine. Animals do not own the mechanism of the “erosion” of instinct, so they could not modify or make a choice of using an instinct or not, after growingup. By owning the erosion of the mechanism of instinct and the ability to think creatively, human beings could select or modify some survival instincts in the process of evolution, and thus culture and medicine begun to develop. Usually human love is said to be an instinct. Human love, something like “man is kind­hearted by nature at birth,” is closer to curative activity; kindheartedness and mutually beneficial human behaviour also receive much attention. But in fact, there is no inborn “human love”. Look back at the cannibalism of primitive times! The Hemudu of the New Stone age had a fairly developed productivity. They were rich and had enough food. They produced rice, raised pigs and dogs, made crusted rice and cooked rice. But the people of Hemudu were buried sometimes in a rather strange way after they died. Some had a big distance between the skull and shoulder bones, some lay on their stomach, some lay on their side with bent limbs, some had broken limbs. It is difficult to image that in the bottom of a pottery caldron were found a pile of fish bones and baby’s thin skulls. After investigation, the experts considered that it was quite possible that the Hemudu cooked human beings and ate them.8 Was this human love? Did animals love and 7

 ibid.  Mei Fugen, Wu Yuxian. The Miracle of Seven Thousand Years — Hemudu Site in China, Shanghai Science and Technology Press, 1982, p.51. 8

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guard their babies like this? Even in late civilized society, cannibalism still could be seen, not to mention war and fighting with weapons. Human love is not instinctive. It may only be epitomized in differing forms by the special construction of forms in human society and their progress and, through them, have some influence on the development of curative activity. I consider that the totality of human qualities, behavior, practice and thinking utilized the survival instinct as an initial factor, in order to organize and develop — through ups and downs — eventually, a system of medicine. This was the true origin of medicine.

39.  Primitive Thinking and the Functions of the Witch The first form of primitive thinking was “collective representation” — a comprehensive activating form of conditional or unconditional reflex made by a primitive group towards external circumstances. For instance, when somebody was ill or wounded his group would exercise a “survival instinct”, to treat him and take care of him collectively. But this was more, for they felt a mysterious participation, a mutually-infiltrating effect, at the same time. Thus the behavioral instinct had translated into a form of thinking which got results. The so-called “erosion of the mechanism of instinct” is mostly such a process of transformation and choice — but finally it became something more like a fixed ritual of collective representation. This meant that the earliest curative activities soon took on a mysterious atmosphere — which the curative activities of animals did not possess. Just as “collective representation” controlled everything, so individual thinking was subconscious. People were puzzled about everything around them and obeyed blindly. There was no true doctor or so-called “independent” curative activity, at that time. All activities were connected to survival and staying alive, with an air of mystery. Even the leader of the primitive group did not know if rituals performed were for treating illness or something else. But gradually individual consciousness awoke. The intelligence of the primitive group was also in transition. Take dreaming as an example. Dreams always belong to an individual; people do not have the same dream at the same time. Collective representation, mysterious participation and the law of mutual-infiltration imperceptibly nourished the consciousness of the individual. On the one hand, an individual’s dreams and their mystery were expressed to influence the overall development of collective representation; but on the other hand, it also directionally manifest a unique personality. As

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time passed on, an individual’s mind developed along with the pretext of collective representation, and along with enhancement of ability, role, and a valued embodied in life and production, all led to a divide among the primitive group. Personal status changed and a leader-like figure, such as a sorcerer appeared. However this must have taken an aeon. Not until the period of late animism, did sorcerers appear. Following on from the “blocking up of the communication between heaven and the earth”, sorcerers had a true monopoly on communicating with the gods in heaven. Later, after a further divide among sorcerers, some emphasized more medicine and became witch doctors. But senior sorcerers still took charge of medicine and acted as witch doctors, at the same time. Compared with more primitive human curative activities, the medicine of witches and wizards had one obvious characteristic — it regarded human life and disease as its object, and tried to explain the causes of disease and the relation between causes and diseases by a system based upon spiritual intervention. It also tried to control and to treat these diseases by witchcraft, by using one supernatural and magical power to control another. This had not been realized or tried before. This is despite the fact that the ancient character for medicine “yi” 毉, which appeared later, (it is not to be seen in the Analytical Dictionary of Characters), did clearly show the relation between witchcraft and medicine. Since sorcerers stood out from the primitive group, they became the first intellectuals with a developed mode of knowledge. According to Fan Wenlan, “The plebeians (lower-class people and multitude) worked and cultured a more knowledgeable group of sorcerers and shi (the officials in charge of historical records and events). Sorcerers and shi spoke on behalf of the gods and ghosts, guided national affairs and the king’s behavior. Sorcerers concentrated on gods and spirits; shi concentrated on human affairs. Sorcerers could sing, dance and treat disease, spoke on behalf of the gods and ghosts mainly by the divination of grass-stalks; while the shi would record human affairs, examine astronomical phenomena and were familiar with the old codes. They spoke on behalf of the gods and spirits mainly through divination by turtle bone. No matter what happened, the king would always ask for advice from the gods and spirits. Only under the guide of sorcerers and shi, did the king take action.”9 Sorcerers and shi were 9

 Fan Wenlan. Part I of the revision of A Concise History Of China, People’s Publishing House, 1964, p.120.

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learned indeed. On Nations – About Chu states: “Gods would only descend to people who were clever, loyal, upright and steadfast; who could see as far as the four directions and hear things at a distance; whose wisdom was as large as heaven and earth and whose holiness as bright as the sun. One such as this was called a xi (wizard), while a woman was called a wu (witch).” On the one hand, this text indicates that sorcerers were more intelligent than the ordinary person and that the “gods descended to them”; while on the other, it also shows that sorcerers did have the ability to “control” gods and spirits, not just passively speak on behalf of them. So it is reasonable to say that sorcery was a kind of “science” during the primitive era, not just superstition. “Sorcery and science were similar in their understanding of the world. They both believed that the succession of events was completely regular and definite. This succession was decided by invariant rules, and so could be accurately predicted and calculated.”10 Religion and superstition were different from witchcraft. Religion believed that natural processes were moldable or could be changed to some extent. It believed it could seduce or persuade those powerful spirits who controlled natural processes to change things according to our interests. But the spirits in witchcraft were inhuman forces that controlled everything. Only through knowing how to manipulate these forces with the proper rituals and spells, could anyone continue to make use of them. The gods in religion and the immortals in superstition were more personified, more like a saviour, not controlled by an inhuman force, so people worked only to please or flatter them instead of coercing or controlling them. This was the difference between sorcery, and religion or superstition. Accordingly, as an important stage in the development of medicine, witchcraft played an obvious role — until medicine finally turned and made its way onto the road of science. Certainly, just as Frazer points out, “the most serious fault in sorcery is not that it did not take for granted that any event was decided by a certain objective law, but to completely misunderstand the nature of that special law controlling the event.”11 This is a serious fault in witchcraft — and the root reason why the medicine of witchcraft was replaced later by a natural and philosophical medicine. It is necessary to point out that the sorcery of ancient China was not as pure as the sorcery studied by Frazer or other anthropologists. Primitive 10

 Frazer. The Golden Bough, p.76.  ibid.

11

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religion, superstition, divination, activities similar to sorcery but not pure sorcery — they were all mixed up together. People controlled, threatened, intimidated, persuaded and implored supernatural forces, but also forced, suppressed, tried to please and flattered them. Even today, some witchcraft is still used alongside religion and superstition within folk-customs. This may be a special characteristic of Chinese culture. Possibly it was because of this mixture that sorcery did not spontaneously develop into religion in ancient China. In conclusion, the medicine of witchcraft was a rather lengthy but fundamental stage during the development of Chinese medicine. It was the first medicine with a structure and system, and was also a basic stage in the formation of medical theory and the abstraction of such a theory. The formation and development of primitive thought had the closest possible relation to the origins of medicine. A valuable theory and practical results, both accompanying the emergence of primitive thought — this was the medicine of witchcraft. In a sense, it is truly understandable that people “fly the flag” by saying that “medicine has its origins in the craft of magic”.

40. The Relationship of Life and Labour to the Origins of Medicine For a long period of time, people have had the view that “labour created medicine”. It is no problem to understand “labour” in its broadest sense — all activities done by primitive man in order to survive were “work” or “labour”. To struggle to live was also “work”. Witchcraft could also be regarded as “mental work”. Furthermore, everything in ancient times was mixed up and undifferentiated. But it is to hold a one-sided view to speak, as modern man does, in a narrow sense only of productive labour, or manual labour. Primitive man disregarded experience during the course of primary thinking. He neither accumulated experience nor proved something using a new empirical fact. In spite of its contradictions his thinking was raw logic. Causal relations were purely due to previous association, or lack of association. There was an acceptance of the dominance of collective representation and mutual infiltration. Everything was a mystery, which could neither be proved, explained nor inferred from experience. So the method of using the accumulation of experience, and the thinking methods such as induction and deduction — used to attain scientific conclusions — were nonexistent for primitive people or at least nonexistent for a

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long period of time. Although experience and phenomena may have been observed and repeated many times, if people did not pay attention to them, they remained a pile of dregs, scattered, chaotic and shapeless. How could these give birth to medicine? Experience did not accumulate into thinking until individual character and ability developed, roughly corresponding to the time of the rise of sorcery. It can be considered that sorcery was aided by experience, and even utilized the growth of experience to a considerable extent. But the more experience accumulated, the more damage was done to sorcery. Finally sorcery was broken, and medicine of witchcraft was forced to abdicate. This process might have been something like this: Primitive man was controlled by collective representation but also had “instrumental thinking” — as they could make and use instruments. But this thinking did not occupy a leading position. Similarly, incidences of bleeding, collision, poisoning (the usual events of life and work) were drowned in collective representation instead of becoming an individual’s experience. Collective representation dominated and was collective for primitive man; while experience was recessive and individual. Individual events seemed to be obliterated and not be remembered long. But this does not mean there were not any vestiges of them left in the human brain. Primitive man had much stronger memories than modern man, but was unable to add to, associate and induce from them. All these memories were isolated by, and clung to collective representation. But the subconscious (or so-called “experience”) would manifest itself after a certain time and became a new stimulus. As primitive man wiped out the experience consciously from collective representation, he accumulated it subconsciously in a psychological and neural reflex. As collective representation developed into animism and even further into sorcery and religion, so experiences were also stored up, getting stronger step by step until gradually they played their role in the thinking and remembering of primitive man. People began to utilize experience. This is how there came to be some true and effective medicines and treatments used in the medicine of wizards and witches. Primitive man used fire, cave dwelling and clothing, etc. originally for living instinctively, without any aim of thinking about health and sanitation. But with the subconscious awakening of experience, these activities became driven by the need for health and sanitation. So did the curative activities of the animal “survival instinct” become dominant. They were originally subconscious, but later became conscious. The emergence of writing and the use of keeping records played a catalytic role.

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While these medical activities were only a part of life and productive labour, subconscious experience was completely ignored. The arousal of the memory of experience must have caused “great tension” created by disease and injury — and the agonies and pain of people from illness, or even the loss of life. Experience must have included the experience of “mysterious mutual-infiltration”, at the start. Being all mixed up together, only the growing of an individual mind could make them draw apart. (This independent maturity might have had a relationship with “dreams”.) So evidently the origin, development and separation out of medicine happened at the same time as the development and growth of a whole primitive culture. Recorded historical myths and legends, and other writings help us in making a more specific analysis. There are some familiar legends telling how “with the tasting of various plants and herbs, medicine began”. “To taste” means to experience and identify. Fuxishi… created the written characters to replace knotting, drew the Eight Diagrams to understand god’s intent and analogized the nature of all things on earth, so the six qi, six fu-organs, six zangorgans, five elements and Yin and Yang, ‘water demotion’ and ‘fire promotion’ had their own images, and the law of all things on earth could be reasoned by analogy. While Yandi and Huangdi tasted the various herbs and made nine types of needles to save the young from illness and death. (The Records of Kings) Shennong…tasted the various herbs and waters to let people know what was healthy and what did harm and what should be avoided and what can be used. When he did tasting he was poisoned more than seventy times in a day. (The Huainan Tzu) Shennong used his red whip to lash at the herbs and trees, and he was the first person to taste them, and thus medicine began. (The Supplement of Historical Book – The Three Kings) Shennong tasted various herbs, and medicine began. (History as a Mirror) Some people suffered from illness and they did not know medicine. So the Yan emperor began to taste the various herbs and he had been poisoned more than seventy times in a day. (The Supplement of History as a Mirror) Huangdi commanded Qibo to taste all the greenery, and be in charge of medicine. Classical prescriptions, the Chinese materia medica and the Suwen (Huangdi Neijing Suwen) were all written since then. (Records of Kings)

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It is generally said that “medicine originated from the sages”. But the above texts obviously magnify their feats, even attributing later medical achievements to them, such as classical prescriptions, the Chinese materia medica, the theory of Yin and Yang and the five elements and the theory of the zang–fu organs. Of course, this is not the case. It is just as Fan Wenlan has said: “Most of these wrong conclusions were drawn by scholars during the Warring States, the Qin and Han”.12 But it is not completely without foundation to say that Fuxi, Shennong, and Huangdi were respected as the first ancestors of all humanity for the Chinese. According to legend, we can calculate that Fuxi lived between the Middle Stone Age and the beginning of the New Stone Age; Shennong about the early-middle New Stone Age; and Huangdi in the middle New Stone Age. Generally speaking, Fuxishi, Shennongshi Yandi, Xuanyuanshi Huangdi all do not refer to an individual, but to a tribal group. Fan Wenlan thinks that “Fuxi and Taihao are always believed to be the same person. But in fact, Fuxi refers to the age of beginning animal husbandry in ancient times, while Taihao is likely to be a person with the name Taihao.” “The Yandi tribe lived in the middle regions”, “The Huangdi tribe first lived in the northwest…later they conquered the Jiuli and Yandi tribes and gradually settled down in the middle regions.”13 The Youchaoshi and Suirenshi lived in an earlier period than the three kings. From all these myths of human origin we can conclude that: 1. The myths combining nature worship, totem worship and ancestor worship together, corresponded with the course of primitive worship and primitive thinking during the origin of human beings; 2. Behind these myths was the process of formalization and ritualization of primitive witchcraft; 3. These myths also showed that primitive scientific (medical) factors from life and life’s activities were pooled together, step by step, after having been refined by primitive thought. Just as Professor Li Jingwei pointed out: “By taking an overview of ancient scholars’ records that say that Suiren, Fuxi and Shennong created medicine and healthcare, we find that although there do exist here some unbelievable factors, it is still valuable to pay attention to the origin of medicine from people’s work, their experience, their means of production and life. These records are likely to accord with the historical facts of the origin of medical science in primitive society in China.”14 12

 A Concise History of China, Part I, p.90.  A Concise History of China, Part I, p.88. 14  Li Jingwei, Li Zhidong. A Brief History of Ancient Chinese Medicine, Hebei Science and Technology Press, 1990, p.26. 13

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In other words, all life and productive labour were integrated into the formation and origin of medicine through primitive thinking and witchcraft. In past discussions of Chinese medicine’s origins there have been some errors of conception or logic.15 In the above the role of various factors which influenced the origin of primitive medicine have been discussed. These include factors such as the “animal survival instinct”, “primitive thinking”, the behaviour of “witches and wizards”, “life and productive labour”, “experience”, and so on. But I want to stress that this evolution was a long and multi-factorial, historical process in the making. At a certain point, a medicine — the medicine of witchcraft crystallized out. Culture itself, even the culture of primitive man, is so peculiar and charming that the origins of medicine and its civilizing process simply had no other choice but to manifest itself out of such an ordinary and magical chaos.

B.  The Beginnings of Early Medicine and Health Care 41. Massage, Daoyin, Hot Compresses, Moxibustion and the Discovery of the Meridian There are some characters describing massage and hot compress in the inscriptions on oracle bones of the Shang Dynasty discovered in Yinxu. Primitive man already had dance (daoyin). In ethnographical studies there are also many examples of this. When the Oroqen people and Zang people slept in the open, they spend a long time warming their back and belly before going to bed, to prevent rheumatism. Generally speaking, the people in the cold northern regions used hot compresses or fire treatment earlier. Just as is said in the Suwen – Different Methods in Different Areas: “In the northern district of mostly highlands is the area of naturally hiding away, where the climate is windy, cold and icy. People lived in the mountains and wild hills and liked drinking milk. So their viscera can be invaded easily by cold and they easily suffered from the disease of abdominal distension, which was suitable to treat with moxibustion. So moxibustion then was transmitted from the north.” Wang Bing noted that “Jiu-nei (moxibustion)” meant “cauterization with mugwort”. which is not entirely correct. The earliest fire-therapy could 15

  See Ma Boying. Dialectical Thinking on Chinese Medicine’s Origin, Medicine and Philosophy, 1991, No.8, pp.38–40.

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work with any fired substance, not necessarily mugwort. Mencius – Lilou Part 1 records: “Someone ill for seven years, could only be cured with three-year old mugwort. Suppose he had not stored the mugwort that long, he would never get well.” Suwen – Chapter 19: Diagnosis According to Take Pulse says: “If someone suffers from numbness, swelling and pain…he can be treated with a hot compress and fire needling.” Historical Records – The Biography of Bian Que says: “After a while, the crown prince revived…. Then Bian Que made his disciple Zibao cook a half-warm portion medicine as a hot compress with an eight-portion lesser dose, also heated and put it as a compress alternately on his costal regions.” These are examples of a “hot compress”, which might have developed from fire therapy. Actually, primitive man must have sensed that the warmth of fire or heat could dispel cold and pain, and activate the skin and muscles. The choice of mugwort for moxibustion must have developed later. Massage and daoyin might be simpler and more immediate. As the most natural method of self-help commonly available to human beings, it could be done by oneself or by others. It simply involved pressing or rubbing the affected area to stop bleeding, or relieve pain with the hand. Suwen – Different Method in Different Place says: “In the central regions it was flat and damp and naturally productive. People could get various foodstuffs without hard work, so most diseases were atrophy, muscular flaccity, coldness in the extremities of limbs, and also fevers, all of which were suitable to be treated with daoyin and massage. So daoyin and ‘pressing’ or massage also came from the central region.” Wang Bing annotated: “Daoyin refers to exercising the bones and moving the joints of the limbs; pressing refers to massaging the skin and muscles; qiao (蹻) refers to lifting upwards the hands and feet.” Daoyin is closely related to dance or gymnastics. Mister Lu’s Spring and Autumn Annals – Ancient Music says: “The Yin qi has stagnated and accumulated since the time of Tao Tang-shi. The waterways have been all blocked and the waters departed from the original ways. People commonly suffered from depressed and stagnant qi which led to unfluent movement and ‘cowering’ of the bones and muscles, so they danced to free up the stagnant qi.” From this text, we know daoyin referred to dance. It seems to me that the combination of massage, daoyin and hot compresses (moxibustion) truly laid the foundation for the discovery and systematization of the “meridian” channel. The idea and theory of the meridian is exclusive to China, just as are acupuncture and moxibustion. These curative methods along with their

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theory were never seen or heard in any other ancient world civilization — ancient Egypt, Babylon, India or Greece — only in the special culture of ancient China. Some Austrian acupuncturists in 1990s had the idea that the short blue lines on the body of the Iceman, who lived 5300 years ago and died in the Alps are the earliest evidence of meridians for acupuncture. Articles have been published by anthropological journals. I have visited the museum in Italian Alps and found the blue lines were just early tattoos. My article was published to refute their ideas.16 In disagreement with the common thought of past authors of the history of acupuncture and moxibustion in China, I believe that channels (meridians) were recognized before acupoints and the points of acupuncture and moxibustion. Besides, the maturity of the theory of acupuncture and moxibustion places it earlier than the theoretical use of Chinese medicines. It is wellknown that the Eleven Yin – Yang Channels of Moxibustion and Eleven Foot – Arm Channels of Moxibustion unearthed from the Han tombs at Mawangdui were finished before the texts of the Huangdi Neijing. The two unearthed books have a couple of obvious characteristics: firstly they name channels and collaterals but no acupoints; secondly the number of channels and collaterals is eleven instead of twelve or fourteen. So there were only eleven channels recognized before the formation of twelve or fourteen channel systems. We can also deduce from this that before eleven channels had been recognized, the understanding of channels was probably fairly chaotic. People probably did not have a clear idea how many channels there were and how they ran, let alone their acupoints. There have been only some disarrayed linear distributions discovered. But these disarrayed linear distributions were very important. Thick veins, tendons and lumpy strips of muscle could be seen under the superficial skin-layer, but they did not catch any special attention. People were enlightened by the drilling of tortoise-shells in divination and paid special attention to special reactions to the hot compress, fire therapy and massage. As mentioned earlier, divination was popular in the Yin-Shang nationality who occupied the central religions. Tortoise shells might be drilled, or cauterized, or both. Sorcerers paid attention not to the drilled or cauterized parts, but 16

 Some Austrians have put forward the idea that the tattoo lines on the 5300-year-old Iceman in the Alps were the earliest testimony of channels and collaterals. I went there to investigate this personally and wrote an article to refute it. Ma Boying. Is There Any Testimony of the Origin of Acupuncture and Moxibustion in the 5300-Year-Old Iceman of the Alps, Asia Pacific Traditional Medicine, No.2, 2006.

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the consequent fissures and the direction of their spread. The Fundamental Laws (洪范) records that there were five types of omens used, and five types of image — yu (雨 rain), ji (霁 clearing up after rain), yu (圉 defense), wu (雾 fog), and ke (克 restraint) — which describe the fissures which appear on the bones when they are drilled or cauterized. Some are of the opinion that “the earliest mention of the five phases” comes from these five divination omens; and that five-phase theory and the “five materials” were derived from these five images.17 In like manner, as our ancestors used massage and moxibustion on the surface of the human body, they would see a line or a red linear distribution on the skin, which was the meridian sensitivity, also called a “sensing phenomenon” — proved to occur by repeated experimentation in modern times. People saw the relation between this sensing phenomenon and the images used in divination, and found in addition that these routes on the skin connected with the internal organs and relieved pain in certain parts. At the same time, “healers” paid attention to the linear sensing phenomenon and its direction instead of just to the pressed or heated location. Combining the netted or linear distribution of the veins and tendons with what they observed, people figured out the rough idea of a meridian system. And after being arranged and organized, it became an eleven-meridian system, and then developed into a twelve- and even a fourteen-meridian system. At the beginning, people only repeatedly pressed or heated the route. Later, they found some points especially sensitive and effective — and thus the acupoints were found gradually. The location of the points was quite small, so pricking and moxibustion were also discovered and performed at these points. Daoyin (dance) might also work to assist “infirm bones and muscles” and “depressed and stagnated qi”, as, in general, it more or less affects the activity of the muscles. Exercising could relax tight or tense muscles, and these muscles and tendons (for example the “twelve meridian sinews”) were quite correctly made a part of the original meridian system.

42.  From Stone Needling to Acupuncture The precursor of acupuncture might well have been stone needling — so then the term “bian stone” would also have meant bian needling. But we 17

 Pang Pu. The Origin of Yin Yang and Five Phases in The History of Ancient Literature in China edited by Xiang Rengdan, Peking University Press, 1986, p.77.

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cannot therefore assume that needling was the very first unique function of the bian stone (or bian needling). The Suwen – Different Methods in Different Places says: In the eastern area where heaven and earth start the Spring, many varieties of fish and salt are found. At the seaside, people live peacefully eating fishes and enjoying their salty taste. But fish can make heat accumulate in the middle of the body, and too much salt can damage the blood, so people there all have dark skin and a loose skin texture and they easily suffer from large carbuncles. Large carbuncles are treated with the bian stone, so the bian stone also came from the east. In the south it was sunny and everything was wellnourished. The terrain was low and the waters and soils unfirm, so fog and mist were common. People liked to eat sour and stinking food, so they had a red and firm skin texture. They easily suffered from contracture and numbness and were treated with micro-acupuncture needle, so the nine kinds of needles also came from the south. These two texts clearly express that the use of the bian stone was different from the use of the nine kinds of needles. They had different districts, were suited to different diseases and had a different usage. The bian stone had been used as a surgical instrument for a long time. Needling or acupuncture was not seen during the time of the Zhou Rituals. Needling was not mentioned in the duties or treatment of doctors (or surgeons) in the text. “Gua” (劀) — cutting should be carried out with the bian stone (bian knife). It follows that the system of medicine in the Zhou Rituals was likely not to be that of the Warring States, Qin or Han Dynasties as some scholars have considered, but from the Western Zhou or earlier. The Zhou Rituals must have been written earlier, not later. The Bian stone was the earliest type of surgical knife in China. The Suwen – Health Preservation also mentions that “When using needling to benefit the people in the world, doctors should have in mind the five keys, but unfortunately they are now ignored. They are as follows: I. Concentrate the mind; II. Understand how to keep in good health; III. Have a complete understanding of the properties of drastic medicines; IV. Be careful of the size of the bian stone; V. Know how to diagnose the qi and blood of the zang–fu viscera.” Quan Yuanqi noted: “The bian stone was used for surgical treatment in ancient times. It had another two names: the needling stone or chan stone. But they are in the same family as tools. There was no iron in ancient times, so people used stones as needles and called them ‘needling stones’. Doctors whetted them and made them in sizes and

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shapes to suit the different disorder. Huangdi created the ‘nine kinds of needles’ to replace the chan stones. Ancient doctors would use different treatments in different regions. People in the east easily suffered from carbuncles, so the bian stone originated from the east.” Wang Bing noted again: “Ancient people took the bian stone as a needle. So if ‘nine kinds of needles’ are not mentioned it means the bian stone.” The same idea comes from Wang Sengru. In The History of the Southern Dynasty – The Biography of Wang Sengru, he says: “Quan Yuanqi wanted to annotate the Suwen and consulted Wang Sengru about the bian stones. Sengru answered: ‘Ancient peoples must have used stone instead of iron for needling. There is the word bian (砭) in the Analytical Dictionary of Characters. Xu Shen explains it as pricking the disorder with stone. The Dongshan Jing said: There were many zhen (needle) stones found in Gaoshi Mountain. Guo Pu says: The zhen stone could be used as a bian needle. Zuo’s Spring and Autumn Annals says: Making them comfortable in an illness is not as effective as treating them with the detestable stone. Fe Zishen explains ‘stone’ means the bian stone. There was no suitable stone any more in latter times, so it was replaced by iron.’” It is said in the contemporary Mountains and Seas Classic – Book of the Eastern Hills that “There was a mountain called Gaoshi Mountain. In the mountain were many jades; at its foot were zhen stones.” Guo Pu explains that “zhen stones could be used as bian needles to treat carbuncles.” Xu Shen mentions “pricking the disorder with a stone”. They both meant using a bian stone to treat the carbuncle but not piercing it with one of the “nine needles”. Pricking abscesses needs a sharp point, not a knife edge. Today a surgical incision made for draining off abscesses is still done by poking or pricking with the point of a knife. So it is also right to call the use of bian “piercing” or ‘pricking’, and to call the bian “stone”, the bian “needle”. But we should understand that it is not a needle in the modern sense, but properly speaking a bian “knife”. At the time of the Neijing, both the bian and the needle were used, so people often spoke of them together. So did the famous doctors of the later Han Dynasty, such as Fu Weng and Guo Yu. The History of Later Han Dynasty – Biography of Guo Yu records: “He treated patient always with the needling-stone”; “The skin texture is very tiny, so the needle-stone should be handled skillfully. Even the slightest error will cause disharmony.” But since needles and stones were used and spoken of together, it was possible to misunderstand them later.

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Actually, a bian stone was equal to a modern surgical knife and mainly used to incise abscesses or cut off a wart or neoplasm. Its function of incising abscesses was described above. The Guanzi – To Implement Law by Law also records: “No absolution is like the bian stone for Acne Sui.18 It is recorded in the third volume of Strategies of the Warring States that: “Bian Que was presented to King Wu of Qin, and King Wu showed him his disorder. Bian Que advised him to cut it away. But King Wu’s intimate ministers said: ‘Our majesty’s disorder is in front of the ear and below the eye. Cutting would not be sure to cure the disorder, and might possibly cause deafness and blindness.’ King Wu told this to Bian Que. Bian Que was so angry that he cast the stone aside and said: ‘A King should consult with someone who knows medicine about the disorder, but now is destroyed by consulting with those who know nothing of medicine. From this we can know what kind rule there is for the nation...” The stone here is the bian stone. King Wu’s disorder on the face must have been a neoplasm, which could be cut away with the bian stone. If it was to be pricked, they would not have worried that the ear or eye could be damaged. This bian stone would have been flat and sharp-edged, like a knife or sickle. The bian in the line “like a bian edge cutting the skin” in the poem Bitter and Cold by Han Yu was a bian stone shaped like a sickle. But the bian in the saying “It was said that Bian Que treated disorders with a bian stone stabbing in to the bone” in Han Feizi – Safety and Danger must have been like a pointed knife. The Lingshu – Jade Version says: “So if the abscess has already turned into pus and blood, it should be picked with a sword-like bian stone.” Throughout the text bian is compared to a sword, so bian must be shaped like a sword with a thin and keen edge. The Lingshu – Nine Needles says: “The fifth kind of needle is the stiletto needling, taking as a model the cutting edge of a sword, two-and-half fen wide, and four-cun long. It is mainly used to treat large carbuncles caused by the struggle between two kinds of heat.” The needle here is made of metal. A needle of jade could be the same shape, as testified by two unearthed bian stones. One was of jade and sword-shaped, unearthed from the ruins of the Shang Dynasty in Zhengzhou in Henan Provence in 1955; and another was sickle-shaped, unearthed from the site of the Shang Dynasty in Taixi Village at Gaocheng City in Hebei Province in 1973. Not until the bian stone developed into the stiletto needle, one of the nine needles, could the bian be called a “bian needle”. 18

 Note that Acne Sui here is a miswriting for a carbuncle or neoplasm.

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Another name for the bian stone was a “Di Shi”, i.e. whetstone. There are many examples. The Han Feizi – The 34th Article records: “The pain of pimple or abscess would hurt so much that people can hardly endure it without piercing to the marrow. People often refuse the treatment with a half-cun di shi which is flicked (弹, tan) in — they only suffer it when they have got to. So Guo Pu had evidence in his notes in the Mountains and Seas Classic that “it could be used as a whetstone needle to treat a carbuncle.” Since there was no anesthesia, abscesses should be cut quickly. This action was so quick the word “flick” is used to describe it. “弹 tan” also means to “poke”. The Han Feizi also says: “The doctors in Qin are good at medicine, but they cannot flick themselves.” “The people asking for treating abscesses with poking must be the ones who can endure the pain.” “Flicking is painful, medicines are bitter. But if people do not take needling and medicines because of the discomfort, the disease won’t be cured, and they won’t be saved either.” The stone in the saying “Bian Que was so angry that he cast the stone aside”, was noted by Gao You to be “a bian, used for flicking a carbuncle.” The bian stone was also used for massage and as a hot compress. Prescriptions for Fifty-Two Diseases has the saying of “Heat a little oval stone and then dip it into vinegar to make a hot compress”. The Bian Classics of Jin Xihou written during the Liang Dynasty recorded that spherical bian stones were heated by such methods as warmed water, simmering fire and then wrapping them and using them to heat a local part of the body, much like the earliest methods used by primitive man to heat food. In 1964, a round flat stone was unearthed from a tomb of the Warring States Period in Chuxiama at Changsha City, Hunan Province, which is still showing a polish, with vestiges of burnt material at both ends. One side was as smooth as glass. It was testified to be a bian stone used for hot compresses. The bian stone for massage was a stone shaped into an oval by grinding. One concave stone such as this was unearthed from a Warring States Period tomb at Taobo near Yiyang City, Hunan Province in 1964, with sockets for fingers to fit in and hold it. It was identified to be a primitive massage instrument.19 This also relates to the original recognition of the meridians and moxibustion mentioned earlier. At the start, the nine kinds of needles were not necessarily made of metal, but possibly of stone, jade, or bone. The “nine needles” were divided into nine as yet, only some were made of chan stone and some were sewing 19

 Fu Weikang. Chinese Medical History, p.11.

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needles, etc. They were sharper, and used for “draining qi” or “pricking to drain blood”. “Draining qi” was a new saying — its original meaning was possibly bloodletting. The Lingshu – Nine Needles and Twelve Original Acupoints records: “The chan needle has large head and keen end, and is used for draining the Yang qi.” The Suwen – Piercing Disease says: “If someone has a severe pain in the shank and cannot be pressed on, he may suffer from a disease in the marrow. If the juegu acupoint20 is pricked to drain blood with a chan needle, the pain will be relieved at once.” The chan needle here was certainly for this kind of treatment. The original chan needle could have been a cone-shaped chan stone. The Book of History – The Biography of Bian Que records: “Yufu treated disease without herbal decoctions, medical wine, chan needles, the bian stone, massage or daoyin, etc.” Si Mazhen’s Explore the Mysteries says: “鑱, pronounced chan, refers to the stone needle.” The term chanci (鑱刺) was explained as to ‘prick with an awl’ in Xuan Ying’s The Sound and Meaning of all Canons. The Lingshu records “The chan needle takes the example of the sewing needle, one-cun and six-fen long. It is sharp for a half-cun from the end, and is mainly used to treat heat-disease in the head and body.” The sewing needle was something like a bone ji, i.e. a bone hairpin. It is said to be a chan stone that Bian Que holds in one of the five “stone portraits of skilled doctors” made during the Han Dynasty and still to be seen at Liangcheng mountain in Weishan County, Shandong Province.21 There were three modes of chan stone: the arrow-headed, the pointed at two ends, or the pointed at one end. By the right shoulder of a skeleton found at the Longshan site in Liangcheng Town, Rizhao County, Shandong Province was a brown pot on which were inscribed two cone-shaped chan stones, similar to sewing needles. These cone-shaped chan stones were possibly the xi (a kind of bodkin for untying knots), just as Liuxiang referred to in The Anecdotes of the Garden – Civilization: “People with the ability to handle troubles and chaos wore a xi”. It seemed to be a kind of magic. But the xi undoubtedly were also used for treatment or had turned from being a therapeutic tool into an adornment. A Book of Rituals – Regulations for Women says: “When the child attended upon his parents... he was wearing a streamer, shawl, whetstone, a little xi, and brass flint on the left side, and a penannular jade ring, leather sleeve, pipe, sheath, large xi, and wooden flint on the right side; … when a woman attended upon her parents-in-law… she took a streamer, 20

 Juegu GB 39.  Ye Youxin. Cone-Shaped Bian Stone in Chinese Journal of Medical History, No.2, 1980.

21

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shawl, whetstone, a little xi, or brass flint on her left, with a needle pipe, thread, silk floss, book bag, a large xi, or wooded flint on her right ... to go to the rooms of the parents … she asked them if their clothes were warm or not, and if they felt pain or illness or itching. Then she rubbed their muscles and massaged them with good regard.” Here the xi seems often prepared for treating a random disease. Cone-shaped instruments of this kind were quite numerous among the unearthed objects of the Shang and Zhou. The non-cone-shaped ends were mostly decorated with patterns of the kui dragon, grasshopper’s head, eagle’s head, etc. Or the shape of a taotie mask was made by holding a cone-shaped bian in the mouth, which was meant to drive away evil as magic. But stone had given way to bone (or horn) by this period. There was also the zui, explained as a “stone needle” in General Elegance – The Instrument and as “bird pecking” in Jade Book. This was done using a chan stone shaped like the “bill of a bird”, made of black flint. The bird-mouthed chan stone among the unearthed objects of the Shang and Zhou Dynasties was made of jade, its bird-mouthed head around 1.3 to 2 cms across; the other part, shaped like a fish or kui dragon’s body, could be held in the hand. All these rather reminded people of the word “毉” or “鹥” (both are variant forms of yi, medicine). The chan stone was made generally of stone, bone, jade or horn, its shape quite big and thick, so people always used it carefully. The Historical Records – Biography of Can Gong says: “Frail patients could be neither treated with moxibustion, chan stone needling nor drastic drugs.” “If someone suffered a disease with yang-hot inside but with yin-cold symptoms outside, he could not be treated with drastic drugs or the chan stone.” The Suwen – Strange Diseases also records: “Weak patients should not be treated with the chan stone.” From these sayings, we know that the chan stone was used only on the stronger. Generally it was believed, the needleshaped chan stone or bone needle would be better. Needle-shaped instruments of jade and horn found in archaeological remains were no doubt for needling — such as the seven bone needles of the Qijia culture found at Linxia City in Gansu Province, the bone needles at the Wangchenggang site from the Xia and Shang Dynasties in Dengfeng City and at the Wadian site in Yu County and Henan Province, etc. Most of those needles were thought to be hairpins or sewing needles by archeologists. The caveman’s sewing needle was the earliest needle. But these needles possibly had another function. The needles unearthed at Anyang had no hole at the end. They were rather thin, so neither used for sewing nor as hairpins. The Lingshu – Nine Needles records: “The second needle is round-pointed needle, based on a

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sewing needle, with a cylindrical body and an oval head like an egg, one cun and six fen long, and is mainly used to treated qi stagnating between the skin and muscle.” “The fourth is an incisive needle, based on a sewing needle, with a cylindrical body and sharp point, one cun and six fen long, and is mainly used for carbuncle, draining heat and bleeding.” Thus both the ‘round-pointed needle’ and ‘incisive needle’ were based on the sewing needle. These texts testify that there was indeed a transition. There was also a more slender needle: “The sixth needle is round and sharp, based on the yak’s bristle, with a slightly large end and small body for deep piercing. It is one cun and six fen long, and mainly used for carbuncles and bi-syndrome. The seventh needle is the filiform needle, based upon the model of a soft hair, one cun and six fen long, and mainly used for cold or heat and painful bi-syndrome in the network vessels. The eighth needle is the long needle, based on the qi needle (綦针, a long sewing needle), seven cun long, and mainly for treating serious evil-qi at depth and long-standing bi-syndrome.” These needles all took a human hair as their model, so they could be made of neither jade nor stone, but metal. There was also the saying: “The ninth needle is the large needle, based upon the model of the incisive needle but with a slightly rounded point, four cun long, and mainly for treating swollen joints where there is ill-qi accumulated.” From these sayings, we know that the large needle was a further development of the incisive needle. The “nine needles” show a process of development. The gold needles and silver needles unearthed in Liusheng’s tomb from the Han were most probably the products of a mature age. The Lingshu also records that “The third needle is the lifting needle, pointed like a broomcorn or millet seed, three and a half cun long, and used for pressing veins or vessels and to expel the evil qi out from the vessels.” This kind of needle has still not yet been found among the jade and stone remains of archeological sites. The texts above explain the development from bian stone to chan stone to the nine needles — but they can all be called bian needle collectively. This developing process also concurs with the idea that meridians came before acupoints. The theory of meridians and the practice of acupuncture and moxibustion thus began.

43.  The Growth of Medical Knowledge The earliest knowledge of medicines in China mostly started from an exploration of the elixirs of immortality. They were the objects of witchcraft and sorcery at that time. Finally the Chinese people extricated themselves from

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sorcery and began, through painstaking efforts, to find and use medicines to treat disease, but always with anxiety and fear. Elixirs could make people immortal, but medicines used for disease were thought to be poisonous. “Shennong tasted various herbs and was poisoned seventy times in a single day” actually means separating out the non-toxic as “food” from the toxic to be used as “medicines”. The Book of History – The Book of the Shang Dynasty – Destiny First Part says: “If one does not feel dizzy after taking a drug, his disease will not be cured.” The note to this says: “The book Dialect says: Being poisoned due to taking drugs is called mingxuan (暝眩) among the people between the Bohai Sea and Taishan Mountain.” Mingxuan is namely “dizziness”. If medicines are to work, people must have such a feeling when taking them. So obviously, this also implies, that the toxic side effects of the medicines were very strong. Conversely, this was the first understanding of drug effects and pharmacology. In the 25th hexagram “Wuwang, 无妄 simplicity”, nine at the fifth place in The Book of Changes it reads: “With an unexpected disease it is better not to use medicines”, proposing that medicines should not be used carelessly without understanding their toxic effects. The Great Unity of Mozi says: “People were often hurt by water, fire and toxicants.” How noxious medicines were! Confucius must have been afraid of taking medicines, as it is said in The Analects of Confucius – Hometown that “Ji Kangzi presented some medicines to Confucius, he appreciated it but said: ‘I do not understand these drugs so I am afraid to take them.’” There was even a case in Zuo’s Spring and Autumn Annals – The 19th Year of Zhao: “Lord Xudaogong suffered from malaria that summer. On the fifth day of May, he took a drug sent by the crown prince Zhi and later died. The crown prince fled to Jin. The book records: ‘He murdered his monarch.’ The nobles say: ‘Try your best to serve your monarch, but better avoid using medicinal drugs.’” A note to this passage says: “The crown prince Zhi himself and not a doctor sent the drug.” “The drug was poisonous, and its use was only understood by a doctor not ordinary people. The book sneers at Zhi sending the drug, so no wonder he was accused of killing his monarch!” This could be a case of medical malpractice. Zhi did not understand the drug’s toxicity, but wanted to express his filial piety, so he was labelled a king-slayer. The Nations also records that Li Ji tested aconite’s toxicity through feeding it to a dog. This could be considered to be toxicity-testing. No wonder it was later stipulated in The Book of Rituals that “If a monarch was ill and had to take a drug, his minister would taste it ahead of him; if parents were ill, their children should taste the drug.”

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But this did not mean that the people of those times were afraid of toxic effects and did not use drugs to treat disease. Lu’s Spring and Autumn Annals says: “…he drank jin (堇) to treat disease.” Jin is aconite, which is quite toxic and still used in Chinese medicine after being prepared and processed. The book also says: “This is just what drugs are about, a good drug can save a life, a toxic drug can kill.” The key lies in the doctor. A Person with a Pheasant Plume – Circular Course records: “The king who walks many roads, takes a sinan (the south-pointing compass of ancient China) as his guide, so then the people learn from him; one who has experience in the toxicity of drugs, becomes a doctor.” An experienced doctor knows how to use a toxicant to treat disease. A Person with a Pheasant Plume also says: “A good doctor transforms disorder into recovery; while an unskilled doctor worsens the disease. Though the patient (the latter) was fortunate enough to survive, he was still wounded and his leg couldn’t move.” Chuang Tzu – Geng Sangchu also says that: “Any disorder becomes more serious after taking the drug made by a poor doctor.” In fact, the ancient viewpoint of “fighting poison with another poison” was developed in China. Disorder was a poison, and so was a drug. But the poison of disease could be expelled by a poisonous drug. So it is reported in Zuo’s Spring and Autumn Annuals – The 23th Year of Xiang that “Zang Sun said: Ji Sun’s love for me is like a disease while Meng Sun’s love for me like medicine and stone needle. Being comfortable with a disease is not as effective as treating it with medicine and stone needle. Stone needles make me alive, but being comfortable with a disease does harm by accumulating more poison within.” Medicine usage was difficult to master, so the knowledge of medicines lagged behind that of massage, hot compresses, moxibustion and bian needling. At the same time, these treatments were suitable for diseases of different levels of severity and depth. Medicines were suitable for serious and longstanding diseases, just as Han Feizi – Comment on Lao Zi repeats Bian Que’s saying: “Disease in the skin can be treated with a hot compress of herbs; a disease in the muscle can be treated with stone needling; a disease in the intestines or stomach can be treated with huoqi (drinking boiled herbs); but a disease in the marrow is in the control of destiny, for the doctor is utterly helpless.” Zuo’s Spring and Autumn Annuals – The 10th Year of Cheng also records: “If a disease cannot be treated with gong (攻), da (达) or drugs, then nothing can be done.” “Gong (攻)” refers to herbal compresses, or heat therapy; “da (达)” means needling; huoqi (火齐) means drugs, viz. toxic drugs. If a disease could not even be treated with drugs, nothing could be

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done. So it is said in The Book of Songs – Great Elegance: “If the disease is like a wild, raging flame, the people cannot be saved by medicines.” The more a doctor experienced, the more he learned. There was a clear division of labour in Zhou’s Rituals. “Doctors were in charge of government decrees, and gathering drugs for medical treatment. If people were ill, or wounded, or suffered from sores, they would come to the doctor’s office. Then they were treated in different divisions according to their disease…” There were four kinds of doctors — the doctor of food (the king’s dietician), the doctor of disease (equivalent to a physician), the doctor of sores (equivalent to a surgeon) and the veterinarian. “Doctors of disease were in charge of the diseases of all people; they treated them with the five tastes, the five cereals and the five medicines…. All people were treated separately.” “Surgeons were in charge of the treatment including cursing, medicines, scraping necrotic tissue out of carbuncles, ulcers, metal woundsand broken abscesses. To cure these diseases, surgeons attacked them with the five poisons, nourished them with the five qi and treated them with the five drugs…”. There is another example in Zhuangzi – A Carefree Excursion. “In the kingdom of Song there was a person good at making drugs for chapped hands, whose family had been rinsing silk for generations. A traveller heard of it and bought his formula at a high price. After having got this formula, this traveller then canvassed the King of Wu. Yue happened to launch an attack on his country, so the King of Wu ordered the traveller to command his troops. That winter, two troops were at war and some of the battles were fought in water but Wu’s troops defeated the Yue completely. So the Wu King bestowed lands on him as a reward, which was because of the formula used for preventing and treating chapped hands.” This formula came from these people who were always rinsing silk and resulted from their experience in using this medicine. Since the formula could treat chapped hands and frostbite, Wu’s troops avoided chapped skin during the war fought on the water and finally won. What a thoughtful general he was! A good doctor used a drug with the special aim of being flexible according to the different conditions of the illness and thereby avoiding the toxicity of the drug. Mozi – Universal Love records: “Before a doctor gives his patient medical treatment, he must have knowledge of the root cause of the disease. If he does not understand the cause, he will be inexpert at curing the disease.” Lu’s Spring and Autumn Annals – Current Circumstances says: “A skilled doctor will adjust the formula when his patient’s disease has changed.

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If the disease changes but the medicine remains the same, even the long-lived will die young.” On the other hand, herbs combined together could reduce toxicity. Just as is said in Zhuangzi – Xu Wugui that “The medicines could make a recovery and without them he could die. But sometimes they could cause death and without them he may still live on. There are such medicines, as aconite, or platycodon root, or semen Euryales, or Polyporus Umbellatus, even a sovereign could not tell what they were. The list is endless!” These herbs were quite possibly from a compatible prescription. Aconite is greatly toxic, the others are non-toxic. A correct compatibility can save people’s lives, while a wrong compatibility will kill them. It is made clearer in Lu’s Spring and Autumn Annals – Classifying that “There are many herbs such as Manchurian Wild ginger and doliches creepers. If they are taken alone, they may kill the patient; but if they are taken in compatibility, they will lengthen a life. Scorpion and aconite are both very toxic, but the compatibility of them means they do not kill people.” This text also sneers at the one who considered himself a wise man but actually did not understand pharmacology at all. “There was a person named Gongsun Chuo, who told people that he could make the dead come back to life. ‘How?’ asked people. He answered: ‘I can treat hemiplegic paralysis. Now as long as I double the dosage of the drug for hemiplegic paralysis, I will bring the dead back to life.’ Gong­sun Chuo did not understand that some things can play a small role, but not a large role; they can work in half a body but not in the whole.” Though only a joke, this also teaches us that the progress of understanding is a long process. The Huangdi Neijing says: “If the patient is strong enough to bear the toxity, he can be treated with strong drugs; if a patient is weak, he will be treated with a moderate drug.” This refers to drug usage according to the constitution of different patients. “Disorder may be new or have been for a long time, a prescription may be large or small, a drug may be toxic or nontoxic, so each drug has its own rule of preparation. A drug with strong toxicity will not be taken any more after six-tenths of the disorder has been cured; a drug with general toxicity will not be taken any more after seventenths of a disorder has been cured; a drug with weak toxicity will not be taken any more after eight-tenths of a disorder has been cured; even a drug with no toxicity should not be taken any more after nine-tenths of a disorder has been cured. After that, the patient should be nourished with cereals, meat, fruits and vegetables, so that the pathogenic factors will be dispelled, the healthy qi recover and the disorder be cured. Do not make overuse of a

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drug that will damage our healthy qi.” This text clearly reflects primitive man’s cognitive understanding of “toxic drugs”. The Suwen also says: “To cure a disorder, it is necessary to take medicines to treat inside the body and we should co-operate with some external treatments as well, such as stone needling or moxibustion.” This text is also consistent with understanding the difference between needling, medicinal drugs and their combination. The Huangdi Neijing only briefly records thirteen prescriptions and a few dozen medicines, and its observations are obviously simpler than those on acupuncture and moxibustion, the channels and collaterals. This also proves it was difficult to master medicinal drugs and that their use was recognized later than that of acupuncture. There was no great progress or summarization concerning medicines until Shen Nong’s Canon of Materia Medica which records three hundred and sixty-five different medicines and classifies them into the best, the middling and the worst. They will not be further discussed here at present. In most medical history books it is believed that it was Shang Tang’s great prime minister Yi Yin, also known as A Heng, a senior sorcerer who created the idea of compatibility in Chinese medicinal formulas, but this does not accord with the facts. Yi Yin was a semi-mythical person. Lu’s Spring and Autumn Annals – Original Flavour says: “A girl from Youshenshi found a baby in the hole of a mulberry tree, when picking mulberry leaves. She dedicated him to the king. The king ordered his cook to feed up this baby and investigate the matter. The cook reported to the king that: The baby’s mother lived by the Yi River. She was pregnant. She dreamed that an immortal from heaven told her that if water came out of the mortar she was using, she should run eastward and not look back. The next day, she saw water leaking out of the mortar. She told her neighbours and ran eastward for ten miles. Then she turned and saw her village had already become a sea. Then she turned into a hollow mulberry tree. So they named this baby Yi Yin.” Later, the King Tang was looking for talented people everywhere in his realm. In order to get Yi Yin, Tang married the daughter of the king of Youshen. As a servant of dowry, Yi Yin accompanied her and was given to Tang. Yi Yin was not a doctor, as is proven by a text in Mozi – Valuing Righteousness. “Take medicine as an example. It is just a handful of grass roots, but it cures disease. Do you think a king will not take a medicine for his illness because it is only a handful of roots? … So, although a low-born person can be seen as superior to a husbandman and lower to a medicine, isn’t this person just the same as a handful of grass roots? … Long ago, King

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Tang was to meet Yi Yin. … Peng’s son said: ‘Yi Yin is just a humble person. If you want to meet him, you can summon him, he is duty-bound to attend.’ Shang Tang replied: ‘You do not understand. If there is a medicine which can make me hear and see better, I will happily try my best to eat it. Now Yi Yin is to regulate our nation like a skilled doctor or a good drug treating a disease. Now that you do not want me to go to meet Yi Yin, means you do not wish me to be good.’” From this text, we can see that Yi Yin was not a doctor but a politician. The reason why later people mistook Yi Yin for a doctor was because Tang had just used a figure of speech comparing him to a doctor. But at least Yi Yin knew a little of the way of keeping well. Lu’s Spring and Autumn Annuals mentions that he answered Tang: “Take in the fresh and get rid of the stale, make the channels always go through smoothly, with the essence and qi renewed every day and evil qi dispelled completely, you will enjoy a natural lifespan.” He also understood cooking skills and stated his ruling strategy to Tang by calling it “governing by the best taste”: Seasoning with the sweet, sour, bitter, hot and salty flavours; what to put in first and how much be strictly observed. The change of taste in the ding (cooking vessel) is subtle — and it is difficult to speak of or be sensed. It seemed that Yi Yin had noticed chemical changes in the ding, especially as he mentions “the delicious seasonings such as the ginger of Yangpu and the Cinnamonum cassia from Zhaoyao Mountain”. Ginger and cassia are essential to treat cold. On the basis of that, people later wrote a book The Decoctions of Yi Yin, which further convinced others that Yi Yin was the father of herbal decoctions. But Zhang Zhongjing at the end of the Han Dynasty did not mention him in the preface to his Treatise on Febrile and Miscellaneous Disease. However Huangfu Mi of the Jin Dynasty said in his preface to an A–Z Classic of Acupuncture and Moxibustion that “With reference to Shennong’s Herbal Classic, Yi Yin wrote his Decoctions exhibiting the talent of a sub-sage. … Zhongjing supplemented Yi Yin’s Decoctions with a book consisting of tens of volumes, most of which were effective in the clinic.” Obviously we have only Huangfu Mi’s word for this, but even so Yi Yin has been mistaken for the father of decoctions until now. The idea that ruling a country might be similar to cooking might have been proposed by Yi Yin. But it was developed later by some famous politicians such as Shi Bo, Guan Zhong, Yan Zi and Confucius. Lu’s Spring and Autumn Annals also developed the sense of “He (和, harmony)” and “Tong (同, identity)”,and showed the similarities between politics and physical phenomena: “There are many herbs such as Manchurian

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wild ginger and doliches creepers. If they are taken singly, they will kill people; but if they are taken together, they will lengthen life. Scorpion and Aconite are both toxic, but taken together they will not harm people. Lacquer is fluid, so is water. But if they meet together, they solidify. The wetter they are, the more quickly they solidify. Copper is soft, and so is tin. But if they fuse together, they will harden…” The principle of compatibility in Chinese medicine had developed in society, politics, human affairs, scientific process and natural philosophy, and it set an example for, or guided the principle of compatibility of monarch, minister, assistant in the composition of prescription. Yi Yin only used the principle of compatibility in cooking and politics — he did not mention nature. Lu’s Spring and Autumn Annals used it in all fields — including physics and chemistry and possibly created the idea of compatibility in Chinese medicine at the same time. Wine might also have played an intermediary role in the relationship between a single drug and the composition of a prescription. Wine came into being a long time ago. Though wine could strengthen the body, it also caused disease, especially when drunk too much. Inscriptions on bones make a record of this. The Yanzi also records that “Lord Jing drank and got drunk. He did not get up until three days later. Yanzi visited the Lord and asked: ‘My Lord, are you ill due to wine?’ ‘Yes.’ replied the Lord. Yanzi said: ‘The ancient people drank but limited it to the promotion of their qi and blood and regulation of the spirit, but not until drunk.’” From this story, we know that wine was common as a drink, and not only used as a medicine, and it could also cause disease. Lu’s Spring and Autumn Annals also says: “Do not force him to eat fatty meat and drink strong wine, otherwise the meat and drink will rot the bowel.” There were many varieties of wine but most common were the four wines — clear wine, medical wine, acid wine and sweet wine which were called laoli (醪醴). It was not only used for sacrificial offerings, but also was an ordinary beverage taken because of its blandness. Lin Yin noted that the “li”(醴) mentioned in Zhou’s Rituals was a kind of light wine-mixture of juice and rice — a little yeast and much more rice, fermented for one night, and slightly sweet.22 The Su Wen – Decoctions and Wine says: “‘How about making decoctions and wine with the five cereals?’ Qibo answers: ‘We must use rice as raw material and rice straw as fuel to make wine. The rice has 22

 Lin Yin. New Note of Zhou’s Rituals, Bibliography and Literature Publishing House, 1985, p.50.

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to be perfect and the straw should be tough.’ ‘Why is this?’ Qibo replied: ‘It is because perfect rice is nourished by the harmonious qi of heaven and earth, and grown in a properly high place. When rice is harvested in good time, its straw is tough.’ Huangdi said: ‘But why did the ancient sages make decoctions and wine but not use them at that time?’ Qibo answered: ‘The sages had them ready just in case, so they made them but did not use them. In the Middle Ages, the morale of keeping healthy slightly declined, then people became weak in mind and body, so they were often attacked by the evil qi. But as long as they drank some decoctions and wine, they soon recovered.’ Huangdi said: ‘But why does it not work very well for people today?’ Qibo said: ‘Today if someone is ill, he will not recover unless he both takes medicine for internal illness and is treated with the stone needle and moxibustion for externals.’” All these texts reflect the process of development, usage and supplementation of decoctions and wine. Later on the formula was reborn by using yeast and formal prescription of herbs such as ginger, cassia, Polyporus Umbellatus, Gordon Euryale Seed, aconite etc. compounded together. These compound prescription can greatly decrease and even take away completely the toxicity present when these drugs are used alone. The principle of “being together in harmony” was the great foundation of the formulas of Chinese Medicine. Cooking and brewing might have played a role in enlightening people or suggesting a medium or specific method. Possibly ancient people did not understand the chemical change in the decoction or wine, but they did see the results and its marvelously curative effect.

44.  The Bud of Prevention The idea of prevention was not a patent product of hygiene and sanitation. It occurred earlier than the “prevention of infection” or “preventive health”. Divination for pursuing good fortune and to avoid disaster possibly embodied the earliest thoughts of prevention. Divination originally meant to forecast and resolve difficult problems, which people were unable to resolve on their own. So the Great Law says: “If you meet with serious problems, please resort to divination.” Zuo’s Spring and Autumn Annuals – The 11th Year of Huan says: “Divination is for resolving problems. If you are not in doubt, why divine?” This included divination for the prognosis of a disease. Qirang (praying and exorcising) was a specific measure of prevention. If people could not take control of something, they must resort to the gods. Through “praying and exorcising”, people wished to evoke the mercy of

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gods or expel an evil. The activity of qirang shows that people desired and tried to control supernatural forces by themselves. Following on after this, the awareness of forecasting and prevention became stronger and stronger. Laozi says: “A situation is easy to sustain while it is at peace; a thing is easy to plan when there is no sign of change; moonlight is easy to identify before it grows stronger; a thing easily disappears before it becomes obvious, so we should deal with something before it appears, and rule a nation before there is disorder.” The Book of History – Zhou says: “According to the old great law, a nation should be ruled before it turns to disorder; a nation should be guarded before it gets in danger.” The Book of Changes – Victory says: “A nobleman always considers all possible disasters in the future and made good preparation for preventing them.” Zuo’s Spring and Autumn Annals – The 9th Year of Cheng records: “It is a big mistake not to make preparations during crude and unfavourable times; it is so much better to make preparations for the unexpected.” Zuo’s Spring and Autumn Annals – The 31th Year of Xiang records: “It is just like guarding a big river in flood. If there is a big break, the floodwater will damage many people and nothing can be done to save them. So it is better to make a small opening to guide the water out in a controlled, prepared way. Just as it is better for us to take medicines when first feeling illness.” Guanzi – Great Sayings records: “If someone makes a plan without his own judgment, he will be in difficulties; if he does something without preparations, he will fail.” Rituals – Moderation concludes that “Preparedness of prevention ensures success, unpreparedness spells failure.” So it was natural for people to associate directly the thought of prevention with medicine. The sayings such as “make a small opening to conduct the water out through a prepared way.” “to take medicines when feeling illness at the start” already contained the idea of prevention. Mozi – Big Choice also says: “The sages hated disease but not danger and difficulty.” Mozi – Small Choice also says “It was hating the disease, not hating the person” which reveals that people work to dispelled danger and disease, and desire to defend others. So Mozi says again: “Running the country when it is already in a mess is like a person digging a well after he has choked, or dying people wanting to see a doctor.” This saying clearly indicates that the prevention of disease should be done earlier. This is also cited in the Huangdi Neijing Suwen – Regulating Spirits According to the Four Qi: “It is too late to treat an already-happened disease and to rule an already-occurring turmoil, it is just like somebody who digs a well after being choked with thirst or producing weapons when already fighting. It is too late!” These sayings

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show the root of all preventive thought in Chinese Medicine: “The sage’s opinion is to treat the coming disease rather than treat the present disease.” Sayings like this were often heard at these times and later. The Huainanzi says: “Skilled doctors often treated a disease before it had symptoms, so patients seemed not to get ill; sages often dealt with disaster in the bud, so there was no disaster.” To Be Simple says: “Supreme people wipe out a disaster before it happens; treat a disease before it occurs.” The Records of Three Kingdoms – Biography of Lu Meng records: “The bright man wiped out disaster in the bud; the wise prepared for trouble in the future.” Deng Xizi says: “Planning could normalize the future, consideration could keep away trouble.” The Chinese idiom to “nip in the bud” was the best expression of the traditional concept of prevention, as it was expressed in war, disaster and disease. There were many methods of prevention such as taboo and qirang “in the folk way” as mentioned above. They have always been part of folk customs. The General Sense of Customs says: “If someone sleeps with his head at the threshold, ghosts will entrap his head and he will become insane.” The Huainanzi also says: “Using a threshold as a pillow, people will be stepped on by ghosts. If ghosts want to mysteriously affect you, they do not have to wait to come in through the door or window; if they come by air, they will not step on you. Actually the door and window are the only route the wind must pass through. Wind is the conflict between Yin and Yang. If someone catches a door-wind, he will be ill, so the sages warned people ‘in the name of ghosts and gold’ to be careful of the wind.” The text clearly explains that sleeping facing the door or window is forbidden to prevent any disease caused by the coming and going of the wind. Behind the qirang and the taboo there is some scientific element. Zhou’s Rituals states: “The siguan (an ancient official) is in charge of the government decree concerning fumigation. He governs the use of fire along with the change of the four seasons in order to avoid diseases caused by seasonal epidemics.” This had the meaning of qirang and taboo. But actually fumigation through the use of fire could kill pathogenic insects such as gadflies and prevent disease. The Guanzi also says: “In March, the storage of faggots in the kitchen should be renewed; the tinder should be changed and replace the drill-stone with a new one; dredge wells and change to fresh water. Then toxins can be eliminated.” “To teach people to build new houses and fumigate their houses, drill stone to get new fire, drain the wells and change their water in order to make people healthy.” These two sayings have the same significance. The Book of Changes says: “One does not drink

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from a muddy well; no animals gather at an old well.” It is a stipulation in The History of Later Han History – Rituals that: “On the Summer Solstice, one should dredge the well and change its water; and the drill stone should get new tinder on the Winter Solstice. This can prevent the warm-heat disease.” This text contains the same meaning. Storing ice was also mentioned. Zuo’s Spring and Autumn Annals – The 4th Year of Zhao says: “Ice was stored in remote mountains and deep valleys where it was so cold that the ice could not melt. People got their ice from there … the Dafu (a senior official in feudal China) and a woman titled by the king used ice to take a sacrificial bath before a funeral … From the titled man and woman to the old and the sick, none were not given ice … Storing ice could be seen everywhere and ice was used everywhere. The ice was stored in the right way, so it would not be over hot in winter or abnormally cold in summer, there would be no cold wind in spring, no lasting rain in autumn, no horrible thunder, no disaster, no frost, no hail and no disease, and the people would not die young either …” This was the earliest idea of “air conditioning” as a preventive measure used for the protection of health. The second way was to pay attention to one’s wellbeing, which included the art of immortality. The Zhuangzi records that Huangdi asked Guang Chengzi: “How can one live long?” Guang Chengzi answered: “Be careful with your body, it will naturally grow stronger. I stuck to this one great point and lived in harmony, so though I am one thousand and two hundred years old, I am not aged in form.” It is impossible for us to live one thousand and two hundred years, but cultivation and improved wellbeing really do keep people healthy. Lu’s Spring and Autumn Annals says: “If essence and spirit are peaceful in the body, you will live long … So if one wants to keep healthy, he must have a good knowledge of the fundamental points of health. If he masters them, he will not suffer from disorder.” So health preservation can keep the essence and spirit sound, and prevent disease. On the contrary, “secular lords often lose their essence (sperm) so they easily become ill and die when they labour. Their desires in the ears, eyes and mouth are never satisfied. They suffer from general dropsy, have stiff bones and muscles, stagnant blood in the vessels while their nine openings become empty. Their actions lose their normal way. Even though Pengzu was there, nothing could be done … Various diseases come out, all kinds of insurgencies break out.” People should act as follows: “Though the ears desire to listen to music, the eyes to see the beauty, the nose to smell the fragrant, the mouth to eat the delicious, these desires should be forbidden when they are bad for life.” Take another example. “If what one wears is too hot, his

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meridians will block, which will lead to obstruction of the qi. If food is too rich and delicious, the stomach will be over-filled. The over-filled stomach will lead to fullness in the chest and distension in the abdomen, which also leads to obstruction of qi. Living like this, how can one live long?” In a word, be peaceful and moderate, do not overtax the body — this is the most important principle in keeping healthy. The thought above was also absorbed by the Neijing. Suwen – the Genuine Qi in Ancient Times say: “Ancient people knew how to keep healthy. They followed the example of Yin and Yang, taking proper methods to keep healthy, having a moderate diet and regular sleep and working without overstrain, so they had a strong body and a healthy mind, enjoyed their natural 100 year life-span and then died.” Lingshu – The Root of the Spirits says: “A wise man keeping in good health must adjust to hot and cold climates along with the change of four seasons, not overstrain in motion, take a proper diet, rest and work regularly, balance Yin and Yang, moderate the hard and the soft, then he will not be attacked by evil qi, and naturally he will live long.” The third method was to dispel external pathogens. How splendid was the Great Exorcism held by Fangxiangshi! Zhou’s Rituals says: “The shushi (an ancient sorceress) was in charge to expel poisonous insects, to attack them to be eliminated with scarlet grass.” “The jianshi (an ancient sorceress) was in charge of moths, to attack them and smoke them out with sikimi.” “The chifashi (an ancient sorceress) was in charge of eliminating insects hidden in the house. They cleaned the walls and used to attack insects with clamshells carbon, and used ash to poison the insects. Some insects (such as fleas) hidden in the wall fissures have to be expelled.” The guoshi was in charge of expelling flies... They burn peony and chrysanthemum flowers and spray ashes and smoke onto flies to kill them.23 These were the more specific officials in charge of eliminating pathogenic insects. Zuo’s Spring and Autumn Annuals – The 17th Year of Xiang also says: “On the 22th day of November, all the people in nation drove away mad dogs.” The 12th Year of Ai says: “Mad dogs bite anything.” From these sayings, we know all people were afraid of mad dogs and drove them away. Mad dogs meant rabid dogs. If a person was bitten by a rabid dog, he will suffer from rabies (hydrophobia). Driving away rabid dogs guarded against rabies. If something could not be eliminated, people tried to keep it away. Zhou’s Rituals says: “Put an end to war, keep guilt and disease away.” 23

 Some say this character refers to frogs, not flies.

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Zuo’s Spring and Autumn Annuals – The 15th Year of Xuan records: “It is said: Rivers and lakes contain filth, mountains and wilderness conceal the sources of disease.” It also warns people to avoid dangers. There is a saying “Debilitating deficient pathogens and abnormal winds should be avoided at the right time” in Suwen – Genuine Qi in Ancient Time. All contain the meaning of prevention. The most hygienic method of prevention was also to eschew. Zuo’s Spring and Autumn Annuals – The 6th Year of Cheng records: “If a soil is barren and water short, disadvantages easily occur, which worry people. Then the worried people become weaker. Thus many people suffer from damp diseases with swollen feet. But if in the living area the soils are rich and the water well-moving, disease will not happen.” Lu’s Spring and Autumn Annals says: “If the water in a place contains little salinity and other minerals, people there easily suffer from baldness and goiter; if the water contains too much salinity and other minerals, people easily suffer from swelling feet and atrophy; if the water in a place is sweet, there are many kinds of beautiful and healthy people; if the water is hot and pungent, people easily suffer from ulcers and carbuncles; if the water is bitter, people easily suffer from deformed limbs, ‘chicken breasts’ and hunched back.” This text teaches people how to select a place to live. Mozi – No Attack says: “People had no peaceful place to live, nor enough food to eat, they did not eat regularly either, so countless numbers of them suffered disease and died on the road.” This text tells how if people do not take healthy measures to avoid living in a bad area they will suffer disease. Disease was treated in its early stage, or in the bud, or treated to avoid a relapse — all of these were ways of prevention in Chinese Medicine. The wellknown story of “A sick person refusing treatment” in Hanfeizi – About Laozi is such an example. Bianque visited lord Cai Huangong three times and advised early treatment but Lord Cai refused. The first time, Bianque said to him that “My lord is ill in the skin texture. If you are not treated in time, the disease will become worse.” Lord Cai did not believe him. When Bianque visited Lord Cai a second time, he said: “My lord is ill in the skin and muscle. If you are not treated in time, the disease will become even worse.” Lord Cai still did not believe him. Bianque visited Lord Cai a third time and said to him “My lord is ill in the stomach and bowels, if you are not treated in time, the disease will become worse again.” Lord Cai still did not take Bianque’s advice. When Bianque visited Lord Cai the fourth time, Lord Cai had been ill in the bone marrow, and nothing could be done. Bianque fled to Qin and Lord Cai Huangong died. If Lord Cai had taken Bianque’s advice and

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accepted treatment, his disorder would not have had a chance to show its symptoms, nor become worse and worse, not to mention leading to his death. A Person with a Pheasant Plume also records that king Wen of Wei asked Bianque: “Who is the best doctor among your three brothers?” Bianque answered: “My oldest brother is the best, my second oldest brother the better, I am the lowest … My oldest brother discovers disease at the first stage before the symptom happens, so he is only known to the family. My next oldest cures disease when it just sprouts, so he is known by the neighbours. I treat disease with the needle, using toxic drugs for serious symptoms in the body, so I am known to all the dukes.” Just like the doctors of prevention today, they are always not as famous as clinical doctors in any clinic. Their social status is also not as high as that of the doctors of a clinic. This was typical thought for the Chinese. The Hanfeizi says: “A good doctor treats a disorder in the skin texture because a thing should be dealt with before it becomes serious…So it was said that ‘the sages performed early.’” “Needling is painful and drugs tastes bitter. But if we did not take needling and drugs for pain, we will not be cured and alive!” Zuo’s Spring and Autumn Annals – The First Year of Ai records what Wu Zixu said: “In virtue the more the better, but in disease it is better to be cured completely.” Though these texts are about disease treatment, they also mean prevention. The Hanfeizi even says that “If a person suffers a disease, he should visit the doctor. If not, he could die.” According to this saying, the patient was treated to prevent death. Sima Qian said in his Historical Book – The Biography of Bianque “If a sage foresees everything in bud time he is like a wise doctor treating a patient at the early stage of the disease. The disease can be cured and the patient lives.” The Huangdi Neijing Suwen – The Corresponding Manifestations of the Yin-Yang also teaches doctors that “The best doctor treats disease at the surface of the skin, the better in the skin, the good doctor in the vessels, the worser kind in the six fu-organs, and the worst in the five zang-organs. If the disease is in the five zang-organs, its curability is the same as the likelihood of death.” It is said in the Suwen – The Spirits of the Eight Right that “A good doctor treats disease in the bud, but a lower level doctor can only treat a disease with symptoms, even in its serious stage.” Zhang Zhongjing said in his Treatise on Cold Pathogenic and Miscellaneous Diseases that “A skilled doctor treats a coming disease.” These sayings become the mottos for doctors throughout the ages. But it was the converse in Zhuangzi. “When Youyushi treated people for sores on the head, he did not put a wig on the patent until the patient became bald, just like a patient not seeing a doctor until he felt sick. A filial son carries in a medicinal drug

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to treat his loving father, with every sign of distress on his face but it is too late. Such an action shames the sages.” The Mountains and Seas Classic has recorded prevention with drugs. The drugs of prevention are 45 in all, such as the Qinggen Bird for preventing pestilence, and eating the Zhen Fish for avoiding disease, etc. But prevention by drugs alone, without witchcraft, only appears later. We can see here that the idea of prevention was one of the earliest ingrained thoughts in China. It influenced Chinese society to a very great extent in every age, and its achievements were massive. It is impossible that prevention could not catch the attention of the scholars of Chinese medical history. Its cultural traces are also obvious.

45. The Famous Doctor Bianque: A Step Up from Witch-Doctoring The appearance of professional doctor marked the point when the culture of medicine finally reached maturity. At first, the profession of doctor was separated from that of sorcerer and became witch doctor, then witch doctor turned into professional doctor. Jiu Daiji, Qibo and Bogao, etc. — all mentioned in the Huangdi Neijing — have no record in the historical biographies, but they played an important role in this evolution. The biographies also record another group of doctors, for example Yiyuan, Yihe and Wenzhi. They were the earliest group of outstanding doctors to break away from being witch doctors. True doctors replaced witch doctors gradually over a long period of time. Zuo’s Spring and Autumn Annals – The 10th Year of Cheng (581BCE) records how Lord Jing of Jin dreamed of a big ghost with long hair to the ground. He believed the witch who lived in Sangtian, so he called her to interpret his dream. The witch said: “You will not get a chance to eat the new wheat.” Lord Jing did not take it seriously and doubted her, so he sent for a doctor from Qin-Kingdom. Yihuan then came by order. That night, Lord Jing dreamed again. In his dream, two mischievous boys were talking how they were afraid of the skill of the coming doctor and wanted to flee to a place “over the huang and under the gao (a region of the body between the heart and diaphragm)”. Yihuan diagnosed that the disease was indeed situated between the huang and the gao. He said it could be treated neither by moxibustion, nor by needling, nor medicines. There was no hope of curing the disease. What he said was the same as the two boys in the dream.

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Lord Jing sent Yihuan back to Qin and gave him many gifts. When the new wheat was serviced, Lord Jing decided the witch in Sangtian had been wrong and killed her. But after the wheat was cooked, as he went to the toilet, he fell down and died without eating the new wheat. This was the story describing the idiom of a “disease in the gaohuang” or a “disease entering into the gaohuang”. Then Qin Yihuan became famous. Medicine had defeated sorcery. But the story itself reflects how the division between medicine and sorcery was unclear at that time. Actually, it is shown they still believed in the dream interpretation of the witch of Sangtian. Zuo’s Spring and Autumn Annals – The First Year of Zhao (541BCE) records the story of Lord Hou of Jin — how when he was ill, he invited He of Qin (Yihe) to give a diagnosis and treatment. Yihe said, “This disease will not be cured. The disease is due to too much sex, which seems to be caused by venomous insects. Actually this disease is caused neither by ghosts nor spirits, nor by diet, but by women. You have lost the will as a good minister and cannot be cured; even the heavenly gods cannot bless you.” Yihe was the first to explain the pathogen of “gu” (蛊 insects), which were “neither ghost, nor diet”. But “Heaven cannot bless you”obviously indicated the beginning of a real medicine, separating out a cause which was neither ghost nor spirit. Then Yihe put forward his theory of disease being caused by the six qi — and so left his name in history. There was also a doctor of Qin named Yikou who ever surgically removed a carbuncle for King Xuan of Qi and treated the hemorrhoids of King Hui of Qin during 375BCE to 316BCE. It is recorded in the Shizi that “A certain Zhangzi suffered a disease of the back. He said to Yikou: It is just a back — you can treat it any way you like. Yikou treated him and it was cured. So if you trust someone, he will not betray your trust and do the best he can.” It is said that Zhangzi was actually the famous prime minister Zhangyi, who had great confidence in the doctor in the story. Yikou did not treat patients by witchcraft. King Kang of Chu (559–545 BCE) commanded one of his doctors to check on a Feng Shuyu, and see if he was really ill or not. Feng had “moved ice from deep in the earth and hid it under his bed, then he put on a lot of clothes and lay on bed covering with a thick quilt and ate little”. In fact, he was malingering. After the diagnosis, the doctor returned to King Kang and said: “He is thin and weak, but his blood and qi are not damaged.” Though he did not know that Feng pretended to be ill by starving himself through eating little, and storing ice under his bed, he knew that Zifeng was well according to “his undamaged blood and qi”, which was very skillful.

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Obviously he was not a witch doctor at all. The story can be read in Zuo’s Spring and Autumn Annals – The 21th Year of Xiang. Gongsun Qiao was a minister of Zheng. He disproved of witchcraft, saying: “If someone cannot understand how to live regularly, he will mess up everything. If one focuses too much on something, he will make himself ill. I also heard that if a lord and his wives have the same family name, the children will not prosper. And if a lord has too many wives, he will fall ill, which any nobleman hates.” This statement concerns reproduction. It is about infertility and is similar to the saying, “marry a person with the same family name and she will bear no children” in Zuo’s Spring and Autumn Annals. Medicine was superior to witchcraft again. The Guanzi (Guanzhong) says “Our Lord puts his trust in gods and resorts to diviners before he does anything, and likes to consult witch doctors — however, this is what makes the evil spirits suddenly appear and do mischief.” This saying clearly points out that the more people believe in spirits, the more they see spirits. Conversely, this saying also disproves of and criticizes the prevalence of witches and wizards. Guanzi was against sorcery. A similar story occurs in Lu’s Spring and Autumn Annals – Close Intelligence. It records that “Guanzhong suffered from a serious disease, and Lord Huan of Qi visited him…He said: The sorcerer of Chang can perceive life and death, and drive away a disease caused by ghosts. Should we distrust him? Guanzhong answered: life and death are decreed by fate; serious disease is accorded to heaven. You do not bear the order from heaven or closely abide in essentials, but rely on the witchcraft of Chang. So he will dare do anything without limitation.” This text sharply denounced witches and wizards. Zuo’s Spring and Autumn Annals – The 20th Year of Zhao records how even Yanzi considered “divination by deities is not that efficacious, the ‘deity turtle’ (oracle) is now superfluous, so you should stop divining. The best is just cultivate Huangdi’s favour, then one will be treated well.” Mozi was well known for his belief in ghosts. But when he was ill, he took another attitude. The Mozi records. “Once Mozi was ill. Diebi asked: ‘You thought ghosts and gods were wise, they can make the good happy and the bad unhappy…You are a sage, so why is it you suffer from illness?’ Mozi answered: ‘How can I be so muddled about my illness! There are many causes which make people ill. Some are ill because of the cold, some because of the summer-heat, some because of overstrain. Say there is a house with a hundred doors, if all the doors are closed but just one is open, will not the thief get in?’” “People have nowhere peaceful to live, nor enough food to eat, nor do they eat regularly, so countless suffer from disease and die on the

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road.” According to this statement, the theory that disease was caused by gods and spirits was backward-looking, and the people of that time realized that not all diseases were caused by ghosts. Confucius respected gods and spirits — but kept them at a distance. As he was ill, Zilu asked if he could pray for him. Confucius responded by asking: “Does it work?” Zilu answered: “Yes. The Lei writings say: Pray to all the gods of the heavens and earth yourself.” Confucius said: “I am saying my prayers for a long time already.” His subtext is: “I am always praying, but I am still ill. It is no use to pray.” He actually disaproved of the idea that praying could cure disease. Zhuangzi – The Natural King says that Huzi was good at moving qi, controlling his heart qi and countenance and keeping in good health. The great witch Jixian was good at face-reading. Huzi changed his features again and again until Jixian was at the end of his resources of skills and then fled away. This was also an example of a triumph over a witch. The Hanfeizi says: “As the proverb runs: Although Wuxian was good at cursing, he could not exorcise his own misfortune.” “As to praying, witches always say ‘I wish you a thousand more years, or ten thousand more years’ life. But in fact, their prayers did not make anyone survive even a single more day. So people slight witches now.” These two texts clearly described how witches were tested and found to be failing. It says again: “As one is ill, one shows respect to the doctor; as one falls into misfortune, one is in awe of the spirits …rule the world with the Way (道), and the ghosts are not that miraculous. So to rule over people is not equal to dealing with ghosts and spirits. Then it is said that ‘it is not gods and spirits that do not show their power, but they do not hurt the people anymore.’ When ghosts and evil spirits haunt and plague people, they make them ill and it is called ‘ghosts damaging humans’; when people drive away ghosts it is called ‘humans damaging ghosts’.” This saying shows a psychological analysis of the cause why people sometimes have a deep respect for gods and spirits and a belief in witch-doctoring, and sometimes not. The Xunzi – Ruling of King also records “It is the duties of the humpbacked sorceress and the lame sorcerer to watch the changes of Yin and Yang, to forecast good luck and bad, to accord with the clouds, to drill the tortoise bone, to display divinatory symbols, to take control of exorcising and choosing lucky days, to analyze various symbols and foresee wealth and woe, and what are the signals of goblins or propitious omens.” The Xunzi – The Heaven says: “Divination then means making a decision over an important matter. But it is not to gain something, only political ornament. So the sovereign regarded divination as a political ornament, but the common people regarded it as something miraculous.” This text describes

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the nature of divination as a cultural phenomenon. It also thought that making sacrifices to cure disease was nothing but a sheer waste of energy and money. So it says: “If someone suffers from damp-qi and wants to cure his disease by killing his pig and beating his drum, he will never cure his disorder but break his drum and lose his pig along with the money!” These selected texts show the attitudes of not only politicians and philosophers but also the common people. People had already stepped out of the mire of witchcraft. After the halo of collective representation in primitive thinking had faded, logic and experience gradually stepped in to help them believe in medicine instead of sorcery. As is said in A Person with a Pheasant Plume: “Accumulating experience, one can be a master; accumulating the experience of poisonous medicines, one can become a doctor.” So, in the Xunzi – Performing Rituals it says: “A skilled doctor is always visited by many patients.” Hanfeizi – Eight Concepts says: “If someone suffers from a serious illness, he will go to see a doctor…or else, he is going to die.” Zhuangzi also comments: “There are many patients in front of a doctor’s house.” So people visited doctors and did not seek out magicians. Bianque was the outstanding representative during this change of direction. The work of Li Bocong is the most detailed concerning the identification of Bianque up to the present.24 It is believable on the whole. But I have gone further. All the stories about Bianque in the history books are basically about two famous doctors named Bianque. One lived between the end of the 6th century BCE and the beginning of the 5th century BCE, at the same time of Zhao Jianzi; the other lived in the late 4th century BCE, roughly at the same time as King Wu of Qin. However, Li’s book did not find some much more important truths. The historical legends about Bianque can be read in Strategies of the Warring States, About the Book of Han’s Songs, Han Feizi, The Historical Records, The Anecdotes of the Garden, Liezi, and even A Note of the Nanjing, etc. Arranging the materials according to time, we find that they span some four or five hundred years, so it is impossible they describe the same person. As mentioned earlier, Bianque became something of a totem. Just as a nickname “Bianque” today is a name for an outstanding doctor. These legends should be put into their social and cultural background. 24

 Li Bocong. A Study of Bianque and His School, Shanxi Science and Technology Press, 1990, p.85.

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There are three stories about Bianque which prove that he had many connections with sorcery. The first was the tale that Bianque learned medicine from Chang Sangjun. He “took medicine from his bosom, gave it to Bianque and said he was drinking water of the heavenly pond”. “Then he disappeared. Bianque thought he was probably not an ordinary man.” After Bianque had taken this medicine for thirty days, “he could see through a person as if behind a wall. So when he examined a patient, he could see the cause and focus of any disease in the five zang-organs.” The second tale tells how he treated Zhao Jianzi, a senior minister in the Jin regime, as recorded in The Historical Books. Everyone thought Jianzi was unconscious but Bianque said it was the same as when, in the old days Lord Mu of Qin journeyed with his mind to the palace of the emperor of heaven, predicting he would wake up in three days. Later Jianzi woke up, and told his dream, just as Bianque had said. Bianque was given, as a reward, a forty-thousand-mu wide field. The third story was in the Liezi that he treated both Lu Gonghu and Zhao Qiying by “exchanging their hearts”. “Bianque made them drink medicinal wine, so that they lost consciousness for three days. Bianque cut open their chests and exchanged their hearts. After taking a magic potion, they revived, and were just as well as before.” This story is very similar to the one in Records of Ghosts and Gods. “Chen Zhai was a wizard in the Jinjiang area of Quanzhou. He was good at the art of jinzhu (‘prohibitions and curses’), and most patients were cured by him. There was a hostel traveler called Su Meng in Zhangzhou. His son was mad and nobody could cure him, so he went to invite Chen Zhai who duly arrived. As soon as his son saw Chen Zhai, he pointed at Chen Zhai and swore at him. Chen said: Your son’s disease had entered into the heart. Then he set up a sacrificial altar and warned people not to peep in. At night, he seized Su’s son, cut him in half, hung him on the east wall of the central room and his heart under the northern eaves, then began to practice magic in the central room. At that time, the heart hanging under the eaves was eaten by a dog. Zai could not find the heart and was very frightened. After going back and forth several times, he went out with a knife. The owner did not know what had happened, thinking he was still practicing magic. After a while, Chen returned with a heart and put it in the abdomen (chest) of the patient. He cursed out loud repeatedly in a wild manner and the body closed up. After the resuscitation, Su’s son kept repeating ‘Delivery post ahead! Delivery post ahead!’ None could understand why. A few miles away from Su’s house, an official mailman from a staging post had died at the side of the road, with official documents in his hand. Delivery stations had been set up on the post road every twenty

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miles in the area of the mid-south. The mailmen delivered each document personally. When he was going to arrive at the next delivery post, he would shout to make the postmaster ready in advance. It turned out that Chen Zhai took out the heart of the mailman to save Su’s son. But he recovered and was as well as ever before.” These are all myths concerning sorcery. Compared with heart transplants today, it seems absurd. The heart was not the brain. Even if the heart had been replaced, the patient would not shout out “Delivery post ahead!” The Records of Gods and Spirits clearly points out that Chen Zhai was a wizard. “He was good at the art of jinzhu.” Chang Sangjun was a wizard too. Bianque learned both witchcraft and medicine from him. Later, Bianque gave up wizardry and practiced medicine, which is the perfect example of the historical process that turned witch doctors into true doctors. The other stories about Bianque were all anti-wizardry. A story in the New Theory of Lu Jia reflects the fight between medicine and witchcraft — but Bianque this time was turned down. “Long long ago, Bianque lived in the state of Song. He offended the Lord of Song and fled to Wei. A sick person in Wei was going to die. So Bianque went to his house and asked to treat him. But his father said to Bianque: ‘My son suffers from a very serious disease, which cannot be cured by you, only by a skilled doctor.’ So he turned Bianque down and invited a wizard to pray in his son’s presence. Finally the patient could not be cured by witchcraft and died. The wizard could help the patient recover but the skilled doctor Bianque could not win trust in the argument. The key point is that people did not understand him.” Nevertheless, the evidence here shows that witchcraft could not cure the patient. Medicine finally would triumph over witchcraft. Bianque had another argument with a Zhongshuzi (an official or attendant) about the “sense of justice” once when he treated the crown prince. This story finally proves how the doctor Bianque with all his skill was victorious at medicine. Despite being thoroughly checked and annotated by Zhong Hua Press, the modern edition of Sima Qian’s Historical Book – The Biography of Bianque still has many errors and omissions. Actually this story was based on the original version of a literary work, About the Book of Han’s Songs. Here I combine the records from these two books to represent both the whole process of the argument and the treatment, so that they tally with the master copy. … A certain Zhongshuzi who loved the skill of treatment appeared and said to Bianque: “I heard that there was once a famous doctor

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named Miao Fu, in ancient times. As for practicing medicine, he made a mat out of sedge and a dog out of grass, then faced north and began to curse with ten incantations, so that those patients who had been supported or even carried in a sedan chair or vehicle would recover and be as well as before. Is your medical skill as good as that of Miao Fu?” Bianque answered: “No.” Zhongshuzi said again: “I also heard of a doctor named Yu Fu in the middle ancient times. He did not treat patient with decoctions, medicinal liquor, wines, the chisel needle, the stone needle, Daoyin, massage, medical compresses, etc. As soon as the patient unbuttoned his clothes, he would know the cause of the illness. Then following the points of five zangorgans, he incised into the skin and flesh, dredged the vessels, tied off the tendons, pressed the brain, fondled the gaohuang, tidied up the diaphragm, washed out the stomach and bowels, cleaned up the five zang-organs, cultivated the essence and qi, changed the shape of body, and made the dead come back to life. Can you treat people just as well?” Bianque said: “No. My method is as follows. I have to take the pulse, observe the expression, hear the voice, examine the posture, I then can tell where the disease is. From the Yang of disease manifestations, I can infer the Yin; from the Yin manifestations I can infer the Yang. Disease in the body can reflect outside, so I can diagnose a patient thousands of miles away. I have many methods of diagnosis, not just one fixed point of view.” Zhongshuzi said: “If that is so, your medical skill is just like peering at the sky through a reed pipe, or plugging into the earth with an awl. What you observe is large, but what you see is small. What you plug is big, but what you hit is just a little. You can only deceive a child with such skill!” Bianque said: “Not at all. There is something like a mosquito’s head, that can be hit by in the dark. There also is someone who can distinguish black from white — even with his eyes closed. The disease that the crown prince suffers from is Shijue (‘unconscious like the dead’). If you do not believe my honest words, then go and try to examine him. You will hear his ears still ringing and see his nostrils flare. If you feel along his legs to his private parts, you will find them still warm. If he is like that, he can be saved.” After hearing what Bianque had said, Zhongshuzi’s eyes could not open well and he felt giddy, his tongue became stiff and he could not speak. Then he went in, to report to the Lord of Guo what Bianque had said. The Lord was very surprised. He met Bianque in the Middle Entrance with his feet bare and walked out the Middle Gate to see him. He said: “It is

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humiliating for you to visit me from afar. But if my son is lucky enough to get treatment from you then he can perhaps recover. If he does not get your treatment, his body is fit for the ditch!” Before finishing what he was saying, his tears poured out, wetting his clothes and making his eyes blink. He was so upset by grief he could not control himself. His face changed colour. Bianque said: “The illness the crown prince suffers from is the so-called Shijue…” Bianque entered in. He told his disciple Ziyang to sharpen a stone needle and to needle the external three Yang and five gathering points; told Zitong to pound medicines, Ziming to do moxibustion on Yang-points, Ziyou to do massage, Ziyi to bring him back to consciousness, and Ziyue to support him. After a little while, the crown prince revived. Then he ordered disciple Zibao to prepare a five-fen medicine as a hot compress and decoct it with an eight-lesser ingredients’ decoction to act as a compress on both sides of the chest, by the ribs. The crown prince then could sit up. Bianque then went on to further harmonize his Yin and Yang. After having taken the medicine for twenty days, the crown prince recovered and was as well as before. How heated the argument is! Facts always speak louder than words. Medicine here achieved a complete victory. So “people heard that story and thought Bianque could bring the dead back to life.” But Bianque replied: “I am not able to bring the dead back to life, he was going to live anyway. I just helped him recover.” This shows he answered realistically. Unlike a witch doctor who thinks he himself owned “the elixir of immortality” and could “bring the dead back to life”. Thus Bianque stood out against the world of witchcraft and sorcery. Talent showing itself! But as a folk doctor, he could not be given the power and status of a sorcerer. He travelled around many states — such as the kingdoms of Qi, Zhao, Qin. In his hometown of Qi, he was known as Qin Yueren, which was his original name. In Zhao, he was called “Bianque” for his outstanding skill. “In Handan, he heard that women were respected in Zhao, so Bianque became a gynecologist; in Luoyang, he heard that old men were loved and cared for in Zhou, so he became a doctor treating ear, eye and stubborn diseases; in Xianyang, he heard that the people of Qin loved children, so he became a pediatrician as well. All in all, he changed his medical skills to fit in, according to custom.” This describes really the situation of a grown-up folk doctor, his social status, how he made his living, roaming

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around everywhere to see patients and training apprentices and disciples. “Anyhow, to take the pulse for diagnosis starts from Bianque”, this is a common saying which acknowledged his high academic status. He was the first real medical doctor in Chinese history. There are some kinds of people whom Bianque thought did not merit treatment: “The first are the conceited, arrogant and unreasonable; the second pay more attention to money than their lives; the third are those too fastidious about clothing and food to be adaptable; the fourth have been exhausted in fighting Yin and Yang and have unsteady zang qi; the fifth are too weak to take medicine; the six trust in witchcraft instead of medicine.” Most pointedly “to trust in sorcery instead of medicine” was the solemn declaration made by doctors of the earlier generation. Some people think “the six people not to treat” were put forward later by Sima Qian. But after investigating the style of his book, A Historical Book, people find Sima Qian’s commentary to be mostly at the end of the text, noted by the phrase “Chief historiographer said”. The Six “people not to treat” are mentioned in the middle of the text, and not written in especially, so they at least seem to be a report of Bianque’s own point of view. But Bianque himself suffered many mishaps during his life. Li Xi, the chief of the imperial physicians of Qin, knew he was not as skilled as Bianque, “so he ordered someone to assassinate Bianque”. These were the ups and downs which occurred in the earliest medical world where doctors strove to be independent from witchcraft. The death of another doctor Wenzhi also shows this difficulty. Wenzhi was a famous doctor of the Song, living between 345 and 286 BCE. Lu’s Spring and Autumn Annals – A Most Loyal Person recorded his story. The King of Qi suffered from depression, so he sent someone to Song to pick up Wenzhi and bring across. Wenzhi arrived, examined the king and said to the crown prince: “I am sure your father can be cured. But once he recovers, he will kill me.” The crown prince asked: “Why is that?” Wenzhi answered: “Your father will not be cured unless he is irritated; but if he really recovers, he will be bound to kill me.” The crown prince asked: “Why?” Wenzhi replied: “His illness has to be treated with fury, otherwise he cannot recover.” The crown prince kowtowed and requested: “If my father recovers and really wants to kill you, my mother and I will plead to my father with our lives for you. Father must have pity on mother and me. So don’t you worry.” Wenzhi said: “Ok. I will treat him, at risk of losing my life.” He agreed a certain date with the crown prince when he would arrive, three times, but he broke his word three times. The king was very angry already. Finally, Wenzhi arrive. But he mounted his bed with his shoes still on, he

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stepped on the King’s clothes and then asked about the disease. The king was furious and did not speak to him. Then Wenzhi spoke impertinently to irritate the king. The king reproached him and then stood up — he was cured. But the king was so angry that he would have boiled alive. The crown prince and queen tried their best to persuade and argue with him, but he did not change his mind and boiled Wenzhi in a cauldron. After being boiled for three days and nights, Wenzhi had not died. Wenzhi said: “If you really want to put me to death, why not cover me up to block out the qi of Yin and Yang?” The king had someone to cover the vessel and Wenzhi died. This is the famous story of how Wenzhi treated a disease by the psychological means of “anger overwhelming depression”. His death was practically a myth, but was explained by “the qi of Yin and Yang”. So now true medicine and true doctors were appearing. A natural philosophical method and theory different from that of witchcraft was also on the rise.

Conclusion of Part One This section describes mainly the initial medical activities of the Chinese and the characteristics of the “witchcraft” stage of medicine. Primitive thinking and witchcraft played a leading role. But with the accumulation of experience, medicine finally broke the fetters of witchcraft. True doctors appeared, their outstanding representative being Bianque. There were one-million seven-hundred thousand years from primitive medicine to witchcraft. Witchcraft also dominated medicine for over three-thousand years. By comparison, theoretically true medicine is only two-thousand and a few hundreds of years old. But the traces of primitive thinking, witchcraft and superstition can still be seen here and there.

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PART TWO

Chinese Medicine Under the Influence and Permeation of Philosophy, Religion and Politics Chinese medicine broke away from witchcraft initially because people had a deeper understanding of the objective laws of the natural world. This was an achievement made by natural philosophy and as a result, Chinese medicine entered the stage of natural philosophy. People explored the relationship between the natural environment, human health and disease, summarized some of its laws and hence gave birth to medical theories. As natural philosophy was not so very pure and transcendent, other aspects of philosophy, religion, politics and the like were also able to exert an influence on Chinese medicine at that time.

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The Heavenly Law (Tao) of Nature and Medicine in Deference to Nature Huangdi’s Inner Classic (黄帝内经) states, “Yin and Yang are the Tao, a universal law for the heavens and the earth, the key link and fundamental principle of all things, the origin of change, the essence and beginning of growing and extermination, and the storehouse of divinity and spirit. To treat disease, one must search for the root.” This makes it clear that the root theories of Chinese medicine were based on a philosophy — and were most certainly demarcated from witchcraft. This achievement was realized by the permeation and integration of ancient natural philosophy into medical practice and theory. However, this was quite a long course: it took about a thousand years — from the Western Zhou to the Qin and Han dynasties.

A.  “Tao Qi” Theory and Medicine 46.  From Ji Zi to Lao Zi, Zhuang Zi and the Jixia In the course of breaking away from the fetters of witchcraft, natural philosophy went through three stages, namely a “heavenly-destiny view”, a “heavenly-Tao view” and a “Tao-qi view”. Primitive religion and witchcraft prospered greatly during the Shang dynasty. At that time, witchcraft was popular among both the upper classes and the ordinary people. It was an absolute theocracy, much like the “divine right of kings”. After King Wu’s revolution, the Western Zhou replaced the Shang and the influence of witchcraft and a belief in ghosts and gods greatly decreased, although theocracy did not totally end. Sacrifices and the responsibilities of 263

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wizards generally still existed, but they became increasingly irrelevant as they no longer held a power superior to others. The belief and power in a government of ghosts and gods was taken over by a transformed ‘heavenlydestiny’ view. The transformed heavenly-destiny view had partly succumbed to human affairs. Zuo’s Spring & Autumn – 31st Year of Xiang (左传·襄 三十一年) cited the Great Oath (泰誓) stating, “The heavens always obey what the people want.” Meng Zi – Wang Zhang 1 (孟子·万章上) cited the words of Zhou Gong that “the heavens look at what the people look, and the heavens hear what the people hear.” Book of History – Multiple States (尚书·多方) records, “The heavens always look for a wise governor among the people.” Book of History – Multiple Talents (尚书·多士) explained the justification used to overthrow the Shang dynasty as, “It is not that our small country dares to overthrow the Shang, but only that heaven doesn’t allow it to last.” In addition, it is recorded that “the destiny of the heavens is not constant” in Book of Songs – Da Ya – King Wen (诗·大雅·文王), and even that “the heavens are not to be trusted” in Book of History – Monarch Prosperity (尚书·君奭), and that “the governor should take the people as his mirror and accept their supervision” in Book of History – Wine Caution (尚书·酒诰). All kinds of affairs not determined by divination and sacrifice were believed by the people of the Shang dynasty. Therefore, Confucius recorded in the Book of Rites – Mourning Record (礼记·丧记) that, “During the Shang, people worshipped gods because the governor asked them to sacrifice to the gods. They emphasized the ghosts and gods, but ignored the rites. The governor advocated punishment rather than awards and the people showed respect but not intimacy… During the Zhou, people advocated the rites. Though they sacrificed to the ghosts and gods, they kept them at a respectful distance. They developed an intimacy with each other and were honest.” This in effect was actually the same as “ascending the will” of the people. “The destiny of heaven is irresistible” and “the destiny of heaven is not constant”. However, what is “the destiny of heaven”? What is its relation to the heavenly gods? How can the destiny of heaven be changed by “respecting merit and protecting the people”? Is “the destiny of heaven” an indication of being offered the throne? We believe these questions show the frame of mind of politicians at the beginning of the Zhou dynasty. After the establishment of the Zhou, the customary behaviour of averting misfortune or disaster and sacrificial ceremonies chiefly intended to alter the willpower of ghosts and gods gradually became secondary, at the same time as political and ethical guides and virtues gradually becoming predominant. The king

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conferred titles on his vassals, carried out systems of hierarchical rule, patriarchy, rites of loyalty, honesty, filial piety and fraternal duty as well as establishing criminal laws — the “Lu Punishments”. The ideological guiding principles for rulers of that period actually came from the Flood Codes (洪范), with Ji Zi (箕子) as its leading character. Ji Zi, an enlightened man who lived among slave owners and nobles, was actually the prime minister during the Shang dynasty (16th–11th century BCE). However, he was once imprisoned by King Zhou (商纣王) who was its last ruler. Two years after the Shang dynasty was overthrown, King Wu of the Zhou dynasty asked Ji Zi the reasons for Shang’s doom. As recorded in the Historical Records – Biography of Zhou Emperors (史记·周本纪), “Ji Zi felt embarrassed to speak evil of the Shang, so he just spoke generally about the dissolution of empires. King Wu of Zhou felt equally embarrassed and, therefore, changed the subject, asking him about the heavenly Tao.” Such conversations formed the contents of the Flood Codes (洪范) — a historical summarization made by Ji Zi and considered the source of the “heavenly Tao” by King Wu. For example, King Wu asked, “Oh, Ji Zi, it is heaven’s tacit will to let the people settle harmoniously, but I don’t understand the orderly conventions of heaven.” Ji Zi answered, “I heard in the past that Gun blocked up the flow of the flood and the waves befuddled the five elements. The heavenly gods were furious and didn’t grant him the nine fundamental laws of the Flood Codes for managing the state — and thus the state was in a mess. After Gun was struck dead by lightning, Yu inherited and became prosperous. He dredged the rivers and alleviated the floods and hence the heavenly gods granted him the nine fundamental laws for managing the state. Hence, orderly conventions for managing a country were established.” Obviously, Ji Zi made use of the story of the heavenly gods and the history of Gun’s death and Yu’s prosperity to illustrate the laws of the “heavenly Tao”. These laws were totally different from the ways of divination and sacrifice prevalent during the Shang dynasty, and were total necessities for the development of society and consolidation of the Zhou. The Flood Codes (洪范) illustrate the “heavenly Tao” from nine aspects — and actually form the basic principles for ruling a country. The 1st aspect is the “five elements”, namely water, fire, wood, metal and earth. The 4th aspect is the “five timings”, namely the year, sun, moon, stars and calendar. The 8th aspect is the “various signs”, namely rainy, sunny, warm, cold, windy and the seasonal. These are the three aspects which summarize natural phenomena and laws. The 2nd aspect is the “five matters”, namely courtesy, speaking, watching, listening and thinking. The 6th aspect is the

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“three virtues”, namely honesty, being staunch and gentle. The 9th aspect is the “five blessings”, namely longevity, richness, being healthy and undisturbed in mind, good in virtue and a natural death, as well as the “six extremes”, namely a short life, illness, worry, poverty, wickedness and weakness. These three aspects are all about social conditions, personal matters and ethics. The 3rd aspect is the “eight administrations”, namely food, goods, the sacrifice, produce, the prime minister, the judiciary, the rites and the military. The 5th aspect is the “sovereign’s rule”, namely “the king should establish just rules”. The 7th is “explaining doubts through divination”, meaning “people who can carry out divination should be selected”. These three aspects relate to the political system and its administration. Clearly, here the “heavenly Tao” had been specified in its natural, social and political aspects. Moreover, divination was distinguished from what it had been before. It is recorded that “when people are appointed to perform a divination, if there are three of them, the result should be judged by two of them being unanimous. If you encounter a large and important problem, you should think it through carefully yourself first, and then afterwards discuss it with officials, ordinary people and divination practitioners. If you agree, the tortoise-shell divination agrees, the yarrow stalks divination agrees, the officials agree and the ordinary people agree, it is called a ‘great unanimous agreement’.” We can here see that divination was now considered only as problem-solving, or as a foil or supplementary measure, far removed from dominating all other things. Tortoise-shell divination was now parallel to divination by yarrow stalks, which was not the case during the Shang dynasty — when the former was mainly performed. Moreover, divination by yarrow stalks had developed further by creating the eight “diagrams/trigrams”, which pertain to the relationships among the eight “natural things”, namely the sky, earth, thunder, fire, wind, marsh, water and mountain, indicating a significant tendency to explore the laws of nature. In a sense, the heavenly Tao became implicit in its natural ways and laws. Before the Shang was replaced by the Western Zhou, divination by yarrow stalks became popular in the Zhou highlands (in Shanxi and Shaanxi provinces), which were the regions of the Zhou clans. I believe divination by yarrow stalks to be superior to tortoise-shell divination in its form of thinking. The Zuo Commentary – 15th Year of Xi (左传·僖十五年) reports, “Monarch Jin Huigong said while in Qin state, ‘If the previous monarch had listened to Shi Shu’s divination, would I have ended up in such a disgraceful state?’ Han Jianzi replied, ‘The tortoise-shell uses signs, while divination by yarrow stalks is about number. The signs only come into being after there is

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substance, and then the signs increase and then there is number’.” Correct Meaning (正义) states, “The tortoise-shell used in divination showed signs of scorching, informing people through the signs of metal, wood, water, fire and earth. For all animals and plants, all things that can fly and walk, the signs exist after the substance — then the signs emerge and increase — then number and counting. This implies that tortoise-shell divination speaks through the image, while divination by yarrow stalks shows by the number.” This explanation is reasonable. That “divination by yarrow stalks shows by the number” refers to making an abstract calculation. During this period in China, mathematics took considerable steps forward. Following the time when “Da Rao made the Jiazi (60-year circle)” and “Li Shou invented number” during Huangdi’s age, there had also been a decimal system at the time of the Shang dynasty, and divination by yarrow stalks during the Zhou dynasty. Divination by yarrow stalks later evolved into the rod or stalk calculus — a relatively complicated mode of calculation: 49 milfoil stalks (or rods) underwent procedures such as even division, drawing one stalk out at random, counting by fours and collecting the remainder; one yao (“line”) could be worked out after the above procedure had been repeated three times, and after 18 times six yao formed, forming a single hexagram. Later on, the milfoil or yarrow stalks were replaced by bamboo “chips”, which turned into the “chip calculus”. The odd–even combinations of the yao numbers were regarded as a law that could see into the future. It is recorded that “King Wen of Zhou developed the Zhouyi when he was under arrest in prison”, which implies a summarization of the methods of forecasting and the mathematics of divination, through using yarrow stalks. After the Shang was replaced by the Western Zhou, “image” and “number” were combined together into a kind of unity. Mathematical abstraction is superior to audiovisual abstraction (“intuition by image”) — by merit of its mode of thinking. The combination of ‘intuition by image’ and mathematical abstraction conducts us towards a more abstract way of philosophical thinking. Therefore, the eight trigrams, 64 trigrams and 384 yao from the Zhou are more valuable — both for forecasting and philosophical analysis. Their mode of thinking actually created a revolution, as the Western Zhou replaced the Shang. The reasons why the Western Zhou replaced the Shang, instituting a great historical revolution, are not confined to dynastic change, but more importantly, lie in an ideological transformation, namely from a “godlyview” to a “heavenly-Tao view”. Meanwhile, this reflected a change in thinking — from intuitive abstraction to mathematical and philosophical

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thought. Simple philosophical concepts burgeoned during the intercourse of the primitive forms of tortoise-shell divination and divination through the yarrow stalks. However, neither the Flood Codes (洪范) nor the Zhou Yi (周易) were able to understand the problems or meaning of the Tao from a philosophical perspective; in other words, the Tao had not yet actually independently arrived. The first book to discuss the abstract concept of the Tao and its philosophical implication was the Lao Zi (老子, or 道德经: The Tao of Power), written during the Spring and Autumn period, after the decline of the Western Zhou dynasty. Lao Zi, namely Lao Dan or Li Er, was born about 580 BCE and died about 500 BCE. The book of Lao Zi (老子) denies the existence of a god with personality, who knows everything. Instead, it lays claim to the “non-action of the heavenly Tao”. This “non-action” is because of “not knowing” — because the heavenly Tao has no personal will. It is recorded in the fourth chapter that “I don’t know whose descendant it (the Tao) is, but the Tao was likely here before the heavenly gods.” This means the Tao is at a level superior to the heavenly gods. “The Tao never acts, but nothing acts without it” (37th chapter). This is because “the Tao can be illustrated, but not in an ordinary way; a name can be given, but not in an ordinary fashion. The nameless is before the beginning of the heaven and earth, while the named is the mother of all things” (1st chapter). “The Tao produces the One, the One produces the Two, the Two produces the Three. The Three produces All Things” (Yin and Yang; 42nd chapter). “All Things in the world come from possession, but possession comes from nothing” (40th chapter). The Tao is the mother of All Things in the world; it commands them. From such a regard, the Tao is the mystery of all mysteries. However, this is totally unlike sorcery. It is recorded in the 25th chapter that “The Tao, heaven and earth are all great, and so is mankind. Among the four greatnesses in the world, humans enjoy one. Humans are modeled on the earth, the earth is modeled on heaven, heaven is modeled on the Tao, and the Tao is modeled on nature.” The Tao is ultimately the Tao of all nature. The Tao is perceivable. Therefore, it is recorded in the 21st chapter that “The Tao as an object exists subtly, sometimes through images and sometimes through substances. There is an essence apparent in its profound and vague phenomenon, which is very real and trustworthy.” The Tao is intangible, but its existence and essence may be perceived through signs and imagery.

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Therefore, the Tao must be relatively definite and not always ultimately subtle or illusory. The natural Tao is “formed in a blend, before the existence of heaven and earth. It is silent and void. It exists independently and unchangingly. It runs in cycles, unremittingly” (25th chapter). The Tao has the features of being relatively static and yet also is endless in its motion and development. If the Tao can be recognized to some extent, people will understand how to follow its guidelines. Therefore, “peace can be easily held, it is easy to prevent possible trouble, a brittle defect will easily fall away, problems in the bud are easy to resolve. Matters should be dealt with before they come into being and affairs treated before turmoil rises” (64th chapter). Understanding the rule of the Tao is significant in guiding practice. This natural Tao (or heavenly Tao) is significantly different from the political Tao (or humanistic Tao). “The heavenly Tao is just like stretching a bow. If it is too high, lower it; if too low, lift it a bit; what is excessive should be reduced; what is insufficient should be supplemented. The heavenly Tao reduces any surplus and supplements an insufficiency. But the humanistic Tao is different in that it benefits the rich at the expense of the poor. Who can contribute wealth to all the people in the world? Only those who possess the Tao” (77th chapter). Such records show that the “Tao” had been totally philosophized in the Lao Zi (老子). We will see how these philosophical theories were transformed into medical theories in the following chapters. During the Spring and Autumn periods, debates on philosophy created the “rise and contention of various schools of thought”. However, the general trend was clear — the age broke away from the control of ghosts and gods and was changing to pursue the Tao of all nature, for its own, practical use. In addition, all schools tried to justify their own thinking. This was a most open and free era of thought. At that time, medical experts were also in the course of searching for the best theories to explain medicine. They were at a loss right up to the time that natural philosophy became more firmly established — as the theory of the Tao eventually became supported by the qi theory. There are insurmountable metaphysical difficulties in simply talking about Lao Zi’s Tao. But actually, the development of philosophical thinking and the dialectical methods of the time propelled the power of human thought. At that time, it was a matter of fact that an intermediate link between philosophical theory and reality was still missing — and theoretical thinking could not aptly justify itself.

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But then, Lao Zi found the idea of “qi” energy and made out of it, initially, an intermediate link. It is recorded in the 42nd chapter that “The Tao produced the One, the One developed Two, the Two produced Three and the Three produced All Things. All Things carry Yin and hold Yang, and they have a special qi, with plenty of dash to it, blended to bring about harmony.” There are altogether 5,000 words in the Lao Zi (老子) book, but only these few discuss “qi”. It was just at this very point that Lao Zi found the support he needed for the Tao. The “Wu Xing” were originally extracted abstractly to mean the Five Elements of all nature and considered to be the bare essentials, when describing things. (Although certainly the term “Wu Xing” means not only the “Five Elements” but also has other abstract meanings — not discussed here.) But, “Qi” had not been included. The problem was that all the five elements, namely metal, wood, fire, water and earth, were visible and apparent — and if they were used to constitute another visible thing, this would not be plausible from a macroscopic or logical point of view. Any form of dialectical, philosophical thought should at least be consistent and not selfcontradictory. This was just so different from the forms of primitive thinking. Qi served just such a function. The character “qi” in oracular inscriptions was written as “ ” (Qian 6.27.4). Explaining Characters (说文) states, “Qi, a pictographic character, stands for a floating cloud.” When primitive people were using fire in cooking, they must have recognized that the boiling water was evaporating and ascending as gas (qi); when they were scorching and carving inscriptions on a tortoise-shell, they must have seen the fumes (qi). The ascending gaseous qi formed into a visible cloud, which soon vanished and became invisible. The gaseous qi was transformed out of water and in turn was able to congeal into dew. The qi fumes derive from the scorching fire and turn to ash as they fall down. Enshrouding clouds of qi are visible even in the daytime when the damp earth is exposed to the bright sun and ice-melt turns to water. Gradually, people extended this mysterious, collective presentation into a uniform abstraction or concept, that is, “qi”. As Country Records (国语) states, Wen Lord of Guo called it “soil qi” and Bo Yangfu called it the “qi of heaven and earth”, both of which indicate as such. Whatever we say about it, qi is intangible, ubiquitous and changeable — it can congeal into water, and water turns to ice and becomes substantial. It can even turn into the qi fumes of burnt substances.… Therefore, the “gas” around people was abstracted into a philosophical “qi” — containing a substantive meaning. This is very well reasoned and meets with macroscopic logic.

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It is plausible that in the saying, “by three, all things come into being” from Lao Zi (老子), the “three” can be regarded as the Yin, the Yang and the qi. “Three” has an important significance in Chinese philosophy. Professor Pang Pu, a famous philosopher of ancient Chinese philosophy，holds that “three” implies either the number and its derived relations, or the “two”, namely the permeation and dependence of the opposite side, with the “one” as an entity that is unified by the opposing sides.1 This statement is quite accurate, but it implies much more. The meaning can go further. “By three, all things come into being” indicates only ones and twos, it is not enough to bring forth all things in the world — this must be the collective result of the combined action of three things. To be specific, “one” refers to the Tao or the Tai Ji, “two” means it contains both Yin and Yang and “three” stands for Yin, Yang and qi. Lao Zi followed the former statement with “All things carry Yin and hold Yang, and have a special qi, with plenty of dash, blended to bring about harmony.” This indicates that the “three” stands for Yin, Yang and qi. Qi is the intermediary, in the course of Yin–Yang interaction and transformation, which generates all things in the world. Such a mediating function is specific for a carrier. For example, when we describe Yin and Yang, it is the same as describing Yin qi and Yang qi. The transformation of Yin and Yang is realized by qi, and the two aspects of the Tao are also dependent on qi’s connection and separation. Accordingly, qi bears a role equivalent to “the source of all things”. Therefore, the Tao has at the same time a theoretical existence and a philosophical identity, while the qi gives it philosophical reality at the same time as substantive existence. Tao and qi are two in one, and one in two. Tao is qi and qi is Tao; they are identical. This fact contributed to the inevitable generation of the “Tao-qi” theory. In the middle period of the Warring States, scholars of the Jixia School gathered around Jimen, the Capital City of Qi kingdom, to give lectures and debate, which brought into maturity the theory of “Tao-qi”. According to textual research, their thoughts are mainly recorded in the chapters of the Xin Shu (心术), Bai Xin (白心) and Nei Ye (内业) books, written by Song Xing and Yin Wen. These chapters were complied into the Guan Zi (管子) book. Their most important contribution was that they developed a theory of “essential-qi” (jing qi). Though qi is the source of all things, creating the homogeny of the Tao, “essence” is actually of far greater importance. The 1

 Pang Pu. Discussion on “Three” from Philosophic Theses Collection of Chinese Social Science in 1981, Sichuan People’s Publishing House, 1983, p. 366.

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Nei Ye (内业) states, “Essence, namely the essential part of the qi.” It is this essential-qi that transforms and produces all things in the world, take for example the saying, “the qi that causes transformation is called essence”. The Nei Ye (内业) states, “When the essential-qi of things gathers together, vitality is apparent. It generates the five cereals on the earth and stars in the sky. It becomes ghosts and gods when it flows between the earth and sky; it creates one called a sage when it is stored in the chest. Therefore, this qi is sometimes bright as the high sky, sometimes dark as the deep abyss, sometimes moist as the soaking sea, or lofty and erect as the mountain. Hence, this qi can be retained by virtue but not by strength, and summoned by the spirit but not by being called. To reverently guard and prevent it from escaping is called ‘being virtuous’. Virtue’s achievement brings about wisdom, which is the understanding of all the things.” This statement explains how mountains, cereals, stars and even ghosts and gods, all came into being and were transformed through the essential-qi. In the meantime, these writers believed people also came into being, became transformed and were able to maintain their health through the essential-qi. The Nei Ye (内业) records, “Human life comes into being as the essential-qi provided by the sky and the physique offered by the earth integrate with each other. Their harmony ensures us of life, while their disharmony deprives us of life.” It also records, “With an essence inside, life continues spontaneously. It becomes manifest as peaceful, giving us a rosy appearance without, and a constant and stable source within, which forms the source of the qi. The four limbs can only be strong when the source is not drained; and the nine orifices remain unblocked only when it does not stagnate… If people can retain a genuine peace and quiet, their skin and muscles will be relaxed, their ears and eyes sharp and clear, their tendons extended and bones strong.” It is also possible that the Jixia School brought about the relationship between essential-qi and water. It was generally acknowledged that “Water is the root of all things”, as recorded in the Guan Zi – Water and Earth Chapter (管子).2 This is surely not unreasonable, but in the same chapter explaining human life, there is also the following, “Human beings are namely water. The essential-qi of man and woman merge as flowing ‘water’. It can be seen that the foetus at 3 months is like a bubble… it completes its shape at 5 months and the baby is ready for delivery at 10 months.” Judging from this, the predecessor of water is still essential-qi. Therefore, essential-qi 2

 Refer to Feng Youlan. History of Chinese Philosophy New Edition, Vol. 1, p. 274.

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is the most primordial thing in existence. A combination of essence and qi brings forth water — while water congeals into the shape of a human being. In the author’s eye, this was probably seen as analogous with cloud-qi congealing into water and water congealing into ice, as happens in nature. Moreover, both Song and Yin explain mental activities through the idea of qi. The Nei Ye (内业) records, “The smooth arrival of qi brings forth life. When there is life, there is mental activity, and when there is mental activity, there comes knowledge. Acquisition of knowledge guides people to know the limit in time.” It also states, “a calm heart inside ensures acute hearing and vision, as well as strong limbs, which can be taken as the indwelling of essence.” The Nei Ye (内业) and Xin Shu (心术) both record the saying, “Just think and think! And think again and again! If you still cannot make sense of it, ghosts and gods will help you. But what is not in the power of ghosts and gods is factually the utmost function of the essential-qi.” This explanation of mental activities as coming about through essential-qi is antitheistic, although not radically so. In the Book of Rites (礼记), qi is adopted as the “substantial basis” of ghosts and gods. It also states in the chapter of Sacrificial Meanings (祭义) that, “All people die and return to the earth (gui 归), so they are called ghosts (gui 鬼), The bones and flesh of the body are buried under the earth and rot into soil. But the qi of the body rises into brightness as a ‘fetid vapor of sadness’. This is the essence of all things and spirit of the gods. It is extremely fine because it is the essence of all things. Accordingly, such spirits of matter can control the ultimate. People use them overtly and reverently name them as ghosts and gods and respect them in awe. And thus a system can be established and the people obey it in awe.” At that time, the invisible and mysterious essential-qi was used to explain various phenomena, and this indicates the prevalence of the essential-qi theory and furthermore that qi was then being regarded as the “root of all things”. Therefore, the Nei Ye (内业) and Xin Shu (心术) state the following: “the Tao exists between the sky and earth. It is big enough to contain everything and small enough to enter into everything”; “as for the Tao, we cannot see its shape when it is in motion, and we cannot feel its virtue when it is in action. It permeates all things without limit”; and “the Tao is ubiquitous and all people have it.” In conclusion, essential-qi was the Tao and the Tao lay in essential-qi. The evolution from a belief in ghosts and gods to a heavenly-destiny view, and further on to a natural heavenly-Tao view along with that of essential-qi, was a revolution in philosophy as well as in science. Lenin put it correctly when he said that “after the gods have been overthrown, what is

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left belongs to the natural world”.3 However, the gods were never completely overthrown, they were eventually replaced by Nature – due to the development of a natural philosophy during the pre-Qin period. Hence the saying, “Tao is Nature itself.” Following this, native medicine learnt from the Tao, hence there came about the cardinal saying, “Medicine follows the rule of Nature”.

47.  Qi as the Root of Medical Theoretics Medicine should not have been involved with mystery and fantasy; but it was inevitable in a period when the prevailing belief was of ghosts, gods and witchcraft. In a period when there evolved a widespread theory of “essential-qi”, our medical ancestors immediately grabbed this “new tool” to construct medical theories, that is, they took qi as the root of medical theoretics. Qi became the intermediary: a bridge or link between pre-Qin natural philosophy and medicine. Most certainly, this constructive process was paralleled also by the development of a pre-Qin natural philosophy. Yi He, living at the end of Spring and Autumn periods, was the first to propose “the theory of the six qi engendering disease”, when answering the questions of a Jin lord. It is recorded in the Zuo Commentary – Zhao’s First Year (左传·昭元 年) that, “There are six qi in the heavens, which descend to transform into the five tastes, five colors, five sounds and six diseases. The six qi are Yin, Yang, wind, rain, gloom and luminosity. They distribute among the four seasons and keep the five sections of the year in order. However, if they are in excess, they cause disaster. Excess Yin incurs cold diseases, excess Yang leads to heat diseases, excess wind causes diseases of extremities, excess rain engenders abdominal diseases, excess gloom results in a confused mind and excess luminosity brings forth excitable diseases. Concerning sexual intercourse with women which is often linking to Yang and obscure times, if it is excessive, internal heat is generated, causing diseases of a confused mind and diseases involving gu (venomous insects).” To explain disease as caused by changes in the six qi of the natural world was a great improvement on former explanations in medical history — based upon ghosts and gods. It meant medical experts began to study disease as caused by factors in the environment, and the agnosticism of ghosts and gods was replaced by finding a knowable cause for disease. These six qi were

3

 Refer to Lenin, Notes of Philosophy.

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specified as the “irregular qi of the four seasons” in the Book of Rites – Climate in a Lunar Month (礼记·月令): “In the first month of Spring, if the climate is similar to that of Autumn, there will be serious epidemic diseases; in the third month of Spring, if the climate is similar to that of Summer, people will be susceptible to contagious diseases; in the second month of Summer, if the climate is similar to that of Autumn, people will suffer from infectious diseases; in the third month of Summer, if the climate is similar to that of Spring, people will succumb to ‘wind cough’; in the third month of Autumn, if the climate is similar to that of Summer, people will be afflicted by rhinitis and allergies; in the second month of Winter, if the climate is similar to that of Spring, people will be susceptible to scabies and plague; in the third month of Winter, if the climate is similar to that of Spring, the foetus often could be injured and chronic illness prevail in the country.” These show the external causes of disease. On the contrary, disease can also occur within the body through a change in qi. Qi is ubiquitous and the fine flowering and motion of all things in the world is dependent on the essential-qi. Just as Mister Lu’s Spring and Autumn Annals – The Guard Monarch (吕氏春秋·君守) states, “The sky is intangible, but all things come into being. The most refined essence is invisible, yet all things become transformed.” The “intangible” sky and “invisible” essence are both qi. Thus, Mister Lu’s Spring and Autumn Annals – Counting All (吕氏春秋·尽数) states the following: The gathering of essential-qi always enters into things and combines with them. If it incorporates birds, it is reflected as flying. If it incorporates beasts, it is reflected as running. If it incorporates pearls, it is reflected as refined and bright. If it incorporates trees, it is reflected as luxuriant growth. If it incorporates saints, it is reflected as wisdom. The arrival of the essential-qi creates the light wings that enable the bird to fly, the walking legs which enable the running beasts, the refined material which enables the bright pearl, the growing force which enables the exuberant trees, and the smart head which enables the wise saints. Thanks to its motion, running water never becomes stale and a door-hinge is never worm-eaten. It is the same with the qi of the body. Significantly, this passage talks about the motive power and vitality of all things in their transformation, change and motion. Such a kind of

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ubiquitous qi also affects the human body greatly. Many ancient documents mention the effects of qi on the body: Being with qi ensures life, while being without qi renders death. The life of all people depends on qi. — Guan Zi (管子) The heart is the qi-governor of the five zang organs. It dominates the four limbs and activates the flow of blood qi. — Shen Zi (慎子) Qi in the mouth turns into speech, while in the eyes, it becomes vision. — Country Records – Zhou Statements (国语·周语) All creatures in the world must have intelligence if blood and qi exist… but the human is the most intelligent of all creatures who have blood and qi. — Book of Rites – Three-Yearly Inquiries (礼 记·三年问). People have five kinds of qi, namely joy, anger, desire, fright and anxiety… these five kinds of qi exist in the interior and show on the exterior. The conditions of people cannot be hidden. — Ji Tomb’s Zhou Records – An Official’s Explanation (汲冢周书·官人解) There are three abstinences for a gentleman. Firstly, abstain from sexual temptation when the blood and qi have not been fully developed in youth. Secondly, abstain from aggressive conquests when the qi and blood are justly energetic in the prime of life. Thirdly, abstain from a desire to gain more profit during old age. — Analects of Confucius (论语) Physiological functions, including mental activity and the movement of the blood and qi in the body, may also be generally described as above. Pathological states are seen in the following examples: Physical immobility causes immobile essence, resulting in qi constraint. If it occurs in the head, there will be head-heaviness and swelling with a wind-headache. If it occurs in the ear, there will be ear diseases and deafness. If it occurs in the eye, there will be strabismus and blindness. If it occurs in the nose, there will be loose nasal discharge and stuffiness. If it occurs in the abdomen, there will be distention and lower abdominal diseases. If occurs in the foot, there will be flaccidity and limpness. — Mister Lu’s Spring and Autumn Annals – Counting All (吕氏春秋·尽数)

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If the person is excessively joyful, Yang will be impaired. If the person is excessively angry, Yin will be impaired. If Yin and Yang are both impaired, the four seasons will not arrive in time, the harmony of cold and heat will not be harmonically formed, and in turn, the human body will be impaired. — Zhuangzi – In Forgiveness (庄子· 在宥) The unrestful qi disarrays everything and makes the blood circle about excessively. It is reflected in enlarged and prominent blue veins, which are outwardly strong and inwardly weak. — Zuo Commentary – The 15th Year of Xi (左传·僖十五年) A mediocre person is short in inner thinking, so he perishes whenever turmoil occurs. As his desires of the ears, eyes and mouth cannot be satisfied, his body becomes generally swollen, bones and tendons restrained, blood vessels blocked, and nine orifices deficient, all of which show a loss of normal function. Even if Peng Zi were still alive, even he would tackle this in vain… Therefore, then various diseases occur and casualties often arise. — Mister Lu’s Spring and Autumn Annals – Sexual Passion (吕氏春秋·情欲) The above reveals the etiology and pathogenesis of diseases concerning blood and qi. It follows then that we must pay special attention to qi and blood in order to preserve health: Lay an emphasis on blood and qi to pursue longevity. — Guan Zi – Moderate Achievements (管子·中匡) Few desires keep the blood and qi in harmony. — Han Feizi – Decoding Aging (韩非子·解老) All people have 360 parts, nine orifices, five zang organs, and six fu organs. We should make the skin and muscles firm, vessels of blood unobstructed, tendons and bones strong, the mind and will harmonically calm, and keep the essential-qi in motion. If such is the case, disease will not come to dwell and bad situations not arise. The retention of disease and occurrence of bad situations results from the essential-qi being constrained. Therefore, stagnant water turns into sewage, stagnant trees are damaged by worms, and stagnant grasses become withered. — Mister Lu’s Spring and Autumn Annals – Resolving Constraints (吕氏春秋·达郁)

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All in all, qi is generalized as the root of human health and disease, and reflected in the “six qi” of the exterior and the “blood and qi” of the interior. Accordingly, medical theories during the reign of natural philosophy all regarded qi as the root and began to study medicine on the basis of ‘qi principles’. In addition, all pathogenic factors were called “xie qi (pathogenic qi)” while the qi that maintained health was called “zheng qi or right qi (healthy qi)”. The renowned “pathogenic and healthy qi theory” was thus established. Treatment also followed the rule of “reinforcing healthy qi and removing pathogenic qi (support the right and dispelling the evil)”. Examples are as follows: When the pathogenic qi attacks the interior, the healthy qi is weakened. — Guan Zi – Situations (管子·形势) The root of all things necessitates health preservation, first and foremost. It is an absolute must to cherish the body. A good and well metabolism means the striae in the muscles and interstitial spaces are unobstructed by the stale qi. Since the essential-qi can be renewed every day and pathogenic qi can be eliminated completely, people live to an optimum age. — Lu’s Spring and Autumn Annals – Put the Self First (吕氏春秋·先己) Physicians use the five flavors, five cereals and medicinals of the five properties to regulate and treat disease. They judge whether the disease is curable or incurable by the five qi, five sounds and five complexions. For surgical diseases, physicians use the medicinals of the five properties to regulate and treat and the five flavors to regulate their medicinal properties. The general rule in applying medicinal therapies is as follows: sour medicinals are for nurturing the bone, pungent medicinals for nurturing the tendons, salty medicinals for nurturing the vessels, bitter medicinals for nurturing the qi, sweet medicinals for nurturing the flesh, succulent medicinals for nurturing the orifices. — Rites of Zhou – A Heavenly Official (周礼·天官) The above is a general illustration of how the “Tao-qi” theory became established within the philosophy of the pre-Qin period, how this theory became assimilated into Chinese medicine and hence how the burgeoning of the medical theories of a natural philosophy came about. However, specific rules concerning the activity of Tao and qi had first to be resolved in philosophy and medical theory. These rules were the Yin–Yang theory and the theory of the five elements.

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B.  The Medical Theories of the Yin–Yang and Five Elements In my opinion, the de (德) in the Lao Zi (老子) is neither the “gaining (得，de)” as understood by some scholars nor the ethics and morals talked about by the modern world. It lies under the “Tao” and should be interpreted as the concrete and practical laws and rules of dealing with social affairs and mutual relations. These “Tao”-based rules, such as Yin–Yang and the five elements, are the general rules of natural movement and change. Therefore, the Yin–Yang and five-element laws developed in the course of searching for the natural Tao — and are another great contribution made by physiologists of the pre-Qin period. They were applied in the context of medical theory and played a core role therein.

48.  The Formation of the Yin–Yang and Five-Element Theories The Yin–Yang and wuxing (five-element) theories were not readymade or fully developed during the pre-Qin period. Their generation, formation and completion took a considerably long time. We can even say that the most complete system didn’t appear until Huangdi’s Inner Classic (黄帝内经). This illustrates that during the course of the combining together of philosophy and medicine, medicine as a natural science also made great contributions to philosophy. It is noteworthy that five-element and Yin–Yang concepts didn’t occur at the same time. The formation of the theory of the five elements was earlier than Yin–Yang theory and the concept of qi. The communication between five-element and Yin–Yang theories only began after the concept of qi came into being. Five “elements” implies five substantial elements in themselves, which is not as abstract as the ideas of Yin and Yang. Without the substantial basis of qi, the five elements would be difficult to explain in nature. Qi became the intermediary between Yin–Yang and the five elements. The Flood Codes (洪范) written by Ji Zi were the earliest literature that described the five elements in detail. They record that, “The five elements include water, fire, wood, metal and earth. The water is characterized by moistening downwards, the fire flaming upwards, the wood bending and straightening, metal reforming and mopping up rotten things, and the earth sowing and reaping. Moistening downwards corresponds to the salty, flaming upwards to the bitter, bending and straightening to the sour, reforming to the pungent, and sowing and reaping to the sweet.” From this we can see there is a linking together of all five tastes. It also states, “I heard in the past that Gun used the five elements all combined together, in a mess, to block up a flood

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that disturbed the order of the wuxing.” Certainly, water, fire, wood, metal and earth were considered as the five basic substances that constitute soil. This recognition is associated with the observing of natural phenomena, agricultural development and the rise of metallurgy. This is understandable for, as the five elements represent the basics of soil and the basic raw materials of any utensil, they would also have had a great impact on all aspects of human life. Professor Pang Pu has pointed out, “From the record of the five directions in oracular inscriptions to the completion of the vast system of the five elements in Mister Lu’s Spring and Autumn Annals – The 12 Periods (吕氏 春秋·十二纪), and during the whole pre-Qin period, there were barely any ideologues who did not talk about the five elements. Those different among them more or less involved themselves, in one aspect or another.”4 The theory of the five elements experienced a great development during the preQin period, coming from such a background. The Five-Element Chapter in the Mawangdui Silk Texts originated from the Zisi-Mencius school.5 It is necessary to point out that at the start, there were only lists of five materials and directions, and it was short of statements on logical relations between the five substances. Such logical relations, namely the “law of the five elements”, gradually came into being only later. The laws of the Five Elements include the following: (1)  Classification According to the Five Elements This kind of classification was the earliest, and it also gradually took the dominant position. The Zuo Commentary – 7th Year of Wen (左传·文七 年) has the following record: “Water, fire, metal, wood, earth and cereals are called the six mansions”. The Book of History – Da Yu Planning (书经·大禹谟) records, “Policies should lie in benefitting the people, such as emphasizing their basic needs (water, fire, metal, wood, earth and cereals), cultivating morals, facilitating life, improving living conditions and so forth.” There are even traces in the Da Dai Rite Records (大戴礼): “Water, fire, metal, wood, earth and cereals are called the six mansions. None of them can be eradicated or other elements added.” In the Four Dynasties (四代), the “six mansions” were even more popular than the “five elements”. However, the cereal element was removed at last and the 4

 Pang Pu. Collection of Thinking. Shanghai People’s Publishing House, 1982, p. 219.  Pang Pu. Mawangdui Silk Texts Solving the Mystery of Zisi-Mencius’s Five-Element Theory. Antiquity, 1977, Period 10. 5

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“five elements” eventually predominated. This classification, corresponding to the five elements in “children’s education” (幼官) and “children’s educational maps” (幼官图) from the Guan Zi (管子), is shown in the following table. Items Five Elements Four Directions Four Seasons Five colours Five Flavors Five Tones Five Qi Five Numbers

Classification Wood Fire East South Spring Summer Green Red Sour Bitter Jue Yu Dryness Yang 8 7

According to the Five Elements Earth Metal Water Center West North Late summer Autumn Winter Yellow White Black Sweet Acrid Salty Gong Shang Zhi Harmony Dampness Yin 5 9 6

(2)  The Mutually Generating Rule of the Five Elements There are no explicit records of such a rule, but it can be implied from many statements by reputable experts. Professor Pang Pu puts forward the idea that, “judging by the application of the Heavenly Stems and Earthly Branches for naming, during the Spring and Autumn periods, we can figure out that the generating rule of the five elements was then in use.”6 Actually, the implication of mutual generation can be most easily deduced from the matching of the five-season sections, in which it is suggested. A record in the Guan Zi – Five Elements (管子·五行) illustrates it thus: From the Jia Zi day, measures should be carried out according to the features of wind… Do not delay spring ploughing… All these measures should be in practice until 72 days later. From the Bing Zi day, measures should be carried out according to the features of fire… There are no storms and grasses and trees grow and flourish… All these measures should be in practice until 72 days later. From the Wu Zi day, measures should be carried out according to the features of earth… Five cereals and fruits are growing and

6

 ibid.

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becoming bigger… All these measures should be in practice until 72 days later. From the Geng Zi day, measures should be carried out according to the features of metal… A cool wind arrives and white dew appears. The five cereals ripen in order… All these measures should be in practice until 72 days later. From the Ren Zi day, measures should be carried out according to the features of water… Everything in the world hides itself… All these measures should be in practice until 72 days later. This record obviously talks about the application of the five elements to five-season sections, showing the relation of mutual generation. It is illustrated more explicitly and accurately later in Mister Lu’s Spring And Autumn Annals (吕氏春秋) and the Book of Rites – Lunar Monthly Climate and Phenology (礼记·月令). However, highly conclusive statements like “wood generates fire and fire generates earth” did not come into existence until the Huai Nan Tzu (淮南子) and Miscellaneous Exposures in Spring and Autumn Periods (春秋繁露) had been compiled. (3)  The Mutually Restricting Rule of the Five Elements Mo Zi (墨子) records, “Restriction does not always exist in the five elements, but only occurs under the proper circumstances.” This means that mutual restriction between the five elements is conditional. On the contrary, there were certainly also some who thought that mutual restriction between the five elements was unconditional. The Zuo Commentary – 31st Year of Zhao (左传· 昭三十一年) also states, “Shi Mo said, ‘… Fire restricts metal, so you will not win’.” In Zuo Commentary – 9th Year of Ai (左传·哀九年), it records, “Shi Mo said, ‘… Water restricts fire, so it is rational to send armed forces to suppress Jiang state’.” Sun Tzu – False or True (孙子·虚实) also states, “Restriction does not always exist in the five elements.” The mutually restricting rule became more complicated in Zhou Yan’s theory. He once stated, “In the spring, we use green elm and willow wood to generate fire; in the summer, we use red jujube and apricot wood to generate fire; in the late summer, we use yellow mulberry and cudrania wood to generate fire; in the autumn, we use white oak to generate fire and in the winter, we use locust and wing-celtis wood to generate fire”, all of which imply mutual restriction. For instance, “the wood for building a fire is changed according to the corresponding color of the five elements in the respective season.” Even more so, his statement about the

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“circulation of the five virtues” talks about the gradual evolution of Emperors, and it was recorded in Mister Lu’s Spring and Autumn Annals (吕氏春秋): When earth qi dominates, the yellow is in favor, so the Yellow Emperor was in charge; When wood qi dominates, the green is in favor, so Da Yu was in charge; When metal qi dominates, the white is in favor, so Shang Tang was in charge; When fire qi dominates, the red is in favor, so King Wen of Zhou was in charge; When water qi dominates, the black is in favor, so the ‘King of Accord’ will be in charge (prophesying the First Emperor of the Qin). (4)  The Harmonic-Qi Rule of the Five Elements This is the “rule of harmony” between the mutual generation and restriction of the five elements. It describes the general routine of the five elements. The Book of Rites – Musical Records (礼记·乐记) states, “If the qi is in harmony, the routine of five elements runs as it should. Therefore, the Yang is not dispersing, the Yin not dense, the bold qi not in anger, the soft not scaring the intimidated, the smooth flow of the qi in all four directions flows together in the center and is reflected outwards. All reside in their own place and do not struggle with each other.” The Operation of Rites (礼运) also states, “… The harmonic-qi of the five elements confers Yang qi to the heavens, which supports the acting of the sun and stars; confers Yin qi to the earth, which forms the mountains and rivers; distributes the five elements to the four seasons, which generate the months… Therefore, the saints act with heaven and earth as root, with Yin and Yang as regulator, with the four seasons as handle, with the sun and stars as epoch, with the moon as measure, with ghosts and gods as emissaries, with the five elements as essence and with the rites as appliance.” The mutual generation, restriction and harmony of the five elements make birth and death possible among all things in the world, and also their mutual promotion and restriction. Sun Zi – A Situational Chapter (孙子· 势篇) specifically states that “The sun, moon and four seasons go and come, in a circle without end. The sound tones are no more than five, but music can be ever-changing when listened to; the basic colors are no more than

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five, but their tints can be ever-changing when viewed; the tastes are no more than five, but they are ever-changing and we cannot favour them all.” Mutual generation and restriction together turn about, in a great circle, which means that then they can be regarded as going round and round, and never-ending. Thus, human life also never stops reproducing. The theory of the five elements originated in ancient China and is unique in the world. It is associated with China’s vast territory and the explicit concept of the five directions, as well as its location in a northern temperate zone and having four distinct seasons. In addition, a flourishing agriculture and the rise of metallurgy in the Shang dynasty — which developed steadily afterwards — all account for the lasting influence of the five-element theory. Later on, it was used to explain things bluntly by schematization — and then gradually it became metaphysical, but this was not the first intention of its creators. The application of the fiveelement theory in medicine mainly lies in the rules given above, without including the general content of its metaphysics. The formation of the Yin–Yang theory was later than that of the fiveelement theory. There is no statement involving Yin and Yang in Ji Zi’s Flood Codes (洪范). In the entire text of the Classic of History (书经, i.e. 尚书), there is only one sentence that contains the term “Yin and Yang”, namely “Taishi, Taifu and Taibao are the three ducal ministers who study measures to manage the country and help the emperor to harmonize Yin and Yang (namely ‘to govern the country correctly’)”. Although Yin and Yang also appear in the following six terms from the Classic of History (书经) — Yue Yang, Feng Yang, Yang Niao, Hua Yang, Hua Yin and the Yang side of Hua mountain — these terms are all geographical or directional. This contrasts distinctly with many other mentions of the five elements. Yin–Yang, mentioned in the Book of Songs (诗经), is sometimes about direction, in relation to the side which catches the sunshine. For example, “Rumbling thunder is on the Yang side of the Nan mountain”, and “I sent off my uncle to the Yang side of Weishui river”. Sometimes, Yin–Yang concerns the weather, such as “gales in the valley blow, often with Yin clouds and rain”, “in spring, the sunshine is Yang everywhere” and “the flourishing millet sprouts are nourished by continuous rains (Yin)”. Yin–Yang is also used for ornate diction, such as in the phrase “the dragon-emblazoned banners fly brightly (Yang), the bells on the front boards tinkling (Yin)”. There is only one occurrence of Yin and Yang combined, namely “After we have observed the shadow of the sun,

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we look at the mountain ridge so as to figure out Yin and Yang, and find out how the water flows down and its springs”. Certainly, the Yin–Yang in this verse had no abstract significance. The Book of Changes (易经) is famous for “explaining Yin and Yang”, as claimed by the Zhuang Zi – In the World (庄子·天下), but in its original edition the Yin is mentioned only once, namely “The crane calls from her hiding place (Yin), and her brood respond. I have some good wine and am willing to share it with you” as recorded in the 61st Divinatory Symbol – Nine Two (中孚九二). Yang is never mentioned, let alone Yin and Yang together. Judging from the above, Yin and Yang do not originate from the Book of Changes (易经). Actually, we can almost think that during the whole period of the Western Zhou and certainly before, the concept of the Yin–Yang was not in existence, there was only the view of their opposition, namely an opposition between two attributes or things. It is possible that the recognition of this opposition primarily came from an appreciation of the two sexes. From the worship of female ancestors to the worship of male ancestors, a basic recognition of sexual differences came about. Almost at the same time, natural opposites like heaven and earth, water and fire appeared during natural worship. People had a new understanding of life and hence understood the opposition of life and death. Later, the opposition of good or ill luck ensued, which became the core of divination through witchcraft. Through textual research, Professor Pang Pu believes their basis resulted from the “mei bo” divination that was popular in the Wu, Yue and Chu areas.7 “Mei bo” is recorded in the Back Hiding (归藏) volume as a kind of divination method carried out by dropping a wooden club or bamboo sheet onto the floor to determine good or ill luck by it falling on its front or back. This was similar to the divination of the Zhou people’s, but the latter applied mathematics and especially the milfoil or counting rod, initially leading people to the idea of abstract concepts such as opposition (that is, the recognition of the opposition of odd and even numbers). The combination of these two divination methods and the advancement of character symbols at the same time were enough, in his opinion, to produce the divinatory symbols “—” and “–  –” (solid line and broken line) for odd and even numbers, respectively. With the development of mathematically related concepts like the counting of the 384 yao, the 8 trigrams and the further 64 trigrams, the abstract concept of opposition 7

 Refer to Pang Pu. Investigation to the Source of Yin–Yang and Five Elements, p. 101.

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greatly increased. As stated earlier, this might possibly have contributed to the saying, “when King Wen of Zhou calculated the 384 yao”. However, no proper records have ever been found to confirm this. The Book of Changes (易经) reads similar to oracle inscriptions in that it records divination, its results and predictions. (The Book of Changes is a record of yao-trigram divinations, made by divination officials from the pre-Zhou period.) These simple records mention only opposing ideas, such as good or ill fortune, the visible or invisible, big or small, heaven or earth, the gentleman or lowly person, deficiency or excess, all of which have no close relation to the “side facing the sun”, so it is totally understandable that Yin and Yang were not involved. Bo Yangfu was the very first person who applied the abstractions of Yin–Yang with the opposing sense to explain natural phenomena. There is a record in the National Languages – The Zhou Language (国语·周语), which goes on as follows: In the 2nd year of King You of Zhou (779 BCE), an earthquake occurred in areas around the Jing, Wei and Ruo rivers of West Zhou. Bo Yangfu said, ‘The Zhou dynasty will collapse! The qi of heaven and earth should run in order. If it runs out of order, it is people who have caused the turmoil. When the Yang is subsiding and could not get out, Yin is suppressed by Yang and unable to evaporate, so an earthquake results. At this time, the earthquake took place in all areas around the Jing, Wei and Ruo rivers, because the Yang had been dislocated and Yin suppressed. Therefore, the water source was undoubtedly blocked. As the water source was blocked, the country would definitely collapse… The collapse of the country will occur no more than 10 years from now because that number has been recorded. If heaven wants to desert us, the deadline will be no longer than this’. In that year, all the Jing, Wei and Ruo rivers dried up and Qishan Mountain collapsed. In the 11th year of King You of Zhou, the dynasty was destroyed and the Zhou dynasty moved its capital eastwards. An earthquake is an impressive phenomenon and when it occurs, it is often accompanied by wind and rain, thunder and lightning, and eruptions of earth gas, showing a drastic struggle between two forces. Therefore, Bo Yangfu’s explanation is quite plausible. His combination of heavenly signs and natural phenomena with social affairs is just a residual “heavenlydestiny” view. Similar records had been in existence at an earlier time,

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namely the time of King Xuan of the Zhou (827 BCE). For example, Guo Wengong said, “…Yang with heat is accumulating and becoming greater, and earthly qi in motion and rising… the Yang qi ascends and the earth is moist and good for sprouting. If there is no motion and change, it is because the earth channels have been blocked and disordered, so crops will not grow… As Yin and Yang will be in even distribution, the spring thunder awakens dormant insects.” These describe the spring beginning, and Yin and Yang in the process of changing — but this statement is not as clear as Bo Yangfu’s explanation of an earthquake as a clash between Yin and Yang. Furthermore, there is the well-known record of falling aerolites and six backward-flying water birds recorded in the Zuo Commentary – 16th Year of Xi (左传·僖十六年). Shu Xing thought, “this is a matter of Yin and Yang, but not an omen of good or ill fortune.” In this case, the Yin–Yang is also applied to explain natural phenomena. Ling Zhoujiu once said, “Only when Yang qi does not stagnate and Yin qi not disperse can Yin and Yang be in harmony and order”, as recorded in the National Languages – the Zhou Language (国语·周语). Here, he generalized the normal pattern of Yin and Yang. As for the occurrence of the solar eclipse in the 20th and 24th years of Lu Zhaogong, Zi Shen and Zhao Zi discussed the reasons. They surmised, “Yang is too weak to balance Yin, so there will be floods”, recorded in the Zuo Commentary – The 21st Year of Zhao (左传·昭二十一年); “since Yang fails to restrict Yin, accumulation of water is the result”, recorded in the Zuo Commentary – The 24th Year of Zhao (左传·昭二十四年). Here, they propose a mutual restriction and transformation between Yin and Yang. Fan Li stated, “Extreme Yang transforms into Yin, and extreme Yin turns into Yang. The sun sets off and returns, and the moon waxes and wanes”, as recorded in the National Languages – The Yue Language (国语·越语). This is the earliest statement of Yin–Yang flux, their waxing and waning. The above records show that the Yin–Yang by then had been generalized to a certain extent. However, Yin–Yang was still one of many concepts of opposition. It is the same in the 5,000 words of the Lao Zi (老子) — there is only one sentence “all things carry Yin and hold Yang”. Massive dialectical concepts of opposition, such as heaven and earth, kind and evil, deficiency and excess, visible and invisible, up and down, male and female, motion and stillness, birth and death, big and small, soft and hard, profit and loss, cold and hot, curse and blessing, difficult and easy, etc. are formulated into concrete concepts, showing that Yin–Yang was not used to explain and epitomize everything.

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In the meantime, the tendency for the Yin–Yang to be rooted in qi became more and more evident. Shen Dao shows this especially in the Shen Zi (慎子): The accumulative and substantial qi belongs to Yin and relaxing and dispersing qi pertains to Yang. If Yin qi accumulates and Yang is forced inside, it struggles to become thunder; if Yang qi on the exterior fails to enter in, it whirls around everywhere to become the wind. If Yin and Yang mingle and struggle with each other, lightning flashes are produced; if ascending Yang qi is dominated by Yin qi, rain is the result; if Yin is assisted by Yang to flow upwards, it becomes clouds; if the cloud disperses in harmony, dews, frost and snow are the result, while in disharmony, haze and epidemic qi’s are formed; if Yin interferes with Yang, clouds become thinner and cannot cover the sun and create a rainbow; if Yang subsides into Yin, the qi stagnates and cannot shrink so then hail comes down; if the night is influenced by Yin qi, frost is formed; if the night is influenced by Yang, dew is produced… This combination of qi and the Yin–Yang greatly propelled the development of the “Tao-qi” theory in a naturally scientific way and was very beneficial to the application of Yin–Yang and five-element theories in medicine, as it provided them with a framework. Another aspect of the development of the Yin–Yang theory was that it became more abstract in concept. The explanations to the Book of Changes (易经) were created by Confucian followers. The book Treatise on the Changes (易传), also called the Ten Wings (十翼), according to legend written by Confucius, took the abstractions of Yin–Yang to a relatively universal level. It is considered that among the 10 chapters of the Ten Wings (十翼), six of them, including Ordered Trigrams (序卦), Miscellaneous Trigrams (杂卦), Talking Trigrams (说卦), Written Words (文言) and The A&B Sign Records (象传上下), were compiled mostly during the Spring and Autumn Periods; the A&B Tuan Records (彖传上下) was compiled in the Spring and Autumn Periods and at the latest at the beginning of the Warring States, and the A&B Xi Explanations (系辞上下) at the latest during the middle of the Warring States. The whole book of the Treatise on Changes (易传) “would have been compiled during the period from the Spring and Autumn Periods to the middle of the Warring States. It was not written only by Confucius,

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but was a collective work by historiographers and Confucian followers. Some chapters may relate to Confucius”.8 Talking Trigrams (说卦) summarized three pairs of common contradictions as follows: “In the past, the saints wrote the Book of Changes (易经), in which the laws of nature were explained. That is, that the heavenly Tao contains Yin and Yang, that the earthly Tao (texture) is of softness and hardness, while the human Tao (virtue) lies in kindheartedness and justice. In the Book of Changes (易经), each trigram contains six strokes, which stand for the collectively paired aspects of heaven, earth and humankind. They are classified into Yang positions and Yin positions and alternatively use the soft and the hard. Therefore, the six positions in the Book of Changes (易经) are well-reasoned.” Actually, kindheartedness and justice are not a distinct pair of contraries, as are the virtual pairs of contraries with universal meaning, such as Yin and Yang, the soft and the hard. In The A&B Xi Explanations (系辞上下), Yin and Yang are emphasized even more. It states that “The Tao is the changing Yin and Yang. They are good in being consistent with the Tao and their nature is to form the human character. The benevolent see benevolence; the wise see wisdom. The common people use them daily but don’t understand them. So, only a few people know the gentleman’s Tao.” Here, the Yin–Yang is regarded as the universal Tao and can only be perceived by a few, that is the wise and moral gentlemen, and has a highly rational value. As “a moral person calls it morality, while a wise man considers it wisdom”, it shows the Yin–Yang to be both universal in existence and as having the ability to explain all things. It also states, “Understanding the changes means resolving problems; but the contingency of the changing Yin–Yang is miraculous.” The Yin and Yang are specified as follows: “Hard and soft rub along with each other, and the eight trigrams interact. Hence, thunder is stirred up, wind and rain are induced to moisten, the sun and moon run in order, and coldness and hotness alternate. The Qian trigram creates male things, and the Kun trigram creates female. From the Qian trigram we can know the great origination of things, while the Kun trigram transforms them into all kinds of products Qian is for recognising the changes, while Kun can simplify them. As there are changes, so they are recognised. As they can be simplified, so they can be followed. Recognising the changes, people approach. Being followed contributes to their effect. As they are approached, so they last 8

 Refer to Zhang Liwen. Study on Thoughts of Book of Changes, Hubei People’s Publishing House, 1980, p. 193.

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longer. Having an effect, they may become larger. Lasting longer is the virtue of Sages, and becoming larger is their enterprise. Therefore, by recognising and simplifying it, the world can be explained — and as the world is explained, so we are able to live in it.” This is the process and connotation of Yin and Yang, in the process of being abstracted and generalized. Thereafter, Yin and Yang become a pair of terms applicable to all things and with opposing attributes. The law and discipline of Yin and Yang thus became the acknowledged and most fundamental rule in heaven and earth, i.e. the Law of Nature. This is the stuff that we call Yin–Yang philosophy and Yin–Yang dialectics — in modern times. We owe an appreciation of it to the authors of the Treatise of Changes (易传), especially the A&B Xi Explanation (系辞 上下), who extracted and abstracted Yin and Yang, and took them from Taoism and inserted them into Confucian philosophy, impacting all aspects of ancient culture in China — including its whole later history. Theories of qi, Yin–Yang and the five elements form the core of the natural philosophy of Chinese medicine. The scale and influence of Pre-Qin philosophy prepared the conditions for and were sufficient for it to finally permeate all Chinese medicine.

49. The Golden Mean, the Three Talents, Image and Number, and the Correspondence Between the Human and Natural Confucius advocated the “doctrine of the golden mean” and the “pursuit of harmony”, but the golden mean or concept of harmony was not initially put forward by Confucius. The Book of History – The Yao Records (书经·尧 典) states the idea of “people’s clear understanding of affairs and harmonizing peacefully all vassal states”. Gaotao’s Strategies (皋陶谟) states, “It is a wonderful thing that people show respect to each other cooperatively and live in harmony.” No Indolence (无逸) records, “People can live happily and in harmony.” Records reflect the fact that the “golden mean” had been emphasized by rulers since before the Shang dynasty. But, it is a matter of certainty that Confucius brought the concept of the “golden mean” to its apogee. The Analects of Confucius – Zilu (论语·子路) records, “A gentleman gets along with others, although they do not necessarily agree with each other. However, a base person agrees with others, even if they don’t necessarily get along.” The Analects of Confucius – Predecessors (论语·先进) records, “Too much is as bad as too little.” The Analects of Confucius – Yong (雍也) states, “The virtue of the golden mean must be supreme!” Similar thoughts are also pre-

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sent in other records. For example, the Guan Zi (管子) states, “The harmony of different things brings forth everything in the world. If all things in the world were the same, the world will never go forward.” The concept of the golden mean is manifest in nature as balance and moderation: the waxing and waning, growth and decline, the mutual transformation between Yin and Yang, along with the orderly movement and generation of things through the harmony of the five elements. In the Treatise on Changes (易传), “vigorous and centrally fair” from Written Words (文言) and “keeping balance with harmony, and at peace” from Tuan Explanation (彖辞) all are basic explanations of auspicious trigrams. The mutual generation, restriction and advocation of keeping to the centre (Earth is generally considered as central to the five directions) are all a manifestation of the concept of the golden mean. The idea of the golden mean is regarded as fundamental to our understanding of the world. Professor Pang Pu points out, “Confucians often talk about the heavens, earth and humankind simultaneously. Humans are placed third in this sequence. But, following relations internally, the human remains between heaven and earth. Heaven and earth are opposed, but humans are not opposed to either heaven or earth. They are integrated. In addition, through the intermediary of the human, heaven and earth are harmonized and become a unity.” He also said, “The simultaneous mention of heaven, earth and human may stem from the idea of considering the relationship of heaven and earth with the human, which was traditional in the thought of people during the Zhou.”9 This is related to the Zhou people’s heavenly-destiny view. Actually, the heaven–earth–human relationship was born out of the concept of gods–human–ghosts. Fan Li proposed in National Languages – The Yue Language (国语·越 语) that “To comply with the heavenly can preserve an abundance; to comply with humanity prevents a collapse; while to comply with the earthly enables people to deal with affairs rationally.” The Records of Yue (越绝书) states, “the Sages know the heavens above, the earth below, and humanity in the middle.” These records contain the sense that the Tao of heaven and earth is being applied to guide human affairs, not just to accord with a heavenly will. The Military Science of Sun Bin (孙膑兵法) unearthed from Yinque Mountain records that “Humans are more precious than anything else in the world… If any one thing, out of a favorable climate, a favorable geographical or favorable human condition is missing, though victory be 9

 Pang Pu. Investigation to the Source of Yin–Yang and Five Elements, p. 100, 113.

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achieved, it will be at a heavy cost.” This is an application of the laws of heaven, earth and humankind to the military. Therefore, the three talents of heaven, earth and the human — with the tenet of the golden mean — existed in rudimentary form, quite early on in history. As for the correspondence between the human and the natural, strictly speaking they are not the same as the syncretism of the humanly and heavenly. The latter is a strongly heavenly-destiny view — that the will of the heavenly gods can manifest in society and humanity, at any one time. The former is the more natural view — that people should adapt themselves to natural rules. In the past, scholars often mixed these two up. In Chinese medicine, the correspondence between the human and the natural is correct — rather than the syncretism of the humanly and heavenly. The Guan Zi – The Five Supplementaries (管子·五辅) records, “If heaven’s timeliness is abnormal, there will be floods and drought; if earth’s geographical conditions are inadvisable, there will be famine; if humanity becomes inharmonious, there will be turmoil and disaster.” This describes how if the heavenly, earthly and human go against the regular law, disasters will occur correspondingly. The Guan Zi – Herdsman (管子·牧民) states, “If people don’t pay attention to the heavenly timing, wealth will not accumulate. If people don’t care about the geographical conditions on earth, food will not be adequate.” It means people should work at farming and breeding in accord with the rules of heaven and earth. Specifically, it is stated in the Four Seasons (四时) that “The Yin–Yang is the great rule of heaven and earth. The four seasons are the significant route of the Yin–Yang. Punishment or benevolent rule should be flexibly applied during the four seasons.” The Universe Collection (宙合) states, “The heavenly Tao is a system of nine, the earthly Tao of eight and the human of six. The emperor regards heaven as father and earth as mother, through whom he is able to develop and govern the state as one… Therefore, understanding Yang qi is for the purpose of working under the heavenly Tao, so the rules of movement of the sun and moon can be applied to benefit the people. Understanding Yin qi is for the purpose of working under the earthly Tao, so the ephemeris can be used to show their orderly movement. If the emperor can thoroughly understand such knowledge and put it into practice, he will govern the state extremely well, just like Huangdi, even without witchcraft and divination which are not really correct.” This means that the great rule of Yin and Yang should be approached and applied through observation instead of divination, and this is obviously not a heavenly-destiny view and certainly not a view of there being a syncretism between the humanly and

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heavenly. Similarly, this book also states, “the Sages take the correspondence of heaven and earth with the human into account.” Mister Lu’s Spring And Autumn Annals – Making a Start (吕氏春秋· 有始) records, “All the things between heaven and earth are just like the human body. This is called the Great Harmony.” It also records in the Lust (情欲) part, “The human is also a unity, just as heaven and earth… So people must lead their lives and deal with affairs in society under the rule of heaven and earth.” The Xuncius – Evil Nature (荀子·性恶) states, “Those who like citing history must be ruled by the present. Those who like talking about the heavenly surely have evidence to confirm what they say.” The Dadai Rites (大戴礼记) records, “People take into consideration heaven and earth.” In the course of denying the heavenly-destiny view, the theory of correspondence between the human and natural was established in an apparently compromising way, but it signified a qualitative shift in people’s appreciation of reality. The understanding of a correspondence between the human and the natural created an epistemological methodology that recognized the natural rules of Yin–Yang and the five elements — and that they could be used to explain and guide human affairs. At the same time, they were used to recognize the human body, its diseases and to explain treatment. The formation of Chinese medical theory thus gained the guidance of a methodology, and this also explains why Chinese medical theory pertains to a natural philosophy. Both the analogical and theoretical foundations of Chinese medicine were formed in this fashion. Heaven and earth are the large cosmos, while the human body is the small cosmos. Henceforth, Chinese medicine arrived at the “law of unity” which existed between ecological nature and the human body. Not only qi, and the natural laws and rules of the Yin–Yang and five elements, but also the theory of “image and number” played a role. The methodology of there being a “correspondence between the human and the natural” applies in this case as well. In the “image and number” theory, the “image” derives from the fissures on the turtle’s back during tortoise-shell divination, while the “numbers” spring from the counting of the milfoil stalks and their calculation in the yarrow stalks divination. Lastly, these were integrated into the Yin–Yang and five elements, becoming another special theory. It once had great influence. The picture of the “orbicular sky and rectangular earth” is a commonly occurring “image”. Mister Lu’s Spring And Autumn Annals – The Round Way (吕氏春秋·圜道) records, “The heavenly Tao is round and the earthly Tao is square, so wise emperors rank their officials by following

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the rules of above and below. Why is the heavenly Tao round? Because the essential-qi goes up and down, and circulates constantly without remaining in one place, so the heavenly Tao is round. Why is the earthly Tao square? Because all things on earth are different in category and shape, and have different functions that can’t replace each other, so the earthly Tao is square.” This passage then progresses on to social politics, “The emperor masters the round way, while the people and officials grasp the square way. The country will be prosperous only when the round and square ways are applied as they should.” The Dadai Rites – A Round Sky by Zengzi (大戴 礼记·曾子天圆) also records, “The heavenly Tao is round and the earthly Tao is square”; “if the sky is round and the earth square, how can the four corners of the earth be covered?” In all these images, numbers are present, such as, “the alternation of one day and one night is a cycle, which is the round way. As the moon passes through its 28 constellations, and the Chariot constellation meets up with Spica, it is also the round way. The essential-qi moves around through the four seasons, with some part of it ascending and some part descending, differing parts that encounter each other — which is the round way as well. It is its movements that bring forth generation. With generation, there will be cultivation. With cultivation, development ensues and expansion is the result. Then maturity follows and declination comes about. Death follows on and disappearance is the final end. This is the round way as well.” In this record, the numerology of astronomy and the seasons is also included, though not in detail. The combination of “image and number” is clearer in the Nine-Palace Chart, the River Map, the Luo Shu Map and the Na Jia Map. A Taiyi Nine-Palace Chart was unearthed from the site of Shuanggutui, FuYang City, Anhui province. It was buried in 165 BCE and probably produced in the Pre-Qin period. In this map, heavenly stems, earthly branches and eight trigrams are matched in a fairly complicated and mysterious system of image and number. The total match of 60 years made by the 12 heavenly stems and 10 earthly branches was already present in the oracle bones of the Shang. It was initially applied to order the years and months, but later matched with the directions, the Yin–Yang and five elements. The significance of the numbers lay not only in the numbers but also in the many other attached and representative symbols. The Dadia Rites – Cycle Recurrent Year (大戴礼·本命) states, “Life is transformed out of the natural laws of heaven and earth, while characters are formed by receiving the qi of Yin and Yang. There must be the formation of an image, transformed from Yin and Yang, and this we call birth. The end of the transformations of the Yin–Yang we call death.

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Therefore, life is the beginning of human nature, and death is the end of life.” “Image and number” were introduced to explain the movement and variation of life, which still fell under the scope of the “correspondence between the human and the natural”. The “large cosmos” and “small cosmos” were both terms mentioned during later periods and were generally an analogy of similars. However, the view of “image and number” was later matched by witchcraft and superstition — and this made it return again to the mystical and mysterious. Generally speaking, Pre-Qin philosophy gradually broke away and became independent from a belief in gods and ghosts which was prevalent during the Shang dynasty, forming a system chiefly founded upon the ideas of “Yin–Yang”, the “five elements” and “qi”. This system was approved by all schools of thought at that time and each school absorbed what it needed — to explain and establish their own individual theories, ideas of nature and society. This pervasive and prevailing atmosphere subtly contributed to the integration of a systematic approach during the establishment of Chinese medical theory. A chart describing this system very generally is as follows. A Belief in Gods and Ghosts ↓ The Heavenly Destiny View ↓ The Heavenly Tao View (Qi, Yin–Yang, Five Elements) ↓ An Explanation of Politics, Society, Ethics, Psychology; An Explanation of the Nature of the Sky, Earth, all Phenomena, Humankind, Diseases, etc. ↓ The Construction of Chinese Medical Theory As Professor Ren Jiyu has pointed out, “The idealism of Yin–Yang and five-element theories does not reflect its natural conception, but appears under the aspect of being a societal and historical view.”10 The combination of PreQin philosophy and medicine evoked the doctrine of “a natural conception of 10

 Refer to Ren Jiyu. The Relation between Ancient Medicine and Philosophy in China – Judge the Scientific Achievements of Ancient Medicine in China from Huangdi’s Inner Classic. History Research, 1956, No. 7.

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philosophy”. Just as the poem says, “the wind sneaked in during the night and moistened things silently”, so the medical theory of China almost certainly unconsciously formed of its own accord. However, it is true that “where water flows, a channel is formed — when conditions are ripe, success will come”. A comprehensive medical theory was just about to arrive.

50. From the Mawangdui Medical Books to Huangdi’s Inner Classic (黄帝内经) The ultimate medical achievement made through the cultivation of Pre-Qin natural philosophy was to be the founding of the basic theories of Chinese medicine, namely those contained in Huangdi’s Inner Classic (黄帝内经). The present version of this book is classified into Plain Questions (素问) and the Spiritual Pivot ( 灵枢), comprising 18 volumes and 162 chapters. Huangdi’s Inner Classic became an immortal classic, through all time and in every aspect of Chinese medicine. According to archaeological discoveries made during recent years, it is estimated that there were other writings before the Inner Classic (内经). For example, the 14 medical books unearthed from the Han Tomb of Mawangdui were just part of them. The agreed opinion11 is that these books were copied at a time between the Qin and Han dynasties. As the silk manuscripts and bamboo slips with scripts were in parts, and had many words missing and titles also, they were sorted out and given names. They are listed as follows: A Moxibustion Classic of 11 Channels of the Limbs (足臂十一脉灸经); A Moxibustion Classic of the Yin–Yang 11 Channels (阴阳十一脉灸经); Methods of Pulse Taking (脉法); The Fatal Manifestations of the Yin–Yang Pulses (阴阳脉死候); 52 Diseases and Therapies (五十二病方); Life Nurturing Formulae (养生方); Miscellaneous Treatment Formulae (杂疗方); A Foetus and Obstetric Book (胎产书); Stopping Food and Breathing Exercises (却谷食气); A Dao Yin Exercise Map (导引图); 11

 Refer to Ma Jixing, Li Xueqin. The Most Ancient Medical Books Discovered in China – Silk Manuscripts: 52 Diseases and Therapies. See 52 Diseases and Therapies, Cultural Relics Publishing House. 1979, p. 183.

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The Ten Questions (十问); A Discussion on the World Supreme Tao (天下至道谈); Methods of Yin–Yang Sexual Intercourse (合阴阳方); Miscellaneous Forbidding Formulae (杂禁方). It is almost certain that the time these books were copied was not the time they were written. Generally speaking, they are regarded as coming from the PreQin or Qin period. Ma Jixing and his followers inferred these books to be Pre-Qin, but Professor Yamada thought we couldn’t infer the date of the medical silk manuscripts from the unconfirmed dating of Huangdi’s Inner Classic to the earlier Warring States.12 The author personally agrees with Yamada that they were written during the Qin or between the Qin and Han periods. Judging from a study of the first five silk books, the 52 Diseases and Therapies (五十二病方) is a record of medical experiences of the time: basically a mixture of medicine and witchcraft. Treatment by prayer and cursing the cause of the illness, taboo and incantations take up 14%, the use of medicinal wine and decoction 25%, external treatment 50% and the rest 11% (mostly unclear due to missing words). As for external treatments, there are mostly the applications of hot or medicinal washes and sprays. Cutting by stone needle and moxibustion are mentioned only four or five times. As for internal treatment, medicinal wine therapy takes up nearly half, about 30 times. For decoction therapy, there are several compounds. We can understand that this is a primitive collection of medical experiences. No theory is mentioned in the books and qi, the Yin–Yang and five elements are not present. There is only one place among the moxibustion treatments, which records, “Apply moxibustion to the Taiyang and Taiyin”. This may perhaps partly reflect the book’s style, which is a collection of empirical therapies. However, it at least indicates that the medicine of that time was influenced very little by natural philosophy. If the author of the Inner Classic (内经) had used these books, he must have assimilated very little and assumed a critical attitude — at least witchcraft was excluded. In the moxibustion and pulse-taking silk books, Yin and Yang are included. For example, Shaoyin, Taiyin, Jueyin, Taiyang, Yangming and Shaoyang are terms that appear in both moxibustion classics. Qi is also included, such as the statement in Methods of Pulse Taking (脉法), “It is 12

 Refer to papers written by Ma Jixing and his fellows as well as The Formation Huangdi’s Inner Classic written by Japanese Prof. Yamada Keiji and published in Eastern Academic Journal, No. 36, 1979, p. 67.

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qi…” The Fatal Manifestations of Yin–Yang Pulses (阴阳脉死候) records, “The three Yang are heavenly qi” and “The three Yin are earthly qi”. However, the five elements are not present, with only a suggestion among the Fatal Manifestations of Yin–Yang Pulses (阴阳脉死候) recorded as “five kinds of death” (namely “initial dead flesh”, “initial dead bones”, “initial dead qi”, “initial dead blood” and “initial dead tendons”). Most certainly, these silk manuscripts have omitted much and their full content is not present. It is clear that they have some direct relation to a few chapters in the Inner Classic (内经). Therefore, the gradual perfection of medical theory in the Inner Classic (内经) shows precisely the course of the gradual permeation of Yin–Yang philosophy into medicine. The philosophy of the Yin–Yang and five elements is more distinct and comprehensively accepted in several kinds of sex manuals from various unearthed bamboo slips. These sex manuals aim at nurturing life and longevity. Just as has been discussed earlier, the arts of seeking immortality always precede medical development. Moreover, the Yin–Yang theory combines better with the idea of man and woman in the manuals. Therefore, it was natural to illustrate sex manuals using the Yin–Yang theory and even to use Yin and Yang as a synonym for sexual activity. The Ten Questions (十问) records ways of joining up with a female, Yin–Yang Combination (合阴阳) talks about methods of sexual intercourse, a Discussion on Utmost Tao in the World (天下至道谈) illustrates profit and loss during intercourse, Life Nurturing Formulae (养生方) and Miscellaneous Therapies (杂疗方) speak of sexual function and antenatal training. These records are tied to a Yin–Yang philosophy on the one hand and close to medicine on the other, and could be regarded as forming a bridge between them. For instance, the Ten Questions (十问) states the following: “Yao asked Shun, ‘What is the most precious thing in the world?’ Shun answered, ‘It is life.’ Yao then asked, ‘How to keep alive?’ Shun answered, ‘Be clear about Yin and Yang.’”; “Huangdi asked Cao Ao, ‘What is it, that when people lose, they die? What is it, that when people have, they can be alive?’ Cao Ao answered, ‘… The key is to get the ‘essence’ in sexual intercourse. When orgasm occurs during sexual intercourse, people should move the body softly and gently. If people do this, the female will have a pleasant sensation and produces five kinds of sighs. At this time, it is proper to have ejaculation.’”; “Huangdi asked Tianshi, ‘What is it that ensures the movement of everything in the world? What is it that enables the growth of grasses and trees? What is it that makes the brightness of the moon and sun?’ Tianshi answered, ‘By observing the heavens, we know the Yin–Yang to be the cause. All things will not continue if they lose it, but if they have it, they will prosper.’” Such records show that the ideas of the Yin–Yang, five elements

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and qi and a natural philosophy were all introduced in these sexual manuals, naturally and effectively just like fish having their existence in water. In the Ten Questions (十问), there are records of Wen Zhi (an ancient well-known doctor) answering questions from the King of Qi State. Even if these stories cannot be verified, they must have been written after the time of Wen Zhi. In the question and answer sessions of Prince Qiao Fu and Peng Zu, there is a statement, “When people are unaware of the universal Tao, they lose the stirring-life qi. Thus laymen in confusion then rely on witch-doctors.” This is obviously an idea excluding ghosts and gods, and divination. It especially differs from the 52 Diseases and Therapies (五 十二病方), and is similar to Huangdi’s Inner Classic (黄帝内经). The natural philosophy of qi, Yin–Yang and the five elements permeated medical theories from differing schools of thought; it concerned medicine itself and nurturing life through sexual intercourse, functioning further as a catalyst to promote the refinement and development of other medical theories. The Ten Questions (十问) was written in the form of questions and answers, and this was inherited by the author of Huangdi’s Inner Classic (黄帝内经). Huangdi’s Inner Classic (黄帝内经), as a summarization of medical theories of the time, has several distinctive features: 1. The law of Yin and Yang is the guideline of all other theories. Plain Questions – A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (素问·阴阳应象大论) records, “Yin and Yang are the law of the entire heavens and earth, the fundamental principle of all things in creation, the parents of change, the root and source of birth and death and the storehouse of the spirit. The treatment of disease must follow this law in order to search for their origin.” The law of Yin and Yang mentioned here, either the law of heaven and earth, or the general rule of Yin and Yang, is placed as fundamental — over and above all other medical theories. It forms the theoretical backbone of the Inner Classic. 2. Qi is regarded as the basic physiological substance of the human body. It can transform into blood and essence, and its control over normal life activities will turn it into Shen (spirit). Thus, it is recorded in Plain Questions – Discourse on how the Generative Qi Communicates with Heaven (素问·生气通天论) that “from earliest times, those who understand the laws of heaven knew that the root of life was based on Yin and Yang. Between heaven and earth and within the six points (4 points of compass, the Zenith and Nadir), the qi of the nine regions and nine orifices, the five zang organs, the twelve sections, they are all pervaded through with the qi of the heavens.” Qi is deemed to be the root of all life. The nurturing

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of life in the Inner Classic probably derives from the Zhuangzi (庄子), which advocates an indifference to fame or gain, the spirit remaining protected within, inhaling fresh essential air, the harmony of Yin and Yang, adapting to the four seasons, living in seclusion and keeping away from vulgar human relationships, and abiding by the laws of heaven and earth. 3. The laws of movement of the four seasons along with Yin–Yang and the five elements realized through qi (together with blood) are applied to explain all human physiology and pathology, the causes of disease, their patterns and treatment. Plain Questions – A Comprehensive Discourse on Regulating the Spirit in Accordance with the Qi of the Four Seasons ( 素问·四气调神大论) also records, “Yin–Yang and the four seasons transform the end and beginning of all myriad beings. They are the basis of death and life. Disobey them and it results in catastrophe and harms life. If one follows them, disease will not emerge.” Plain Questions – A Discourse on the Six Regulations Governing the Manifestations of the Viscera (素问·六节藏象论) records, “so that the overcoming qi of five elements (phases) with the seasons gives a name to the zang organs.” It also states, “The five phases succeed each other; each of them governs one of the sections of the year regularly. After the end-day of an annual cycle it goes round and begins again anew a fresh circle. The time period stands while its respective qi spreads abroad. This process is just like a ring, without any end.” Plain Questions – The Generation and Completion of the Five Zang Organs (素问·五藏生成篇) states, “The pulses whether small or large, slippery or rough, floating or deep can be distinguished by the fingers; this phenomena can associate with the conditions of the five zang organs, things can be deduced from objects of the same kind. The five zang organs have five tones, this can be discerned by way of reasoning. As for the subtle appearances of the five types of complexion, this can be examined with the eyes. This integration of pulse and complexion make the diagnosis and treatment perfect.” Hence, almost all the classifications of the internal organs, the movement of qi and blood, the diagnosis and treatment methods and principles follow this line of enquiry. As for the cause of disease, it also concerns the relationship between pathogenic factors and healthy qi. Plain Questions – A Discourse Deliberating upon Heat Disease (素问·评热病论) records, “Where pathogenic factors attack, the healthy qi must be deficient already.” Plain Questions – Regulation the Qi of the Channels records, “When a pathogenic factor emerges, it either emerges in the Yin or in the Yang. When it emerges in the Yang, it is acquired through wind, rain, cold, or summerheat. When it emerges in the Yin, it is acquired through beverages or

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food, habitation, sexual intercourse, or through emotions such as joy or anger.” Plain Questions – A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (阴阳应象大论) states, “if someone is attacked by the pathogenic factors of the heavens, it harms the five zang organs. If someone is attacked by the temperature of his food or drink, it harms the six fu organs. If someone is attacked by the damp qi of the earth, it harms the skin, flesh, sinews, and vessels.” The Spiritual Pivot – Occurrence of Various Diseases (灵枢·百病始生) records, “If the person himself is not in deficiency, the pathogenic factors such as wind, rain, cold and heat cannot alone harm him. When the body is not weak, people will not suffer from illness, even if a sudden violent storm or rain occurs. A disease only occurs when the body is weak and the pathogenic factors strong. Both meeting together then means that the disease appears in the body.” Plain Questions – A Discourse on the Jade Mechanism and the True Qi of the Zang Organs (素问·玉机真藏论) states, “The wind is the leading cause of all the various diseases.” 4. The theoretical constitution of Inner Classic may also be completely described as “the correspondence between the human and natural”. Plain Questions – A Discourse on Pain (素问·举痛论) records this explicitly, “Those who are good at discussing the law of the heavens, they must be able to verify the law of the heavens to mankind. Those who are good at discussing events in the past, they must be able to conform to the present. Those who are good at commenting on others, they must be sufficient unto themselves.” This is literally a copy of the text in the Xuncius (荀子). More interestingly, theories in this book are established by analogies of correspondence. Plain Questions – A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (素问·阴阳应象大论) records, “The great people of the past match heaven above to nurture the head, followed the image of the earth beneath to nurture the feet, between and beside them they took the affairs of mankind to nourish the five zang organs. The qi of heaven communicates with the lung; the qi of the earth communicates with the throat; the qi of the wind communicates with the liver; the qi of thunder communicates with the heart; the qi of the food communicates with the spleen; the qi of the rain communicates with the kidneys. The six qi are like large rivers; the intestines and stomach are as a sea. The nine orifices are where the qi flows out like water…” The name of this chapter, “Phenomena Corresponding to Yin and Yang”, indeed indicates an analogy. Wang Bing of the Tang Dynasty made a note on the term “visceral manifestation” that “the inner state is manifested on the exterior, where it can be perceived”. A rigid analogy such as this may

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seem a little ridiculous nowadays. For example, Spiritual Pivot – The Attack of Pathogenic Factors (灵枢·邪客) records, “The sky is round and the earth is square, so the human head is round and the feet square — to correspond with them.” A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (阴阳应象大论) records, “Heaven is not sufficiently present in the North-West. Hence the North-West is Yin, and so the ears and eyes of man on the right are not as clear as on the left. The earth is incomplete in the South-East. Hence the South-East is Yang, and the hands and feet of man on the left are not as strong as on the right… These are the locations where the Yin and Yang of heaven and earth cannot be complete.” Plain Questions – A Discourse on the Division and Union of True Qi and Pathogenic Factors (素问·离合真邪论) records, “Now, the degrees and numbers introduced by the Sages, they definitely correspond to heaven and earth. Hence, heaven has its lunar lodges and 365 degrees; the earth has its main waters while man has his main channels.” Many people give a faint smile and suggest that the theories of Inner Classic are not perfect. However, these passages show clearly a trace of acceptance by the author of the Inner Classic concerning the PreQin Theory of Correspondence between heaven and earth.   At the same time, the theory of “image and number” is confirmed plainly in the book. Plain Questions – A Discourse on the Six Terms and on Condition of the Zang Organs (素问·六节藏象论) records, “The heavens employ six times six regulations (divisions of time), and the earth uses nine times nine laws to form one whole. Heaven has ten celestial stems, the day has six (pairs of horary characters) which revolve. When Jia, the first celestial stem, has returned six times, a cycle of sixty years, or one life-time, has been complete — based upon the standard of threehundred-sixty days to one year. From older times, communication with heaven was the origin of life; and from the beginning of time the qi of Yin and Yang circulated through the nine orifices. Life is influenced by the five elements, its qi is three. Three serve to complete heaven, and three complete earth, and three for the human as well. Three times three makes nine, nine acts in nine areas, nine areas for nine viscera. The external body has four viscera (i.e. head, ears and eyes, mouth and teeth, the thorax, according to Wang Bing) and five internal viscera (i.e. liver, heart, spleen, lungs, kidneys), and they unite, thus making nine viscera, corresponding to the general system.”13 Hence, there arise the categories of the five zang organs, six fu organs, eights winds, twelve channels and so on. 13

  From Ilza Veith’s translation: The Yellow Emperor’s Classic of Internal Medicine, University of California Press, 1949, p. 137.

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5. The Inner Classic considers that the standard for health and purpose of treatment lies in the “golden mean”. The one who occupies the “golden mean” is a pingren (healthy and well-balanced person). Plain Questions – On the Normal Pulse of a Person (素问·平人气象论) records, “A healthy and well-balanced person is not affected by disease.” Plain Questions – Discussion on the Essentials of Pulse (素问·脉要精微 论) states that the normal pulse should move “as smooth as a pair of compasses with a soft Yang energy in spring, be as full as a rule with a strong and abundant energy in the summer, the autumn pulse in correspondence should be like a balance with ascending Yin and descending Yang at different levels, and the winter pulse in correspondence should be like a scale with the Yang energy lying low”, [according to Wang Bing] having no more and no less than enough. Plain Questions – Ancient Ideas on How to Preserve Natural Healthy Energy (素问·上古天真论) records that people must “abide in the harmony of Yin and Yang, and adapt to the changes of season”. Therefore, “the sages always try to balance Yin and Yang, to ensure a normal coordination between muscles and channels, to strengthen bones and marrow as well as to smooth the flow of qi and blood. In such a way, the internal and external are harmonized, and pathogenic factors cannot impair the body.” Plain Questions – Discourse on how the Generative Qi Communicates with Heaven (素问·生气通天论) states, “The essential principle of Yin and Yang is to keep the Yang densely strengthened and in harmony with the Yin. Without harmony between Yin and Yang you have something like a year that has spring but no autumn, or a winter with no summer. Thus the harmony of Yin and Yang is the supreme standard which is also called ‘the sagely standard’. If the Yang is strong but cannot keep dense, the Yin qi will be exhausted. Only when the Yin is at peace and the Yang compact can the body and spirit be normal. If Yin and Yang separate from each other, the body and spirit are completely exhausted.” So, the Spiritual Pivot – A Discussion on the Regulation of Channels (灵枢·调经论) states, “Disharmony between qi and blood causes all kinds of disease — with variations.” The Spiritual Pivot – Root and Connection (灵枢·根结) concerning doctors states, “The best doctors treat people to keep the qi in balance; the physician of medium level will confuse the pulses; the inferior practitioner will only exhaust the qi and endanger a patient’s life. That is why it is said: beware of an inferior physician!” As for specific treatment principles, there is “reduction” and “supplementation”, which also accords with the “heavenly Tao” of Lao Zi (老子), where he speaks of “reducing any excess and supplementing any deficiency”.

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6. The Inner Classic assumes a negative attitude towards ghosts and gods, as well as towards witch-doctors, which it inherited from the Pre-Qin natural philosophies and Dr Bian Que. Plain Questions – A Different Discussion on the Five Zang-Organs (素问·五藏别论) states, “You cannot discuss medical theory with those who are superstitious of ghosts and devils.” Spiritual Pivot – The Pathogenic Wind (灵枢·贼风) states, “Huangdi asked, ‘What you have just said concerns those things that can be comprehended by patients themselves. However, some cases occur suddenly due neither to an invasion of pathogenic factors or stimulation by internal injuries such as fear and fright. What’s the reason? Can they only be explained by haunting ghosts or devils?’ Qibo answered, ‘It is because there are latent pathogens in the interior which are not yet shown in effect. However due to the person having something too much emotionally detestable or something enviable, the flow of qi and blood in the body is disturbed, which combines with the latent pathogens to cause disease. Such an internal change is extremely subtle in that there are no distinct signs and it cannot be observed and heard, just like the haunting of ghosts.’ Huangdi asked, ‘Some of the above diseases could be cured by cursing skill, why?’ Qibo answered, ‘It is because ancient witch-doctors knew the characters and the reasons of such diseases and then treated them through cursing their cause’.” This explanation of disease treated by witch-doctors is fairly scientific and reasonable from a psychological point of view. It also reflects the fact that the author of the Inner Classic did not reject witchcraft absolutely or unreservedly, but tried to understand and explain it. Besides Huangdi’s Inner Classic (黄帝内经) being a classic and monograph in Chinese medicine, it can also be regarded as a philosophical work. There was nothing comparable which explained nature, life and all other aspects of qi, the Yin–Yang, five elements and so on at that time. From the view of philosophical abstraction and refinement, it explored further the subdivisions of Yin and Yang, the waxing and waning of Yin and Yang, the laws of the movement of the five elements, the qi theory, etc. For instance, the movement of the five elements (phases) in the Inner Classic is no longer a closed cycle, but a spiral of change and development. Certainly, to describe the contribution of the philosophical aspect of the Huangdi Neijing is not a task for this book, so no redundant discussion will be made here. But, it is important to note that a theoretical system for Chinese medicine had now been established by the Huangdi Neijing’s new philosophy and an innovative medical knowledge created now for all times.

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Occultist Culture and Medicine Under the Impact of the Confucian Classics and Chenwei1 Philosophy A.  The Fangshi2 Culture and Some Secret Medical Groups The fact that the Huangdi Neijing (黄帝内经) was the crystallization and combination of pre-Qin philosophy along with its medical practices does not mean that it was during the pre-Qin period that the book was composed, nor does it infer the acceptance and popularity of medical science as a profession for contemporary physicians. In fact, believers in the natural sciences — the important practical forms of pre-Qin culture — eventually almost all joined the (Taoist) occultist ranks. Medical science, in the hands of the occultists, most of whom were physicians themselves, inevitably bore the profound influence of (Taoist) occult culture, which in turn was intimately connected with many of the most important medical books, as well as its most prominent physicians.

1

 Prophecy and divination combined with some mystical Confucian beliefs went beyond the Five Confucius Classics. Chenwei was prevalent during the Eastern Han Dynasty (25–220 CE). 2  Fangshi (方士 occultism) and its culture were a kind of peculiar cultural phenomena in Chinese history which mainly occurred and existed during the period from the pre-Qin to the Wei-Jin-Nanbei dynasties. Witchcraft, such as shamanism, and Fangshi were not the same thing, Fangshi was not witchcraft. Fangshi could originally be a part of Taoism but was not the same as the Taoist religion. Taoists could be alchemists or experts at making pills of immortality, but not real scientists or technicians. They could treat patients but did not have to be pure doctors. But they had to have a kind of special mystical skill, something like medicine, so they could also be called Shushi (术士，a skilled immortal). 305

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51. Research on the Date of the Composition of Huangdi Neijing (黄帝内经) Arguments have long lingered around the date of the Huangdi Neijing (黄帝 内经). However, some common viewpoints can now be elucidated by the words of Lu Fu,3 writing in the Yuan Dynasty: “The Neijing – Suwen (内 经·素问) is universally acknowledged as a book of questions and answers between Huangdi and Qibo. Judging from its purpose, we know that it could never have been composed within a short period of time; nor could it have been done by one hand, as is clear from its contents. Yet Liu Xiang4 preferred to take it as a collection of words by scholars of the Han Kingdom; while Chengzi5 said that it dates to the end of the Warring States. However, most probably it was as popular as The Book of Rites (礼记) to scholars in the Han Dynasty and passed on along with the words of Confucius and Zisi.6” Most experts, simply quoting “not within a short period of time” and “not by one hand” did not realize that Lu Fu, comparing the Huangdi Neijing (黄帝内经) with The Book of Rites (礼记), decided that both were composed during the early years of the Western Han Dynasty. The title of the Huangdi Neijing (黄帝内经) was explained thus by Liu An in his Huainanzi – Xiuwuxun (淮南子·修务训): “The mediocre usually pay their respects to the past and look down on the present. Therefore, to publicize their theories and doctrines, the advocators needed to link them to the names of Shennong and Huangdi.” Thus, it is most likely that this book was composed during the early Han Dynasty when the thinking of Huangdi and Lao Tzu was in its heyday. It was referred to as the “thinking of Huangdi and Lao Tzu” because, explicitly in the words of Mr. Zhang Shunhui, “The scholars during the last years of the Zhou wrote down on bamboo tablets and textiles what they heard and thought, and these writings became so popular in the early years of Han that their advocators titled them as coming from Huangdi — to make them appear loftier. Hence the title — ‘the thinking of Huangdi and Lao Tzu’.”7 3

 Dai Liang (戴良), Cangzhouweng, Vol. 27 from Collections on the Jiuling Mountain (灵山 房集) in Yuan Dynasty. 4  Liu Xiang (刘向77–6 BCE), a scribe, bibliographer and writer in the Western Han Dynasty, who compiled Strategies of the Warring States, Chu Ci and others. 5  Chengzi, i.e. Cheng Yi — (程颐 ), a famous Confucian scholar in the North Song Dynasty. 6  Zisi (子思), the son of Kong Ji (孔伋483–402 BCE), grandson of Confucius, famous thinker in The Spring and Autumn Period, who is believed to be the pioneer of Mencius and thus created “the school of Si and Mencius”. 7  Zhang Shunhui, A Probe into the Doctrines in Zhou and Qin Dynasties, Zhonghua Book Company, 1982, p. 72.

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Another direct reason for the title “the thinking of Huangdi and Lao Tzu” can be found in the words of Sima Qian: “Lord Yuechen,8 who once studied the thinking of Huangdi and Lao Tzu, received education first from the Master Old-on-the-River whose birthplace still remains a myth. The Master Old-on-the-River gave instructions to An Qisheng, who then taught Lord Maoxi, teacher of Lord Yuexia, one of the elders of the family of Lord Yuechen. Lord Yuechen, enlightened by Lord Yuexia, then taught Lord Gai who later made his teaching career around the areas of Gaomi and Jiaoxi in Qi State and became the teacher of Premier Cao.” (Historical Records – Biography of Yue Yi (史记·乐毅列传)) Premier Cao here refers to Cao Can, a meritorious general who lived during the Han dynasty, when the thinking of Huangdi and Lao Tzu was embraced by such influential men and women of the time as Empress Dowager Dou, wife of Liu Heng, the Emperor Wen and mother of Liu Qi, Emperor Jing of the Han, and Xiao He, Lu Jia and Jia Yi among others, all of whom made particular contributions to the prosperity of the early Han dynasty. The popularity of the idea of “governing by non-interference” and the “doctrine of Yin–Yang and Five Elements” can be traced to all these people. Take Jia Yi’s words in his New Book – To the Birds (新书·鸟赋) for instance: “Take heaven and earth as a giant pot, and nature as the furnace artisan; make the Qi of Yin and Yang into fire, and none can ever be free from its smelting. To gather, depart, decrease or grow, even so, how can all abide by a particular law? There is no doubt that things keep changing, without end.” Or Lu Jia’s words in his New Words – Attention to Details (新语·慎微), “complying with nature and acting with the Yin–Yang rule; observing the celestial sky and sensing the human heart… isn’t one who seeks a rule in All Things in nature just someone who has attained a certain spiritual sublimation, like those of ancient times?” He also said in his New Words – Basic Laws of Nature (新语·道基), “ firstly, to clear the position of the sun and moon on top, to arrange the stars in right order, to tackle the seasons in sequence, to harmonize Yin and Yang, to emit qi and to rule gender; secondly, to settle the Five Elements as well as the rules of nature as ‘sprouting in spring, outspreading in summer, astringed in autumn and stored up in winter’ and also to know that thunder and lightning usually are Yang and snow and frost usually Yin…” Such opinions inherited completely the idea of the Five Elements of pre-Qin Taoism, and also became quite popular at the time.

8

 Yue Yi, eminent strategist in the Warring States Period.

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Therefore I, the author, speculate that The Huangdi Neijing (黄帝内经) was not composed in the pre-Qin period, but, more specifically, after Mr. Lu’s Spring and Autumn Annals (吕氏春秋) in 239 BCE and before the Huainanzi (淮南子) in 179 BCE: that it was in the early Han Dynasty when the thinking of Huangdi and Lao Tzu was quite popular. The reasons can be listed as follows: First, after his disciples had finished the book Mr. Lu’s Spring and Autumn Annals (吕氏春秋), Lu Buwei (290–235 BCE) had the text hung on the doorpost of Xianyang City (the capital of Qin) and offered a reward of 1,000 pieces of gold to anyone who could bring its words to perfection, but all tried in vain. Not one word was added or deleted. Also, according to research, the medical contents of this book are far inferior to those of the Huangdi Neijing (黄帝内经). It mentions some witch-physicians like Wupeng and others but not Qibo and Bogao, and in particular the Yin– Yang and Five-Element thinking in the Huangdi Neijing (黄帝内经) are much more profound than in Mr. Lu’s Spring and Autumn Annals (吕氏春 秋). Based on this, it was not difficult to change some words in Lu’s book for the high rewards it brought. To conjecture that the Huangdi Neijing (黄 帝内经) could not have been composed before Mr. Lu’s Spring and Autumn Annals (吕氏春秋) is quite reasonable. Yet the light shone upon the Huangdi Neijing (黄帝内经) by Mr. Lu’s Spring and Autumn Annals (吕氏春秋) should not be undervalued, just as Professor Ren Jiyu said: “Historically speaking, Mr. Lu’s Spring and Autumn Annals (吕氏春秋) made a special contribution — not by putting an end to the pre-Qin, but by ushering in the Han.”9 Second, it is also unlikely that Huangdi Neijing (黄帝内经) was composed later than The Huainanzi (淮南子), a collection of diverse authors just like Mr. Lu’s Spring and Autumn Annals (吕氏春秋). The most obvious reason is that the theoretical descriptions of the inter-generation of fiveelement theory are quite crude in the Huangdi Neijing, and without concise generalizations, being similar to those of the Youguan (幼官), the Yueling (月令) and Mr. Lu’s Spring and Autumn Annals (吕氏春秋). However, there are clear and concise descriptions of the basic law of inter-generation and its meaning in The Huainanzi – Tianwenxun (淮南子·天文训), such as “water generates wood, wood generates fire, fire generates earth, earth generates metal, and metal generates water. The day when the son agrees with the mother is called yi; the day when the mother agrees with the son is called 9

 Ren Jiyu. History of Chinese Philosophy, People’s Publishing House, 1963, Vol. 2, p. 18.

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bao; the day when the son and the mother agree with each other is called zhuan.” Such hypertheoretical and abstract ideas, if they already existed, had not been absorbed by the author of Huangdi Neijing (黄帝内经), and they would have gone beyond people’s beliefs. In fact, these ideas were soon put into words by Dong Zhongshu (probably 179–104 BCE) who was living around the time of The Huainanzi (淮南子), in his book the Chunqiu Fanlu (春秋繁露). Dong, during the Jing Emperor’s reign from 156 BCE to 141 BCE (during the Han), was a boshi, or official teacher in charge of education, and later attained great fame after Emperor Wu claimed the throne in 140 BCE Standing up at the imperial court, and disputing with other officials, he was put in an important position by Emperor Wu who later adopted his proposal of “banning all that was not listed in the Six Arts10 or not in compliance with Confucianism, in order to prevent its development.” This was the beginning of the movement of “rejecting all kinds of theoretical schools except Confucianism”. In later years, by giving a pretext of illness, Dong took refuge at home and focused on book-writing and lecturing, and eventually became a Confucian master and founder of the New Confucian Classics School during the Han period. His Chunqiu Fanlu (春秋繁露) was probably produced during his retirement. In this book, there are such ideas as “there are five elements in nature, namely wood, fire, earth, metal and water. Wood generates fire, fire generates earth, earth generates metal and metal generates water. Water represents winter, metal represents autumn, earth represents ji-summer (i.e. the last month of summer), fire represents summer, and wood represents spring…” (from the Five Elements (五行)) and these ideas were quite similar to those in the Huainanzi (淮南子). However, they could not be found in the Huangdi Neijing (黄帝内经). So arose the specific term for the ji-summer. Therefore, it is ungrounded to say that the ideas of Yin–Yang and Five Elements in the Huangdi Neijing (黄帝内经) were influenced by Dong Zhongshu’s Chunqiu Fanlu (春秋繁露). Moreover, the expression “primordial qi”, commonly used in Chinese Medical theories by later generations, made its appearance in the Chunqiu Fanlu (春秋繁露) but is not in the Huangdi Neijing (黄帝内经) — in such sentences as “when primordial qi flows harmoniously outward to the skin and through the texture of the flesh, people attain their best physical condition” (from Elements of Heaven and Earth) and “when the emperor 10

 Six essential abilities upheld by Confucianism, namely arts of rites, music, archery, horse riding, handwriting and counting.

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implements justice in his rule, peace can be restored with primordial qi being trajected through the whole universe” (from Principles for Emperors). If this expression contained exactly the same meaning as the one in “the universe gave birth to primordial qi” in The Huainanzi (淮南子) (quoted in the Taiping Yulan (太平御览) in its chapter on Heaven), it could be concluded that the term “primordial qi” had most likely first appeared in the Huainanzi (淮南子). Thus, Dong Zhongshu might have taken this expression from the Huainanzi (淮南子) into his book the Chunqiu Fanlu (春秋繁露). Yet the modern version of the Huainanzi – Tianwenxun (淮南子·天文训) only uses the phrase, “the universe, originating from a formless and empty chaos, gave birth to qi”. It was only after Dong’s Chunqiu Fanlu (春秋繁露) that the term “primordial qi” became quite common. For instance, Liu Xin11 in his Musical Records (钟律志) spoke of the “taiji and the primordial qi” which appears also in the Han Shu – Records of Music and Calendar (汉书·律历志). The Geographical Records of the Hetu (河图括地象) also makes the remark that the “primordial qi together with the sun constitutes the heavens”, while the Chunqiu Shuotici (春秋说题辞) also says that “the primordial qi, an intangible chaos, turns out to be the heavens”. This term was also mentioned in the Baihutong – Heaven and Earth (白虎通·天地篇) where it says, “heaven and earth were born from primordial qi and thereafter gave birth to everything in the universe”. When it came to Wang Chong’s On Balance (论衡), every time he mentioned primordial qi, it would undoubtedly become an excellent idea and be hailed by crowds of people. Such expressions as “primordial qi” and the “inter-generation of the five elements” were excellent and popular ideas as well. If the Huangdi Neijing (黄帝内经) was composed after Wang Chong’s On Balance (论衡), why did it not follow its thought and ideas? So it can be said truthfully that Dong Zhongshu’s idea of the “interaction between heaven and man” or the “unity of heaven and man” did not exert an influence upon the Huangdi Neijing (黄帝内经), nor did his idea of “man being a copy of heaven”. The Huangdi Neijing (黄帝内经) did not advocate ghosts and gods, whereas, Dong Zhongshu performed sacrifices to heaven for it to rain or not rain. As a matter of fact, Dong inherited the theories of Yin–Yang and Five Elements as well as the philosophy of qi and gave them a certain social perspective and political slant, completely different from the Huangdi Neijing (黄帝内经) which carried them forward towards a more naturalistic worldview. 11

 Liu Xin, a famous editor of classic documents and mathematician at the end of the Western Han Dynasty.

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This means that the time span for the composition of the Huangdi Neijing (黄帝内经) from the above discussion is in fact shortened to sixty years (from 239 BCE to 179 BCE) during the early Han period when the thinking of Huangdi and Lao Tzu was at its height, a time a little bit earlier than Liu An’s completion of the Huainanzi (淮南子). Recent years have witnessed quite a number of papers on the dating of the Huangdi Neijing (黄帝 内经). For instance, Professor Ren Yingqiu and Professor Long Bojian researched this with a separate date for each chapter.12 Also, it does make some sense that many authors take as proof specific words or expressions — the numbering of years with heavenly stems and earthly branches, or calendars, or different terms for beans such as “Shu” or “Dou”, or the term qianshou (黔首, black head)13 and so on. However, some unimportant terms, which can be used and changed or even tampered with by later compilers, can never be sufficient proof. For instance, to refer to beans, the Huangdi Neijing (黄帝内经) adopted “Dou” but not “Shu”, while the Nan Jing (难经) did it the other way around. Can we take this as proof that the Nan Jing (难经) was earlier than the Huangdi Neijing (黄帝内经)? Of course not! As for the term qianshou, it is true that it appeared in the pre-Qin period and continued to be used after the Qin. But it was by no means a term only for the Qin people. Therefore, only those essentially academic expressions like “primordial qi”, the “inter-generation of the five elements” and so on could be acceptable, because they deserve serious consideration. Any random alterations must be unacceptable. However, the background to the composition of the Huangdi Neijing (黄帝内经) is my foremost concern. More evidence for its social and cultural background will be provided below.

52.  Medical Schools, Lord Cang,14 His Masters and Apprentices A study of the social and cultural background from the Warring States to the early Han period reveals the unity of the Qin and Han Dynasties, following the upheaval and secession of the Warring States together with the 12

 Ren Yingqiu et al. Collected Papers on the Studies of Huangdi Neijing, Hubei People’s Publishing House, 1982. Long Bojian, Overview of Huangdi Neijing, Shanghai Science and Technology Press, 1980. 13  A term for the common people, used in the Warring States Period and Qin Dynasty. 14  Chunyu Yi (probably 215–140 BCE), a renowned physician of Chinese medicine in the Western Han Dynasty, who was also called Lord Cang as he once occupied the position of head of the Tai Cang (a state granary) at the imperial court.

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contention of ‘a hundred schools of thought’. However, political unity does not embrace or simply imply academic integration — and differing schools continued to exist. Just as there were differing schools during the pre-Qin period, medicine could never be mono­lithic. It belonged to the arts and skills related to doctoring and, generally speaking, physicians during the Qin and Han were all occultists, and were recorded in the category “Records of Arts and Skills — a Brief on the Fangji (方技)” in the book Han Shu (汉书) — in which “Medical Classics” and “Classical Prescriptions” are two chapters directly relating to the medicine of the day. By nature, medicine belongs there as well the arts and skills of fangzhong 房中, i.e. sexual health, and the shenxian 神仙, i.e. the arts and skills of immortality. Let’s take a further look at the two chapters “Medical Classics” and “Classical Prescriptions”: “‘Medical Classics’ shows the physical state of the blood and vessels, the main and collateral channels, the bone marrow, the Yin–Yang, and the exterior and interior — in order to find out the causes of disease and to keep alive the dying; it also tells of treatment methods — using, as suitable, acupuncture or stone-needles, various herbs clinically-fired to gain a component potion. The most appropriate treatment is the proper use of the ‘inter-promotion of medicines’ to remove disease — just as ‘a magnet attracts iron’. On the contrary, unqualified physicians, in violation of the principles and said to ‘create a serious disease out of a light one’ and ‘cause the living to die’.” This is the same in present medical theory. “‘Classical Prescriptions’ shows how to use herbs in prescriptions, that is, according to a diagnosis applying the suitable cold or warm nature of medicines, and by virtue of their properties and flavors make a medical reflection — using the natural climate as a reference point, and distinguishing between different medicines agreeable to the internal organs so as to find a different medicine, with a different cold or hot nature, which can then be used to dredge stagnation and to relieve the crux — thus to eventually restore health. While, on the other side any misuse of a medicine would worsen the condition — the cold becomes colder and the hot hotter, which would damage the vital essence. Such would be a mistreatment. Hence the proverb, A disease without treatment could have a middle level of therapeutic effect which is better than an incorrect treatment.” Such physicians were like the therapists of today. It is probably owing to there being differing results after appropriate or inappropriate treatments that there exists a saying “better leave it alone than treat it, then you’ll at least get a result which is neither good nor bad”.

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These masters of classical prescriptions might be categorized into an empirical school, whose works, according to the records, number 11 altogether, include the thirty rolls of Twelve Prescriptions for Pain of the Internal Organs (五脏六腑痹十二病方), the forty rolls of Sixteen Prescriptions for Hernia of the Internal Organs (五脏六腑疝十六病方), the forty rolls of Twelve Prescriptions for Febrile Symptoms of the Internal Organs (五脏六腑 瘅十二病方), the 26 rolls of Sixteen Prescriptions for Anemofrigid Febrile Symptoms (风寒热十六病方), the 23 rolls of Prescriptions by the Originals Huangdi, Bianque and Yufu (泰始黄帝扁鹊俞拊方), the 31 rolls of Eleven Prescriptions for Centrical Injury of the Internal Organs (五脏伤中十一病方), the 17 rolls of Prescriptions for Mad Disorders of the Internal Organs by Exogenous Attack (客疾五脏狂颠病方), 30 rolls of Prescriptions for Convulsions with Incised Wounds (金创瘛疭方), the 19 rolls of Prescriptions for Women and Children (妇人婴儿方), the 32 rolls of Preparations of Decoctions (汤液经法) and the seven rolls of Dietetic Incompatibility in Shennong and Huangdi (神农黄帝食禁). All of these, by name and title, are no more than collections of empirical prescriptions and methods of treating internal and surgical diseases, those of gynaecology and pediatrics. If it is true that the medical book unearthed in the Mawangdui Han Tomb titled Fifty-two Prescriptions (五十二病方) is in fact the Prescriptions for Convulsions with Incised Wound (金创瘛疭方),15 it is just as states above: that there was only experience recorded here — and no theory. This being said, it is still difficult to divide all these master prescriptions into different theoretical schools. The medical classics, said to include seven books — the 18 rolls of the Huangdi Neijing (黄帝内经) and the Huangdi Waijing (黄帝外经), 37 in all; the nine rolls of Bianque Neijing (扁鹊内经) and Bianque Waijing (扁鹊外 经), 12 in all; the 38 rolls of the Baishi Neijing (白氏内经) and the Baishi Waijing (白氏外经), 36 in all; the Baishi Pangjing (白氏旁经), 25 in all — comprise in fact only three schools — those of Huangdi, Bianque and Baishi. According to Supplements and Corrections to the Fangji in Records of the Arts and Culture of the Han Shu (汉书艺文志方技补注) (1875?) by Mr. Zhang Ji of Chengdu, Sichuan Province, China, “Baishi”, untraceable in any historical book, means “Boshi”, i.e. Bogao.16 Yet Yao Zhenzong holds the opinion that “Baishi refers to Qibo, hence the name Boshi”.17 15

 Fu Fang, Li Jingwei. On the Book Title of Fifty-two Prescriptions and its Surgical Achievements, Chinese Journal of Medical History, 1981, Vol. 1, p. 19. 16  Zhang Xianshi. Supplements and Corrections to Fangji in Records of Arts and Culture of Han Shu, Volume 1, collection edition of Chengdu Yisheng Hall, p. 20. 17  Yao Zhenzong. Trimming for Records of Arts and Culture of Han Shu, collection edition of Shishi Shanfang, p. 166.

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It was Shantian Qinger, a Japanese professor, who firstly proposed that schools actually did exist at an early phase of Chinese medical history, and that the sect of Huangdi was the first, followed by the sect of Shaoshi — both of which were surpassed by the sects of Shaoyu, Qibo and Bogao, which all eventually resulted in the domination of The School of Huangdi.18 Lately Mr. Li Bocong has put forward an opinion that “The School of Bianque was the first medical school in Chinese history”,19 but it was quite a long period from the beginning of this school until the rise of The School of Huangdi — which took its predominant place during the time of the Southern and Northern Dynasties (265–589 CE). His views are actually overstated. There is no doubt that Bianque was a great medical master during the pre-Qin Period. In those ages, doctors such as Bianque mainly practiced as folk practitioners. Their medical experiences, including their views and prescriptions, were most likely recorded (for instance, by apprentices) and circulated among the common people. Such was the source for Bian’s Biography written by Sima Qian. However, these records may be part of the eleven classical prescriptions but not part of the medical classics, i.e. the Bianque Neiwaijing (扁鹊内外经), which probably represents another tradition. On 12 July 2012, a quantity of bamboo slips was unearthed in the Laoguan mountain M3 tomb of the Han Dynasty in the north suburbs of Chengdu, Sichuan Province. Archaeologists preliminarily believed the writings on slips to be the Medical Books of Bianque (扁鹊医书). Further research is awaited. From some reports it seems there are seven to nine parts of medical books, including one for treating horses. One of them was named Sixty Formulas in which “Bixi says…” is recorded. Some scholar thought the “Bixi” was a homophone of Bianque. From this they identified these works as being part of the Medical Books of Bianque. This is doubtful. There were many herbs discovered in the M3 tomb and some different herbs together seem to be made up into a formula, one by one. These are different from others. This room could have been specially made for the use of a doctor. Nevertheless, it is of course possible that the Bianque Neiwaijing made its appearance earlier than that of the Huangdi Neiwaijing (黄帝内外经), but it could not be handed down until the time of the Southern and Northern 18

 Ren Yingqiu et al. Collected Papers on the Studies of Huangdi Neijing, Hubei People’s Publishing House, 1982, p. 122. 19  Li Bocong. Studies on Bianque and his Medical School, p. 112 and 294.

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Dynasties. A more reasonable explanation is that when the thinking of Huangdi and Lao Tzu was quite popular during the early Han period, some medical researchers included parts of the Bianque Neiwaijing (扁鹊内外经) within the Huangdi Neiwaijing (黄帝内外经) or Nanjing. As for the opinion that Qibo or Bogao was actually Baishi, if it is true, then the Baishi Neiwaijing (白氏内外经) becomes another major part of the Huangdi Neiwaijing (黄帝内外经). It is obvious that the author of the Huangdi Neiwaijing (黄帝内外经) held Huangdi in esteem — but more personages are needed in the writing form, and as a result all these characters appear as mentors in the book. Bianque, the famous physician of history, could never be the mentor of Huangdi because Bianque actually existed; thus Qibo and Bogao, unreal characters, were the choices. Hence the array of characters in this book. Bogao also appears in the Chuang Tzu (庄子), and Qibo in the Historical Records – Fengshan Book (史记·封禅书) as “when Huangdi offered sacrifices to Mount Tai, Fenghou, Fengju and Qibo ordered him to worship at East Mount Tai…” Both, by popular account, were contemporaries of Huangdi and also senior to him. Three medical classics, namely the Huangdi Neiwaijing (黄帝内外经), Bianque’s Neiwaijing (扁鹊内外经) and Baishi’s Neiwaijing (白氏内外经), were recorded in Liu Xiang’s Qilue (七略) and Ban Gu’s Han Shu (汉书). It is explained that “the Fangji (方技), practiced in the arts of prolonging life and keeping health, were some of protectors with a position at the imperial court. Qibo and Yufu in ancient times, as well as Bianque and Qinhe in middle antiquity, who once discussed state affairs by means of disease analyses, also spoke on how to run the government using the terms of disease diagnoses. It’s the same for Lord Cang who made his contribution to the thriving early Han. Nowadays, the arts and skills of the Fangji have almost sunk into oblivion, so we must mention them and their books in order to pass on their ideas.” A sadness can be sensed in these words. Yet these authors did not know that there were secret and unknown schools of Chinese medicine around at that time, and Fangji did not sink into oblivion. Lord Cang, named Chunyu Yi, was one of the hidden members of this clan. According to the Historical Records – Biography of Lord Cang (史记·仓公列传), Lord Cang, with the family name Chunyu and first name Yi, was officially the chief of Taicang (a state granary), in Qi State. He was not a professional physician, but possessed the excellent art of medicine and “treated people with a diagnosis, so that whether the patient would turn out dead or alive — he was always right”. Nevertheless, he liked “to travel frequently and be a guest to feudal princes, was rarely at home and

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sometimes this would be resented by patients as he could not treat their disease.” This is evidence for the style of an occultist. In the 13th year of the reign of Emperor Wen of the Han Dynasty (167 BCE), he was charged with the above faults, and judged guilty. He was sent under escort to the west into Chang’an (today’s Xi’an). Ti Ying, his fifth daughter, appealed to Emperor Wen and said she was willing to be a slave-maid herself to get her father freed from the penalty. Emperor Wen, taking pity on her for her filial piety, at last set Chunyu Yi free. In the same year, Emperor Wen abolished the flesh penalty (i.e. tattooing the face, cutting off the nose, hewing off the feet, etc.). Chunyu Yi returned home and lived such a leisurely life that he was occasionally asked questions by the emperor concerning medicine. If this affair had not happened, it would be unlikely his medical arts would have come to light. Furthermore, all his answers were recorded and kept as part of the imperial archives — which made it possible for Lord Taishi, i.e. Sima Qian, to review and record them in what is called the Book of Diagnosis (诊籍) in which altogether 25 cases are passed down generation by generation, so that later people can consult them. It was in such a fashion that the medical folk secrets represented by his learning, which came from his teacher and the tutoring of his apprentices, came to light. According to historical research, Chunyu Yi was born in 215 BCE (32nd year of Qingshihuang, Yingzheng, the first emperor of China) and died in 140 BCE20 when he was 76 years old. He was 49 years old when he was found guilty. He showed an interest in medicine when young, “but most of his prescriptions did not work”. Later on, he was taught by Gongsun Guang, “learning prescriptions, including the ‘changing arts’ to attain the balance of Yin–Yang and speech skills, and received secret forbidden prescriptions completely”, so much so, that his medical arts were much improved. In the eighth year of Gaohou (180 BCE) when he was 36 years old, Gongsun Guang recommended that he learn medicine from the famous physician Gongcheng Yangqing (i.e. Yang Zhongqian) who was then over seventy years old. It was from this mentor that “he received the books by Huangdi and Bianque, learned to diagnose diseases by observing the five colors on the face which enabled him to make proper judgments as to whether patients were curable or not, and perfect his medical theories and arts.” Three years 20

 He Aihua. Studies on the Birth and Death Year of Chunyu Yi, Chinese Journal of Medical History, 1984, Vol. 2 and Ma Boying. Three Corrections on ‘Historical Records-Biography of Lord Cang’, Da Gong Bao Newspaper, Hong Kong, 15 August 1985.

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later, “he tried to treat patients to save their lives and it worked.” A year after he had completed his study (176 BCE), Yangqing died at the age of nearly eighty. The apprentices of Lord Cang included Song Yi, Gao Qi, Wang Yu, Feng Xin, Du Xin, Tang An and so on, none of whom were official, professional physicians. There is also a “Lord Cang Isolated Prescription” in Volume 12 of the Invaluable Prescriptions for Ready Reference (千金要方) by Sun Simiao. Private tutoring of medical arts can be roughly sensed from the above. It is a coincidence that Lord Cang and his mentors and apprentices make a group of nine and Bianque, also known as Qin Yueren, together with his mentor Chang Sangjun and his apprentices, also make a group of nine. These can be taken, at least, as two small groups existing at that time — and bring a clearer vision of how tutoring worked in different schools. The fact that Yangqing instructed Lord Cang with “books on diagnosis through taking the pulse, using the method of Huangdi and Bianque” reveals that the collaboration of the schools of Huangdi and Bianque was already taking place.

53. The Huangdi Neijing (黄帝内经) and Secret Medical Schools Lord Taishi said, “It was the one practicing medicine who brought disaster to Bianque, and Lord Cang himself was punished for lying low” Historical Records – Biographies of Bianque and Lord Cang (史记·扁仓列传). It seems that the death of Bianque boosted not only concealment by later physicians but also the rise of secret groups in the form of mentors and apprentices. Such a conclusion by Sima Qian suggests that the number of hidden physicians then must have been quite a few, which also might be the reason why there are so few named physicians during the Western and Eastern Han Dynasties mentioned in the historical records. The seclusion of Fuweng has something in common with that of Lord Cang. Especially with regard to medical tutoring, both Gongsun Guang and Yangqing were warned repeatedly “do not instruct others” and “be careful not to unleash on my offspring that which you learn in my prescriptions.” Do not teach “if he is not the particular one”. Chunyu Yi answers, “I would rather die than teach someone freely.” The fact that Yangqing insisted on the ignorance of his descendents reveals clearly how secretive it was to teach medical arts. There must have been some particular form for these secret folk medical groups — since they did exist in the real world. There are a few mentions in the Huangdi Neijing (黄帝内经). In the Suwen – On Sanbu Jiuhou (素问·

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三部九候论), Huangdi, when seeking instructions from Qibo, said, “I would like to learn their principal rules in order to show my descendents and let them pass down by generations, engraved on the liver and lung and imprinted on the bones, and I will receive your instructions by smearing the blood of sacrifice on my mouth to swear an oath — and never reveal anything to others at random.” His repeated stress on “do not teach if he is not the particular one” and “do not instruct if he is not sincere” (Suwen – On True Words Hidden in Golden Chamber (素问·金匮真言论)) is similar to the sayings of Yangqing and Gongsun Guang. To smear the blood of a sacrifice or person on the mouth was a very common rite — forming a secret folk association in China. More descriptions appear in the Lingshu – Jingfu (灵枢·禁服). When Leigong inquires of Huangdi on the essence of the diagnostic method by taking the pulse of Sanbu Jiuhou, and of acupuncture, “Huangdi answers, ‘Good question! But this is forbidden by my teacher who insisted on private instruction because we had made a wound on our arms and drunk some of each other’s blood, smearing it on the mouth as an oath. If you want to learn, why not make a fast and then the rite?’ Leigong grovels again, and says, ‘I sincerely demand your instructions as to a rite such as this!’ So after three days’ fast, he turns to Huangdi and asks, ‘Today is the full Yang day. Could I take a rite now and make a covenant?’ Thereafter, in the fasting room, both Huangdi and Leigong cut wounds on their arms and smeared each other with blood. Huangdi himself prayed, ‘Today is a full Yang day, we make the rite of smearing blood. Now I would teach the prescription-book to you. You are to keep it private. Otherwise, you’ll be punished.’ Leigong bows his knee again and said, ‘I will act on.’ Huangdi, with his left hand holding the hand of Leigong, gave him the book and said, ‘Caution! Caution! Let me tell you now…’” The rite usually consisted of four steps, namely a three-day fast, armcutting and blood-smearing, a covenant-making with heaven, and a book-giving with handholding, along with praying words — which recalls the rites of witchcraft. This also appears in other chapters, for example, “I’ve heard that the wisest and clearest truth is that which is helpful for the cause of a wise man. These books with their clearly expounded words are such that a fast together with a careful choice of day is needed to receive them.” “Huangdi then chose a lucky day and kept them carefully in his secret chamber to pass them on down, for later generations.” So these rites were quite sacred and accompanied by a mysterious strictness. Yet this was simply what they consisted in — donating or passing on

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books to others; initially, there must have been a grander rite for the joining together of master and apprentice, which could be taken by secret medical groups with a strong witch-like flavour attached to an after-rite, where a mentor–apprentice relation would become established. The secret group of Lord Cang and his apprentices had something in common, both in constitution and function, with that of Huangdi and his apprentices. Lord Cang from Gongsun Guang “learnt prescriptions, including changing arts to attain the balance of Yin–Yang and speech skills, and received prescriptions all totally”. From Yangqing he got “the prescription books written by Huangdi and Bianque, and learned to diagnose disease by observing the five colors on the face” as well as receiving “books on medical views” and “books on secret prescriptions” including the Maishu (脉书), the Shangxiajing (上下经), the Five Colors Diagnosis (五色诊), the Qikeshu (奇 咳术), the Kuiduo (揆度), the Yinyang Waibian (阴阳外变), the On Medicines (药论), the Shishen (石神), the Forbidden Book on the Sexual Intercourse of Yin–Yang (接阴阳禁书) and so on. The medical books unearthed from the Mawangdui Tomb were predecessors to the Huangdi Neijing (黄帝内经). Gongsun Guang and Yangqing both came from Linzi, in the area of the Qi and Lu states; that Chunyu Yi “came from the same place” (同产处) has been explained as them being “twins”, but that is wrong — it means the same birthplace. Both of Chunyu’s mentors, living at the end point of the Warring States Period, were edified by the School of Jixia (稷下学派) which flourished in the Qi State at that time. They mixed up the natural philosophy and medical science of the pre-Qin period, so it was quite natural for them to be in touch with differing schools: like those of Huangdi, Bianque, Baishi (i.e. Qibo or Bogao) and others. So natural was it that it was like the proverb, “the pavilion beside the water gets to see the moon earlier through its reflection”. The Huangdi Neijing (黄帝内经) is centred on Huangdi accompanied by “five mentors” (Qibo, Bogao, Shaoshi, Shaoyu and Guiyuqu) and one apprentice (Leigong, who could be different from the God of Thunder). According to what these people discussed, these could be taken as five schools, or masters in five different fields. Among them, Qibo, who acquired the most comprehensive knowledge, was good at expounding on medicine, internal and surgical diseases. Bogao was skillful in anatomy, physiology and pathology; Shaoshi was particularly great in psychology and ENT diseases; Shaoyu was rich in the knowledge of spirits, bodies, foods, etiology and pathology. All were masters of acupuncture and could treat diseases with medical herbs. Only Guiyuqu, who made his one and only appearance in the Tianyuanji Dalun (天元纪大论) when he talked freely on astronomy and geography (with but a word on medicine), was an astronomical

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geographer, especially great on Yin–Yang and the Five Elements. So he might not have been a physician. His identity matches with that which is discussed in the Historical Records – Fengshan Book (史记·封禅书), “thus he began the timing sequence — and the world moved around in circles” which belongs to astronomy. However, this chapter was important as it helped people understand natural ecology. Leigong himself was apprentice to Huangdi and without doubt he inherited his theories completely. When it comes to the written form of the Huangdi Neijing (黄帝内经), by analysis,21 there are 168 chapters in the present version and 86% of them, that is, 124 altogether, were written in the form of questions and answers. Therefore, it is most likely that they are some kind of recorded dialogue — which became the basis for the later writing of the book, where a question-and-answer form could not be produced simply out of an author’s imagination. These notes are similar to the type of notes taken at today’s higher medical educational institutions (postgraduate teaching for instance; they at least belong to the further education of senior physicians). In this case, Lord Cang, with a medical basis, received further education from Gongsun Gang and Yangqing, especially the latter who gave Cang the books written by Huangdi, Bianque and other masters and circulated them privately at the end of the Warring States. Furthermore, the 21 books mentioned or quoted in the Huangdi Neijing (黄帝内经) include the Maibian (Changes of Pulse 脉变), the Five Colors Diagnosis (五色), the Kuiduo (揆度), the Shangxiajing (上下经) and so on, which were very likely those mentioned in Lord Cang’s answers to the inquiries made by Emperor Wen. Therefore, a bold hypothesis might be that Huangdi in the Huangdi Neijing (黄帝内经) really is the incarnation of Yangqing. It was written under the name “Huangdi”, but by common practice “to publicize their theories and doctrines, the advocators needed to explain them by using the names ‘Shennong’ and ‘Huangdi’” (from The Huainanzi (淮南子)). To make a further point, Leigong (雷公) might be Lord Cang (仓公), both terms in Chinese differ by just one character. Placing the books of different schools under the name of the mentors of Yangqing, i.e. the mentors of Huangdi, brings the other names of Qibo, Bogao and so on to the front of stage. It should come as no surprise to uncover the identity of Huangdi’s apprenticeship because it is common for him to be depicted learning medicine in Huangdi Neijing (黄帝内经) — just as is described in the Zaiyou chapter 21

 Ma Boying. Research on the Writing Form of the Huangdi Neijing, Traditional Chinese Medicinal Research, 1990, Vol. 2.

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(在宥篇) in Chuang Tzu (庄子), where Huangdi, when inquiring of Guangchengzi on the art of longevity, stated that he “walked on his knees and made a deep bow towards him”. As for the mentor–apprentice relationship described in the Huangdi Neijing (黄帝内经), Qibo is respectful, while Huangdi is humble. If Qibo was not respectful, it would show insufficient respect to an emperor like Huangdi; likewise, if Huangdi was not humble, it would not reveal his identity as apprentice. Yet this is hard to justify because of the restrictions of the recorded notes. However, it must not be the case in those chapters that are not in the question-and-answer format, which have been extracted directly from existing literature. Here, further evidence becomes clear for the hypothesis of the recorded notes between mentor and apprentice being the basis for the later writing of the Huangdi Neijing (黄帝内经). For instance, the following is a dialogue typically reflecting the behavioural relationship between mentor and apprentice: … Qibo made a deep bow and kneeling again, answered, “What a recondite question! It has put me in an awkward predicament. Only a sacred emperor would pursue such profound truths! Now please let me tell you everything I know about it.” Cupping one hand into the other before his chest, Huangdi humbly said, “you have enlightened me in a way that though my eyes have never caught sight of it, nor my ears heard its number, yet still I can clearly understand what you mean — with good sight and sharp hearing.” Qibo said, “this is because the sages are easy to communicate with — just as a good steed is easy to tame.” Huangdi then said, “I’m not such a sage. It’s said that truths and principles can broaden one’s mind. Right now, I want to enquire of you about these truths for the simple purpose of getting rid of obscurities and solving the puzzles, which means these are far from profound theories. Yet I’m still eager for your explanations to get the best of their meanings. I’ll keep them in the Golden Chamber and never divulge anything of them at all.” Then Qibo kneeled again and standing up said, “then let me explain them to you right now…” [Suwen – On Qique (素问·气穴论)]. But this hypothesis does not mean that the Huangdi Neijing (黄帝内经) is just a collections of notes from Yangqing’s instructions to Lord Cang; it suggests Yangqing had already retained some recorded notes, later taken by Lord Cang — who then, while learning from Yangqing, made new notes related to those chapters in which Huangdi instructed Leigong. Lord Cang

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had stayed home for 14 years and it might be during this period that he collected the notes of his answers to the inquiries by Emperor Wen — as he had sufficient time and the right conditions. Indeed, this hypothesis is probably ungrounded. Yet, I still believe it is either the recorded notes of Lord Cang and his mentor, or some other similar secret folk medical group that made up the Huangdi Neijing (黄帝内经). In short, there should be no doubt in anyone mind, that it must have been written by some secret folk medical group. Another stimulus for book-writing by Lord Cang might relate to the proposal by Lu Jia (陆贾240–170 BCE) who was a famous statesman, thinker and writer during the initial stages of the Han dynasty, and contributed to the development of early Taoism: “Deal with affairs abiding by their rules, and to take medicine for its good function. Books do not have to be written by Confucius, and prescriptions do not have to be put together by Bianque. All that is good is that they correspond to the facts, or needs and can be in line with the law — that one can follow them and act according to the real circumstances” (see New Words – Shushi (新语·术事)). Being exiled to the west in Chang’an provided Lord Cang with a chance to listen with his own ears to the enlightened remarks made by politicians who advocated the thinking of Huangdi and Lao Tzu, and thus he may have been inspired or “encouraged”. In brief, it was during the prosperous time under the rule of the Wen and Jing Emperors that the thinking of Huangdi and Lao Tzu enjoyed fair popularity, and that the Huangdi Neijing (黄帝内经) was composed, as the time was just right. However, the good times don’t last long. With the Wu Emperor of the Han Dynasty claiming the throne, “rejecting all kinds of theoretical schools, except Confucianism”, the thinking of Huangdi and Lao Tzu was replaced by Confucianism. To make matters worse, with the Wu Emperor’s adoption of Dong Zhongshu’s proposal “banning all ways not in compliance with Confucianism and those which prevent its development”, the books hidden in folk circles like the Huangdi Neijing (黄帝内经) were eventually deprived of the chance of coming into the spotlight, once and for all. Classic Challenges (难经), its full title being Huangdi’s Eighty-One Classic Challenges (黄帝八十一难经), is believed to be a book written to explain the Huangdi Neijing (黄帝内经), and must have been composed soon after the Huangdi Neijing appeared. It might otherwise have been a book newly created, to supplement it. It is also possible that the 81 topics in it are most likely notes — recorded during the giving of instruction in

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the Huangdi Neijing (黄帝内经), between mentor and apprentice. Yang Xuancao of the Sui Dynasty, in his preface to its second annotation, said, “Huangdi’s Eighty-One Classic Challenges (黄帝八十一难经) was written by Qin Yueren22 of Bohai… there are two volumes to the Huangdi Neijing (黄帝内经), each of nine rolls. Its profound content makes it quite hard to understand. So, Yueren selected their essence, wrote out their quintessence and put it down in a book. Compiled into rolls, its eightyone topics were devised to explain profound truths, to probe abstruse implications and to enlighten later generations, thus it was named the Eighty-One Challenges.” It is surely incorrect for the preface to say that it was Qin Yueren who made the book. It would be more likely that the book was written by some successor of the school of Bianque, as Li Bocong proposed. The Huangdi Neijing, though it already had absorbed some of the school of Bianque, still had some ideas missing. For instance, the idea of the “left kidney and right life-gate”,23 that one “could solely take the cunkou pulse for diagnosis”, that “the Sanjiao has a name but is invisible” and some other specific anatomical data are not found in the Huangdi Neijing. It is quite possible that another medical group challenged it and put forward these ideas so as to bring its medical theories closer to perfection. There must have been other similar folk medical groups around then, which were always kept secret and not strictly mentioned in historical books. The above-mentioned Fuweng, “a man from Luo County of Guanghan Prefecture, often cast his fishing line into Fu River and made his living by begging among the people. When seeing patients, it was common for him to treat them with a stone needle, and it worked instantly. So later he wrote a Needle Book (针经) and Ways to Feel the Pulses (诊脉法) — to pass his knowledge on, down to later generations” (Han Shu – Biography of Guoyu (汉书·郭玉传)). However, there is no record of his life available, as he wrote books in seclusion in the folk world. It was only when Guo Yu, an apprentice to Cheng Gao (Fuweng’s pupil), was recruited as imperial assistant physician that the secret group was brought to light.24 22

 That is, Bianque.  According to the Challenges, between the two kidneys, the left one is the kidney, while the right shows the life-gate. 24  It is worth noting that in the Han tomb M3 of Laoguan Mountain in Chengdu was recently unearthed a small wooden model person in which the 27–28 Jing–Luo meridians and more than 100 points were marked. Chengdu TCM University appraised the totally tally with modern charts of acu-meridians and points. If so, this is the earliest model of acupuncture. 23

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There was also Han Kang, living in the post-Han Dynasty,25 who often gathered herbs in famous mountains to sell at non-negotiable prices in Chang’an City, for over 30 years. Once a woman wanted to purchase some herbs from him, but he would never negotiate. The woman was so angry and said, “Aren’t you Han Boxiu26 who never negotiates?” With a sigh, Kang responded, “I meant to conceal my name, but now even this little woman knows it. How can I continue to deal in medicines?” So then he fled to Mount Baling and would not accept the offer of a title such as boshi or gongche.27 Later he even escaped along with his Taoist magic, although Emperor Huan sent black silk money as a great gift to him and a one-horse carriage,28 in order to engage him — he fled. He eventually died a peaceful death. Thus, we can see that the anonymity of physicians during the Eastern and Western Han Dynasties was quite a common occurrence. However, the Imperial governments’ attention was directed to these concealed occultists later, because of another side of occult medicine, as we will see below.

B.  Another Side to Taoist Medical Science According to the Han Shu – Records of Arts and Culture (汉书·艺文志), the Fangji (方技) did not just simply dabble in Medical Classics and Classical Prescriptions, but also in the sexual arts, the skills of health and pursuits or arts of longevity, and skills of immortality, all of which, because of their concern with keeping well and a spiritual long life, were closely related to medicine and thus formed part of it at that time. What is more, the occult physicians, by making positive as well as negative contributions to medicine, did things with vigour and vitality.

54.  The Occultist’s Art of Well-Being29 The Confucians believed that, “Life and death are determined by fate, wealth and one’s rank, decreed by Heaven”.30 The occultists and Taoists were 25

 That is, the Eastern Han Dynasty, compared to the Western Han Dynasty which is also called the Pre-Han Dynasty. 26  That is, Han Kang. 27  Official titles during the Han Dynasty. 28  Such a carriage was used for the passenger to sit comfortably during the Han Dynasty. 29  “养生” (Yangsheng), I use the “Well-being” which commonly is also called “Keeping Healthy”. 30  From The Analects of Confucius – Yan Yuan (论语·颜渊).

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totally distinct from this, in that they upheld the “art of immortality” and the “medicine of immortality”, i.e. an elixir. The book of Lao Tzu (老子) says, “to make a foundation with deep roots and firmness, that is the way of durability and longevity.”31 Guan Tzu (管子)32 proposed that “Anything mortal is formed of spirits from heaven and bodies from the earth, both of which, together just constitute a human being. So, when they are in harmony with each other you can have life, while without harmony you can’t. It is difficult to observe — as the internals of harmony are invisible, and neither is there any analogy of the externals available. Yet immortality can still be achieved, by keeping peaceful in mind and resolute in heart.”33 These occultists believed that people could determine their own longevity, or at least keep healthy enough to attain longevity, or even immortality. Abstinence was the first priority in the process of keeping healthy, just as is revealed in the words “keeping to abstinence hurts no-one”34 and “avarice causes unsmoothness in life — so the sage must only keep a moderate desire”.35 “If there is a kind of sound which pleases the ears but also deafens them, nobody would like to listen to it. If there is a color which pleases the eyes but blinds them, nobody would like to see it. If there is a food which pleases the mouth but makes it dumb, nobody would like to eat it. Therefore, the sages’ attitude toward sound, color and taste are to take them in if they are helpful to life and discard them if they are harmful to life… when going out and taking a carriage, and aiming for ease and comfort, this forced enjoyment ought to be called the ‘bringing-the-feet-into-trouble vehicle’. When a man takes meat, drinks wine and forces himself to do so, in such a case, this food ought to be called the ‘rotting-the-guts food’. If a man is obsessed with women and revels in the music of lustrous enjoyment, such lusts and music should be called the ‘felling-the-life axes.’”36 In the words of Chuang Tzu – Tianyun (庄子·天运), “a man with a gentle and quiet temperament and taking it easy in life, will free himself from the worry of disease and be protected from the damage of pathogenic qi. He can also be free to stick to his moral principles whilst his mental force and spirits remain unhurt… keeping a pure and serene state and feeling ‘nothingness’ are the way to conform to the true state of nature.” This may also be considered to 31

 See Chapter 59 in Lao Tzu (老子).  A book by Guan Zhong (725–645 BCE), a renowned philosopher and statesman in the Spring and Autumn Period. 33  From Neiye (内业) in Guan Tzu (管子). 34  Ibid. 35  Ibid. 36  From Mr. Lu’s Spring and Autumn Annals – Bensheng (吕氏春秋·本生). 32

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be “keeping to abstinence”, and using the still and quiet mind to nourish and protect the essential qi. Yet abstinence is also not such a major or significant factor. There are other active ways of keeping healthy, among them exercises combining deep breathing and physical movement. In the Daoyintu (导引图) drawing unearthed at Mawangdui, the 44 animal moves, with sidenotes describing “moving a stick to make a balance between Yin and Yang”, “moving like a bear climbing a tree”, “moving stretching the back like a harrier”, “moving alternately covering and uncovering the ears to avoid deafness”, “movements of the knees to remove pain” and so on, can all heal disease and help attain good health and longevity. These are the continuation and sublimation of ancient dances and exercises. Hua Tuo’s Five-Animal Exercises were most likely to have been born out of them. The silk book, the Qugu Shiqi Pian (却谷食气篇), unearthed from Mawangdui Tomb, deals with methods of breathing which regulate the Qi flowing in the channels, such as “taking pyrrosia leaf instead of grain”, “shiqi means breathing in and out”, “the rising sun dries everything”, “breathing the evening mist and dew together”, etc. Here, qugu means “fasting” or not eating. You are advised to eat qi and drink the colourful cloud flows, through the correct methods of breathing. However, it is a pity that only barely 300 words have survived and further details are unavailable. Yet a similar opinion is conveyed in the words of the Chuci (楚辞): “I’d eat the six essences and drink the dew and mist, oh! I’d rinse my mouth with morning cloud and sunbeams new. I’d keep my spirit pure and limpid, oh! Exhale the foul and inhale the essential qi.”37 So then, both express the same idea. The practice of qugu shiqi also includes the activity of fuer (服饵, “eating bait”). The above method of “taking pyrrosia leaf instead of grains” is such a case. Again the Chuci (楚辞) states, “To ascend the Kunlun Mountains, oh! Eating the cream of jade. oh! It will make people live as long as heaven and earth; brilliant as the Sun and Moon.”38 These words express the same idea. In the past 30 years, 10 pieces of Han Dynasty bronze mirrors have been unearthed in Hunan Province with the picture of “an immortal drinking from the jade spring”, inscribed with the words, “these imperial mirrors are so large, exquisite and ingenious, that the immortals living on them drink from the jade spring when thirsty and eat dates when hungry, 37

 Translated by Xu Yuanzhong.  Ibid.

38

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and never feel old”.39 From these remains, we know that the method of “drinking from the jade spring” was one of the methods of “taking bait”. However, it seems that this way of keeping healthy and preserving wellbeing was not one upheld by Chuang Tzu (庄子), who may have pursued something higher: “Adopting the special method of breathing, getting rid of the stale and taking in the fresh, stretching the limbs or wings like a bear or bird — all these are only a way to prolong lives, and all these doers of Daoyin, and the like, aim at keeping healthy, such as the ‘macrobians’ Pengzu (彭祖). However the natural way of heaven and earth is so supreme and eulogized by everyone — that it can just be achieved indifferently by the sages’ inaction — they do not strive sedulously for perfection but gained high-level respect, without any special study they attain humanity and justice, without official rank everything is done according to rule, without ‘flowing like a sea or river’ they still feel free, without any Daoyin they attain longevity. Forgetting everything — then they can get everything.”40 There is a story in Chuang Tzu: “A man was swimming in a river too wild even for giant turtles, alligators, or fishes to attempt. Seeing this, naturally Confucius mistook him for a ghost — but he turned out to be a man when he reached dry land. So Confucius asked the man his Way (道) of swimming, and the man answered, ‘I have no special Way at all. I started here since I was born, grew up here so it is familiar, such torrential waters are my fate.’ ‘I was born on dry land, that is my cause; I grew up with this river and such is my personality; I do not know why it is, but I just follow fate.’”41 Through these words, Chuang Tzu proposes the principle of wellbeing and conforming to nature, i.e. living with fate. Thus, he says, “keeping innocent, without distraction, focus intently and calmly all the time and don’t change at all... be silent and when indifferent, practice non-action, when acting, comply with natural laws.”42 Chuang Tzu’s view on well-being can best be represented by the words of Guangchengzi43 in the following story: Guangchengzi (广成子, an earlier Taoist mentioned in Chuang Tzu and contemporary of Huangdi) was lying with his head facing south when Huangdi, on the leeward side, crept in on his knees. With a deep bow, Huangdi asked, “I’ve heard that you have 39

 Zhou Shirong. On the Han Dynasty’s Bronze Mirror with a Picture of An Immortal Drinking from a Jade Spring, Journal of Chinese Medical History, 1984, Vol. 2. 40  From Chuang Tzu – Keyi (庄子·刻意). 41  Ibid. 42  Ibid. 43  An immortal in Taoism.

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attained the ultimate Tao. May I ask by what methods of keeping well I can attain longevity?” Guangchengzi rose abruptly and said, “A good question! Come then. Let me tell you what is the ultimate Tao. The essence of the ultimate Tao is broad and profound; while it’s extreme is shapeless and soundless. Do not watch and listen, keep mentally calm. Then the body naturally goes its own right way. You must keep tranquil and sober. Do not exhaust the body. Do not disperse your spirits either. By these means, you will attain longevity. Nothing seeing; nothing hearing; nothing knowing, then spirit sticks and body is immortal. Be cautious about internal cultivation, obstruct external interference. Knowing too many trifles causes failure. Now I have led you to the highest and brightest state, and to the primitive nature of the Yang. I can lead you to the land of the ultimate Yin through the Indistinct Distant Gate. Everything in nature, in heaven and earth has its own function and Yin and Yang have their concealments too. So take care of your own body, and it will grow stronger by itself. As I have been sticking to this One Rule and keeping in harmony all this time, so have I kept my health one thousand and two-hundred years without any weakness of old age…”44 In Chuang Tzu’s opinion, those ways to attain a long life as practiced by Pengzu (彭祖) are basic but inferior, while the Shenren (神人), Zhiren (至人) and Zhenren (真人) — who are all immortal — belong to three higher levels of longevity. Chuang Tzu (庄子) tells us the following: In the mountains of Miaoguye, there lives a Sage (Shenren神人) whose skin is as white as snow and who moves as gracefully as a maiden. She breathes the wind and drinks the dews, but eats not grain. She walks on clouds and rides on a flying dragon, to travel beyond the four seas.45 He also says this: “The paramount figure (Zhiren 至人) is miraculous, he will not be scared by ardency, everywhere, even the great lakes firing up will not do it, and he will not feel cold when both the Yellow River and Han River freeze up. He will not be frightened by the mountains, blasting thunder or the seas, swelled up with the storm winds. Yet still riding the clouds and driving the sun and moon, these folk may travel beyond the four seas, everywhere, and remain untouched — both in death and in life.”46 44

 From Chuang Tzu – Zaiyou (庄子·在宥).  From Chuang Tzu – Xiaoyaoyou (庄子·逍遥游). 46  From Chuang Tzu – Qiwulun (庄子·齐物论). 45

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He also says this: “The Zhenren (真人person with detached wisdom) of ancient times does not have dreams during sleep, does not worry during their sober state, and does not care about the taste of the food they eat. Their breath was subtly deep — and could go through to the heels — while mediocre people only take in the breath though their throat.”47 These are close enough to (or even exactly like) “immortals”. The Huangdi Neijing (黄帝内经) also describes four kinds of people, like the person with “detached wisdom”, the “paramount figure”, the “sage” and “virtuous man”, all similar to those mentioned above. However, the latter describes people not immortal gods, which is to say something about keeping healthy, not about methods of immortality. Yet in the Chuang Tzu (庄子), the methods of keeping healthy in order to attain immortality take qi as their basis, which is nearly the same thing. This book describes “keeping the pure and peaceful qi… never overdoing it and hiding in the time-circle which has no beginning or end, acting among the ever-changing myriad of things, from start to finish. Concentrated attention on nature, nurturing qi, and making virtue and behavior in perfect agreement are all essential and will enable a person to communicate with the natural myriad of things. Someone such as this can stick to their natural disposition and keep their soul intact, which makes it unhurtable.”48 Thus, we can see that Chuang Tzu was hesitating between a commonplace person and an “immortal”. What is mentioned above is in complete agreement with what was believed by the occultists of the Qin and Han. Hence, there appeared quite a number of stories such as the following: Zhang Liang, a minister during the early Han Dynasty, “had suffered quite lot of different kinds of diseases but since he entered Huangu Pass,49 he had practiced a method of Daoyin and not eaten grain — and confined himself to his own house for over a year.”50 Later he followed Chisongzi (赤松子), travelled everywhere, and most probably became immortal. Also in the Hanshu (汉书), it is said “both breathing in fresh air and out waste aire, to nurture the internal organs, and focusing on gathering in the essence for the spirit, can be used to keep well — and then it is no problem attaining longevity.”51 In the Huainanzi (淮南子), it is said 47

 From Chuang Tzu – Dazongshi (庄子·大宗师).  From Chuang Tzu – Dasheng (庄子·达生). 49  According to the historical records, Zhang Liang helped Liu Bang establish the Han Dynasty to replace the reign of the Qin dynasty after their troops entered Hangu Pass in 206 BCE. 50  From Han Shu – Biography of Zhang Liang (汉书·张良传). 51  From Hanshu – Biography of Both Gong Bao of Jili (吉立两龚鲍传). 48

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“having no worries or joys helps us reach the ultimate in virtue; being sensitive without caprice, the ultimate tranquility; having no hobbies or desires, the ultimate in ‘nothingness’52; no likes or dislikes, the ultimate peace; and a soul undistracted from physical things, the ultimate purity. Achieving the above five states builds a bridge to immortality.”53 The construction of the Divine Gathering Manna Basin (仙人承露盘) by Emperor Wu of the Han Dynasty was just as Zhang Heng described in his Ode to Xijing (西京赋): “Put up a tall pole with a deity statue on it holding a big basin, to collect the clean dew (manna) from the clouds, and then drink this together with powdered jade at breakfast — it can make one alive and give one longevity.” These are all methods of cultivating well-being, along with qugu and shiqi, and “exhaling the stale” and “inhaling the fresh”. Later the skills and inner practice of meditation (内丹术) were half based on these practices. Another major method of preserving well-being during the pre-Qin period was the Skill of Making Love in Bedrooms (房中术) which, however, did not appear in any book by pre-Qin scholars. It did not occur until the Hanshu – Records of Arts and Culture – Brief on Fangji (汉书·艺文 志·方技略), where it said that “the bedroom arts create the ultimate state of pleasure both sexually and psychologically, as well as the ultimate Tao. Thus wise emperors tried to control bedroom pleasures by promoting musical productions outside and set rules for etiquette within bedrooms. According to some records in the Zuo Zhuan (左传), previous emperors ordered musical productions in order to restrict their pleasures. The joy being under control then could bring longevity, else indulging in bedroom pleasures whilst neglecting other things would bring about disease and make you lose your life.” It seems that bedroom healthcare was once quite popular and later reconciled by music. The latter sentence must have been a Confucian opinion. The related information was recorded in altogether eight books which then were preserved, including the 26 rolls on the Art of Yin by Rongcheng (容成阴道), the 36 rolls on the Art of Yin by Wuchengzi (务成子阴道), the 23 rolls of the Yin–Yang of Yao and Shun (尧舜阴阳), the 20 rolls of the Art of Yin by Tang and Pangeng (汤盘庚阴道), the 25 rolls of the Art of Yin by Tianmu and Others (天老杂子阴道), the 24 rolls of the Art of Yin by Tianyi (天一阴道), the 20 rolls of a Prescription of Recuperating Yang by Huangdi and the Three Kings (黄帝三王养阳方) and the 17 rolls of a Prescription for Having a Son — Conceptions by the Three Schools (三家内房有子方), 52

 That is, Xu, a term in Taoism, meaning a state of no desire or action.  From The Huainanzi – Yuandaoxun (淮南子·原道训).

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mainly written before the Han Dynasty. Unearthed in the Mawangdui Tomb, the Ten Questions (十问), the Intercourse of Yin and Yang (合阴阳), On the Ultimate Tao of Universe (天下至道谈) and so on are in the form of dialogues among Huangdi and Tianshi, Dacheng, Cao Ao, Rongcheng, Zuoshen, etc. blended with some other characters, like Yao, Shun, Pengzu, Prince Qiaofu, Wenzhi, Zhao Emperor of Qin and so on. Judging from these facts, the writing time of these books was most likely from the end of the Warring States Period to the early Han period. They mainly discuss the arts and techniques of sexual intercourse in bedrooms — for the pursuit of “remaining free from aging and becoming youthful again, looking healthy with smooth and bright skin” and “staying away from disease and thus attaining longevity”.54 Their goal was related to healthcare and well-being, and can be considered a positive way of promoting well-being. Furthermore, I believe that the unearthed manuscript from Mawangdai in 1975, titled An Inscription on Activating Qi Circulation in a Jade Pendant (行气玉佩铭), produced in the early Warring States Period, is also specifically a prescription on how to activate qi circulation during sexual intercourse. The inscription reads, “Activate the Qi. Go deep into the vagina and collect the qi there. Then penetrate more until the lowest phase that is the place of earth. Stop a while to make a consolidation. Then new things start sprouting and growing. Then withdraw out and it is the place of the heavens. Pound and pestle a few times on, in the heavens as well as on the earth. Following this way you can create longevity but if you oppose it, you will die.” Therefore, from the above we can see that it must have been quite fashionable for well-being to be created through the sexual arts of the bedroom. Despite the all-inclusiveness and separation of differing schools in the periods from the pre-Qin to the early Han, these methods of well-being all had the same goal — retaining good health in order to increase longevity by using differing techniques.

55. Occultists in Search of Elixirs and the Immortal Alchemy of the Yellow (Gold) and White (Silver) The Hanshu – Records of Arts and Culture – Brief on Fangji (汉书·艺文 志·方技略) states that “Immortals are those who due to being able to keep their bodies and souls together and not die, rove to any other place, at will, for tranquility of mind. They are not afraid of, or dread the living world or 54

 From Ten Questions (十问).

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the dead, for the realms of life and death mean nothing to them. Yet some people specifically focus on immortals’ unconventionalities and have produced more and more freakish and weird articles on them. Such is incompatible with what our wise Emperors have instructed us. Confucius said, ‘The searching for concealments and sinking into absurdity has been recorded by later generations, and I will never do such things.’ Such an idea was followed up by Liu Xin55 among others: ‘Never speak on things related to weirdness, violence, turmoil or the immortals.’”56 Yet there are altogether 10 books on the immortals, including the 20 chapters of the Mixi Zazidao ( 宓戏杂子道), the 26 rolls of the Shangsheng Zazidao (上圣杂子道), the 12 rolls of the Huangdi Zazi Buyin (黄帝杂子步引), the 18 rolls of the Huangdi Zazi Zhijun (黄帝杂子芝菌) and even the 10 rolls named The Massage of Huangdi and Qibo (黄帝岐伯按摩), to name just a few. There were also other well-known occultists — Song Wuji, Zheng Boqiao, Chonshang and Xianmen Gao during the Warring States; Xu Fu, Han Zhong, Hou Gong, Shi Sheng and Lu Sheng in the Qin; Li Shaojun, Miu Ji, Shaoweng, Luan Da, Gongsun Qing, Yu Ji, etc. during the Han. The Historical Records – Fengshan Book (史记·封禅书) states, “Since the times of the Kings Qiweiwang and Qixuanwang, Zou Yan (驺衍) and other fellows have written down in their books the thoughts of the Five Phases Circle… and then, later, Song Wuji, Zheng Boqiao, Chongshang, and Xianmen Gao, all his successors turned out to be men of Yan Kingdom and all of them, turned into Fangxiandao,57 and practiced occult magic such as dissolving the body and turning into immortals.” These people were probably similar to those Song Yu mentioned in his Gaotang Fu (高唐赋) as “people, who had some occultist magic about them, like Xianmen, Gaoxi, Shangcheng, Yulin, Gongyue, Jugu” and the like, and the number was quite low. This shows that at that time, the scholars gathering in Jixia58 had 55

 That is, Liu Xiu, son of Liu Xiang, famous scholar in the Western Han Dynasty, the founder of the Guwen Jingxue School, i.e. the school of classical learning based on earlier texts. 56  From The Analects – Shu’er (论语·述而). 57  A name for the occultists of the Yan and Qi Kingdoms during the Warring States Period, who upheld the thoughts of the Immortals “神仙家” or Yin–Yang-doers “阴阳家”, and prospered especially in the times of Kings Qixuanwang and Yanzhaowang. Thus, they got their name the Fangxiandao, which was advocated by Qinshiwang and Hanwudi. They are commonly acknowledged as the predecessors of Taoism in China but were not an official organization or religion. 58  A place in Linzi, capital of Qi state during the Warring States period. The king of Qi built an academy there to recruit virtuous and learned people. Thus, the scholars gathered there

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formed into differing schools of thought, among which was the school represented by Zouzi59 who focussed on theoretical deduction. In this way “Zou Yan, with his thoughts on Yin–Yang determinism (or destiny), became reputed in the circle of the Lords. However, his thought was not successfully acted upon by the Occultists in the Yan and Qi areas. Thereby there were created countless Occultists who became weird, pedantic, fawning and drifted into flattery, absurdly and in a mystifying manner.”60 This is what was often criticized as “The thought of Zou Yan — pedantic, exaggerated and eloquent”. “At the beginning, his thoughts flowed out so indiscriminately that kings and dukes would be amazed and began to follow him. However, although they felt quite edified, they found it impossible to turn his ideas into practice.”61 As a result, the decline of the Zou Yan school boosted another school represented by Song Wuji and the like, who practiced magic, that is, “dissolving the body and turning into immortals”. From this change, one can see that on the one hand, ghosts and gods had partly staged a comeback, in a transfigured form; on the other, according to Mr. Yang Dongchun,62 an in-the-world concept, originally quite deeply rooted, had transformed into an out-of-world concept — which gradually gained the upper hand. So, therefore, the occultists’ magical skills originally were a branch of the school at Jixia. This school is also connected with the medicine of the elixir. A story in the Hanfei Tzu (韩非子) goes, “One of his worthy attendees would present an elixir of immortality to the king of Jing (i.e. Qinxiangwang of Chu state, on the throne from 298 to 263 BCE). As the ‘audiencer’ was going into the hall, holding the medicine in his hand, a warrior of the palace-guard asked, ‘is it edible?’ At the answer ‘yes’, the warrior snatched the medicine and swallowed it. The king was so angry he ordered his officer to kill the warrior. Then the warrior asked the officer to speak persuadingly to the king: ‘When I asked him if it was edible, he answered me ‘yes’.’ So I ate it. But now the King is going to kill me — which tells me the medicine is deadly. Therefore, it is he himself, who has cheated the King. Would it not be better to free me because I’m innocent, then the people will know the ‘audiencer’ himself was deceiving the King?” Here, Hanfei denounces the so-called “medicine of immortality” by logical reasoning. Meanwhile, it and made Qi state the most prosperous during this period. 59  That is, Zou Yan mentioned previously. 60  From Historical Records – Fengshanshu (史记·封禅书). 61  From Historical Records – Biographies of Meng Tzu and Xun Tzu (史记·孟荀列传). 62  Yang Dongchun, Outline of Chinese Cultural History, Bei Xin Bookstore, 1933, p. 252.

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shows that quite a number of people presented such medicines or a number of such medicines — the people who took them were quite numerous. Therefore, the Lord of Taishi, Sima Qian, recorded that “Kings like Qiweiwang, Qixuanwang and Yanzhaowang sent men far over the seas to Penglai, Fangzhang, and Yingzhou, the three holy mountains which, according to fairy-stories, stand at the center of the Bohai sea, not far from the human world. But when someone did approach them, the wind always took him off again. One occasionally did find the three holy mountains where there lived the immortals and medicines of immortality. There, all things and animals are white — and there are palaces built of gold and silver. From far away, the three holy mountains look like clouds; whilst getting closer, they appear to be lying under water. When they were almost touchable, the wind took the man and his boat away. In the end, he did not get to land. How regretful! People have never willingly given up exploring for them.”63 This shows conclusively that there is an intimate connection between the occultists’ pursuit of the immortals and their medicines of immortality. Both the two schools at Jixia received respect and trust from the First Emperor of the Qin, after he unified China. At an earlier time, when a man from the region of Qi reported a memorial to the throne regarding Zouzi’s theory of the Five Phases Circle, “the First Emperor was so satisfied he adopted it”. Thus, the first month of the year was reset to October in the lunar calendar, the colour black was upheld and the country was governed by the law of the Water Feature.64 They had the belief that the soul did not die after the death of the body and could still find various enjoyments underground, so in 246 BCE, he ordered people to cut into Li Mountain and build a magnificent tomb. Yet earthly pleasures were what he indulged in — and so he longed for immortality. As a result, in 219 BCE, he offered up a Great Worship, sacrificing to Mount Tai, and simultaneously “travelled eastward to the seas, paid respect to famous mountains, large rivers as well as the gods of the eight directions, and pursued an eternal life — just as Xianmen, etc. did, one of the immortals.”65 Today, the “First Emperor Vine Dais” in Boxing county, Shangdong Province, according to the Yinyun Stories (殷芸 63

 From Historical Records – Fengshanshu (史记·封禅书).  According to Zou Yan’s thought of the Five-Features Circle, the Five Features were represented by the five elements such as wood, fire, earth, metal and water, the five of which circulate one after another. Zou Yan often used this principle to explain the changing times and the replacement of dynasties. 65  From Historical Records – Fengshanshu (史记·封禅书). 64

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小说), is the place where the First Emperor made his acquaintance with the immortals. At that time, there also was “one man from Qi, namely Xufu (徐巿),66 who together with others wrote to the Emperor, saying that far away over the seas, there were three holy mountains named Penglai, Fangzhang, and Yingzhou respectively, where the immortals lived. Then he asked to be allowed to make a fast and begin his journey, accompanied by virgin boys and girls, to search for them. Thus Xufu with his thousands of virgin boys and girls went to sea to search of the immortals.”67 This is the beginning of the First Emperor’s use of occultists — trusting in them to look for the longevity medicines of immortality. Xufu’s efforts were in vain: “On the sea, the ships were forced to return for no favourable wind was blowing. They did get a sight of the three holy mountains but they could not reach them.” Most probably what they saw was a mirage. In 210 BCE, the First Emperor travelled to sea for a third time, “hoping to get a magic medicine from the three holy mountains in the sea”. “At Langya, Xufu, the Occultist, together with others had set off to sea for the magic medicine, as well. But their search was futile, it took several years and cost a great deal. Out of fear of punishment from the First Emperor, they made a deceit, saying that ‘the medicine of Penglai was available, but there were giant sharks about which meant we failed to get it. So we request help from all those who are good at shooting, that they can shoot the sharks with machine-crossbows when they appear.’ The First Emperor… then ordered the men who were going to sea to carry fishing tools for these giant fish and himself waited with his machine-crossbow, at his side for the giant fish, to shoot them…”68 However, there is no mention as to whether Xufu or the like were sent out to sea again for the magic medicine or not. Later legends state that Xufu, together with his 5,000 virgin boys and girls, again set sail to the sea and by wind and tide drifted to Japan, where Xufu’s Landing Site and Xufu Village are still recognized today. It is said that evidence can be found in the Japanese ancient records: “According to Fuji’s ancient books69 Xufu, by order of the First Emperor of Qin, came to Mount Fuji looking for the medicine of immortality and thereafter settled down there.” “Xufu’s visit in the 72nd year70 of the Korei Emperor is also

66

 Xufu (徐巿) is Xufu (徐福).  From Historical Records – Biography of the First Emperor of Qin (史记·秦始皇本纪). 68  From Historical Records – Biography of the First Emperor (史记·始皇本纪). 69  The Periods of Heian (794–1185) and Kamakura (1185–1333). 70  215 BCE. 67

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recorded in the chronology of ancient Japan.”71 In today’s Liaoning province of China (another opinion says it was Shandong province), there is a village considered to be the hometown of Xufu. People go there to pay tribute. The real Xufu could not be traced any further after the death of the First Emperor of Qin in 210 BCE. Lusheng, Housheng, etc. were other occultists trusted by the First Emperor. In 215 BCE, the First Emperor went to Jieshi (碣石) and sent “‘Lusheng of Yan’ off to search for the Occultists Xianmen and Gao Shi… then he sent off Han Zhong, Hougong, and Shisheng to look for medicines of immortality.” Here, Gao Shi could be Gao Xi and Xianmen, according to Dr. Joseph Needham (1900–1995), a transliteration of Shaman, in the Tungusic language — originally meaning one who practices witchcraft.72 This is also commonly now known as “shamanism”‘ and is popular in today’s northeast regions of China. Xianmen must have come from Siberia into China and been respected as an immortal. “Lusheng of Yan was sent to sea in search of immortals and returned with a catalog of fortune-telling and divination, in which was written ‘it will be Hu that puts an end to the rule of Qin’.” Henceforth, the First Emperor sent troops to attack the areas of Northern Hu. In 212 BCE, Lusheng tried to convince the First Emperor, saying, “We have tried hard to find the Lucid Ganoderma mushroom, magic medicines and immortals, but in vain. It seems there are some ‘obstructers’ in place. In our humble opinion, your majesty should travel often in secret, in order to dispel these devils. Only then, will the immortals with ‘detached wisdom’ arrive. This means, that if your majesty lives in places known to men, the immortals will be held back. ‘Detached immortals’ do not get wet though they step into water, nor get burnt when they go through fire. They can travel on clouds and by air, and live as long as heaven and earth. Now your majesty is so busy ruling the whole country that inward tranquility and ease are persistently unavailable. Therefore, I hope that keeping the Palaces your majesty lives in unknown to others might bring the medicines of immortality to you.” After that, the First Emperor exclaimed, “I have such an admiration for these immortals with detached wisdom!” After this event he called himself73 “a ‘detached wisdom’ immortal, but not a zhen 朕.”74 71

 Cited from Che Li, Chinese Medical History, Heilongjiang People’s Publishing House, 1979, p. 45. 72  Joseph Needham, Science & Civilization in China, Vol.2, translated by Chen Lifu et al, Taiwan: the Commercial Press, p. 203. 73  From Historical Records – Biography of the First Emperor (史记·始皇本纪). 74  A term adopted by the First Emperor of Qin to refer to himself. Since then, it has became

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Thus, secret palaces were built with tunnels connected one to the other — which people could not reach, because they did not know where they were. But Housheng and Lusheng made remarks behind the Emperor’s back, saying, “the First Emperor is by nature stubborn and self-opinionated… he is so ferocious and greedy for power, we should not find any immortal medicine for him.” Then they fled. Furiously, the First Emperor convicted them of crimes such as defamation and more. Also in the belief that all the other Confucians had conspired also with them, he ordered them to be buried alive. “There were over four-hundred and sixty so-called ‘violators’ all buried in Xianyang.”75 “Another order was made to plant gourds on Mount Li in winter and when the gourds bore fruits, he sent ‘court academicians’ (erudite scholars) to watch over the melons as a plan of premeditated murder — and then killed over seven-hundred of them, at that place.”76 Hence, it was all a miserable tragedy. Here, the so-called “Confucian scholars” may be explained as actually being skilled occultists.77 The truth is that these occultists did not deliberately cheat the First Emperor. They themselves held the firm belief that there did exist immortals and medicines of immortality. What they searched for or gathered were precious and magic medicines, like the Lucid Ganoderma fungus. They also stressed maintaining a pure, serene and indifferent ease, and recuperating the qi — just as expressed in the Chuang Tzu (庄子). The occultists of the Jixia schools were growing in number under the influence of a natural philosophy centred on “qi”, which marked them out as different from the practitioners of witchcraft of earlier times. The failure of “searching for” medicines boosted a shift to “making” medicines. Simultaneously, the thoughts of there being immortals stimulated the rise of many new schools which sought the chance of occupation via the alchemical skills of the Yellow (gold) and White (silver). Again, it was the occultists in the Yan and Qi areas who practiced the alchemical skills of the Yellow (gold) and White (silver), during the reign of the Wu Emperor of the Han. One of the celebrities of these times was Li Shaojun who gained the admiration of the Wu Emperor, with his tributes of practicing a worshipping ritual to the kitchen god, a method of non-grain eating, and a prescription for avoiding getting old. He was a retainer of Marquis Shenze and took charge of occult-related things. Li a word used specifically for emperors in China. 75  Ditto. 76  From Wenxian Tongkao (文献通考), Vol. 14. 77  Cited from the book Word Explanations (说文).

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Shaojun concealed his age and laid claim to being seventy years old, and being able to control ghosts and immortalize people.” “He also told the emperor that ‘through worshipping the kitchen god to call the ghosts and gods one can then transform cinnabar into gold. This gold can be forged into catering utensils. People who use these, then can attain longevity. Then living long enough, they can meet immortals on Penglai Island in the Eastern Sea. Thus a worshipping ritual can make oneself immortal indeed. This is what happened to Huangdi, as well. Once I travelled to sea and met with An Qisheng, who was eating a date as large as a melon. An Qisheng, he is an immortal from Penglai Island, and he would make his presence felt to anyone agreeable to him and avoid anyone unagreeable by hiding himself.’ After that, the emperor began to offer sacrifices to the kitchen gods on his own behalf. He sent Occultists to the Eastern Sea to look for such immortals as An Qisheng, and ordered the extraction of gold out of such medicines as cinnabar.” Ironically, years later, Li Shaojun died of disease but “the emperor thought that Li had become an immortal, and not died.”78 How superstitious was the Wu Emperor！ So, according to their beliefs, an occultist could become immortal if one could find a way to totally change cinnabar into gold and silver. At first, the initial purpose of the “alchemy of the Yellow-White” was longevity, to acquaint oneself with the immortals and to become an immortal oneself. Thus, the emperor “ordered Huang Chui and Shi Kuanshu to learn Li’s occult tricks. But it all ended up with failing to discover the so-called immortal An Qisheng — together with the springing-up of lots of absurd and pedantic Occultists along the coast, in the regions of Yan and Qi who followed the example of Li Shaojun, by coming to the emperor to speak of immortal things.”79 All these many excellent and hilarious comedies about pursuing immortality can be found in the Historical Records – Fengshan Book (史记·封禅书). Sima Qian once accompanied the royal patrols and witnessed rituals for worshipping such gods as those of heaven, earth and so on. Consequently he denounced what the occultists had done. The Wu Emperor of Han seemed to realize this too when in his remaining years, around 89 BCE, knowing that “what had been done had brought misfortune to his people”, he adopted the proposal of Tian Qianqiu that “there are so many Occultists talking about looking for immortality, but without effective results. So I 78

 From Historical Records – Biography of the Filial Wu Emperor (史记·孝武本纪).  Ibid.

79

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propose to get rid of them all”. Then he dismissed all those who were said to be waiting for the arrival of the immortals. He often sighed to his officials and said, “I was such a fool to be cheated by the Occultists. How could there be immortals in this world? All absurd nonsense! Both dieting and medicinetaking can only make it less probable that one will get ill.”80 However, the Wu Emperor had caused an all-round transition from the thought of Huangdi and Lao Tzu to the occultists’ pursuit of immortality, facilitating the spreading of the alchemical skills of the Yellow (gold) and White (silver), as well as the making of “medicines of immortality”. Furthermore, the occultists during this reign of the Wu Emperor practiced tricks closer to witchcraft — some even swindled others to cover up their failures or to be taken into society. After the Wu Emperor, the occultists lost the favour of the emperors and quite a lot then shifted their activity to the lower or folk world. According to the Hanshu – Biography of King Huainan81 (汉书·淮南王安传), “(King Huainan) recruited thousands of Occultists and they produced the twentyone chapters of the Book of Internals (内书) and numerous chapters of the Book of Externals (外书). What is more, the eight rolls of the Middle Book (中篇), centering on the skills of searching for immortality and the alchemy of gold and silver, contained over two-hundred-thousand words.” Liu An himself practiced the way of immortality and recruited occultists from all other areas to perform this alchemy. In the end King Huainan did not become an immortal, but actually died in prison instead. Other occultists, who formed secret groups in the folk world, might have been disciples of Mo Tzu, and most belonged to the Shi stratum82 and were skillful in craft production. They perhaps discovered the miraculous changes made by gold and silver during their crafting. Such marvelous transformations were imagined as being caused by ghosts and gods. The gold-catering utensil described by Li Shaojun was most probably made by the craftwork of gilding performed by the disciples of Mo. Zhu Sheng, in his Brief History of Chinese Medicines (中药简史), believes that it involved a procedure of extracting mercury out of cinnabar first and then gilding gold onto bronzecatering utensils using the rod-coating method. It is said that some gilded 80

 Ibid  That is, Liu An (179–122 BCE), the grandson of Liu Bang, a renowned scholar in the Han Dynasty, compiled The Huainanzi (淮南子). 82  Shi (士), originally a title for the warriors in ancient and tribal societies, later became the lowest part of the ruling class in the feudal society. Because only the ruling class was entitled to education, Shi became a title for people who had acquired certain skills and know-how. 81

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utensils unearthed from Wu Emperor’s Tomb in 1981 are good proof of this, in Zhu’s opinion.83. But I (the author) consider this to be a craftwork technique, worked out by Mo’s disciples. The most renowned occultists of the Qin and Han Dynasties were without exception listed in books such as the Lie Xian Zhuan (列仙传), the Shen Xian Zhuan (神仙传), the Gao Shi Zhuan (高士传) and so on which treated them as either immortals or half immortals. Besides those mentioned previously, such as An Qisheng, Li Shaojun, Huweng and Fei Changfang, there were others intimately connected with medicine such as Shen Xi, Feng Gang, Cui Wenzi, Su Dan, Anqiu Wangzhi, Li Changzai, Ge Yue, Wang Yao, Shen Jun, Feng Junda, Dong Feng and the like. They gathered magical herbs, treated diseases of the common people, especially preventable contagious ones, and meanwhile were practicing with the aim of gaining a longer life. All in all, what a tremendous and timely contribution they made!

56. The Compositional Background to Shen Nong’s Classic of Materia Medica (神农本草经) Shen Nong’s Classic of Materia Medica (神农本草经 Shennong Bencao Jing), or simply the Herbal Classic (本经), was China’s first comprehensive work of pharmacology. It was composed on the basis of both the cultural background of the pursuit of medicines for longevity during the Han period as well as the accumulated experience of many previous treatments. More specifically, possibly it was composed during the Western Han Dynasty.84 The term “本草 (bencao) — Materia Medica” appeared as early as the Han Shu – Jiaosi Zhi (汉书·郊祀志), which records an imperial position of “Bencao Daizhao”, awaiting an order of a herbal inquiry — which was cancelled in 73 BCE So this title could not exist if there was no reason for a connection between this official position, and some specific general term for herbs. Also in the same book, in its 92nd Volume, A Biography of a Courageous Warrior (游侠传), it is described how “Lou Hu, also styled Junqin, was in the Qi area. His father, a medical practitioner, passed his knowledge on from generation to generation. When he was quite young, he followed his father by curing diseases at Chang’an and thus often attended 83

 Zhao Kuanghua. Development and Chemical Achievements of the Technique of Mercury Extracting out of Cinnabars in Ancient China (我国古代抽砂炼汞的演进及其化学成就), Natural Science Study, 1984, No. 1. 84  Ma Boying. Anthropological Study on the Composition of Sheng Nong’s Classic of Materia Medica (神农本草经), Traditional Chinese Medicinal Research, 1992, No. 1.

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aristocratic families. He was respected even by the elderly for his ability to recite texts on medicine, bencao (herbs) and occult skills, some containing millions of words.” Such descriptions reveal to us that Lou Hu and his father were both Taoist physicians. He changed his occupation to politics probably between 28 BCE and 25 BCE. This implies he must have read the Herbal Classic earlier. What is more, in 5 BCE, i.e. the fifth year of the reign of the Ping Emperor of the Han, he wanted to “recruit all scholars who knew well the scattered Confucian classics,85 ancient records, astronomy, calendar and books on counting, music, philology, history, occult skills, bencao (herbs), and those skilled in teaching the classic books such as the Five Classics,86 The Analects of Confucius, the Classic of Filial Piety, and the Erya (A Dictionary), and therefore the emperor ordered local governments to send all such scholars by horse-coach to the capital. As a result of this order, thousands of scholars entered the capital.”87 These are the earliest mentions of the term “herb” and all appear during the Western Han Dynasty. Subsequently the term made increasingly frequent appearances. Yet, as for the composition of herbs being put into a book, this was unlikely to have happened prior to the time of the Wu Emperor, because the emperor longed for medicines of immortality so much that occultists in the area competitively presented “myriads of magical prescriptions” and “gathered thousands of miraculous ganoderma herbs”.88 He also encouraged the alchemical practice of the skills of the Yellow (gold) and White (silver), being made from cinnabar — so that on the one hand, there was great popularity in herbal practice and working with cinnabar and gathering (for instance, the Lun Heng – Xing’ou (论衡·幸偶) says, “herbs, of all types, are beneficial and can be gathered by medical-men to be made into excellent medicines”), while on the other, many of these herbs were listed in the book and graded as superior in class. Cinnabar was especially first-class for its significant role in the process of “transforming cinnabar into gold”, “whence it demonstrates the important position that catering-utensils made of gold or silver occupy in promoting better health and longer life”. Research on Shen Nong’s Classic of Materia Medica (神农本草经) up to the present day 85

 The pre-Qin classics collected by Confucius but not graded into the Six Classics include the Book of Songs (诗经), Book of History (尚书), Book of Rites (礼记), Book of Music (乐经), Book of Changes (周易) and Spring and Autumn Annals (春秋). 86  The five Confucius classics including Book of Songs (诗经), Book of History (尚书), Book of Rites (礼记), Book of Changes (周易) and Spring and Autumn Annals (春秋). 87  From Han Shu – Biography of Ping Emperor (汉书·平帝纪). 88  From Historical Records – Fengshan Book (史记·封禅书).

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reveals that there is an abundance of expressions on the effects of “first-class herbs”, including, “to have a good link up to the gods and never to grow old”, “to get a healthy body and a longer life and lighter body, after a long time taking these medicines”, “to get a light body and never get old after taking a cream-like medicine made out of herbs”, “making a cream-like medicines, then taking it for a long time to make a light body”, “to make a cream-like medicine and take it a long time and never be old”, “to get long life with cream till one turns immortal” and “changing iron into bronze, gold or silver”. Such descriptions can be found everywhere. Meanwhile, there were also a considerable number of similar descriptions of the effects of “middle-class herbs” in the second section of the Shen Nong Classic of Materia Medica. For instance, the effect of mercury was “to relieve poisoning through taking gold, silver, bronze, or tin; and if mercury is melted and returned to cinnabar, it can be taken for immortality to make one a celestial being.” Such expressions evidently show the influence of the Wu Emperor’s pursuits of magic and the alchemy of gold and silver. What’s more, witchcraft started afresh during the reign of the Wu Emperor and stimulated the bringing up of the ideas of “ghosts and souls”, so that the causes of disease were believed to come from ghosts and gods. There are quite a number of similar opinions in the Herbal Classic (本经), which were contrary to those in the Huangdi Neijing (黄帝内经). For instance, in the Herbal Classic (本经), it’s said that “cinnabar... can pacify the souls, tonify qi, kill evil ghosts, and help one communicate with the gods and enable immortality.” “Realgar…can be used to get rid of demons, evil ghosts, pathogenic qi and all poisons from several insects.” Also “musk… can take out ghosts and demons…” All the above bear the mark of the time. The present version of Shen Nong’s Classic of Materia Medica (神农本 草经), compiled in 1799 by Sun Xingyan (孙星衍, 1753–1818) from the “white printed” words of a Materia Medica Arranged According to Pattern (证类本草, published 1083), only retains what was described about herbs in the original book, but this was by no means its sole and primary feature. It can be traced through scattered writings in other books. For instance, the Taiping Yulan (太平御览, published 983 CE) cited the Shen Nong’s Classic of Materia Medica (神农本草经) as saying, “Taiyi Tzu (太一子) said that for medicines, the top-class ones can nourish life, the middle-ones cultivate the temperament, while the lowest-ones simply cure disease. So Shennong made his scarlet whip to test out the features of herbs. He thoroughly understood Yin and Yang in the six meridians and travelled along with

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Taiyi to all the mountains and lakes. During their travel, everything they saw, no matter whether it was grass or stone out of the earth, or bone and flesh, heart and thought, skin, hair or feathers, he would whip them with his scarlet whip and test them all. After he had become clear on what disease they could cure, he would try them for taste — so that once even he was poisoned by seventy herbs in a single day.” The first sentence quoted here also appears in the Yiwen Leiju (艺文类聚, published 624 CE). “Taiyi (太一)” refers to “Taiyi (太乙)” who was first worshipped by the Wu Emperor of the Han in 133 BCE, after the emperor adopted some proposals of the occultists. This book also states, “Again, Shennong made a deep bow and asked Taiyi Tzu, ‘I’ve heard that you are over one hundred years old, but without any signs of dying. What kind of qi does it for you?’ Taiyi Tzu answered, ‘to go up to the heaven, there are nine doors, and amongst them, the middle one is the best.’ Shennong then followed him and tasted all the herbs he found, in order to save lives.” Taiyi once again said, “the top-class medicines can make the body healthy and prolong life until you go up to the heavens and become an immortal who can travel the heavens or go down into the underworld, and drive along all souls; who will bear feathers and fur on his body and fly ‘for the time taken to eat a meal’.” And so on and so forth; such sentences were also cited from the Shen Nong Sijing by Ge Hong (葛洪 283–363) in his Baopuzi (抱朴子). The above quotations seem possibly to reconstruct the original form of Shen Nong’s Classic of Materia Medica (神农本草经); that is, its texts were not as ancient as the Neijing (内经), although its form was in a dialogue similar to the latter. The present version does not cover all its related medical theories — much of which must have been included in the original. Only at the end of the third volume are there some words like “the three classes of herbs constitute altogether three-hundred and sixty-five kinds of herbs — corresponding to the three-hundred and sixty-five degrees of movement of the sun, moon and stars which make up a year — and one degree making a day.” This conforms with “the principle of man being a copy of nature” reflected in the Neijing (内经) and especially in the Chunqiu Fanlu (春秋繁露). The Anthology of Medicine (昭明文选, South-Liang Dynasty, written by Prince Xiao Tong 501–531) also quotes from these scattered chapters, saying such things as “Spring and summer belong to Yang, while autumn and winter belong to Yin” and “spring produces the qi of Yang which gives

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growth to everything in nature”. In the Taiping Yulan (太平御览), it says that “the five tastes89 are to nourish the spirits and reinforce the souls and vigour. The five stones90 are to nurture the marrow and make the muscles strong. Among all herbs, those which taste sour are to tonify the liver, nourish the heart and wipe out nephropathy; those which taste bitter are to tonify the heart, nourish the spleen and get rid of hepatopathy; those which taste sweet are to tonify the lungs, nourish the spleen and cure heart disease; those which taste hot are to tonify the lungs, nourish the kidneys and take out splenopathy; while those which taste salty are to tonify the lungs and remove hepatopathy. Therefore, the five tastes conform to the five elements and the human body to the four seasons. In a word, human characters correspond to the four seasons and their lives to the five elements. While each element nurtures an aspect of the human body well, life will never die; the generator nourishes the generated, and life gets prolonged; the generated tonifies the generator, and no diseases will come — throughout one’s whole life.” Such thinking using the Yin–Yang and Five Elements is often considered as a successor to that in the Neijing (内经). Thus, it can be concluded that Shen Nong’s Classic of Materia Medica (神农本草经) was composed by occult physicians shortly after the time of the Wu Emperor of the Han, being the crystallization of a combination of occult culture and taking medicines. It must also have been fully compiled then. So Tao Hongjing said, “As for the effects of herbs, it must be made clear that the effect of each herb is affected by people’s knowledge of it. Otherwise how could people get to hear of them?… This book must belong to the same type of book as the Suwen (素问). Also it has been further embellished by later generations… So, the fact is that the shires and counties where the Herbal Classic (本经) became a system, were those of the late Han (25–220). This was perhaps recorded by Zhang Zhongjing (张仲景ca. 160–218),91 Hua Yuanhua (华佗 ca. 145–207)92 or others… Since the Wei and Jin Dynasties (220–420), Wu Pu and Li Dangzhi have made even more changes to it.”93 So from this comment we can decide that this book must have lost its original composition after being scattered about and lost, and suffered repeated compilations. 89

 Five tastes: sour, sweet, bitter, hot and salty.  Five stones: violet quartz, white quartz, halloysitum rubrum, stalactite, and sulfur and alum which can be used to make pills according to occultist. More discussion in Chapter 9. 91  Zhang Zhongjing, a renowned physician of traditional Chinese medicine and called a Medical Sage. 92  That is, Hua Tuo, a renowned physician of traditional Chinese medicine. 93  From Notes to Herbal Classic (本草经集注序). 90

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57. The Calamity Due to Witchcraft Gu, Chunyu Yan Killing the Queen and Their Involvement with Occult Physicians The pictographic character of a gu, that accords with inscriptions on oracle bones and tortoise shells of the Shang Dynasty, shows a small insect in a tray. If someone got ill because of a gu, he would suffer abdominal distention or a mass in the abdomen which could cause death. Similarly, it is not totally unlike the present day when people are often affected by diseases such as bilharzia, liver cirrhosis or liver cancer, and the like. The first one to discuss fully diseases caused by a gu was Yi He (医和) according to the Zuo Zhuan – The First Year of Zhao (左传·昭元年) and the Guoyu – Jinyu (国语·晋语). In analysing the disease for Lord Jinpinggong, he said, “This disease is incurable. You’re ill because you keep too intimate relations with women and away from men, your perplexing lust for women brought gu into your body. It’s not because of ghosts or the food you ate, but because of your perplexing lust — which messed up your spirit and demoralized it.”94 Here, he seems to refer to a psychological or venereal disease. He also said, “women, during gloomy times attract the Yang, when a man makes too much sexual intercourse this will generate interior heat and he will get the ‘perplexing gu’ disease.”95 Here, gu is linked to the cause of too much intercourse and mention is made of a heat syndrome. Yet what on earth is gu? Yi He explains, “Gu often conceals itself, but in fact is born from the flying dust of the grain. It can hide in all things, among which grain is especially perfect. It is clear that grain creates the perfect conditions for the gu to get together and hide itself. So, people who eat grain keep company with virtuous people during the day, and this grain does not contain any worms; and take rest with virtuous women in moderation at night-time and so avoid the harm done by the gu. Now since our emperor kept such intimate relationships with women, day and night, it was just like eating gu with grain together, which would be not only eating grain but gu too. Analyzing the formation of the character gu (蛊), it contains two characters, a worm, or grub (虫) and a utensil (皿) integrated together. This explains what I have said.”96 This is similar to another source, “Gu is what grows out of a licentious, sex-life, with perplexing lust. The aspect of the character gu (蛊) is formed by a utensil (皿) and a worm (虫). Besides this, gu also describes that which 94

 From Guoyu (国语).  From Zuozhuan (左传). 96  From Guoyu (国语). 95

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flies out of the grain. In the Book of Changes of Zhou (周易) it says women seduce men just as ‘the wind flies off the hills’,97 and this is called gu. They are the same thing.”98 These descriptions show that gu referred to the flying moths which the grubs give birth to in the grain, and this is closely connected to sexual relationships. This might suggest a study of the relationship between disease and parasites, which is undoubtedly far removed from the idea of gu used in witchcraft. But gu also appears in the oracle bones. In 677 BCE during the reign of Qindegong, over 100 years earlier than the time of Yi He, it is recorded that “In making a Fuci,99 people chop dogs up into pieces and place the pieces of meat at the doors of the four directions to eliminate the disaster of gu.”100 The Shiji-Suoyin (史记索隐) also says, “It is told in the Zuo Zhuan (左传) that a ‘gu (蛊) is formed by a utensil (皿) and a worm (虫).’ Yet atrocious ghosts appearing at the sacrifice are also called gu. So the Yueling (月令) writes, ‘during the time of the Danuo,101 people make a zhe (磔) (i.e. a sacrificial animal) which is killed and placed at the doors of the four directions.’ It is noted that zhe (磔) also means rang (禳) (i.e. to sacrifice and wipe out disasters) — if they do not make the sacrifice, a ferocious ghost, or gu, will come out and harm the people. To avoid this, people make sacrifices at the doors of the four directions. So this is also called ‘sacrificing dogs to defend the doors of the four directions’. It’s similar to what is described in the Fengsutong (风俗通) as ‘sacrificing dogs to get rid of disasters’.” All these oracle bones, atrocious ghosts, ferocious ghosts and sacrificing dogs to wipe out disasters are the stuff of witchcraft — and totally different from the explanation of gu made by Yi He. It seems that there was a coexistence of the two meanings and implications of gu during the pre-Qin period. Until the dynasty of the Han, especially during the reign of the Wu Emperor, “witchcraft gu” gained an upper hand when “Occultists and other wizards often gathered together in the capital, leading those crooked into turmoil and committing vicious acts and conjurations which perplexed the people.”102 Such are the facts of “wallowing in the mire” when there is an evil intermingling of occultists and wizards. There were even some witches 97

 According to The Book of Changes (周易), in divination, Gu is the 18th hexagram, which symbolizes the wind of the hill, meaning the beginning of turmoil. 98  From Zuozhuan (左传). 99  Name for a type of sacrificial ritual in the pre-Qin Dynasty. 100  From Historical Records-Fengshan Book (史记·封禅书). 101  Name for a sacrificial ritual to get rid of plagues in ancient China. 102  From Zizhi Tongjian (资治通鉴), Chapter 22.

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who were entitled to go in and out of the palace; they buried woodmen under every room and cursed endlessly, debating, one with another, out of jealousy and informing against each other, so much so that the emperor was eventually infuriated and executed hundreds of maids in the palace, and ministers as well. Emperor Wu felt a dread of these things and was so suspicious that a daydream formed: “In his dream, there were thousands of woodmen striking him with sticks”. After that, he fell ill. A minister, named Jiang Chong, concerned at the discord between the queen and the prince, made a memorial to the throne saying “it is witchcraft gu that causes the emperor to be ill.” Then the emperor ordered Jiang Chong to “charge the prisons specifically for witchcraft–gu doers. Chong brought in the foreign wizards, had the earth dug up for woodmen, seized all who made the gu appear and made sacrifices at night, and searched out any ghosts they had summoned. If there did appear some foul corruption, the one accused would be thrown into prison, and tested, using scalding hot-iron pliers to burn and force them to yield. The people were forced into lodging false accusations against the witches and wizards, and officials then sentenced them all as traitors. Thus from the capital to areas nearby, right up to the prefectures and shire-kingdoms, the deaths caused by this collective punishment amounted to tens of thousands of people.” This easily reminds us of “the witchcraft trials” during religious reforms in western countries. In fact, “witchcraft gets worse, using witchcraft to suppress witchcraft.” Some new tricks were created against the gu: burying woodmen and performing yansheng,103 a form of dark witchcraft, passed down generation by generation, showing the transmission of witchcraft and wizardry. But the occultists, even after suffering this disaster caused by the witchcraft–gu, eventually survived. So we can see that occultists were involved in complex situations — as well as having different features about them. They were not all the same. Some aimed for medicines of immortality, some for the magic of immortality with the transmutation skills of the Yellow (gold) and White (silver), some saved lives with their medical skills, some killed people with their knowledge of poisons and herbs, or cut up a person’s body. Morally and ethically, occultists had not been entitled to medical practice. Queen Lu,104 in power after Emperor Liu Bang died, out of enmity against Lady Qi105 103

 One type of witchcraft, to defeat a rival by curses.  Lu Zhi, the wife of Liu Bang, the first emperor of the Han Dynasty. 105  One of Liu Bang’s favorite concubines, usually recorded in history as Ms Qi, later killed by Queen Lu. 104

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and her son Prince Zhao, ordered a man to kill Prince Zhao with dan (酖) wine. Dan (酖) wine is deadly because “the dan bird eats adders, and if one uses a quill made from its feathers in drawing a picture of wine, one can make the wine lethal at once.”106 This belongs to the combining of witchcraft with the use of poisonous wines. Later, Queen Lu “had Lady Qi’s arms and legs chopped off, her eyes gouged out, and her ears burnt off, forcing her to drink medicines which made her dumb and put her alive into the latrine. Queen Lu even named her a renzhi (a human swine).” Although Queen Lu was cruel and tyrannical, she could not do without the help of occult physicians, for the dumbing medicines, amputations, exoculations, ear-burning and the like could not be carried out without occultists. This recalls to our memory Sima Qian suffering fuxing, or gongxing107 or “geshi for males (cutting the genitals off the male bodies); youbi for females (maybe a practice of battering until the uterus, ovaries and the rest came out or were damaged)” and the like, all of which belonged to the category of surgical operations, and were cases of there being “devilhelpers” among the occultists. Another devil-helper was Chunyu Yan, a woman who was good at delivering babies and treating gynaecological illnesses. In the third year of the Xuan Emperor (71 BCE), Queen Xu, during a difficult birth, was poisoned by Chunyu Yan. It turned out that Xian, the wife of Huo Guang, wanted her own daughter to be queen, and had asked Yan to poison Queen Xu during her difficult labour and Yan accepted the idea — because she just wanted a favour from Xian to help win a promotion for her husband. Xian told Yan, “it is the most dangerous time for women during their labour; it is like one life compared to nine deaths. Now the queen is at a critical moment and you can take this chance to put in the poison.”108 This shows that the death rate during childbirth was so high that it was easy to cover up a death caused by poison. It was common knowledge at that time, even if Xian also knew it. But Chunyu Yan was worried that she would be discovered because of the principle of trialing a medicine — before the Queen took it. In any case she had no other choice. So she added monkshood and put it into the biggest pill she could. Queen Xu, after taking the pill, said, “my head suffers a keen pain. Do the pills contain toxicant?” Then she died in terrible vexation. Monkshood is jin (堇, or aconite), a poison — and labouring women are 106

 Ying Shao, Jijie (集解).  That is, castration, a cruel punishment in Ancient China, to cut off the genital organs. 108  From Zizhi Tongjian (资治通鉴), Chapter 24. 107

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very likely to die if they take it. Hence, the name of Chunyu Yan has been accompanied by notoriety ever since. This reveals to us that during the Han period occult physicians, although radiant to all appearances, were puppets with no regard for morals or status. On the contrary, it was those who concealed their identities, wandering into the folk world or living in seclusion in mountains and forests that made it possible for real progress to begin in medical science.

C. The Impact on Medicine of the Study of the Confucian Classics, Chenwei Theology and Anti-Chenwei Philosophy The confrontation during the Han Dynasty between the differing directions taken by the study of the Confucian Classics, Chenwei theology and antiChenwei philosophy forced the medicine of the times into a difficult position: both in choosing as well as all aspects of their impact on society.

58. Studies of Two Types of “Ancient” and “Present” Confucian Classics and Chenwei Theology The stable feudal society which survived for nearly 2,000 years in China really should owe much to Dong Zhongshu (董仲舒 179–104 BCE).109 He advanced the idea of “honoring only Confucianism” and it was he who transformed all the pre-Qin Yin–Yang concepts of nature into one social ideology, thus making a tight-knit Confucian system which, being seen as orthodoxy for Confucians, laid a firm foundation for the kingcraft of ruling — and which also could add mystery to the king’s will through “the interaction of the feel of heaven and man for each other”. Dong Zhongshu’s other contribution was his creation of the study of the so-called “Present Confucian Classics” (今文经学). The study of the “Present Confucian Classics” originally referred to those classics passed down from memory, and from oral tradition, which had been written in the official script of the Han Dynasty (汉隶). These classics included the Book of Songs (诗经), the Book of History (尚书), the Book of Rites (礼记), the Book of Changes (周易) and the Spring and Autumn Annals (春秋). Under the name of a Biography of Gongyang in the Spring and Autumn Annals (春秋公羊 传), he collected all these books into one system and made those originally considered “incompatible with our present needs and inclined to praise the 109

 See above.

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past or condemn the present“ conform with the Han’s feudal system — by “seeking hegemony over the thinking of Huangdi and Lao Tzu and creating reciprocal status with our kingcraft”. Consequently, there appeared a fashion of studying the “present Confucian classics” which meshed also with the factual content of his proposal — to “reject all other thought and honor only Confucianism”. Then “evil thoughts can pass away... thereby the dominant thought should be united into one, making the rule of law transparent for the common people — so that then they know what to follow.” This was his second proposal. Later there arose a new school concerned with the study of the so-called “Ancient Confucian Classics” (古文经学) which, written in the old script (using such characters as those of the six pre-Qin states) included the Book of Rites (礼记), The Classic of Filial Piety (孝经), the Book of History (尚书), The Analects of Confucius (论语), the Biography of Zuoshi (左氏传), the Zhouguan (周官), The Ritual Classics (礼经), the Ancient Book of Filial Piety (古孝经), The Ancient Ritual Classics (礼古经) and so on. Owing to having differing chapters, different written characters and a distorted understanding, people’s opinions differed and became widely divergent. Hence, there came about fights between the two schools of “ancient” and “present” Confucian classics. However, the rise of the study of ancient Confucian classics did not occur till the time of Liu Xin (under the reign of Emperor Ai) at the end of the Western Han dynasty. Liu Xin, the guoshi110 for Wang Mang’s later dynasty, was supported by Wang — and made use of the ancient Confucian classic, the Zhouli (周礼) to usurp power and reform the system by predating the ancients. By this means, the status of the “Ancient Confucian Classics” became elevated. The studies of the Confucian classics (both the “ancient” and “present”) thereafter dominated the mainstream of development of Chinese (Han) studies and exerted a profound influence on later generations. Professor Zhou Yutong once correctly pointed out that “the production of the study of the ‘Present Confucian Classics’ helped to form a clear system of social and political philosophy for China; the production of the study of the ‘Ancient Confucian Classics’ helped the establishment of China’s philology and archaeology; while the production of the erudite study of the Song Dynasty helped the formation of its metaphysics and moral philosophy.”111 110

 Guoshi (国师, a consultant of state), the title of an official position which ranks third among the seven Lords set up by Wang Mang who founded the Xin Dynasty (8–23) to replace the Han. 111  Zhou Yutong. Foreword for History of the Study of Confucian Classics by Pi Xirui, Zhonghua Book Company, 1959, p. 4.

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Its impact upon medicine was revealed in the way medicine followed a tradition of respecting, interpreting and accordingly explaining the classical medical works. The impact resulting from Confucianism and feudal ethical etiquette occurred everywhere. The Huangdi Neijing (黄帝内经), centred on a Yin–Yang concept of nature, was not able to long remain secluded in the folk world. Consequently, witchcraft came back to life again, in a new guise. Besides this, under the advocation of Dong Zhongshu, the study of the “Present Confucian Classics” promoted wanton catastrophism: “corresponding to the catastrophes recorded in the Spring and Autumn Annals (春 秋) and implying that the Yin–Yang movement had been mistaken.” Or else it sought out “auspicious signs” for emperors or Confucians, or preached about “generation from induction”, predetermined destiny from the gods and the admonition of the gods, or made sacrifices for rain or for no rain and many other aspects of condemning, denouncing, supplication, etc. — eventually falling into the heresy and mysticism of Chenwei (讖纬)112. Thereafter prophecies and figures, the sequences of the hexagrams, and divinations of Yi Jing-ology grew into a grander system which was brought to its climax by Jing Fang, Feishi and Jiaoshi. Such as it was, the natural concept of heaven and earth was transformed into the techniques of “image and number”, prognostication and graphic prophecy. Hence, Zhang Taiyan said, “The uproar of Chenwei as well as its bizarre heresy, which is not conspicuously everywhere… owes much to the direction given it by Dong Zhongshu.”113 Meanwhile, “Wang Mang was keen on incantations and fate; it is said the rise of the Guangwu Emperor owed his successes to Chenwei and it was thus quite popular at that time… even those who explained the five Confucius classics would refer them all back to Chen.”114 This continued until the fourth year of the Zhang Emperor in the Eastern Han period (79 CE), when, after the proposal of Yang Zhong, the emperor gathered together scholars in the Baihu Taoist Temple (白虎观) to study similarities and differences between the five Confucian classics. As a result the famous Baihu Tongyi, the Full Meaning of the White Tiger (白虎通义), was created. Since then, Chenwei, originally subordinate to the study of Confucius classics, became transfused into it, making it one whole! 112

  Chenwei, generally speaking the practice of divination combined with a mystical Confucian philosophy 113  See A Rebuttal to the Establishment of Confucianism from Second Part of Taiyan Notes in Collections of Zhang Taiyan. 114  From Book of Sui – Records of Classics (隋书·经籍志).

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“Chen” 谶, the words of Chen (谶语) or images of Chen (谶图) all meant originally enigmatic words or prophecies made by the occultists and wizards, who “cunningly created enigmatic words, and meant they could foretell propitious or inauspicious fortune.”115 During the time of the First Emperor of the Qin Dynasty, Lusheng of Yan had returned from the seas and made a memorial to the throne writing of prophecies, recording things the ghosts and gods had said and in one sentence, stated that “it will be the Hu who will be the end of Qin.” Such words were misunderstood by the First Emperor to mean the Hu nationality in the north and he then sent a troop of 3,000 soldiers with Meng Tian as the general to attack them. Yet later generations interpreted “Hu” as meaning Huhai, his son, i.e. the second emperor of the Qin, who put an end to the Qin. There was also a story told of the excavation of a Confucian tomb by the First Emperor in which a posthumous note was found saying, “A man unknown but claiming to be the First Emperor of the Qin Dynasty, will enter my hall, dig up my bed, mess up my clothes, and eventually meet his death by being buried alive by sand-dunes.”116 Such were the “words of Chen”, forged by later generations. During the time of the Wu Emperor of Han, a man from Fenyin got a precious ding117 which was said to “appear with the prosperity of the king’s rule — whereas it will forfeit itself with the decline of his rule”.118 It was mentioned by Sun in his Picture of Auspice Responses (瑞应图). This again had been predicted by Chen. When Liu Xiu (刘秀), who later as the Guangwu Emperor was the first emperor of the Eastern Han dynasty, “was destitute, and in a lowly position, still selling grain in the Wan area, again Li Tong prophesized through Chen — telling of ‘the rise of Liu’s family again, with Li as assistant’.”119 This was known as “Graphic Prophecy” (图谶 tuchen). The Guangwu Emperor, after he had proclaimed himself emperor, became even more firm in his belief of “graphic prophecy” — so much so, that he would not stop “reading graphic prophecies, even after he caught a cold and coughed continuously because he often read away from his formal palace, and in corridors covered in dew.”120 In 56 CE, “he 115

 From Summary of the General Catalogues of Si Ku Quan Shu (四库全书总目提要), Vol. 6.  From Yingyun Fictions (殷芸小说). 117  An ancient cooking vessel. 118  From Yingyun Fictions (殷芸小说). 119  In Chinese history, the Han Dynasty was under the rule of Liu family but later waned and was replaced by Wang Mang’s Xin Dynasty which was then ended by Liu Xiu, the first emperor of the Eastern Han Dynasty. 120  From Observations and Records of the East Han (东观汉记). 116

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announced a graphic prophecy for the whole country,”121 stating that “it can get rid of most doubts.”122 Even the famous scholar Zheng Xuan123 was a firm believer in graphic prophecy. There were various names for Chen, such as “图书” or “pictures with writings”; they were usually produced with words as well as pictures; some were called hou (候) because they told of the qi of the stars in order to calculate fortune and disaster through observing celestial phenomena, a mystery which went far further than the occultists cheating about creating immortality. Fu (符) were magic figures or incantations drawn by the Occultists and Taoists later on. The word fu in fuhe (符合) — to obey the god’s will” — meant to prove the credibility of the prophecies, fuming (符命) meant “foretelling their fate, coming from the god’s order”, and fulu (符箓) was also used, because the characters were painted in the colour green (lu绿, “green” is a homonym). All these names were used continuously by later generations, especially as Taoist terms. There were also Books of Wei (纬书, Weishu), usually produced by Confucian scholars but also by occultists, wanting to interpret the Confucian classics (经书, Jingshu or Books of Classics). The meridians or acupuncture channels of the body are jing (经 meaning “classics”) and the latitude or the latitudinal parallels are called wei (纬) in Chinese — and books of interpretation were also called Wei-Shu (Books of Wei). So, these were half classic and half interpretation, mingled along with prophecy, and together they comprised the “seven Wei’s” as follows: the Yi Wei (易纬) which included the Qianzaodu (乾凿度), the Kunlingtu (坤灵图), the Tongguayan (通卦验), etc.; the Shu Wei (书纬) including the Xuanjiqian (璇玑钤), the Kaolingyao (考灵耀), the Dimingyan (帝命验), etc.; the Shi Wei (诗纬) including the Hanshenwu (含神雾), the Tuiduozai (推度灾), etc.; the Li Wei (礼纬) including the Wenjia (文嘉), the Douweiyi (斗威仪), etc.; the Yue Wei (乐纬) including the Dongshengyi (动声仪), the Jituzheng (计图征), etc.; the Wei of Filial Classics (孝经纬) including the Yuanshenqi (援神契), the Goumingjue (钩命决), etc.; the Wei of Spring and Autumn (春秋纬) including the Yankongtu (演孔图), the Yuanmingbao (元命苞), the Yundoushu (运斗枢), etc.; and the Wei of the Confucian Analects (论语纬) which was added by later generations. In these books, the following terms were commonly used: fu, qi, jue, xing, yan, ji, etc. inspired from works such as the Chuang Tzu – Under Heaven (庄子·天下), the Hanfei Tzu (韩非子) and so on. Hence, we 121

 From Post-Han Shu – Records of Guangwu Emperor (后汉书·光武帝纪).  From Post-Han Shu – Records of Huan Tan (后汉书·桓谭传). 123  Zheng Xuan (郑玄 127–200), a courtesy name for Kangcheng (康成), an influential Chinese commentator and Confucian scholar near the end of the Han Dynasty. 122

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know that these Books of Wei were a combinations of Confucianism and Taoism. Yet what they talked about was no more than the prophecies of “heaven’s will” — either in the form of auspicious or evil omens, using a vague balladic language in a legendary style and using exaggerated expressions, to create grotesque and gaudy prophecies in order to dazzle the people. The Books of Wei contained fairy stories about medicines as well, like the story of immortality in the Wei of Spring and Autumn – Yuanmingbao (春秋纬·元命苞); it described a celestial room existing on Mount Taihua and magic medicines on Mount Shaoshi. It occurs in the Shi Wei – Hanshenwu (诗纬·含神雾) and the Wei of Filial Classics – Yuanshenqi (孝 经·援神契), while ghosts and gods who can prolong or take years off your life are recorded in the Hetu – Jimingfu (河图·记命符). All went far beyond the Confucian classics through their telling of absurd, far-fetched stories. The advocacy of Chenwei was not banned until the Northern and Southern Dynasties (420–589). In the Jinshu – Biography of the Wu Emperor (晋书·武帝纪), it was recorded that “in the third year of the Taishi reign (468 CE) the advocacy of Chenwei and ‘star qi’ was banned.” The Weishu – Biography of Xiaowen Emperor, the Gaozu Emperor (魏书· 高祖孝文帝) records that “in the ninth year of Taihe (485 CE), the emperor released his edict that ‘the thriving of the Graphic Prophecies of the Chen originated from the end of the periods of Dong Zhongshu, Wang Mang and Liu Xiu. Such things as these are not classics, for use by the state administration, but sorcery and fraudulent practices which rely upon them. From now on, all books of Chen, all secret books of Wei, and their copies as in the Record made by Confucians in a Closed Room (孔子闭房记) are to be burned. Anyone who dares to keep any of them hidden will be sentenced to death. Wizards and witches who pose as ghosts or gods, or tell lies, either auspicious or ominous, and conduct the practice of ‘divination in alleys’ — if they are not using records of classical works — are to be strictly suppressed.” This shows that the rulers yet sensed that the books of Chenwei were not of any help in solidifying their rule. However, it was unrealistic to believe they could take these books out completely, since they had, as part of an ideology, made their appearance in the world. As a result, they spread covertly to later generations and even infiltrated into the magic arts of Taoism, in another form. Some were mentioned many times in medical books, as well. The Post-Han Shu – Fangshizhuan (后汉书·方术传) records, “the Godly Scriptures, extraordinary special documents, and jade brochures, golden ropes, etc. that were hidden in the immortal palace of

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souls and spirits or on the jade altar of the immortals, have all been a great waste of effort. As is well-known, the Images of He and Writings of Luo,124 pictures of turtles and dragons,125 the magic arts of Jizi, musical records of Shi Kuang, Books of Wei and the ‘stamped Fu Lu’ are all usually employed for ‘exploring profoundities’ and inspecting the human world. Most popular are the magic arts of Fengjiao, Dunjia, Qizheng, Yuanqi, Liuriqifen, Fengzhan, Rizhe, Tingzhuan, Xuyu and Guxu — together with the magic techniques of Wangyun and Shengqi — all of which help in the study and judgment of either so-called ‘auspicious work’ or else some devilment. Yet their rules are too profound and abstruse to be clearly understood.” Here, we can see that the deep influence of the occult arts did not even escape medicine. The rejuvenation of a belief in ghosts and gods by these diviners shows the impact of Chenwei on the common people’s depth of thinking. In Wang Fu’s Qianfulun (潜夫论), it is said that “some will abandon medicine and turn to pray to the gods and, as a result cannot understand these deaths caused by cheats and delays created by witchcraft, instead they despair that they have not turned to a necromancer earlier. It is plainly obvious, that such dupes will become greatly bewildered.” Zhang Zhongjing wrote a foreword himself to his own Treatise on Febrile and Miscellaneous Diseases (伤 寒杂病论), saying that “at that time, people were confronted by disasters, and fell into astonishment, fear and trembling, lowering their aspirations and forfeiting their honour by placing their hope in witchcraft and the divine. However this was a fatal cul-de-sac, and turned out failure and death, inevitably… the whole world was bewildered, without anyone being enlightened…” Such words reveal a vivid picture. Considering the general progress of medicine at the time, this represented a regression.

59.  Anti-Chenwei Philosophy and Thoughts of a Primordial Qi As for mainstream philosophies during the Western and Eastern Han dynasties, the shift from upholding Huangdi and Lao Tzu to worshipping gods and ghosts, and the transference from advocating studies of “present” and “ancient” Confucius classics to Chenwei theology, rekindled the superstitions of witchcraft and their conception of there being a “God’s will” or “destiny”. However, the philosophy of there being a natural view which had 124

 Image of He and Writings of Luo are the picture and writings which were appearing in the rivers Huanghe, i.e. Yellow River, and Luoshui, i.e. Luo River. Legends have it that the image of He and the writings of Luo symbolize the destined throne claims of new emperors. 125  Both were considered as miraculous things, like a totem symbol in ancient China.

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prevailed since the pre-Qin period did not die out, and these philosophers, comparatively sober-minded, stuck to their anti-witchcraft stance — face-toface with the overwhelming views of those concerned with immortals and Chenwei. Even those who stayed deep in the palace like Queen Ma “never favoured witchcraft and cursing for treatment,” when ill.126 As an all-inclusive work, almost an encyclopedia, although the Huainanzi (淮南子) contains things like the occultist’s pursuit of immortality and the alchemy of gold and silver, more importantly, it possesses a natural view of Yin and Yang, as well as a Monism of Qi — which makes up the predominant part of its 21 chapters, while criticizing theism and the idea of ghosts. As for Yang Wangsun, Sima Qian, Yang Xiong and others, their attitude was atheistic. For instance, Yang Wangsun once said, “death refers to the changes which happen when one’s life comes to its end, and it is the final destination of all things.” “I want to be buried naked in order to return to my truest self.”127 Yang Xiong even criticized Chenwei as shouwei (“selling fakes”) and believed that “the living must suffer death, just as beginning meets its end. This is the natural law.” “Gods and ghosts, vague and indistinct, are there or not there, and the sages did not comment on them.”128 Huan Tan’s several memorials to the throne were created in order to lash out at Chenwei: “Nowadays, some people, who are looking as if they are smart and skilled are actually playing petty tricks and using ‘figured skills’, forging books of Chen as ‘graphic prophecies’ when they are actually using them to cheat the greedy and indecent, and eventually mislead those in authority. Why is it we cannot keep away from such issues?”129 When the Emperor Liu Xiu130 wanted to use Chen for a decision on the building of a bier platform, Huan Tan refused him with the words “I never read Chen” and “Chen is not part of the Confucian classics”. He used a metaphor to explain the relation between men’s bodies and spirits, relating them to a candle: “When a man grows old, he will lose his teeth and his hair turn white, his flesh shrivel and it becomes impossible for his spirit to keep nourished and flow smoothly all through his internal and external body and organs; he will exhaust all his qi (energies) and die — just like the burning out of a candle.” Huan Tan also said, “After a man is born, he grows; he grows until he becomes old; as he becomes old, he meets death at the end. 126

 From Post-Hanshu – Biography of Queen Mingde (后汉书·明德马皇后传).  From On Buried Naked (裸葬论). 128  From Fayan (法言). 129  From Post-Hanshu – Biography of Huan Tan (后汉书·桓谭传). 130  That is, Guangwu Emperor of the Eastern-Han Dynasty. 127

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This is a sequence just like the succession of the four seasons.” He even held the view that people sought the magic techniques of immortality because “they were those who could not extricate themselves from bafflement.”131 Zhang Heng, an outstanding astronomer, criticized the theory of the “interaction and feel of heaven” — of the heavenly and human influencing each other — and objected to the study of the Books of Chenwei by describing the outcome of his astronomical observations and by producing apparatus, the armillary sphere, the seismograph and so on. He pointed out that the “Books of Chenwei, unfounded and presumptuous, are not what the sages advocated” and “should all be confiscated and banned”.132 Among those who objected to Chenwei, the most prominent was Wang Chong (王充 27–97 CE), born in Shangyu, Zhejiang province, China. He wrote On Balance (论衡) which gave a comprehensive criticism of the theological view of the world from Dong Zhongshu to Chenwei, together with what was contained in the Baihutongyi (白虎通义). As for furui (符瑞, auspicious incantations), zaiyi (灾异, calamity as a warning signal), fengshui (风水, geomantic omens), bushi (筮, divination), jisi (祭祀, sacrifice), yansheng/yanyan (厌胜/殃，magic pranks to benefit or stifle somebody), qirang (祈禳, praying to avert something), qiuyu (祈雨 praying for rain), leixing (雷刑, penalties from thunder) and so on, he made a thorough scouring out of them all — explicitly claiming an anti-Chenwei position. His theory of Qi Monism, or natural view, of there being a Primordial qi, is especially significant and had a tremendous impact. In his opinion, “Heaven and earth, are by nature basically qi.”133 “Before birth, man exists among the Primordial qi; and after death, he returns to it.”134 “As qi from heaven and earth is concatenated, a man is produced naturally.”135 “The qi of Yin and Yang condenses, as a man who will die when his life-span comes to its end then transform back into qi.”136 So he firmly believed that natural law was objective: “How could heaven understand man’s doings when man is ignorant of what heaven does?”137 And “a man cannot affect heaven by what he does, and similarly heaven cannot correspond with man according

131

 From  From 133  From 134  From 135  From 136  From 137  From 132

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Xinlun–Qubi (新论·祛蔽). Yandu (言毒). Tan Tian (谈天). Lun Si (论死). Wu Shi (物势). Lun Si (论死). Bian Xu (变虚).

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to his conduct.”138 He also denied the existence of ghosts: “It is impossible for a dead man to transform into a ghost” and “what forms the essential qi is blood in the vessels, which is exhausted when a man dies; and therefore the essential qi also extinguished. As it lacks essential qi, the body decays and becomes dust and earth. How could a man ever become a ghost?”139 “A man cannot become a ghost (after he dies), he must become harmless because he becomes insensible and unconscious then too.”140 He even made the simple deduction that if men turned into ghosts after their death, there must be a terrible traffic jam on the road and overcrowded houses with so many generations of new and old ghosts living there together. So where could men find spaces to live? Such a refutation was quite logically valid. He also said that “all the ghosts in the world are merely what living persons think of and long for and imagine — they are not transformations from the spirit of the dead. What causes this? Disease. When someone is confined to his chamber by an illness, he is afraid of ghosts coming. Being in fear, his imagination runs away with itself, producing illusory visions of ghosts appearing.”141 In a complete reversal away from the thought of ghosts causing disease, he explains that these psychological and mental illusions are due to the disease. He adds, “All flesh and blood beings cannot either avoid birth and death. It is from the living that we recognized the dead. Heaven and earth naturally produce life, and so death as well. If Yin and Yang did not concatenate into life, there would be no death either. Death is the end of life; death is the proof of life.” “Those who learn skills in order to attain immortality must inevitably fail.” “Nothing in the world can escape death. So how can man become immortal?” He points out that “it was false to say that the Huainan king became immortal and rose to heaven” because according to the historical facts, “Liu An, the Huainan king, died of a suicide after the discovery of his conspiracy against the Emperor”.142 He said, “Bushi (divination)143 is never an enquiry into heaven and earth, and its signs and figures are not related to the ultimate truth either.”144 All the above concerned the general relationship between Primordial qi, life and death.

138

 From Ming Yu (明雩).  From Ming Yu (明雩). 140  Ditto. 141  From Ding Gui (订鬼). 142  From Dao Xu (道虚). 143  Bushi, to make predictions using turtle shells, divinatory grass and others. 144  From Bushi (卜筮). 139

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While commentating on human physiology, he held the opinion that “the life of a man relies on a consort of Yin-qi and Yang-qi. Yin mainly determines bones and flesh, and Yang, the soul.”145 “Blood is the essence of life.”146 “Breath corresponds to a diffusion of blood and vigor, attached to the bones and flesh.”147 When a man dies, “his blood vessels break and the feet cannot move anymore.”148 “The spirit makes for life. If it remains intact, life is prolonged and will not end.” “Clothes are for keeping warm; and food for feeding oneself. Protected by warmth and with a full stomach, the spirit may be vigorous.”149 “Life, after birth, cannot avoid suffering disease — just as the spirit will evaporate along with it, at the end of life. It is the same for human beings, whose spirit dies with their bodies.”150 “The life of man depends on the qi of food.”151 “Man has blood-vessels just as the earth has rivers. Blood flows in the vessels sometimes fast, sometimes slow, sometimes in moderation, like the rivers. The tides are just like the breathing of man, in and out.”152 As far as disease and treatment are concerned, Wang says, “Whether awake or aware people can see and hear because of a vigorous spirit. Therefore, when a man gets ill, his qi becomes exhausted and vigor drained.”153 “Mankind’s diseases, either hot or cold, are not caused by their morals or conducts, but from their bodies suffering wind or evil qi. A change of morals or conduct cannot remove cold or hot. Such familiar things in our bodies cannot be removed by changing our behavior. How can a person regulate the qi of a state or governor’s territory, so far away? Harmed by cold, man can take medicines to get rid of it and the pain will lessen; if the cold shifts to heat, a pill for sweating will help you recover.”154 “The body getting ill is like a disaster befalling heaven. If the blood-vessels get blocked, diseases follow; and disorders of the climate will bring disasters one year.”155 “That mountains fall and rivers clog up is just like a swelling, abscess or

145

 From  From 147  From 148  From 149  From 150  From 151  From 152  From 153  From 154  From 155  From 146

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Ding Gui (订鬼). Lun Si (论死). Dao Xu (道虚). Si Wei (死伪). Dao Xu (道虚). Lun Si (论死). Dao Xu (道虚). Shu Xu (书虚). Ding Gui (订鬼). Cold and Hot (寒温). Qiangao (谴告).

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carbuncle in one’s body, as the blood-vessels become blocked.”156 “Man is intelligent and wise because he contains the common qi of the five elements — but in the human body they are formed and hidden in the five internal organs.”157 “When a man is dying of a warm-heat disease, an awfully ominous color appears on his face, indicating that his disease is caused by pathogenic qi which, if not healed, brings death. Then life meets its end.”158 “When a man takes in something unclean, his mouth cannot recognize its filth; and if he knows after eating it, it is called changwu (‘illness born in intestines’).”159 Wang Chong had a thorough understanding of medicine and the human body, and he explained it from the natural point of view of “Primordial qi“. Therefore, it is highly reasonable to say that the adoption of the term “Primordial qi“ in medicine by later generations came about basically under the influence of Wang Chong (admittedly also partly under the influence of Taoism). After Wang Chong, there arose Wang Fu, Xun Yue, Zhong Changtong, Ying Shao and others who either inherited or supplemented Wang Chong’s idea of anti-witchcraft theology. For instance, Zhong Changtong (仲长统, 180–220), who was a shangshu lang160 (尚书郎), once participated in the practical appointment of Prime Minister Cao Cao (曹操). He upheld the principle of “people first, heaven second”, and said, “What a bustling rejuvenation of sacrificial rites for the gods and ghosts! What rumors of absurd heresy and fallacious dreams! Red scripts and magic pranks everywhere!… Isn’t it a tremendous mistake to seek blessings among these ominous issues, and to pursue a trust in foolish and dishonest people?… All these issues of magic pranks and rites which do not belong to what our ‘ritual classics’ call for, should be eliminated immediately.” “Those who know the laws of the nature but have no moral integrity, are the likes of wizards and diviners of the lower class and beneath contempt. Of the main, they are ministers who trust in natural law but manage human affairs by violating these laws, puzzling and befuddling kings and thus subverting the country and destroying while families.”161 156

 From Gan Xu (感虚).  From Lun Si (论死). 158  From Zhi Qi (治期). 159  From Lei Xu (雷虚). 160  A title for an official position in the Han Dynasty. 161  Cited by Qunshu Zhiyao (群书治要) from Changyan (昌言). 157

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It is noticeable that Zhong Changtong’s own words were quoted by Sun Simiao (541–682 CE), a renowned medical doctor during the Tang, in the Yangxing (养性) chapter (Chapter 27) of his Qianjin Yaofang (千金要方). Zhong explains, “The kings’ palaces are filled with thousand of beauties and the officials’ families with hundreds of concubines. They drink mellow wine pouring it into their marrow during the day; and make love, draining their blood and vigor in bed at night-time. They enjoy obscene music and wild sights, entertained at home without going out or travelling without and never returning back. The same goes on at either an upper level for kings and lords, or at a lower level for rich and powerful families. Then as a result childbirth comes at the wrong time, or when they are too young have children. Some being too young strain to have children; some produce sperm, which is deformed. So their sperm is weak and unhealthy and the fetus has an insufficient blood supply. Once such a congenitally defected baby is born, it is difficult to maintain it in health. The baby often becomes ‘steaming hot’ as it has too thick coverlets on its body, its spleen and stomach harmed by too rich food. So it is hurt both congenitally and post-natally, which results in a vulnerable infant. Even worse, these weak young ones, before even reaching maturity, indulge their lusts. Hence, here is a ‘double-double’, disease on disease. Throughout the whole country, there is not one excellent doctor. Physicians have no cautious skill when treating a patient but fraudulent conduct themselves — and often make mistakes. Sometimes they themselves fall ill and cannot cure themselves. Nowadays, there are few who can reach an age of one hundred. Isn’t this because their duties are not carried out, purely and correctly?” Here, we find Zhong Changtong with an analysis of the truth of the matter; he observes and criticizes both the medicine and the disease. However, it’s a pity that his writings have mostly been lost, which makes it impossible to get a full view of them. Zhang Zhongjing (ca 160–218), a contemporary of Zhong Changtong, was heir to this atheistic philosophy. One of his major motives for writing his Treatise on Febrile and Miscellaneous Diseases (伤寒杂病论) was his aversion to wizards and their prophecies, who were all the rage at the time — and the negative and declining spiritual condition shown by the “begging to heaven and accepting its failures” both within and outside the imperial court. He hoped to rediscover a medical tradition based upon a natural philosophy, which had existed since the time of Bian Que, using feasible medical prescriptions and acupuncture techniques which could save people’s lives and keep them from unreasonable death. In this way he was

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able to revitalize medical classics such as the Neijing (内经) and Nanjing (难 经). He pushed medicine on to a new stage.

D. The Background for the Medical Achievements of Zhang Zhongjing and Hua Tuo 60.  The Confucian Tradition of Zhang Zhongjing, a Medical Sage The philosophy during the Western Han (206 BCE–24 CE) and Eastern Han (25–220 CE) dynasties continued on from Taoism into Confucianism, but at a later stage became entrapped in a superstition of gods and ghosts — while retaining some religious features. Yet having still the aspect of an academic approach, it tolerated the thinking of other schools, which explained the large share of atheistic schools at that time. More precisely, in the sphere of medicine, the natural view of Yin–Yang, Five-element and a Qi system still dominated medical theory. There also appeared some new achievements made by secret medical groups in the folk world. It was against such a complex cultural background and from the stimuli of outbreaks of epidemics that there arose such an excellent and unrivaled physician as Zhang Zhongjing, whose representative work A Treatise on Cold Damage and Miscellaneous Diseases (伤寒杂病论) had a tremendous impact on Chinese medicine for the next 2,000 years. Zhang Zhongjing (张仲景), also named Zhang Ji（张机), was born in Nanyang, Henan province, China. The years of his birth or death (160?– 218?)162 are still unclear. Legend says he was once prefect of Changsha town, which, however, was not recorded in the historical books or any biography. The circumstances of Zhang Zhongjing’s book are revealed to us by Sun Simiao: “Medical masters in the south of Yangzi River keep secret the important prescriptions of Zhongjing and never show them to students.”163 However, Sun Simiao quoted quite a lot from Zhang’s own preface, and 20–30% of his prescriptions for shanghan illness were adopted from Zhang Zhongjing’s treatise. So it is quite possible that Simiao had read the book and wanted to make part of it public. Zhang Zhongjing was initially nurtured in the Confucian orthodoxies. He once prefaced himself by saying, “Be industrious in order to learn ancient teachings and adopt various prescriptions. In writing, make references to the 162

 Ma Boying, Brief Study on Zhang Zhongjing, Chinese Medicine Research, 1991 (4).  From Qianjin Yaofang (千金要方), vol.9.

163

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Suwen (素问), the Nine Volumes (九卷), the Eighty-One Challenges (八十一 难), On Yin and Yang (阴阳大论), the Tailu (胎胪 fetus), the Records of Medicines (药录), and the Pingmai Bianzheng (平脉辨证 diagnosis of the pulse) as well…” All these medical classics must have been part of the books collected by the government, or in circulation then in the folk world. The renowned physicians he lists include Shennong, Huangdi, Qibo, Bogao, Leigong (God of Thunder), Shaoyu, Shaoshi, Zhongwen, Changsangjun, Bian Que, Yang Qin, Lord Cang, etc. among whom Shennong, Huangdi, Changsangjun, Bian Que, Yang Qin, and Lord Cang can be found in the Historical Records (史记); Shennong also appears in Shen Nong’s Classic of Materia Medica (神农本草经), and Huangdi, Qibo, Bogao, God of Thunder, Shaoyu and Shaoshi are characters from the Neijing (内经). Zhongwen is unknown and cannot be traced in today’s existing ancient medical documents. All in all, the above-mentioned books form the basis for the medical knowledge and theories of Zhongjing. The sixteen volumes of A Treatise on Cold Damage and Miscellaneous Diseases (伤寒杂病论) today exist as A Treatise on Cold Damage Diseases (伤寒论) and A Synopsis of the Golden Chamber (金匮要略) as, according to legend, they were divided by Wang Shuhe（王叔和）— who categorized all hot illness under “cold-injury” diseases, while the rest were put in the category of “miscellaneous” diseases. Some prefer “acute diseases (卒病)” to “miscellaneous diseases (杂病)”, while opponents claim this is too farfetched because the word “卒” is simply left over from the complex form “雜” (i.e. “杂”) from which some parts have been dropped. The word “卒” means “acute”. Febrile diseases are acute, and so are all the other diseases in the Synopsis of Prescriptions of the Golden Chamber (金匮要略). There are no chronic miscellaneous diseases like leprosy, TB and the like in the book. So it makes no sense to retain the term “acute diseases”. Even though “acute diseases (卒病)” is used in the title of Zhongjing’s preface, in the content of the preface, it is still “miscellaneous diseases (杂病)”, which proves the possibility of the original title of the book being A Treatise on Cold Damaged and Miscellaneous Diseases (伤寒杂病论). Zhongjing’s book touches on neither ghosts nor gods, nor does his preface, nor the main body of the book. For instance, there are descriptions of the causes of disease: “The causes of all disease are no more than the following three: first, pathogenic qi intruding the main and collateral channels till the internal organs form an internal cause of the disease; second, in people’s four limbs and nine orifices, there are blood vessels linked together. Any blockage in these areas provides for an external cause, as the skin and

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muscle is invaded; third, some hurt caused by sexual indulgence, metal tools such as knives, or else animal or insect bites. A further study into these three can include all causes of disease.” There is nothing here referring to diseases caused by ghosts or gods. Controversies have arisen on “the third chapter, ‘conventions of febrile diseases’” probably because some thought it had been added by Wang Shuhe. Yet the words from On Yin and Yang (阴阳大论) quoted in it correspond quite well to those in the author’s preface. So although it bears the sorting marks of Shuhe, they must still be the original words of Zhongjing. Such phrases are “forecasting should be divined by the calendar of the Plough constellation, in order to make clear whether or not it is occurring during the normal phase of the four seasons — and to find out the possibility of an epidemic occurring within an abnormal phase.” These are not signs of a wizard’s astrology, but the influence of a coexistence of astronomy and astrology — and could relate to the theories of “Wuyun Liuqi”, “Xiang-shu”164, etc. Also there appear “divine pills”, noted by Cheng Wuji (1063?–1156) in the Jin Dynasty to be “diaphoretic medicines”. They are not, as Cheng noted, occult medical pills and not pills for immortality. In addition the term “a calamity foretold in the pulses” reveals the influence of “the prophecy of disasters” prevalent during the Western and Eastern Han dynasties. Surrounded by the so-called “revival of the Occultists and wizards” and this being commonplace, it was impossible not to be affected by them. Therefore, there are words in the Synopsis of the Golden Chamber (金匮要略) which state that “pregnant women will produce babies with more than five fingers on one hand, if they eat ginger.” “During the seasons of spring and autumn, people can get Jiaolong disease (dragon disease) by eating celery — because a dragon sperm lurks inside the plant.” “Both water and wine, if the shadow of a human form is reflected on their surface, are unsuitable for drinking.” Phrases such as these all bear the hallmarks of witchcraft, while “Shaokun Powder” is similar to the witchcraft use of contagious substances. When Zhang Zhongjing made pathological analyses he used mainly the terms “qi” and “Yin–Yang”. The system of generations, restrictions, overrestrictions and reverse restrictions of the five elements is discussed in detail in chapters such as Chuanbian (传变 transmissible change), Pingmai (平脉 the pulse) and so on, and especially in the Synopsis of the Golden Chamber (金匮要略) which, though seldom using the terms “wood”, “fire”, “earth”, 164

 Six weathers include the windy, fiery, summer hot, humid, dry and cold.

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“metal”, “water”, etc. in a direct way, carries on the spirit of the five elements through the whole book. In recent years, some non-native scholars take the fact that there are no exact terms such as “five elements” in the Treatise on Cold Damage Diseases (伤寒论) to state that this is proof denying Zhang Zhongjing’s acceptance of the theoretical system of the Neijing (内经). In fact they do not understand that the two books, the Treatise on Cold Damage Diseases and Synopsis of the Golden Chamber, were actually one, both written by Zhang Zhongjing. The Treatise on Febrile Diseases (伤寒论) took the six weathers and six channels as a dialectical principle and connected them to the common idea that the causes of hot diseases were the impact of changes in the weather. There are six weathers coming from heaven and five elements here on earth. So when the pathogenic qi attacks, the system of six weathers and six channels should be used to analyze them. This should be considered one indication of the astronomical progress made during the Western and Eastern Han dynasties. Without doubt, the Treatise on Cold Damage and Miscellaneous Diseases (伤寒杂病论) was a grand generalization and summation of epidemic disease, along with a record of personal treatments made by Zhongjing at that time. He was the first doctor to creatively combine the theory of the Neijing (内经) with his clinical practice experience, standardizing it as bianzheng lunzhì 辨证论治 (pattern identification and treatment). He produced 397 methods of treatment and 113 prescriptions in the Treatise on Cold Damage Disease and 262 prescriptions in the Synopsis of the Golden Chamber (金匮要略). Thus, he may be called “the ancestor of all prescriptions” and founder of the TCM clinical theoretical system of pattern identification and treatment, which led Chinese medicine into a new age. Thereupon, he deserves the title “Sub-Medical Sage” under the Confucians. One should also mention in passing the famous expert in pulse taking, Wang Shuhe (王叔和), also known as Xi (熙). There is no record regarding his years of birth and death, but he was a junior to the generation of the celebrity Wang Zhongxuan（王仲宣 177–217）who met Zhang Zhongjing in 194 AD (Wang was 17 years old) — when Zhang told him there was covert illness within his body (actually it was leprosy). But Wang ignored him and died when he was 41 years old. Also, a student of Zhang Zhongjing, Wei Xun (卫汛) was Wang Shuhe’s friend and they often travelled together. One could infer Wang Shuhe had opportunities of contacting Zhang Zhongjing or had maybe studied the quintessence of the Treatise on Cold Damage and Miscellaneous Diseases, getting it from Wei Xuan. Later Wang

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Shuhe was a senior medical officer at the end of the Wei (魏 220–265) and the beginning of the Western Jin Dynasty (西晋 265–316). He edited the Treatise on Cold Damage and Miscellaneous Diseases — just as “a waterfront pavilion gets the moonlight first.” Wang Shuhe must have felt the importance of the pulse in diagnosis. Before his time a knowledge of the pulse was not systematic and one could find bits of it scattered in Bian Que, the Huangdi Neijing, the Nanjing and the Treatise on Cold Damage and Miscellaneous Diseases variously. Wang Shuhe collected, tidied and explained them in 10 volumes comprising his Maijing (脉经 Pulse Classic). He ascertained the method of du qu cun kou (独取寸口 just taking the pulse on the wrist) to replace the sanbujiuhou (三部九侯 taking the pulse at three places and nine areas). He identified 24 pulses, with their characters and linking illnesses, as important signs in diagnosis. Pulse taking is indispensable, and one of four methods, with its place in diagnosis irrefutable. If we say Zhang Zhongjing established the specifics of the system of pattern identification, then Wang Shuhe tidied up pulse diagnosis, and both contributed a very great deal to Chinese medicine.

61. Hua Tuo, a Miraculous Doctor, His Occult Elements and Demeanour Living a little earlier than Zhang Zhongjing, there was another renowned doctor and surgeon named Hua Tuo (华佗 145?–207), who lived at the end of the Eastern Han Dynasty. Yet the difference is that Hua Tuo has been recorded in the historical books; he was so well known that almost everyone，even women or children, knew him. His reputation was partly due to his colourful representation in the Romance of the Three Kingdoms (三国演义) and the fascinating story of him “scraping the arm-bone to eliminate poison, for General Guang Gong (关羽)” — stories which were not recorded in the Post-Han Shu (后汉书) or Records of the Three Kingdoms (三国志) and were never actually mentioned in the histories. According to the Romance of the Three Kingdoms (三国演义), the story of Hua Tuo “scraping the bone to eliminate poison” for Guang Gong took place at a time when, according to the histories, Hua had already been killed by Cao Cao (曹操) long before. Before the execution of Hua Tuo, Cao Cao rejected the proposal of Xun Yu that “Hua Tuo is so skilled in his medical technique, which can save people’s lives, that he is better pardoned.” Cao responded, “It doesn’t matter, the world will not be sad to get rid of such a rat!” Hua Tuo in Cao Cao’s

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sight was considered an insignificant non-entity (a rat) — which reveals that his reputation was not so great that he could draw the attention of Cao Cao, one of those politicians who promoted the talented. It never occurred to Cao Cao that he had just killed a brilliant medical genius, whose death would put an end to the development of Chinese operative surgery forever. Not till the death of his beloved son did Cao sigh and say, “I really repent of my killing of Hua Tuo, now that I see my son’s abrupt death has happened because I am without Hua Tuo.”165 This was simply regret for his own loss. In the eyes of Cao Cao, Hua Tuo was no different from any other occultist he had supported — those whom he despised as well, deep in his mind. Hua Tuo was once a Confucian scholar in his early years, but later rejected the recommendations of “Xiao and Lian”.166 He had inherited a tradition of the Confucian classics, and yet finally became a Taoist. According to Zhang Hua’s Natural History (博物志), Cao Cao “was keen on the methods of ‘keeping well’ as well as having a knowledge of medicines. So he recruited Occultists from all directions. Zuo Ci from Lujiang, Hua Tuo from Qiao County, Gan Shi from Ganling, and Xi Jian from Yang City, to name just a few.” Hua Tuo, one of those recruited by Cao Cao, was definitely an occult Taoist. His Five-Animal Exercises were one of the techniques for keeping well if you were of occult temperament. He said to Wu Pu, his apprentice, “Men must exercise their bodies — but not excessively. Exercising the body can help digest the qi of food in the stomach, so as to get a smooth circulation of the blood and keep away disease, just like a leather door-hinge never gets worm-eaten. That’s the reason why the ancient immortal-seekers often did Daoyin (导引 Qi conducting exercise) imitating the movements of animals — such as climbing or hanging on trees like bears, twisting round their heads while keeping their bodies unmoving like hawks, stretching the body and bowing the waist, as well as exercising the joints to keep them from aging. I have a method called the Five-Animal Exercises, respectively — tiger moves, deer moves, bear moves, ape moves and bird moves. They use qi-conducting exercises as a guide to getting rid of disease and keeping the limbs and body healthy. If there is something uneasy or uncomfortable in the body, get up and make an exercise — imitating any one single animal. As a result when the sweat comes, apply some powder to make the skin 165

 Cited from Post-Hanshu (后汉书).  Xiao and Lian (孝廉) were two subjects of piety and sense of honour to select officials in the Han Dynasty. 166

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smooth. Then you’ll feel relaxed and comfortable, hungry and want to eat.” Wu Pu followed his words and lived till over ninety — when he had good hearing and eyesight as well as intact teeth. Thus, we know that Hua Tuo was an advocator, or else himself formed a school of ‘immortal qi-conducting exercises’ for keeping healthy and retaining well-being, which belonged to the same category as those practiced by Gan Shi. When Fan’e, Hua Tuo’s other apprentice, “learnt from Tuo and asked for food-medicines which could benefit the people’s health, Tuo gave him the formula of QiyeQingnian Powder: one jin of sumach leaf powder, and fourteen liang167 of Qingnian (fragrant solomon) powder. Tuo told him to compound a medicine using this formula and guaranteed that, after long time taking the medicine, he would get rid of the ‘three worms’, i.e. parasites, from the body, and his five internal organs would become healthier, his body lighter, and his hair not turn white. Fan’e followed his advice and lived to over onehundred years old.”168 Taking medicines for keeping healthy and retaining well-being were what Xi Jian from Yang City was also good at. The above undoubtedly proved Hua Tuo to be one of the occultists who pursued methods of immortal well-being. As a matter of fact the recruitment of occultists by Cao Cao was done to control them and prevent rebellion. This is made clear in the Biandaolun (辨道论), written by Prince Dong’e Cao Zhi when he says, “There are Occultists in society and our king recruited them all… the reason for gathering them together in Wei Kingdom was that his majesty was afraid of the common people, instigated by evil-doers, gathering to play with the ideas of sorcery, and misleading the populace…At home, our king and the crownprince, and all my other brothers thought them funny and did not trust them.” Such an opinion was also expressed in Cao Pi’s Dianlun (典论), and he gave an example of “Yilang169 Li Tan, from Anping, who learnt their (Occultists’) methods to ‘stop eating grain’ but ate poria fungus and drunk cold water instead. Later he suffered diarrhea and lost his life…and Dong Fen, the staff officer in army, and Jijiu170, an officer from the Hongnong area, who ‘took deep breaths’ — but overdid it so that he could not breathe and became unconscious. After quite a while, he came to… and also Yan 167

 Both jin (i.e. 16 liang) and liang (about 15 gram in the Han Dynasty) are units of weight in China. 168  From the Records of the Three Kingdoms-Biography of Hua Tuo (三国志·华佗传). Similarly hereafter. 169  An official title. 170  Junmou and Jijiu, both were official titles in the Han Dynasty.

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Jun, a eunuch, also went somewhere, learning the skills for helping longevity and Daoyin exercise which were really just loafing around… During the middle years of Guanghe (179–184), the Prince of Beihai was also infatuated with the skills of Occultists and claimed to be an immortal, but it turned out he died of disease… There are other examples, like Liu Xiang169 who was bewildered by the words of Hong Bao, and Jun You by Zi Zheng’s talk. Since ancient times, foolish issues and falsehoods are never apart!” Hua Tuo was such a man “recruited in order to be controlled”, which provided the reason for him being unhappy. Later he returned to his hometown and would not go back — he gave the excuse of his wife’s illness, hoping to get free from the Emperor’s control. But Cao Cao did not change his mind, so sent men to check on him. “Hua relied on his skills of concealment and detested the issue, and therefore refused to go back, which threw Cao into a boiling rage” so he then had him put in prison and executed. Such is what history tells us. On the one hand, Hua Tuo was unwilling to serve Cao Cao; on the other hand, Cao Cao was to blame because of his arrogance and bad temper. All these events can be traced back to Hua Tuo’s resistance to Cao. The medical skills of Hua Tuo seemed not outstanding at the time, or at least Cao Cao did not believe them to be so. Hua Tuo was born in Bo County, Anhui Province, China. Practicing in Xuzhou area, he was initially a physician of the folk world who treated people with acupuncture and medicine and might especially have been renowned for his skills in eliminating parasites. The sixteen exemplary cases recorded in the Records of the Three Kingdoms (三国志) involve four cases of pulse taking, one case of facial colour diagnosis, three cases of acupuncture, six of herbs and two of de-parasiting; five describe prognosis, two mention dietary therapy and warm water soaking, one is a case of psychological therapy and one a case of operational surgery (another two cases of operational surgery were recorded in the Supplementary Biography of Hua Tuo (华佗别传). The Post-Hanshu History (后汉书) records seven cases. His skill in acupuncture was praised by Chen Shou (陈寿), author of Records of the Three Kingdoms: “when moxibustion was to be adopted, he would choose just one or two acupoints and gave seven or eight zhuangs171 on each. Then the disease was wiped out. If acupuncture was to be used, similarly just one or two acupoints would be chosen and before giving needling, he spoke to the patient, saying the feeling should stretch 171

 In moxibustion, one moxa cone was called one zhuang, and there are usually three to five zhuangs to a patient or more zhuangs for each moxibustion.

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somewhere — and when the qi arrived, he also spoke to them. As soon as the patient said that he felt it, Tuo drew the needle out and the disease was cured.” One case told that after acupuncture by another physician, the patient “coughed quite badly and felt uneasy in bed.” Then Tuo looked at him and said, “That physician, who previously wanted to needle the stomach, yet mistook it for the liver. You will eat less and less, day by day and become incurable after five days.” It turned out just as he said. Here, I (the author) hold a strong suspicion that “liver 肝” was a mistake, it should have be written “lung 肺” (both shapes in Chinese are similar). Therefore, we can say that Hua Tuo had diagnosed the first case of acupuncture accident — the puncturing of the pleura had caused a pneumothorax. In another case, Hua Tuo made the dead foetus abort from the body with acupuncture, which reflected his excellent technique. When Hua performed acupuncture to relieve Cao Cao’s headache he told Cao he could not cure it only by acupuncture — this showed that he should be respected for telling the truth. It is said that Hua Tuo was the first man to discover the acupoints hua tuo jiajixue recorded in Ge Hong’s Zhouhoufang (肘后方): “When Hua Tuo treated those who died of cholera, he climbed up on the roof and called to their souls. Then as for those whose souls have been called back — but still did not recover — Hua Tuo would hold the belly of the patient and lay him on his stomach, stretch out his arms and measure the length between the two elbows with a string. After that, he used the string to find the lower spinal acupoint and fix two points, each one cun from the spine left and right, and on which he made one-hundred zhuangs of moxibustion. If this still did not work, moxibustion could be used on the vertebra — level with the elbows. Hundreds of patients were treated by this method and all could rise immediately after moxibustion. Tuo passed this skill on to his apprentices and every generation kept it a secret.” Here, “climbing up to the roof and calling the souls” belongs to Taoist witchcraft. Chen Shou went on to say that Hua Tuo was “also skillful at prescriptions which altogether consisted of just a few herbs, but he could measure the differing amount of each herb in his heart without weighing it — and let the patient drink the medical potion immediately after it had been boiled. Then attention was called to some taboos, he left — and the disease was cured.” In some cases, Tuo used the method of “sweating and purging” and the pills of Siwu Nu Wan. His judgment and prognosis were almost always right. His psychological therapies were similar to those of Wen Zhi172 in 172

 Wen Zhi, a physician in Song State during the Warring States Period, who was very skillful in psychological therapies.

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“the restraining of worry by anger”.173 All these are sufficient for the title “miraculous” to be given to Hua Tuo. Yet what made his name a household word, handed down from one generation to another, was probably his skill at treating parasites or eliminating intestinal worms. There were no records about de-parasiting or de-worming in all the historical books, unofficial documents and folklores prior to this — Hua Tuo was the first. “A man was sick in his throat and could not eat, although he was very eager to. His family carried him in a carriage to the physician. Tuo heard his moans and stopped his own carriage to take a look. Then he told them, ‘On my way here, I’ve seen a cake-selling-booth which has vinegar — with soaked and mashed garlic in it. Go and fetch three liters for the patient to drink, and the disease will be cured.’ The patient did as Tuo said and immediately vomited out a snake-like worm which he hung up on his carriage. Then the patient wanted to visit Hua Tuo who, however, had not yet returned home. There were children playing on the ground in front the door — who came up to him — and said to each other, ‘he must have seen our father, because I’ve seen the worm on his carriage!’ The patient entered the house and sat down, where he caught sight of tens of worms hanging on the northern wall.” It seemed that Hua Tuo had successfully treated many infestations which must have been marvelous at that time, so he would hang them up on the wall to show them off. Later when Chen Deng, the prefecture of Guangling, fell ill and Tuo diagnosized him, he said, “There are liters of worms in your stomach which will cause internal gangrene.” After the treatment, Chen “vomited out over three liters of worms, whose red heads were still moving and had a body like raw fish.” Eating dirty or unboiled food would most likely breed parasites, which sometimes unsurprisingly could even amount to “three liters”. Hua Tuo’s skill in de-worming or de-parasiting and his formula of Qiye Qingnian Powder for Fan’e to “get rid of the three worms” belong to the same type of medicine. There must be some connection between the character tuo (佗) in Hua Tuo’s name and his skill in de-parasiting or de-worming. Parasitic worms hung on the wall were not considered filthy, and on the contrary would be excellent in honouring him — even in giving him a name or nickname. Hua Tuo, originally named Fu, had another “styled” name, Yuanhua (元化). Fu (旉), according to the connotations given by Yan Shigu, means “starting and stretching”, similar to that of Yuanhua, which was in concordance with the 173

 Anger represents wood, while worry implies earth. According to the system of the Five Elements, earth is restrained by wood. Therefore, anger can suppress worries.

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ancient tradition that name and “style” name must bear the same meaning. However, Tuo (佗) does not comply with Yuanhua (元化). Tuo (佗) also means “other (它)” which is similar to the character “snake (蛇)” and synonymous with another character “snake (虵)” which is also called a “worm (虫)”. In oracle inscriptions, “other (它)” was a form of “ ”, the pictographic character for snakes and worms, and “other (它)” was synonymous with “also (也)” which could be written as “ ”. Therefore, tuo (佗) being the word “other (他)”, is pronounced the same as the word “other (它)”. In Ge Hong’s Baopuzi (抱朴子), in the chapter titled Zaying (杂应), Hua Tuo is written as Hua Ta (华他). At present, tuo (佗) is inverted into tuo (驼). Yet in the Post-Hanshu – Biography of Hua Tuo (后汉书·华佗传), such descriptions as “vomiting a snake-like worm” and “hanging tens of snake-like worms on the wall” suggest the same meaning as “snake (虵)” in the Records of the Three Kingdoms (三国志), which describes it as a “worm (虫)”. All in all, tuo (佗) was not the original name for Hua, but simply his nickname. In later times some books printed “华佗” as “华陀” but this “陀” is linking him with Buddha (佛陀). Some people misunderstood and drew a forced analogy — saying Hua was a Buddhist. This is totally wrong. Hua Tuo’s status actually was as a surgeon of the time. As for the operational surgeries performed by Hua Tuo, there were a few cases in the records. One case states that “A literary official felt uneasy, and Tuo told him, ‘you’re terribly ill and your belly needs to be opened up to take something out. Even so, you cannot live longer than ten years. Your illness will not kill you, but your life will come to an end after you have been sick ten years. Therefore, operational surgery is unnecessary.’ The man could not bear the pain or discomfort, yet was determined for the thing to be taken out. So Hua Tuo performed surgery and the illness was cured. Yet the man still died ten years later.” In another case, “a man was sick and felt very painful in half his belly. Over ten days, his hair and beard fell out. Tuo said, ‘it’s because your spleen is half-decayed. It can be treated by opening up your belly.’ Then Tuo asked him to take some medicine and lie down for him to open the belly where Tuo found the spleen half-decayed. The decayed flesh was scraped out, and the wounds bound with some ointment, the patient then drunk some medicine and after one hundred days, recovered health.” In the Supplementary Biography of Hua Tuo (华佗别传), there is another case in which Hua Tuo, in treating the daughter of Liu Xun who suffered a knee-sore, “made her take medicine and afterwards the girl lay down unconscious”, then he took out a “snake-like worm” from her knee.

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The adoption of taking the anaesthetic powder mafeisan (麻沸散) before surgery was surely a magnificent invention in the medical history of the world. It is an effect of Chinese medicines that an anaesthetic powder, together with wine, can make the patient faint as if drunk and become lethargic and not feel the pain. This is the outcome of the herbal powder. Previous chapters mentioned “if the medicine could not bring the reaction of dizziness, the disease cannot be cured” and Chunyu Yan (淳于衍), in poisoning the queen, used monkshood (i.e. aconite). It was well known, long ago, that aconite can stop pain. Jiao (Zanthoxylum) seeds are also a kind of poison. In the first year of Xiping (172 CE) during the reign of the Ling Emperor of the Han Dynasty, “when Empress Dowager Dou died… Li Xian, the Taiwei,174 had just become ill. He got up using a chair and made the jiao into a powder, taking it along with him. He said to his wife, ‘if the Empress Dowager cannot be buried along with the Huan Emperor (her husband), I will not return.’”175 He meant to drink the powdered wine to kill himself. Such a wine can kill people when taken as an overdose, but relieves pain in an appropriate amount. “During the time after the Three Kingdoms Period, in the Northern or Southern Dynasties, nobles were usually ordered to drink narcotic wine and after they became lethargic, the punishment was implemented — they were executed.”176 For instance, Tuoba Hong, Xiaowen Emperor of the Northern Wei Dynasty, defeated Xun, the ex-crown prince, in the twentieth year of Taihe (497 CE), and “ordered Xing Luan, Zhongshu Shilang,177 and Wang Xi, Prince of Xianyang, carrying the jiao powdered wine with them, to go to Heyang to crucify Xun.”178 The Xiaowu Emperor of Song in the Southern– Northern Dynasty, in the first year of Yonghe (508 CE), killed Wang Xie of Peng City, “who was killed by warriors after he drank poisonous wine.”179 During the reign of the Jianwu period of the Qiming Emperor (494–498), Zi Ke was governor of Wu area. When Wang Jing, the Dasima,180 rose in 174

 An official title of ancient China as the top leader of army.  From Zizhi Tongjian-Records of Han-Forty-nine Chapter-Xiaoling Emperor (资治通鉴· 汉纪四十九·孝灵皇帝). 176  Gong Chun, Hua Tuo, the Great Surgeon in China, Chinese Journal of Medical History, 1955 (1). 177  An official title of ancient China. 178  From Weishu–Biography of Xun, the Ex-crown Prince (魏书·废太子恂传). 179  From Weishu–Biography of Wang Xie of Peng City (魏书·彭城王勰传). 180  An official title of ancient China during the Southern–Northern Dynasty as the head of army. 175

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rebellion in Kuaiji (now Shaoxin in Zhejiang province) he used the name of Zi Ke — but Zi Ke ran away and was nowhere to be found. At first, Yaoguang, the Prince Shi-An, wanted to persuade the emperor to kill all the men of the Gao and Wu families. So the emperor ordered Zhao Zhou, Prince Jingling, together with others, altogether over sixty people, to go to Yongfu province, and at the same time ordered the imperial physicians to boil two hu181 of jiao powder, and had tens of coffins got ready, telling Shen Huifu, his servant, that “When the jiao has been boiled enough, let them drink it and crucify them all. I hope all of them are killed by mid-night.”182 According to the Materia Medica (本草), peppers coming from the Shu area (Sichuan Provence), if sealed at the tip, could be used to kill people. All the above examples concern execution after anaesthesia, which is sufficient to prove that the technique of anaesthesia did not become lost, instead it was used to kill people through some “technological process”. It can also be deduced that jiao and aconite might both have been ingredients for mafei powders (Mafei San). The invention of anaesthetic powders such as Mafei San by Hua Tuo could not have been a rumour. Though nowadays, the loss of the formula for anaesthetic powder makes it impossible to find out its ingredients, there could be something traceable in the “bewitching perfumes” and “narcotic herbal powders” quite commonly used later by highwaymen and thieves. Some researchers make a conjecture that mandragora might be the main ingredient for the anaesthetic in Mafei San, or in other words, it might be the jiao called “dianqie (i.e. belladonna)” by local people in Guangxi province, China. Aconite is compatible as a powder. According to the Shiyi Dexiao Fang (世医得效方), Wei Yilin, during the Yuan, used mandragora and radix aconiti agrestis to make anaesthetic formula in medicine. Later the Japanese Hanaoka Seishū applied this formula as his surgical anaesthesia in 1805, and shocked the whole world. Modern man extracts hydrochloride, used for anaesthesia in Chinese medicine, from mandragora. Another view is that hemp (麻蕡) could have been the main herb for the powder. All in all, all these were herbs found in the mountains and the trial and application of these herbs in surgeries were not in the tradition of Neijing (内经) but representative of the occult characteristics of Hua Tuo. This technique of ancient anaesthesia might still not have been lost and perhaps continues to be used today, as the following story suggests. For 181

 A unit of volume.  From History of Southern Dynasty-Sons of Gao Emperor of Qi State (Part I) (南史·齐 高帝诸子) (上). 182

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instance, according to the Huguang Tongzhi (湖广通志), “Zhang Shizheng, a surgeon in Jinzhou, was good at healing fractures. When the king Tangwang (i.e. Li Shimin 李世民，later the second emperor of the Tang Dynasty) hid in Jinzhou, a soldier in his army got hurt and suffered fractures of the shin-bone — and went to Zhang for help. Zhang let him drink medical wine. Then he incised the flesh and took out a piece of broken bone as big as two fingers. After binding it with some ointment for several days, this soldier recovered and was as before.” Here, the wine must have been some kind of anaesthetic. The Taiping Guangji (太平广记) cites, from the Wenqilu (闻奇录), “Cui Yaofeng, Defense Officer of Jinzhou, had a nephew named Li Yanji who suffered itches on his left upper eyelid. There was a tiny sore swollen up which later grew as big as a goose egg. The root of the sore was like a thread, which pressed on his eye and made it impossible to open. Yaofeng was very worried about him. One day, he let Li drank wine and he got extremely drunk. The sore was cut off without him feeling it.” Here too, the wine must have been an anaesthetic wine. The Yinhualu (因话录) records that Cui Xian, a prime minister during the Tang Dynasty, suffered from “proud flesh like polyrus on his left eye orbit, which almost covered his pupil and caused much trouble to his eyesight. He turned to various physicians, but all in vain.” Later someone recommended he be treated by Tan Jian, who “asked Cui, ‘how much wine can you drink?’ Cui answered that though he was not very good at drinking, he still could drink a few full cups of wine. Tan was very pleased… and asked Cui to have several cups. Then Cui sat still without thinking. After a while, Tan gently touched the proud flesh and said, ‘it is such a small case.’ At first, Cui felt the flesh being pulled and remained silent, despite the pain. Then the sound of scissors was heard… Tan provided several liang183 of good silk-cotton balls, reddened them and wiped away where the flesh was and put on medical powder. Cui did feel less pain. Then Tan asked Cui to open his eyes. Cui saw that the cut-off flesh was as big as a little finger and like a dried tendon…” Here, the wine Cui drank and the applied silk cotton were quite probably effecting anaesthesia and pain relief. The practice of applying medicine onto the eyelid belonged to local anaesthesia — which had never been heard of before. It is similar to the story of Wu Yong who cleverly “robs the birth-presents” in the novel Water Margin (水浒传). This story tells of how Yang Zhi used “narcotic herbal powder” in wine for his adversary to drink, and thus achieved victory. 183

 A unit of weight in China.

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The secret inheritors of this technique of anaesthesia were the occultists, and they all had a common ancestor in Hua Tuo. All the above stories reveal that Hua Tuo was nurtured by the occultist’s culture of immortality and especially good at medical techniques. His Daoyin exercises for keeping the qi flowing in the body and his dietary methods were not of the school of immortality, but concerned with keeping healthy, well-being and longevity; but his medical skills and acupuncture were extraordinary for the time. Yet it is quite tragic that his writings in prison were handed over to a turnkey — and burned due to that turnkey’s fear and cowardice. Hua Tuo’s other writings, though perhaps passed on, were mostly scattered and lost. Today, the Zhongzangjing (中藏经), under the authorship of Hua Tuo, is quite ancient in style and content as well having within it inventions which must bear the mark of Hua Tuo. In Wang Shuhe’s Classic of the Pulse (脉经), there are Hua Tuo’s “secrets of diagnosis by voice and countenance” which can be used as reference. Yet what is recorded in books such as the Suishu – Records of Classics (隋书·经籍志), the Liangqilu (梁七录), the Chongwen Zongmu (崇文总目) and so on which carried the authorship of Hua Tuo are actually forgeries by later generations. The recently published book A Secret Biography of Hua Tuo, the Great Physician (神医华佗秘传) also belongs to this type. The apprentices of Hua Tuo, such as Wu Pu and Fan’e, practiced the same way — using dieting with herbs, Daoyin, in order to exercise the body, and acupuncture. Wu Pu was especially good at herbs and produced six volumes of Wu Pu’s Medicine (吴普本草), while Fan’e conducted special investigations into acupuncture and could give acupuncture treatment on such places as the breast and back, places which mediocre physicians dare not touch, as a result of which diseases were cured immediately. Another apprentice, Li Dangzhi, was also proficient in herbs and wrote the Herbal Classic of Li Dangzhi (李当之本草经). However, the three of them never seemed to inherit the secrets of Hua Tuo’s de-parasiting, anaesthesia or surgery. The death of Hua Tuo put an end to the development of traditional Chinese surgery. Though minor progress was made by later generations, it did not take a predominant role and this eventually resulted in endo-therapeutic methods being used to deal with surgical problems. Therefore, there were no real surgeons or surgery in ancient China, which was a heavy loss throughout Chinese medical history. Was this ignorance of medical technique due to a random accident?

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Religious Taoism and Medical Culture A. The Inherited Relationship Between Religious Taoism and Medicine 62. The Role of Occult Medicine During the Establishment of Religious Taoism In English, “Taoism” means either the philosophical Daojia (道家) or the religious Daojiao (道教). Therefore, this English word has caused much confusion. The Daojia is the famous philosophical school started by Laozi and Zhuangzi during the Spring–Autumn and Warring States period (770–221 BCE), but the Daojiao, as a religion, was formed at the end of the Han dynasty. So here we must clearly state that Daojia stands for Philosophical Taoism with its philosophers, while Daojiao means Religious Taoism — and subsequently the Daoshi (道士) refers to the Religious Taoists.1 Before Daojiao (Religious Taoism) appeared there existed some primitive religions such as witchcraft. Religious Taoism was actually growing within the cultural atmosphere of Chenwei theology — with its ideal of the immortality. The thought of Laozi and Zhuangzi was theologized, and Laozi considered as the founder of Religious Taoism. The occultists, alchemists, sorcerers and Mohist (墨家) swordsmen became an organizational foundation, while the dissemination of Buddhism in China triggered and enlightened religious worship and organizational form — they learn or copied from Buddhism: temples and statues, grades or status, worship, the production of canons, etc. At its earliest stage, there were two kinds of Religious Taoism. One was folk Taoism, viz. ghost Taoism (鬼道), 1

 In this particular chapter, please remember Taoism on its own simply means religious Taoism, while a Taoist is a religious Taoist. 377

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witch-ghost Taoism (巫鬼道), etc. which treated diseases with Taoist “water talismans” and taught people about ghosts; another was aristocratic Taoism, viz. the Xian Dao (仙道, “the Tao of the Immortals”) or Fang Xian Dao (方仙道) — “Occult Taoism”, concerning immortality and the external alchemy, which created dan to eat for attaining longevity or immortality. Later the two kinds of Taoism combined and “immortalizing Taoism” remained the theme. Such Taoism aimed to cultivate both life and selfnature, and believed that human beings can become immortal through cultivation. It was desirable in Taoism to work against destiny (to a certain extent) and be prepared to actively change one’s fate. Medicine during the two Han Dynasties belonged to the occultists, with their skills such as alchemy and was under their control. As the occultists in “immortalizing Taoism” performed yellow-white alchemy in order to produce an elixir, they also practiced medicine and treated disease with the theory of the Neijing. So some of the theories, medical skills and formulae from the Neijing were also absorbed by religious Taoism and the Taoist canons mentioned medical books and terms. Almost every religious Taoist knew a little medicine. The occultists of Cao Cao were respected by later generations as immortals in Religious Taoism. The Taoist writings of the king of Dong’e stated the following: … Gan Shi and the others understood their lord was persistent. They were not paid more than officials and did not receive any awards without credit. It was not easy for them to have the chance to visit the island of the Immortals and few wore magnificent embroideries. So they did not dare speak out anything absurd or unusual. I lived with them and witnessed Xi Jian, who had not eaten for one-hundred days but was living as well as before — he appeared composed himself. Anyone will die if he does not eat for seven days, but Jian was still living. Not eating may not prolong life or treat disease, but it can make people fearless of famine. Zuoci also was good at coition skills, to extend the life-span but only people with a strong will and great skill can do this. Gan Shi was old but looked young, and all these occultists were attracted by him. He spoke a lot, but most of it was off-beam and bizarre. I was lucky enough to have a talk with him alone… He said to take a pair of five-cun carp, first cook up one of them with a drug and then put both into a boiling pan of fat. The one cooked in the drug could still swim on the greasy surface or sink to the bottom as if in a pool, waving its tail and blowing out its gills,

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but the other was cooked enough to eat. I often asked him: “Can this drug be tested?” He said it could only be found at a place beyond the Great Wall, thousands of miles away. Besides, unless he himself went to collect it, the drug could not be found. Things like this went on a great deal. It is difficult for me to cite them one by one, so I just tell of them here — tremendous, bizarre occurrences. If Gan Shi had met the First Emperor of the Qin or Emperor Wu of the Han, he would have become a somebody, just like Xu Shi, or Luan Da. Though these Occultists were not immortals, they had their own unique and outstanding magic. So it is not unreasonable that they became worshiped in Religious Taoism.2 The founders of Taiping Taoism were also sorcerers and occultists. For example, Yu Ji (i.e. Gan Ji ?–200 CE) from Wu was a founder of Taiping Qingling Taoism, and lived during the period of Emperor Xian at the end of the Han Dynasty and into the Three Kingdoms. Gan Ji came from the Northern Seas. He had suffered from leprosy for several decades. No medicine could cure him of the disease. One day, he saw a person called Bo He selling drugs down in the market. Gan visited Bo He. Bo said, “Your disease can be cured. If you want to do it, please meet me under the magnolia tree at the northern end of the great wooden bridge at the time of the crowing rooster tomorrow and I will teach you how.” The next day, when the cock crew, he went to the agreed place and found Bo He had been there already. Bo said angrily, “Don’t you want to be cured? Why were you late?” He changed the time to midnight on the following day. So Gan went there at sundown. After a while, Bo He came. He said, “Maybe you can do it, maybe not.” He gave him two volumes of a primer and told him, “This book will not only cure you, but also prolong your life.” Mr. Gan knelt down and accepted the book. Bo He said again, “When you go back home, you must copy out this book 150 times.” Mr. Gan studied hard and understood its ideas. He cultivated himself inwardly and treated disease outwardly. No disease was left uncured. He lived 300 years and finally cultivated the Tao himself and became an immortal (this tale is from The Immortals, a lost work). Obviously, this story about an immortal is extradited from occult folklore, especially as it concerns medicine. The book Bo He had written is called the Taiping Scripture.

2

 Since now Taoism or Taoist means religious Taoism or religious Taoist, I no longer include the adjective.

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Zhao Jiao (张角), the leader of the Yellow Turbans Uprising, was also a founder of Taiping Taoism. The History of the Later Han Dynasty – The Biography of Huangfu Song records that “In the beginning, Zhang Jiao claimed himself to be a great sage master from Ju Lu. He worshipped Huangdi and Laozi, and kept disciples to treat patients. The patient firstly knelt down and kowtowed to think of their own faults — and then was given a water talisman as treatment. Quite a few were cured and trusted him.” The Records of the Three Kingdoms – The Biography of Zhang Lu quoting from the Dianlue (an unofficial history book from the Three Kingdoms) states, “During the period of Guanghe, in the east, appeared Zhang Jiao… Jiao created Taiping Taoism… The master of Taiping Taoism held on to a nine-joined cane to help in cursing with the incantations of the talisman, taught people to kowtow and think of their own faults, then to drink the water talisman. If the patient felt better day by day and recovered, it would be pronounced he believed in Taoism; if not, it would be pronounced he did not believe in Taoism.” They acted like witch-doctors. Zhang Ling, Zhang Heng and Zhang Lu — three generations of the same family — also founded “five-dou-of-rice Taoism” (五斗米道), viz. Tianshi Taoism (天师道). They lived during the period of the Emperors Huan and Ling, at the end of the Han Dynasty (147–189) and were proficient in the books of Laozi, astronomy, geography and secret Chenwei. They called on people to practice medicine. It is indeed recorded in The History of the Later Han Dynasty – Emperor Ling, quoting from the record of Liu’ai that “the treatment of patients who have to pay five Dou of rice (each Dou is about 2.2 gal.) is called that of a ‘five-dou-of-rice master’.” The Records of Three Kingdoms – The Biography of Zhang Lu quoting the Dianlue says, “They led patients into a quiet room and made them examine their own faults… and prayed for them. The method was the following: write down the patient’s name and his remorse for the crime on three pieces of paper, then put one on a mountain, meaning give it to the sky, bury one under the ground, and sink one in water, which was called ‘the three officials hand-written’. Patients commonly gave them five dou of rice as a reward, so they were called ‘fivedou-of-rice masters’. In fact, this was nonsense and of no benefit in curing disease. But people ordinarily are unwise and many leapt to join them.” Li Kuan founded Lijia Taoism in the county of Wu, and also “treated disease through ‘cursing water’. All the officials, to a man, gathered around him. Later, a huge pestilence broke out in Wu, and Li also died of it.” But Li was said to have become an immortal, not really to have died (抱朴子 Baopuzi – Tao’s Meaning).

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This was the start of folk Taoism and the origin of the Fulu tradition (符箓派). This developed along with the basic traditions of occultists, sorcerers and the Tuchen (图谶), those who practiced prophetic arts, and often had a close relationship with medicine. So it is not strange at all that there is much about medicine in the classical Taoist book, the Taiping scriptures (the Taiping Qingling Book). The following are examples: A “perfected man” asks, “Why do so many people frequently suffer disease?” The Immortal replies, “If the liver spirit goes out and does not come back in time, people will go blind; if the heart spirit is gone, people will have pale lips; if the lung spirit is gone, people will have a stuffy nose; if the kidney spirit is gone, people will be deaf; if the spleen spirit is gone, people will lose their taste; if the head spirit is gone, people will become confused; if the brain spirit is gone, the stomach will be in disharmony and cannot digest; if the limb spirit is gone, people cannot move. Oh, the spirits like to live in the wilderness and not near habitation, and not in dirty places! If they want the spirits to come back, they must fast in a sweet-smelling room — and all disease will disappear. If they do not fast, the spirits will not come back but go up to heaven to complain about them all. So, more and more people suffer from disease and continue to die.” “The common people have three kinds of lives corresponding to the three types of qi, namely the Taiyang, Taiyin and the Middle Harmonious qi. Longevity is the upper-life-span of one-hundred and twenty years, the middle-life-span is eighty years, the lower-life-span is sixty years. A one-hundred and twenty year-old corresponds to the heavens. If you live one year more, you will pass the boundary of heaven and earth. An eighty year-old corresponds to Yin and Yang, respectively the eight directions, the earth and all things on the earth. The dead are gone and the living are said to be ‘staying’. A sixty year-old corresponds to the Middle Harmonious qi, so it is when you get dun gua. Dun means fleeing, gua means a diagram: so this is the ‘charging time’ for your life. If people always do good, they will live longer than the above three types which we can call ‘exceeding our life-span’. But if people always do bad, they will not live long this way and die young. If a fetus dies before being born, it is said to take away the guilt of its ancestor. If the heavenly qi is unpleasant, many people will suffer from head disease; if the earthly qi is unpleasant,

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many people will suffer from foot disease; if the five elements are at war, many people suffer from disorder in the five viscera; if the seasonal qi are in disharmony, many people will suffer from disease in the limbs; if the three lights from the sun, the moon and stars are abnormal, many people will be deaf and blind; if the Yin and Yang qi struggle with each other, many people will suffer from cold and heat; if things on the earth fail to be in normal places, many people will be confused and subject to disorders; if the spirits in heaven and earth are angry, many people will become ill with ghosts; if the Taiyang qi is excessive, many people will die of warm disease; if the Taiyin qi is excessive, many people will die of cold disease; if the punitive qi is excessive, many people will suffer a sudden death; if the eight solar terms are in abnormal order, many people will suffer from flatulence or weak breathing. Now when Yin and Yang in the universe are out of their true positions or phase, they cause disease and harm everything.” Taoism mingled with every part of medical theory — inserting its idea of gods and ghosts — and so created its own medical system. The other part of Religious Taoism was Danding (丹鼎派) Taoism, founded by the followers of the immortal alchemists performing the “yellow-white” operation. The Zhouyi Participation Bond (周易参同契) of Wei Boyang (魏伯阳) was its representative work. The life of Wei Boyang cannot be verified. It was said he came from Kuai Ji (会稽, i.e. Shaoxing of Zhejiang Provence). It is recorded in Peng Xiao’s Preface to the Given Chapters and Verses for Zhouyi Participation Bond that “People do not know the teacher, from whom Wei Boyang got the ancient Dragon–Tiger Scripture. He mastered its essence. Under the guide of the Book of Changes, he wrote three articles named the Participation Bond… and some chapter or supplements… He wrote the book using fables to hide his ideas and showed it to Congshi Xu (an official) of Qingzhou in secret. Mr. Xu added some notes anonymously. At the time of the Emperor Xiao Huan during the later Han (147–167), Wei Boyang gave it to Chunyu Shutong from the same town and subsequently the book was popularized.” Dan means elixir. Dan-making means to refine an elixir into pills which can cure all diseases and make people immortal. In Religious Taoism, dan-making with the same purpose became a very popular branch of external alchemy, i.e. External Dan (外丹). The Simple Master – On Immortals records what Ge Hong said: “Immortals use yaowu or ‘medicine’ to nourish the body and a regime of shushu or

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‘skillful figures’ to prolong life. So they do not suffer from disease internally nor are invaded by disease externally. Though they are very old, they still look young. It is not difficult if one masters such a way… people do not know that life can be prolonged by themselves, through self-cultivation.” Ge Hong was one of the leaders of Danding Taoism. The “dan” was named a “drug” by most alchemists. This text reflects the nature of Danding Taoism and the relationship between this group and their medicines. In fact, the title “Daoshi” (or Taoshi, 道士 a Religious Taoist) also derives from “Fangshi” (方士 occultist), and the two characters for “people performing daoyin 导引” (Qi-conducting exercise) were originally written as daoyin 道引. Later, this idea was extended to mean “people with Taoist knowledge and skills” (有道之士). The History of the Later Han Dynasty – The Biography of Ji Zun records, “at the beginning, Zhang Feng preferred an occultist’s astrology using the skill of figures and divination. A person with Tao knowledge and skills predicted Feng would be emperor and put a stone in a five-colored bag and tied it to Feng’s elbow and said: ‘There is an imperial jade seal in this stone.’ Zhang Feng believed it and rebelled.” The History of the Later Han Dynasty – Biography of Diwulun records, “He thought he would not get promotion for long time, so he moved his home to Hedong County, and changed his name to Wang Boqi. He carried salt from Taiyuan to Shangdang. Wherever he went, he always cleaned up the feces on the road before leaving, so passers-by called him a daoshi.” The Primary Study records, “The Taixiao Langshu Scripture says: ‘People who practice the great Tao are called daoshi. What does a shi (士) regulate? People’s affairs. People’s behavior and minds follow reason and reason only defers to the Tao, so then such a person complying with Tao is called a daoshi (Taoshi)’… the Religious Taoshi section in the Taoist Code in the Three Caves says: ‘There are five kinds of Taoists. The first are heaven and nature Taoists, such as Gaoxuan Huangren; the second are immortal Taoists, such as Du Chong, or Yin Gui; the third are mountain Taoists, such as Xu You, or Chao Fu; the fourth are non-secular Taoists, such as Song Lun, or Peng Chen; the fifth are secular Taoists, such as Huang Qiong, or Jian Keng.’ The Taoist Master Lu said: ‘All Taoists take morale as their father, spirit as their mother, clear peace and quiet as their teacher, and supreme concordance as their friend. Their three-hundred commandments help them to avoid the non-omenic disasters; performing all the threethousand dignified rituals properly promotes their good fortune.’” From the above, we know that Taoists were not all the same at the beginning: some were occultists, some hermits, some practiced natural truths, some culti-

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vated their personality, some were learned, some knew graphic prophecy, and so on and so forth. Some even believed in clean living as a self-priority, and took “purity” as their symbol. These people gathered together along with differing aims and rituals and created Religious Taoism; their dedicated title become daoshi, i.e. taoshi, they were a “Religious Taoists” (道士) and this was their specific title. In short, the Taoists grew out of the alchemists who “got together and got organized”, while Taoist magic moved into the realm of the continuation and normalization of the “supernatural arts”. Taoist thought was a smelting of Taoist ideas about qi, Yin and Yang, the five elements, Confucianism, prophecy, Mohist thoughts of worshipping ghosts, the morality of swordsmen, alchemy and the regime of the immortal alchemists and their medicine. Taoism represented the pursuit of long life and of never growing old. In addition, Religious Taoism, with its remote ideals and principles, its spirit of inquiry and exploration, its multifarious and mysterious rituals, also finally became established during the end of the Eastern Han Dynasty.

63.  The Origins of Alchemy and Medicine Dan-making was a unique skill, fostered by the Taoists, and included the making of internal and external dan, the pursuit of longevity and immortality. External Dan consisted of the “yellow-white skill”, i.e. alchemy (making medicinal gold and medicinal silver) and the “golden elixir skill” (making an edible elixir of long life). There was cinnabar (dansha) in the Shanhai Jing (山海经), but no mention of “making” or “smelting”. So we do not know if there was someone at that time making or taking dansha. During the time of the First Emperor of the Qin, there was a saying “the occultists (alchemists) all want to make (smelt) wonderful medicines”, which was thought by Professor Wang Kuike to illustrate the beginning of alchemy. Dansha was a kind of medicine. The yellow-white alchemy in the Han has been described in detail in the last chapter. There were eight chapters about “the yellow-white alchemy of the immortals” in the middle part of King Huainan’s book, which have been lost. Liu Xiang had perhaps read it. There are dozens of surviving books about alchemy from this early period, such as the Taiqing Gold Liquid Dan Scripture, the Huangdi Nine Ding Dan Scripture and the Thirty-Six Water Methods. They have all been included in the Taoist Treasures collection. The books about dan increased. Among them, the Zhouyi Participation Bond of Wei Boyang was regarded as “the Eternal King of the Dan Classics”.

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The reason behind Alchemy and making dan for eating was that one intended to become immortal. The text of the Zhouyi Participation Bond says, “Medicinal gold mainly consists of cinnabar, which usually has a natural relationship to mercury. Their transformation is always a consequence of an interaction between them. If someone wants to become immortal, he should take from an identical category — that is, something immortal.” The Biographies of the Immortals records, “A person called Ren Guang, came from Shangcai. He was good at dan making and sold dan at the market for eighty or ninety years… People in Jin kingdom always ate his dan.” “Zhu Zhu… went to the Dang Mountain with a Taoist… and ate dansha for three years.” “Chi Fu from Barong was the Zhubu (an official or main secretary) of Green Rooster Temple. He could produce dan by a water method and took it with saltpeter for thirty years, and looked like a lad.” They all rejuvenated their lives and lived long by taking dan. As Wei Boyang had said, “Black sesame can prolong life, the Huandan is quite edible. Its gold nature is immortal, so it is treasured by every family. Alchemists take it, so they live long.” They thought the strongly anticorrosive properties of gold could transfer to life and make us immortal. This was simply a transformation caused by the thought of “mysterious mutual permeation”.3 The Simple Master – Inner Part – Against Secularism records Ge Hong saying “Gold and jade in the nine orifices will keep the body from decay, salt on meat will keep it from rotting. So no wonder taking something beneficial to health and life will make you immortal.” The Simple Master – Immortal Drugs also says, “People taking gold will live as long as gold; people taking jade will live as long as jade.” The Simple Master – Golden Dan explains it further: “Even the five cereals can enable people to live. With them, people will live; without them, people will die. So what about this top-grade elixir? Is it not a million times more beneficial than rice?… Gold will not disappear even when fired a hundred times; it never decays if buried in the ground.” It “will make people stay young and immortal. So maybe this is to strengthen the body itself with the help of strong objects outside of the self. Just like a fire nourished by oil, it will never go out. Also like the base of a utensil covered with bronze, it will not be corroded, even in water. This is to guard the body with the strength of bronze.” It is right that Zhao Kuanghua summarizes the guiding idea of alchemy as to “strengthen the self with foreign objects”.4 Its essence is mysterious mutual permeation. 3

 See earlier Ch.2  Zhao Kuanghua. The idea and property of Chinese alchemy. Chinese Journal of Chemistry, No. 7, 1983. 4

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Taking golden dan might also have had a relationship with the idea that yellow was advocating as it upheld the central one of the five elements (in the Han Dynasty). The Zhouyi Participation Bond quotes from The Book of Changes in Zhou (Zhouyi, 周易) that “The Yellow (qi) within gradually disseminates into the interstices and then can nourish and moisten the flesh and skin.” This saying derives from a note to Kun hexagram (earth) in the Note to the Text: “A nobleman is like yellow within, he can disseminate the qi. That is it is in a regular position in the body and fine within, can smoothly go through the limbs and develop its enterprising work. So perfect!” So, the Zhouyi Participation Bond again says, “After the golden dan reaches the five viscera, it will evaporate and steam out to nourish the limbs like mist in the rain and winds. Then person’s complexion look brilliant and moist, their white hair returning black, new teeth also sprout in their lost place. Old men rejuvenate as young, venerable old women and maidens change their appearance and avoid misfortune. So they are called perfect figures.” Lastly some people themselves even become immortals: “They visit the immortals of heaven riding on a white crane, dragon or kylin.” Such fancies of immortality actually came from the transfer of the indescribable changes of colour made during the making of the golden dan, especially it being yellow. People must have noticed the colour change during the alchemical process, especially the beautiful golden yellow colour — and they concluded that the nature of gold could make people live long, through the idea of mutual interaction. Cinnabar (mercuric sulfide) itself is not gold, but it was thought that it could be turned into gold by the alchemists. Ge Hong said, “The created gold is the quintessence of all drugs. It is even better than natural gold.” Cinnabar is red mercuric sulfide. It can decompose into mercury and its sulphide by a refining and chemical process. They did not understand its chemical composition and principle, but saw the phenomenon of chemical change, and such a mysterious change triggered people’s curiosity and made them infer its action — through mysterious mutual interaction. Therefore, cinnabar was regarded as “lord of the spirits, the root of genesis, the source of the divinities”, “the forefather of great medicines, the ancestor of the golden dan” (see The Secret Recipes for Great Magical Dan). There is a list of cinnabars in the Compendium of Materia Medica which quotes the alchemist Qingxiazi from the Sui that “Dan is covered with eight stones and contains a golden essence within… if someone wants to be calm in mind and immortal in body, he must take cinnabar.” Mercury was regarded as “mother of the five metals”. The Zhouyi Participation Bond says, “As mercury meets fire, it will disappear and can-

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not be seen any more. Just like a hidden ghost or dragon, people do not know where it has gone.” The Perfect Figure Zhang writing about Metal and Stone and Magical Dan quotes from the Potential Thoroughfare: “Mercury generates everything, which is only understood by sages. Water is most noble, mercury is water’s mother. In the sky, it is rain and dew; on the earth, it makes springs. It can turn into shapes square or round — along with its container — and never competes with things. It is good at managing everything and generates everything.” Mr. Yinzhenjun’s Five Phases Theory of Metal and Stone says, “The essence of the world is no more than the Tao, whose tiny essence is as thin as qi. What nourishes qi and calms the soul best — is nothing but mercury.” Mercury is marvelous. The mercury of the rivers and sea hidden in the Mausoleum of Emperor Qin Shihuang was designed to create immortality in his body — this is recorded in the Histories – Emperor Qin Shihuang and is well known. A technique for surveying mercury in the earth has been twice used to measure the amount of mercury in the unopened Mausoleum of Emperor Qin Shihuang.5 A 12,000 m2 area with strong anomalies of mercury has been found in this 125,900 m2 mausoleum, which proves that the record in the Histories is true. Furthermore, Chen Kangying proved that mercury can slow the decay of the body.6 So it was believed, just as the Amplification on Materia Medica says, mercury “fills the body and slows its corruption.” There is also something here of the idea “no decay, therefore becoming immortal”. So cinnabar and mercury were the chief ingredients of the immortal and golden dan. The Dan Scripture in the Upper Cave describes it wonderfully: “Cinnabar is a marvelous stone, used as the best medicine. It has a fine, red, sleek and strong texture, and embraces chastity and clandestineness. The longer kept, the more marvelously varying it is. It can sublimate and be powdered. It can be refined and sometimes is like snow. It can turn into true mercury and can be a reducible dan (i.e. a ‘returned elixir’ huandan 还丹). It can also resist fire and melt into liquid. It cannot even be consumed or rot under the ground. It is keen, extraordinary and clandestine… In former years, Li Shaojun in the Han Dynasty lived hundreds of years. He had not any special ability about him but could make Huandan from cinnabar. He sometimes used dansha to forge gold and then used these gold vessels to hold food that could nourish his body… Its toughness and chastity can keep

5

 Chang Yong, Li Tong. A preliminary study about the mercury in the Mausoleum of Emperor Qin Shihuang. Archaeology, 1983, Vol. 1907, No. 659. 6  About Body recorded in Internal Medicine Journal, 1951, Vol. 2, p. 162.

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people alive long.” The Dan was said to be increasingly miraculous, as if it were really true. During the process of making golden dan, alchemists also discovered realgar (arsenic sulfide) to be special. It was yellow like gold and easily participated in chemical change (sulfur is known to be an active element in modern chemistry). For example, it could make copper into “gold” (arsenic copper, viz. medicinal gold), so people mistakenly thought “copper can make gold”, as recorded in the Miscellaneous Records of Famous Physicians, or as mentioned in the Zhenghe Materia Medica, “the best realgar is edible if its toxicity is subdued by herbs; the better realgar can turn copper into gold; the third level of realgar can turn silver into gold.” The Compendium of Materia Medica records, “Realgar is often found near gold pits.” As a result, sulfur was thought to match up with mercury. The Secret Recipe of Great Magical Dan says, “Sulfur is the essence of the greater Yang — and mercury is the qi of the greater Yin.” So the Perfect Figure Zhang writing in Magical Metal and Stone Dansha says concerning the vessel for making dan, it can be done by “taking the essences of Yin and Yang to follow the ways of the ‘creation of heaven and earth’, naturally making dan with the harmonies of water and fire — so that then ‘from nothing comes something’, and you, yourself form the spirit of a human-being.” Nothing was more important than realgar in alchemy. There was even a saying in The Secret of Dan House of Cheng Liaoyi from the Song Dynasty that “If a family owns the best three ‘yellows’ (realgar, orpiment and sulfur), it does not need fields and estates; if a family owns the best arsenic, gold and silver will be as cheap as dirt.” Sheng Nong’s Classic of Materia Medica records that realgar has the function of “killing spirits, evil ghosts, evil qi and various noxious insects. It is better than weapons. If people eat refined realgar, they will be as light as immortals.” “Various parasites will die and various diseases gone; all immortals and ghosts in mountains or valleys will serve him.” Today realgar is still an important medicine. The Classical Skills records that King Jianping in the Southern Song said, “There is a treasure hidden in the middle of the world which is called ‘orpiment’. Orpiment can turn into realgar after one thousand years. Realgar can turn into gold after another thousand years.” Sun Simiao succeeded in making a chixue liuzhu dan (a substance like a set of bright-red, coloured silks, with pearls and netted hangings like a web). Arsenic (As) and arsenic compounds produced in the refining process of realgar (As4S4) and orpiment (As2S3) were later used as medicines for insects and to cure syphilis. Lead was another important ingredient of the dan (the external dan). Lead can often in mineral form occur with silver, so impure lead may con-

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tain some silver. With a low melting point, lead easily becomes liquid. During the melting, its colour also changes. The Record of All Things by Ji Ran says, “Black lead turns into yellow dan, then into a ‘fluid powder’.” Powdered lead was a commonly used cosmetic. The wonder at this can be seen from the saying in the Zhouyi Participation Bond: “If someone knows white from black and holds to the black, the intriguing changes will automatically occur. The white is the golden essence and the black has the nature of water.” Water is the key position for the Tao. Furthermore, “lead is black outside but contains a golden essence within”. It could make mercury change into silver and be forged back into black-yellow gold. So, the Zhouyi Participation Bond said, “During the start-up of Yin–Yang, the black contains the yellow sprout.” “After the hufeng (lead powder) is put into a fire, the color changes and the hufeng powder returns to lead.” The New Theory says, “Qian (鈆, i.e. 铅, lead) includes jin (金, gold) and gong (公, elder forbears) — lead, which is then the elder forbear of gold and silver the younger brother of gold.” These changes appeared bizarre to the alchemists. Lead played an important role in alchemy. Mr. Saturn’s Materia Medica, during the Song and Yuan dynasties, said, “Lead is ancestor of the five metals… realgar is the sprout of metal and it contains the golden qi making it the ancestor of gold; lead in a silver pit is the ancestor of platinum.” Bright orange and yellow lead dan (Pb3O4) and mituoseng (密陀僧 litharge, or lead monoxide PbO) were both used — not only as medicines but also as immortal-making dan. Alchemists thought these were condensed out of the essential qi of lead and called them the huanghua (黄华 yellow essence). If lead and mercury were melted together, “lead and mercury spat out their bright purple or ‘auratus essence’… named ‘dark yellow’.” “Dark yellow” was a mixture of HgO–PbO or HgO and Pb3O4. Alchemists “took a daogui (刀圭 knife-tip) of dark yellow put into a strong fire made by the blowing of bellows. After a short while, as long as the eating of a meal, it became gold.” The Huangdi Jiu Ding Dan Scripture says, “Taking a pill as big as a pea for hundred days, one will be cured of all disease and become immortal.” These were not only elixirs but also medicines. Lead and mercury were the principal raw materials for making external dan, so this alchemy was also called “lead–mercury alchemy”. There were also other records. The Great Cave’s Alchemy of Treasure’s Scripture says, “Iron is formed into a body from the essence of ding Yin in the south; copper is given a soul by the qi of yi Yin in the east; silver is given its texture by the spirit of xin Yin in the west; lead and tin both are born with the qi of ren and gui in the north… gold is given its corporeal soul by

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ji Yin in the middle palace.” A Record on the Stone Wall in Taiqing records some texts as matching up with the theory of the five elements. “Copper is the green emperor in the east, the essence of the green dragon, belonging to the wood element; dansha is the red emperor in the south, the essence of the rose finch, belonging to the fire element; white alum, etc. is the white emperor in the west, the essence of the white tiger, belonging to the metal element; lodestone (magnetitum) is the black emperor in the north, the essence of the xuanwu (tortoise and snake), belonging to the water element; realgar is the yellow emperor in the middle, the essence of the yellow dragon, belonging to the earth element.” These heavy metals, sulphur, white alum, etc. were of strong toxicity and taken orally. After being refined, they might have been altered somewhat. So more than a dozen of the dan in Ge Hong’s Simple were probably not toxic. In his Simple Master – Gold Dan, it says, “The second of the nine-dan is the immortal dan… take three knife-points, then all parasites will be dispelled and all diseases cured.” “The little dan… take three pills as big as a sesame seed, twice a day for thirty days, then all disease in the belly will be cured and parasites eliminated; take it for onehundred days, and the muscles becomes strong and the bones tough; in one-thousand days, the god of life will have removed your name from the death book. You becomes changeable and can change your look. You have no shadow under sunshine and will live as long as heaven and earth.” All had the function of creating “longevity and dispelling disease”. From the modern point of view, alchemy mainly opened up the prospect of the development of chemistry. People taking dan might suffer poisoning, especially chronic poisoning. Most Chinese medicines were for external application. They promoted tissue regeneration and killed insects or infection, such as the “nine-one dan”. It was invaluable that alchemy blazed a trail for drug treatment. Chinese alchemy passed to Europe via the Arabs and opened the door to western Chemistry. P. A. Paracelsus (1493–1541) said, “Alchemy aimed not at making gold, but at creating drugs for treating human disease.”7 The idea of Chinese alchemy (treatments and elixirs) certainly influenced the West. For quite a long period, alchemy was not only the enterprise of alchemists but also accepted by royal families, so it was impossible to deny its function. In the Northern Wei Dynasty, there was the “Imperial Dan Workshop House”, which was subordinate to the academies of the Jixian Yuan (集贤院) or Hanlin Yuan (翰林院) and there were many 7

 Dr. Joseph Needham. The pharmaceutical and chemical characteristics of ancient Chinese alchemy and its west transmission. In Chinese Cultural History, Vol. 3, Shanghai Ancient Books Publishing House, 1979, p. 110.

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intellectuals or skilled people similar to those in the National Academy of the Tang or Song dynasties. In the Yuan, Ming and Qing Dynasties, it became less popular but could still be seen among people in the mountains. Recently, even Zhang Jueren (張觉人)8 revealed he had been making and taking dan, which might be evidence of its survival. So it seems inadvisable to deny that external dan may have some general benefit before conducting an intensive study of its function and toxicity. But it is also quite true there were a few people who died taking dan throughout history. A Note of Twenty-Two Histories by Zhao Yi during the Qing dynasty records many people dying from taking dan, such as the Emperors Taizong, Xianzong, Muzong, Jingzong, Wuzong and Xuanzong in the Tang Dynasty and the officials Du Fuwei, Li Daoshi and Li Baozhen. In The Epitaph of Imperial Doctor Mr. Li, Han Yu told that Li Yu, minister of engineering Gui Deng, vice-prime minister Li Xuzhong, minister of punishment, Li Xun, his young brother and vice-minister of punishment, Li Jian, military governor in Xiangyang and minister of engineering Meng Jian, imperial censor and military governor in Dongchuan, Lu Tan and Jinwu general Li Daogu all died from taking dan. “When the minister of engineering Gui Deng was ill from taking mercury, he said he felt like a red hot iron rod went straight down from the head, as if the flames came out from all apertures on his body and joints. It hurt so much he violently yelled out to die. On his mat, mercury was often found. His illness was intermittent. He spat out blood for more than ten years and then died. Li Xuzhong died from malignant sores on his back. Before dying, the minister of punishment Li Xun said to me: ‘I am mistaken about this dan medicine’… When Lu Tan was dying, his urine was mixed with blood and flesh. It was so painful that he begged for an early death. Jinwu general Li Daogu got Liu Mi’s dan when Liu Mi was punished and he himself also took it and died at the seaside at the age of fifty.” “I do not know when dan began to be taken, but the people who have been killed by them are innumerable. However it still gets more and more admiration and is advocated, which causes it to still be popular nowadays.” Taking dan and taking herbs occurred side by side. Men of letters and the intelligentsia, for example Li Bai (李白), Wang Bo (王勃), Lu Zhaolin (卢照邻), Yuan Zhen (元稹) and Bai Juyi (白居易), all dipped into this vogue of making dan, taking dan and visiting famous mountains. Bai Juyi did not succeed in making dan. He was so vexed when he saw “that the beautiful virgin” (mercury) had disappeared. But he felt better 8

 Zhang Jueren, born 1911, renowned teacher of TCM, finally retired in Chengdu in 1972, famous for making Dan.

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when he saw that all the people taking dan had short lives. His Missing Old Friends poem with which he consoled himself says, “Han Yu took sulphur and never recovered from disease. Yuan Zhen made prepared-Qiushi (秋石 hominis urinae depositum praeparatum) and died young. Du Mu got a recipe for dan and did not eat meat any more. Cui Yuanliang did not even wear cotton clothes to show the wonderful power of dan. They were all ill and died young, not one lived longer than middle age. Only I did not take any dan and am living still.” The History of the Song Dynasty – The Biography of Xue Juzheng says Xue Juzheng was poisoned by taking dan. As soon as he stepped out of the imperial door after visiting his emperor, he could not speak or drink. “He breathed air out weakly, like a cloud of smoke. As soon as possible he was carried back to his mansion, where he died.” Records of Talking in the Summer Holidays by Ye Mengde says, “Officials taking dan had different healthy conditions, before and after. I witnessed two of them. Lin Yanzhen lived in Wu. He had always been strong and ate as much as two people. He often boasted of being strong. A doctor with the name of Zhou Gongfu said he got a dan recipe from Song Daofang, and said this Dan could lengthen his life-span and do no harm to his body. Song was a skilled doctor in Gongzhou whom Yanzhen trusted. Yanzhen took the dan for three years and suffered from abscesses on the head. At the beginning, the abscess at the hair-line was the size of a millet-seed. After two days, he had an abscess almost at the same level as the chin and whiskers, on the chest and back. Ten days later, he died. When the disease was serious, the doctor ordered people to wipe out the pus and blood with silk, and wash the sores with water. As the water became clear, a little cinnabar was found, which had gathered in the body and was expelled along with the toxicants. Another was Xie Renbo. Whenever he heard somebody stored dan he begged to be given it to take. He was afraid of it running out but he never asked for its formula. Last year, he also suffered from head abscesses. Someone talking with him caught a strange look in his face. The people knew there was going to be an attack of the disease, but the patient himself did not realize it. When he became aware of it, the disease was already very serious and came on as fast as a storm. After one night of suffering, he died. In the past ten years, I personally witnessed two people dying from dan, which should be taken as a warning from them.” During those times, people should have gradually recognized the toxicity of dan. It is recorded in The History of the Northern Dynasties – Biography of Youwu Daorong that “Emperors Wen and Xuan (in Northern Wei) commanded alchemists to make a nine-turning golden-dan. After being made,

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the Emperor put it in a jade box and said: ‘I enjoy happiness on earth so much that I am reluctant to fly to heaven. I will wait for the moment before death to take it.’” The Records of Explanation of Taoist Dan also says, “Golden dan and medicinal made of stones are different in nature and often have great toxicity. Since Fuxishi and Xuanyuanshi, no Taoist who has taken Dan has survived or became immortal.” “People desire a long life, but die sooner.” However, people who died from being poisoned were often given the title Shijie Xian (尸解仙) and said to have “left the corpse and become immortal” by the Taoists, which meant they had become immortal and gone to heaven. They deceived themselves as well as others. Another explanation was that “fire toxicity had still been in the dan” or the dan had not been made correctly. The History of the Song Dynasty – The Biography of Liu Huaishen records, “Liang in Liangzhou wanted to be immortal through studying Taoism and taking the dan medicine. He engaged the Taoist Sun Daoying of Wudang Mountain to make immortal drugs. In the first year of Taiyu (472 CE), the drug was just finishing in Yizhou, but the fire toxicity hadn’t yet been eliminated. Sun did not permit Liang to take it, but Liang wanted it very much. In the early morning, he opened the citydoor to draw well-water and take the drug for the first time. After the meal, he felt a pricking pain in his heart and died shortly afterwards.” In short, those who died from taking dan were not few. The female body found in the Han tomb at Mawangdui in Changsha contained tens to hundreds of times more lead and mercury than normal. The amount of mercury in the organs varied but was found in all her tissues. In her small intestine, there was even some mercury residue, which had a different chemical structure from the compounds in the coffin fluid. This was probably due to taking dan, which may have been the cause of her death.9 If people take too much mercury at one time, they will die on the spot. Chronic mercury poisoning has been shown by the Minamata disease in Japan, which was due to a river being polluted by waste mercury from a factory. Chronic lead poisoning is also one of the major occupational diseases of modern industry. Without a doubt, lead accumulation can lead to chronic poisoning. Alchemy being used for the creation of external dan had both a positive and negative influence on medicine and human health. Alchemy was popular before the Song Dynasty. But after that, it was gradually replaced by the use of internal dan — due to its toxic effects. 9

 Hunan Medicine College. The Study of the Body in the First Han Tomb of Mawangdui in Changsha, Cultural Relics Publishing House, 1980, p. 224.

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64. The Development of Internal dan and Its Influence on Medicine The use of internal Dan (内丹 inner alchemy) was part of the technique whereby the Taoists worked out and kept fit: meditation, regulating the breath, exhaling the old and inhaling the new (“getting rid of the stale and taking in the fresh”), and making dan after “nine rotations within the body” — which meant circulating the internal qi inside. In fact, it was a physiological and psychological training. Some of its secrets have not been demystified by modern science, till just recently. Taoists use mystification as an art — so they sometimes call it “golden skills” or “lead-mercury skills” using the terms of wai dan “external” alchemy. In the Pre-Qin Dynasty, it was included in a regime along with the practice of the breath, daoyin, taking medicines and “foetal respiration”. This was the seedbed of internal alchemy. In the Huainanzi – The Qi Customs, Tai-Nation Instructions, etc. it was recorded that Chi Songzi and Wang Qiao were “exhaling the old and inhaling the new”. Wang Bao’s A Panegyric on the King Gaining His Virtuous Ministers describes, “To do pitching movements and crook-andstretch the body like Pengzu, to breathe slowly like Qiaosong.” Bian Shao’s Inscription on Laozi says, “Primordial qi transforms into spirit; breath dominates essence.” The Tablet on Three Lords Mountain in the fourth year of Guanghe, during the reign of Emperor Ling of the Han Dynasty says, “To maintain the serene indifference and with ease to recuperate the noble spirit, breathe skillfully, live long.” Zhong Changtong during the period of Emperor Xian says, “Be calm in a room, meditating on the mystery of thought in Laozi; breathe the essence, trying to be someone like a paramount figure.” These texts all show that outer and inner alchemy both continually developed during the Han Dynasty. Heshanggong’s Note to the Laozi also introduced a specific method: “People of self-cultivation breathe in the essence — without it being heard.” “The heavenly door of self-cultivation is the nostril. The nostrils open to breathe out, and close to breathe in.” “The doors of the nose and mouth are the way for the primordial qi to come in from heaven and earth. People should breathe slowly, delicately and continuously with the nose and mouth, as if the breath were there, as if not.” “The way to immortality is the way of the Xuan Pin (玄牝 ‘dark and female’). What is xuan is heaven, referring to (air through) the nose in people; what is pin is the earth, referring to the mouth in people.” “The heavenly Tao is the same as the human Tao. There is a correspondence between man and the universe, and an essence running between them.” On the whole, breathing and daoyin developed to a great extent during the Qin and Han

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dynasties; but taking medicines and using foetal breathing were still not common, although they later became the mainstay of intrinsic dan alchemy. Intrinsic dan alchemy developed from taking qi instead of rice and through the discovery of “foetal breathing”. The Simple Master – Against Secularity quotes from Some Fantastic Tales which tells of a four-year-old girl in turbulent times. She was too young to walk far to avoid the troubles. A townsman Zhang Guangding could not carry her on his back so he only could hide her in a large tomb, preparing for her dry provisions and water, enough for several months. Three years later, the rebellion had been put down. Zhang Guangding came back and wanted to bury the bones of his adopted little girl. To his surprise, she was alive and still sitting there. She could even recognize her parents. Her father brought her out and “asked her where she got food. The girl replied that at first she felt very hungry when the food had all been eaten. Later she saw an animal in a corner stretch out its neck to inhale the air. She tried to imitate it and then did not feel hungry any more. In this way, she lived day after day, month after month, until now. She had not been out, the clothes and quilts left by her parents had not been harmed, so she did not feel the cold. Guangding expected to see an animal there but then found a large tortoise. After she came out of the tomb and ate common rice, she felt abdominal pain and nausea, and vomited. It was a long time before she was accustomed to eating rice. From this story, people knew that tortoises were endowed with a method of immortality. So this proved that if the Taoists copy them they could live as long as a tortoise did… So the perfect Taoist followed the way of the tortoise to lengthen life, taking in qi instead of rice.”10 This story might have been made up later — even a myth — but the tortoise’s immortality created through “taking in qi” and the survival of the girl must have enlightened the Taoists and instructed them in taking qi instead of rice. They were encouraged much by this story and often cited it in Taoist scriptures. In fact, the Taiping Scriptures had already recorded an explanation in detail, as follows: If one wants to stop taking food, one should first take a ‘guiding life’ remedy to retain the qi. After taking these qi remedies, you will be a little hungry three days later, and slightly hungry seven days after that. But after ten days, you will not feel hungry any more, which means having a little success — and you will have been reborn. All tangible food is hard to digest, so it is better if it is only taken once a day along 10

 From the Simple Master (抱朴子).

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with a little intangible food. One hundred days later, people can eat nothing. This is a way out of poverty, a way to help the nation and nurture its people and a way to help heaven and earth nourish all people. Eating little is propitious, eating much is inauspicious. Eating nothing is also inauspicious for it will lead to an obstruction of the bowels. To keep the bowel free, one meal a day is appropriate; two meals is more; three meals is bad; four meals cause intestinal distension; five meals lead to famine; six meals to big disaster, and then any number of diseases break out and the people die if there year of great famine. After moderately eating for a thousand days, the insides will be full but without food. All diseases disappear, you look good, and nothing needs to be banned or kept away. During ancient times people who gained the Tao ate nothing but lived long. Monarch, minister and people could live peacefully and carry out their duties. Thus the rich could accumulate wealth and the poor were able to survive. This was explained by the theory of disease and physiology. The same source also says the following: So people taking in food have a limited lifespan while people eating nothing live as long as the immortals. People eating qi achieve a bright spirit. People neither eating nor drinking will live as long as heaven and earth. How wonderful it is to take in qi instead of rice! The Taiping Scriptures also records a method of refining the essential qi after taking it in: The bright spirit and essential qi is in the body, it ‘follows the mind and travels’ without leaving the body. If people have a bright spirit, they will neither suffer disease, nor grow old, nor be invaded by evil qi when they are out and about. If people lose this bright spirit, they will be invaded by evil and die soon. This really does work! If people want to not be attacked by disease, they should keep hold of their essence… when the spirit is kept hold of, people live long; when the spirit declines, people grow old; when the spirit is lost, people will die. This is under the control of natural law. Why do humans struggle like they do! One’s safety lies in one’s spirit. So the body is a running carriage, the qi is the horse to the carriage and the spirit is the driver. Their rise and fall is a common truth. If the body loses its spirit, it is just like a city without a wise governor.

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These texts referring to healthcare, “following the mind and travelling” (above) and “feeding like a foetus” (i.e. “foetal breathing”, see below), are even more significant. How is it the unborn foetus does not eat but has qi? There is a natural qi and the ebbing-and-flowing of qi is Heaven’s way. What the fetus gets in the womb is its natural qi. After it is born, it breathes in the Yin–Yang qi, which ebbs-and-flows, up and down. If people work hard and study the Tao, they can attain the natural qi again. People who achieve their natural qi will become immortal, but people breathing in ebbing-and-flowing qi will die. So only people who attain the real Tao and breathe the inner qi instead of the outer qi can nourish their self-nature, get back to the condition of being like a foetus and return to life. So they should cultivate it themselves, to get internal qi in order to nourish the body. Again it says the following: If people return to their natural qi again, their hearts are like that of a baby and they are reborn; if they breathe the Yin–Yang qi, they will die. The Simple Master – Solving Problems says that the following: If people attain foetal breathing, they can breathe without the nose and mouth, just like a fetus in the womb. Thus they have made the Tao. To start with, they take in the qi through the nose, close it, and hide it within as long as a count of one-hundred and twenty, then breathe it out slightly. People should breathe the qi so silently that it should not even be heard by themselves. The qi breathed in is often more than that breathed out. Put a feather on the nose and mouth. If the feather does not move when the qi is breathed out, you have made it. Increase the count, step by step, for a long time, even up to thousand. Then you can become younger, day by day. Today this practice of conducting qi while “foetal nourishing qi” is called qigong (气功) — but this qi is not the same as the concept of “qi” in the natural environment mentioned in the Huangdi Neijing. The Neizhi Tongxuan Secret quotes from the Zhouyi Participation Bond: “Never you’re your cultivation so that the genuine qi circulates around like fluid in the

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body, like endless spring rain when the ice melts. It circulates around from head to foot, then up again, round and round and never-ending.” This refers to the zhoutian (“circulation of heaven”) exercise of internal alchemy, describing how the internal qi circulates in the body. However, it is clearly different from the theory of qi circulation in the Huangdi Neijing. In fact, early on there were no such terms as 外丹 (external alchemy) and 内丹 (internal alchemy). The Lingjianzi – Breathing Note made by Xu Xun in the Eastern Jin Dynasty says, “Breathing and swallowing qi are both done for neidan (内丹 internal alchemy)”, which might be the very first use of the two characters neidan together — “内丹 internal alchemy”. The Vow of Master Si in Nanyue by Chen Huisi11 says, “the help given us by the outer dan is to make an internal dan.” This is the earliest recorded contrast between an external and internal dan. Exhaling the old and inhaling the new is internal alchemy. Taoists later differentiated between external and internal alchemy and classified “conducting the qi”, such as foetal breathing, exhaling the old and inhaling the new air, and daoyin, as arts of internal alchemy. People believed ingesting a mysterious dan could make them immortal and that consuming a refined substance could transform them. When doing this, external alchemy played a major role and internal alchemy an auxiliary role. But the combination of both external and internal alchemy was even better and more believable for the alchemists. It is recorded in Volume 9 of Zhang Gao’s On Medicine that “Lord Lao said: Natural change in heaven and earth is unpredictable. The Yang-dragon and Yin-tiger, wood-fluid and gold-seed, their qi both come together and produce an external dan. The internal dan is made as follows: retain the qi in the organs moderately; exhale the old and inhale the new; and the qi circulates endlessly up to the niwan (泥丸, the head) and down to the dantian (丹田 under the umbilicus). In the morning, a person gains five stones in the red palace and these then nourish all spirits. This is the internal dan which can prolong life — while an external dan can make you immortal. However, if the internal dan has complete but the external dan fails in reaction or the external dan has a reaction but the internal dan is not enough, then both could be a reason for failing to rise to heaven as an immortal.” In this text, the combination of both external and internal dan is stressed. So making both external and internal dan together became the general trend — and was recognized gradually as the proper way to become immortal. On the Great Dan, Lead 11

 The Vow of Master Si in Nanyue 南岳思大禅师立誓愿文.

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and Mercury also says, “The outer dan is so very perfectly made from nature… It shares the same path as heaven and earth, it shares the same crux as an internal dan. Is it not then precious?” The Sixteen-Times-TurningProcessed Gold Dan says, “The first grade dan is called a dragon-tiger big huan-dan… If people have an internal dan and take it, they will transform and fly in their flesh and bone up to heaven and become immortal; if people without an internal dan take it, they will become earth immortals.” “The second grade is called the ‘white-jade immortal incantations dan’… It has the same effect as the above.” “The third grade dan is the ‘little golden-fluid dan’… If people with an internal dan take it, they will become immortal; if people without an internal dan take it, they will live forever.” “The fourth grade is the ‘purple-moving dan’… If people with an internal dan take it, they will become immortal; if people without an internal dan take it, they will achieve longevity.” The fifth grade had the same effect. So over rather a long period, a combination of external and internal dan became most important for these alchemists. Not until external alchemy slowly declined did internal alchemy occupy its major position. However, one work which involved no external dan but only the use of an internal dan actually appeared quite early. This was the Huangting Jing or “Yellow Courtyard Scripture”, which had a major relationship with medicine. The Huangting Jing (黄庭经) is listed as one of “the three codes” of Taoism along with the Tao te Jing (道德经) and Zhouyi Participation Bond. The Tao Te Jing speaks of the source, the Zhouyi Participation Bond of the external, while the Huangting Jing describes internal dan. Professor Wang Ming concludes that the Huangting Jing appeared in 288.12 Later Lady Wei of the Jin Dynasty (her name was Hua, alias Xian-an, lived 252–334) wrote an External Imagery of Huangting Jing to supplement the earlier “internal imagery” of the Huangting Jing and finished it in 334. It is said that Lady Wei wrote it after reading a secret draft from the Wei and Jin dynasties. Possibly there was only one book, the Huangting Jing. During the period of the Eastern Jin, a person with literary talent edited it, eliminating many names and gods with the colour and imagery of the viscera. They discarded the rich secret descriptions in the writing, turning it into a simpler text with much more clarity. In balance there were two contrasting books, one an internally viewed scripture and the other an externally viewed scripture. 12

 Wang Ming. A Study of Taoism and Its Thought, Chinese Social Science Press, 1984, p. 335.

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The phrase “internally viewed and externally viewed” can be read in many books. The Xunzi – Demasking says, “The external view is turbid, but the internal view is clear.” The Huainanzi – Astronomy says, “the sky is round, the earth is square. The square earth governs darkness, the round sky governs brightness. Just as the bright sky spits out Yang qi, so fire and the sun illuminate the view outside; just as the dark earth contains Yin qi, so water and the moon illuminate the view within.” Liang Qiuzi noted in the Internal Huangting Jade Jing that “Huang means center; ting refers to the center of the four directions. ‘External’ refers to things outside, such as the sky, the person and the earth. ‘Internal’ refers to things inside, such as the brain, heart, and spleen. These are known as the huangting. ‘Internal’ (nei, 内) refers to the heart. ‘Jing’ (景) is viewed as an image. An external image refers to the sun, the moon, stars, cloud; an internal image refers to the blood, flesh, tendon, bone and viscera. The heart in the body is observed as an image within, and this is called an ‘internal view’ (内景).” Chapter 24 of the Huangting Neijing Jing says, “The hidden view of the organs is different from the outer. It is that which holds the qi, nourishes the essence and makes the lips red.” Both “making everything visible within” in the Taiping Jing and “cleaning up the spirit to look within” in the Huangdi Nejing mean to understand all the activities of the qi, blood, essence and spirit in the body and these two phrases also illustrate the source of the phrase “internal view”. The description of the viscera in the Huangting Jing is indirectly inherited from the Huangdi Neijing. However, its middle link could be the Taiping Jing and Heshanggong’s Note to Laozi. Heshanggong’s Note to Laozi says, “If people can nourish the spirits, they will not die. The spirits are the spirits of the five-zang organs. The liver stores the soul, the lung stores the corporeal soul, the heart stores the spirits, the spleen stores ideas, the kidney stores essence and the will. If the five-zang organs are damaged, the five spirits will be gone.” This text is also from the Lingshu. Heshanggong’s Note to Laozi says, “Hold to the one, to the Tao wholeheartedly to keep abreast of the five spirits.” “If people can stick to the Tao in body, not overstrain essence, qi and the five spirits, they will live long.” These thoughts of healthy living also were in the Neijing. In the Taiping Jing, however, the five-zang organs have obviously been deified. For example, “The qi of the four seasons and five elements comes into the belly to become the spirits of the five-zang organs, whose colors correspond to the colors of the four seasons, heaven and earth… These spirits of the four seasons and five elements become the zang-organs gods when they enter the body; when they come out the body, they change back into the spirits of

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the four seasons and five elements again. Those gods in a human are called the gods of the five virtues, similar to the zang-organs gods… East the riding god holds a spear, the Southern riding god holds a halberd, the Western riding god holds a crossbow axe, the Northern riding god holds a shield-inserting knife; the Central riding god holds a sword and drum.” The Internal Huangting Jing says the following: The Heart god is called Danyuan (Red Source), also called Shouling (Keeping Spirit); the lung god is called Haohua (White Canopy), also called Xucheng (Deficiency); the liver god is called Longyan (Dragon Smoke), also called Hanming (Hidden Bright), belonging to the shadowy wood and smoking path, taking control of cleanness and turbidity; the kidney god is called Xuanming (Darkness and Obscurity) also called Yuying (Giving Birth to children); the spleen god is called Changzai (Forever), also called Hunting (Soul Residence), the gallbladder god is called Longyao (Dragon-Bright), also called Weiming (Brave). The five-zang organs and six-fu organs all have their own deity (from the Heart God chapter). The Hair god is called Canghua (White Hair), with another name Taiyuan (The Heaven); the brain god is called Jinggen (Essence Root), with another name Niwan (Muddy Pill); the eye god is called Mingshang (Your Majesty), with another name Yingxuan (Very Far); the nose god is called Yulong (Jade Ridge), with another name Lingjian (Keen and Strong); the ear god is called Kongxian (Free), with another name Youtian (Quiet Land); the tongue god is T called ongming (Life Fortune), with another name Zhenglun (Correct Principle); the tooth god is called E’feng (Sword Edge), with another name Luoqian (Cutting Everything) (from the Utmost Tao chapter). There were “eight views and twenty-four gods” in all. Each organ, even the skin, hair and nails, was labelled with the name of a god. These gods took control of the functions of the organs, which was the main feature of Taoist Medicine and followed by all Taoist books. Take the Seven Taoist Exhortations of the Clouds by Zhang Junfang during the Song Dynasty as an example. “The brain god is called Jueyuanzi, alias Daodu, one cun and a fen long, with white clothes. The hair god is called Xuanfuhua, alias Daoheng, two cun and a fen long, with black clothes. The skin god is named Tongzhongzhong, alias Daolian, one cun and a fen long, with yellow clothes.” It gave names to the gods but the names were not the same as those given earlier.

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But such names for gods were not very significant in the process of neidan cultivation. The idea of there being a “huangting palace” and three dantian (“elixial field”) in the Huangting Jing was a new development and quite practicable. “Above is the soul in the three guanyuan.” “The deep essential qi in those three gates.” “The qi returns to the purple and the holding yellow enters into the dantian altogether.” “The essence in the three dantian is subtle.” The locations of the three dantian are the following: “The upper dantian is the brain, also named the muddy pill.” “The middle dantian is the heart, also named the red palace.” “The lower dantian is the qi sea, also named the essence door, three cun under the navel.” In every dantian, there is a god in charge. (There was another saying, “The upper huangting is the brain center, the middle huangting is the heart center, the lower huangting is the spleen center”.) The idea of the “three huangting” and “three dantian” was established to suggest the making of internal dan — the aim of “refining essence and transforming qi, and refining qi to fashion an immortal”. Meditating on the huangting, cultivating the dantian, accumulating essence and gathering qi came into being as the key method of making internal dan and immortality. The Zhong Lu Preaching says, “Refining form to make qi, refining qi to make spirit, refining spirit to comply with Tao, all begin with the returned dan… the dan refers to the dantian, all three. The upper dantian is the spirit house, the middle dantian is the qi mansion, the lower dantian is the region of essence. Essence produces qi, which lies in the middle dantian. Qi produces spirit, which lies in the upper dantian. Genuine water and genuine qi combine into essence, which lies in the lower dantian… Essence, qi and spirit are the treasures of the three dantian.” The theory of “essence, qi and spirit” in Chinese medicine is actually borrowed from Taoist internal alchemy. The Internal Huangting Jing located the essences, qi and spirit of the Taiping Scriptures in the three dantian. The Taiping Scriptures describes them as, “The three qi come together as one and become the ‘spirit root’. These three originate from the qi of heaven, earth and people. Spirit from heaven, essence from earth, qi from a concordance in the middle, they all come together to form a unity. So spirit rides on qi and essence goes between them. These three are regulated in harmony and help each other. So if someone wants to live long, he should love qi, respect spirit and treasure essence.” Because of these several Taoist scriptures, Chinese medicine later regarded essence, qi and spirit as three treasures of the human body, while the Neijing also had a tendency to refer to them — although the terms were never mentioned together as such.

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During their practice, although the Taoists located three dantian, they especially treasured the lower dantian. In the Huangtianjing, the lower dantian was called the “qi sea”, “jingmeng: door-of-essence”, “guanyuan: the strategic pass” and “mingmeng”, that is, life-gate. “Its spirit lives three cun under the navel, where there are stored many essences which can automatically support the body itself.” Liang Qiuzi noted, “the Jade Scripture says: the lower dantian is the root of life, the house of the spirit and the source of the five qi. It is three cun under the navel, adhering to the spine. The lower dantian is also the ‘utterly innocent baby’s palace’; it stores the sperm for a man and the embryo for the woman. It gives birth to a utterly innocent baby. It is also the door to Yin and Yang. The qi in the lower dantian is green to the left, yellow to the right, white above and black below.” The theory of the mingmen or “life-gate” in Chinese medicine was much influenced by this theory of the lower dantian. The Huangting Jing contains many details on the practice of internal alchemy. First was “breathing in the primordial qi to become immortal.” This refers to breathing in the primordial Yang qi, exhaling the old and inhaling the new, which is different from any previous breathing method. This method meant to breathe in the sun’s qi and to swallow the moon’s essence. “To the sun or moon, my best Tao! the god Yuyi of the sun and the god Jielin of the moon are good at healthcare. There is nothing old in this Jade Haven. The qi of the sun and moon can make people young again and refill their heads!” Taking in the qi of the sun and essence of the moon in order to restore one’s essence and nourish the brain is the fundamental principle of breathing exercises which fashion an internal dan. It was necessary to take in no food before taking in qi. “The various cereals are ‘soil demons’. They come with a beautiful appearance but a fishy smell with an evil which destroys the spirit and foetal qi. How can people then become young again? The three souls fall into a trance and the corporeal soul goes off astray. Why not take in the qi and essence of Great Heaven and become immortal?” Taoism believed the fishy smell of various cereals could confuse the spirit, so people should not consume them but take in the great heavenly qi of the sun and moon. This explains the story of the girl taking in qi in the tomb. Since then, taking in qi instead of food became the most basic way of practicing internal alchemy. For example, the Taoist leader Kou Qianzhi attained the Tao in this way. “He loved the Tao years ago but wanted to be out in the secular world. He studied the way of Zhanglu and took dan medicine. But all of this did him no good for many years… Then Qianzhi was taught a pithy formula and method for ‘taking in

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the qi’ and daoyin. Thenceforth he could take no rice. He looked young and good, with abundant qi and a light body” (Wei History – Marks of Gods and Spirits). The second method was to use foetal breathing. “The three dantian are so pleased that they order the foetal gods to dance. Nine qi brilliantly flow out to heaven.” Foetal breathing means breathing like a foetus in the womb, which breathes the internal qi itself without a mouth or nose. “The essential qi of the three dantian is subtle.” “The qi in the three dantian circulating endlessly, correspond to the gods.” The qi of foetal breathing circulated around the three dantian. Perhaps it was an inward vision to guide the qi: “Close the eyes to gaze inward and the five-zang organs can naturally be seen. The Heart god and other gods get along together. The seven orifices are freed up and the life-gate full of vigor. The freed-up channels protect the life root, which is always at peace. Even at one-hundred and twenty, one still can make it return. But over this age, it is very difficult for one to keep to the Tao, unless a nine-times turning dan is made.” How marvelous the internal dan made through foetal breathing is! The Secret to Being Immortal said Lady Wei in Heng Mountain made this Tao. She says, “Inward vision makes me hear a voice from four directions; see and listen thousands of miles away. After a long practice, it even can make people automatically know things thousands of miles away. I practiced hard and then could see things thousands of miles away.” “I often close my eyes to look inward and see my own organs. After long practice, everything in the body is seen naturally, very clearly.” This is like someone who practices qigong and “owns a supernatural ability to hear and see things several hundred miles distant.” A third method was coition medicine — which meant storing and returning the sperm in order to nourish brain. “Close the three passes and take a solid grip to stop ejaculation”; “in the small square cun of the lower pass is stored the essential sperm. Neither square nor round, there is a window closed. When sperm and spirit return to the three dantian, the old could become young.” “Essence can transform into a foetus, so storing essence can prolong one’s life. The qi in the three dantian flows through the right passes, turning nine times without obstruction, then being upright and with a singlemind, the spirit, qi, and essence naturally prosper.” These are all about storing the sperm (essence), circulating the qi and returning the sperm (essence) to supplement the marrow during sexual activity — in order to make internal dan. The Huangting Jing laid the foundation for the theory and practice of internal alchemy. The internal alchemists developed it greatly later, in such

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works as the Taiqing Huangting Jing, the Middle Huangting Jing, the Magic Fleeing the Body Huangting Jing, the Nourishing Spirit Huangting Jing. The famous calligraphist Wang Xizhi loved geese so much that he copied out the Huangting Jing in exchange for a goose, according the seller’s request. The visional image of the Internal Huangting Jing was tried to fathom out everything, carefully, by the Taoists, day by day. The Reinforcing–Reducing Figure of Internal Huangting Jing drawn by Hu Yin, a female Taoist during the Tang Dynasty in 848, absorbed the medical content of the Neijing. It was fairly simple. It was not used for foetal breathing but for eliminating disease. It says “lung xi (呬 pant), heart he (呵 sigh), liver xu (嘘 exhale slowly), spleen hu (呼 breathe), kidney chui (吹 blow), gallbladder xi (嘻 giggle), these are the six different ways of breathing qi for the six different organs… They are used to eliminate disease, not for foetal breathing.”13 This book and its pictures fused together internal alchemy and the medical theory of the Neijing, providing a complete concept of the body as a small universe. It greatly influenced medical workers, especially The Images of the Internal–External Huangting Jing, written by Zhu Gong, a famous doctor during the Song Dynasty. In Taoism, the theory and method of internal alchemy developed as well. For instance, the Taoist Chen Tuan, at the end of the Five Dynasties and beginning of the Song dynasty, wrote Chen Xiyi’s Twenty-Four Methods of Sitting Meditation and An Abstruse Guidebook, and engraved the figure of the “non-pole” (wuji 无极图) on the stone wall of Hua Mountain, setting up an inborn-acquired (pre-heaven/post-heaven) theoretical model of internal alchemy. It consists of five circles, standing for the seven stages of the work: (1) the xuanmu (immortal place, or “dark female”), (2) “making essence and transforming qi”, (3) “making qi and transforming spirit”, (4) the “five qi gathering into the upper dantian”, (5) “harmoniously taking the water of Kan (hexagram) to fill up the fire of Li (hexagram)”, (6) “refining the spirit and returning to the void”, and (7) “reverting to the non-pole”. This figure greatly influenced the theory of the “inborn-acquired life-gate” and “primordial qi” of Chinese medicine. The Marvelous Scripture of Zhong Liquan and Lu Yan summarized internal alchemy in seven steps: (1) “matching Yin and Yang”, (2) “gathering and dispersing water and fire”, (3) “intercourse between dragon and tiger”, (4) “refining the dan pills”, (5) “a golden light out at your elbow”, (6) “getting the jade fluid returning dan” and (7) “getting the golden fluid returning dan”. Then the “Yang essence would be 13

 The origin of the six-sounds method, popular in present qigong.

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formed, the spirit-house strong, people feel neither cold in winter nor hot in summer and look good and young.” Shi Jianwu’s Zhong Lu Preaching discusses Yin and Yang, the five elements, the dragon and tiger, the lead and mercury, drawing and increasing, heche (circulating the genuine qi in the body), returning the dan and inward vision, a total of eighteen articles in all. It says, “The heart belongs to fire. How to make the fire descend? The kidneys belong to water. How to make the water ascend?… The kidneys, belonging to water, contain a fire which turns the water into steam. The steam goes up to nourish heart. The heart belongs to Yang too. The two Yang meet together as the Taiji (太极, the final pole) which then transforms into Yin, so that steam becomes fluid and descends down from the heart to the kidneys.” This is the formation process of the internal dan. This theory of fire and water moving upward or downward also influenced the medical theories of Li Dongyuan. The Song Dynasty was a great age for internal alchemy. One factor was that external dan was so difficult to make. The disadvantages, such as dying young and chronic poisoning became increasingly obvious, and this caught the attention of the people. Another factor was that people in Taoism turned increasingly against the idea of an external dan — and this thinking finally became dominant. Meeting a Master in Heng Mountain records Xia Yuanding as saying, “The drug is within me, I need not resort to anything else from outside.” He disagreed with the theory of “strengthening oneself with the help of external objects”. Zhang Boduan (alias Pingshu, from Tiantai County of Zhejiang Province, also known as Immortal Ziyang), the leader of Southern Taoism, finished Understanding the Truth in the 8th year of Xining (1075) and gave a strong refutation of making the golden external dan. He said, “Herbs, gold, silver, they all are dregs for bodily health.” “Don’t use common lead.” “We all have an elixir.” “Do not learn the refining of dan like others?” He thought only “a golden fluid returning dan” (internal alchemy) can give people longevity. So “the Tao gives birth to one qi just out of nothingness, the qi gives birth to Yin and Yang, the qi with yin and yang combines to form the three bodies, which then give birth to everything prosperously.” Understanding the Truth by Zhang Boduan was regarded as a classic by practitioners of internal alchemy. The Abstracts of Full Books in the Four Treasury says, “This book gives especially the gist of making the internal golden dan. Understanding the Truth and Wei Boyang’s Participation Contract are both regarded as authentic Taoist scriptures.” Zhang Boduan also wrote the Eight Vessels, in which the belt vessel, thoroughfare vessel, etc. are different from those of other doctors’ books. Even the Verification of the Eight Extra Meridians by Li Shizhen adopted his

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ideas. It says, “the channels in the Eight Vessels of Ziyang are slightly different from those of most doctors. However, only a practitioner with inward vision can see the internal scene of the body, so he must be right.” Doctors also believed such words as those of the Taoist alchemists. The leader of Northern Taoism Qiu Chuji (丘处机, 1148–1227) and his master Wang Chongyang also thought highly of making internal dan while disregarding external dan. They differentiated the making of internal dan in Southern Taoism — as employing first “self” or xing for the cultivation of personality, and later “life” ming. Qiu Chuji was summoned to Great Snow Mountain by the first emperor Genghis Khan (成吉思汗) in 1219 and arrived in 1222 when he was 74 years old, after 10,000 km of travel. He answered questions three times on the “way of longevity” and also preached his Quanzhen Taoism. The first emperor of the Yuan Dynasty called him a real immortal. Quanzhen (全真, whole true) Taoism thenceforth became the authentic orthodox school of Taoism. Qiu Chuji wrote the Great Dan and On Growth and Decline in Well-being, stressing “Sit in a quiet room, discard worries and thoughts, nothing without, nothing within.” Thus, internal alchemy turned into an authentic orthodox alchemy. Zhuang Boduan formed the Southern School of Taoism during the Song dynasty and his disciples Shi Tai, Xue Daoguang, Chen Nan and Bai Yuchan together were called the “five ancestors of Southern Taoism”. Their works such as the Haiqiong Transmission of Taoism had a great influence — because of their combined deep study of the theory and method of alchemy. Their theory was “life (ming) first and then later the cultivation of personality (xing).” After the Northern School sprung up, both of them united — taking the making of internal dan as the sole position at the top. Internal dan also infiltrated and combined with Chan Buddhism. Qigong from ancient times is thus factually a continuation of the making of internal dan, having much in common with medicine.

B.  A Taoist’s Magic and Medical Skills As has already been pointed out, occult medicine formed one of the foundation stones of Religious Taoism. So all religious Taoists, from founder to later-generation leaders and traditionally all levels of Taoist nuns or mendicant Taoists (among the ordinary Taoists), knew a little medicine. The Huangdi Neijing became their classic and was included in the Taoist Treasury. It was generally believed that Taoist magic consisted of stepping to the Big Dipper and constellations, summoning the wind and calling for

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rain, performing geomantic arts, fengshui, performing incantations and other Taoist rituals, all of which appeared mysterious and dazzling to people, and that is all. But Taoists themselves actually believed profoundly in all they said and did — and that these magical procedures actually did eliminate disease and save life.

65.  The Taoists Holding Some Medical Skills The Taoists never rejected true medicine or medical skills. On the contrary, they accepted and absorbed them, such as the Neijing, the Treatise on Febrile Diseases, folk recipes and prescriptions. But they also made some changes along the way. There is an example in the Taiping Scriptures as follows: Now due to retribution after many previous mistakes, we have now not only many disasters caused by ghosts, spirits, worms, evils, etc. but moreover diseases such as the rheumatisms, carbuncles and scabies, etc. Epidemic diseases at the moment are too many to name. One can suffer dozens of diseases, even more. Some diseases are terrible, but some curable. Many skills can eliminate disease — perhaps each skill cures each disease. For example, a diviner can know how to eliminate a disease caused by an evil; a great doctor is good at formulae and can cure disease also; people good at needling channels can eliminate disease by needling; people good at moxibustion can eliminate disease with moxibustion; people good at ‘exposing’ can eliminate disease with their own particular skill; people good at performing a sacrifice can eliminate disease through sacrifice; people good at inward visions of ghosts through a ‘spirited-guide-self’ can eliminate disease again their way. One person kills one disease. So these several kinds of people can eliminate several kinds of diseases. But now diseases are many, and people often suffer dozens of different diseases. Some even claim they have suffered from every single disease — as many as a hundred. Almost everyone bears the pain of disease. Though many skillful professionals have tried their best to eliminate all these ‘several diseases’, others remain and afflict them for long while and kill them in the end. People cannot survive this disaster themselves. How many years can one live? How many diseases can one suffer? Anything in the world can rise and fall. The principles of heaven such as the four seasons and five phases all

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occur in turn. The eight trigrams of the universe are the noumena of heaven and earth, and they sometimes fall to decline, so why not us humans? Humans are the same as heaven and earth, as the moving circle of four seasons, five phases, six covers and eight directions, all are linked together. Nothing can avoid this. So people should prepare themselves to get rid of misfortune at the source. If people do not forget danger when in safety, nor forget death when alive; nor forget disorder when enjoying order, they will live long. Therefore managing the way to treat evil — people need not suffer too many diseases. If one person can eliminate one disease, ten persons can eliminate ten diseases, hundred persons can eliminate a hundred diseases, a thousand persons a thousand diseases, ten-thousand people then ten thousand diseases. Is it possible for someone to suffer from ten-thousand diseases? Well, then they will all be cured. This text may seem to be just like “talking dreams in your sleep” to ordinary people. It may be using Taoist code words or perhaps it is just poorly written. But one thing is certain — Taoists believed diseases could be cured. Treatments were those such as acupuncture, moxibustion, drugs and incantations. The following sentences from the Taiping Scriptures also explain further that disease can also be prevented. The Taiping Scriptures records an “acupuncture and moxibustion formula”, meaning performing Taoist magic using acupuncture and moxibustion: Moxibustion and acupuncture are used to treat disorders by harmonizing the three-hundred and sixty vessels and freeing up the Yin and Yang qi. Three-hundred and sixty vessels correspond to three-hundred and sixty days. One vessel is responsible for each day — according to the four seasons and five phases. They circle around the outer body, gather in the head and connect up with the viscera inside. Their ebb and flow is along with the four seasons. If any one of them is diseased, a correspondence will be destroyed. When there is a greater degree of disorder, they may be knotted, damaged, go in the wrong direction, etc. so they should be treated. Moxibustion, the essence of the great Yang, the bright seat of all justice, is used for finding and doing away with evil. Needle, the essence of the great Yin, the brightness of Venus, has the function of killing. If one treats ten patients and ten patients are cured, he must have obtained the prophecy of the Heavenly Book on the Vessels and by the help of the gods, his treatment corresponds

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to the vessels. If one treats ten patients, and nine are cured and one missed, by the help of the spirits his treatment corresponds to the Yin vessels. If one treats ten diseases, and eight are cured and two missed, this belongs to human skill ‘according to practice with the mind’. If one’s skill is worse than this, one should not be practicing medicine. If you do, you might damage the spirit. If pulse A is abnormal but you treat B, that means you are in a dream, you do not know the pulse is solitary and standing out — and they could be injured and die. So if you want to know whether your work corresponds with the nature of heaven or not, you can put the book of pulse-taking in front of the patient and compare it with the patient’s pulse — this is called ‘checking with the original text’, and is similar to when discussing the text of the Shujing (classical Book of Documents) looking it up in front everybody… if a Yang pulse is irregular, but you treat it as an irregular Yin pulse, then the health in the person is damaged and they cannot live long. The pulse correspond to things in the world, and grows along with the qi. But if it is damaged, disorder will start. If people understand well the pulse, they will cultivate their self-nature and know whether the seasonal qi is here or not. Thus if people who were once irregular are treated they will find order again. The ancient sages lived in tranquility, they felt their own pulse to know if it was regular or not, and judged the normal or abnormal in the four seasons and five phases and whether the body was healthy. So they could keep themselves in good health and the nation at peace. Can anyone not be cautious over this? But if misled, a person casually taking much moxibustion and needling will find it hurts the normal vessels and healthy qi, goes against the four seasons and five phases and brings about disaster. A great man will be damaged a lot and a common person a little and they will move their living-place often. This is naturally happening. So the ancient sages paid particular attention to this — Emperors and Kings live in their own place and take their own pulse to know how to predict the fates, propitious or portentous, from the six directions — which is called ‘knowing the far through the near’, or ‘knowing without from within’. This is an important way of getting to know the gods. This text about acupuncture, moxibustion and vessels might also seem a little incoherent. However, the correspondence between vessel and time was the beginning of the theory of the “midnight–midday ebb and flow” in acupuncture. “Knowing without from within” was just the opposite of “knowing

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within from without”, mentioned in the Neijing. On the contrary, the method of “knowing without from within” must just have been a new invention. From all of the above, we can understand that there is a close relationship between Taoist medicine and orthodox medicine.

66.  The Taoist’s Magical Arts of Forbidding or Incantation “Jin 禁” was a kind of special Taoist word meaning “forbidden”, to “check” or “curb”, or “taboo”. “Zhou 咒” meant incantation or spell. Forbidden taboos and incantations were two special types of magic, performed using language. They were also used to prevent an attack from evil: under a spell or to mobilize a god’s army to wipe out an evil. First, the Taoist spoke a few words to intimidate the evils by boasting of himself as being representative of the god and having boundless supernatural power. A kind of psychological fighting! Then he gave the order — and spoke out what kind of punishment it would receive if it disobeyed the order. It was all rather like an ultimatum. According to the Taiping Scriptures, this incantation was a “prophetic remark coming from the gods in heaven.” “They were collected together in a roll and called the book of auguries.” This obviously had developed from the ideas in the tuchen (图谶 graphic prophecy) books. The augury was “spoken to make the god come and go, to and fro, along with the qi.” “People got the idea and called it ‘cursing the god’.” “Cursing works a hundred percent.” “Cursing makes the god treat the disease. Ten patients treated with cursing, ten patients cured, and none missed.” It again says, “These words are spoken by the gods in heaven when they summon other gods. By accident, their names were passed down to the world and heard by Taoists. Taoists got them and now speak them, using the god’s words to treat the disease. If they are spoken by ‘a passer-by’, they do not work. Disaster often does not leave people for a moment. Treasuring life, heaven is worried that a special prescription will not work soon enough and that a skilled doctor may not master a life after mistaking the pulse and so miss the chance to save a patient. Therefore, these important words spoken by the essential Tao have been put in our mouths in order to save lives. If you want to get these important words, stand before an invalid and recite the curse and secret words. If the invalid recovers, they are the true words. If the invalid does not recover, the words are false and should not be followed. Someone only uses these cursing words to treat a patient who recovers, he could not definitely get the same effect with other ‘secret words’. This means they are just ‘iso-

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lated words’. Such words should not be recorded. It is the uniqueness of ghosts and gods — if a common person, a ‘passer-by’ would simply use these words, they would be ‘isolated words’, and this is not the right way to go about calling a ghost or god. Human beings are far from heaven, so how do we know if the Tao is true or not? If there is a correspondence between heaven and the Tao, the Tao is true. If there is none, the Tao is false.” This passage describes the method of verifying an incantation using a god (the phrase “passer-by” and “isolated words”). The true incantation of the god must be effective. Ge Zhaoguang misunderstood this passage in his translation, and it is not consistent with the original intent.14 On one hand, incantation was connected with prophecy; on the other hand, it came from folk magic. In Simple Master – The Truth, Ge Hong said, “In the Wu and Yue area, incantation does work and has a connection with ‘qi’. The people knowing it do not catch the plague. Even when they sleep in the same bed as an invalid during the plague season… they can also subdue a tiger, panther, snake or bee and make them cower down. Use the ‘qi’ to subdue a wound made by a knife, and the blood will stop. ‘Qi’ can also re-connect bone and sinew. With the ‘qi’ to subdue the shape of the weapon, people cannot be wounded. If they are bitten by poisonous snakes, the ‘qi’ will cure the wound quickly, with the ‘qi’ doing the subduing.” This does not happen through the incantation but through using qi. Those who practice incantations should be given the “forbidding rite”, of which there are many. Take the following examples cited from the Qianjin Yifang (Supplement to Invaluable Prescriptions, Canon of Forbidding, Vol. 1): “Accept the forbidding rites on the first day of the first month of the lunar year: At dawn on the first day of the first month of the lunar year, in a quiet and clean place, take a bath and gargle, then put on new and clean clothes. Without being seen, burn incense, face east, take the Yu step for three rounds, don’t turn back, then kneel down to read out: ‘To the three masters, prodigies, immortal girls, heavenly doctors, skilled doctors, all masters, Over-Lord Laojun, all immortals, the sun, the moon, the five stars, the twenty-eight constellations, the Big Dipper, the Three terraces, all spirits, to you all know that: I, your disciple, accept this Taoist incantation to save people from all troubles and miseries, wipe out all poisons and evils. Do it soon, as an order from the Over-Lord Laojun!’” 14

 Ge Zhaoguang. Taoism and Chinese Culture, Shanghai People’s Publishing House, 1987, p. 93.

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“Accept the forbidding scripture, which reads: ‘Think of easternwood, forbidden in my liver; think of southern-fire, forbidden in my heart; think of western-metal, forbidden in my lung; think of northern-water, forbidden in my kidney; think of central-soil, forbidden in my spleen. Think of the left-green dragon, the right-white tiger, to the front, rose-finch and to the back, black-tortoise, my Heavenly Lord make it forbidden, to all things without trouble. Eastern Heavenly King, western Heavenly Queen, please do my Taoist forbidding. Do it soon, stop soon! It is an order from Over-Lord Laojun!’ Then recite the forbidding texts three times, do obeisance twelve times. Do not speak with others for seven days. Do not speak vice. Do not scold. Do not wash hands for seven days.” (Forbidding Scripture, Vol. 1) The performances of forbidding art were also various. The Qianjin Yifang (Supplement to Invaluable Prescriptions, Forbidding Scripture) gives such a requirement: First take the Yu step for three rounds, hold a knife in the left hand and water in the right, glaring with the eyes, hurry the breath and then use the forbidding spell and spray spittle out, which means to spit. Say: ‘… I spit you out so leave as soon as possible. If you don’t, I will send Zhang Chengbo to catch and truss you up, and put you in boiling water in a big cooker. Do it soon. This is an order!’ There is also the forbidding prescription for a difficult labour: “First give a glass of forbidding water to a lying-in woman to drink, next say the forbidding words: ‘There is a Yin–Yang in the heavens, the five phases on earth, the stars in the sky. The sun and the moon are bright, the seasons take on their normal orderly change. The foetus’s muscle and bone have already formed, its whole body and limbs have already grown strong. Hair also has grown. Today is the birth time. What are you waiting for and why delay coming out? Hebo is at the door, Siming is at court, the sun and the moon have already become full. Why not be born today? Whether you are boy or girl, Siming orders you to come out with the placenta, without delay. Do it soon as an order!’” Some prescriptions are quite simple. For instance, there are forbidding words for wounding by a metal weapon. The incantation reads, “I am hit by a hundred arrows, but receive no wounds after treatment. One person draws back the bow — it causes a million to startle. If even a single arrow

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can break up a thousand battle arrays, this forbidding rhyme will overcome. Do it soon as an order!” There are some other accompanying actions. There is the following incantation: “On a malarial day, come to the riverside with a stone and make an incantation without stopping: ‘Yuanyuan yuanyuan, the way has no difficulty. Catch the malarial evil and send it back to the river god. Do it soon, as an order!’ Then cast the stone into the water. Don’t look back.” (Handbook of Prescriptions – Emergencies – For Malaria) Very many forbidding incantations involve water. Taoists mutter incantations, spray water and spit. Spitting was thought to have a great effect. The Qianjin Yifang (Supplement to Invaluable Prescriptions, Forbidding Scripture) said the following: Forbidding a malignant sore with spit: Hold and close off the qi three times and pray, God-masters accept the incantation and the great Tao will do good. The incantation is as follows: ‘Even the best medicine is not as good as my spit. If I spit towards the sky, it can kill flying birds; if I spit towards the trees on Southern Mountain, the trees will snap; if I spit towards the stones on Northern Mountain, the stones will crack; if I spit water to the north, the rivers will dry up; if I spit towards every insects’ poison, that insect will be killed and the poison disappear. If I spit at a wound or sore, the bleeding will stop and flesh come back; and sinew and bone reconnect; muscles became strong. Bianque and Dr Lu taught me this forbidding recipe. After I spit three times, any sore will be cured, any evils gone. Heaven’s sound and god-master is dwelling at your place. Do it soon as an order!’ The Handbook of Prescriptions for Emergencies – For Eye Disease says the following: Huatuo’s forbidding prescription for a sore eye: Order the invalid to open the eye with his own two fingers, spit towards the sky and make the incantation: ‘Brrr! Small and narrow house, no guest is allowed to stay!’ The bad eye will soon disappear. Spitting water is mentioned as follows: An incantation of water to be sprayed out over an invalid: First take a bottle of clean water, make the incantation three times, breathe in

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and close the eyes. The gods will be angry with the ghost and hit it with five qi. The incantation is as follows: ‘Hold to the clean, hold to the turbid, hold to the right, hold to the water to melt everything. Blame stone, stone will crack; blame wood, wood will break. Evils can not invade the upright, danger can not invade the body. The Great Tao is popular abroad, it subdues evils and spirits. If the gods are angry, jade and stone will melt, all disease will be cured, all disasters come to an end. Come out, come out. Do it soon as an order!’ Making an incantation using water to treat all disease: First get some clean water and put it in a pot, then make this incantation ten times. ‘Taiyi water is long and great. It goes through the large intestine and passes into the bladder, cleansing the five-zang organs, so then the stomach, spleen and kidneys, ears and eyes, are all there and alert. Diseases are totally cured and evils wither away. Do it soon as an order!’ Then drink the water and wash the whole body. [Qianjin Yifang (Supplement to Invaluable Prescriptions, Forbidding Scripture)] Incantations sometimes need a special sound, which is called a Xu (嘘, hush) or Xiao (啸, roar). It imitates the sounds of animals, or is directly made by an animal. The Handbook of Prescriptions for Emergencies said, “Exorcise all kinds of malaria. On that day, hold a cock and make it a crow aloud, any type of malaria will be cured.” The cock is used to make the crowing or “roaring” sound. Sun Guang of the Tang Dynasty said the following in his Xiao Zhi (啸旨, Roaring Intentions): Heavenly qi coming from the throat is voiced sound, and called ‘speaking’; heavenly qi coming from the tongue is clear sound, and called ‘roaring’. Voiced sound can communicate between people and express disposition. A good clean roar can move the gods and help us escape death. Kind speech can be felt thousands of miles away; compassionate roaring can move all the spirits. This was how the ancients studied the Tao! This book classifies roaring into twelve categories: external arousing, internal arousing, holding, hiding, dispersing, crossing over, much sinking, little sinking, booing, shouting, the five highest, and the five lowest. According to this book, making the sound “boo” out loud is a kind of roar, which might have developed from witchcraft. For instance, the Calling Back the Soul song of Qu Yuan states, “The devices have already been set,

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make a long roar for the arousing! Come back, soul! Be back in your native land, do not leave any more!” Taoist scriptures mention many kinds of roars. The Top Cave Purple Bright Transforming Immortal Scripture says, “Roaring out on the NineMysteries Platform, the cliff will condense all dreariness.” The Genuine Mandate says, “At Yanxuan Temple on the Western Queen, a loud roar pursues the spirits.” “Mixuan driving a four-horsed carriage, roars to command all spirits!” The History of the Later Han Dynasty – Biography of Xu Deng has this record of two Taoists: “Xu Deng, from Fujian, turned into a man from being a woman. He was good at witchcraft. Zao Bing, also known as Gong’e, came from Dongyang. He could perform the ‘witchcraft of Yue’. At that time, there was war, and pestilence broke out. These two people met on Wushang River and promised to treat the disease by combining their skills together. They… advocated being thrifty. They sacrificed to the immortals only with eastrunning water instead of wine, and mulberry bark instead of dried meat. But all their incantations against disease actually worked.” They were also good at roaring. Zhao Bing came to a river and asked for a ferry, but the boatman refused. So he “made a long roar to call up a wind and then crossed over the river on the turbulent current.” Xu Deng could also forbid the river to flow. A “roar” could also be called a “boo”. The Simple Master says, “If people boo at water with good skill and qi, the water will go upstream several steps; if they boo at fire, the fire will go out; if they say boo to a tiger or wolf, the tiger or wolf will not move; if they boo at a poisonous snake, the snake will not crawl towards them; if they boo at someone wounded by a weapon, the blood will soon stop; if they boo at someone wounded by poisonous insects, even if he is a hundred miles away, he will be soon well. If the wounded is a woman, boo on the right; if the wounded is a man, boo on the left.” Also before roaring and booing, one should exercise, so as to have sufficient qi. There are some other special forbiddings as follows: Put the invalid on the ground and draw on the ground by the left shoulder for a man or by the right shoulder for a woman, with a knife. Engrave on the ground by the face, the shape of the invalid’s nose. Then dig the knife into the picture of the nose one fen deep and wait without moving. The person should act as a spirit or god and makes his plea. So he asks: “Who are you? Why do you come here?” Then the spirit will leave. Next use the fingers wipe to out the picture on the ground. The command can be given at a point several inches from the

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shoulder if you want the ghost to leave. But the interrogation cannot be omitted. (Handbook of Prescriptions for Emergencies – The Fifth Prescription for Unconsciousness) A master puts five needles into the patient’s topknot. If the patient is mad, store water in some earthenware and cover it with a three-chi new cloth, with a large knife placed on top of it. Put on a serious face and call out to see the patient. The invalid will probably want to leave. Don’t let him go. Take the water and spray or sprinkle it over him, look at him angrily, repeat the question three times, wipe off the water, flip his forehead near the hair line and ask him: Do you want to be well? The invalid must not answer. Then flip him fourteen times again and he will answer. Needle the inside of renzhong (an acupoint) below the nose near the nostrils, stop as the ears move slightly. Next along by the nose and then also one cun away from the hair line, needle into the nose point again horizontally. Finally cross-examine him again, and wake him up. Then the incantation is done. (Handbook of Prescriptions for Emergencies – Eighteenth Prescription for Trance due to Shock) The above forbidding method uses a knife, needling, cross-examination and forbidding speech. More marvelous forbidding arts follow: Chen Xianda was a great warrior, killing many enemies, but he was hit in the left eye by an arrow during the war at grandmother Du’s residence. The arrow was pulled out but the arrow-head was still in. An old woman with the family name Pan at Dihuang Village was good at forbidding. She first nailed a nail into a post and then walked her special step to exercise her qi. The nail and the arrowhead shot out. The forbidding spell made the arrowhead in the eye of Xianda come out. (The Book of the Southern Qi Dynasty – The Biography of Chen Xianda) This can be called “qi forbidding”, similar to Qigong. More common are forbidding spells, which are called “taboos”. People are forbidden to eat pork, dog meat, mutton, greasy fish or something damaging the blood… wheaten food, garlic… for the hundred days after recovering from a serious disease. (Handbook of Prescriptions for Emergencies – Prescription for an Overstrain Recurrence of Seasonal Disorders)

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To treat malaria… take three pills every time it comes. On the day of the attack, face north and take the pills with warm wine… Make them at noon on the Fifth day of May, do not allow yourself to be seen by chickens, dogs and women. (Handbook of Prescriptions for Emergencies – Prescription for Malaria) There are many forbidding arts and taboos like that in the Qianjin Yifang – Jinjing (Supplement to the Invaluable Prescriptions, Forbidding Scriptures) and numerous other medical books. Many taboos in medicine (including dieting) are to do with prohibitions. They became folk customs.

67.  The Art of Taoist Talismans Taoist talismans had a similar medical function to incantations. However, if written on peach wood, silk, paper or even engraved on a sword or Taoist talisman seal, Taoist talismans were thought to have a stronger and more long-lasting effect. They could be used in the house, on the door or carried by the patient himself to drive away disordered evils. Taoist scriptures crucially stress Taoist talismans. The Taiping Scriptures says, “Heaven’s talismans turn their essence into Taoist talismans and are written in the color red. If a Taoist talisman is swallowed into the body, its writings may be seen on the belly — which is greatly auspicious — and all evils driven away. The Five Officials and Five Kings began the Tao. These were forefathers to the gods and can close all passages. Outside they may appear dark — but within it is so well-lit that everything can be clearly seen. Keep them a long time and a heavenly doctor will come. Then all disease will be cured and people live long. Stupid people cast them away but the wise treasure them. This is the way to live long.” According to the Simple Master – Extensive Reading, Ge Hong had already viewed the ten volumes of Taoist Talismans for Disease and the twenty volumes of Mr. Kettle’s Talismans at that time. A luted figure with seals was also a type of Taoist talisman. Simple Master – To the Mountain records an example. “Long ago, there was a giant turtle in a deep pool, called ‘turtle pool’. This turtle could turn into a spirit and make people ill. Dai Bing, a Taoist of Wu, saw it by chance. He made hundreds of luted ‘seals of Yue’ and took a boat to cast them into the pool. After a good while, a giant turtle, more than a zhang (more than 3 m) long, emerged and refused to move. He killed it and his patients all recovered.” A luted “seal of Yue” could be made by printing a figure on mud. There are many kinds of talismans to be used when entering mountains, engraved on the date-plank of the above book. “Ge Hong says this talisman was carried by Lord Laojun, keeping away all ghosts, snakes,

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tigers, wolves and evils. Engrave it on a date-plank, bow to it and then wear it at your belt. It really does work.” Most talismans used for treating disease were swallowed with water. The Handbook of Prescriptions for Emergencies says, “a prescription for a prolonged loss of sense accidently caused by a nightmare: write this talisman on a piece of paper, burn it, mix it with a little water and then put it in the fatal one’s mouth, hang a mirror in front of his ears, pat him, call his name and he will come back to life in no more than half a day.” The Qianjin Yifang (Supplement to Invaluable Prescriptions) also records five talismans. It says briefly, “Take this talisman before you take medicine, it does good! After driving away the evils, the medicine must work. Write it in a red script, take it on an empty stomach and then take the medicine.” First take the Taoist talisman, then the medicine. “A talisman for malaria” in volume 10 of Qianjin Yifang (Supplement to Invaluable Prescriptions) is recited and then put on the forehead of the kitchen god. Taoist talismans also can be painted directly on part of the patient’s body. This can be seen in a Handbook of Prescriptions for Emergencies: The prescription for bellyache is as follows: “Write the word ‘wind’ on the tongue and then paint two crossing centipedes. Swallow this piece of paper. Another prescription: Before an attack, lie with the head facing southward, hold the breath and write the word ‘ghost’ on the five hearts of the body (palms, soles and chest, forehead and tongue.” It is not easy to catch a ghost and put it behind bars, using a peach talisman. It also involves using acupoints: If possessed by ghosts, patients might shout, or cry out, or scold, or laugh, or sing or recite. They are thought to be insane because someone has died. If the patient has such symptoms they are named ‘the evil of a ghost’. It is only after the ghost has been caught and sent away, that the patient will recover. The method is as follow: During the attack, order two people to press and ‘twist’ the patient’s points guimen (ghost door) and guishi（ghost bazaar）— acu-points on the left hand — while another two people to do the same on their right hand. ‘Ghost door’ is palm-center and ‘ghost bazaar’ is the low-lying place behind the wrist. Try to extend their five fingers then you can find the low-lying place. This place is between the two large sinews at the end of the thumb behind the wrist. After you twist these places, they should not move. Otherwise, the ghost will flee and cannot be subdued. Not too violently either, otherwise they will get tired and their hands will slip and the ghost will escape. But not too slowly

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either, otherwise the ghost cannot be brought under control. They must judge by their own emotivity and control the speed of the action. Then order two people to prick the jianjing (GB 21) acupoint with a palm seed at the same tempo as the pressure made on ‘ghost door’ and ‘ghost city’. Stop as the ghost gets under control. If the ghost is not getting under control, prick faster a little; if he is getting under control, prick slightly slower. If the patient is a man, fat and strong, prick faster and harder. Adjust the prick according to the strength or weakness of the patient. If the palm seed is sharp, wrap it up in something. Do not hurt or injure the patient. Recite an incantation. Then the ghost will be subdued. If the patient stops cursing, and it looks like he is under control and is begging to leave, then send someone to catch the ghost. The Master of incantation asks the ghost its name, its residence, age, and if it had any mate. Why do you come here? Write the answer down according to what the patient says. If the ghost is subdued and asks to be left alone, and not stay any more time, the Master tells the people to stop pricking jianjing, prepare what the ghost needs and send it away. If the ghost needs food, give it food; if it needs silver, gold, a horse, carriage, silk or people them draw them on a paper and give them to him according to requirements. Use white paper to draw on; use jasmine flowers to dye it a gold color first. If the ghost is coming from a far way and needs a place to stay then it should be given it. Send it away as soon as possible or the following morning. It is also allowed to be send away a little later. When the ghost is going off, you need a seven-cun long, three-finger-wide peach board talisman such as used with a sevencun long heddle (a wire contrivance) in a loom. On the peach board, in red, write down the year, the month, the day, the ghost’s residence, name, age, the number of the people possessed, and write ‘to the five great gods, general Hebo, the ghost so-and-so did harm to my family, now it has been caught and we have given it all it has asked. So please send it away soon. Do not let it stay longer！ Do not let it live here more! Do this soon as an order!’. [Qianjin Yifang (Supplement to Invaluable Prescription, Forbidding Scripture)] The patient here might be suffering from something like a mental illness. There are some talismanic books for disease in the Dunhuang book rolls.15 For instance, For Disease is a general book of Taoist talismans writ15

 Gao Guofan. Ancient Customs and Changes in Dunhuang, Hohai University Press, 1990, p. 103, 114.

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ten to cure diseases of the people in the Tang Dynasty, during the third year of Xiantong (862). There are also amulets for preventing disease. In For Disease, the talisman is swallowed or put on the door to exorcise disease. For example, it might say the following: “He becomes ill on a zi day because of the ghost named Heavenly Thief. It has four heads and one foot, with a protruding tongue. It makes people’s limbs stop moving, the fluid in the body is neither stored nor discharged, so they suffer from extensive abdominal edema. They are half-paralyzed and soon die. If the ghost’s form is destroyed, the patient will recover. Write down this talisman in red and give it to him to swallow, and then put it also on the door. Do it soon as an order!” “Someone becomes ill on a chen day because of the ghost named Iron Teeth. It has a red body and face and horn on its head. It likes to eat un-cooked blood. It makes people vomit, with alternate attacks of chills and fever, headache, cold feet and eye ache, with unclear vision. If its form is destroyed, the ghost will be destroyed too. Write these talismans in red and give to the patient to swallow, and then put them up at the door. Do it soon as an order!” Every day, there is different ghost which causes a different disease, so the talismans are also different. The ghosts and spirits driven away are earth spirits, kitchen gods, northern spirits, tree spirits, mountain spirits, ghosts of people dying in a foreign country, new ghosts, childless ghosts, lucky woman ghosts, drowned ghosts, etc. There is a talisman for difficult labour too. It is said on the back of the talisman that “This talisman for difficult labour is swallowed with a peach decoction embellished with vinegar; the amount changes according to age. Use seven peach kernels without tips. This method is very secret. Don’t disclose it.” However, a small talisman for difficult labour reads, “The woman in difficult labour swallows it, and the baby will be born. If the baby holds a talisman, it is good luck!” There are yet also rituals for swallowing talismans: (1) Cook a peach decoction and swallow the talisman together with it. (2) You have to put a little vinegar in the decoction. (3) Eat peach kernels; get rid of the tips before eating, standing them on a table seven times, eat them seven times. (4) After labour, make the baby hold a talisman, which states, “This baby was born by this talisman and is holding it out clearly.” Peach kernel and vinegar possibly can expedite a child’s delivery, but people also believe that “the peach can dispel ghosts”.

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From all of the above, we can see that Taoist talismans were often used in medicine, needling, etc. As they were often effective, this is quite understandable.

68.  The Taoist’s Magic or “Supernatural Power” It is said that Taoists had some “supernatural power” because of their external and internal alchemy. The Simple Master – Against Secularity records what Ge Hong said: “There are more than nine-hundred types of witchcraft, such as changing countenance, swallowing knives and spitting fire, making a sitting person die when standing, bringing forth clouds and fog, summoning snakes and insects, gathering fish together, turning thirty-six stones into water, jade into rice, gold into fluid, not getting wet even in whirling water, not getting wounded even when walking on knives. If Taoists practice external and internal alchemy, they can never fail in doing these things.” Most of these “supernatural powers” were nothing but talk. They were unbelievable and might possibly be said to belong to the category of magic. Ge Hong believed what was said in the Mohist’s Five Agents (墨子五行记). “With medicine and Taoist talismans, a Taoist cannot fail in anything. He can fly everywhere and hide himself with an uncertain look. As he smiles, he becomes a woman; as he frowns, he turns into an old man; squatting on the ground, he turns into a little child again. Even his staff can turn back and create woods and forests. His newly planted trees can bear fruit, his ground becomes a river when drawn on the earth, scooping out a little soil he can make a mountain. He can make things cook just by sitting there. He also can summon clouds and fire. He can do anything.” But Ge Hong never tested these things himself. He also believed what was said in The Jade Maiden’s Secrets. The text Due to Extensive Reading says, “One can do a great many things in magic. One can turn into birds, animals, gold, wood, jade or stone. One can summon clouds and call for rain and snow from hundreds of miles away, cross a large river without a ferry or bridge, turn into many people, fly by the wind, go to any place. One can breathe out seven colorful qi, see in any direction and things underground, brilliantly shine and make the dark places turn bright.” It is normal to read these sayings in mythologies such as A Journey to the West. But it is unreasonable to cite them again and again in Taoist Books. However, Ge Hong also used a few cases to refute Taoist witchcraft. His contradictory attitude might be due to his striving against factionalism. Mostly Taoist supernatural powers and magic were used together to treat disease — but the effects of the medicine helped the magic. They

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became even more marvelous. So Various Reactions says, “When the ancients began to practice the Tao in ancient times, they all held to and studied medicine to help treat disease and safe-guard lives — and could get instant results. But some mediocre Taoists did not understand this. By rumor of what they heard, they neither cared about prescriptions for disease nor lived in seclusion so as to perform internal cultivation whole-heartedly — and keep away disease. And as disease attacked the people, they did nothing to combat it, nor could use decoctions to treat patients. They did not even do as much good as the common people. This is just as is said: ‘going forward they had not the step of the Handan people, retreating back they also lost the loyalty of the Shouling.’” So Ge Hong collected hundreds of volumes in his Prescriptions in a Jade Box and made up the three volumes of the Handbook of Prescriptions for Emergencies. These Taoist arts could also keep away the plague. The Simple Master – Various Reactions says, “In the year of metal and wood, there will be a plague. Among ten-thousand people, only one will survive. Is there any method to keep the plague away?… The secret method for immortals is when in an epidemic area to think of the body as made of five pieces of jade, which can change color according to season… The second method is to imagine wearing a golden scarf wrapped around one’s head and imagine the heart as a flame, as big as a ladle — then you will fear nothing. You can also imagine your hair disheveled a big star at the end of each hair. The fourth method is to imagine you are the Big Dipper, the first star of the Big Dipper on your head, the handle of the Big Dipper pointing forward. The fifth method is to imagine the colorful qi of the five zang-organs coming out the eyes and surrounding oneself as in a cloud and fog, which means green liver qi, white lung qi, yellow spleen qi, black kidney qi and red heart qi. Then you may sleep in the same bed as the patient even. You also can make the ‘Yu step’ — to call for an immortal fairy on duty or imagine oneself to be a strong man with a heavy golden hammer and a hundred-and-twenty people to defend against…” These methods of keeping away the plague were sympathetic magic, with the intent of preventing infection. Taoists also used the magic power of a “mirror”. The Tales of Yin Yun and Stories in West Capital both record that there was a square mirror in Xianyang Palace, through which the internal organs could be seen. The Simple Master also records that there was a mirror revealing monsters on Linlu Mountain. If one set up a bright mirror, or a moon–sun mirror or a four-circled mirror on a mountain, one could see the fortune of one’s future propitious or ominous omens. All these tales might be made up by Taoists to boast of

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their own “mirror magic”. But many Taoists would carry a mirror with them to exorcise evils and ghosts. It might also be called Taoist magic. Besides that, the Taoist’s Yellow-Talisman Great Rite and Fast for releasing souls from purgatory also had something to do with medicine. Zhao Bi’s Imitations of the Knitted Brows says that “the Shu Lord’s concubine Zhang Taihua was killed by thunder while she was visiting Qingcheng Mountain.” The Record of Qingcheng Mountain records her as saying, “Until today, my soul was still detained in the underworld and without permission to leave. I plead to you for mercy and an early departure from the nether-world.” On the day of the Zhongyuan Ghost Festival, the alchemist Li Ruochong performed a Yellow-Talisman Great Rite and Fast to release her soul from purgatory. “After the sacrifice, he dreamt of a beautiful figure appearing to thank him: ‘Thanks to your mourning and recommendation, I have being re-born in this world.’” A Dongyuan rite and fast could also be performed to exorcise the plague and it had a complete ritual. For example, the Seven Taoist Books records a fast for eliminating “three dead insects”: “put three glasses of water on a table, drink them and say: ‘The water of the sun and moon, please eliminate the dead insect living in my head’; ‘water of the true Taoists, please eliminate the dead insect in my belly’; ‘water of the sun and moon, please eliminate the dead insect in my feet.’ If the ‘three dead insect’ are not eliminated, people cannot practice the Tao. So this is very important for the beginner.” The Taiping Scriptures and the Simple Master even point out that it is the first step in becoming immortal. However, medicine might be taken along with the evocation to eliminate the three dead insects. It is recorded in the Qianjin Yaofang – Invaluable Main Prescriptions that “Xi Yin said: You must eliminate the three dead insects before taking medicine. First eliminate the three dead insects, then take the herbal medicine. When the herbal medicine begins to work, then take the wood medicine. After the wood medicine works, then take the stone medicine. In this orderly fashion, as the medicine works, everything will get into good condition and people will live long. The prescription for eliminating three dead insects: ‘three dou juice of unprocessed Rehmannia Root, boil up three times in a cooking stove put in a place to the east, on a reed-twig fire; add two liters of ‘clear varnish’, stir with a catnip stick; next day remove one chi, then add three liang of red lead. Again removed one chi more adding three liters of powdered melon seed; remove one chi again and add three liang powdered rhubarb, decoct the mixture over a slow fire. Don’t burn it! Then make into pills. First take

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a pill as big as a parasol-tree seed, three times a day. Turbid blood will be discharged from the nose and all insects eliminated after thirty days, and the patients recover after fifty days and their skin look very sleek.’” There were also kinds of secret magic guides, used to treat disease. For instance, The Notions of a Travelling Official records, “Yu Yonggong suffered from a disease due to summer-heat when travelling, and had been having diarrhea for several days. On the ninth day of September, he dreamt about a place like an immortal residence, where sat a person dressed as an immortal official. On the wall, he saw a prescription in rhyme and read: ‘Summer-heat poison in the lung, damp qi brims over the feet. If these poisons are not discharged, people will suffer diarrhea, dysentery or malaria. Refine realgar to make a medicine cake and take it with a licorice decoction and they will recover. All other treatments are wrong.’ He did as he had been told and recovered.” He got directions from a Taoist from Qingcheng Mountain. The Stories of Bozhai records that Lu Shizhong “performed orthodox ‘celestial-mind’ magic and was good at dispelling evils.” He sometimes tapped with his fingers on the supposed skull of an old fox and said, “this skull was used in ancient times to treat illness due to overstrain, why not used it now to kill a demon?” This story also illustrates how to “find direction through metaphor”. There were also people cured with medicine and magic combined. The Dongwei Record says the following: During the Xiande period, there was an insane person, who regularly sang out: ‘Take a walk in the bright springtime, in the human world it’s always February, raining and dirty! Bright spring is gone and the autumn wind blows, old people are so sad, it’s a broken-hearted affair!’ He sang out again: ‘The five-clouded canopy exquisite, the celestial storehouse just in your own body! I am in such a mood, it never stops, it needs a single white radish to fire up my palace!’ Later, a Taoist wanted to cure him. The patient told him he always dreamt about a woman wearing a red dress leading him to a great palace, where a little girl sang this song. The Taoist said: ‘This is barley poison. The woman represents the heart god and the little girl the spleen god. According to the medical classics, radish can cure this poison and is called ‘huowugong’ (resisting the poison by firing up the palace).’ He treated the patient with medicine and radishes, and the patient recovered.

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The magical arts used in Taoist medicine were very many and too numerous to count. They were especially popular among the common people and most believed in them. However, they did not much influence the mainstream. Upright scholars even regarded them as somewhat grotesque.

C.  Taoist Doctors and Their Grand Contribution Magical skills in Taoist medicine had been used in the prevention of plague, and in general medicine, but did not become generally influential. However, it was not rare for some who were Taoists to step into the mainstream. For a time, some even became great leaders and left their names to posterity, for 1,000 years.

69.  How Ge Hong Dabbled in Medicine Ge Hong was leader of the Danding Schools of Taoism. Not only that, his hundred volumes of Prescriptions in a Jade Box and three-volume Handbook of Prescriptions for Emergencies had a great influence on medicine — and he became a famous medical expert and occupied a decisive position in medical history. However, he was not a real professional doctor, as can be seen from his lifetime experiences and the writing of these medical books. Ge Hong was born around the fourth year of Emperor Taikang during the Western Jin Dynasty (283 CE). His ancestors were high officials of the states of Wu and Jin. When he was thirteen, his father died of disease while occupying the position of Taishou (governor) in Shaoling. Then hard times came on the family. But Ge Hong worked stubbornly, he even cut and sold firewood to buy paper and pens, and borrowed books to read until midnight. At sixteen, he had read nearly ten-thousand volumes, including The Analects of Confucius, The Book of Songs, The Book of Changes, The Book of Filial Piety, many other Confucian classics, histories, books of thinkers of various schools and miscellaneous articles. He was known for his Confucianism, which was the foundation of all his thought. But he was not a complete Confucian. He did not read the River Diagram, The Book of Luo River and other books about divination, not to mention the various writings on astrological divination, arithmetic, nine-palace and three-chess piece divination, Taiyi (Tao), Taoist talismans, etc. He considered these books as “bitter and uninteresting”. But still later he learned fengjiao (divination with wind), watching the qi (a kind of fengshui), the “three mysteries” (the Laozi, Zhuangzi and Book of Changes), dunjia (an ancient type of witchcraft),

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liuren (divination with the five elements) and the Taiyi. He only “had a rough idea of them, and had not studied them a great deal.” This was his first experience of learning about the Tao. At fifteen, he could compose verses and articles, which became the foundation of his writing. At twenty, the Shibing Riot broke out. Ge Hong joined the army and was assigned the post of commandant. Due to his distinguished achievements in the battle, he was appointed to the post of Fubo general, but he refused. This was his first experience of the military. Later he threw aside his weapons and arrived at Luoyang to look for rare books, but a war blocked the road to the north and he met Ji Jundao and followed him to Guangzhou to be advisor to his army. But it wasn’t long before Ji Jundao was murdered — and so Ge Hong resigned and went into mountains, to “cultivate the Tao”. Before that, he dipped into everything and had no fixed profession. Ge Hong thought of himself as “blunt, slow of speech and ugly”. “I am unkempt and dress in rags, of which I am not even ashamed,” he said. So “my fellow villagers all call me the person of plain simplicity.” “Therefore I call myself simple” (he was styled “the master who embraced simplicity”). He stayed in the south for many years, where he met the governor of Shangdang, Bao Xuan, and married his daughter. He visited many famous mountains and got to know many Taoists. According to his Simple Master External Chapters – Autobiography, Ge Hong began to write his Zishu or “something of philosophy”, and finished 20 volumes of the Simple Master Internal Chapters, 50 volumes of the Simple Master External Chapters, hundreds of Epigraphs and Prose constructions, 30 volumes of Articles about the Army, 10 volumes of Immortals, 10 volumes of Hermits and copied 310 volumes of books, including five classics, seven histories and the books of many thinkers of various schools, military affairs, medicine, miscellaneous subjects and strange short stories. His Internal Chapters is about Taoism — and discusses immortals, ghosts, medicine, healthcare, prolonging life and exorcism; the External Chapters discusses Confucianism, including gain, loss and “the judgment of the everyman”. These books were written after he had arrived in Guangzhou. Some were lost because of the war. During the time of Jianwu (317–318), these books were revised while other copies remained untouched. Internal Chapters, Prescriptions in a Jade Box and Handbook of Prescriptions for Emergencies have already been mentioned, so these books should be in the list of copies of the 310 volumes of books mentioned above. His Handbook of Prescriptions for Emergencies was probably finished in about 303 CE. It was certainly not untrue for Tao Hongjing to say in his 500 CE preface that “People have been looking at Ge

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Hong’s prescriptions now for two hundred years.” From this book alone, we know that these were not a record of Ge Hong’s own personal experiences, but collected, opted in and copied out. The Handbook of Prescriptions for Emergencies came mainly from Prescriptions in a Jade Box. In all his books and experiences, there was no trace of him practicing medicine. The Internal Chapters often mentions Zheng Yin, a disciple of Ge Hong’s ancestor Ge Xuan. If the Internal Chapters was written when he was 20, then Ge Hong should have entered Taoism at about 18. Zheng Yin performed the ceremony for him. The lineage was as follows: Zuo Ci → Ge Xuan → Zheng Yin → Ge Hong. Zheng Yin gave him the Taiqing Dan Scripture, the Nine-Ding Dan Scripture, the Gold Fluid Dan Scripture, the Three Kings Scripture, The Real Figures of Five Famous Mountains and set up an altar for Ge Hong to swear on at Maji Mountain. It is recorded in the Simple Master – Internal Chapter on Extensive Reading that “I accepted this forty-year impartation with blood-oath and made a pact.” From that time he began to make dan-elixirs, so he went to Luoyang in search of rare books and to Guangzhou to seek the Tao. At the beginning of the reign of Emperor Xianhe (327), the situ (an ancient official title) Wangdao (lived 276–339, a founder minister of the Eastern Jin Dynasty) appointed Ge Hong his secretary, and then an advisor to the army. From that, we know that Ge Hong had already returned to Wu before that date. In the year 330, an imperial order appointed him Guannei marquis and gave him two-hundred households of crops in Jurong. Ge Hong submitted a report on their decline, but got no answer. Later he made good friends with Gan Bao, who thought Ge Hong was talented and selected him to assist in the composition of a national history. But Ge Hong declined again on the pretext that he was too old and wanted to make dan, in order to achieve a long life. “I heard that the Cochin area produces dan and beg to be a magistrate at Goulou.” The imperial order did not permit this, because of his seniority. Ge Hong requested: “I do not do it for glory, but only for dan.” Then the king agreed. In the External Chapters, Ge Hong also said, “From when I first had knowledge until now, when I am soon old, I neither spoke evil-doings of people nor any private matters.” He was right to call himself “old”. According to the saying “seventy is old” in the Analytical Dictionary of Characters, we judge that Ge Hong had this phrase in mind and was near 70 at this time. So he stayed in Danyang in all about 20 years. Finally, “Ge Hong went to Guangzhou with his son and nephew. Inquisitor Deng Yue wanted him to stay, but he refused and went on to Luofu Mountain to make dan. He was appointed

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governor of Dongguan, but again resigned.” His nephew (son of his brother Wang) became an official at Dengyue. “He lived idly in the mountains for many years, never stopping writing.” His many works including the External Chapter Autobiography were written at about this time. At 81, he sat “till noon and then died sleeping. When his nephew from Deng Yue came, he missed seeing him alive.” According to that, we can conjecture that Ge Hong died in 363 CE.16 There are different opinions on the time of his death. The Book of the Jin Dynasty says he was 81. Citing the Note of Luofu, the Taiping Geography says 61. Hou Wailu, Chen Guofu, Qian Mu, Hu Naichang, etc. support the idea of “sixty-one”. Wang Ming supports the idea of “eighty-one”, from the testimony that Ge Hong says that Ping Zhongjie died in the first year of Yonghe (345 CE) in his book Immortals, so Ge Hong could not have died in 343 CE. According to the phrase “going to be old” mentioned above, I judge he was nearer 70 at that time, so I support the theory of “eighty-one”. From the above evidence, we know Ge Hong just dabbled in medicine. Now let’s discuss his Handbook of Prescriptions for Emergencies. Ge Hong first collected together a hundred volumes in his Prescriptions in a Jade Box (also known as the Golden Chamber Prescriptions). In its preface, he speaks of “picking the essence in order to make a Handbook of Prescriptions for Emergencies in three volumes.” “Handbook” means “convenient to carry around”. It was customary for people to carry a bag on the arm, in which they carried essentials. There was the poem “Where is it, our favourite beauty? Up the elbow in a sachet.” Handbook of Prescriptions for Emergencies was written to meet the urgent needs of the poor in the fields and Taoists in mountains. So it was first intended for convenience and emergencies, and aimed at being simple, practicable, effective and cheap. There is a lot of content concerning epidemic prevention in the Handbook of Prescriptions for Emergencies. The mention of prevention of infection, in the field of medicine, begins with Ge Hong. For instance, there is a one-pill prescription for a “warm poison with spots” under “exogenous and seasonal febrile disease”, at that time also called “plague”, which consisted of rhubarb, liquorice, ephedra, almond, etc. He said the following: “When a patient’s family sees the disease, they can first take the medicine. Then they do not catch the disease easily. This pill can be prepared in advance.” “First take” and “prepared in advance” both imply preventative medicine. 16

 An unmarked citation can be seen in The Book of Jin Dynasty – The Biography of Ge Hong

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Smallpox “can be prevented by a virtual poison, using black rehmannia paste.” “My drugs can be prepared for cholera, but the pill ‘理中 Lizhong (regulating the middle)’ and the ‘四顺厚朴 sishun houpo (magnolia) decoction’ should not be made in advance because people can buy them at the autumn market themselves.” This sense of prevention is often present in the Simple Master Internal Chapters as well. This is probably because Taoists often went into the mountains to fashion dan. One might say that all thought of prevention in medicine began with the ideas of Ge Hong. Ge Hong also often used Taoist talismans and dan in treatment: “Sudden death, unconsciousness and syncope are all due to separation and blockage, or some exhaustion in the natural Yin and Yang qi of the patient. In cases like this, it is still hopeful that the patient will survive for the qi has not yet all gone. At that time, ghosts and gods are often said to be present, so talismans are also helpful.” (Handbook of Prescriptions for Emergencies – A Prescription for Sudden Death) Dan was used also in the Handbook of Prescriptions for Emergencies: “There is a prescription for the first day of an exogenous febrile disease, a seasonal febrile disease, a headache and high fever, with a large pulse: pound zhidui leaves and root, along with three liters, mix it with one liang of ‘red lead’ and a liter of water…” There is another prescription. “Smear the red lead all over the body, sit towards the fire. After sweating, the patient will be well.” Diseases due to the shegong (a poisonous insect) or sand louse are treated with purslane and rocambole in Ge Hong’s Handbook of Prescriptions for Emergencies. In the Simple Master – Internal Chapter, this disease is said to be due to spirits of rivers and mountains, and is treated with a forbidding prescriptions of the Taoists: “Now in the wild country of Wu and Chu, the summer-heat and damp create stagnancy. Though it is by Heng and Huo Mountains, there are many noxious insects. The ‘short fox’, also called the ‘creeper’, or shegong, or sheying, and is a kind of water insect. Like a cicada, it is ‘triple-cup’ shaped, it has wings to fly, but no eyes and sharp ears. In its mouth something ‘crosses over’, like an angled crossbow. If it hears the human voice, it will use its ‘angled crossbow’ to spit at the human, like an arrow. The person shot at will soon suffer sores. Even if someone’s shadow is shot, he will fall ill, but not get sores so soon. If the person does not get treatment, he will die. This disease is like an acute, exogenous febrile disease. People suffering it die within ten days.” “There are also chiggers on land or in water. After rain or in the morning and evening, they stick to people on a journey. When the sun is

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scorching hot and the grass dry, they are a few around. They are as large as a hair-end. As first they cling to people then enter the skin like a thorn, and there is great pain. At this moment, they can be picked out with needle. They are red as dan and move with claws. If they are not picked out in time, they penetrate into the bone and go around the body and kill you, like shegong. If you ever go to a place with chiggers, you should make moxibustion all over the body after you return home. Then the insects will drop to the ground. If you carry a musk pill made with eight ingredients, or a ‘relieving pill’, ‘life-saving pill’, ‘jade-boxed pill’, ‘rhinoceros horn pill’, or a ‘seven-stared pill’, the qini (Chinese mosla), then the chiggers and the ‘short fox’ cannot came near you… If Taoists know a forbidding prescription such as in the ‘Hundred Forbidden in the Cave’ formula and permanently carry it on them, or just a ‘keeping it simple’ prescription, they also will not be invaded by various poisonous insects, even though they take no drugs.” (To the Mountains) Eating qi instead of rice, as the immortals do in order to preserve their health, was mentioned at times of famine to relieve hunger by Ge Hong in the Handbook of Prescriptions for Emergencies. For example, there is “a prescription for relieving famine, when there is no food”: “Food is necessary for us to live. If we have no food for a few days, we will die. The Materia Medica recorded something about keeping away hunger. But it is not recorded in the medicinal prescription books because this marvelous art is not easy for common people to understand. So people die from hunger all along the roads, at times of famine. How sad! Here is an easy method for people who run and get lost in the wilds, or fall into a deep gorge, or well or tomb, where there is no food to eat. They must take water and qi to live. The method is as follows…” All the above prove that Ge Hong was a Taoist alchemist concerned about healthcare. He branched into medicine by cultivating the Tao and making dan. He was a dialectical materialist in making dan and selecting prescriptions for the people, but more a metaphysical idealist in other ways. The Handbook of Prescriptions for Emergencies became well known because of its simplicity, convenience, effectiveness and cheapness, which cannot be said to be the case for Taoist mysticism. This book records the symptoms of smallpox, tuberculosis, tsutsugamushi disease, schistosomiasis, jaundice, hepatitis, anthrax, rabies, etc. for the first time in medicine.17 17

 Ma Boying. The differentiation of the major infectious diseases in ancient Chinese. The Study of Natural Science History, 1991, Vol. 10, No. 3, pp. 280–287.

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There is not much mysticism or superstition in his writings. Even as a collector, he also made great contributions to medicine. His Handbook of Prescriptions for Emergencies (肘后方) reflects the great improvements in medicine made during the Jin Dynasties. The understanding of the features of infectious disease and especially the concept of prevention reached an unprecedented level. Ge Hong and his Handbook of Prescriptions for Emergencies have always had an immensely positive influence on future generations. He also set a good example by his accumulation of medical experience and compilation of medical books. On 5 October 2015, the Chinese Professor Tu Youyou won the Nobel Prize in medicine for her discovery of anti-malarial artemisinin in 1972. Artemisinin helped to cut significantly the mortality rates of malarial patients and made a great contribution to human medicine. Her key idea had been mentioned in Ge Hong’s Zhou Hou Fang (肘后方).

70.  The Taoist Naturalist and Leader Tao Hongjing Tao Hongjing (456–536), also known as Tongming, or the “Huayang Hermit”, posthumous title “Teacher Zhenbai”, was from Moling in Danyang County. Before he was 36 years old, he began seeking an official career, hoping to be shangshulang at 40. Unfortunately, from the age of 22, he was constantly an accompanying reader of official documents for rulers such as King Baling, King Ancheng, King Yidu, etc. of the Southern Qi Dynasty. At 36, he was only granted the title fengchaoqing (sixth-grade official). He was very disappointed. The Seven Taoist Cloud Books quotes a record of Hermit Huayang: “This year I am thirty-six, but I am still fengchaoqing. There is no future in this and I better leave early to avoid humiliation.” The Histories of Southern Dynasties – The Biography of Tao Hongjing says that in the same year, namely the 10th year of Yongming (492), “he took off his court dress and hang it by the Shenwu Gate and reported to resign.” He lived in seclusion in Juqu Mountain (now Mao Mountain), built Huayang Hall to cultivate the Tao and became the leader of Shangqing Taoism. He was greatly successful in reforming the Taoism of the Southern Dynasties. Even as a young man, Tao Hongjing admired the Tao. He read the Immortals book by Ge Hong at ten years of age. The Histories of Southern Dynasties – The Biography of Tao Hongjing says, “He studied it day and night and decided to seek how to care for his health. He said to others: When I look up, the clouds and sun do not seem far away.” He was also

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proficient in the Confucian classics. “He had read more than ten-thousand scrolls of books. If there was one thing he did not understand, he would feel ashamed.” The Record of Hermit Huayang says, at seventeen, “he was handsome, with bright, clear eyes and wide eyebrows.” He was well known for his talent in prose, and very popular with another man of letters Jiang Xiao. His elegant and outstanding articles won the praise of literary giants, such as Shen Yue, Ren Fang, etc. who commented, “Just like watching the sea in clear autumn weather. How boundless! How immeasurable its depth!” He was good at calligraphy too. Since the age of four, “he kept writing, using a reed-pen in the ashes.” “He was proficient in the official script of the Han dynasty. Not sticking to the common type of script, he created an especially beautiful and vigorous style.” He was also good at drawing, playing the lute and chess. So Tao Hongjing could be called a master of his generation, in literature and art. Besides this, he was proficient in astronomical almanacs, geography, medicine, healthcare and alchemy. He was a naturalist. History recorded that he created an astronomical instrument, the huntianxiang (planetarium). He also made wonderful explanations using numerology and constructing auguries. For example, Xiao Yan was going to claim the kingship in place of Qi. The Histories of Southern Dynasties – The Biography of Tao Hongjing records, “At the time of taking the crown, Fan Yun and Shen Yue helped him in this imperial business. They did not know what name to take for the new state. Tao (Tao Hongjing) cited the saying about ‘water, a knife-edge and wood’ in Wang Zinian’s Song of Return, calculated the graphic prophecy and concluded that the word Liang ‘梁’ should be the nation’s name for the good fortune of the country.” Tao Hongjing ordered his disciple to submit the word to Xiao Yan and selected an auspicious day for the abdication. He also predicted that the Liang Dynasty would not last long and wrote a poem: “Yifu is willful and sloppily absurd, Pingshu is always full of empty talk without action. How can they understand that Zhaoyang Palace would become Chanyu palace one day?” In the Houjing Rebellion, the usurper did indeed capture the power from the emperor in Zhaoyang Palace. When Emperor Wu of Liang ascended the throne, Hongjing had been in the mountains. But they still communicated many times. The Chronicle of the Liang Dynasty – The Biography of Tao Hongjing records, “The emperor showed many favors to Hongjing. The letters between them never stopped. Officials visiting him would arrive, one after another.” “When there was a punitive expedition or something important to decide, the emperor always consulted him before making a decision. The emperor kept writing to Hongjing a few times every month. People

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called him ‘the prime minister in the mountains’. The emperor, the crownprince, dignities and lords never stopped visiting him and presenting him with gifts.” In the third year of Tian Jian (504), Xiao Yan ordered the people to send gold, cinnabar, azurite ore and realgar to Tao Hongjing in order to make dan. In the fifteenth year of Tian Jia (516), he rebuilt Taiqing Taoist Altar for worshippers of the Tao. Before that, he had built for him Zhuyang Hall on the northern part of Leiping Mountain and Hua Yang Hall on Jijin Ridge. The Secret Record of the Hermit Huayang reads “the upper story was for Tao Hongjing, the middle story housed his disciples, the lower story was for visitors.” “Hundreds of kings, lords and high officials during the Qi and Liang Dynasties wanted to be his disciples, but they were all refused except for Xu Mian, Jiang You, Qiu Chi, Fan Yun, Jiang Yan, Ren Fang, Xiao Ziyun, Shen Yue, Xie Yue, Xie Lan, and Xie Ju, etc. They performed the rituals of a student before him, before he went into mountains. After Tao Hongjing had lived in seclusion, they always gave him further promotion.” His disciples numbered more than 3,000 (some say only dozens). “Only Wang Yuanzhi and Lu Yichong were called the best.” It said in True Taoism – The Biography of Zhenbai in the Mao Mountains of the Liang that Emperor Wu of the Liang constantly tried to persuade him out of the mountains to become an official. He replied with one poem and a picture. It was titled, In Answer: What’s in the mountains contained in The Sett of Hermit Tao: “What is in the mountains? White clouds above the hills. But they are only for me to enjoy, it is difficult presenting them to you.” He painted two oxen. One was shown on the meadows by the water; another on a gold bridle, whipped and roped by some person. Emperor Wu laughed and said, ‘Such a fellow can do anything. How can I bring him to court? It is impossible — like holding a tail to pull a tortoise back to return.’” From the above, we know Tao Hongjing studied both Confucianism and Taoism. He was versatile. There was nothing he did not understand; there was nothing he was not able to do. Tao Hongjing’s ancestors were Taoism believers. They greatly admired the two people named Ge (Ge Xuan and Ge Hong) and the two named Xu (Xu Shang and Xu Mi) in the same county. Tao described himself as “the last of his clan”. He studied personally under Xu Hui and called him a “true Taoist master”. But according to the Record of Hermit Huayang, he studied the Tao formally “in the three years of jiazi, yichou and bingyin (484–486), and became a disciple of Sun Youyue of Dongyang, the owner of Xingshi Hall, and studied Taoist talismans and scriptures.” Sun Youyue was a famous Taoist during the Southern Dynasties. He took Lu Xiujing of Jinyun

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Mountain in Zhejiang province as his teacher many years ago. There he lived in seclusion in order to cultivate the Tao in the mountains, for 47 years. Once he went to the capital with his master Lu Xiujing, where many officials and men of letters made friends with him. At that time, Tao Hongjing visited him as accompanying reader to the King. “Lu Xiujing appreciated Hongjing very much and taught him all he knew of the Taoist scriptures and their admonitions, without holding anything back.” But Tao was not satisfied with that. He went to all the famous mountains south of the Yangtze River, visited Taoists in seclusion and hunted for the lost manuscripts of the Shangqing scriptures of Yang Yi, Xu Mi, etc. Finally he found them in Maoshan Mountain in 488 to his great delight. In 490, he went to Zhe and Yue to search for immortals, visited Lou Huiming, Du Jingchan, Zhong Yishan and all the famous mountain retreats around, such as Tiantai Mountain, Changshan Mountain in Dongyang, Tianmu Mountain, Yuqian Mountain, Linhai Mountain, Anguo Mountain, etc. in Wuxing. In 492, he lived in seclusion formally in Maoshan Mountain to sort out and develop the Shangqing Scriptures and wrote his True Admonition, the Secrets of the Tao, Nature Cultivation and Healthcare, etc. During twenty years from 505 to 525, Tao Hongjing attempted to make dan seven times with the support of Emperor Wu of the Liang. He failed six times. But the last time, as the ding cauldron was opened, “the light and energy was so brilliant that his eyes could not remain open and his heart beat fast.” The dan had been made! So he wrote his Main Collections of Taiqing Dan and many other books about making dan and taking medicine. Tao Hongjing and his disciples worked hard for decades and made Maoshan Mountain the centre of Shangqing Taoism, worshipping Lady Wei of Nanyue as their ancestor. In fact this continued Ge Hong’s aim and completed the reform. Thereafter, Taoism changed from its old style of “immortal Taoism” for the gentry (in the southern region of Changjiang River), and this reform became the official Taoist orthodoxy. Tao Hongjing summarized and developed the cultivation and alchemy of Shangqing Taoism, founded Maoshan Mountain Taoism and set up a complete system of Taoist beliefs. Tao Hongjing himself had unshakable status as a Taoist leader. Tao Hongjing also cultivated Buddhism. According to the sixth volume of Dialectical Theory written by Falin during the Tang Dynasty, “He always respected Buddhism. He saluted in the Buddhist manner when meeting a monk, he set up figures of Buddha in caves, led his disciples in confession every morning and evening and instructed them to keep on reading the

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Buddhist scriptures.” The Secret Record of Hermit Huayang says, “He set up both Buddhist halls and Taoist halls on Maoshan Mountain and performed rituals in the halls every other day. There were figures in the Buddhist hall but none in the Taoist.” It is said in The Histories of Southern Qi Dynasties – The Biography of Tao Hongjing that when he went to Zhenjiang Province, “He dreamt that he had registered to be a bodhi called ‘Victory Bodhi’. He went to Ashoka tower in Yin County and vowed to accept the five abstentions.” The Maoshan Mountain Record says that in Zhuyang Hall, “to the east there was a green altar and to the west a white tower.” “He built them in seclusion and meant to cultivate both Taoism and Buddhism.” Some of his disciples in old age were Buddhists. He is recorded in The Tablet of Changsha Hall of Maoshan saying, “Things in the world are so many, but all of them fostered by the liang yi (Yin and Yang). Laws are so diverse and confused, but none can lie beyond the three religions.” The Ten Rewards records, “To respect religion is to be kind and good, then the dharma (fa) will not be held in the wrong way.” So Tao Hongjing cultivated Confucianism, Taoism and Buddhism. Before dying, he made it his will that his hands and feet were to be covered by a Buddhist robe, “the burial objects are to be a carriage and horse, Buddhists and Taoists at the door, Buddhists on the left and Taoists on the right.” Burial objects to come from the Confucians; Buddhists refers to the monks of Buddhism; Taoists to the disciples of Taoism. This saying clearly indicated that he aimed to combine the three religions together. So Tao Hongjing’s medical works comprise only some of his encyclopedic natural knowledge. He was not a doctor. His medical works such as A Supplement to Prescriptions for Emergencies in 500, an Annotated Shen Nong’s Herbal Canon at the end of 5th century and Records of Famous Doctors a little earlier than the former are the collection, rectification and supplement of other people’s works — but not collections of personal experience. The number of things he saw, heard and did and his rich reading were extensive; the medicines in his Annotated Shen Nong’s Herbal are as many again as those in the original Shen Nong’s Herbal Canon, a total of 730. Three categories of medicine are enlarged into seven categories: including jade, herbal, fruit, insect, etc. which shows the great insight of a naturalist. His outstanding insight is also reflected in the differentiation of medicinal properties, their place of production, collection, shape and the contrast between ancient measurements and modern ones — and he also spotted that the implication of the saying “the mingling (a boring insect) has children, brought up on the back of the luolei (type of solitary wasp), so

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should you foster your own children as the mingling does” was wrong.18 The Histories of Southern Dynasties – The Biography of Tao Hongjing says he “visited all famous mountains and searched for immortal drugs.” “Every mountain and valley he visited, he would sit or lay down for a while.” The cultivation of Taoism and rich life experiences were the background for his medical research. The eight-volume Huayang Hermit’s Supplement to Prescriptions for Emergencies came about as Tao Hongjing added to the three-volume Prescriptions for Emergencies by Ge Hong. He supplemented the original 79 prescriptions in order to make 101. This idea came from a saying in the Buddhist scriptures: “earth, water, wind and fire as four basic elements form the body, and each element of the people will suffer from one-hundred and one diseases.” He reluctantly changed Ge Hong’s style into a medical Buddhist form, but without including Buddhist medicine. Tao Hongjing wrote much. It is said that his works total 44 in all: the five-volume Effective Prescriptions, the one-volume Method of Taking Herbal Medicine, the one-volume Hundred Formulations of Gold Dan, the one-volume Method of Taking Mineral Medicine, the one-volume Recipes Without Rice, the one-volume Marvelous Prescriptions, etc. They all seem to involve medicine. But they are all lost and we cannot further probe into their relationship with Taoist culture and medicine. It is easy to judge from their names that these books were of a naturalist and one who served alchemy. The handwritten copy of his The Essence of the Assisting Formula of Visceral Drugs found scattered in the Dunhuang caves is very close indeed to Taoist medicine. In summary, the Annotated Shen Nong’s Herbal and Supplement of Prescriptions for Emergencies of Tao Hongjing had a great influence on later medicine.

71.  The Great Sun Simiao in Medicine and Taoism The outstanding medical doctor Sun Simiao was truly proficient in both Taoism and medicine. He died in the first year of Emperor Yongchun (682) during the Tang Dynasty. His life span is still in doubt. Generally, people think he was born in 581 CE (the first year of the Sui Dynasty), as presumed by Professor Li Jingwei. But I daringly conclude that he was born in 541 CE 18

 These two lines are from a poem in the ancient Shijing (Book of Odes). The notion wrongly explained the mingling as using an adoptive mother, i.e. the luolei. Tao found out that in fact the mingling’s children became food for the luolei wasp.

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(being the same birth year as the first emperor of the Sui Dynasty), which can be fully justified from all the historical material.19 Until new evidence is found, both ideas are possible. The Qianjin Yaofang (千金要方 Invaluable Prescriptions) records Sun Simiao as saying that he himself “was attacked by wind-cold during childhood and often visited doctors so that it exhausted all the money of my family.” He had such a deep and bitter experience of disease that he “decided to study medicine at eighteen.” “At 20, he had a good understanding of medicine.” “He could cure and keep himself in good health and did not have to see a doctor anymore.” He had been rather proficient in medicine. In the Old Tang History – Biography it says, “He was a sensible boy.” “He began to learn at seven and read much every day. At twenty, he liked to read the books of Zhuangzi, Laozi, thinkers of the hundred schools and Buddhist scriptures.” “During the reign of Emperor Xuan of Zhou (579 CE), he lived at Taibai Mountain in seclusion due to the turmoil in the royal family.” He said, “I have eaten five or six liang of stalactite water since I was thirty-eight, so I have a good understanding of its nature and know how to moderate it.” He also had become a good master of healthcare at that age. This can be read in his Invaluable Prescriptions. Since that time he became a Taoist doctor, with “flying alchemy”, took stalactite water, cultivated his self-nature, practiced the Tao and visited famous mountains, such as Taibai Mountain, Zhongnan Mountain, Songshan Mountain, Emei Mountain in Sichuan, etc. He made dan and practiced medicine for more than forty years. During that time, he wrote works about alchemy such as The Key of the Dan Scriptures, On the Dragon and Tiger, a Recipe for Alchemy, etc. He wrote the On the Three Religions with master Daoxuan of Shramana, which gave his influence a Buddhist tinge. Emperor Wen of Sui always wanted to employ him but he refused. When Li Shimin, the second emperor of the Tang, came to the throne, he was summoned “to the capital. The emperor was surprised by the young look of Sun Simiao and said: ‘The people of the Tao should be respected. Xianmen and Guangchen are right!’ Simiao was given the title of a noble but again declined.” At that time, Sun Simiao was already 86, so Li Shimin (at 40) was surprised at his youthful look. Soon he came back to his native place Yaozhou and lived at “Small Wutai Mountain” (today named Medicine King Mountain) to the east of the county. There he cultivated the Tao, practiced medicine, collected herbs and 19

 Ma Boying. An investigation of the birth year of Sun Simiao and his biographical chronology. Chinese Journal of Medical History, 1981, Vol. 4.

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began to write his Invaluable Prescriptions. He said in the preface that “In my old age, I work hard on medicine in my spare time… I explore its mysteries, study it in its ancient and modern guises, and I have written a book of prescriptions which I call Valuable Prescriptions.” He spent thirty years writing his thirty volumes of work and finished at about the end of Zhenguan (649). During this period, the Old Tang History – Biography records that Wei Zheng “often visited him for he had been ordered to write the histories of the five dynasties of the Qi, Liang, Chen, Zhou and was afraid something could have been left out. Simiao told them all as if he had seen it with his own eyes.” He revisited Emei Mountain, bought and brought back more than forty jin of realgar from Wudu and much azurite ore. “He went to Weijia in Shu County to refine it,” and finally made the “Taiyi immortal dan.” He had treated “more than 600 lepers with his own hands, one-tenth of whom were cured, among them were officials and famous foreigners.” Other effective cases also can be read about in his Invaluable Prescriptions. All of these show Sun Simiao to be true in his identity as a doctor. Rituals in the Tang Dynasty records that when Li Zhi, the Gaozhong Emperor, came to the throne in the third year of Xianqing (658), he “summoned Sun Simiao on Taibai Mountain to live in the old abandoned mansion of the Poyang princess.” “In the fourth year of Xianqing, Gaozhong called on him and offered him the position of counselor; Sun Simiao again declined and began his Qianjin Yifang (Supplement to Invaluable Prescriptions).” The Old Tang History-Biography says in the fourth year of Xianheng (673), Lu Zhaolin, Song Lingwen and Meng Shen “paid and attended him as their teacher.” “He talked about the Qi and Liang Dynasties as if he had witnessed them.” In April, Simiao was “summoned to the palace” to attend to the sick Emperor Gaozhong for half a year in Jiucheng Palace and given the official title “chengwulang in charge of the emperor’s pharmacy”. Then in the first year of Shangyuan (674), he resigned because of illness and died in 682. “He left the message before dying that he wished to be buried simply with a few objects and no sacrifice during the memorial ceremony. His look did not change after a few months. His corpse was so light when moved into the coffin it was as if there was nothing in it but his clothes.” It meant that he had become an immortal and gone. He had finished his thirty volumes of a Supplement to Invaluable Prescriptions before dying. Sun Simiao was a deeply accomplished medical scientist in both theory and clinical practice, and also a great expert in healthcare and alchemy, and so was called “Sun Zhenren (a true Taoist, a person with detached wisdom)” by people in later years. In the third year of Chongning in the

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Northern Song Dynasty (1104), he was granted the title Miaoying Zhenren. He attained great achievement in the cultivation of the Tao and in danmaking. The invention of gunpowder is generally believed to come through his method of “sulfur alchemy”. In his two books of prescriptions, especially the Supplement to Invaluable Prescriptions, many volumes describe natural cultivation, medication, coition medicine, sublimation and refinement, scriptural prohibitions, etc. These books do not mention alchemy but the method of “subduing the sulphur fire”. It was indeed invaluable that he integrated all these subjects into medicine, through his own prominent experience and commentary. His great achievements in Taoism and medicine were unprecedented and unsurpassed in the future. Cultivation and the making of dan, in order to become immortal, were an unnecessary aim for Sun Simiao. He said, “It is difficult to become immortal but easy to cultivate our own self-nature” (Supplement to the Invaluable Prescription – Self-Nature Cultivation). In fact, he sought longevity by taking medicines and healthcare, and by saving people’s lives through medicine. Unlike Ge Hong and Tao Hongjing, he had the benefits of rich clinical experience. Sun Simiao took an overview of the works of his predecessors, searched for folk prescriptions and adopted prescriptions from overseas. As a great medical scientist, he surpassed all achievements before the Tang Dynasty and opened the way for a bright new future in medicine. The great contributions of Sun Simiao have been mentioned many times, such as understanding aspects of exogenous febrile diseases, acupuncture and moxibustion, gynaecology, pediatrics, pharmaceutics, etc. His treatment and description of diabetes, goiter, beriberi, nyctalopia, etc. have had great significance — not only in traditional Chinese medicine but also in world medicine. Two sermons especially, The Great Doctor with Great Morals and The Great Doctor Studies, set an example forever, for later physicians. His works have often been quoted since the Tang dynasty. The essential part of his works was carved into the Invaluable Monument during the Ming Dynasty. Sun Simiao was called the “king of medicine” from the Qing Dynasty onwards. Today Medicine King Mountain has been renovated, and Sun Simiao Medical Ethics Monument has been erected and a temple fair of medicine held each year on his birthday, the 1st February, and so on and so forth. He has had a far-reaching influence on medicine and folk customs. It should be pointed out that taking tonics in a clinical setting has much to do with Simiao. Laozi had said, “supplement a deficiency; drain an excess.” The Zhou Rituals also records that one “supplements with drugs”. The Huangdi Neijing even takes this as an important principle. Acupuncture

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with prescribing skills had been much used in reinforcing and reducing. Zhang Zhongjing’s emergency prescriptions for acute fever disease in general were not used much in reinforcing. Some prescriptions such as Lizhong Tang, and Sini San for “regulating the middle qi” and treating cold limbs, were slightly tonic. But tonics were not used as a great principle of therapy nor were they popular. Tonics were occasionally recorded in the books of the Wei and Jin Dynasties. However, in the Invaluable Prescriptions of Simiao, many chapters discuss tonics. For instance, in the “bladder” chapter there is a “section of miscellaneous tonics”, which reads “Peng Zu said nothing is more useful than deer horn to keep people young, keep the qi untouched by too much sex, keep a rosy complexion… Amber powder treats all diseases due to deficiency, eliminates Yin impotence and dilute semen, or weakness.” “Desert cistanche powder can make people better, tonify and strengthen bone, supplement marrow and Yin qi.” “Aconite powder can treat the five overstrains and seven woundings, Yin impotence and exhaustion.” Clearly they all came from healthcare practices and the “nourishing the immortal” practice of Taoism — and finally became established as major factors in the treatment of disease. There are some decoctions in other chapters, such as a “strengthening-the-kidney decoction to treat deficiency of kidney qi, xiaoke (similar as diabetes), polyuria, and lower back pain” and “an Astragali seu Hedysari decoction to treat xiaozhong (a kind of xiaoke), overstrain, deficient qi, and frequent urination”. What shows even greater maturity is his development of a list of tonics in a special volume — in the Supplement to the Invaluable Prescriptions when discussing overstrain and tonification, which shows that theory and practice were then ripe. This had a great influence in the clinic, so much so that all ideas of tonification are thought to have come from Sun Simiao. But another view is that it represented a general developmental trend in clinical medicine. Sun Simiao made extraordinary achievements in external and internal alchemy — and used these, relating them to healthcare. He advocated that taking nourishment and dan, the cultivation of self-nature and diet all eliminate disease and prolong life. He said in Vol. 14 of A Supplement to Invaluable Prescriptions that “Now people living in seclusion do not really wish to be immortal, but hope without coercion or attack from outside, to gain natural longevity. However, it is necessary to understand the ‘small dan’ and best to know the ‘spirit dan’ — these are indispensable for emergencies. Fuhuo (fireless) cinnabar for retaining essence and nourishing the soul is suitable for taking over long time. Fuhuo (fireless) sulphur can treat beriberi, remove cold masses, regulate the lower back and knees, and

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strengthen the body. A little huan dan can eliminate wind and treat disease. Fuhuo (fireless) magnetite can make the eyes bright and bones strong… people should pay attention to these formulas with a Materia Medica. Using other fired dan, they want a miracle but it cannot be achieved so suddenly. People who have such wishes must wait with care and honesty, until perhaps they meet a true one.” Internal alchemy is discussed much in his Invaluable Prescriptions. “People should often practice Huangdi’s ‘introspection and inward vision’, then the five zang-organs with five colors can be clearly seen, like ‘hanging jade-stones’ (or stone chimes) in the body. Every morning, get up at dawn, face south, put the open hands on the knees, while using your ‘inward vision’ with the ‘heart and eye’, watching the qi move up to the head and down to the yongquan (acupuncture K1, on the sole of the foot), dawn after dawn (which is called ‘meeting with the qi’). Breathe in with the nose, breathe out through the mouth, slightly, do not let the mouth gape. If you want to accumulate qi, breathe in much and breathe out little. If you feel hungry, inhale qi into the abdomen…” This is the method of regulating qi. Then one can treat oneself. “If you suffer from coldness in the heart, the qi is hu (呼 breathe out); in a fever, the qi is chui (吹 blow) out; with disorder in the lung, the qi is xu (嘘 exhale slowly out); if the disorder is in the liver, the qi is he (呵 sigh) out; with disorder in the spleen, the qi is xi (唏rustle out); if the disorder is in the kidney, qi is xi (呬 pant out). After midnight, breathe eighty-one times; at cock crow, seventy-two times; at dawn, sixtythree; at sunrise, fifty-four; at the chen time (from 7 a.m. to 9 a.m.), forty-five times; at the si time (from 9 a.m. to 11 a.m.), thirty-six. Before that, make daoyin three-hundred and sixty times to left and right.” There are other various well-known regimens; for instance, the Regimen Motto of the True Taoist Sun Zhenren is as follows: Too much anger injures the qi; too much thought injures the spirit; An overstrained spirit easily exhausts the heart; weak qi easily brings about disease. Neither overjoyed nor over sad; please have a regular diet; Never be drunk at night, nor angry in the morning. Knock the heavenly drum (occipital area) before you sleep; gargling saliva after getting up; It is difficult for evils to attack the body; essence qi will be all over the body. If you want to be free of disease, keep away from the five pungent foods;

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Calming the mind should be a fitting joy and happiness; Treasure the qi and keep it to the five purities. Whether you live long or not is decided not by fate, but one’s own practice. If one can do as one is told, plainly one can move towards gaining the truth. These sayings are not necessarily the original work of Simiao, but express his ideas well. They reflect his great influence on having a regimen. In addition, the folk custom of drinking Tusu wine has much to do with Sun Simiao. The earliest record of Tusu wine can be read in Vol. 9 “Avoiding the Warm Evil” in Invaluable Prescriptions: “To keep away pestiferous qi, not to suffer the warm disease or exogenous febrile disease, Tusu wine is made on the first day of the year: take fifteen zhu rhubarb, eighteen zhu atractylodis rhizome, fifteen zhu platycodon grandiflorum and Sichuan pepper each, eighteen zhu cortex cinnamomi, six zhu aconite, twelve zhu smilax china, and sometimes one liang radix sileris, in one prescription. Chew these seven herbs, next put them in a crimson bag, sink in a well in the ground at midday on the last day of the twelfth month of the lunar calendar. Take it out at daybreak on the first day of the first moon of the lunar year, then put it in wine to boil several more times, drink it in a room with the door facing east. First drink a little, then more. One decides the amount oneself! If one drinks Tusu wine, one’s family will not be attacked by pestilence; if one’s family drink Tusu wine, pestilence will not appear within a mile. On the third day, put the dregs back in the well to drink next year and you do not suffer from disease all your life-time. If there is a well inside as well as outside one’s home, drugs should be put in it to drive away any warm pestilence.” The custom of drinking Tusu wine in the first lunar month passed on to later generations. The list for “Tusu powder” in Vol. 5 of Wide Records of Customs of the Year by Chen Yuanliang in the Song Dynasty says, “Beautiful Days: ‘It was said that Tusu was the name of a thatched hut, where lived a person who gave his neighbors a dose of medicine on the eve of every year and told them to put the drug-bag in the well. On the first day of the New Year, draw the water out the well and pour it into a wine bottle so that all the family may drink it, and they will never be attacked by disease or pestilence. Now people get the prescription but do not understand its name, only calling it Tusu.’” The person in the thatched hut should have had Taoism as the hobby. The method is so similar to that of Simiao one wonders if it came from Simiao. As a custom, it is popular all over the country. A poem of

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Wang Anshi says, “The last year dies away to the sound of firecrackers, every family drinks Tusu wine happily in the warm spring weather.” Many people still drink Tusu wine nowadays. All in all, the brilliant sixty-volume Invaluable Prescriptions and Supplement to Invaluable Prescriptions of Sun Simiao became monuments to Taoist medicine.

72.  Contributions from Other Taoist Doctors The great contributions and medical deeds of Sun Simiao cast a Taoist light over the future, much like a brilliant flower in full bloom. He also became representative of an orthodoxy in mainstream medicine which existed the whole of that era. Medicine did not depend for its main support on Taoism any more. Taoist precepts, canon, factions and ceremonies all had become normalized. Generally, Taoists were no longer like Sun Simiao but lived freely in the mountains or among the people and practiced medicine, although they were still willing to accept the medical purposes established by Sun Simiao as a supplement to the medical system of the canon of the Huangting Neijing. At the same time, others even became famous medical practitioners themselves — and followed Sun Simiao into medical history, as they made important contributions to the development of mainstream medicine. For example, take Meng Shen (621–713), who waited upon Simiao as a disciple together with Lu Zhaolin. As a young man, Meng Shen loved medicine and alchemy. He learned the Yin–Yang, the calculation of the astronomical calendar and medicine from Simiao. He once got a jinshi (or high degree, like a PhD), acted as an accompanying reader to Emperor Ruizong in his fiefdom and later took the post of cishi (prosecutor) in Tongzhou. He was also a famous litterateur. The Old Tang History records that Meng Shen went to visit the shilang (a high officer in court) Liu Yizhi at home. He “saw a piece of gold from the Empress and said ‘It is a golden drug. Put it into the fire, and there will come out colorful qi.’ Yizhi tried it, and it happened just as expected. Empress Wu Zetian heard about it and became sullen. She demoted Meng Shen to be sima (a lower post) of Taizhou. But he got promotion again many times later.” So Meng Shen was also rather proficient in alchemy. In CE 705 when Meng Shen retired he lived in seclusion at Yiyang Mountain to make medicines. Old though he was, he was as strong as a young man. He once said to his relatives that “if one wants to live long, one should never stop speaking well of things and

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taking good medicine.” He wrote three volumes of a book Prescriptions of Tonics, which was later enlarged and renamed by Zhang Ding and became Dietetic Materia Medica. Another three volumes of Effective Prescriptions were lost. So we know Meng Shen was a Taoist, but we do not know whether he had attained the full status of a Taoist, through ceremony or not. The same can be said of Sun Simiao. Meng Shen made many contributions to medicine. To observe the curative effects when treating jaundice, he invented the use of white silk soaked in the urine of patients every day and then dried. Then he made a comparison between them. The method was similar to today’s urine dipstick, first mentioned in the Handbook of Prescriptions for Emergencies by Ge Hong: “First the eyes become yellow, then the face and finally the whole body. Tell the patient to urinate on a piece of white paper. If the paper is as yellow as if dyed by a cork tree, heat toxins are present in the body. A treatment should be given at once.” So Meng Shen was litterateur by name, but a Taoist doctor in reality. There was another Taoist disciple called Wang Bing (ca 710–805), also known as Qixuanzi. He was a taipuling (official) during the Baoying period of the Tang (762–763), so later called Wang Taipu by the people. His main contribution was to enlarge and annotate the Huangdi Neijing – Suwen. In a manner of speaking, it was thanks to Wang Bing that the Suwen became established and popular. Due to his annotation, the Suwen became more Taoist, and the theory of Taoist medicine also more mature. He said in his preface that “I have loved the Tao and healthcare since I was young. I am so lucky to meet this genuine scripture, which has become an eternal mirror for me.” He got a secret copy of the Suwen from the study of his teacher Guo Zhaitang, which came from his teacher Zhang. Zhang and Guo’s capacities cannot be verified. But their secret impartment to Wang Bing gave the work a mystical colour. His saying “to get rid of the fetters, to get out of danger, and to preserve its naive essence, to guide the qi to move” was Taoist-style talk. The “old scriptures” added to the work by Wang Bing consist of seven articles about the “circulation of the qi”, that is, Heavenly Tianyuan Theory, the Five Elements and Their Movements, The Six Subtle Qi, Qi Transformation, Five Movements in the Normal, The Six Qi in the Normal and The Crux of the Ultimate Truth. Today these articles are still in dispute. Some think they are original; some think they were written by Wang Bing. They are eloquent and wide ranging in substance and discuss astronomy, geography, the five movements and six qi. There is so much variation and profundity in Taoism that they are admired by all Taoists. Wang Bing also wrote the Abstruse Pearl “to express his thought”, which

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was lost before the Song Dynasty. Just as Lin Yi said in his new correction, “Wang’s Abstruse Pearl has been lost. Now there are ten volumes to the Abstruse Pearl and three volumes to the Bright and Hidden Aim — said to have been written under his name. Though not written by Wang Bing himself, they do develop Vol. 19 to Vol. 24 of the Suwen. The Bright and Hidden Aim with its three volumes is a good match for the Tianyuan Jade Book in exterior and interior manner.” These books were included in the Taoist Treasury and became precious for any Taoist. So it is not difficult to infer how much of a Taoist Wang Bing was! He noted that in the Suwen the idea was to “strengthen fire to subdue excessive Yin” and to “strengthen water to subdue excessive Yang”, which is rather like the speech of the alchemist. The Neijing ignores ghosts and gods, but Taoism admires them, both attitudes preserved by Wang Bing when he annotated the Suwen. He took a middle course between them. For instance, the phrase “who can come and go alone, finding even the finest change in the heaven and earth, Yin and Yang, nothing can escape his sight” in the Suwen – Health Preservation section does not mention ghosts and gods. But Wang Bing’s commentary note says, “This obvious and very rapid effect is close to it being like the shadow from a light, the sound from a drum — it happens because the gods can ‘come and go alone’. Ghosts are impossible to order.” The same section also says, “the medical Tao has neither gods nor ghosts. Coming and going is free.” So, the Suwen clearly takes a negative attitude towards ghosts and gods. But Wang Bing notes it is “like a shadow following people, like an echo after a sound, surely this is neither ghosts nor gods but just a reaction in itself!” His explanation that ghosts and god could not attack indicates that in his heart he believed in gods and ghosts. All in all, such notes by Wang Bing could not change the standpoint of the Suwen. But anyhow, he added these seven chapters and they have had an immense effect and influence, both positive and negative. There was also the Taoist Wang Huaiyin during the early Song dynasty, from Suiyang, who lived in Jianlong Temple at Bianliang. He was good at medicine. At the beginning of the Taiping Xingguo (977) period, he was summoned to resume his secular life and take the post of Shangyao Fengyu (in charge of the emperor’s drugs and diagnosis). He was three times dismissed but finally became an imperial, medical top official and was ordered to compile the Taiping Royal Prescriptions with vice-medical official Wang You and Zheng Qi. His book is invaluable. Though Huaiyin resumed secular life, undoubtedly he was an outstanding Taoist doctor at an early age. There was also the famous Taoist doctor Ma Zhi during the Song dynasty. He got a copy of the Prescriptions made at Sea and gave himself up

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to a thorough study of them; it was said to have been written by Sun Simiao, but in fact it was written under his own name. He had a good knowledge of medicine and often gave effective treatments. In the fifth year of Kaibao (972), he cured the disease of Emperor Taizong of the Song Dynasty along with Liu Han and became imperial physician. The next year, he was ordered to correct the Chinese Materia Medica with nine others, namely Shangyao, Fengyu, Liu Han, imperial medical official Zhai Xu, Chen Zhaoyu, etc. They added 134 new kinds of drugs. Ma Zhi also annotated 20 volumes of a New Revision of Materia Medica in Kaibao. All these contributions are by Taoist doctors. After that, there were no famous Taoist doctors for a long time. Then in the middle of the Ming dynasty, there lived the Taoist Fei-Xia (meaning flying clouds), named Han Mao (alias Tianjue, also known as Bai Zixu, although people called him Bai Feixia). He came from Luzhou City in Sichuan Province. He was studying to be an official as a young man and failed the exams several times, so he gave up Confucianism and began to study Taoism and medicine. He travelled over almost the whole country and attended upon the skilled Chen Dounan at Emei Mountain, the famous doctor Wang Shanren in Jinhua City, the old immortal Huang He at Wuyi Mountain, the good doctor Xiu Xiu Zi in Lushan Mountain, etc. He got the secrets taught by them all and finally became skillful at medicine. He saved many lives and became famous. He reached Chu, where there happened to be an outbreak of spring pestilence. People did not understand this disease and had no idea about it. He got young boys to take the “dan for the five plagues” to every sick family. The following day, hundreds of people could sit up and were better. During a visit to the capital in the times of Zhengde (1506–1521), Emperor Wuzong gave him the name Baoyi Shouzheng Zhenren (The True Taoist Keeping True for the One) and built the White Cloud temple for him to reside in. Later he came back to Emei Mountain and settled down in Chengdu in his old age. During the period of Jiajing, (1522– 1566), a Jinshi said he had met Han Feixia when visiting Emei Mountain, who taught him how to breathe qi and take medicine. This Jinshi lived to be 94 years old. According to this story, Han Mao was skillful in both medicine and Taoism. He wrote Han’s Medicine in two volumes (1522), the Treatment of Syphilis in one volume, Marvelous Taoist Prescriptions, Simple Yunnan Prescriptions, Han’s Effective Prescriptions, etc. Now only Han’s Medicine remains, of which its description of synthesis of the “four diagnostic methods” and format of making a medical case record are unprecedented, and followed by many practitioners to the present day. Many prescriptions are

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simple, convenient and effective. The “Three Seeds Decoction for Parents” is still often used. He said concerning “waxberry sore”, viz. syphilis that “this disease is not only due to being infected by another person through sex. Weak people, both young and old, might catch this disease after going to market, the closet or talking with a patient, and accidently meet up with the poison. They might get sick at once or it might start later.” It was not easy to have such insights about syphilis — which had just arrived in China during that time. There now exist the “Feixia Cave relics” on the top of Xianding Mountain in Luzhou, where Han Mao practiced self-cultivation for a while. Han Mao was the most famous Taoist doctor after Sun Simiao. There were many other Taoist doctors. Though they did not make as great a contribution as those mentioned above, they were certainly part of Taoism. Some expanded the influence of immortal Taoism, some worked silently on medicine. For instance, inoculation was invented by the Taoists, and will be described in later chapters in some detail. Some were mostly recorded in books on the immortals. For example, the Youyang Miscellany records a Taoist in Jingzhou called Wang Yanbo, “He was naturally apt at medicine, especially skilled at differentiating the pulses. He diagnosed disease, prognosis and life-span by the pulse and never missed. One day, the son of Shangshu (an ancient official name) Pei Zhou suddenly got seriously sick. All his doctors were at a loss. One of them said that Yanbo was skillful in medicine and he was invited to attend as soon as possible. He felt the patient’s pulse for a while and said: there is no disease at all. He boiled some powder of herbs for the patient to drink and the boy got well. Pei Zhou was puzzled and asked Yanbo of the reason. Yanbo answered: ‘Your son was poisoned by a carp with no gills.’ It was caused after he ate the fish. Pei did not believe it at first. He cooked the carp with no gills and gave it to his servants to eat. To Pei Zhou’s surprise, the same symptoms appeared.” The carp with no gills might be a kind of pufferfish but less toxic. The Supplement to a National History also records, “Wang Yanbo said himself that his medicine would become very popular. Then he set up four cookers to boil up herbs at court. The old and young all crowded round to ask for the herbal drinks. Yanbo pointed to the different cookers and said: ‘This is for patients with hot disease; this for cold; this for wind; this for the patients with qi disease.’ The patients took their drinks and left. Next day, all the patients went to thank him personally with money or silk as presents. It worked for everyone.” The Optional Immortals Record says, “There was a carpenter in Guangling, who could not handle an axe anymore because of his contracted

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limbs, due to disease. He begged, creeping along on his knees. One day, he crawled to the temple of the Earth Goddess and met a Taoist … who gave him several pills and said: ‘You will be well after taking them’… After returning home, he took the pills. Soon his limbs ached very much until midnight and he fell asleep. He woke at dawn and felt his limbs had become light. Then he got out of bed and found he could walk as well as before.” The following comes from the biography of Zhen Qizhen in The History of the Song Dynasty: “Zhen Qizhen, alias Daoyuan, came from Shanfu County in Shanzhou. He read many classical works and was proficient in poetry and prose. He wanted once to become a jinshi but failed. He sighed: ‘It is no use to overstrain the spirit and consume one’s essence to seek fame.’ Thence he gave up his pursuits and enjoyed himself with Taoist books. He visited a fellow Huagai on Laoshan Mountain. After a long while, he visited the capital and became a Taoist at Jianlong Temple. He travelled around all quarters and saved many lives with his medical skill without taking any payment.” It is said in the biography of Zhao Ziran that “Zheng Rong was once acting in the royal army. One night, he met an immortal, who said to him: ‘Taoist qi is on you — so eat no cooked food!’ Then the immortal taught him medicine and how to save lives. After seven years, he bestowed on him the name Ziqing and he was accepted as a Taoist and lived at Shangqing Temple. He gave a medical drug for leprosy to many patients. He needled people’s arms and gave them medicinal cakes in order to treat disease.” The biography of Huangfu Tan in the Southern Song dynasty states, “Queen Dowager Xianren was troubled by eye disease, which could not even be cured by the royal doctor… Tan was well known, so the Emperor Gaozong summoned him and asked him how to treat it. Tan said: ‘When the heart is free — the body will be sound.’ It is said, ‘the emperor does nothing and the nation is well ruled…’ He treated her eyes and soon she got well. The emperor was so pleased, and gave him many gifts and ordered him to pray at Qingcheng Mountain. He also summoned him and asked about the skill of prolonging your years. Tan said: ‘Control all lusts and desires. Don’t let yourself go too much. Thousands of rolls of dan books are no better than keeping oneself at peace…’” Unlike common doctors, these Taoist doctors had their own peculiar skills. The invention of variolation was linked with the liberal tradition and explorations made by Taoist doctors. Such Taoists often concealed their names, but medical creativity used to appear in the mountains. According to the Record of Qingcheng Mountain, there were dozens of famous Taoist

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doctors on Qingcheng in Sichuan Province from the Tang to the Ming dynasties — such as Du Guangting, Yuan Tiangang, Mei Biao, Han Yin’an, Mr. Xing, Li Xuan, Dr. Hao, Peng Xiao, Zheng Rong, Huangfu Tan, Miraculous Xu, Guo Changru, Kang Daofeng, Sa Shoujian, Golden Nail Li, Zhang Huaigui, Luo Zhongguang, Guo Yunxuan, Xie Wu. There were also many famous Taoist doctors living on other famous Taoist mountains. Also there must have been Taoist doctors living among the people, very many indeed.

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CHAPTER 9

Neo-Taoism and Medicine During the Wei, Jin, Southern and Northern Dynasties A. Neo-Taoist “Idle Talk” and the Fashion of Taking Stone Powders The profundity of Chinese metaphysics (xuanxue 玄学) was now born, along with a new philosophical style — and in general, it belongs to the Taoists. It occurred during the whole period of the Wei, Jin, Southern and Northern Dynasties (265–589). It may be called Neo-Taoism and it concerned the Neo-Taoists. Their “idle talk” (qingtan 清谈 “empty talk”), their natural and unrestrained behaviour and enjoyment in taking some special mineral formulae for heat were particular features of their lifestyle. Their demeanour was just as Lao Zi described: “The upper-class intelligentsia hear the Tao then work hard for it; the middle-class hear the Tao and just imagine the Tao not to be there at all; the lowest-class hear the Tao, and laugh loudly. If there is no laughter, there is no way to talk about the Tao.” It was such as them, a laughing group of people that invented Neo-Taoism.

73. Neo-Taoist Idle Talk and a Comprehensive View of an Undisciplined Life The malady of studying Confucian classics during the late Han Dynasty was partly its extreme theologization, dumped on others by “learned” people, and partly the making of annotations in the name of “textual research” — loaded with pedantic, trivial detail and textual criticism. The Han histories

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record that “a single classic could be annotated in over a million words”1 and “a five-character composition bear annotations of twenty or thirtythousand words”, and this went so far that textual research brought unreadability to these works, and made them tedious and cumbersome. But as a result, the study of the profound theories of Lao Tzu (老子), Chuang Tzu (庄子) and the Book of Changes (周易) thrived and gradually grew. They formed a new pillar and set of philosophies for the feudal rulers, now faced with social turmoil and national secession, as well as the chaos caused by the late Han wars. However, the success of Taoism and Buddhism could never be displaced by the philosophical thinking of such outsiders, who nevertheless seized a golden opportunity to enhance independent thinking — that is, to subvert the nature of waning classicism, with their enlightened and metaphysical Taoist and Buddhist discussions. Despite all this, a fresh boom in Chinese philosophy began. By their very nature, the so-called Neo-Taoists gave rise to a new and particular form of philosophical thinking. The approach of Neo-Taoism was indeed metaphysical, a xuanxue (or “metaphysics”).2 According to Tang Yijie, “with regard to philosophical history, a dark metaphysics, Neo-Taoism, unrelated to either isolated, static, or one-sided views, and opposed to a dialectic approach, arose as a means of looking at pertinent issues.”3 It became quite jumbled up during the Wei and Jin Dynasties — as it sprung out of Wang Bi and He Yan’s gui wulun 贵无论 (“theory of nihility”), the ideas of “favouring non-being as the root” around the Zhengshi years of the Wei (240–249), progressing on into the so-called “non-being view” centred on “transcending the Confucian ethical code (名教) and favoring nature” as well as on the “being view (chongyu, 崇有)” of Xiang Xiu. It was Xiang Xiu who upheld “reverence to Confucianism while keeping Taoism as well” during the Bamboo Grove period (254–262). The movement kept on continuing into Pei Wei’s “being view” (chongyu) which stressed the “necessity of usefulness since birth”4 along with the view of “independent transformation” held by Guo Xiang alongside his belief that “all things are in the dark, and metaphysical” around the years of Yuankang (around 290); then it made its way again 1

 Hanshu – Biography of Confucian Scholars (汉书·儒林传).  Also called the study of the “preformed and beyond” 形而上学, a phrase lifted from the Xici appendix to the Book of Changes. 3  Tang Yijie, Guo Xiang and Neo-Taoism in Wei and Jin Dynasties (郭象与魏晋玄学), Hubei People’s Publishing House, 1983. 4  Pei Wei (267–300), famous Chinese philosopher in the Jin Dynasty. 2

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to the “non-being view” of Zhang Zhan who upheld “the principle of non-being over everything”, and on to “the primordial nature of nothing” — in Dao’an’s saying, “nature begins with nothing”. The circumstances of these ideas seem very numerous and jumbled. However, clothed in the fashion of the times the traditional Chinese philosophical systems of “being and non-being”, “fundamental and incidental”, “noumena and affects”, etc. then became clarified and formed and the cloak of theological teleology — concerning an induction occurring between the human and the heavenly — was to some degree abandoned; at the same time Wang Chong’s concept of “primordial qi” and other more natural views of qi were borne out. Thereafter, these impelled philosophical thinking into a brand new phase of development, dialogue and speculation. All these constituted the so-called “metaphysics of the Wei and Jin”. These were the main contents of the talk of the scholars and intellectuals of the time. They were learned and erudite, eloquent and talented. They “talked on and on in torrents of words”, and also, being romantic, behaved in a way divorced from reality and life, dissonantly and unconventionally, thus creating their own uniquely unrestrained style of “Neo-Taoism”. Such a mystical demeanour later progressed so far as to “disdainfully discard the ancient classics, to scorn all ritual, to loaf around in the world with pompous and flatulent speeches made by perplexed youths, whose lives were turned upside-down. They spoke with extravagant diction, mistold the truth and, in a pseudo-sophisticated form, bewitched the whole world. Gentlemen of official circles changed their normal ways, and the customs in the districts of Zhu and Si were degraded and forgotten. Therefore kindness and justice declined, culture and gentility were stained, and the whole system of Confucian ethics collapsed. The whole nation was toppled. While these people with their ‘false words and eloquence’ and ‘weird and unremitting’ behaviors were the drivers.”5 Influenced by these kinds of people, the whole of society also degenerated. For example, “Some common people adored highly the unrestrained behavior and laissez-faire attitude of Dai Shuluan and Ruan Sizong, believing in their greatness, and ridiculously overrating their own mediocrity and imitating their behavior. They went with hats askew or even hat-less, their bodies naked, squatting down impolitely, washing their feet in front of other persons, or even urinating in public, banqueting alone, or filling the winecup only for their own use, not for relatives… But really the ancients held 5

 Jinshu – Biography of Fan Ning (晋书·范宁传).

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sensible views, they had high ethical standards, strove for kindness and justice — how could people such as these, with their views close to blasphemy and such ribald behaviour, qualify?”6 Yet a social fashion of idle talk, metaphysics, undisciplined behaviour and an indulgent lifestyle were all the rage at that time. Their influence was so powerful that the so-called “learned people” of the subsequent Southern and Northern Dynasties followed them exclusively. Later, during the Yuanjia years (424–453) of the Liu-Song Period of the Southern Dynasty, “dark metaphysics” was set up as a subject of study and its views passed on to pupils who came out in admiration for such a famous project. They called it “the Southern Study”. Later during the Liang Period, the “Three Dark Metaphysics” based on the Lao Tzu (老子), Chuang Tzu (庄子) and Book of Changes (周易) prevailed: Their discussions were called “dark metaphysics in speech” and their writings “dark metaphysics in books”. Now the acme of dark metaphysics had arrived. From the above description we could copy out a sentence from Dickens (1812–1870) which states that “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way — in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.” (A Tale of Two Cities) Some old scholars believe the Weijin–Nanbei Dynasty to be an age of ideological confusion, absurd and irremediable; but another earnest historian would like to say it was an age of liberalization and a liberation of the mind and thinking — as during the Spring and Autumn Period (770–476 BCE). Similarly, we can quote from John Fowles (1926–), “In essence the Renaissance was simply the green end of one of civilization’s hardest winters.” (The French Lieutenant’s Woman, Ch.19) A kind of liberty of thinking and spirit of independence was growing widely. Such an attitude could also be found in medicine. “Purely idle talk” in daily life was the aim of the philosophy of those times. Luxuriant and unrestrained behaviour was the blessed lifestyle. That the “celebrities” of those times rarely cared for death was associated with a 6

 Baopuzi – Cijiao (抱朴子·刺骄).

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changing view of life and death. According to research by Yang Bojun on Lie Tzu – the Yang Zhu (列子·杨朱篇),7 composed in the Wei and Jin Dynasties, this view of life and death then was different from that of the ancients. It can be well justified in one sentence — “enjoying life, because human life is mortal.” Yang Zhu points out that lives are mostly short, so we should enjoy happiness when living: “one hundred years is the maximum limit of longevity and there is hardly anyone who attains that. Even if there existed such a one, his childhood and old-age together occupy almost half his life; his sleep at night and rest during the day take up almost half the rest; disease and pain together with distress and dismay, another half of the rest. So the remaining ten years or more, when one can be content and at leisure, living for oneself, without any kind of small vexation is a very short while indeed. So, what should people in the world live for? What happiness can we obtain? Let it be that of delicious and rich food, music pleasing to our ears, and sensual beauties before our eyes.” Yang Bojun goes on: “It was acknowledged by the ancients that life was a temporary arrival while death a temporary departure. Whatever they did, they followed their instincts and likes. They would never go against natural laws, nor would they decrease their earthly pleasures… Hence they would not be disciplined by so-called fame… They enjoyed life with all its natural fun but did nothing against their own hearts or wills. Because fame after death was not pursued either, they could not be confined by penalties or punishments. In a word, such questions as how famous they were, or how long they could live meant nothing to them at all.” Then he quotes Chao Mu, who was a brother to Zichan, exhorting the people, “I would rather die than follow what you preach about propagating etiquette in order to show off before others, or suppress my inherent nature in order to attain fame. On the contrary, I will go all out for enjoying what this life can provide, only fearing that my belly will be broken during my wild drinking, or fatigue will prevent me wantonly enjoy my lusts to their fullest extents. How can I have time to worry about how good my name is — or what dangers life might bring?” These words well suited those celebrities of the Wei and Jin dynasties. Moreover, Yangchu also states, “things differ in nature in their ways of being, but are identical in their dying, the wise and foolish, the rich and poor may be different but they both share the same space, and are identical in their dying with the same process of decay, rotting, disappearing and being 7

 Yang Bojun, Interpretations of Lie Tzu, Zhonghua Book Company, 1979, p. 348.

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extinguished… and it is the same for things in the wild, which eventually die no matter whether after ten years or a hundred years, just as do kind and courteous men, villains and fools. Even the great Yao and Shun turned into decrepit skeletons at death — and the same goes for the detestable Jie and Zhou. All skeletons are identical and none can tell one from the other. Therefore, why not seek happiness in life? Forget about the afterlife!” Life is mortal and death the goal of everyone and everything. Such were their views on life and death which, although they might seem to encourage a totally unrestrained lifestyle, eventually evolved into a clear new view of human existence and also a philosophy of “dark metaphysics” which was different from those coming before, which had sought to prolong life on this earth. As a result, dualist and even contradictory features in attitudes to life arose, and these can be exemplified by the coexistence of “favouring nonbeing” (贵无) while still having a “being view” (崇有), in practicing an unrestrained lifestyle and yet seeking to keep healthy through diet. Take Zhang Zhan (张湛) for example, who contributed to the Lie Tzu (列子). He can be called a “keeping-healthy master” and was quite good at medicines. Yet it is a pity that his ten volume work On Keeping Healthy and twelve volumes of Secrets of Prolonging Life (延生秘录) cannot be found. Some of his ideas can be traced from others’ writings such as “reading harms the eyes” in the present edition of Good Prescriptions for All (普济本事方) by the famous Dr Xu Shuwei in the Song Dynasty, where it says, “It is a truth that reading can hurt the liver and harm the eyes. Fan Ning in the Jin Dynasty once suffered from pain of the eyes and he went to Zhang Zhan for help. Zhang fooled him and said, ‘The ancient prescription I will give you originated from Song Yangzi who got it when he was young and taught it to Menbo in Donglu State. Then it was passed on to Zuo Qiuming who passed it down, generation after generation, to Du Zimei in the Han and Zuo Taichong in the Jin. All these virtuous people, who suffered eye disease, received this prescription which says: firstly, read less; secondly, think less; thirdly, focus on looking at internal things; fourthly, simplify appearances; fifthly, get up late; sixthly, go to bed early. These six steps you need to assist you with the spirit-fire, and to keep the qi moving so just hold them in your chest for seven days then store them in heart. Keep practicing for a long period, then you will be able to count the number of eyelashes nearby and see the end of horsewhip far away. If you still keep practicing, you will see through walls, as though they have holes in them. Thus it not only benefits your eyes, but can also prolong your life.’ Some took these prescriptions as if they were magic, and did not think of them as a joke.”

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Yet we all can see that Zhang Zhan’s words meant he was somewhat of a celebrity. However, Xu Shuwei, a famous physician during the Song dynasty, pointed out that less use of the eyes does indeed make them improve. The Qianjin Yi Fang (千金翼方) Volume 12 “Taboos on Temperament Cultivation (养性禁忌)” also has quotes of the magnificent ideas of Zhang Zhan: “Zhang Zhan said that in order to keep healthy, many prescriptions were written down, generation after generation. But among them, those of Ji Shuye were the best. Yet his thought was idealistic and sometimes not practicable. But my words in truth matter and a return to the facts when talking about ‘essence’ and ‘effect’ is important. I thereby record these words here in order to benefit our offspring. They are easy to follow as they do not violate our nature while pleasing ourselves and are fine and detailed, concerning every small movement or action we make daily. We do not need to give up our enjoyable hearing and eyesight, but look around and see all things that are feasible. Their sense seems concise but their view encompasses a wide field; and achieves more through making less effort. These are what are known as, ‘those easy rules, easily known, simple rules, easily followed’. So the real essence of this prescription is: first, save your spirit; second, preserve your qi; third, protect your outlook; fourth, dao-yin, that is stretch your body out in practice; fifth, talk and discuss; sixth, drink and eat; seventh, have sex; eighth, fight vulgarity; ninth, use medicines; tenth, heed taboos. Nor more than these have I learnt.” These words by Zhang Zhan are the essence in keeping healthy. What he upheld ran along parallel tracks — with both one’s health and the earthly pleasures of the eyes and ears stressed, side by side. Despite this, Zhang was a rather cautious man concerning medicines. The Virtue in a Great Physician (大医精诚) in Qianjin Yao Fang (千金要方) states, “Zhang Zhan said it is always very difficult for doctors to be proficient in classical prescriptions. Nowadays, diseases which have the same internal condition might present with different symptoms; and vice versa. Therefore, neither the efficiency or deficiency of the five zang and six fuorgans, nor the free circulation of the blood and qi, or obstruction, can be simply observed by eye or ear; instead, pulse-taking should be taken into account in order to detect them. Whether the patient has a disorderly pulse quality of a fluting or deep, wiry or tight type at the cunkou pulse, or the circulation of the qi through his acu-points is at which level, or the skin and bone is sometimes thin and sometimes thick, sometimes soft and sometimes hard, all these can be detected only by taking on a diagnosis made with the most meticulous care.”

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Ji Kang, a celebrity,8 once “entered the mountains with Wang Lie, who was tasting stalactite rock-juice as sweet as syrup. After tasting half of it, he gave some to Ji Kang, but the syrup coagulated into stone instantly”. It seemed that Ji Kang was not blessed to drink the stalactite juice. “Kang also overheard the last words of some Taoist saying that ‘taking the baishu and huangjing herbs could prolong life’ and he firmly believed it.”9 It looks like Ji Kang was only able to keep healthy by taking herbal medicines, not the stalactites. Ji Kang later wrote On Keeping Healthy (养生论), Questions and Answers on Keeping Healthy (答难养生论) and On Good or Bad Luck in Dwellings and their Influence on Keeping Healthy (难宅无吉凶摄生论) to express his somewhat objective acknowledgements of life, death and the art of keeping healthy, with ideas such as “Some people say immortality can be attained through the effort of learning and hard practice, and one will never die. Yet it has always been said that the most one can reach is one-hundred and twenty years — the same, ancient and present. More than this must mean one is some kind of demon or monster. These views on attaining immortality and never dying, are both lost to the truth.” So there was often disagreement among people on attaining immortality, but there was agreement on keeping healthy, for instance “with this small and thin body, man suffers hurts from all sides; with this fragile body, he is under both internal and external attack. So how can this body attain longevity since it is not a thing like a tree or stone?” And, the following words were also stated: “those who are good at keeping healthy… with peace and tranquility within, behave at their leisure; disposing of selfish and greedy lust, fully aware of the damage done to their moral cultivation by fame and social status, they turn indifferent eyes on them and refuse to pursue them. Nor will they prohibit such doings as lusting within. Knowing that delicious food can hurt their nature, they cast it away without pity and not because they are too poor. Therefore, they can be broad-minded without having any worries, for outward things that hurt their hearts have been driven out and peace of mind comes their way, without distraction. With a quiet art to guard and maintain their vitality, as well as the harmonious qi of all nature to nurture them, they can get close to natural law quite easily. Meanwhile, taking ganoderma mushroom-type medicines to cultivate their mood, drinking sweet springwater to nourish their internal organs, improving their health by drowning in the sunshine, pleasing the heart by playing and composing music and 8

 The following quotations are all from On Keeping healthy (养生论) by Ji Kang.  From Jinshu – Biography of Ji Kang (晋书·嵇康传).

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songs, they can truly attain a happy heart, a healthy body, and a lofty mind, all of which, without deliberate heed to pleasure, actually heightens their joy, and freed from the worries of life, makes life last longer. Persevering in this way, man can live as long as Xian Men and Wang Ziqiao.”10 Thus, we can say immortality was surely out of the question, but making the body healthier and life longer were accessible. In Kang’s opinion, the key to keeping healthy lay in this: “Bodies cannot do without spirits and vice versa the spirits must find a host in the body. We have to understand that life is fragile; it can be injured by little mistakes and easily lost. So we must preserve our spirits by cultivating our mood, and build healthy bodies by gaining tranquility of mind. Let neither love nor hatred linger in our emotions, and without either worry or joy in mind, keep our body healthy and our qi and blood in perfect order, with tranquility within and desire without. Meanwhile, together with the exercise of deep breathing and taking medicines, an intimate combination of body and spirit will bring about a harmony of internals and externals… All the nutrition we take in will cultivate our mood and never not affect our bodies… So we have Shennong’s words: ‘first-class medicines can prolong people’s lives, while middle-class ones cultivate mood’, which show that he quite accurately understood that medicines are good correspondents in helping keep us healthy.” Ji Kang also states, “Keeping healthy usually incurs five problems: firstly, the desire of fame and wealth which is hard to extinguish; secondly, joy and anger which is difficult to dissolve; thirdly, earthly lustful pleasures; fourthly, delicious food never being stopped; fifthly, a lax and sapless spirit… So withdraw your vision and look inward, concentrate the spirit in simplicity, let the mind rest in the bewildering field of abstruseness, breath in the limitless air and then you can live, avoid illness and prolong your lives… Those who accumulate mercy keep their word to the truth and are often known to others. Prudent in speech, and in control of their diet they are acquainted with all scholars. I know of nothing more important than this.”11 All these words reveal to us a scholar who traced the arts of keeping healthy to their Taoist source, without there being anything in it that speaks of the marvels of immortality, or even an unrestrained lifestyle. According to the following quotation from the Qianjin Yao Fang (千金要方) Volume 27, 10

 Xian Men and Wang Ziqiao were both ancient legendary figures who understood the myth of keeping healthy and leading immortal lives. 11  From Questions and Answers on Keeping healthy (答难养生论) by Ji Kang.

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Ji Kang also made a study of how to cure disease as well as how to keep healthy. He could be called the first person to observe the causes of beriberi: “Ji Kang said, ‘It is quite true that there is more disease during years with a good harvest and less disease in hungry years. That is why in the area of Guanzhong people’s prevailing customs are diligence and frugality. Their daily food is only salted vegetables and sauces — but they rarely catch sick and can live a long life. While on the southern side of the Yangzi River and south of the Five Mountains, the lands are abundant in every kind of delicious food from the sea and land. Unfortunately people there often get ill and die prematurely. When an intellectual is sent out there from the north to be an official, faced with an abundance of everything, he takes it as a blessing and the whole family, old or young, high or low in position, willfully dine and wine. At night they are always sated and drink so much their bodies become hot and prostrate. They lie and sleep naked and their stomachs cannot digest what they take in. Within a month, everybody gets ill, either from cholera, or beriberi, or turgor, or fever, or malaria, or dysentery, or foul nodes, or malignant nodules, carbuncles, or swellings, ulcers, piles or anal fistulas, a stroke or paralysis or flaccidity. And not knowing how to cure the disease, they end up dead. Such cases can be found everywhere. They blame it on not acclimatizing and not knowing the true cause. It is really a pity when you think about it. People should understand and give up their bad habits.’” For those interested, beriberi was very common after the southern move of the Jin and Song Dynasties, and was caused, according to the modern research, by a lack of Vitamin B1. This vitamin is richly contained in coarse grain and rice husks, but not in pure rice flour. This description by Ji Kang coincides with this view. When Sun Simiao proposed the use of a porridge of grain husks to deal with beriberi, it was to supplement deficient vitamins and his prescription became the earliest type of treatment. One thing needs to be made clear here: that there were also some among these people who liked to also talk about medicine. King Wu of the Liang Dynasty said, in his Quanyilun (劝医论), that such talk was beneficial to research on medical theories, as in the following words: “Only by studying the essence and the rules of these metaphysical ideas, and testing their scholarly origin through ‘pure talk’ by day and lecturing by night can one begin to learn. At the very beginning, one might have been defeated by a waste of ideas and get carried away by flattery, but in the end one could transform into a master and write books through one’s own efforts and, with time passing, could be truly called a Real Master with an abundant knowledge.

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Even after that, we still need to talk a lot more and probe more and more into analyzing and researching this stuff — sometimes without even eating or sleeping, and yet still be dissatisfied with ourselves…” In short, medicine prospered during the age of the Wei, Jin, Southern and Northern Dynasties, while at the same time the discussion on “dark metaphysics” also helped all life flourish.

74. The Prevailing Fashion of Taking Medicines such as Wushi San The fashion of taking special kinds of medicines such as Wushi San was in vogue for a while during the Wei and Jin Dynasties. It was also influenced by a combination of the views of seeking ease and enjoying life, and those of pursuing longevity — as discussed previously. Essentially, the practice of taking medicines such as Wushi San had quite a lot of “dark metaphysics” in it. Making and taking dan (an “elixir”) and some special medicines, as a way of prolonging your life, have a long history and can be dated back to the occultists and Taoists who tried to refine every kind of substance in order to get to the pills of immortality. Taking special medicines included taking “powdered stone”, just as “taking stone powders” (服石 fushi) was synonymous with taking medicines (服食, fushi). In fact, the fashion of taking stone powders during the Wei and Jin periods was much related to an outlook on life of enjoying happiness and ease. It was said in A New Account of the Tales of the World – Speeches (世说新语·言语篇) that “He Pingshu said, ‘taking Five Minerals Powder (五石散 wushi san) was not only simply for treating disease, but also for making the spirit more optimistic and energetic.’” Here, “the spirit more optimistic and energetic” is far more than a “merriness of the mind” — more like the feeling of “ethereal lightness” roused after taking opium, or heroin in present society. It was noted in the above book that “Prime minister Qin Chengzu, when speaking about ‘Hanshi San’12 said that ‘the prescription for Hanshi San, though originating in the Han Dynasty, was adopted rarely and was hardly ever passed down. Its popularity began with He Yan, minister of the Wei Dynasty, who first ever tasted its magical effect and thus spread the news of it to the world. Thereafter many further sought it out and consumed it.’” These words 12

 Hanshi San 寒食散 or “taking powders cold”, i.e. wushi san 五石散 or “Five Minerals Powder”.

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reveal that its prescription had almost been lost. So how was it that He Yan received its magic effect and spread it on to the world? Take a look at what Huangfu Mi says: “Five Minerals Powder medicine was unknown to the world. Some said it came from Hua Tuo, and others from Zhongjing. By a making textual check into the facts, we know that Hua Tuo paid special attention to the minutest details and also liked making frugal prescriptions with single ingredients. Zhongjing, judging by his Hou’s Black Powder and Amethyst Prescription liked to use several herbs in one prescription. This is probably what happened with the stone powders or herbs taken cold. So, it was made by Zhongjing and not Hua Tuo. Furthermore, in Hua Tuo’s treatments, he usually inspected the belly to see the symptoms of the internal organs and sometimes even ‘washed out’ the organs — so prescriptions were not the only method he relied on, to treat patients. As for Zhongjing, although his proficiency might be inferior to Hua Tuo, he was also excellent in testing and identifying symptoms, and his choice of the proper use of herbs and stone medicines for treatment was supreme, superior to all other physicians. Undoubtedly treatment using Hanshi powder was hard to be control and it made doctors’ lives difficult. He Yan was a minister, who had himself indulged in sexual pleasures. He was the first of these times to take this powder and after taking it, he became clear-minded and strong-bodied. The whole capital was thrilled and passed on the recipe one to another. Those who had suffered from disease a long time, recovered within a short while. Those ‘country cousins’ enjoyed shortterm benefits from it, and did not have any future trouble. After He Yan died, more and more people took his powder and no one wanted to stop at that time, myself included.”13 What Huangfu Mi has said shows that it might be probable that the prescription of Five-Minerals Powder taken cold was originally created by Zhongjing to cure disease, but He Yan, by accident, took it and became “clear-minded and strong-bodied” which was useful for his enjoyment of sensual pleasures, i.e. the strengthening of sexual potency. Sun Simiao in his Qianjin Yao Fang (千金要方) said, “Some people are greedy, taking Five Minerals Powder for bedroom pleasures.” Chao’s Analyses of the Causes of all Diseases (巢氏病源) also said that “A person, who has had a stroke, can have a hard penis which never atrophies, and seminal fluid which ejaculates and flows out incessantly. This is because taking Five Minerals Powder since early youth the powder’s heat affects the kidneys but it causes deficiency of 13

 From General Treatise on the Causes and Symptoms of all Diseases (诸病源候论), Roll 6.

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the xiajiao (lower warmer).” Thus, Su Shi in his Dongpo Zhilin (东坡志林) said, “The fact that some eat stalactites and take aconite and meanwhile indulge themselves in wine and sexual activities for a longer life in this world originates from He Yan. And it really is no wonder that Yan, who was young and rich, took this hanshi (‘cold food’) powder to meet his lustful desires.” The above explains how the idea of taking stone powders was like “fire requiring oil”. Surrounded by the fashion of the times, which meant enjoying all life, the practice spread wildly — just as when you add oil to fire. Yet the Five-Minerals Powder was not simply an aphrodisiac: It could make the body stronger and prolong life as well. Qin Chenzu once said, “The Hanshi medicines are truly the best quintessential prescriptions to put in first place, before any others. Although they cannot make your body mount the clouds, put your head in a whirl, or train the muscles and alter the marrow, they can be assistant to living and have no equal in helping people keep healthy and prolonging their lives.”14 Also in the Qianjin Yifang (千金翼方), it is written, “The Five Minerals Powder for protecting life, if taken a long time, can vigourize the taker’s body, make it stronger and prolong his life.” The monk Shi Huiyi held the same opinion: “The Five Minerals Powder, one of the top class of medicines, can preserve health and prolong life by harmonizing the spirit and potency, that is besides curing disease.”15 The function of this powder was justified by the personal experience of Ji Han, a naturalist, who wrote Vegetation in the South (南方草木状), recorded in his Ode to Hanshi Powder (寒食散赋): “When in my later years, I had a child who was really sick — at only ten months old — vomiting and with diarrhea all day, and feebly on the verge of death, I was determined to give him Hanshi Powder. It then restored him to health within a month. How deep my sorrow was for my baby, only an infant and so ill. I had sought every treatment, formal or unorthodox, and tried every way hoping to protect him. The baby grew slowly better and stronger, day by day. With nobody to consult, we ventured to partly use this Hanshi Powder, which did not hinder the old medicines. There was a magical achievement, it really worked and saved my baby from dying, restoring its vigor and vitality.” These above descriptions truly show the undeniable effects of FiveMinerals Powder, and how it can function to cure disease, prolong life, strengthen the body and help in sexual intercourse. If this was not the case, its popularity at that time would have been groundless. 14

 From Ishinpo (医心方), Roll 19.  From Ishinpo (医心方).

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Yet, in my own opinion, it is probably untrue that Five-Minerals Powder was created by Zhongjing; probably it was some mineral powder or golden elixir made by the ancient Occultists. It is likely that the book Shishne (石神, Essence of Minerals) started the use of stone powder medicine for treating disease. Chunyu Yi mentioned this book, which he gained from Yangqing during his study. The Huangdi Neijing (内经) records, “Emperor Huangdi asked, ‘You tell me repeatedly that sorghum, herbs and mineral powders cannot be used for diseases like heat disorder and middle-consumptive thirst because both mineral powders and herbs can cause insanity. Those who suffer from heat disorder and middle-consumptive thirst are usually rich people who dislike to be forbidden sorghum; while with the ban on herbs and mineral powders the illness cannot really be cured. I want this explained in detail.’ Qibo answered, ‘Herbs are wonderful and mineral powders are fierce. Both are too strong and sharp to be used except by Dr Yihuan and Dr Yihe whose skill in mind is very good.’”16 Wang Bing annotates, “Mineral powders are stalactites and quartz.” So we can know that there were also known to have been a few cases of disease caused by taking mineral powders in the pre-Han Dynasty. It was recorded in Prescriptions of Xiaopin (小品方) that “Hua Tuo used Qini Tang (soup of Qini — Adenophora trachelioides) to detoxify medicines for those who, perhaps for 10 or 30 years, had suffered from fever or thirst, dryness with cold, and who wanted to drink liquid and eat, or else not. Hua Tuo wanted to use this formula to scatter the heat. Heat is often wrongly created by taking sulfur stone. Then cooling and washing them for the heat, using water, makes them worse. Some serious cases can even rend the body. The heat caused by taking alum stone causes them to tremble because of its dry heat; or they have taken amethyst which causes impotence in bed, with no energy to stand; or often they desire cold. All these symptoms are caused by the subdued qi and disharmony in the internal organs and thus is best to be treated with soup…” The evidence suggests that Hua Tuo had found a way to detoxify Five-Minerals Powder. The chapter “On the Gains and Losses of Taking Medicines” in his Zhongzangjing (中藏经) states that “suffering gain or loss after taking minerals or gold depends solely on its appropriateness or not.” This together with other examples well proves that occultists at that time were used to taking minerals and medicines containing gold, which sometimes brought about bad results and thus needed detoxifying. Later the herbalist 16

 From Su Wen – On Belly (素问·腹中论).

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Zhongjing used Hua Tuo’s prescriptions to deal with Cold Damage and several other diseases. According to research made by Yu Jiaxi,17 in his Textual Research on Five Minerals Powder, the five minerals are red halloysite, kaolinite, purple gedanite, stalactite and sulfur, among which the last two can be replaced by gypsum rubrum and talcum. All these are put together with dry ginger, cinnamon twig, ledebouriella, trichosanthes, ovate atractylodes, ginseng, radix platycodi, asarum, and aconite in different quantities. This might constitute the prescription made by Zhongjing after he met with Wang Zhongxuan, who told him “You are ill and at the age of forty, your eyebrows will completely fall out unless you take the decoction made of Five Minerals Powder”; again these minerals might comprise the main body of “the Hanshi prescription of violet quartz amethyst-powder used to cure cold damage illness and prevent relapse” recorded in Volume II “On Prescriptions for Miscellaneous Diseases” in the Synopsis of Golden Chamber (金匮要略). This prescription is said by Huangfu Mi to be that prescription of violet quartz amethyst recorded in the classic by Zhongjing. Recorded in the classical prescription books put together by Zhongjing, there is another power named “Hou’s Black Powder” which contains only one mineral — alum — while the rest contain some fourteen herbs including chrysanthemum, Sichuan lovage rhizome, etc. This prescription was said to be used “to cure those who suffer from severe leprosy, feeling cold and weak inside.” Yet this prescription, according to Yu Jiaxi, is a combination of the above two prescriptions by He Yan, who only adopted five minerals out of them all. However, it might be that He Yan got his prescription from the occultists. Shennong’s Herbal Classic (神农本草经) classes purple quartz, white quartz, stalactites and five-colour gedanites (i.e. of the colours blue, red, yellow, white and black) as superior types of medicine “which mainly function to prolong our lives, which correspond to heaven and contain no toxins; and which can be taken either more often or for prolonged periods of time without any harm, and can also benefit health and prolong life”, while sulfur was categorized in the middle class of medicines “which mainly function by cultivating the nature of people, and the appropriate adoption of which will bring about no or little toxicity, and can cure disease and make people strong”. Therefore, both these types belong to tonics — which help in keeping people healthy and curing disease. When Yu decided to replace the white quartz and violet amethyst with white and purple gedanite, 17

 Yu Jiaxi, A Study on Five Minerals Powder (寒食散考), Collections of Studies by Yu Jiaxi (余嘉锡论学杂著), Zhonghua Book Company, 1963, p. 181.

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he was really making it up. It must have been quite popular among occultists at that time to take these five minerals — as a way of becoming immortal. Yet He Yan was by no means an occultist and he might have found the prescription for Five-Minerals Powder truly by accident. So it is really an oversight on Yu’s part, who held his view solely based on what Huangfu Mi had said. The truth is there was no sulfur at all in Zhongjing’s Violet Quartz Hanshi San prescription — it contained mostly cold or cooling materials such as rhubarb, dragon bone (mastoid ossis fossilia), gypsum, glauberite, talcum, etc. to restrict the heat of the other four minerals. Therefore, it is wrong to blame the drawbacks of Five-Minerals Powder on Zhongjing. In Sun Simiao’s Qianjin Yifang (千金翼方) there is a Hanshi Wushi San prescription: violet quartz, white quartz, halloysite, stalactite, sulfur and alum. The Five-Minerals Powder which He Yan used for himself could perhaps trigger toxic and other side effects if there were no restrictive medicines to match it with — or if it were taken without a method of detoxifying. In the Qianjin Yaofang (千金要方), Su Simiao comments on the prescription for “detoxifying Five Minerals Powder”: “The prescription for the Hanshi Five Minerals Powder was said to be found nowhere in the ancient sages but used by Lord He during the late Han. Especially since the time of Huangfu Mi, those who took the powder would without exception get sores on their back, their bodies fall apart and in the end they would fall down. I have seen with my own eyes, since growing up, the frightful results of many officials taking it — people who said they would rather eat pueraria poison than take the Five Minerals. People should be fully aware of its violent toxicity and be cautious. Wise people would set fire to such a prescription, immediately on getting it.” Huangfu Mi himself said, “More and more people took this powder and refused to stop, at that time, including myself. Although violent effects were not common it could take a man’s life. One of my cousins, named Changhu, suffered from atrophy of the tongue and his tongue almost shrunk back into his throat; Wang Liangfu of Donghai country suffered from ulcerative carbuncles on his back; Xin Changxu in western Gansu Province suffered ulceration of his back muscles; Zhao Gonglie in Shu County of Sichuan lost six of his cousins to it. All these sufferings were caused by taking Hanshi San. Among these, some were quite elderly and some still young, only 5–6 years old. Though I have seen this and sighed at it, I am just like a single drowning man, laughing at those drowning. Yet patients will not take a warning from this, and stop themselves. Many therefore come to consult me.”18 The fact that Five-Minerals Powder involves 18

 Quoted by General Treatise on the Causes and Symptoms of all Diseases (诸病源候论).

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toxic side effects and even causes death is probably due to the internal heat becoming suppressed within — and then breaking into ulcerative carbuncles. Yet people could not regulate and control themselves when taking it, judging from the words of Huangfu Mi. Five-Minerals Powder, also called Hanshi San (Cold Food Powder), was certainly connected with ideas of “cold”. The heat which came after taking it was probably a regular medical reaction. Again from Sun Simiao, “Five Minerals Powder was originally named Cold Food Powder, because it had to be taken with something cold, and the body washed with cold water. You must always take something cold with it, only wine can be drunk warm and clear. Otherwise the taker will suffer from all kinds of diseases. Taking something cold with the powder deals with the heat caused by it.”19 Sun Simiao said, “All the breaking out of symptoms caused by these minerals such as an aversion to the cold, a headache, and the tightening chest, sometimes quite regularly, are like those of malaria. On such occasions, it is the best to have a shower with cold water, this can stop them. Everything the patient takes must be cold except the wine, which must be warmed.”20 Xu Xiaochong during the Tang Dynasty made his comments too: “All Cold Food Powders and Mineral Powders contain heat and can make those who take them hot, when they break out. Therefore, what they eat must be cold to neutralize it. Thus it is called Cold Food Powder.”21 Huangfu Mi proposed using the powder with due action to restraint the heat. He was aided by walking when he felt its efforts, as he says in the following words: “After taking the powder, labour must be done. If the patient is too weak to walk by himself, he must be supported by someone else to walk. What’s more, he should be clothed lightly to feel the cold, drink something cold, be fed cold food and be bedded cold. The more cold, the better… If the medicine he takes in cannot break out it will make the taker tremble; the diet should be included some warmed wine and the patient needs to get up and move around as in active exercise…” With all these caveats, Cold Food Powder can be used in treatment. For example, “when a pregnant woman catches cold and suffers from serious pain in her body, and she cannot be moved because of her condition, taking a dose of Cold Food Powder in warm wine and having a cold bath can do her good. After this, if she feels numbness somewhere on her body, the area should be washed with cold water, If she feels cold, drink some doses of 19

 From Qianjin Yifang (千金翼方), Roll 22.  From Qianjin Yaofang (千金要方), Roll 24. 21  Quoted by Ishinpo (医心方). 20

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wine…”22 Judging from these results, we should not underestimate the toxic side effects of Five-Minerals Powder, but neither should we be scared and regard it a scourge. If this were the case, celebrities would not have followed the fashion of taking it and making it such a great pleasure in their life. The behaviour of first taking the powder and then walking up and down to disperse the heat of the drug became a fashion of the times. The celebrities of the Wei and Jin Dynasties “walked up and down to let the heat of the mineral powder disperse”. This meant they had to wear wide and roomy garments which added to their natural and unrestrained behaviour, leaving their bodies uncovered — which was said to be quite unconventional and showed a free spirit — or else they drank warm wine and became drunk, as did the two Ruans and their fellows.23 So the fashion of the Wei and Jin dynasties not only displayed a free spirit but was also related to the medical action of the drug. On the one hand, they could get the drug to work; on the other hand, it justified their extravagant behaviour. It was really killing two birds with one stone. Thus, whether in court or cabin, everybody was glad to take it. For instance, see the description in the Liangshu – A Biography of Celebrities of the Time (梁书·处士传): “Zhang Xiaoxiu, also named Wenyi, came from Wan in Nanyang County. He was quite frank in nature and do not like a showy or luxurious life-style, often wearing a hat made of husk-tree bark and cattail shoes, carrying a zhuwei (horsetail whisk)24 wrapped in palm leather in one hand. He was often taking Cold Food Powder and could lie on a bare stone in the cold winter.” Also in Weishu – A Biography of Xing Luan (魏书·邢峦传), it was recorded that “The Gaozu Emperor, during his walk for dispersing the heat of the drug, saw Luan’s house in the southern part of Sikong Estate and sent a man to tell Luan ‘today in my walk for the drug to work, I stopped by your house. What a fantastic feeling this site has — Gazing East De Mansion.’”25 So we see the Emperor also took the powder and walked to control its symptoms. It has to be admitted that taking this mineral powder damages those who take it, especially those who are weak in self-control or not fit for such medicine. What’s more, the bad effects appear gradually and apparently later, and not instantly. It was a case of inappropriate behaviour when 22

 Quoted by Chao’s Causes and Symptoms of Diseases (巢氏病源).  The two Ruans here refer to Ruan Ji and his niece Ruan Xian, both placed among the renowned “Seven Sages of the Bamboo Grove (竹林七贤)” during the Jin Dynasty. 24  Something like a decorative fan, for the celebrities of the Wei and Jin dynasties to hold in hand as a sign of status. 25  Possibly a beautiful site in the Southern and Northern Dynasties (420–589 CE). 23

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Huangfu Mi took Five-Minerals Powder for his disease but could not accompany it by walking out to let the heat disperse — he was unable to. Others whose diseases became worse, suffered ulcerations, or even sudden death are recorded in the books. Take the words of Yu Jiaxi for example: “Yu Lichu previously compared Cold Food Powder to opium, but in fact the diseases related to it are more than those for opium. When taking opium, the sufferers become addicted to it, fall ill if they stop taking it and then recover if they continue. While with Cold Food Powder, a few doses are enough to cure any disease… It is a pity that during the Six Dynasties plenty of people fell ill or died because of this powder!”26 So in short, there are three clear points to be made about taking these mineral powders. First, taking mineral powders was quite distinct from the art of pursuing immortality, for one reason — there were fewer deaths through taking mineral powders than there were through taking Golden dan. Huangfu Mi said that he had seen with his own eyes and heard with his own ears nine people who suffered ulcerations or died. This number could not be said to be small, but neither is it large — it is really taking it too far for Yu Jiaxi to build his reckoning on this one fact. It is obvious he was exaggerating and wrong when he said “there were tens of millions of deaths caused by taking mineral powders over five-hundred years”. Judging from the material there “were only fifty or so cases found in searching the books from the Three Kingdoms down to the dynasties of the Zhou and Sui”: five deaths and 18 diseases caused by taking powders, 26 cases mentioned due to the powder’s effects or no damage done, and in several other cases, the effects were not mentioned at all. If taking them was a terribly bad thing, there must have been many more records in the historical material; also cases of deaths and diseases must have been a majority in the records, while there are only five cases of death mentioned. Second, the cause of the death or disease was usually related to ignorance of the restrictions on taking powders, according to the historical material. There were far fewer deaths and diseases caused by taking powders after Huangfu Mi wrote his “On Cold Food Powder” essay, explaining how to take control of its effects and the way to help it work — together with his Six Taboos, Six Musts, Eight Don’ts and Three Insurances. In addition Excerpts of Prescriptions of Xiaopin (小品方) held the view that “Any bad effect caused by taking powders is because of going against the restriction on its use, but they shift responsibility and say it is the fault of the powder 26

 Quoted in Chao’s Causes and Symptoms of Diseases (巢氏病源).

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itself. A thorough understanding of this will bring about an appropriate reaction.” There were also ways of treating the poisonous effects among those who took powders. Take Xu Sibo for example: “General Fang Boyu had taken tens doses of Five Minerals Powder but with no effect. He became more and more averse to cold and even wore lots of clothes during summer days. After making a diagnosis, Dr Xu Sibo said, ‘You have suffered from hidden heat inside you a long time and must let it out, by being ‘watered’ in the winter months’. In November when it was snowing heavily, two men sat Boyu, unclothed, on a stone and watered him over his head. After twenty dou (斛, ca 2.2 gals) watering, Boyu could not utter a sound and gasped for breath. The family asked them to stop, in tears, but Sibo sent men to keep them away, with sticks in their hands. Anyone who tried to make a plea for him was struck down. After another hundred dou of water, Boyu began to move and some qi swelled up out on his back. After a while, he sat up and said, ‘I am so unbearably hot. Please give me some cold water to drink.’ Sibo gave him some water and he drank a full liter immediately. After that his disease was cured. Since then, he often felt warm and wore only thin clothes in winter days, and had a stronger and fatter body.”27 Thus, a renowned physician was created. There were other physicians who became famous for adopting the Five-Minerals Powder like Xu Wenbo, Cao Xi, Jin Shao, Fan Qu, the Buddhist Daohong, the Buddhist Huiyi and so on. Cao Xi proposed “warm therapy”, contrary to the cold therapy of Huangfu Mi, which became a source of dispute between the two groups. Chen Yanzhi in his Excerpts of Prescriptions of Xiaolin (小品方) criticized warm therapy, as cold therapy was winning in the competition. Daohong created an antidote in his Antidote Formulae for Cold Food Powder (寒食 散对治方) to neutralize the toxic minerals in the powder by using other corresponding medicines. For example, he used ovate atractylodes rhizome and trichosanthes to cope with stalactite, and this was also recorded in Excerpts of Prescriptions of Xiaopin (小品方) — which added that this remedy could not be used in emergencies. The doctor Xu Zhicai must have been inspired by Daohong when he wrote his Double-drugs Compatibility (药对), which is unavailable today. Also, Sun Simiao adopted these methods. All the above prove that taking powders pioneered traditional Chinese medical research, its theory of pharmacology and applications. The use of “doubled-updrugs” as antidotes is still advocated by the well-known modern physician Shi Jinmo today. As for Sun Simiao, with his collections of in all 45 ways of detoxifying Cold Food Powder (when dealing with ulcerations and the like), 27

 From History of Southern Dynasties-Biography of Zhang Rong (南史·张融传).

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he not only created many detoxifying techniques but also tremendously promoted the development of surgery for ulcerations. Later it was recorded in the History of the Five Dynasties – Biography of Duan Shen (旧五代史·段深传) that in the years of Kaiping (907–960 CE), Duan was appointed to the position of Hanlin for his excellence in medicines. After being ill for a long time, the First Emperor in the Song Dynasty asked him, “My disease has broken out more and more frequently, so much so that herbs cannot deal with it. I am thinking about using mineral powder, used by so many people and effects. What do you think of it?” Duan was deeply convinced that he must not take it and said, “It was said in the Biography of Lord Taicang (太仓公传) that mineral powder cannot be used for those who hold heat inside and have trouble passing urine. For mineral powder is too fierce and tough with a strong toxicity. Any toxic medicine should only be used by a soldier in an emergency, when it is absolutely necessary. Do not take it, unless you are critically ill.” The Emperor took his advice. This also shows that physicians were fully aware of the indications and restrictions on taking mineral powders for the treatment of disease. Third, there was more than one prescription for Cold Food Powder or Five-Minerals Powder. In fact, some prescriptions contained strong toxins such as Five-Mineral Rebirth Powder; some can be taken by ordinary people such as a “single dose of stalactites”. Sun Simiao once said, “I took five or six liang (50g) of stalactites when I was aged thirty eight. Thereafter I understood the powder clearly.” He also said, “People who don’t take mineral powder will meet with misfortune whatever they do. They will suffer ulcerations, scabies, tinea, plagues, malarias and abdominal masses every year. They will worry over eating and sleeping, and neither will they succeed if they build a house. Not only will they themselves suffer ill health, but also their sons will have trouble growing up and producing offspring. Only when they take mineral powder, will everything go smoothly. So a man must take mineral powder.”28 In later times, researchers really became confused about Sun Simiao’s “paradox” — his opposition to and recommendation for powders. Yet as a matter of fact, what Sun was opposing was something like Five-Mineral Rebirth Powder (although it was still listed in his book as dealing with specific diseases). It is probable that Sun Simiao proposed taking stalactites later when they became a major ingredient of mineral powders. The Collection of Liu Zongyuan (柳宗元集) mentioned that “The best local stalactites in Lianzhou have all been gath28

 From Qianjin Yaofang (千金要方).

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ered.” There was one herbal apparatus, the “stalactite bowl” — used to grind stalactites into powder during the Tang and Song dynasties — and today such an apparatus is still in use with its original name. It was obvious that stalactites were easy to gather and because of their low price became quite popular with the people. Wang Tao, too, proposed taking mineral powder in his Medical Secrets of an Official (外台秘要). He rearranged the prescriptions for powders to aid in detoxifying them by “deleting something old and rewriting something new, and compiling two volumes which were so precious that they can passed down through the ages and enlighten later generations, so they have clear knowledge about their usage.” So it is clear that prescriptions for the powders were always in development and there were many believers. All in all, taking cold food or mineral powders had both positive and negative effects upon the development of social medicine, and we cannot only take one view about it.

B. The Prospering of the Medicine During the Wei and Jin Dynasties 75. Huangfu Mi and The Classic ABC of Acupuncture and Moxibustion (针灸甲乙经) Huangfu Mi gained fame in acupuncture and moxibustion and is named by some the “father of acupuncture” today. Yet during the Western Jin Dynasty (265–316), he was considered more a celebrity than a medical scientist. Zuo Si29 once composed an Ode to the Three Capitals (三都赋) before he rose to fame. But he was laughed at by Lu Ji, the great writer and celebrity, who arrived at Luo Yang and heard Zuo Si was composing an ode. His letter to Lu Yun, his younger brother, said, “One vulgar man here is audaciously trying to compose an Ode to the Three Capitals. Even if he finishes it, it will be valueless, I will take it to cover my wine urn with!” His comment meant that what Zuo Si had composed must have seemed vulgar. Later when Zuo Si finished his Ode, “none in the whole world placed any value to it. Zuo Si himself knew Huangfu Mi enjoyed high prestige, so Zuo visited him and showed him the Ode. Huangfu praised it highly and wrote a foreword for Zuo.”30 “Since then, Zuo’s ode became greatly esteemed… All the wealthy 29

 Zuo Si (250–305), also named Zuo Taichong, famous litterateur in the Western Jin Dynasty. 30  From Zang Rongxu’s Book of Jin (臧荣绪晋书).

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and powerful families raced to transcribe his works — so much so, that they caused a lack of paper in Luoyang and it became quite rare and expensive.”31 But what if Huangfu Mi had been famous not for his literary achievements, but for his knowledge of medicine? The foreword he wrote would perhaps not have drawn such tremendous attention. It ever stirred up a story about the “expensive paper of Luoyang”. It can be proved by historical analysis that Huangfu Mi was a greatly erudite scholar who composed wonderful works, such as the Age of Kings (帝王世纪), a Biography of a Prestigious Scholar (高士传), the Biography of Hermits (逸世传), Biographies of Exemplary Women (列女传), Xuan Yan’s Spring and Autumn Annals (玄晏 春秋) and so on, all of which built him up as a talented figure who possessed great learning and created brilliant works. What’s more, in the field of medicine, he also wrote On Cold Food Powder (寒食散论) and The Classic ABC of Acupuncture and Moxibustion in twelve volumes. However, this was only during the latter part of his life, and was quite like comparing an ant to an elephant when considering his great works of literature. Huangfu Mi (215–282 CE), named Jing when young, had another name Shi’an and also assumed the name Master Xuanyan (“the dark metaphysical and quiet master”). He was born in Zhunuo, Anding, today Zhunuo County in Lingtai, Gansu Province. Though being the great-grandson of Huangfu Song, a taiwei32 during the Han Dynasty, he was born into a family reduced to poverty. Adopted by his uncle, he then moved to Xin’an (today Mianchi County in Henan Province) and did not return to his own family seat until he was 40 years old. He was naughty and mischievous during childhood and often learned from army ruffians, by stealing melons and not loving to study or engage in honest work. He remained a spendthrift until his aunt with tears in her eyes exhorted him to work harder, when he returned as a prodigal son, at 17 years old, and then began to labour and study hard. Afterwards he studied under Xi Tan and gained a good mastery of the various classics. Simultaneously his personality changed into a quiet person, determined to cherish high ideals and do something grand. Hence, he got the name “book addict”. However, he unfortunately suffered quite a miserable existence. According to research by Yu Jiaxi,33 he “was badly ill at the age of 35”. It was a “wind impediment” and he himself said that “the long suffering of this serious disease caused half my body to become numb and it 31

 From Jinshu – Biography of Zuo Si (晋书·左思传).  Taiwei was a supreme government official in charge of military affairs during the Qin and Han Dynasties. 33  See Yu Jaixi’s work above. 32

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was difficult to move, as my right foot was smaller.”34 It must have been some type of hemiplegia, possibly caused by a stroke. At the age of 47, in order to deal with this disease, he took Cold Food Powder but ended up with a more tragic result: “I took Cold Food Powder without the appropriate instruction and — not paying attention to the right restrictions — was poisoned instead of benefiting from it… while I was feeling very hot in the cold winter, I had to go naked and ate ice; while in the hot summer, I was irritated by the heat and suffered from choking coughs, or was afflicted by malaria, or something like a typhoid fever. My body swelled up and my limbs felt heavy and ached. I was in such dire straits I could only moan and shout for help. My father and brothers saw this and left; my wife sighed and got ready to say goodbye to me.” “Exhausted by the disease, I was so depressed I once tried to kill myself with a sword and only stopped at my aunt’s pleading.”35 Holding on to the last, Huangfu later adopted the prescription of “Three Yellow Herbs” from his brother Shiyuan and began to take a turn for the better. Therefore, it must be correct for Yu Jiaxi to say that On Cold Food Powder (寒食散论) was composed in the fourth year of Xian’ning (278 CE). Huangfu Mi said in this work, “It is not because of my talent (of medicine), only because I have fallen ill several times and gained experience. A physician is not born with any special knowledge, he needs to acquire it through experiment.” So it seems that he did know how to detoxify the Cold Food Powder and was proud of it too. Yet this was only four years before his death. He died finally at the age of 68. In the third year of Taishi (267 CE) during the Wu Emperor’s reign in the Jin Dynasty, Huangfu Mi, at the age of 53, “was repeatedly pressed by the Emperor” to receive an appointment at the court, but he “refused to be an official and was determined to study and write books”, as he writes in his On Staying in Nature (元守论). He had written to the Emperor that “because of my illness, I have to give up an overcautious life in official circles and join those rambling in the wild timberland.”36 These words were not just an excuse; they actually did reflect his style as a celebrity. Such things happened several times and finally “he proposed to borrow some books from the Emperor and the Emperor agreed and delivered a full carriage of books to him, and he read inexhaustibly, despite his weak and frail condition.” It was during the years of Ganlu (256–260 CE) that Huangfu Mi had written his Classical ABC of Acupuncture and Moxibustion (针灸甲 34

 From Jinshu-Biography of Huangfu Mi (晋书·皇甫谧传).  From the Benzhuan (本传). 36  In ancient China, officials would comb their long hair with a hairpin in the court. Here, “with loose hair” means not serving at court. 35

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乙经) for which he wrote his own foreword. He described it thus: “In the years of Ganlu, I was sick and had many attacks of ‘wind-stroke’ and almost became deaf. It was a hundred days before I finally found the appropriate medicine from numerous prescriptions all of which were simple and easy to use. Then I gathered together and collated the ‘three sections’, in order to categorize my ideas into some sort of order through deleting repetitive and surplus words, and compiling the best into twelve rolls.” The “three sections” mentioned here were the three earlier books: the Classic of Acupuncture (针经) (i.e. the Miraculous Pivot (灵枢)), Suwen (素问) and Major Acupuncture Treatment on the Mingtang Acupoints (明堂 孔穴针灸治要). At this time, he was between the ages of 42 and 47 and had not yet tried Cold Food Powder. There might perhaps be some common ground between this book and his treatise On Cold Food Powder (寒食散论). It seems extremely likely as a patient who suffered from stroke sequela that he had tried acupuncture, but perhaps only had some slight improvement or it had stopped him getting worse. After so many trials, the cramps and his confined condition probably forced him to try Cold Food Powder — which eventually resulted in his life going down its tragic path. The Classic ABC of Acupuncture and Moxibustion (针灸甲乙经) was a milestone in the history of acupuncture and it made an indelible contribution to the art. Yet it was not produced by a clinical master, but by a great and erudite scholar. However, it is quite common in Chinese traditional medical history that progress draws in some force from outside its medical culture. There is nothing strange in this.

76. On Material Things (物理论), The Theory of Spiritual Perishability (神灭论) and Views on Life and Death The liberation of thought during the Wei and Jin dynasties boosted much discussion and disputation in metaphysical philosophy, among which the “natural view of primordial qi” put forward by Wang Chong (27–97? CE) and others was absorbed, and even expanded on, by the philosophers of the Jin and Liang dynasties (ca 265–557). Among those scholars who touched upon a medical view of life and death, the most notable were Yang Quan and Fan Zhen. Yang Quan (杨泉) was from Wu State and lived during the Three Kingdoms Period. Though being appointed a shizhong37 when the Jin Dynasty arrived, he turned the post down and remained a hermit the whole of his life. The dates of his birth and death are unknown. On Material Things (物理论), 37

 Shizhong was an official post of Privy Counselor in ancient China.

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the book he wrote, discussed every aspect of the world, including astronomy, geography, technology, agriculture, medicine and so on. The complete work was already lost by the Song Dynasty. Some remaining parts on “primordial qi and life” state the following: The primordial qi is very grand — it may be named the Grand Heaven. The Grand Heaven is namely the primordial qi itself. Grand means grand and that is all, nothing else. Man keeps in qi and is alive, his vigor ends and he dies. To die means to perish, which is to totally disappear. The same goes for fire which dies without firewood to keep it going, it then dims its light. Just like nothing is left burning after a fire dies out, there is no spirit left after a man dies. The more wit and wisdom, the more they deplete vigor and blood, like oil to a candle-light — which is brighter when it has a thicker wick, consuming more oil. If the wick is thin, the light will be dim and consume less oil. Therefore, less consumption insures longevity. If the qi derived from food taken into one’s stomach is more than the primordial qi, a man will be fat and not live long; contrariwise, if the primordial qi is more than the qi in taken from food, the man will be thin and share a long life. The art of keeping healthy commonly lies in lessening the qi we acquire from food, then all diseases could be avoided. Yang Quan was aware of the old saying “to be old and thin is difficult for the rich”. He used the candle’s light and its relation to the source of oil to explain the relationship between man’s body and function, his physique and spirit, which was quite unprecedented. Yet what he thought medically was identical to what had been said in the Neijing (内经). He pictured blood and qi as the “inner essentials” — with our life phenomenon seen as a flame. Therefore, man dies without vigour, and will disappear with nothing left, which means there are no such things as ghosts. His view was the same as that of Ruan Zhan and Ruan Xiu, another two philosophers of the “idle talk” school, who lived during the Jin Dynasty. According to the Jinshu – Biographies of Ruan Zhan and Ruan Xiu (晋书·阮瞻阮修传), “Ruan Zhan believed in the ‘no-ghost’ view and nothing could dissuade him. He always said that this view was enough itself to distinguish dark or light.” “Those who debated about whether there were ghosts or not, all

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believed a person turned into a ghost after he died. Only Xiu believed in no ghosts. He said, ‘now I hear of people, who have seen ghosts, saying that the ghosts wear what they used to wear when alive. If man becomes a ghost after he dies, will the clothes become ghosts too?’ All who were arguing agreed with him. Later when he wanted to cut down the ‘trees of She’38 he was stopped. Xiu said, ‘If the She spirit existed and then the trees were planted, the She spirit would move out if the trees were cut down; while if the trees were planted and then the She came in, it will disappear when the trees are cut down.’” His point was quite logical and advocated a “noghost” view which was identical to that of the philosopher Yang Quan. He Chengtian, who lived in the Song among the Southern Dynasties (370–447 CE), was an atheist too. His works like the Daxinglun (达性论), Baoyingwen (报应问) and so on carried on the views of Yang Quan in criticizing Buddhist ideas of samsara, karma and an “unceasing soul” — all of which were popular at that time. He said in his Daxinglun (达性论) that “The heavens are divided into Yin and Yang, the earth is useful for things soft and hard, while man stands up for benevolence and justice. Man cannot be born without heaven and earth, while heaven and earth cannot be spiritual without man. These three should be a trinity and supplement each another.” “As for the question of ‘life being doomed and the spirit disappearing with the body dying out — just like the changing course of the seasons, the prosperity of spring and decline of autumn — how can a body remain?’ Zong Bing made his answer in An Answer to He Hengyang (答何 衡阳书), “men’s bodies are so coarse, while the spirit magical. The body is in concord with the spirit. So how could they die simultaneously?” Then He replied in his Answer to Zong (答宗居士书): “the body and spirit both supplement each other. The ancients compared their relationship to that of fire and firewood. The fire becomes dim when the wood is in short supply; and the fire dies out when there is no wood. Even though the spirit is magical, how can it live alone without a body?” In such a fashion, Yang Quan’s views on life and death and his view of the body and spirit became amalgamated into a systematic approach. As for medicine, Yang Quan made another contribution not found in the edition of On Material Things (物理论) surviving today, but in the Collections of Ancient and Present Books – Medical Part (古今图书集成· 医部全录): 38

 In ancient China, the place where people worshipped the god of earth was called “She”, while where people usually planted trees was called the “trees of She”.

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Physicians are those who cannot be relied on unless they are benevolent and loving-hearted; and who cannot take the job unless they are intelligent and reasonable; who cannot be trusted unless they are honest and pure in nature. Therefore, the ancients chose physicians who were all descendents of those with prestigious names. Their virtues were benevolence, forbearance and a universal love for the people; their intelligence enabled them to solve awkward questions smoothly. They knew the order of heaven, earth and the gods; they had a grasp of the destiny of life, death, good and bad fortune. They could discriminate deficiency and sufficiency and fix the key-link in the turning times of adversity and steady progress. They acted according to the serious or light nature of the disease — to measure out each portion of each dose of medicine. Never ignoring how small or minute the difference might be, they understood all profundities. Such a practitioner may be called an excellent physician. What’s more, Taoists are keen on indifference — just as trees and grasses grow in the shade; however most physicians prefer the warm as it can help blood move smoothly through the vessels. But they only know the outline of things and not their meticulous features, and do not know the different scales of hardness and softness, and are unaware of the differences of lunar days and climate, whereas they regularly change forward and backward. Good physicians can know the features of a disease when they take the pulses on the cunkou at three depths. They are the people who can prescribe medicine either hot and cold according to the lunar days; who can diagnosis the conditions of disease with reference to the pulses; who can produce herbs and minerals in good compatibility. They have an excellent reputation and can be called ‘doctors of renown’. However, there are some physicians at the height of their fame who are no good at curing disease; and some unknown, who are really masters. The one who turns to physicians for help must investigate and make the appropriate judgment. Here, the discussion on the difference between famous physicians and good ones, and the advocating of a medical spirit which seeks truth and perfection, is all in concordance with the spirit reflected in his book On Material Things (物理论). Fan Zhen (范縝 450–515? CE) in the Liang Dynasty, was another famous atheist who came after Wang Chong, and was born into poverty. He was good at talking volubly and haranguing others, quite in the style of the

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metaphysical “idle talkers”. He once debated with Xiao Ziliang, Lord of Jingling during the Qi Dynasty on karma: “Formerly Zhen had served with Ziliang, Lord of Jingling in Qi State. Ziliang firmly believed in Buddhism, while Zhen was strong on the idea that ‘there is no Buddha at all’. Ziliang asked, ‘Since you do not believe in karma, how can you explain people getting wealthy or staying in poverty?’ Zhen answered, ‘Life is like the trees’ flowers which fall in the wind — some blowing beyond the curtain and falling on the beautiful carpet, and some into the cesspits beside the fence-walls. Those which fall on the carpet become people like your highness; while those which fall into the cesspit end up like me. Why does such a difference between a luxuriant or low-down existence have to come from anything like karma?” Ziliang could not answer and found the other’s views deeply disturbing. So Zhen decided to give further reasons by writing his Theory of Spiritual Perishability (神灭论).39 No sooner was this book published then “both court and commonalty were stirred into an uproar. Ziliang gathered Buddhists round him to argue with Zhen — but still they could not convince him.” Then Ziliang tempted him with a high official post with a salary to match, but Fan Zhen answered that he “would not sell his views for rank”, thus showing the moral integrity of such a celebrity. Right up to the third year of Tianjian (540 CE), during the Wu Emperor’s reign in the Liang Dynasty, when Buddhism was declared the official religion, the Emperor himself drew together Buddhists such as Fayun, Cao Siwen, the sheren40 of the East Crown Prince and influential officials like Xiao Chen, in all, 66 persons, to write 75 articles besieging Fan Zhen’s Theory Of Spiritual Perishability (神灭论). Yet unyielding as ever, Fan Zhen fought back arguing against Cao’s Against the Theory of Spiritual Perishability (难神灭论) and writing Answering Sheren Cao (答曹舍人), so as to refute him — and make Cao admit that he himself “could not take the edge off his argument”. In his Theory of Spiritual Perishability (神灭论), Fan Zhen first puts forward the point that “the spirit is the body and vice versa. Therefore, the spirit exists when the body does; while when the body disappears the spirit perishes.” “The body is the material substance of the spirit while the spirit is the body’s effect. So the body refers to the material substance of the spirit; while the spirit refers to the effect of the body. Neither can be severed from the other.” Then he takes the “blade and its sharpness” as metaphor: “The spirit to material substance is like sharpness to a blade; the body to the 39

 From the Liangshu – Biography of Fan Zhen (梁书·范缜传).  The Sheren was an official post in ancient China.

40

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effect is like the blade to its sharpness. The so-called sharpness is not the blade; while neither is the so-called blade the sharpness. Yet without sharpness, there is no blade; and without the blade, no sharpness. Never is there sharpness without a blade. Therefore how could there be spirit without a body?” Then he continued to analyse the differences between the substance of a tree and that of a man, their vicissitudes, their fruiting and firmness — in order to point out the basic dissimilarity between “the body of the living” and “the skeleton of the dead”. Only with a body can there be senses, which are the “essences of life”; while a skeleton has nothing of sense, it is simply a representation of death. Such a theory was much more profound than ever before. The opposition argued against him, asking “if the body is the spirit, are the hands and other parts of the body, the spirit too?” Logically, this was arguing by the “disguised replacement of concept”. Fan Zhen answered by saying that “all are different parts of the spirit”, and “the hands and other parts have sensations, but no worries about true or false”. “The judgment of true or false is determined by the heart.” By explaining the different functions of the senses, he continued to explain the function of thinking as being restricted to a specific sense — just as the function of seeing cannot be fulfilled by the ears. Thereafter, someone asked, “then can it be that the emotions of someone called Zhang are held within the body of someone called Wang, or the temperature of a Li is hidden in the body of a Zhao? Of course not!” Such a view of different senses having different functions is in concordance with the entirely clear relationship between medical physiology and anatomy. In the last analysis, Fan Zhen also explained sacrificial temples as actually being built to create an ordered and ethical society. This was also a good argument. In Answering Sheren Cao (答曹舍人), Fan Zhen explained the relationship between dreams, gods and bodies, and the difference between spiritual and physical disease, and cleared up the confusion about dreaming by asking “The sage said that he turned into a butterfly in his dream (here referring to Chuang Tzu’s Dreaming of being a Butterfly), but can it really be that he turned into a flying insect? If so, he would try to carry the shafts of a cart when dreaming of turning into an ox; or bend down and look to be mounted when dreaming of turning into a horse. And the next day, one should wake up a dead ox or dead horse.” He also pointed out that “man’s life is formed by the qi from heaven and the body from the earth; thus, when he dies, his body is to be buried under the ground and his qi goes upwards.” This shows that after death everything perishes and there is no transformation into ghosts or gods. He said “The attachments of the common people mean they

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usually value life rather than death; if the spirit still remains after death, so then their awe must linger on; while if the senses do not remain after death, it must be just a slight change.” “Confucius said, ‘If I said that there were still senses after death, filial sons would make light of their lives and allow themselves to be buried with the dead; while if I said there were no senses after death, undutiful sons would abandoned the dead and leave them unburied.’”41 Here, Fan was explaining the sacrificial rituals as practiced within the common understanding of the people. Fan Zhen raised both the concepts of life and death and atheism to new heights, much more thoroughly than Wang Chong did. The metaphysics of the Wei and Jin Dynasties, though mostly absurd, did not show any lack of penetrating thought and ideas. This probably created the fertile philosophical ground for the medicine of the time — which kept on moving forward, far beyond the field of ghosts and gods.

77. Medicine Prospers in the Wei, Jin, Southern and Northern Dynasties The time between the end of the Han and the beginning of Sui Dynasty may be described as a “time of turmoil” lasting some 400 years. During this period, the remnants of the classics of Confucianism were still extant; there were many disputes on whether Buddhism should be accepted or not, but it all resulted in Buddhism beginning to prosper. Meanwhile, Taoism stood up as a religion and started to gain a firm foothold, as the Taoists spent their time busily refining magical potions and pursuing immortality; it was during this same period that the metaphysical “idle talk” of the famous celebrities (referred to above) contributed to the distinguishing features of the era. At the same time, atheism spread with its theory of Primordial qi and Yin and Yang. In short, it was a time for a great liberation of thought, as various schools burgeoned in circumstances that could compete with or even surpass the Spring and Autumn or Warring States period, which itself had given birth to such a clutch of glorious scholars. It was a time which witnessed the fastest development of Chinese medicine, in all its long history. According to the statistics of the author, among the medical works written at this time, there were 170 writings and 1,548 volumes listed in the Suishu – Biography of Classics and Books (隋书·经籍志); this is excluding 41

 With reference to the words in Liu Xiang’s Shuoyuan Chapter Bianwu. These words do not appear in The Analects of Confucius (论语).

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the 100 volumes of Ge Hong’s Jinkui Yuhan Fang (金匮玉函方) mentioned in the foreword by Ge Hong himself in his Handbook of Prescriptions for Emergencies (肘后方). In Zhang Gao’s Yishuo (医说), the number of renowned physicians during the past Wei, Jin, Southern and Northern Dynasties had been 46, with 41 mentioned in the Suishu – Biography of Classics and Books (隋书·经籍志); adding all those recorded in the historical books of the Wei, Jin, Southern and Northern Dynasties and in the Collections of Ancient and Present Books – Medical Part (古今图书集成· 医部全录), the number amounts altogether to 148 names. This is at least double the number of the 36 writings, 881 volumes and 45 named physicians listed in the Hanshu – Biography of Art and Literature (汉书·艺文志) during the 436 years of the two previous Han Dynasties. With regard to the 369 years of the Wei, Jin, Southern and Northern Dynasties, this really was a boom time for Chinese medicine. All these physicians can be categorized into two groups: influential and powerful families; and hermits or those living in mountain and forest retreats. The former included imperial physicians and medical officers, while the latter identified Buddhists and Taoists and physicians scattered throughout the folk world. Rambling around, free from academic or medical ties, their achievements were of great benefit to later generations. First, many medical works from previous eras were sorted and annotated. For example, Quan Yuanqi annotated the Suwen (素问), Wang Shuhe sorted out the Shanghan-zabing lun (伤寒杂病论), Huangfu Mi compiled his Classic ABC of Acupuncture and Moxibustion (针灸甲乙经), Lu Bowang made annotations to the Nanjing (难经), Tao Hongjing wrote the Bencaojing Jizhu (本草经集注) and so on and so forth, all of which helped to bring the hidden Chinese medical theories of the Han dynasty to light. Second, there was also the evolution and development of basic medical theory. For example, Wang Shuhe composed the Maijing (脉经), Xu Zhicai the Yaodui (药对) and Qin Chengzu the Yancerenjing (偃侧人经) which was the first acupuncture classic with illustrations, and then there were Cao’s Prescriptions of Moxibustion (曹氏灸方) and Lei Xizo’s Paojiulun (炮炙论) (Master Lei’s Discourse on Medicinal Processing). Third, these authors promoted the development of clinical medicine. For example, in general practice, there were the Handbook of Prescriptions for Emergencies (肘后方), Excerpts of Prescriptions of Xiaopin (小品方), Supplementary Records of Famous Physicians (名医别录), Prescriptions for Miscellaneous Diseases (杂病方), Valuable Prescriptions (要方), Pre-emergency Prescriptions (备急方) and the Jiyanfang (集验方); in multidisciplinary medicine,

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there were the Bianshanghan (辨伤寒), Gynecology Prescriptions (妇人药方), Pediatric Prescriptions (疗小儿药方), Prescriptions for Ulcers and Carbuncles (疗痈疽金创要方), Prescriptions Left by a Ghost (鬼遗方), Ophthalmology Prescriptions (疗目方) and Prescriptions for Ears and Eyes (疗耳眼方); for detoxifying Cold Food Powder, there were the Prescription of Cold Food Powder (寒食散方), Treatment of Cold Food Powder (寒食散对疗), Detoxifying Cold Food Powder (解散论) and Restrictions for Cold Food Powder (解散消息节度); for the treatment of beriberi, there were Prescriptions for Miscellaneous Foot Diseases (脚弱杂方), Prescriptions to Heal Miscellaneous Foot Diseases (疗脚弱杂方) and so on; for the treatment of infectious diseases, there were some corresponding descriptions in the Handbook of Prescriptions for Emergencies (肘后方) and Excerpts of Prescriptions of Xiaopin (小品方). The On Prescriptions for Precaution (议论备豫方) also seems to be concerned with prevention. Fourth, there was the beginning of the establishment of formal medical institutions for education. For example, Qin Chengzu proposed the Emperor commence medical institutions for study and learning. Fifth, the importing of foreign medicines began. For example, some Buddhist medical treatments and drugs were brought in and accessed. Lastly, there was the developing of a therapy of pills and potions for both external and internal dan, and generalized treatments for keeping healthy. The achievements listed above show the obvious, major medical trends of the age. To make a full list would be out of the question. In addition there were some particularly unique features to the medicine of the Wei and Jin dynasties. For example, the tradition of being a physician of several generations actually made medicine fashionable for a while. Take the eight generations of Xu physicians, for instance: Xu Xi, originally lived in Shangdong Province and later crossed the Yangzi river to move to Danyang; he was keen on the scholarship of Huangdi and Lao Tzu. He lived in seclusion at Qinwang Mountain in Qiantang where he acquired one roll of the Bianque Jingjing (扁鹊镜经), from a Taoist. Then he took pains to learn medicine and later became well known throughout the country. His offspring were famous physicians in every generation, who become officials either in the Song or Qi of the Southern Dynasties or the Wei and Qi during the Northern. Among them, Xu Qiufu, famous for his acupuncture, was once said to perform acupuncture on a ghost, who later visited him after recovering its health. How miraculous his skills were! Xu Daodu, who could not walk because of a foot problem, was often carried by imperial carriage into the

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palace, by the order of the Wen Emperor of the Song Dynasty to treat diseases of the princes, and they were all effective. The Wen Emperor said, “There are Five Excellencies in this world, all of which dwell in Qiantang.” The Five Excellencies referred to jutanqi (ancient football), poetry, hengshu (penmanship), weiqi (the chess of besiegement) and Xu Daodu’s skills in treating disease. Xu Shuxiang, his brother, was also skilled in medicine. Xu Wenbo not only cured the Dowager Lu, mother of the Xiaowu Song Emperor of the Southern Dynasty with “stone-removing soup”, but also the lumbago of imperial servants and heart disease linked to back pain. He could also perform abortions to test the sex of a foetus with acupuncture. All these were really amazing skills. Xu Sibo treated Fang Boyu by detoxifying him with Cold Food Power, treated Zhang Jing’s parasitic disease, the Monk Shen Yi’s eye pain and for a women suffering from chronic cold and an old ulcer caused by a nail injury, he used a particular method using potion made of part of the pillow of a dead person. Besides this, Xu Chengbo diagnosed diseases with a curtain between himself and the patient, and though he failed to refine pills for the first Emperor of the Wei Dynasty, his medical treatments were often quite effective and he got large rewards. What’s more, he often swallowed Taoist charms. Xu Xiong also trained in the family tradition and was good at diagnosis. He was very fond of “idle talk” and kept good relations with the rich and powerful. Xu Zhicai was famous throughout the Northern Dynasties. In his treatment of heel pain, he once drew out two “clams” from a cut on the heel. He was also fond of jokes and thus was in great favour. His sons, Shaoqing and Tongqing, did not learn medicine, but one of their sons named Xu Zhenhui was a renowned physician and famous for his treatment of jaundice. Xu Zhifan, also good at medicine, died in the year of the Emperor Kaihuang. His son Minqi was a skilled physician and was appointed as chaosan dafu to the Sui Dynasty. Those listed above show eight generations of one family, although Dr Xu Zhifan and his son lived in the Sui period. This was a typical medical family. Some of the stories recorded in the historical books are far-fetched, of course — but they reflect the trend of the medicine of the time. Yet according to the written works surviving today, these are not deliberately mystifying stories but quite close to the common truth. It is generally believed that it was Xu Zhicai who compiled and composed the Prescriptions for Miscellaneous Diseases (杂病方), Prescriptions for Miscellaneous Pediatric Diseases (疗少小百病杂方), Xu’s Family Secret Prescriptions (徐氏家传秘方) and the ten volumes of Lord Xu’s Family’s Experienced

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Prescriptions through Eight Generations (徐王八世家传经验方) recorded in the Suishu – the Biography of the Classics and Books (隋书·经籍志). This was explained by Yanyong Tamba in his Study on the Chinese Medical Classics (中国医籍考) as “taking six generations till Zhicai arrived and eight generations including both Shu Xiang and Si Bo, the grand-uncles in the clan. He put all his edited family’s prescriptions into these books. Lord Xu was also another of his titles as he was given the title xiyang junwang, and thus called ‘Xu-Wang’.”42 This makes sense. Zhicai also wrote two volumes of Yaodui (药对) to make clear the principles of medicinal relativity, and three volumes of Pediatric Prescriptions (小儿方) which have been lost. In creating “seven types of prescriptions in ten catalogued formulas, according to function”, he made these seven types the same as those in the Huangdi Neijing, but the “ten catalogued formulae” were Xu Zhicai’s own creation: “dispersing formulae can be used to eliminate congestions; obstructionremoving formulae can eliminate stagnation; tonic formulae for weakness; purgative formulae for blocks; light formulae for excess; heavy formulae for eliminating timidity; lubricant formulae for eliminating stiffness; astringent formulae for eliminating prolapse: dry formulae for damp; and moistening formulae for dryness”. He made great contributions to the theory of pharmacotherapy and “attained the same achievement by different paths” with the use of “matching medicines” when detoxifying the Five-Minerals Powder. His “ten formulae” were later augmented with cold, hot, ascending and descending formulae by Kou Zongshi in the Song Dynasty and Miao Xiyong in the Ming, making fourteen types of formulae in all — a division into categories which is still followed by the Chinese medical formulary to this day. The generations of physicians during the Wei, Jin, Southern and Northern Dynasties were by no means limited to Xu’s family. There were others like the Li family in Guantao, the Li family in Zhao County, the Wang family, the Xu family, the Yao family, etc. Among these, the prescriptions of Yao Sengyuan of the Yao family, who put together the Collections of Prescriptions (集验方), were especially adopted by later generations and many were quoted in the Waitai Miyao during the Tang Dynasty. Furthermore, people like Fan Wang, Ying Zhongkan, Wang Min, Yang Xin, Qin Chengzu and others all came from medically influential families and made great contributions to people’s health. Medically influential families were truly a great new force, arising in that era. 42

 Junwang was a title from the nobility, inferior only to princes in ancient China.

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As for the hermit physicians living in mountain and forest regions, most of them were Taoists and Buddhists like Ge Hong, Tao Hongjing, Hu Daoqia (or Hu Qia), Yu Fakai, Zhi Facun, the Taoist Yang, the Buddhist Shishen, the Buddhist Tanluan, the Buddhist Huiyi, etc. all of whom made tremendous contributions. Among these medically influential families and those physicians living in mountain and forest regions, there appeared a number of very skilled physicians who specialized in different fields during the Wei, Jin, Southern and Northern Dynasties. Besides those listed above, there were also the following: The first was Wang Shuhe. Huangfu Mi praised him, saying, “In our recent times, taiyiling43 Wang Shuhe composed and edited medical books among those left behind by Zhongjing — and his opinions are truly outstanding.”44 Judging by this, we know that Wang was once a taiyiling (head doctor serving the emperor) in the Jin Dynasty, though he was not recorded in any biography or formal history. When or where he was born and died are unknown, but according to Yu Jiaxi, “he made acquaintance with Wei Xun, an apprentice to Zhongjing, and it is probable he had seen Zhongjing with his own eyes.”45 So it must be not much later than the Late Han Dynasty at the latest, quite close to the time of Zhongjing’s writings. Wang Shuhe possibly had got hold of Zhongjing’s writings and rearranged them, hence the title of “Zhongjing’s Meritorious Officer”, which he perfectly deserved. Otherwise, there might have been nothing preserved and left for later ages. Shuhe also wrote the Maijing (脉经), approximately between 266 and 282 CE, making a general summation of sphygmology. This book, dividing all pulses into 24 types and focussing on the cooperative relation between the unique cunkou pulse and the zang-fu organs, tremendously influenced the development of Chinese medical science, in later times. Another physician was Fan Wang. He suffered poverty, and was orphaned at an early age by his father dying. When he was six years old, he followed his mother and moved south of the Yangzi River to live with the Yu family, a family on his mother’s side in Xinye. At the age of thirteen, he lost his mother and mourned for three years — following the exhaustive ritual. He became very diligent and studious as he grew up. However, because of the poverty of the family who could not subsidize his education, he lodged in a cabin in the garden, wearing the cheapest cloth and eating 43

 Taiyiling was an official post for physicians in ancient China.  From his own foreword to a Classic of Acupuncture and Moxibustion (针灸甲乙经). 45  From Sikutiyao Bianzheng (四库提要辨证), Roll 12. 44

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only vegetables. Reading from the dim light of a burning fire, he finally became an erudite scholar and quite good at talking about Confucian ethics. He was therefore appointed to several official posts with the highest being taishou46 in Dongyang County, and was thus called Fan Dongyang. In Dongyang County, he opened numerous schools and benevolently performed his official duties. Also he was skilled in prescribing medicines and keen on saving lives and treating patients, regardless of their income. He wrote over 170 volumes, preserved in the work Prescriptions of Fan Wang (范汪方) [i.e. Prescriptions of Fan Dongyang (范东阳方) and Miscellaneous Prescriptions of Fan Dongyang (范东阳杂方)]. With respect to the Shanghan diseases and surgery, he was quite innovative and made an impact upon later generations. Tao Hongjing praised him, saying, “His discretion in treating disease was often rewarded with the desired effect.” Though his works are lost today, quite a lot of quotations can be found in the Waitaimiyao (外台秘要) and the Japanese Ishinpo (医心方). All in all, Fan Wang can be considered a typical example of a clinical physician during the Wei and Jin dynasties. There was also Chen Yanzhi, author of the twelve volumes of Excerpts of Prescriptions of Xiaopin (小品方) [also named the Jingfang Xiaopin (经方小品)], whose dates are also unclear. Recent research shows that he was born in the central plains and lodged around the areas of Jingzhou– Yangzhou, after the southward migration of the Jin court. His Excerpts of Prescriptions of Xiaopin was accomplished approximately between 454 and 473 CE, during the Liu-Song Dynasty. Judging from quotations from sixteen documents in the Catalogue of Four Books of the Secret Cabinet (秘阁四部 书目录), he might have been able to get access to the court and make acquaintance with the rich and powerful. As for his book, titled “Xiaopin” (小品) it might have been influenced by the Buddhist Astasahashrika Prajnaparamita Sutra (小品般若经); in his discussion on “Restrictions When Taking Powders” he says, “herbal medicines quickly disperse any poison but you need an adjustment in diet; for those who take mineral powders, the poison will be slow to disperse and they will find it difficult to recover.” So he must have personally treated patients who suffered from toxins due to taking mineral powders or magic pills. It is quite clear he was experienced in treating these disorders. We can see this through his criticism of three other writers’ views, including those of Huangfu Mi. From his own compilation Prescriptions for Detoxifying Mineral Powders we know his experiences of treatment. He was an important physician of his time. His 46

 Taishou was a title for the prefecture chief in feudal China.

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Excerpts of Prescriptions of Xiaopin (小品方) was listed among the “mustread textbooks” by the general taiyishu,47 and in the school for training high-level doctors during the Tang Dynasty it surpassed the Handbook of Prescriptions for Emergencies (肘后方) in importance. It was of unique value, as Chen Yanzhi was a working physician. In other words, Chen Yanzhi was an important figure — and his Excerpts of Prescriptions of Xiaopin (小品方) was a great work, produced during the Wei and Jin Dynasties. It deserves further study. There are also two books which are considered forgeries. One of them is the Zhongzangjing (中藏经) falsely attributed to Hua Tuo, with a foreword by Deng Chuzhong, where he states, “I am the son of Hua Tuo’s daughter. As I was mourning for his death in Hua Tuo’s bedroom, I had a dream where he told me to take a seat and he said to me, ‘Zhongzangjing (中藏经) is the book to save people’s lives. You can take it now, but do not show to others.’ When I woke up, I was quite terrified and confused. So then I asked for Hua Tuo’s old things and found among them a stone casket. I opened it and there was a piled-up mass of papers in the casket. It was the Zhongzangjing (中藏经). Because I am really clumsy in doing these things, I gave it to Si, my second son. Hence I write this foreword to tell the truth of how it happened.” There is no way of knowing whether Deng Chuzhong was actually the grandson of Hua Tuo, but Lu Fu in his book called Deng a Shaoshi Shanren (“Shaoshi mountain man”). If this title is correct then Deng should have been a hermit from Shaoshi Mountain. And, the book, if not composed by Hua Tuo, might have been written by someone during the Six Dynasties Period. Still, it is beyond doubt that the book belongs to the Wei, Jin or Southern and Northern Dynasties. Considering that Wu Pu and Fan E, Hua Tuo’s apprentices, lived during the Wei and Jin, it is highly probable that Hua Tuo, who might not have written the Zhongzangjing (中藏经) himself, did actually pass down some advice to his disciples who recorded and sorted it out into a book which gave play to the theories of the Neijing (内经), and made a glorious contribution particularly to differentiating between deficiency and excess in the zang-fu organs. The other “forgery” is Chu’s Posthumous Papers (褚氏遗书), which was written under the pseudonym of Chu Cheng. Chu Cheng, the Songwen Emperor’s son-in-law during the Southern Song Dynasties, was an honest official and good at medicine. During the Jianyuan years (479–482 CE) of the Southern Qi Dynasty, he was the taishou, or head official in Wu County. When Lord Yuzhang fell ill, Chu Cheng was called in by the first Emperor 47

 Taiyishu (太医署) was an official organization of physicians in ancient China.

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of Southern Qi to treat his Lord — and he recovered instantly. After that, he was promoted to zuohu shangshu,48 but in the first year of Emperor Qiwu’s Yongming reign (483 CE) he was impeached and removed from office. After years in prison, he was set free and became shizhong,49 taking the Youjun General under his command. It was in the same year that he died. His daughter was the queen of Donghun during the Qi Dynasty. While he was still in the position of taishou in Wu County, “Li Daonian, a civilian, came to the county on official business. Cheng saw him and said, ‘you are seriously ill.’ Li answered, ‘I have suffered from a ‘cold disease’ for five years and no physician can cure me.’ Cheng felt his pulses and said, ‘Your disease is neither cold nor hot, but caused by eating too many boiled eggs.’ Then he ordered his servant to stew up a liter of perilla-seed and let Li drink it. With only one portion of the drug, Li vomited out something the shape of a sheng,50 enveloped in saliva. With the saliva cleaned off, it turned out to be a chicken complete with feathers, wings and claws — which could even walk away. At that moment, Cheng said, ‘This is not the end of it.’ When Li drank up the rest of the drug, he vomited up another thirteen chickens and his disease was cured. People praised it as marvelous.”51 Such descriptions might almost be absurd, but there must have been some truth in the fact that Chu Cheng was skilled at curing disease. The Hennan Annals (河南通志) says, “Chu Cheng, born in Yangzhai, wrote ten medical papers, generally called Chu’s Posthumous Papers (褚氏遗书).” The reason it has been called a forgery is because the book has been unearthed twice, at differing times. The first time was in the second year of Qingtai (935 CE) at the end of the Tang Dynasty. As Xiao Yuan wrote in the foreword, “When Huang Chao rose in revolt, his followers took advantage of the turmoil to rob tombs and snatch gold. Once they found a large tomb over three meters in width. In the middle, there were eighteen stones in the form of a big coffin, covered by six stones inscribed with ‘the tomb of Chu Cheng of the Southern Qi Dynasty’… all the stones were facing inward so the inscriptions were still very clear. The stones’ inscriptions were initially suspected by the robbers to be something on ‘the art of war’, but when removed and laid down outdoors they saw they were wrong…” When Xiao Guang, one of Xiao Yuan’s earlier ancestors, saw these stones, he protected them with care and carried them back to the ship he had arrived in. Furthermore, he printed hundreds of copies of 48

 Shangshu was a very high official minister in ancient China.  Shizhong was a privy counselor in ancient China. 50  Sheng was an ancient container to measure volume of litre. 51  From History of Southern Dynasties – Biography of Chu Cheng (南史·褚澄传). 49

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their inscriptions and spread them around for people to read. Then the stones were again buried as coffin stones. The second time this book was unearthed was during the Song dynasty when “in the first years of Song Emperor Qinzong Jingkang (1127), people from the Jin Kingdom invaded the country and turned to robbery, during the turmoil.” As a result, they found north of Yangzhou City the tomb of a certain “Xiao”, and excavated nineteen stone slabs from it which formed a stone book, together with a foreword by Xiao Yuan. As recorded by the Buddhist Yikan, “The family of Xiao suffered misfortune connected to this tomb and I have just arrived to see the stones myself and therefore make a record of them.”52 Then the book was copied and circulated throughout the country. This was in the year 1127 CE — almost 200 years later than the first time it was unearthed. Suppose the book was indeed a forgery, it seems unnecessary to make up a story of two tomb robbings. In fact, the Siku Quanshu Tiyao (四库全书提要) does not take this work as a forgery. What’s more, a study of the contents of the book reveals that besides taking ideas from the Neijing (内经), it was also influenced by Buddhist medicine. But more particularly, the book contains the original main views of Chu himself. It is impossible to list all the names and stories here. Ge Hong, Tao Hongjing, Lei Xiao and others, who were also very famous, have been described in other chapters. All in all, it was a time when numerous talents burgeoned. These many and varied physicians, with differing identities, made differing contributions and carried out different deeds as a result of the unique style of freedom which flourished during the Wei, Jin, Southern and Northern Dynasties. It was in no way inferior to the period of the Renaissance in Europe.

52

 From Buddhist Yikan’s foreword to Chu’s Posthumous Papers (褚氏遗书).

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Confucianism and Medicine A.  A Medicine Dominated by Feudal Ethics “Feudal ethics” is a general term used when describing the Confucian religion. With the impact of Confucianism, many ethical rules became more theoretical. What’s more, since the ancient Emperors had advocated Confucianism, its codes began to be taken as social policies. Its core codes were humanity (kindness), justice, propriety, wisdom, honesty, faith, forgiveness, filial piety and fraternal duty, the Three Cardinal Guides (ruler guides subject, father guides son and husband guides wife) and the Five Constant Virtues (benevolence, righteousness, propriety, wisdom and trustworthiness). Everything that happened in the history of China, either positive or negative, was closely related to these core codes, including medicine.

78. From Licking Piles and Sucking Carbuncles to “Cutting the Flesh of His Thigh to Cure His Parents” It is strange that some people were willing to lick the Emperor’s piles in ancient China. Chuang Tzu – Lie Yukou (庄子·列御寇) records, “Emperor Qin suffered from sores and thus wanted to employ doctors for treatment. He would reward — with a carriage — doctors who could treat sores and oozing furuncles, doctors who could lick piles for him with five carriages, and give even more carriages to those who would do even more disgusting jobs.” It seems that the status of a doctor was quite inferior. The Han Feizi (韩非子) states, “Doctors who will suck injures or the blood of other nonrelatives are driven by profit.” It indicates that such behaviour might be driven by the generous reward. Nevertheless, it was a doctor’s duty to treat sores. Yan Tzu, a top official in Warring States, also treated sores, but it was not for reward. At that time, 491

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Duke Jing of Qi State was afflicted by a subcutaneous ulcer on the back. Gao Zi requested, “It is my profession to treat subcutaneous ulcers.” After he had finished the job and left, Yan Tzu asked to see Duke Jing. He entered the room, “asked servants to prepare washing articles, cleaned and warmed his hands, knelt down on the mat and laid his hands on the sores of the Duke.” Yan Tzu’s behaviour was similar to that of a doctor, but it was actually for a political purpose. As for “sucking carbuncles”, doctors today occasionally practice it when necessary and sterilization is unavailable. However, courtiers in ancient time sucked carbuncles out of flattery rather than for medical reasons, taking the idea of the Confucian “rites” to an extreme. Deng Tong sucked carbuncles for Emperor Wen of Han as stated in the Historical The Records – Biography of Treacherous Court Officials (史记·佞幸列传). There was no record of licking piles afterwards in history, but it is not rare to see records of sucking carbuncles and licking eyes. The Book of Jin – Biography of Xu Miao (晋 书·徐苗传) records, “My brother suffered from mouth ulcers and Miao sucked them for him.” Biography of Li Ban (李班传) records, “After Li Xiong was ill in bed, Li Ban looked after him day and night. When Li Xiong was young, he was frequently involved in battles, which left him with many injuries. At this time, his illness was severe and his injuries produced pus and ulcerated. His sons, Li Yue for instance, felt disgusted and stayed away from their father. It was only Li Ban who sucked the pus out, without any sign of reluctance.” The Book of the Southern Qi – Biography of Han Lingmin (南 齐书·韩灵敏传) records, “In Gaizhong Yongxing County, Wang’s daughter was inflicted by a serious disease at the age of 5 and she became blind. She was extremely filial. At the age of 20, both parents died. While she was beside their dead bodies, she cried and blood came out of both her eyes. Her little sister E licked the blood and her left eye opened at once and she could see. People at that time called it ‘touching filial piety’.” The Book of Zhou – Biography of Liu Xia (周书·柳霞传) records, “Liu Xia’s mother once suffered from a subcutaneous ulcer between her breasts. The doctor told her the only cure would be if someone would suck the ulcer so that the pain alleviated a little’. Xia responded immediately and her mother recovered for a few days. This is what is known as touching filial piety.” The Old Book of Tang – Biography of Emperor Gaozong (旧唐书·高宗纪) records, “Emperor Taizhong once suffered from carbuncles. The prince supported him, accompanying him on his carriage and during walks, and sucked his carbuncles in person over several days.” The History of the Song Dynasty – Biography of Liu Xiaozhong (宋史·刘孝宗传) records, “As his

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adoptive father had lost his sight in both eyes, Xiaozhong licked them. Seven days later, his father regained his sight.” These are all similar examples. As a result, sucking carbuncles was transformed into an example of “heaven being moved by filial piety”, and this resulted in propaganda for filial piety. It was especially combined in Buddhism with retributive justice, which made filial piety a popular subject in medicine. The development of feudal ethics and rites benefitted a great deal from Buddhist ideas. There is a spectrum of cases in which people beg for Heaven’s blessing when treating disease. For instance, Book of Liang – Biography of Yu Shami (梁书·庾沙 弥传) records, “Liu, the head wife, was ill in bed. Shami served at her side day and night. If she needed acupuncture or moxibustion treatment, he would try it first personally.” The History of Southern Dynasties – Biography of Wang Zihan in Southern Sea (南史·南海王子罕传) records, “Zihan’s mother was once ill in bed, so he prayed day and night… His mother recovered as well, which was regarded as a result of his touching filial piety.” The History of Southern Dynasties – Biography of Xu Fen (南史·徐份传) records, “… Xu Fen was filial and fraternal. Ling once suffered from a serious illness, so Xu Fen burnt incense, cried and chanted the Classic of Filial Piety (孝经) on his knees for three days and nights. Ling suddenly recovered.” The Biography of Zhang Jinzhi (张进之传) records, “Zhang Chu was from Zitong county, Yizhou city. His mother was ill at a critical time. Chu prayed and even burnt his finger to make a vow. Heaven was moved by such absolute sincerity, and thus his mother recovered.” Burning the finger “for filial piety” was originally the behaviour of ascetic Buddhist monks and it became the most pious example of filial piety. Behaviour such as “sucking carbuncles” must be the like. A typical case is “cutting off flesh from the thigh for treating the diseases of parents”. Old Book of Tang – Biography of Wang Youzhen (旧唐书·王友贞传) records, “When Youzhen was aged 20, his mother suffered from a serious disease. The doctor told him it could only be relieved by eating human flesh. Thinking of nothing but a cure, Youzhen cut off the flesh from his own thigh to feed his mother. His mother then recovered. Empress Wu Zetian heard of this and after she went to his house to see, praised him with a silken banner.” This event occurred in the reign of Empress Wu Zetian (684–704 CE). The doctor was unknown. Books of medical history believed it was perpetrated by Chen Cangqi (713–741 CE), who wrote the Supplement to The Materia Medica (本草拾遗) in CE 739. New Book of Tang – Collected Biographies of Filial Persons (新唐书·孝友列传) records, “In the Tang Dynasty, Chen Cangqi wrote Supplement to The Materia Medica, in which

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human flesh for treating emaciated diseases was recorded. It must have been derived from the folk-story that someone cut off their thigh-flesh for their own parents’ recovery.” Medicine Talks (医说) also records, “Chen Cangqi, from Mingzhou city in Kaiyuan period, wrote Supplement to The Materia Medica, in which human flesh for an emaciated illness was recorded. Since then, the common people have followed this record of cutting off human flesh from the thigh.” Actually, Chen Cangqi was not the first to record it, though he is to be blamed for recording it in a medical book and causing such a baneful influence. Its earliest record is in the Buddhist text, the Precious Volume of Wonderful Sounds (妙音宝卷). “Emperor Miao Zhuangyan had three daughters, namely Miao Yan, Miao Xiang and Miao Ying. At one time, the Emperor was ill with scabs all over his body. The doctor said he could only recover if his own child’s bone and flesh were mixed with the medicine. The older two daughters were reluctant — only the young girl Miao Ying agreed to cut off her arm for her father’s disease. The Emperor recovered from the illness. Later, he was afflicted by an eye disease and Miao Ying again grubbed out her own eyes voluntarily for her father. The disease was cured as well. Eventually, Miao Ying reached the spirited state of immortality and incarnated as an Infinitely Merciful Mendicant Priest.” Introduced from Buddhism, such cases of “cutting of thigh-flesh to cure parents” in ancients time became a foolish example of filial piety. There are four similar cases recorded in the Tang Dynasty, and more than ten during the Song. The History of Jin Dynasty – The Records of Establishing Politics (金史· 创政传) also states, “A son served at the side of his ailing mother day and night. He cut off his thigh-flesh to feed her again and again.” “He licked his mother’s eyes with his tongue frequently and several days later, his mother regained her vision.” There are eight cases in The History of the Yuan Dynasty. But even cutting off thigh flesh is dwarfed by opening the brain. The History of Yuan Dynasty – Legends of Qin’s Two Daughters (元史·秦氏 二女传) records, “Qin had two daughters, whose names were unknown and they came from Yiyang, Henan province. Their father was once ill and in a critical state. The doctor told them it was incurable. The elder sister prayed with the door closed and opened her skull to remove part of the brain, which was then mixed with the medicine. Her father recovered as a result. Later, her father was ill again. The younger sister cut off her own thigh-flesh and put it into the porridge. Her father recovered straight away after sipping the porridge.”

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In the Yuan Dynasty, not only were the Han influenced by corrupt feudal ethics and rites, but also the people of Mongolia. The New Records of Yuan history – Legends of Pu Lanxi states, “Pu Lanxi was eight years old, and she was raised by Emperor Yuzong in the palace. Once her mother was ill, and so she cut off her own thigh-flesh, with which medicine was mixed for treatment. She never let this be known to others. The Emperor Yuzong praised her for her filial piety.” Legends of Hu’s Filial Daughter (胡孝女传) records, “It was said by the people of that province that diseases of one who had served in the army could be treated by the ‘chest flesh’ of a human being. One day, after the family members had gone out, Hu’s filial daughter cut off her own ‘chest flesh’ with a knife by herself, in order to treat others. She was thus injured.” Though Hu’s filial daughter found it difficult to recover from the injury, she would never have repented or regretted this, as it meant abandoning the constraints of feudal ethics. In the Ming Dynasty, things became even more serious. There are many cases recorded in the History of the Ming Dynasty (明史), such as Yang Tainu’s cutting out his liver and Li’s filial wife’s cutting off her own breast. The Grand Compendium of Materia Medica (本草纲目) cited one case from He Mengchun’s Abstract of Records at a Winter End (余冬序录). It states, “Jiang Bo’s wife was ill, so the rib-side flesh of her son was cut off for treatment. However, the disease was not cured. They prayed to the god and offered to kill their own son as a sacrifice. His wife recovered and so his 3-year-old son was killed. This event was heard of by the Emperor Taizu, who was angry with its reversal of ethics — and he punished Jiang Bo by beating him with a cane and asked the Ministry of Rites to discuss it.” It is horrible to see people killed by feudal ethics disguised as medicine. It would have become more of an epidemic, if not prohibited. There was once a prohibition during the Five Dynasties, but it aimed at preventing people escaping military service. The Historical Records of Five Dynasties – Miscellaneous Legends of He Ze (五代史记·何泽杂传) states, “People were unwilling to serve in the army. They often used excuses such as cutting off thigh-flesh for a parent’s illness or a breast for burying with a dead parent’s body.” In the seventh chapter of the old history The Records of Five Dynasties – Biography of the First Emperor (旧五代史·太祖纪), it states that in the year of 907, “in all prefectures and counties, there is no need to report cases of cutting of fingers or thigh-flesh from now on. In these years, the cutting off of thigh-flesh is common among army men and folk, especially in Qing, Qi and He areas. The Emperor said, ‘If they do it from the bottom of their heart, it is filial piety. But if they just want to escape the levy

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and survive better by self-mutilating the body, this is far from curing disease. It is better to prohibit it absolutely.’” However, this behaviour went on even after prohibition. The History of Ming Dynasty – The Legend of Ren Hengtai (明史·任亨泰传) records, “Hengtai proposed: ‘A dutiful son shows filial obedience to his parents. He respects his parents when they are together; he wears a smile when he looks after them; he is worried and invites good doctors to treat them if his parents are ill. Lying on ice and cutting off thigh-flesh is not a permanent cure. People cut out the liver if cutting off the thigh-flesh is not enough, and they even kill their offspring if cutting out the liver is not enough. This defies morality and causes damage to life. There is nothing worse. Having no offspring is a major aspect of this and not in accordance with filial piety. It is better to strictly prohibit it. If people are foolish, just let them do it, but it shouldn’t be praised.’” In this record, feudal ethics are applied to constrain feudal ethics. Though “it shouldn’t be praised”, many cases were still recorded in the “legends of filial women”. “Just let them do it” is a kind of permission. Li Shizhen said in The Grand Compendium of Materia Medica – an Entry on Human Flesh (本草纲目·人 肉条), “Notes after Farming (辍耕录), written by Tao Jiucheng, records: Undisciplined soldiers in history have eaten human flesh, which is called ‘a desire for the flesh of a two-foot sheep’. These soldiers are inhuman — it is not enough to put them to death.” Be it undisciplined soldiers eating human flesh without an excuse or feudal ethics killing people for the sake of highsounding ideals, there is no difference between them.

Not Daring to Damage Any Part of the Body The Mencius – Li Lou Vol. 1 (孟子·离娄上) states, “There are three ways one may neglect filial piety, but having no offspring is the major one.” Zhao Qi noted, “As for the three ways of neglecting filial piety in rites, the first is flattery by any means, with the cost of injustice to your parents; the second is not seeking money or advancement when your parents are old and poor; the third is having no wife or son — which terminates the continuation of the family.” But the discipline of damaging any part of the body is not included here as a case of neglecting filial piety. The Classic of Filial Piety – Beginning Chapter (孝经·开宗明义章) states, “The body, our hair and skin are all given to us by our parents. Not daring to damage any part of the body is the beginning of filial piety.” This was a newly added section inserted at the beginning of the Han Dynasty, to mean that a living person should keep the body intact, or take care of the

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body after injury. It is often used to explain the underdevelopment of anatomy in Chinese medicine. More importantly, it is a necessity to perform filial piety with an intact body. Zengzi said, “It can be called filial piety if someone guards an ancestral temple with an intact body” [cited in Mister Lu’s Spring and Autumn Annals (吕氏春秋)]. This surely indicates that it is impossible to carry out anatomy — because anatomy entails dismembering the body given to one by one’s parents. A typical case is recorded in The History of the Southern Dynasties – Gu’s Legend (南史·顾之传). It states, “In Xiang County, Pei Prefecture, Tang Ci went to have a drink at Peng’s house in the neighboring village. He came back sick and vomited up more than twenty kinds of poisons. He wanted to have his abdomen cut open after death and his wife, Zhang, did so. One could see the five zang organs all rotten and broken up. However, the governor thought Zhang was brutal to cut open her husband’s abdomen — so she should be charged with damaging her husband’s five zang organs; and her son too, Tang Fu, was not filial as he didn’t discourage his mother from doing it. Therefore, both mother and son should be executed in public. This was an unprecedented case. Sangong (an ancient official position) Liu Xie felt compassion for them and proposed, ‘Peng’s wife just carried out her husband’s will, and the son understood. Filial piety was indeed in his heart — not deliberately doing harm’. On the other side, the official Gu Zhi held that the wife was corrupt and the son unfilial, saying ‘The wife behaved brutally and there is no need to feel compassion for them.’” This illustrates a debate on the justice of anatomy after death, quite similar to the present legal status of euthanasia. Liu Xie argued it was in accordance with filial piety, while Gu Zhi thought it was immoral. These two famous literati had views that were the polar opposites of each other. In the end, Zhi’s conservative argument won, as the Emperor judged that wife and son must be executed. The verdict could not have been more severe. A genuine autopsy (including a pathological investigation of the organs) in ancient China was never carried out, because of the pressure of feudal ethics and the rites. People have not dared to carry out anatomy since. However, this didn’t mean that feudal ethics forbids all kinds of dissection. It actually allowed the anatomical dissection of prisoners, captured enemies and even sometimes vivisection. There are altogether five such records in the histories: (1) King Zhou of Shang: He has been mentioned in previous chapters. The Book of Histories – Extreme Oath (尚书·泰誓) records, “The King Zhou of Shang ordered soldiers to burn faithful and upright officials,

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and open the abdomen of pregnant women.” “He ordered soldiers to cut open the legs of someone wading in water (to see how he could bare the cold), and to remove the hearts of virtuous people. He thought killing enhanced his prestige. The harm of this spread all over the country…” This king performed vivisection on pregnant women, people wading in water, on the virtuous top official Bi Gan and more. (2)  Wang Mang: History of the Han Dynasty – The Records of Wang Mang (汉书·王莽传) states, “After Wang Sunqing of the Zhai Yi party was captured, Wang Mang asked Shang Fang, an imperial doctor, and skillful slaughterer to cut open Wang’s body. They measured the internal organs, and gained an understanding of the beginnings and endings of the vessels using bamboo wires poked through the vessels. They suggested that such information could be used for medical treatment.” This record shows that the vivisection performed on Wang Sunqing was clearly for medical purposes. In a similar fashion, Ge Hong’s ancestor luckily met with remission and avoided this misfortune. (3)  Wu Jian: Notes after Guests (宾退录) records, “In the period of Qingli (1041–1048 CE), Ou Xifan and his allies were killed over three days in Guangxi province. Fifty-six of their abdomens were cut open. Wu Jian, a Tui official in Yi Zhou, inspected them closely.” Facts of the Song Dynasty (宋朝事实) written by Li You records, “Du Qi, a transport official, lured more than six-hundred people of the opposing party to a meal. He put jimsonweed flower in the wine and made them all drunk… Thus all of them could be arrested and executed. Three days later, Xifan and ten more were arrested. Their abdomens were cut open and a map of their internal organs drawn.” It seems “10 more people” should be corrected to “tens of people”. The result of the dissection is recorded in the Truth Existing Map (存真图) as follows: “Yang Jie said, ‘When Ou Xifang was cut open, State Official Wu Jian ordered painters to draw explicit pictures as a record.’ Wu Jian said, ‘Over two days, 56 abdomens of Ou Xifan and his men were cut open. The insides were observed carefully. There are three openings in the throat, namely one for food, one for water and one for gas. I asked subordinates to blow gas into the three openings and found they were independent of each other. The heart, liver, gallbladder and spleen are below the lung. The small intestine follows the stomach and the large intestine is at the end. The contents of the small intestine are clean and lustrous, while in the large intestine, they are filthy. The urinary bladder is at the side of the large intestine. There are different kinds of heart, such as large, small, square-

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shaped, long, oblique, straight, one with orifices, and one without any orifices. Only Xifan’s heart was red and spindle-shaped, as shown in the picture. As for the liver, some of them only have one piece, while others may have two or three pieces. One kidney is located at the right and slightly inferior to the liver, while another kidney at the left and slight superior to the spleen. Since Meng Gan coughed a great deal, his lung and gallbladder are both black. As Ou Quan had eye illness when he was young, his liver has white spots. There is a kind of correspondence between the external and internal. The yellow stuff all over the body is fat.’”   This was a large-scale anatomical dissection, in which 56 people were killed and dissected at the same time, a kind of vivisection. However, Wu Jian was just a Tui official rather than a doctor. What’s more, the task was complete in just two days, so it is easy to understand the roughness of the drawings. There are many mistakes in the above description and the drawings are surely full of errors, though these have long been missing. (4) Li Yixing: The Truth Existing Map (存真图) records, “In the middle period of Chong Ning (1102–1106 CE), thieves were to be executed in the market. Prefecture Chief Li Yixing ordered doctors and draughtsmen to attend. They touched the membranes and picked up the fat of the bodies carefully and meticulously. Yang Jie checked the results and found that below the throat, the heart, lung, liver, spleen, gallbladder and stomach were in connection; the small intestine, large intestine, kidney and urinary bladder overlapped. The attachment and joints of the channels and collaterals, the transportation of essence and blood, and whole situation was just the same as in the ancient books. There were few exceptions.”   In this case, it is unknown how many thieves were dissected. The pictures drawn were conserved in the Second Publication of Internal Pictures of Mysterious Gate and Pulse Verses (重刊玄门脉诀内照图) written by Sun Yu in the Yuan Dynasty. There are pictures of the anterior, posterior and lateral sides of the body, the heart, diaphragm, “railing portal” (conjunction of the small and large intestine), life-gate, small intestine, large intestine and so on. They are superior to the previous pictures, but still quite rough. (5) Qin Cha: A New History of the Yuan Dynasty – Record of Zhao Xiaci (新元史·赵匣刺传) states, “The Song army was defeated utterly. Zhao Xiaci was wounded in three places and an arrowhead went into his left

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shoulder, where it couldn’t be removed. Qin Cha respected his courage. He cut open the shoulders of two condemned prisoners to measure the depth of the bone-joint and found that the arrowhead could be drawn out. Therefore, he ordered subordinates to cut the wound and remove the arrowhead. Xiaci remained calm during the operation.”   This is a case of regional anatomy performed on two condemned prisoners for the reference of debridement. The arrowhead was thus removed and the curative effect obviously quite good. These five cases of anatomical dissection were all in accord with feudal ethics and also a kind of vivisection, being characteristic of Chinese anatomy. This is because the cruelest punishment on prisoners, thieves and enemies could be performed anyway. Since killing them was legal, performing anatomy on them was allowed by feudal ethics. Hence, there was no need to pay them any sympathy. We can see from these examples that the anatomy forbidden by feudal ethics was that performed on the bodies of the common people. Actually, there must have been more cases in ancient times. In 1983, an archaeological team in northern Shaanxi excavated an ancient town site of the Guifang Clan — a northern minority during the Shang and Zhou dynasties — west of Lijiayan village, Qingjian County. There was a 42 × 47-cm carved stone remaining in the temple courtyard, on which there was a skeletal image with the remaining ribs and spine carved out in lines. It is considered the earliest carved image of the structure of a human body in China.1 The Neijing Inner Classic (内经) states, “The skin and flesh of a man 8 chi tall can be measured on the exterior, and anatomy carried out when a man has died.” This indicates that an autopsy was common during the period of the Inner Classic, a time free from feudal ethics. The anatomical records found in the Inner Classic can only exist on such a basis. In a painting depicting street vendors made during the Song Dynasty, in the Palace Museum, it is a surprise to see a child’s skeleton hanging at the end of a vendor’s shoulder pole. The skeleton is drawn accurately and clearly, showing that people at that time were not short of anatomical knowledge, or didn’t think a skeleton dirty or hideous. However, human anatomy had never been regarded as vital and necessary in ancient Chinese medical history, until the emergence of Wang 1

 Wu Zhirong. The Earliest Carving Image of a Human Body Structure in China. Chinese Journal of Medical History, March 1987.

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Qingren. It seems that making a general description of the human body had been enough in the Inner Classic (内经) and the Classic of Difficulties (难 经). The anatomy performed later was just to confirm that recorded in the classics. The common points of the above-mentioned cases are vivisection, consent, roughness in the manner in which they were carried out and compliance with the classical and ancient records. But there is nothing to be critical of here as, fundamentally speaking, no elaborate anatomy was required for the classical theoretical system or the structural methodology established by the Inner Classic. Internal medicine was mostly applied to treat diseases of external medicine. Some cases of operations recorded in The History of Yuan (元史) occur merely because of the influence of Mongolian or Arabian doctors. Operations were rare in Chinese medicine, so there was no need to perform anatomy. Another reason that contributed to the underdeveloped anatomy of Chinese medicine was the existence of traditional Chinese rites, which considered humans superior to all other animals. Man was regarded as the intelligent part of the universe and unparalleled among any other kind of creature. Humans couldn’t be compared with beasts. Therefore, there had never been any anatomical research conducted on animals and no one dared to say the internal organs of animals were the same as those of human beings in shape, location or function. Animal anatomy was basically carried out in the Western world by doctors such as Galen. Though mistakes were made, anatomy in the Western world was far more elaborate and accurate than in China. During the Renaissance, human anatomy was even more important, so much so that previous mistakes were soon corrected and the understanding of the human structure immediately became more profound. Experimental medicine — using animals as experimental subjects — was also established and quickly developed. The Chinese tradition disdained such experiments and no one would believe in them, or they would say, “surely human beings are more than pigs and dogs!” This was probably the fundamental cause of the underdevelopment of Chinese anatomy. From the Ming Dynasty to the emergence of Wang Qingren (1768–1831 CE) at the end of Qing Dynasty, there were hardly any new records of anatomy made. This was closely related to the domination of the neoConfucianism school and feudal ethics. During the period of Wanli (1522– 1619 CE), Sun Yikui wrote Additional Thoughts on Medical Themes (医旨 绪余), in which his second volume, the “Correct Meaning of the Nanjing – Comments on the Sanjiao”, cited the sayings of He Yiyang. He Yiyang said, “In my early years, I took up medicine. I performed anatomy on thieves and

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checked their internal organs. The length of the heart is longer than that of the pig and its top is flat but not sharp. The large and small intestines are the same as those of the pig, but the small intestine often bears red striae. The bladder is the urine container. Other organs are in accordance with the records made in the Nanjing (难经).” We don’t know who He Yiyang was, but according to the record, he made a kind of vivisection and he is the first person to compare the internal organs of mankind with those of a pig. This idea had never seemed important in the Chinese medical world and no one had ever explored animal anatomy or extended these ideas to human beings before. This was a real pity. Yet during the period of Wanli, Wang Qi and Wang Siyi, father and son, wrote a Mapped Collection of the Three Talents (三才图会). It contains seven volumes of a Mapped Collection of the Body (身体图会), in which drawings of human organs were made from old ones. Shen Tong at the beginning of Qing Dynasty wrote a volume An Explanation on the Bones (释骨), which conducted textual research on previous characters and names in detail, but there was no personal view on anatomy. In another book, Drinking Vessel (觚) written by Niu Yuqiao (?–1704), it is recorded, “In Xianghua Temple at Wuchang city, a monk thought he was choking to death. His last words to his apprentice were, ‘Cut my chest and abdomen open’. As a result, a hairpin-like bone was found in his chest. The bone was put on the scripture desk for a long time to instruct others.” This seemingly was a kind of pathological anatomy, but no more information is available. This is also recorded in Xiang Zu’s Notes (香祖笔记) written by Wang Yuyang. Later there was one Wang Qingren, who was skeptical of the records of anatomy made in ancient times. He proposed the following: “There have been many qualified Prime Ministers able to govern the country, but never a perfect doctor who has written a medical book. The reason why there has never been a perfect doctor is that in ancient times, the records made of internal organs were erroneous, while in recent times, doctors abide by previous theories, which are not correct at root. Since the medical root has been set crooked, what doctors know about illness must be different from the actual state of affairs — even if they are extremely capable. That’s why there is no perfect doctor who understands medicine. When diagnosing disease, a doctor should be clear about the internal organs first. I have read theories and drawings of internal organs made by the ancients, but they are full of contradictions. I once had the willingness to correct them, but I had no chance to observe the internal organs. I hate writing medical books without a knowledge of the internal organs. It is nonsense. Treating disease without

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knowing the internal organs is just like a blind person walking in the dark night.” The wish of Wang Qingren was intense and his motive correct, but he could not carry out anatomical dissection by himself. He had to wait for an opportunity. He waited 10 years from the age of 20 to the age of 30 until in the second year of Jiaqing (1797 CE) he passed Daodi town, Luan City. He caught sight of a batch of corpses of children who had died from the pestilence. He spent 10 days observing more than 30 corpses, though they were just what the dogs had left, with opened chests and abdomens, and incomplete internal organs. By piecing them together, he inspected approximately ten complete bodies. However, it was difficult for him to see the thoracic diaphragm clearly, let alone their refined anatomy. Two years later, a mad woman killed her husband and father-in-law in Fengtian City (now Shenyang) and was punished by being cut to pieces at the execution ground. As the subject was a female, he couldn’t bear to inspect her. In the 14th year of Jiaqing (1828), he saw a male criminal being cut to pieces in the execution court of Chongwenmen, Beijing, but “though the internal organs could be seen, the diaphragm had been broken and I missed the chance to observe a complete diaphragm.” In the 8th year of Daoguang (1828), there was a criminal to be cut into pieces, but he was not allowed to be present. At the end of the next year, he was invited to treat a Xinjiang General’s illness and learned he had often killed enemies and cut their abdomens open. Thus, he asked to see the shape of the diaphragm and finally understood it clearly. In all 42 years, he only had one chance of observing all the internal organs of a human body in Daodi town. Nevertheless, he wrote the Correction of Errors in Medical Works (医林改错) which was published in 1830 CE However, Wang Qingren had actually looked at and observed the internal organs, although he had not conducted anatomy on them. Such a result surely affects the accuracy of his work. The descriptions of internal organs in the Correction of Errors in Medical Works (医林改错) are pitifully slight to the eye of modern people, and many people criticized them as “more errors than corrections”. This criticism is actually too biased. What Qingren had drawn was much more accurate than previous anatomical drawings and the shapes and locations of the organs were relatively precise. His mistake lay in his misunderstanding of the physiological functions of these organs. For example, he mistook arterial vessels, which had no blood in the dead body, for trachea or “breathing gates”. The record is as follows: “Two tubes of the left ‘qi gate’ and right ‘qi gate’ run downwards both sides of the lung pipe to the anterior half-part of the lung pipe, where they join together just like two branches of

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a tree unite into a single root. This is as thick as a chopstick, which then runs downwards into the heart and then leaves left of the heart shaped as thick as the handle of a Chinese writing-brush. Following this, it runs down behind the left heart and goes in front of the spine by passing left of the lung pipe and lung. It goes down to the tailbone, being termed a ‘common defensive duct’…” Obviously, this is a correct description of the left and right common carotid arteries, aortic arch, thoracoabdominal aorta and so on. But he believed wrongly they were channels of qi flow. He also mistook the running of “qi” in the common carotid arteries. He found stagnant blood in the vena cava, so he mistook it for a “common blood duct”; he found profuse blood above the diaphragm, so he mistook it for a “blood mansion”. These are all mistakes. However, we can’t consider them as completely wrong because they can be explained by the theories of Chinese medicine. Chinese medicine always takes the theory of qi blood flow as guide. It was not strange that Wang Qingren speculated as he did because what he thought of qi and blood was intuitively observed in his anatomy. Moreover, he further inferred a “disease mechanism” and established a new theory — a theory of Blood Stasis. He proposed many decoction formulae, such as Orifice Unblocking and Blood Invigorating Decoction, Blood Mansion Stasis-Expelling Decoction, Expelling Stasis below the Diaphragm Decoction and Lower Abdominal StasisExpelling Decoction. He propelled the development of many theories and the clinical practice of Chinese medicine; beyond all doubt, these formulae do have significant effectiveness in treating many strange and difficult diseases. This can also not be thought as hitting the mark by lucky accident. Wang Qingren was an anatomical innovator and what is more important is that he creatively added to and developed the theoretical system of Chinese medicine. However, his innovations were not thorough — as he was constrained by feudal ethics and influenced by complying with the classics. He was later even scolded for this by Lu Jiuzhi (a famous TCM doctor during the Qing dynasty). It is thus not hard to imagine the difficulties which stood in the way of anatomical development in ancient China.

79. The Monarch’s Medicine Tasted by Officials, Understanding Medicine as Filial Piety and Feeling the Woman’s Pulse Through a Gauze The Book of Rites – Considerable Rituals Vol. 2 (礼记·曲礼下) states, “If a monarch is ill and has to take medicine, his official should taste it first. If

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the parents are ill and have to take medicine, the son should taste first. If the doctor is not proficient in the Three Classics, don’t take his medicine.” The Chapter of the Sons of King Wen (文王世子篇) mentioned the king’s illness, saying, “As for the king’s medicine, his sons must taste it first in person.” These show the rules of feudal loyalty, filial piety, rites and morality that one must observe. For example, in the Han Dynasty, the Book of The Han Dynasty – Records of Chao Cuo (汉书·晁错传) states, “The King’s mother was once ill for three years. The King didn’t let his mother have the medicine unless it had been tasted by him.” The king surely gave a good example, but it is quite possible that before the king tasted it, some of his officials did. A son of the king was scolded in the following record. The Book of The Han Dynasty – Records of Jing 13th King (汉书·景十三王传) states, “King Xian was very sick and all the concubines took care of him at the bedside… When the medicine was served, his son decidedly refused to taste it and also didn’t look after him in the evening.” However, even King Wang Mang did quite well in this aspect. Book of The Han Dynasty – Records of Wang Mang (汉 书·王莽传) states, “When his father, a senior general, was afflicted by wind disease, Mang took care of him and tasted his medicine at any time, even when the general had disheveled hair and a dirty face.” The Yuan Dynasty was governed by the Mongols and fearing the officials didn’t observe the rites of the Han nationality, the King had to pass an order. The History of Yuan – Records of Tie Qi (元史·铁奇传) states, “In the 17th year of Zhiyuan (1280 CE), the king called in the Zhengyi Official and Medical Supervisor. He said to him, ‘I heard if the monarch is ill and has to take medicine, the official should taste it first; if parents are ill and have to take medicine, the son should taste it first. So from now on, since you are in charge of my food, you should taste these foods and medicines for me.’” Certainly, there are other reasons for tasting medicine. About Medicine (医说) written in the Song Dynasty records, “Li Fangyu was from the capital city. Early on when he was a medical official at the palace, Yuge, an imperial concubine, suffered from a productive cough. She was unable to sleep in the day and her face was swelling like a plate. At that time, she was the favorite of the king. When King Weizong visited her and saw her, he was very worried. He asked Li Fangyu to treat the disease right away. Li had prescribed medicine several times before. The imperial edict shown to Li said he must go to write his confession at the Interior Eastern Gate right away, and if his treatment was not effective, he would be executed. Li was anxious about his inferior medical skills and cried, together with his wife. Suddenly he heard a

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fellow shouting outside: ‘One Wen (ancient money unit) for a dose of cough medicine; if you have it, you will sleep well tonight.’ Li asked his subordinates to buy 10 doses of the medicine. The medicine was a little bluish-green. You ate it by mixing it with several drops of sesame oil in diluted chivewater. Li thought the nature of this herb was fierce, but it might make the bowels relax. He mixed three doses into one and tried it himself. Since there was no other prescription he could think of, he just put three doses into one and presented it to the imperial concubine in the Forbidden Palace. He told the imperial concubine to take it twice. At sunset, her cough stopped and the next dawn her facial swelling disappeared.” This is a case of tasting medicine in advance for the sake of one’s own life. It would have been essential for him to do so. Tasting medicine to prevent drug intoxication, especially by the “poisoner”, and thus protect the king or one’s parents seemed free of criticism at that time. But when “tasting medicine” is changed into “tasting stool”, it truly becomes disgusting. The Book of Liang – The Records of Yu Qianlou (梁书·庾黔娄传) states the following: At the beginning of the Qi Yongyuan period (499 CE)… it was no more than 15 days after Qianlou arrived at the town that he heard his father Yi had suffered from an illness. Qianlou felt suddenly scared and sweat streamed out all over his body. He gave up his official post right away and went back home. His family members were all surprised by his sudden return. At that time, his father had been sick for two days. The doctor said, ‘The prognosis can only be made by tasting the stool to know whether it is sweet or bitter. If it is bitter, the prognosis is good.’ Hence, after his father suffered from diarrhea and dysentery, he took some to taste. As the flavor was quite sweet and smooth, he felt bitter in his heart. The History of Northern Dynasty – Records of Tian Yi (北史·田翼传) states, “In the middle of the Sui Kaihuang period (581–600 CE), Yi’s mother suffered from fulminating dysentery. Yi thought she might be poisoned, so he tasted his mother’s stool in person.” Some even tasted vomited matter. Book of Sui Dynasty – The Records of Li Shiqian (隋书·李士谦传) states, “Li’s mother once suffered from vomiting. Poisoning was suspected, so Li knelt down and tasted the vomited matter.” There were never cases of tasting the stool initially in China. It came from India and other places where faeces were taken as a medicine, in Longmen formulae. Chinese books on formulae regarded the stool as dirty

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and never used it. In ancient Babylon, “Rotten flour or putrid other matter was used to expel evils. Wizards selectively applied snake poison, rotten meat, urine, feces, the gallbladder of the calf or pig, and other rotten matter swept up from the house. It seems the matter used as medicine must be as smelly and filthy as possible to spoil the demon’s stomach.”2 It was the same in ancient Egypt and India where the stool was stored as medicine in the pharmacy. In ancient India they also thought the “seven human discharges”, including urine, faeces, sweat, mucus, hair, nail and skin, were transformed by food, so the illness could be tested by tasting them. However, it was known diabetes could be diagnosed by tasting the urine from a very early stage. Arcane Essentials from the Imperial Library (外台秘要) written by Wang Tao in the Tang dynasty also has a record of tasting the sweetness of urine, which may derive from India. Tasting the stool was also brought in by Indian Buddhism Medicine. It was then blended with Chinese feudal ethics, as an indication of filial piety. There are many records in the history books. Old Book of Tang Dynasty – Records of Guo Ba (旧唐书·郭霸传) writes, “At that time, Wei Yuanzhong, a senior official, was ill in bed. All the Censors went to visit. Guo Ba was the last to visit. He saw Yuanzhong was worried about the disease, so he asked Yuanzhong to defecate, by which the severity of disease could be tested. Yuanzhong awaited the result with panic. Ba told him with a smile ‘If your stool tastes sweet, you will not recover. But if it is bitter, you will recover very quickly.’” The History of Yuan Dynasty – The Records of Wang (元史·王氏传) states, “Wang’s wife was called Hui, who came from Dadu. In the 14th year of Emperor Zhizheng (1354 CE), Hui fell ill and was in a critical state. Wang said ‘I have heard if the patient’s stool is bitter, the patient will recover’. Thus he tasted her stool and found it sweet. Wang was then worried.” Judging from the above records, taking faeces as medicine changed slightly into testing faeces. Testing urine was more common in medieval Europe, while in the Yuan Dynasty of China, it was testing faeces. The dubious custom of tasting faeces meant it was very easy to spread gastrointestinal infectious diseases. But as it was praised under filial piety, such a disgusting practice was encouraged. This really is a pity. On the contrary, knowing medicine was essential for a dutiful son. Tasting faeces was surely ridiculous, but because of the presence of filial piety it was well argued that when learning or practicing medicine it was a necessity. This idea could have come from Zhang Zhongjing’s proposal in 2

 Refer to p. 8 of Five Thousand Years of The World Medical History translated by the author.

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the Preface of the Treatise on Cold Damage (伤寒论序), which records, “The people of the present-day should be blamed for not paying attention to medicine or not learning medicine well enough, as it could be helpful in diseases of their superiors, like the king or their parents, and of their inferiors, for instance the poor and humble.” Since mastering medicine ensures both loyalty and filial piety, people observing feudal ethics were rather willing to accept it. There are many such records in The History of Northern Dynasty (北史): When Zu Dao was young, his mother was often ill. So he read all kinds of medical formulae, becoming extremely proficient and a famous doctor. He warned his sons that ‘If a son is unable to know recipes and medicinal formulae, how can he be a filial son?’ This caution was passed on for generations. [The Records of Xu Zhicang (许智藏传)] At the beginning, Yuanzhong concentrated on learning medicine because his mother suffered from illness a great deal. Hence, he was good at herbal formulae and therapies. With a kind and merciful heart, he gave treatment to patients regardless of their station in life. [The Records of Li Yuanzhong (李元忠传)] Since his mother had been ill for many years, without improvement, after having treatment even by famous doctors, he learnt classic formulae assiduously. By applying both herbs and acupuncture, he cured his mother’s disease. As a result, he was famous for his medical skills. [The Records of Li Mi (李密传)] Sun Simiao also advocated learning medicine for filial piety. His Preface to Essential Recipes Worth A Thousand Gold (千金要方序) records, “I recall that the saints’ idea of teaching was to make self-study and self-understanding possible. If we are unable to treat diseases of the monarch and our parents, we are not faithful and filial enough.” There were many doctors with such an original purpose during the Tang dynasty. The New Book of the Tang Dynasty – The Records of Zhen Quan (新唐书) says, “Zhen Quan studied medical records and books for his mother’s illness. He thus became an experienced doctor.” Records of Wang Tao (王焘传) states, “Wang Tao was extremely filial. He was a sima (official rank) at Xuzhou city. His mother had been ill for many years, so he looked after her day and night, searching out herbal formulae everywhere, and visited many experienced doctors. He thus learned medicine very well. He put what he acquired into a book, calling it Arcane Essentials from the Imperial Library (外台秘要).”

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The Records of Li Fengji (李逢吉传) states, “Li Fengji’s father had a stubborn lesion on the face, so Fengji read the formula books thoroughly and formulated herbal preparations himself.” Wang Bo had an especially great impact at that time. He was a famous writer and vigorously advocated “Being a son one should never be short of a knowledge of medicine.” The Records of Wang Bo (王勃传) states, “At that time, Cao Yuan from Chang’an city had some secret recipes, so Bo visited him and learned all his recipes.” He hence became an amateur doctor. He mentioned himself, in a preface to the Classic of Difficulties (难经): “I was often instructed by my father that in ancient times if a son knew nothing about medicine, he was regarded as not filial. I thus visited good doctors and learnt their skills secretly.” Wang Bo had learnt medicine for more than 6 years and was devoted to practicing life-nurturing ways. Thanks to his writing reputation and propagation, having some knowledge of medicine and practicing filial piety became a popular custom at that time and was even more common after the Tang dynasty. It turned into one of the motives for learning medicine among the common people. A special example of this, mostly influenced by Confucianism, was “feeling a pulse through a thread”, which often occurred on the stage during an opera. This derives from the idea that “bodily contact between a man and a woman is improper”. Mencius – Li Lou Vol. 1 (孟子·离娄上) states, “If you don’t help your elder-brother’s wife who is near-drowning, you really have the heart of wolf. Bodily contact between a man and a woman being improper is part of the ‘rites’. However, you should be flexible when your elder-brother’s wife is near-drowning, and give her your hand.” Someone asked Mencius if a doctor could touch a woman’s body parts or feel her pulse directly if she fell ill in order to diagnose the disease. The answer Mencius gave was “you should be understanding when a woman is ill, and give her your hand.” In the period of Emperor Wan Li (1573–1620 CE) during the Ming Dynasty, the special case of “feeling a pulse through a thread” arose. County Annals of Xiang Yang (襄阳县志) records, “Cui Zhenren, alias Mengzhuang, was from Beishuiguan. He studied medicine day and night with his family cousin, until he had acquired all its magical recipes. In the period of Wan Li, the Emperor’s mother was ill. Zhenren was called in and he felt her pulse by a thread going through a hole in the bed curtain. Her disease was cured soon after she had his formula. As he refused any official title or money, the Emperor ennobled him as a zhenren (Pure Man). He later became an immortal at Mount Wudang, and called himself Pu’an.” This record was advocated by Emperor Wan Li, but Danbo Yuanjian, a Japanese medical expert of the

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textual research school, pointed out that “this is probably a far-fetched case, taking the idea from Sun Wukong’s story in the fiction A Pilgrimage to the West (西游记).” The book Medicine (医) records, “The legend of feeling a pulse through a thread in the histories has never been recorded in a medical book.” Therefore, “feeling a pulse through a thread” can be regarded as fictitious, not a fact of medical experience. However, there was still no rule “prohibiting the touching of a female’s hand when feeling for the pulse” during the Han Dynasty. The Later Book of The Han – Records of Guo Yu (后汉书·郭玉传) states, “When Guo Yu was young, he learned medicine from Cheng Gao. He acquired methods of diagnosing diseases, prescribing formulae, identifying subtle movements of the six qi, and deducing Yin and Yang. In the period of the He Emperor (89–104 CE), he was appointed as an imperial doctor and his treatment was often quite effective. The king was curious about him. One day, he ordered a man who had beautiful hands like a girl to stay with a girl behind a curtain. Then he asked Guo Yu to feel the pulse of the two hands, one from the man and another from the girl, and make a diagnosis. Yu answered ‘The left one is a Yin pulse, while the right one is a Yang pulse. The pulses are from different genders and they seem to be from different persons. I am puzzled at this.’” Judging from this, feeling the pulse of a female directly was allowed in the Han Dynasty. The purpose of letting two persons stay behind the curtain was only to test Guo Yu’s technique of feeling the pulse and his ability to distinguish male and female when not seeing the subjects. The History of the Northern Dynasty – Xu Jian (北史·徐謇传) has a similar case. It records, “Xiangwen wanted to test his capabilities and asked a patient to stay behind a curtain. Jian felt the pulse with the separation of a curtain. He understood the illness clearly as well as the complexion and syndrome.” About Medicine (医说) written by Zhang Gao in Song Dynasty includes a doctrine of “not lusting after women”, which records, “There was an intellectual during the period of Xuanhe (1119–1125 CE). He had been ill for many years after hundreds of treatments. One day, his wife called in a good doctor, whose name was He Cheng. She led the doctor into a private room and said to him, ‘My family have sold everything to treat this longtime illness of my husband, so we have no money to cover the medical fee. This time, you can have sex with me as a fee.’ The doctor refused her sternly.” This shows communication between a doctor and woman was normal, and the doctor could even enter the private room of a woman. But doctors had a noble virtue; they didn’t lust after women.

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However, About Medicine (医说) also quotes from the Extension of the Materia Medica (本草衍义), which criticizes the action of having “a woman cover her hands with a silk cloth for doctors to feel her pulse”. This indicates there was a taboo of bodily contact between a male doctor and a female patient during treatment in the Song Dynasty. It is recorded in the following example: “Though gynecology is indicated especially for women’s diseases, treatment methods of the ancient saints cannot be wholly applied. At present, female patients from a rich family stay in a remote room and behind a curtain for treatment. Moreover, their hands are covered with a silk cloth. Therefore, inspection of complexion and pulse feeling become impossible. Two of the four diagnostic examinations (inspection, auscultation/olfaction, inquiry and palpation/pulse feeling) are thus missing. Huangdi once said, “For all treatment of disease, one investigates the patient’s physical appearance, his qi, and complexion. When physical appearance and qi agree, this is called ‘curable’. When the complexion is glossy and the movement in the pulse is at the surface, this is called ‘easy to recover’. When physical appearance and qi disagree, this is called ‘incurable’. When the complexion has faded away and is not glossy, this is called ‘difficult to recover’.” He also said, “The way of diagnosing disease is to observe a person’s brave or timid nature, his bones, his flesh, and his skin, enabling one to recognize his state. Thus this is to be considered the law of diagnosis.” If a doctor prescribes a herbal formula without feeling the pulse and inspecting the complexion, is this feasible? In such a case, no doctor can fully exert his medical skills. This is the stupidity of doctors and it can’t be reformed even after generations. Since a doctor can’t completely collect information or apply medical theory, he must ask the female more questions. The female loses confidence in the doctor because there are so many questions and will refuse to drink the herbal decoction. It seems there are many such cases. Emperor Qi Huangong didn’t believe Bian Que’s diagnosis even when he had inspected his complexion, let alone in the present state when no complexion can be inspected. Alas, how difficult it is!” Judging from the above, covering the woman’s hand with a silk cloth when feeling the pulse came into being in the Song dynasty and the initiators were rich and powerful people, who regarded a woman as their private plaything and took advantage of feudal ethics to cover their privacy. Both Zhang Gao and Kou Zongshi, the authors of the Extension of the Materia Medica (本草衍义) were opponents of this. They upheld justice and thus refuted such actions by their statements. However, the endeavours of medical experts were still restrained and restricted by feudal ethics. The History of the Ming Dynasty – Records of

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Imperial Concubines (明史·后妃传) states, “Doctors were not allowed to enter the palace to diagnose diseases of the imperial concubines. Instead, they were only permitted to prescribe formulae by hearing information from others.” This became official — and people were unable to recognize its foolishness. As a result, people observed this prohibition and doctors had to comply with it as well. Li Chan in the Ming Dynasty included it as a medical rule in An Introduction to Medicine (医学入门) published in 1515 CE, and it records, “If the patient is a woman, the doctor should ask her closest relative to inquire after her complexion, tongue condition and dietary state first of all and then make a diagnosis. Or, if the woman is seriously ill, the doctor should make the diagnosis on the other side of bed-curtain. Or, if the woman is not seriously ill, the doctor should carry out the diagnosis behind a curtain. The female patient must put gauze over her wrists. If a poor women has no gauze, the doctor should prepare the gauze himself.” Fortunately, he didn’t write “feeling a pulse through a thread” in this book. A doctor surely understands that he is unable to feel a pulse through a thread, unless a modern “energy-converter” becomes available that can detect a pulse at a distance. Still some continued to resist. Gong Tingxian wrote in The Restoration of Health from the Myriad Diseases (万病回春) published in 1587 CE, “Nowadays, when patients ask doctors for treatment, they just stay in a dark room and behind bed-curtains. They don’t speak of the problem and only let the doctor feel the pulse. As for women patients, most of them don’t allow the doctor to inspect them. How is it possible for a doctor to know the patient’s voice and complexion? What’s more, women cover their hands with silk handkerchiefs and the like. It is indecent for doctors to ask them and they don’t answer even if they are asked. Isn’t this a difficult situation for doctors as the result is that the patients become more ill after the treatment?” Later, Chen Shigong proposed a relatively feasible rule, which is also generally observed by doctors in modern China. The rule comes from the “five disciplines and ten essentials of doctors” written in the Orthodox Lineage of External Medicine (外科正宗) published in 1617 CE. He writes, “If the patient is a woman, widow or nun, the doctor can only inspect her in her room with an attendant accompanying them. If there is no attendant, inspection is not allowed. The inspection should be more truthful because of such an inconvenience. Even though he is in woman’s quarters, the doctor should not talk about private matters.” Actually the above rule is quite similar to the rules of Western gynaecology and the rules of protecting patients’ interests in modern times.

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Therefore, correct medical ethics may result from ancient feudal ethics and a feeling of moderation. “Covering with a silk cloth or gauze” was the consequence of oppression caused by Confucian rites, while “feeling a women’s pulse through a thread” was merely an exaggeration made from drama and fiction.

B. Neo-Confucianism, “Down-to-Earth” Learning and Medicine Chinese philosophy reached a new climax during the Song Dynasty, as it was during this period that neo-Confucianism was born. Neo-Confucianism included the school of neo-Confucianism (Zhu Xi was its leading representative) and the philosophy of mind (with Lu Jiuyuan and Wang Yangming its representatives). Among those of the Qing Dynasty, the “Down-toEarth” Learning movement became a noted school of thought. There were generally different developmental forms of Confucianism during different periods, but they all relied on a common core and the two theoretical pillars of Confucian religion and feudal ethics.

80. From the Taiji Diagram to the Innate Root — The “Kidney’s Life-Gate” Neo-Confucianism was initially a new combination of Taoism and Confucianism. “Exterior Confucianism and Interior Taoism” began to have supporting theories. In the first place, the “venerable ancestor” Chen Tuan carved the Wuji Diagram on the cliff of Huashan Mountain, illustrating the five major phases of refinement which occurred during internal alchemy, namely gaining a recipe, refining the body, the concordance, obtaining the medicine and bodilessness. This was an illustration of the coordination of spiritual and physical life. Later, Chen Tuan passed this illustration on to Zhong Fang, Zhong Fang to Mu Xiu, Mu Xiu to Li Zhicai and thence to Guo Yong. Mu Xiu also passed on the Taiji Diagram to Zhou Dunyi, and the latter to Cheng Hao and Cheng Yi. At the same time, Zhou Dunyi pursued his study with Zen Master Chang Cong at Donglin Temple. The Noble Direct Compilation (尚直编) records, “Master Donglin taught him the full details of Buddhist theory and Zhou spread it abroad as the Taiji Diagram and Explanation.” In addition, he was also inspired by the sayings of Hui Nan and Fo Yin. “Dunyi once exclaimed,

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‘This ingenious idea is actually inspired by Huanglong (i.e. Hui Nan from Huanglong Mountain) and elucidated by Fo Yin (from Guizong Temple, Lushan Mountain)’. However, the theory of the Changes is so profound that Master Donglin’s ideas are incapable of explaining them completely.” Hence, we can see that neo-Confucianism was also influenced by Buddhism, and is actually an integration of Confucianism, Taoism and Buddhism. Zhou Dunyi (1017–1073 CE), also known as Mao Shu and Lian Xi came from Lianxi Village, Dao County, Hunan province. As he was the master of Cheng Hao and Cheng Yi, who were later Zhu Xi’s masters, Zhou Dunyi is regarded as the originator of neo-Confucianism during the Song dynasty. His Taiji Diagram and Explanation integrates the Yin–Yang, five elements and other notions into one, and explains the occurrence of all the things in the world in the following way: The Wuji (no ultimate) gives birth to the Taiji (greatest ultimate). The motion of the Taiji generates Yang and its motionlessness produces Yin. Extreme motionlessness turns into motion again. Motion and motionlessness are interdependent. Yin and Yang are thus derived as two aspects of the same thing. Yang governs motion and change, while Yin dominates motionlessness and integration, and the elements of water, fire, metal, wood and earth are produced. The qi of these five elements runs into and distributes order between heaven and earth, creating the turn of the four seasons. Therefore, the five elements come from Yin and Yang, and Yin and Yang are transformed by the Taiji. However, the Taiji is rooted in the Wuji. Each of the generated five elements has its own individual nature. The fortunes of the Wuji and the abstruse integration of its parents’ essences in Yin, Yang and the five elements are its prerequisites. If masculine qi dominates, a baby is male; if feminine qi is leading, a baby is female. Similarly, the interaction of Yin and Yang qi transforms everything. Infinite changes hence come into existence after the birth of all things on earth. But mankind gets its purest essence and is the most intelligent. After they are born, an individual’s intelligence develops and grows into a great wisdom. People feel different according to the nature of the five elements and form different characters, good and evil, emerging as an endless procession of affairs. The sage abides in kindness and justice, and advocates inner peace and selflessness.3 This is the ultimate human code. So the ‘Sages can 3

 Author’s note: No desire ensures inner peace.

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be as selfless as the virtues of heaven and earth, can be as fair and square as the bright sun and moon, can possess an order of energy as in the four seasons, and can perceive good or evil just as ghosts and gods.’ If a junzi (gentleman) cultivates himself with this human code, his life will be auspicious. If a base person goes against this human code, he will reap misfortune. The Book of Changes (易经) says, ‘The code of human life is kindness and justice. It is as permanent as the Yin and Yang of the heavenly Tao, as hard and soft as the earthen Tao’; it also says ‘seeking the source of life and death makes us realize the real meaning of life and death’. Great indeed is the Book of Changes. No previous master of philosophy before Zhou Dunyi had unified Yin and Yang, the five elements and qi. His Taiji Diagram and Explanation was further elucidated by the Explanation of the Taiji Diagram (太极图说解) written by Zhu Xi (1130–1200 CE), a great Confucian, and thus gained a wider influence. The Taiji Diagram sketches out the mode of the universe and its words specifically point out the generation and running rules of its prime power. This was indeed a great summarization and development of the philosophies of the Tao, qi, Yin, Yang and the five elements — ideas which derived from the pre-Qin period. However, the impact of this on the theory of Chinese medicine occurred rather later, probably more than 400 years later. It was initially applied in the Key Link to Medicine (医贯) written by Zhao Xiangke during the Ming Dynasty (published in 1617 CE). It records, “The Wuji is the Taiji before division, while the Taiji already has the division of Yin and Yang. The diagram of the Taiji is the pictogram of the Taiji. The circle is named the Wuji. Since there is no heaven before the formation of the Taiji, which should be invisible, why is a circle visible here? Because it is done as a last resort, to show learners. People also are subject to the shape of the Taiji — as we come into being also between heaven and earth. I drew an image of the person according to the ancient Bronze Man and found on it clearly the wonderful points of the Taiji all over the human body.” Zhao Xiangke thus applied the Taiji in order to explain the human body and tried to find the location of the Taiji within it. He held that the Taiji of the human body was the “life-gate”. He wrote, “The life-gate locates at a point 1.5 cun away from each kidney. It is in the middle of the body, namely at the ‘one Yang embedded between the two Yin’ as stated in the Book of Changes (易经). The Inner Classic (内经) states, ‘To the side of the seventh

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joint, in the middle there is a small heart.’ This refers to the life-gate. It is the genuine monarch and governor of the body. It is the Taiji of the body. It is invisible, though it locates between the two kidneys… This is the invisible, innate fire that is different from the visible, acquired fire… The invisible fire of the life-gate exists between two visible kidneys, where it is called the huang ting (‘Yellow Court’). Therefore, the kidney is the root of genuine qi of the five zang organs.” Sun Yikui (1522–1619? CE) wrote Remnants of a Medical Decree (医旨 绪余), in which he advocated a “Theory of the Stirring Qi in the Life-Gate” and also applied the Taiji Diagram and Illustration to explain it. He wrote, “The parent’s essence of Yin, Yang and the five elements join together most wonderfully. Before the gender of the baby is known, the two kidneys come into being. They are just like beans, in that when the bean sprouts out the earth, the two halves of the bean separate and a little genuine qi is contained at the base of the root, generated between the two halves. The genuine qi is the propelling power, which is called the ‘stirring’, or ‘primary’ qi. It forms at the beginning of life out of nothing. This primary qi is the thing in itself, or ‘noumenon’ of the Taiji. The ‘stirring’ qi is named as such because generation comes from movement, the stirring of the Yang. This is what the motion of the Taiji depends on. The two kidneys are static, motionless things. Motionlessness leads to transformation, and this is the motionlessness of the Yin. Ceaseless coordination of motion and motionlessness results in the Yang’s changes and the Yin’s integration, bringing forth water, fire, wood, metal and earth. So this is why this point is called a ‘life-gate’.” The theory of the “life-gate” as the innate Taiji and root of the primary qi had thus been established. Zhao Xiangke developed this further into a theory of embryology in Key Link of Medicine (医贯). It records, “The fetus of the human occurs when the qi of ren channel is sufficient and only when the life-gate has come into existence. Existence of the life-gate generates the heart and the heart produces blood. The lungs are generated after the existence of the heart. The lungs form the skin and hairs on the body. The kidneys come into being after the lung and produce the bones and marrow. The kidneys integrate with the life-gate and thus are in two separate parts.” Zhang Jiebin also developed this idea further in The Complete Works of [Zhang] Jing-yue (景岳全书) completed in 1624. He records, “The fire within the water is the innate and genuine qi stored within the kan-water (historical trigram symbol). This qi runs upwards to connect with the acquired stomach qi for transformation. It is actually the root of the generation of all other parts.”

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Also, Li Zhongzi (1588–1655 CE) developed a theory of the “kidney as the innate root, and the spleen as the acquired root”. He wrote in Required Readings from the Medical Ancestors (医宗必读) the following: “Why is the kidney the innate root? This is because the two kidneys existed before the forming of the body. The kidney is the root of the zang-fu organs, the root of the twelve channels, the root of respiration, and source of the san jiao, on which the human body is dependant at its beginning. Therefore, the kidney is the innate root. Why is the spleen the acquired root? This is because people feel hungry if they have nothing to eat for a day and die with empty stomach if they don’t eat for seven days. The Inner Classic (内经) states, ‘Being able to eat is good, while failing to eat is bad.’ If the stomach qi collapses, no medicine will be any good. Once the body is formed, nutrients must be taken in. The food enters the stomach and its nutrients are distributed into the six fu, ensuing fu qi, which nourishes the five zang organs. Blood is thus produced to support the human body. Therefore, the spleen is the acquired root.” The kidney mentioned here actually refers to the lifegate. Hence, the theory of the primary qi of the Taiji gave a solid foundation to Chinese medicine, always exerting influence on later generations of theories and the clinical practice of medicine. Its great success during the Ming dynasty has been revealed here.

81.  Zhang Jiebin’s Taoist Medical Theories Zhang Jiebin was a famous medical expert during the Ming Dynasty, who was influenced by neo-Confucianism and the philosophy of mind that begun in the Song Dynasty. He deduced theories, and formulated and analysed herbal formulae, following the Neijing (内经), along with the contemporary Ming philosophy of mind. Therefore, he made some developments in medical theory, but there was an element of subjectivity in his clinical deductions that took him some distance from reality. Zhang Jiebin (1563–1640 CE), also named Huiqin, Jingyue or Tong Yizi, was from Shaoxing, Zhejiang. He followed his father to the capital city when he was thirteen. He learned medicine very well from Jin Ying, a famous doctor. When he was forty years old, he joined the army at the Shu Governor’s Office. He stayed there for several years without any achievement. Then he went back to his hometown to practice medicine. He read all the books written by famous doctors and his medical skills improved day by day, so he became better known. He was also quite knowledgeable in the Six Classics, military strategy, physiognomy, astronomy, geomancy and ancient

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musical tones. He wrote many books, including The Classified Classic (类经), the Appendices to ‘The Classified Classic’ (类经附翼), the Pictorial Appendices to ‘The Classified Classic’ (类经图翼), The Complete Works of [Zhang] Jing-yue (景岳全书) and so on. He was greatly influenced by neo-Confucianism and its philosophy of mind. His nickname Tong Yizi literally means the “one of the Taiji”, indicating he knew this diagram well. In the 4th year of Tianqi (1624 CE), he completed his Classified Classic (类经). The Pictorial Appendices to the ‘Classified Classic’ (类经图翼) is simply a book that applies the Tai-chi Diagram to explain the Neijing (内经). Zhang Jingyue was especially influenced by Wang Yangming. He wrote Imparting the Mind Records (传心录), also named Imparting the Faith Records (传忠录), to follow in his footsteps. He wrote as follows: “Everything occurs for a reason, especially medical treatment. Medical theory can be so broad that it embraces all aspects of the world; while in a narrow sense, it can gather in just one single mind. The doctor has one mind, but the patients’ diseases are many and varied. It is surely difficult to treat so many kinds of diseases. However, each disease has its own root. The doctor’s mind is just like the North Star, while all the other stars are like different diseases. If the North Star is used to confront all the other stars, it will be unequal to the task. But if it is applied to face only one star, there will surely be a straight line between them with one illuminating the other. Then the North Star will not be the inferior one. Therefore, in medical treatment, the doctor’s mind must be clear on the root of the disease. Using the doctor’s single mind to tackle one single disease ensures an explanation for all puzzles. Isn’t it that easy? This one mind means understanding the root. Since the root has been understood, the doctor can identify for certain the Yin or Yang nature of the disease, without confusion. After Yin and Yang have been identified, he may differentiate the opposing aspects of exterior and interior, deficiency and excess, cold and heat. If a doctor can identify these six changes and differentiate Yin and Yang, no disease will be mistreated… I make these records to state clearly the theories that unify Yin and Yang and guide us along to the grand Eight Principles. The prosperity of a country depends on its soldiers, while a patient’s life is in the hands of the doctor. Grasping the heart of a philosophy of mind is primary. This explains why this book is entitled Imparting the Mind Records. However, whether imparting the heart or imparting the mind only concerns people’s health, so I have also named it Imparting the Faith Records.” This clearly shows his belief in Wang Yangming’s Study on Imparting Records (传习录), from which he deduced his medical theories. The Taiji

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gives birth to the Yin and Yang, and Yin and Yang to the “six changes”. These make up the “eight principles” widely known in Chinese medicine. This deduction is quite accurate and extremely useful in clinical practice. The Appendices to ‘The Classified Classic’ (类经附翼) and The Complete Works of [Zhang] Jing-yue (景岳全书) have the following quotations: “The greatest treasure in the sky is the sole sun, so the greatest treasure in the human body is one single puff of the genuine Yang.” “The Yin and Yang of Taoism are initially from the same source.” “Yin and Yang in the human body are a reflection of the qi, blood, and cold and heat of the zang-fu organs. As for the invisible and innate Yin and Yang, the Yang is called the primary Yang, while the Yin is called the primary Yin. The primary Yang is just the invisible fire, which is the magical power of generation and transformation. All life depends on it, so it is also called the primary qi. The primary Yin is namely the invisible water, which is the tiangui (water) for growth and generation. The strength of the body depends on it, so it is also called the primary essence. The primary essence and primary qi are just the primary spirit for transforming and producing essential qi. All qi generation depends on it… Doctors at present only know the visible, pathogenic qi, they don’t understand the invisible, primary qi…” Zhang Jiebin here makes several theoretical conclusions concerning the theory of primary qi. But his methodology is derived from Wang Yangming’s philosophy of mind. Zhu Danxi also advocated a theory that “Yang is often in excess (redundant), while Yin is insufficient” and also that “qi having excess is commonly due to fire.” Zhang Jiebin refuted this argument by logical reasoning, using the philosophy of mind on the basis of the innate and primary qi of the Taiji life-gate. In his Queries on the Records – About the Yang Being Often Redundant (质疑录·论阳常有余), Zhang Jiebin records that “The two is the Yin, the acquired substance; the one is the Yang, the innate qi. Spirit is transformed by qi from heaven, so the qi of the genuine Yang is the one that develops our human body. The bodily structure is formed by essence and essence derives from qi. The essence of the genuine Yin is the one that builds our human body… Zhu Danxi took the example of the waxing and waning of the sun and moon to illustrate his belief that the ‘Yang is often in excess, while the Yin is insufficient’ and held Nourishing the Yin Pills to be a kind of magical medicine. However, he didn’t understand that the tiangui water failing to arrive was at root because of the qi. Though the form of the Yin qi belongs to Yin, it is also produced by qi, which pertains to Yang. As a result, the warmth of the whole body is kept there by Yang qi and when people die, although the form of the body still exists, the qi of the body is gone. This is

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a Yang collapse before the remaining Yin. Hence, the birth of the human body depends on Yang, and so does death. It is not the Yang that causes harm. It is the Yang that ensures life and when Yang is depleted, death results… We can see our life is run by this puff of genuine Yang. What’s the point of him saying the Yang is often redundant? It is unreasonable of him to use bitter and cold herbs to reduce the Yang qi!” Queries on the Records – About Redundant Qi Being Fire (质疑录·论 气有余即是火) records, “Redundant (excess) pathogenic qi can be seen as fire, but a surplus of healthy qi makes up further the primary qi of the body. The primary qi of human life is formed from the life-gate. The life-gate is the dwelling of the spirit and root of the Yang qi. Therefore, if the fire of the life-gate is vigorous, more essence of food will be turned into essence. This is why we say ‘no generation can be brought about without this fire’. This fire is simply qi and it can’t be misconstrued as a redundant pathogen. Qi gives birth to the lesser fire of our human life and it is the root of our physiology. If the healthy qi is in surplus, it cannot be considered as fire. Zhu Danxi’s words really lack clarity.” Jingyue’s theoretical deduction is very insightful. At the least, he clarifies the concepts of innate qi, acquired qi, healthy qi and pathogenic qi. He advocated supplementation by warming, while Zhu Danxi favoured nourishing Yin. They are both a little one-sided, so Jingyue’s argument may also not be totally applicable in clinical practice. However, he is reasoned in his argument. Very few historical experts in Chinese medicine could make such logical deductions. Zhang Jingyue was in favour of applying shu di huang (Radix Rehmanniae Praeparata) and thus nicknamed Zhang Shudi. His recognition of the properties of shu di also derived from his philosophy of mind. The Complete Works of [Zhang] Jing-yue (景岳全书) records, “... they say shu di huang is not a tai-Yin (spleen) or Yang-ming (stomach) herb as it acquires the earthen qi, but I don’t believe it. It is only the raw herb which is cool natured, so patients with spleen Yang deficiency should be cautious in having it in this way since the spleen and stomach are in favor of warmth. However, the treated herb, namely shu di, has a neutral nature with extreme Yin and pure quietness. Thus it can supplement the genuine Yin of the five zang organs, and is especially important to the organs more in need of blood. Isn’t it then a herb for the spleen and stomach channels? What’s more, the life of the whole body depends on the qi and blood. Qi belongs to Yang and is characterized by moving, while blood pertains to Yin and is featured by keeping relatively still… Ren shen (Radix et Rhizoma Ginseng) and shu di are indispensible to reinforce qi and blood. Therefore, ren shen

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is essential for Yang qi deficiency in all the channels; just as shu di is a must for Yin blood deficiency in all the vessels. Ren shen has the function of strengthening transportation, while shu di possesses the virtue of quietness. Hence, shu di and ren shen, one Yin and one Yang, are in an interiorexterior relation for generation, both in substance and qi aspect. No other herb has such neutral properties as shu di huang.” Though a little biased, he was still a rare medical theorist within the medical tradition, one who was so deeply influenced by the neo-Confucianism of the times that he applied it to his own medical theories and associated experience.

82. Medical Reflections on Acquiring Knowledge by Probing into Things As opposed to Lu Jiuyuan and Wang Yangming’s “illuminating principle through mind”, Zhu Xi advocated “investigating principle through specific things” and “acquiring knowledge by probing into things”. In comparing them together, Zhu Xi’s view may be termed an “objective idealism”, but they are generally consistent with each other. Strictly speaking, Zhang Jingyue’s theories have many factors of “acquiring knowledge by probing into things”, because in terms of medicine, the patient and the disease are the ultimate object for any physician in clinical practice. Zhu Xi once said, “On a large scale there is the Wuji and Taiji, while on a small scale there are trees, grass and insects. Each of them has its own reason for existing. If we fail to read a book, we miss the knowledge of that book; if we don’t investigate an event, we are deprived of understanding its inside story; if we pay no attention to probing into a thing, we are unable to learn any knowledge of it. We must look at everything in order to understand it.” This is recorded in Zhuzi’s Language Category (朱子语类) Vol. 15. Based on this theory, Zhu Xi got to understand the grass, trees, humans, beasts and suchlike. He understood them in the following way: “At the beginning of heaven and earth, only the qi of Yin and Yang is in existence. This qi moves at random and Yin and Yang rub against each other. Sometimes, the rubbing is quite severe, which means some dregs or residue are produced. As there is no way out, the dregs accumulate making the earth at the center of our world. The lucid qi becomes the sky, sun, moon, and stars, all of them only circling around in the peripheral regions. The earth remains still in the middle, but should not be thought of as below.” (Vol. 1) “I guess that at the beginning of the chaotic world when heaven and earth were mixed up and had not yet separated, there was only fire and

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water. The precipitated dregs of the water became the earth. If you stand high and look over the mountains at present, you can see they are wave-like, shaped just the same as water waves. The only thing we don’t know is when the precipitated dregs coagulated together. They were very soft at an early stage, and only became harder afterwards.” (Vol. 1) “We often see clamshells in the high mountains or in stones. These stones are namely from the earth of early times and clams are creatures which live in water. Things below change into things high above, while soft things transform into hard ones. This is an extremely profound idea, and it can be proved by evidence.” (Vol. 94) Zhu Xi obviously observed some facts — and then proposed these hypotheses of celestial formation and crustal movement because of his thinking of “acquiring knowledge by probing into things”. These hypotheses were undoubtedly the most advanced and scientific of the time. We can’t help admiring his imagination and ability to propose such hypotheses. However, despite this, his methodology in “acquiring knowledge by probing into things” was hermeneutic instead of explorative. Therefore, his theoretical hypotheses could not be deepened further. Many medical experts followed this methodology of “acquiring knowledge by probing into things”. Zhu Zhenheng (1281–1358 CE) was one. He was also named Yanxiu and people called him Mr. Danxi. He came from Yiwu, Zhejiang province, and founded one of the four great medical schools during the Jin and Yuan dynasties. His knowledge found its origins in Zhu Xi’s neo-Confucianism. He was taught by Xu Qian, a fourth-generation follower of Zhu Xi at Bahua Mountain in Dongyang city. He later practiced medicine and was imparted Liu Hejian’s medical theories by Luo Zhiti. He also absorbed the arguments of different schools, such as those of the “Yi water”. He learned the theories of Taiji and Zhu Xi’s methodology. He wrote Further Discourses on the Acquisition of Knowledge through Profound Study (格致余论) and many other works, all as a result of his probing into medicine. He advocated a “ministerial fire” and thought that the “Yang is often in excess and the Yin insufficient”. He was famous for his school of “Yin-nourishing” in clinical practice and his impact spread out as far as Japan. He discusses “ministerial fire” as follows: “The motion of the Taiji generates Yang while its motionlessness produces Yin. Changes come about from the moving Yang while the motionless Yin results in integration. Water, fire, wood, metal and earth are thus each formed with their own individual nature. However, only fire has two categories. One is ‘monarch fire’, or

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human fire and the other is ‘ministerial fire’, or heavenly fire. Fire is Yin within and Yang without, which is characterized by motion. The monarch fire is so called because it generates our bodily substance and qi, and is distributed in the five elements; the ministerial fire is so positioned as it is born in the void, waits for distribution in our lives and then because it is moving becomes perceivable. The heavenly governs the generation of things, so it is moving permanently. A human being also has this property, so he then also becomes permanently in motion. Therefore, all permanent motion is actually due to ministerial fire. As it is seen in the heavens, it becomes thunder, which is the wood qi; if it occurs in the sea, it is qi of water; if it occurs in the human body, it lies in the liver and kidney, as the liver pertains to wood and kidney to water… The heavenly can’t generate anything without this fire, and the human body can’t transform anything without it either.” Zhu Danxi took the Yin and Yang of the Taiji, the movement of the body and qi, the distribution of the five elements, and “monarch” and “minister” as analogies to deduce the existence of the “ministerial fire” within the body. Here, we can see his recognition of human physiological functions and pathological manifestations arising from clinical practice. However, he was totally applying philosophical ideas to make what he recognized into a theory. He even cited Zhou Dunyi and Zhu Xi’s sayings. Zhou Dunyi said, “After the spirit has been developed and intelligence completed, the five natures interact and all other things are produced.” After the completion of the intelligence, the five natures interact in order to produce other things, so they must be in motion. This motion is so called after the five kinds of fire in the Inner Classic (内经). The ministerial fire is easy to set on and be stirred up by the fire of the “five natures”, becoming frenetic. This frenetic fire changes unpredictably and lasts long enough to boil the genuine Yin. Yin deficiency causes diseases and depletion of Yin leads to death. The qi of monarch fire may be compared to summer heat and dampness, while the qi of ministerial fire may be compared to just fire. So ministerial fire is fiercer than monarch fire. Hence, some people call it the “thief” or “culprit” of the primary qi. Zhou Dunyi also said, “A sage abides in kindness and justice, and advocates inner peace and selflessness.” Zhu Xi said, “We must always let the natural heart manage the body — then each human heart follows its destiny.” Therefore, if we want to control this fire well, we should let each human heart follow its destiny in the natural heart — and thus be able to prioritize direction and inner peace (motionlessness) in order to regulate within the motion of the five kinds of fire. Only by this process, can the ministerial fire be beneficial in transforming other things. So this being the case, what’s the point of regarding it as a culprit?”

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Zhu Danxi thus illustrates the pathogenesis of ministerial fire causing disease and also the treatment necessary to prevent it from causing disease. He admits, “The above saying is just a spread of Zhou and Zhu’s ideas.” This shows clearly that his idea of ministerial fire created a new theory of pathogenesis in Chinese medicine, based on the neo-Confucianism of “acquiring knowledge by probing into things”. This theory laid the foundation for his “Nourishing the Yin” theory, which is indeed effective in clinical practice for diseases caused by Yin deficiency and hyperactivity of fire. It hence later became the code for treating these kinds of diseases. It was related to his experience in treating disease, and we must admit that constructing this theory was consistent with the Chinese medical system, not to mention its defects with regard to aspects of previous medical classics. However, deduction by pure theory has its shortcomings, due to the nature of probability and the uncertainty of all outcomes. Sun Yikui provided a criticism in his Additional Thoughts on Medical Themes (医旨绪余), as follows: “In the Further Discourses on the Acquisition of Knowledge through Profound Study – Ministerial Fire Chapter (格致余论·相火篇), Danxi took the thunder-dragon fire as analogous to ministerial fire, but also divided fire by making monarch fire into human fire and ministerial fire into heavenly fire. This is rather foolish!… In my opinion, fire is the power for transformation and creation, so it can’t stay still, but it also can’t move around frenetically. Fire can be divided into categories of the human and heavenly, but monarch and minister can’t be attributed to man and heaven, respectively… In terms of the human body, the monarch fire lies in the heart, while the ministerial fire resides in the pericardium and sanjiao. This has been a set conclusion since ancient times… it might seem as if the liver and kidney both have fire, but it is the pathogenic fire of the five emotions, not the healthy fire of the five elements. The pathogenic fire causes disease and is the culprit of the primary qi. It is not produced in a single day. Now Danxi took the Yin fire of the liver and kidney to be the thunder-dragon fire and heavenly fire rather than the fire of the six qi as the heavenly fire; he took the monarch fire to be the human fire instead of the fire of the seven emotions. The liver stores the blood and the kidney holds the essence. Danxi said both of them had ministerial fire, but where did he see this?… He was not clear when using the term ‘minister’, so his argument about ministerial fire is incorrect.” Sun Yikui’s criticism is well reasoned. Inaccuracy of concept definition is a common problem in Chinese medicine when using deduction by analogy. In addition, no one has ever observed the actual form of “ministerial”

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or “monarch” fire, so no one can distinguish them accurately, not even Sun Yikui. In fact, they all made deductions by taking the analogy of “monarch and minister” from sociology. Such ideas are unable to be defined, either by extension or intension, in the realm of medicine. They are abstruse things, so Sun Yikui’s criticism is only supplementary and cannot refute Danxi’s thinking. As a result, the theory of ministerial fire still prevails. Zhang Jiebin also criticized this theory, but he came from the point of view of the meanings of the characters. He said in The Complete Works of [Zhang] Jing-yue (景岳全书), “When I read this theory, I laugh at its ridiculous observations… Each of the five elements is responsible for one duty, but he only regarded fire as being divided into monarch and minister, why?… He has deviated far away from the sages’ meaning in calling the ministerial fire the culprit. Moreover, the common culprit fire that causes disease is not the genuine fire of monarch or minister regardless of whether it is interior or exterior. There is merely the pathogenic fire. This pathogenic fire can be called the culprit, but not the ministerial fire.” Though all these debates are targeted at probing the facts, different understandings and opinions grew since there was no strict definition or logical system. The benefit was that the concept became more evident — as the truth became more clear through debate. Collective Lectures of Wu’s Medicine (吴医汇讲) has an article discussing the ministerial fire as debated by Danxi and Jingyue, which is comprehensive and well written: “Jingyue’s argument is that ‘the abnormal location of the sun shortens people’s life without any obvious signs being present’, while Danxi’s argument is that ‘the sun is a fire that moves swiftly about and nothing can control it’. For Danxi to consider the sun as fire is surely wrong, but is it right to consider fire as the sun? A Major Discussion on the Theory of Yin and Yang and the Corresponding Relationships between All Things in Nature (阴阳应象大论, a chapter of the Neijing) records, ‘A strong fire reduces the qi while a mild fire strengthens the qi.’ The difference between the strong fire and mild fire is the answer to their arguments. Therefore, their theory can only ever be completely appreciated by combining together both arguments. The actual theory can never be found if you hold to one side only.” The above shows an application of the typical methodology of “acquiring knowledge by probing into things”, as used in a debate on medical theory. In fact, there had been much clinical experience and observation of fire heat patterns in the Yuan, Ming and Qing dynasties, but further exploration of their theoretical explanations was still required. However, there was also an irresistible trend to introduce neo-Confucianism into theoretical

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discussion. Since experts cited different classics and had different understandings of the “philosophy of mind”, different conclusions on “acquiring of knowledge by probing into things” arose. Zhu Danxi also applied a similar methodology to other theories, such as the “Yang being often in excess, while the Yin being insufficient”, “caring for the young” and “seeking the root in treating disease”. Nevertheless, the reflection on medical theories induced by neo-Confucianism during the Song and Ming dynasties on the whole had a positive impact.

83.  The Medical Tradition of Abiding in the Classics The Analects of Confucius – To Retell (论语·述而) records, “Confucius said, ‘I just retell old stories and do not do creative work. I believe in and love the ancients. I privately compare myself to Peng Zi.’” It seems Confucius advocated ancient matters and the classics. Interestingly, his own sayings also became classics for later generations. In the light of this, “retelling and not doing creative work, believing in and loving the ancients” may be the slogan, but this is not truly “not doing creative work”, it is merely “loving the ancients”. After the study of Confucian classics and Confucianism had been widely advocated, people propagated their own theories extensively under the guise of “abiding by the Rules of Yao and Sun, the Systems of King Wen and Wu of Zhou”. This was also the case in medicine. However, despite this being the case, there are quite some treasures in these private theories. In the first place all the previously mentioned experts had also practiced “abiding in the ancient classics”. They always promoted their own theories in the name of explaining classical entries and carrying forward their profound significance. Thanks to their endeavours, theories of Chinese medicine were renewed all the time — and moved slowly forward. Throughout its history, those who proposed more all-encompassing theories become wellknown innovators. Nevertheless, the significant shortcoming of this practice was that it was impossible to be a medical revolutionary and break away from the classical framework. With the development of “Down-to-Earth Learning” in the Qing dynasty, “abiding in the classics” was advocated even further. A general circumstance can be seen in records such as a Treatise on the Origin and Development of Medicine (医学源流论): “Since Confucians can’t preach without referring to the Sage’s classics, how can doctors treat disease without the help of those classics?” “Read nothing but Zhang Zhongjing’s

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books, and only use formulae designed by Zhang Zhongjing.” All practice of medical theories and treatment was required to “speak by the Sage’s classics and treat according to ancient methods.” However, people have differing tastes, and therefore different arguments on the method, origin and tradition of “abiding in the classics” developed. Under such conditions, medical experts found the space to develop their own opinions. They most typically debated the Treatise on Cold Damage (伤寒论). The initiator of this debate was Fang Youzhi (1522–?) during the Ming dynasty. Some time earlier, the Treatise on Cold Damage (伤寒论) written by Zhang Zhongjing had been compiled by Wang Shuhe and annotated by many subsequent medical experts. The tradition of textual research, emendation and annotation became a popular method of “abiding in the classics”, and further development was not in short supply. However, Fang Youzhi suddenly hit upon a wild idea that the Wang Shuhe’s edition was the original version — written by Zhang Zhongjing. Thereafter, a series of later annotations had certainly turned it upside down. He said the following in his Systematic Analysis of the ‘Treatise on Cold Damage’ (伤寒论条辨): I have read this book in all its aspects. By repeated careful thinking, I figured out that the writings on the bamboo slips had been much disarrayed. The compilation was initiated by Wang Shuhe, but that was a long time ago. During this period, dynasties have changed and the world has become different, so it is certain that there must be bamboo slips damaged by worms, and the shortcomings of human behaviors. However, experts who made annotations didn’t notice this and just annotated according to previous versions. It is just like children learning from their teacher, they recite after the teacher, but care nothing about the content. If they encounter puzzling points, they just piece them together in a piecemeal way. They just amend incorrectly other erroneous versions. This hazard undoubtedly becomes more serious with time. Fang Youzhi’s thought also derived from the neo-Confucianism of the Song and Ming dynasties. He respected Zhang Zhongjing as a saint, saying that “Zhongjing had experienced this first, so he wrote this monograph… Therefore, he is respected as a saint in the medical field, just like Confucius is regarded as ‘the master’ by Confucians.” Later, he goes on, “Even though

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the saints were great, no one can be born beyond heaven.” “Heaven lies in the principle of the mind. The mind lies in the heart, and this is the same in all history as it is in the present.” As a result, in Zhongjing’s book, “treatment methods become principles followed by people for generations; formulae become mother-sets applied by people throughout the world. Hence, he made great achievements in collecting and formulating medical theories. This was the same with other masters. Though their theories were different, all of them were born from heaven.” Fang Youzhi thereby worshipped Zhongjing’s Treatise on Cold Damage (伤寒论) and saw it as the acme of neo-Confucianism — and it could not be altered. Under such a premise, Fang Youzhi proposed Zhongjing’s book must be restored to the original. He thought many passages in the version compiled by Wang Shuhe were “records of Zhongjing’s words with words of praise included as appendices”, including the chapters on “differentiating pulses”, “normal pulses” and “cases due to cold damage” in volume 1 and also “are diaphoresis, emesis and purgation suitable?” He thus revised the book boldly and drastically, according to his knowledge and imagination. He believed he had restored the original version of Treatise on Cold Damage (伤寒论), prior to Wang Shuhe’s recension. Yu Chang (1585–1665?) in the Qing Dynasty praised Fang Youzhi greatly. He said in Tracing Back to the ‘Treatise on Cold Damage’ (尚论篇), “The Systematic Analysis of the ‘Treatise on Cold Damage’ (伤寒论条辨) written by Fang Youzhi during the Wanli period is a book that breaks away from the remarks and routine of Wang Shuhe. It thus obtains the principle of ‘abiding in the classics’. Wang Shuhe’s version deviated from the classical text a great deal, so Youzhi restored it to order, to preserve the original version. It is self-evident that right or wrong have been settled. Accordingly in the three chapters on the Taiyang, he revised Shuhe’s version by classifying wind-cold damage into ying and wei levels. His judicious judgment must now be seen as setting a precedent.” Later, a school of famous medical experts followed this edition, such as Zhang Lu, Huang Yuanyu, Wu Yiluo, Zhou Yangjun, Cheng Yingmao and Zhang Nan. They also created and developed his views. Opponents of course arose from the “school of previous theories”. They described the Treatise on Cold Damage (伤寒论) in A General Impression of the ‘Treatise on Cold Damage’ (伤寒论宗印), saying, “The chapters, sentences and disease-transmission articles of the classic are listed respectively. By intensive study, we can conclude that they are coherent and in order. It is believable the book is not made up of stray fragments of texts found on

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bamboo slips and Shuhe’s compilation is in no way inferior.” This school was advocated by Zhang Suichen, Zhang Xiju, Chen Nianzu and so on. They held the version that Wang Shuhe complied with Zhongjing’s original version and was free from any displaced bamboo slips; Cheng Wuji’s annotation was also seen to be perfect. Both sides “abided in the classics”, but the classics they “abided in” were different. Chen Xiuyuan put this point also in his Simple Annotation on the ‘Treatise on Cold Damage’ (伤寒论浅 注): “Wang Shuhe’s contribution to the compilation of the Treatise on Cold Damage (伤寒论) is worthy of praise for generations. He may have added some chapters without titles. Wang Andao took pity on this effort. However, the contents from the ‘chapter on distinguishing pulses and patterns of taiyang disease’ to ‘overstrain recurrence’ are all Zhongjing’s original. The start and end of the chapters and sections correspond. Wang Kentang said, ‘it is like a fairy dragon emerging from the depths, with head and tail responding to each other, its scales dense and in orderly fashion covering its whole body. I dare not add or take away one single word, or alter a single section in this new carving.’” The debate on Shuhe’s version may be summed up by Min Zhiqing’s comment in a Collection of Key Illustrations on Cold Damage (伤寒阐要编): “As each of them only believes his own opinion to be the right one, the matter can only be settled when Zhang Zhongjing is resuscitated.” Relatively honest words were also stated by Xu Dachun, “opinions must be rooted in the classics and treatment in accordance with the ancient methods.” He said, “Debates by later generations have resulted in a compilation of different versions of the books, each of which altered several articles of the original. They criticized the failings of others and expressed their own ideas. There thus created more alterations, and more disarrangements. Eventually, there can be no final conclusion. They didn’t understand that Zhongjing’s book was only intended to rectify therapeutic errors, not be a book for establishing formulae according to the classics… At that time, Zhongjing just established formulae accordingly, following the patterns of disease. He did not have in mind an inherently set order.” It is true that Zhongjing’s book was intended to rectify therapeutic errors, being made during his time. It was written by combining together the actual state of the poor therapeutic effects of his time with his own experience, induction and reasoning. The book honoured as a classic was the result of those who came after him. However, Xu Dachun only “abided in” the Inner Classic (内经). His words, it was “not a book for establishing formulae according to the classics”, hit the mark with a single arrow. There

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were still other schools that joined in the debate during the Qing dynasty, which cannot be mentioned here one by one. The debate began by “abiding in the classics”, but much research on diseases due to cold damage was done and many good results obtained. This was a consequence of the joint influence on medicine of neo-Confucianism and the school of Down-to-Earth Learning, all of which has its positive points. The thriving of the “Down-to-Earth Learning” school was originally closely related to neo-Confucianism. The Emperor Kangxi highly praised neo-Confucianism. He offered sacrifices to Confucius and Zhu Xi, listed neo-Confucianism as one of the “10 philosophies” and wrote an “imperial decree” in person to spread it throughout the country. Later Emperor Yongzheng stipulated that every household must know the Wide Instruction of the Imperial Decrees (圣谕广训) and everyone should recite it. Almost everyone had copies of the Complete Books of Zhu Xi (朱子全书) and Essentials of Temperament and Theories (性理精义). At the same time, literary inquisitions were vigorously put forward. During the long reign of the Emperor Qianlong, there were 74 such cases, in which nine generations of a victim were executed, totalling nearly a thousand people. Everyone in the intellectual world felt in danger, so they had to study ancient works to save their lives. They emendated and conducted textual research on rhyme, character and other systems in the ancient books. Unexpectedly, a large number of “academic” experts emerged. Thereafter, medical experts in the Qing dynasty carried out the most profound textual research on ancient texts. An Imperial Collection of Four Divisions (四库全书) and Collection of Ancient and Modern Book (古今图书集成) are typical. It is unknown how many medical experts and how much time were actually involved. But surely, a great fortune of literature was built up for later generations. Aside from the debate on the Treatise on Cold Damage (伤寒论), influenced by the “abiding in the classics” movement, there were debates between the “school of classical formula” and the “school of empirical formula”. The school of empirical formula advocated experience and included folk formulae, which was despised by the school of classic formula. However, Xu Dachun proposed another brilliant view. He wrote in the Treatise on the Origin and Development of Medicine (医学源流论) as follows: “There are only two books (namely the Treatise on Cold Damage and the Synopsis of the Golden Chamber) for us to refer so as to understand the treatment methods of the ancient saints. They are the so-called ‘ancestors of formulaic classics’, which are parallel to the Plain Questions (素问) and Spirited Pivot (灵枢)… Doctors today always talk about ancient formulae. Actually, the

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term ‘ancient formula’ is not consistent. If it refers to formulae of remote times, there are none extant except those in Zhongjing’s classics. If it refers to formulae established during the Song and Yuan dynasties, formulae that can be followed and passed on are quite rare and there are lots of ridiculous ones, which should never be taken as classical. If we call all formula before the Ming dynasty ancient formula, there could be no less than several million. There are only several hundreds of common medicinals, but the formulae have mounted up to several million. A formula can easily be made by just picking up several medicinals. What’s the point of always mentioning a certain formula? Alas, how strict ancient formulae were when established, while how easy are modern formulae to set up!” This statement describes our work at present and the ancient classics, and indicates that the former are dwarfed by the latter. It also points out the nonsensicalness of a debate between classical and contemporary formulae. Mr. Ren Yingqiu has classified Xu Dachun as being a member of the “school of treatment based on pattern identification” among the cold damage schools.4 Though this cannot be said for sure, Xu actually not only honoured the classics but also emphasized swiftly applying remedies in the clinic. He wrote a passage in the Treatise on the Origin and Development of Medicine (医学源流论) appreciating The Book to Safeguard Life Arranged by Categorized Patterns (类证活人书) written by Zhu Gong, which also illustrates this: “Among all the books written in the Song, the Book to Safeguard Life (活人书) is the best. It can enlighten people on the Treatise on Cold Damage (伤寒论) and help develop Zhang Zhongjing’s ideas… This book is unique among classical writings in that it does not have individual opinions. It is studious and deeply thought out. Is this not a book that elaborates the theories of the predecessors without putting forward any original ideas of his own? This is enough to carry it forward into the future!” His comment can be said to sum up the characteristics of the “abiding in the classics” studies during the Qing dynasty. Take the rise of the school of Warm Diseases for example. It was very innovative, but medical experts of that school all called themselves “advocators of the classics”. They followed the Plain Questions (素问) and Spirited Pivot (灵枢) (from the Neijing), and even boasted that their theories came from Zhongjing. This is a tradition in Chinese medicine, which has a long history. During modern times, Xie Liheng remarked quite rightly on this in his Treatise on the Origin and Development of China’s Medicine (中国医学源流论): “When the tradi4

 Refer to Ren Yingqiu. TCM Theories of Different Schools.

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tion of Confucian orthodoxy cited by the Confucians is transferred to medicine, Shennong and Huangdi for medical world become just like the Yao and Shun Emperors of old and the Wen and Wu kings of the Zhou for Confucians; Zhongjing and Hua Tuo in medicine become as Zhou Gong and Confucius in Confucianism. So when people spoke about medicine, they had to mention Shennong and Huangdi, the Plain Questions (素问) and the like. If they didn’t, it was almost as if they did not know they were on the list of those knowledgeable about medicine.” To put it more bluntly, the author held that medicine before the Song dynasty was “Tao medicine”, while in the Song dynasty, “Confucian medicine” abruptly arose. In terms of methodology, Tao medicine was characterized by observing things, summarizing rules and generally being creative, while Confucian medicine developed new theories through “abiding in the classics” in order to illustrate its theories, and advocated explanation and searching for any previous rationale when confronted by new situations.

C.  The Rise of the Confucian Doctors To be called a Confucian doctor was regarded as the greatest honour in the Chinese medical world. This was a result of the high regard given to feudal ethics and Confucianism in China. However, Confucianism and medicine combined just after the Song dynasty. Before the Song, Confucians still held a disdainful attitude towards doctors, just as Han Yu had said in About Teachers (师说): “No gentleman wants to become a wizard, a doctor, a musician or a manual worker.”

84.  To Be a Good Prime Minister or Excellent Doctor During the Song dynasty, the practice of medicine had been regarded as the ideal way to carry forward the Confucian principles. There were three reasons. First, a doctor’s status increased gradually due to the Emperor’s preference. Second, the orthodox position of the Confucian religion consolidated and became more significant. Third, Confucianism itself tended to think highly of “acquiring knowledge by probing into things” and to value practical application. Hence, “to be a good prime minister or excellent doctor” became a popular concept and a saying for the Confucian gentry. Thus, the tradition of the Confucian doctor began to form. The saying “to be a good prime minister or excellent doctor” was really appealing. It was originally linked to Fan Zhongyan (989–1052). Wu Ceng

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recorded it in his Casual Records made at Nenggai Study (能改斋漫录) as follows: “When Fan Zhongyan was a humble citizen, he once prayed for a career in an effective temple. He asked the question ‘Could I become a minister in the future?’ The answer was no. He asked again ‘Or, could I become a good doctor?’ The answer was again no. Therefore, he sighed, ‘If a man can’t do good to people, he does not possess the will of a great man’. Another day, somebody asked him, ‘It goes without saying that a great man’s will is to be a minister. But why do you want to be an excellent doctor? Isn’t it too humble a position for you?’ He responded: Oh, surely not! The ancients said, ‘The saints always helped the people, so there were no useless people in their eyes; they always wanted to rescue things, there was no useless thing in their thinking’. That which a great man should learn must always be imparted to him by someone wise. He will consider anyone who hasn’t got the benefits he has. The one who can bring these benefits to all walks of life will surely be a minister. But since we can’t reach that position, the one that can help people is none other an excellent doctor. If someone can really be a good doctor, he can treat the diseases of the monarch, his relatives and the common people as well as keep healthy himself. All in all, there is no post beneath that of a minister that can spread these benefits to all walks of life, except that of a doctor.” Fan Zhongyan’s highest post was as a Canzhi Zhen Shi (Assistant Administrator), equal to Vice-Premier, during the period of Emperor Renzhong in the Song Dynasty.5 He was praised for generations because of the way he carried out his duties, because of his famous saying, “concerning the people first and enjoying life last” and because of his political virtue concerning the country and the people. The statement of being either “a good minister or excellent doctor” totally reflected political ethics. Fan Zhongyan was never appointed to be formal premier or doctor. But his acts were enough to be praised, just as a good premier. Zhu Xi called his saying, “concerning the people first and enjoying life last” as words which could “cheer up any scholar-official”. We can also say that his saying, “either a good minister or excellent doctor” also made a great contribution to “cheering up” any Confucian doctor. Many ancient doctors were inspired by this saying. For example, in The History of Song Dynasty – Records of Cui Yuzhi (宋史·崔与之传), “Cui Shiming, from Guangzhou in the 13th century, tried to become an official 5

 Canzhi Zhengshi equalled “temporary premier” in the Tang Dynasty and “vice-premier” in the Song Dynasty.

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many times, but failed. He said every time he either wanted ‘to be a good minister, or an excellent doctor’. He thus devoted himself to studying medical books and charged nothing for treating poor patients.” Another example is in the preface of Fengke’s Collection of Empirical and Famous Formulae (风科集验名方) written by Zuo Yuanfeng. It says, “In success, one tries to be a good minister, but if not, one wants to be an excellent doctor. Surely, being an excellent doctor is not equal to being a good minister. However, the responsibility of the doctor is as great, as the people’s lives are in his hands.” The “excellent doctor” mentioned by Fan Zhongyan actually meant a “Confucian” doctor. Lin Yi said in his Preface to the Newly Revised Edition of Huangdi’s ABC Classic of Acupuncture and Moxibustion (新校 正黄帝针灸甲乙经序), “Those who understand heaven and earth are called Confucians, while those who understand Heaven and earth without knowing human affairs are merely technicians. Though doctors are ascribed the title ‘technicians’, they are doing Confucian work!” This is the key to the practice of a Confucian doctor. And yet, having a Confucian background is a must in becoming a Confucian doctor. In the second year of Chongning (1103), Emperor Huizong of the Song Dynasty issued an imperial edict to greatly promote this fact: “Medical study is to be established in order to cultivate superior doctors.” This equalled the setting up of a State Medical University in order to cultivate senior doctors. The court officials often discussed this matter: “At present, no medical technicians have been awarded or promoted. It is because their standard of learning is low and regarded as shameful by scholars. Therefore, no officials of noble character or high prestige study and engage in it. Since medicine is to be promoted and superior doctors to be cultivated, they should no more be attached to the Chamber for Ceremonies. They should be considered as belonging to the Three Studies section, that is, belong to the Imperial College. The mode of instruction can imitate that of the Three Studies… Its rules can imitate those of the Three Studies… In terms of encouragement, they can be granted a family background and be regarded as officials with a noble character… Those who study medicine should not be ascribed into the seventh level. Some good graduates of the Shangshe Imperial Study should be sent to hold the post of pharmacists, doctors, medical staff, and to become medical teachers for vassal states, or for the armies of each province, etc.” — From The Records of Important Meetings of the Song Dynasty (宋会要辑稿). To separate medical study from the Chamber for Ceremonies and include it in the Imperial College system simply aimed at incorporating

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medical study into Confucian education, thus altering the whole nature of medical education and also quality of the doctors produced. Their “standard of learning being low” refers to insufficient Confucian cultivation of doctors. If doctors could understand Confucianism, they would become “superior doctors”. In the eye of Emperor Huizong of the Song, “superior doctors” would be the same as “Confucian doctors”. It can also be seen in these words of his: “At the beginning when establishing medical study, it is necessary to cultivate as many Confucian doctors as possible.” “The imperial court establishes medical study and cultivates officials. Those studying Confucianism are asked to master the classics such as the Inner Classic (内 经), and be clear on diagnosis and treatment. If they can do all this and treat disease, they may be called Confucian doctors. This will be really beneficial.” If doctors could meet the above requirements, they would be treated the same as Confucians and be regarded as having a “noble character”. They would also be granted official positions. Doctors had no official rank before the Song dynasty. At the beginning of the Song dynasty, doctors were granted the systematic rank of “military officer”. Henceforth, the status of doctors changed greatly. The status of the Confucian doctor was thus established. Emperor Huizong of the Song thought this status was still too low and wanted to promote them by making exceptions. Judging from the above, “Confucian doctors” refers not only to excellent doctors but also to those who were good at both Confucianism and medicine. Confucian doctors could be Confucians knowing medicine or Confucians practicing medicine. The avocation of Confucian doctors actually meant applying Confucianism to help and remold medicine, not just encouraging people to understand Confucianism along with medicine. The formation of the Confucian doctor can thus be traced back to the compilation of such books as Formulae from Benevolent Sages Compiled during the Taiping Era (太平圣惠方) and to the establishment of the Bureau for Revising Medical Books, which had existed ever since the Emperors Taizu and Taizong of the Song, in which Confucians acted in a senior role and doctors were subordinate. Such work lasted a long time and had a widespread influence, paving the way for the later phenomenon of the “Confucian doctor”. Fan Zhongyan’s saying played the role of catalyst while Emperor Huizong of Song Dynasty intentionally guided it on. In addition, it can’t be denied that the proposal of making doctors also Confucians met the demands of some “down and out” Confucians. It offered them a way out, which satisfied their spiritual needs and also provided them with a chance of making a living. We can see these points in the

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following story recorded in the Ancient and Modern Traditions of Medicine (古今医统): “During the period of Qingli (1041–1048), Shen Chang, a successful candidate in the highest imperial examinations, was honest, straight-forward and difficult to get along with. He served in the government office for a short while, but had never been recommended for higher rank by the province. He thus sighed often, ‘I went through the imperial examinations, but still am haunted by poverty. Is this my destiny?’ He went to the capital city and tried to make a living by other means. Once he passed by the Donghua Gate and accidentally saw several officials riding horses at a high speed, followed by a troop of inferiors. He asked a local citizen, ‘What’s their official rank?’ The citizen answered, ‘Medical officials of the Imperial Academy.’ Shen Chang sighed again, ‘I understand deeply the theories of Confucianism, but do not think I am inferior to such doctors!’ So he began to create the intention of learning medicine.” This shows that the status of “medical official” was begrudged by downand-out Confucians. But Shen Chang’s understanding of medicine was superficial. He thought medicine was inferior to being a Confucian and did not want to make any painstaking effort. Zhao Conggu, an imperial doctor, gave him a lesson by saying, “Medicine is surely subsidiary to Confucianism. However, it is associated with people’s lives — which means you can’t study it absent-mindedly. If the learner doesn’t concentrate his mind in learning medicine, he will not find its very delicacy… Confucianism instructs us in the rites and morality, while medicine tells us of the weakness and strength of the body. Not knowing rites and morality is being ignorant of the doctrines of Confucius and Mencius; whilst being unclear on weakness and strength will harm people’s lives. A Confucian to be learning medicine, how could this be despised?” This passage indicates the general psychology of down-and-out Confucians at the time of the emergence of Confucian doctors. On the one hand, they regarded it as a way to obtain a reputation and make a living; on the other hand, they also despised it and believed it could be easy. Many of them thus took up medicine after failing in the imperial examinations. However, lots of them became famous medical experts, including Li Shizhen, Zhang Yuansu, Liu Wansu, Ge Yinglei, Ge Qiansun and his son, Yu Chang, Wang Ang, Zhang Lu, Wu Tang and so on. They abandoned Confucianism to practice medicine but made outstanding contributions to medicine eventually and all of them can be called truly Confucian doctors. After these events, Confucian officials in the Song dynasty didn’t disdain medicine anymore. Instead, they regarded knowing nothing about medicine

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as shameful. Many a scholar official personally sorted out and collected empirical or privately kept formulae, compiled them and then had them published. Books such as Chen Yaosou’s Collection of Empirical Formulae (集验方), Lang Jian’s Collection of Empirical Formulae (集验方), Qian Weiyan’s Divination Formulae (筮中方), Hong Zun’s Hong’s Collection of Empirical Formulae (洪氏集验方), Lu You’s Collection of Empirical Formulae (集验方), Yang Tan’s Yang’s Family Stored Formulae (杨氏家藏 方), Wei Xian’s Wei’s Family Stored Formulae (魏氏家藏方), and Su Shi and Shen Kuo’s Fine Formulae of Su and Shen (苏沈良方) are of this kind. There are also many medical books compiled or written by civilian officials, such as Sima Guang’s Medical Questions (医问), Wen Yanbo’s Key Sections of Maps of Materia Medica (节要本草图) and Medicinal Codes (药准), Gao Ruone’s Erroneous Writings and Meanings of Plain Questions (素问误文阙 义) and Categorized Synopsis of Treatise on Cold Damage (伤寒类要), Cheng Jiong’s To Understand Book of Safeguarding Life (活人书辨) and Corrected Book of Medical Classics (医经正本书), and Zheng Qiao’s Completed Book of Materia Medica (本草成书), Categorized Supplement to Materia Medica (本草补类) and Food Identification (食鉴). In addition, lots of literati wrote something about medicine also, such as Hunang Tingjian’s Preface to Communication with the Gods (通神论序), Su Shi’s postscript to Simplified Formulae for Supporting the People (简要济众方), Cai Xiang’s Preface to Selected Formulae from Benevolent Sages (圣惠选方序), Zhu Xi’s Postscript to Supplement to What had been Lost from the Treatise on Cold Damage (伤寒补亡论跋) and Wen Tianxiang’s Preface to Wang Caobi’s Verses of Golden Chamber (王朝弼金匮歌序).6 We can even suspect they were obtaining benefit through associating their names with medicine — that is, being involved with medicine was an honour. In the meantime, there were critics who thought scholar officials should not take up medicine lightly. For instance, Ye Mengyun in the Southern Song dynasty said the following: “Scholar officials are wise and selfconfident, so they can do anything in the world except medicine. That can’t be forced. Among all the officials in the court, only Gao Wen is a qualified doctor. He is especially good at treating diseases caused through colddamage. It is unknown who was his master. Officials like Sun Zhao and Du Ren are only medical beginners, compared to him, but they have been able 6

 This list of these people and their books is taken directly from the article One Way of Permeation of Confucian Culture in Medicine written by Zhang Ruixian. This article was an academic paper in the 9th National Annual Meeting of Academic Discussion on Medical History in 1990.

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find fame. Gao Wen is from Yunzhou, where there are lots of doctors good at treating this disease. All of them learnt from Gao Wen. In the period of Chongning and Daguan, I was in the capital. I found some Confucians like Dong Ji and Liu Yin who were masters of Zhang Zhongjing’s formulae and therapies. I tried them several times and their efficacy was very good and no common doctors in the regions of the Yangze or Huai river could compare to them. When Su Shi was in Huangzhou, doctor Pang An’chang from Qi Zhou was also good at treating diseases caused through the cold-damage and had gotten hold of Zhongjing’s theories. Chao Gu, from Sichuan, had formulated a Holy Powder Formula, which was not present in previous medical texts, but came from someone mysterious — he said so himself. This formula cured any diseases due to cold damage even without knowing the symptoms. Su Shi was curious and even wrote a preface for it, in which he compared it to Sun Simiao’s Three Buildings Powder. Pang An’chang dared not to refute him. Hence, this formula was included to his book on ‘cold damage’ and all the people in the world believed in it. You cannot deviate an inch in treating diseases, especially diseases due to cold damage. If the medicine is applied by mistake, lots of patients will be killed instantly. Is there really any formula that can be applied without knowing the symptoms? After the Xuanhe period, this formula was popular in the capital. Imperial medical students believed it so completely, numerous people must have been killed by it. Doctors at present have realized this and begun to have it abolished. Now Chao Gu was a chivalrous and curious man. He once followed Han Cunbao, a Shaanxi General, but was unsuccessful in his career. At that time he stayed in Huangzhou, while Shu Shi travelled around with him. Shu Shi admired his chivalrous character and accepted his formula. People in the world believed in the formula because of Shu Shi’s writing. People believed in it because he was such a celebrity and neglected the test of that formula in association with people’s lives. Nothing is more bewildering than this.” — From The Records made when Avoiding the Summer Heat (避暑录话) Ye Mengde seriously criticized the harm caused by the improper spread of the Holy Powder Formula. The hazard lay in its propagation by Su Shi as a scholar official and famous Confucian, and that “people in the world believed in this formula because of Shu Shi’s writing”. We can see that when Confucians become involved in medicine, if they know little about it, they could do harm to people and the harm could be serious. The Holy Powder Formula must have resulted in many deaths during the Ye Mengde period. However, Zhang Gao first wrote in About Medicine (医说) that “Holy

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Powder Formula’s efficacy is unique. Last spring, many Hangzhou people fell ill and many numbers were cured by this formula.” This suggests that such a formula did have efficacy, but it should be applied appropriately. Most Confucians were involved in medicine just occasionally, so they often could not identify what was in it properly. Yu Bian in the Ming Dynasty agreed with Ye Mengde’s comments. He wrote in Follow-up to Medicine (续医说) that “In the year 1493 of the Hongzhi period, a serious pestilence occurred in the middle of Wu city. Sun Pang, prefect of Wu, ordered doctors to make pills out of the Holy Powder Formulae and distribute them to all civilians. He also publicized the formula. After having taken the pills, patients developed a mania, or coma and then died, none of them survived… They didn’t know that the ingredients in that formula were fu zi (Radix Aconiti Lateralis praeparata), gao liang jiang (Rhizoma Alpiniae officinarum), wu zhu yu (Fructus Evodiae), dou kou (Fructus Amomi rotundus), ma huang (Herba ephedrae) and huo xiang (Herba agastachis). These ingredients are all dry and hot in nature, which stirs up pathogenic fire. It is no surprise that death was the result! If treatment is given without identifying Yin and Yang, the killing will be more acute than that by the knife or sword.” Yu Bian was a medical expert, while Zhang Gao was a Confucian. The difference lay in this. The Holy Powder Formula is very harmful if not applied in accordance with observable symptoms. Confucians should never have taken it lightly! Nevertheless, “medicine being the concern of Confucians” was gradually the case. During the Yuan dynasty, the status of Confucians decreased. People were categorized into 10 levels in descending order: superior officials, inferior officials, monks, Taoists, doctors, workers, hunters, citizens, Confucians and beggars (or craftsmen, prostitutes, Confucians and beggars). A doctor’s status was higher than that of a Confucian. But even accounting for this, the concept of the indivisibility of Confucianism and medicine still lingered in the mind of the Han people. The calling of Confucian doctors was still popular and it still meant a good reputation. Ruojin, a famous Confucian scholar during the Yuan dynasty, wrote in “Preface to a Confucian Doctor Yan Cunxing” as follows: “Confucians understand the meaning of the Six Books and are clear about the reasons for things in this world. As for theories in other fields, if they are involved, they will certainly ‘investigate the root’, search out profound connections, and thoroughly probe into any differences. They are not like common people in that they study persistently… My fellow townsman Yan Cunxing studied hard when he was young. He learned extensively many

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things, involving classics, history, and different schools of medicine. He wanted to become a successful candidate in the highest imperial Confucian examinations and tried to serve the people. However, the imperial examinations having been abolished, he took up medical books and tried to master medicine, so as to go around the country and realize his ambition… Some years ago, I stayed in the capital city and heard people praise him highly. This year, I went back to my hometown and many learned people spoke highly of him. As I talked with him, he mentioned the ideas of many schools and the contents from the Six Classics. He is truly a Confucian, before being a doctor. He is different from common doctors…” — From Fu Yuli’s Collection of Verses and Writings (傅与砺诗文集). This actually is a record of a Confucian doctor who originally wanted to be a Confucian, but became a doctor instead. He was good at both Confucianism and medicine, and was honoured by the people. Fu Ruojin also wrote a “Preface to my Medical Descendent Li Yiqing”, in which he described him as a “Confucian and doctor from a family of generations of doctors”. We can see that Confucian doctors were well revered also during the Yuan dynasty. After the Ming dynasty, the status of Confucian doctors became much higher and it was regarded as an orthodox profession. Just as Hu Han said in his Selection Methods (择术), a section from Volume 3 of the Collection of Hu Zhongzi’s Writings (胡仲子集) states, “Confucian doctors treat patients regardless of profit; spread kindness without being self-conceited; and approach patients showing constant patience… They practice medicine in the city, not refusing the poor and humble, showing no favor to relatives and friends. In terms of government officials, they don’t take pride in official rank or salary, and don’t envy power or benefits. This is the acme of Confucianism.” Hu Han believed Confucian doctors could do things Confucians had failed to do, and the virtue of the Confucian doctor was the most noble of all. This was just the same as the real meaning of Fan Zhongyan’s saying: “either a good prime minister or excellent doctor”.

85.  Various Yongyi (Quacks) In Chinese history, the title “excellent doctor” has had a long existence, while the term Yongyi (“quacks”) occurred a little later. For example, Mo Tzu – Non-Offence (墨子·非攻) writes, “It is just like applying medicine to treat a disease. Now here is a doctor who uses medicine to treat patients in the country. But if only four or five out of ten-thousand recover after taking

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his medicine, it cannot be called ‘applying medicinals’”; “and if only four out of more than ten-thousand patients recover after taking his medicine, he still couldn’t be regarded as an excellent doctor.” Here, the term applies to an excellent doctor, but is not used as a special term. From Huangdi’s Inner Classic (黄帝内经), the Spirited Pivot – Origins and Junctions (灵枢·根结) states, “Excellent doctors balance the qi of the patient, medium doctors disturb the pulse of the patient and inferior ones deplete the qi and put the patient into a crisis. Therefore, you should beware of inferior doctors.” The Spirited Pivot – Pathogenic Qi, Zang-Fu Organs and Manifestations (灵枢·邪气藏府病形) records, “If one can combine together any three aspects, he can be an excellent doctor. An excellent doctor cures nine patients out of ten. If one can combine together two aspects, he is a medium doctor. A medium doctor cures seven patients out of ten. If he considers just consider one aspect, he is an inferior doctor. An inferior doctor cures six patients out of ten.” Doctors are categorized into three levels, but the standards in the above two quotes are different. It shows there was no unified opinion at that time. The Plain Questions – Discussion on the Most Important and Abstruse Theory (素问·至真要大论) records, “That is why the book entitled Essentials (大要) says, ‘Ordinary doctors often feel complacent and think they know everything.’” “Ordinary” here doesn’t seem to mean inferior, but just those who were thoughtless. The term “Yongyi” appeared earliest in the preface to Sun Simiao’s Valuable Formulae (千金要方). In the author’s preface, he cites a passage from Zhang Zhongjing’s preface to the Treatise on Cold Damage (伤寒论). However, in Zhang’s version, it is written “Fangyi (ordinary doctors)”, while in Sun Simiao’s version, it has been changed to “Yongyi (quacks)”. It is possible that Zhang’s original version also was written “Yongyi”, but there is no evidence for this yet. It is certain that “Yongyi” had been commonly used to describe those who were poor at medicine and had bad medical ethics during the Tang dynasty. For example, the Old Book of the Tang Dynasty – Records of Zhang Wenzhong (旧唐书·张文仲传) states, “Wenzhong talked with the king that… Though they are all doctors, their characters are different. Yongyi (quacks) can’t administrate medicinals correctly and treat improperly all the time. So they kill people.” Xu Chunpu in the Ming dynasty once classified and defined doctors in his Ancient and Modern Traditions of Medicine (古今医统) as follows: “Those learning medicine, their proficiency is different, so their names should not be the same. Those who are proficient at medicine are called wise doctors; those who are good at medicine are called excellent doctors; those

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who can prolong the life-span of the king and ministers are called state doctors; those who are poor at medicine and don’t understand medical theories are called quacks; while those who treat disease by hitting drums, dancing and praying are called witch doctors.” This is merely Xu’s classification. In addition, he also mentions “timely doctors” but these were not included in the above classification: “It is said that ‘wise doctors’ are inferior to ‘timely doctors’. It is possible that though timely doctors don’t read books and understand theories, they can cure patients by luck as they have been practicing medicine a long time. They often say, ‘By advantage of my ten years of practice, come to visit me for help as soon as possible, if you are ill’. They also said, ‘Your intensive reading of medical classics is not as good as my rich experience inspecting patients’. There is even a proverb that states: ‘Opposed to the heart are the small-intestines, the liver, gallbladder and kidney; a timely doctor earns his keep, a thousand coins a day’. Thus the saying: ‘wise doctors are inferior to timely doctors’. This may be very true. But the Precious Mirror of Hygiene (卫生宝鉴) says ‘We must be cautious of fortunate doctors and the very capable’. Patients today are not aware of this and seek treatment from those timely doctors. This is just like giving up and be willing to jump into a dark ditch. Is there any difference!” Accordingly, it seems that “timely doctors”, or “fortunate doctors”, were quacks. Though the above story to some degree is making light of practical experience, doctors having both an intensive reading of the classics and a rich clinical experience are surely better than those with only clinical practice. A typical example of a “timely” or “fortunate” doctor is in the Chats Made Out of a Guest’s Window (客窗闲话) written by Wu Xiang’an in the Qing dynasty. The general story is this: Wu took up medicine and established a pharmacy at the same time. He once treated a county magistrate’s daughter with Ledebouriella Powder (防风散) for a common cold. However, she died, so he ran away from the town. Later, the county magistrate was promoted to a higher position away in the city. Wu thus went back to practicing medicine again and gathered together with the townspeople for a celebration. During the banquet, someone visited and asked for drugs for treating measles. He told his wife’s brother to give them the drug. Unfortunately, he then found out the drug given by mistake had been poisonous white arsenic, so he ran away again. To his surprise, this white arsenic was taken by a military general and his prolonged cold was cured. Therefore, the general came to reward him. He hid and dared not meet the

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general until he knew the reason. He obtained a generous reward and his business began to prosper ever after. He built a grand house and wrote on the gatepost a couplet he had written himself, which literally said, “Luck wanes when Ledebouriella Powder kills people; luck waxes as white arsenic saves people.” His medical career relied totally on luck. Strictly speaking, “timely doctors” and “fortunate doctors” were different from quacks, who knew nothing about medicine but earned money by selling fake medicine and using deceitful practices and tricks. Though they were not proficient at medicine, they knew something about acupuncture and medicinal decoctions. If they had been trained as “Confucian doctors”, accidents would have been at the most “mistakes of medicinal application” or “medical negligence”. There are many such cases, but these doctors were not termed “quacks”. The following is a case in point. The History of Jin Dynasty – Records of Li Gao (金史·李杲) states, “When Yuenian, Feng Shuxiang’s nephew, was about 15 or 16 years old, he suffered a disease due to cold damage. According to the clinical manifestations of red eyes, thirst and 7 to 8 times pulsation in a single breath, the doctor prescribed Purgative Decoction (承气汤) to relax the bowels. At the time when the decoction was ready, Li Gao visited. Feng told him the reason of having this decoction. Li Gao felt the pulse and was greatly shocked. He said, ‘It is nearly killing the boy! The Inner Classic (内经) says… Now bring me some dried ginger rhizome and monkshood. I will deal with the illness by treating pseudo-heat with heat.’ The color of the boy’s nails changed almost before the new medicinal decoction had been taken. Then he drank 8 liang (400 g) of the mixture and recovered after the sweat had been driven out.” The doctor mentioned in this case was not completely wrong, but Li Gao’s insight was much greater than that of an ordinary doctor. Even if the boy had died after the treatment, the doctor might not have been regarded as a quack. Criticism of “timely doctors” and “fortunate doctors” at that time was probably related to the jostling between orthodox Confucian and grassroots doctors. In the eye of the Confucian, only Confucian doctors were excellent doctors, while grassroots doctors read little and must be mediocre. Collections of Wu Wending’s Family Storage (吴文定公家藏集) states, “As for medicine, a person will not understand its theories without proficiency, and will not know it’s generalities without profound reading. Therefore, previous medical doctors always asked a learner to read the Confucian classics first, and understand the Book of Changes (易经), Plain Questions (素问), the Classic of Difficult Issues (难经), the Classic of Materia Medica (本草经) and the Pulse Lore (脉经). Why didn’t they omit

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these aspects? Because people can never master the delicacy of meanings and theories without a knowledge of the Four Books, or know the waxing and waning of Yin and Yang without the Book of Changes (易经), or identify diseases without the Plain Questions (素问), or recognize herbs without the Classic of Materia Medica (本草经) or comprehend the pattern of illness by feeling the pulse without the Pulse Lore (脉经). Hence, not a single one can be omitted. On the other hand, human life is vitally precious, and diseases change enormously. Patients can be young or old, and have a weak or strong physique. In diagnosis, the environment and season should be considered, disease patterns must be identified and disease phases be differentiated. With the combined attack of six different pathogenic factors, emotional disorders and an irregular qi movement in nature, the formulae prescribed are particularly different. By inspecting the complexion, feeling the pulse, and inquiring after their daily life, we know patterns can be similar, but the remedies will actually be different. Sages actually teach people by revealing their ways briefly. A learner must study the strong points in all kinds of books and combine this understanding with clinical practice in order to treat disease. Then is it possible to be an excellent doctor.” This passage can be regarded as setting the standard for an “excellent doctor”, namely a Confucian doctor. Quacks are those who can’t meet this standard. However, it also involves some kind of bias to differentiate excellent doctors and quacks by using the standard of a Confucian doctor. At anytime, the curative efficacy of the medicine should be the optimal standard. This was also greatly emphasized during the Dynasties. For instance, according to the History of the Song Dynasty (宋史), in the first year of Huangyou (1049), Emperor Renzhong of the Song announced an imperial order: “Don’t let poor people risk their lives by being mistreated by quacks.” According to the Long Compilation of History as a Mirror (资治通鉴长编), in the 5th year of Jiayou (1060), the Emperor wrote an imperial edict that “Because of the serious plague in the capital, poor people are being mistreated by quacks and many of them dying. Let medical officials from the Imperial Academy select some famous doctors to distribute medicinal formulae by combining together their observances of clinical manifestations in the dispensing department.” This shows the attitude of government. As the verse written by Lu You goes, “Quacks control the life of the people, while laymen criticize through articles.” It seems there were quite a few quacks during the Song dynasty. There were even quacks wandering around the villages and lanes. For example, The History of the Jin Dynasty – Records of Jia Xuan (金史·贾

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铉传) states, “In the 3rd year of Taihe (1203)… Doctor Sun Shiming wrote the 12 bold characters ‘Being Entitled to be a Mr. Magical Acupuncturist…’ on a piece of yellow paper and drew the two red characters ‘green dragon’ at the bottom of the paper between the margin and the date, so as to cheat common people. Some officials wanted to arrest him and control him.” After the Tang and Song dynasties, condemnation of quacks became even more likely. This was undoubtedly positive in that it promoted medical morality and the refinement of medical skills. It also made patients aware of selecting doctors cautiously. The learned had a deeper understanding of the quacks. For examples, Gu Yanwu wrote in Records of our Daily Knowledge (日知录), “In ancient times, quacks killed people. At present, quacks don’t kill people, but they also don’t save their lives. They keep people in between life and death, but then the patient will die as the illness turns worse.” The consequence of this was that “quacks killed people without a knife”, but he proposed a strict standard: Whether a quack or not, do not just judge them by the life or death of the patient directly after the treatment. If the patient doesn’t die at that particular time, but the illness still lingers on, it is also the fault of the quack. Xu Dachun even pointed out that some “famous doctors” were probably also quacks. The Preface to Analysis on Thorough Knowledge of Medicine (医贯砭序) records, “If people practicing medicine are sophisticated, talkative, lucky, socially active, good at promoting themselves, and look virtuous, they will become famous as doctors. Such doctors kill people, but people don’t know it. Even if the people know it, they don’t blame it on the doctor. In turn, others are called ‘quacks’. People ascribe their helpful efficacy to an accidental event and if there are mistakes, people blame it on the other as well. This being the case, fame as a doctor is neither determined by medical virtue, nor by medical skill.” Similarly, Zhou Xueting even thought some so-called “great doctors” were actually quacks. He wrote in Three Fingers of Zen (三指禅) as follows: “I have known several so-called ‘great doctors’ alive at present. They are not great and they only use supplementary herbs in large doses. Why do they use large doses of supplementary herbs? The more they prescribe, the more they earn. When they go out, they wear light clothes and ride around on strong horses. One might well say with an ostentatious air. When they feel the pulse, they sit up straight, concentrate their mind and close their eyes. They look really well-intentioned. When it is time to prescribe formulae, they will think for a long time. It seems they are very attentive. However, the herbs prescribed are just huang qi (Radix Astragali), bai zhu (Rhizoma Atractylodis

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Macrocephalae), fu zi (Radix Aconiti Lateralis Praeparata), gan jiang (Rhizoma Zingiberis). They don’t know if a heat-natured disease is supplemented, the heat pathogen becomes more intense; while if a cold-natured disease is supplemented, the cold pathogen becomes more congealing. With repeated treatments, the diseases progresses, leading to flaccidity of the patient. What a pity! But by carefully investigating the reason, I find that they just take it for granted. They are only able to aggressively apply the short-cuts of medicine; then they are pleased with themselves that they can prescribe the odd formulae. Though they don’t know what the spleen and stomach are, and what the life-gate is, they still mention ‘a debilitation of the spleen and stomach’ or the ‘decline of the life-gate’. There are thousands of herbs in the world, but they know no more than 10; there are thousands of formulae in the ancient books, but they only use two. They just use a supplementary method — regardless of it being an interior or exterior disease. They only try to warm the body without thinking whether it is a Yin or Yang pattern. They don’t study the Spirited Pivot (灵枢) and Plain Questions (素问); they find the Decoctions (汤液) and Classic of Difficult Issues (难经) hard to learn. The books of the Han, Tang, Song and Yuan dynasties have many explanations; the ideas of medical experts are vast. There are thousands of sayings in the medical books, but they only remember a few. There are seven orifices to the heart, but no one can live when it is dissected. It is just like speaking of ice to summer insects — they only know the heat, not the cold. They are just like frogs sitting at the bottom of the well — they only know the hollowness beneath them, they don’t know the stones without. It is a pity that so many heroes and high officials are wronged and killed. Gifted scholars and beautiful ladies are harmed and lose money unnecessarily. In the evening, they never reflect on the cases of the day. After half a lifetime practicing medicine, the formulae they prescribed are hardly surprising. Therefore, these ‘great doctors’ avoid seeing wise doctors, and grass-roots doctors they are ashamed to meet. Alas, wise doctors are rare, and people are reluctant to be treated by grass-roots doctors. Hence the pernicious influence of so-called ‘great doctors’ becomes aptly appealing to the people.” Such a statement is surely aimed at a particular kind of doctor, not just those in favour of applying supplementary herbs. These so-called “great doctors” merely had the form of a doctor without any true skill or genuine knowledge. They were not as experienced as grassroots doctors. Zhou Xueting’s understanding makes it easier to identify “excellent” or “quack” doctors in both ancient and modern times. Just as Wu Tang stated in his

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Preface to the Systematic Differentiation of Warm Diseases (温病条辨), “What of the crime done against the people — they don’t die from the illness but from medical treatment? Having a doctor is no better than having no doctor. Not to learn medicine proficiently, is not as good as giving up learning medicine.” This saying should be a permanent motto for medical learners. Xu Dachun said in the Treatise on the Origin and Development of Medicine (医学源流论), “Medical students today talk nonsense. They just take it on to make a living. They don’t know that the subject of medicine contains the secrets of the Heaven and earth revealed to us by ancient Sages, as well as power of nature to save people’s lives. Its theories are delicate, exquisite and enthralling and no one can learn them well other than smart and agile-thinking people… No one can learn them well other than the erudite and apprehensive… No one can learn them well other than the broad-minded and modest… No one can learn them well other than the diligent and retentive… No one can learn them well other than the deeply proficient and meticulous. So those involved in medicine, must be people with outstanding qualities to them and with an extensive knowledge… People conventionally think Confucians should not do the things workers do, that is a trade of craft, so there are rarely doctors both good at Confucianism and medicine. As all people try to learn medicine in a short while, the proficiency of the medical staff daily declines, people are mistreated and we are seeing them dying all around us.” Wu Tang and Xu Dachun’s statements both show a penetrating insight. If the excellence in medical education could not be strengthened, it would lead to a rarity in Confucian doctors and the widespread use of quacks. Every medical learner should read the Admonition to Quacks (庸医箴) written by Gong Xin during the Ming dynasty. Isn’t it shameful that people can be found everywhere, who try to learn and practice medicine for a living without a thorough understanding of the subject? In conclusion, “excellent doctors” and “quacks” have an objective existence — and have always existed in the history of medicine. This also demonstrates a projection of Confucian culture onto the culture of Chinese medicine, influencing the doctors’ behaviour, ethics, medical skill, education and the like.

86.  Kindness in Medicine The core culture of the Confucian was an ethic of “kindness”. Thus, in a society permeated by Confucian culture, medical ethics was naturally confined to this one single idea. Yu Chang said in his Precepts for Physicians

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(医门法律) that “Medicine means kindness. A benevolent gentleman must be sincere, with human sympathy.” There are also many such sayings by Confucius and Mencius, for example “Kindness is human beings”, “A man of kindness loves the people”, “He gives benefits to the people and helps out the needy”, “People will be kind to you only if you can be kind to them; people will be tolerant of you only if you are tolerant of them”, “As we support and are filial to our elder relatives, we do not forget other elders outside our kin; as we raise and educate our own children, we do not forget other children”, “All people have the sense of compassion; all people have the sense of shame” and so on. These ideas almost rested intact in medical ethics. Confucian doctors or even excellence in doctors were classified merely by a moral standard and technical standard. The moral standard was mainly Confucian. However, there are no words relating to “kindness” in the Inner Classic (内经). It didn’t appear until the arrival of Zhang Zhongjing. In the preface written by Zhang, he sighs and says, “When they become an official, they can’t take care of or understand others; when they retire from a post, they can’t take care of or understand themselves.” He scolded officials because “when they encounter disasters and are hardship, they are dim and stupid as wandering souls.” He also cited a saying of Confucius that “Those who understand things by nature are the most intelligent; those who understand things through study take second place.” We can see that Zhang Zhongjing had some knowledge of Confucianism and considered studying and practicing medicine as part of being kind and practicing filial piety. However, he still hadn’t genuinely inserted Confucian ethics into medicine, with regard to such ideas as kindness and filial piety. Huangfu Mi had more to say on this aspect, building on Zhang Zhongjing. He wrote in the preface to The Systematic Classic of Acupuncture and Moxibustion (针灸甲乙经), “Those who find themselves at a height of 8 chi (about 1.70 m), but know nothing about medical issues, may be called ‘wandering souls’. If people are not proficient in medicine, though they have a loyal heart and practice filial piety and kindness, even if they try their best when their monarch or father are in crisis, it will be of no avail. That’s why the sages probed into medical matters, by deliberate thought and explicate discussion.” However, he actually only proposed loyalty, filial piety and kindness, and was confined to saying “knowing medicine is a must for practicing filial piety”. He was unable to put forward a set of professional ethics or behavioural standards. Moreover, he was no clinical expert, so he failed to develop an ethical approach on a large scale.

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But Sun Simiao was a medical ethicist. Being influenced or enlightened by Buddhist doctrines, he wrote The Proficiency and Honesty of Great Doctors (大医精诚), which contains the first passage in ancient China to mention the taking of an admonition or oath in medical ethics. The core was still Confucianism kindness. He was in fact the first to introduce Confucian kindness and Buddhist ideas into medical ethics. Nevertheless, the moment the medical family accepted “kindness” as a criteria of evaluation was much earlier. For example, the History of the Late Han Dynasty – Records of Guo Yu (后汉书·郭玉传) states, “Yu was kind and not arrogant. He always tried his best, regardless of poor or humble patients…” This is a moral judgment. Later, it was applied in judging medical experts. For example, Hua Tuo was judged as “evil”, as he was often less than “in favor of giving a hand”. It was also used to evaluate medical books. For instance, the Hearty Book of Rescuing Children (活幼心书), written by Zeng Shirong, states, “This ‘heartiness’ is a kind of hearty persistence, a kind of heart-felt sympathy, or sincerity.” There are quite a few medical books using “kindness” in the title, to show the author’s state of mind, such as Records of Kind Deeds (仁术志), A Guide to Kindness (仁术便览), the Treatise on the Kindness of Zhai’s Pediatric Formulae (仁斋小儿方论), Kind Zhai’s Direct Guidance (仁 斋直指) and The Records of Kindness itself as an End (仁端录). Yang Quan was the first to propose a standard for an “excellent doctor”. An excellent doctor should have three qualities about him: a background of physicians in his family for generations, a kind heart showing generosity and charity, and third an ability to understand and propagate medical techniques. Doctors with good medical skills but without good medical ethics were called “famous”, rather than “excellent” doctors. The Chapter on a “Statement for Medical Workers” from the Summary of Delicate Treatises and Formulae for Pediatric Health (小儿卫生总微论方), written in the Southern Song dynasty, by an unknown author, fully summarizes the standard of medical ethics. It records the following: “The law of practicing medicine means that the practitioner must put himself ‘in the right place’ first, and then ‘put things right’. He who can put himself ‘in the right place’ means being able to clarify theories and fully apply skills. He who can ‘put the things right’ means being able to aptly use medicinals to treat disease. Only in this way can problems be solved and a cure be realized. If one can’t put oneself in the right place, how can one put things right? If one can’t put things right, how can one cure an illness? Those who practice medicine must be gentle, refined, modest, polite, amiable, not arrogant, and not pretentious. They should collect formulae and theories widely, comprehend

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statements and theories profoundly, be clear on the movement of the qi, understand Yin and Yang, be good at diagnosis and pulse-taking, be proficient at observation and inspection, identify the true and false, differentiate cold and heat, examine the root and branch, and recognize the severity of the disease. They shouldn’t exaggerate a mild disease, or overstate something simple. They should treat rich and poor equally, and apply medicine indifferently. If they can do these things, they will be almost moral. If they cannot, they should be regarded as the greatest foe to people’s lives. Those practicing medicine should give a hand regardless of the distance they have to travel or status of those who consult them. If they arrive at a patient’s home to treat the disease, they must ask whether the patient has asked for other doctors. If they have, they must ask what decoction and herbs the patient has taken, whether purgative therapy has been applied. Deficiency or excess of a disease can thus be detected. If purgative therapy has been applied, deficiency will be the result. Then, together with other data collected by the examination, the treatment will be error-free. What’s more, when treating pediatric diseases, they must be clear on children’s different constitutions, whether they are from northern and southern regions of the country, as well as understand the difference in cold and heat natures. Then they do not apply the same therapy in each situation, which was a thing the ancients were most cautious about.” The above record includes ethical standards, behavioural norms and medical skills altogether. The author regarded both good service and skills as coming from a heart of kindness, which was achieved by the practitioner putting himself “in the right place”. Admonitions of Wise Doctors (明医箴), written by Gong Xin, records this concisely: “Wise doctors today should possess the ‘heart of kindness’. They must have read extensively, be proficient in the arts of the Tao, have a clear knowledge of Yin and Yang, know the movement of the qi perfectly, be able to identify the nature of herbs, detect the exterior and interior state of the pulse, apply supplementary and purgative remedies correctly, differentiate deficiency and excess conditions accurately, administrate formulae according to the disease and its patterns, and treat the poor and rich alike. They shouldn’t claim credit or seek improper profits. The kindness done when saving a life is the most precious thing in the world. This kind of wise doctor can leave a good name for ever.” “Norms of Medical Interns” written by Li Chan and included in the Introduction to Medicine (医学入门) chiefly standardizes the code of instruction for medical students — and serves for the preparation of doctors for the future, especially concerning ethical education. It emphasizes the

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necessity of reading books and holds that Confucianism can guide medicine well. “Medicine derives from Confucianism. Without reading a (Confucian) book to clarify its theories, one will be ultimately fatuous and vulgar in behavior, and unable to practice medicine in a flexible manner.” The Restoration of Health from a Myriad Diseases (万病回春) written by Gong Tingxian also records “Ten Essentials of a Medical Practitioner”, “Ten Essentials when treating Patients”, “Common Faults of Medical Practitioners and Patients” and so on. These are discussions on the behaviour of the doctor and patient, and their mutual relationship, being a study tending towards medical behaviorism. However, its beliefs were still generally guided by “kindness”. See for instance the following: “Once a heart of kindness exists, this must mean someone good who can provide liberal relief to the masses and make great contributions”; “a doctor must be kind and loyal instead of attaching importance to the benefit arising from treatment. Though patients may be rich or poor, the administration of herbs should be the same.” The Five Disciplines and Ten Essentials of Medical Practitioners (医家五 戒十要) written by Chen Shigong can also be regarded as a comprehensive collection of ancient codes of medical morality. This statement is quite long, so it is not cited here. However, the core concept is still “kindness”. Therefore, if we consider “kindness” as being the moral core of the feudal ethics which guided the Chinese, medical ethics comes within its scope. As cases of kindness are well recorded in other historical and unofficial writings, I have no intention of listing any here.

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The Emperors, Their Government and Medicine It has been said before that Taoist philosophy was the soul of invention in all aspects of Chinese medical theory and practice, while Confucian philosophy established a system of regulation — and the principles of medical practice and ethics. The latter were mainly under the Emperors and the administration of their various government departments. This system started during the Zhou Dynasty, and was expounded and propagated by the Confucians. There was a system of feudalism in ancient China, and medicine could not be exempt from it.

A.  The Emperors and Their Medicine 88. The Emperors of the Han and Tang Dynasties and Their Dealings with Medicine Emperors and their relatives were also sometimes sick and asked for medicine. But each of them had a differing attitude towards disease. Duke Huan of Qi resented people knowing about his sickness so he refused any doctor or treatment. However, finally he had to accept seeing Dr Bian Que — at the last second, before dying. The First Emperor of Qin was often ill, so his doctors were always beside him, and this is supported by the textual references in the Historical Book – Biographies of the Assassins. “Jing Ke pursued the Qin Emperor, who ran around the columns of his palace to flee him. At that time, medical official Xia Wuju hurled his medical bag at Jing Ke… the Emperor awarded his officials according to their contributions. He awarded Xia Wuju two-hundred yi (one yi is equal to about 1 kg) of gold and said: ‘Xia Wuju so loves me that he hurls his medical bag at Jing Ke.’” 553

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This involved the relationship between Emperor and doctor. On some occasions, the Emperors loved medicine and pursued it for their own interests, but some hated doctors as they failed to make the dead come back to life. In short, an Emperor’s attitude influenced medical progress. Let’s begin with the Han Dynasty. “The Emperor Gaozu of the Han was hit by a stray arrow when he attacked Qing Bu. On his route, he became seriously ill. Queen Lu met a good doctor. The doctor went in to see the Emperor and was asked about the disease. The doctor answered: ‘It can be cured.’ Then the Emperor abused him: ‘I was a common person but won the world with only three inches of sword. Is it not fate for me to die? Life is predetermined by Heaven. Even Bian Que can do nothing about it!’ He refused the treatment of the doctor, rewarded the doctor with fifty jin (i.e. 25 kg) of gold and sent him away.” (Historical Book – The First Emperor of the Han) Emperor Gaozu was very self-confident and believed in destiny instead of medicine. But he did not belittle the doctor and gave him a generous reward. The Wu Emperor of the Han believed in the skills of immortality and also thought “destiny” could be modified. He was willing to accept treatment. The History of the Han Dynasty – the Empress’s Relatives says, “An acupuncturist Xiu needled Emperor Wu of Han and got twenty million in cash.” The reward was generous. The Han Emperor Wen’s attitude towards medicine could be seen from him summoning and inquiring of Cang Gong. He wanted to create an understanding of medicine. The Han Emperor He took no account of medicine. He did not even trust Dr. Guo Yu, for there had to be a test before he would accept treatment. Go Yu cured his queen by only giving her needling once, but he got no reward. Finally Guo Yu died in the high post of “senior imperial physician” when he was very old (the History of the Later Han Dynasty – Biography of Guo Yu). The premier Cao Cao, at the end of the Han dynasty, belittled doctors as “rats and scoundrels”. Though he “regretted killing Dr Hua Tuo”, he then paid no attention to Dr Zhang Zhongjing, another famous contemporary, and looked down on them all. However, suffering from a head-wind (migraine) just as Cao had, the Emperor Tabasi of the Northern Wei Dynasty had a rather different attitude towards doctors: “Zhou Dan, from Hu near the capital, was good at the skills of an occultist, especially medicine. He was head of the imperial physicians and cured Emperor Tabasi of vertigo. So then he was favored by the Emperor, promoted to Tejin (a special high position) and granted the title ‘marquis’” (History of the Wei Dynasty – Biography of Zhou Dan).

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Liu Yu, the later dethroned Emperor of the Southern Song Dynasty, knew a little medicine. But he treated life as a trifling matter: “The Emperor Liu Yu strolled out from Leyoumen (‘happy journey gate’) where he met a pregnant woman. He was also skillful in diagnosis and said: ‘This baby will be a girl.’ He then asked Dr Xu Wenbo about it. Wenbo answered: ‘There are two babies, one boy and another girl. The boy is on the left, black and blue, smaller than the girl.’ With a quick temper, Liu Yu wanted to cut open the belly. Wenbo sorrowfully said; ‘Cutting might be unfavorable. Please let me needle her. The baby will be soon born.’ He drained the Taiyin acu-point on the leg and supplemented the Yangming point on the hand through needling. As soon as the needling had taken effect, two babies were born, just as he had said.” The Jianwen Emperor of the Liang Dynasty, Xiao Gang, cared greatly about medicine as he knew quite a few Emperors had been cured, so he appreciated the famous doctor Yao Sengyuan and wrote his Admonishments to Know Medicine. All these showed that he was interested in and loved medical matters. The attitudes of these Emperors reflected the admission of and concern for medicine during the Wei, Jin, Southern and Northern Dynasties. Emperor Taizong of the Tang did not understand medicine, but he revered doctors and sympathized with his own people. The Old Tang History – Biography of Sun Simiao says that at the beginning of his accession, Emperor Taizong summoned Simiao and praised him: “People with the Tao should be respected. Xianmen and Guangcheng were not mere legend!” He visited everyone older than 100 years personally and gave special care to them. Zhen Quan was a famous doctor too. It is recorded in The New Tang History – Biography of Zhen Quan that “During Zhen Quan’s time, when he was already one-hundred years old. Emperor Taizong visited him personally to inspect his diet and ask about his regimen.” Taizong also was very concerned with his officials. The Old Tang History – On Korea records that “His right-hand man and general-in-chief Li Simo was hit by an arrow. Emperor Taizong sucked blood out of the wound personally and everyone was moved.” The Old Tang History – Biography of Li Ji says that Li Ji “was suffering from a serious disease, which was said to be curable only by mustache ash in an empirical prescription. Emperor Taizong cut his own mustache to make a medicine for him.” The New Tang History – Criminal Annals records “Emperor Taizong once saw a Mingtang Acupuncture Channel diagram and found out that the five zang-organs were all on the back. Any mistake in needling them would kill the patient. He sighed

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‘Beating is the lightest of the five punishments; but death is serious. How can we let the lightest punishment bring about the death of people?’ So he announced that criminals would not be whipped on the back any more.” The Old Tang History – Emperor Taizong also says, “On the Wu-Yin day of the fourth year of Zhenguan, whipping on the back was stopped as a punishment as there are many acupuncture points there.” Emperor Taizong greatly respected medicine, which had a beneficial outcome for both common criminals and civilians. Emperor Taizong might have suffered from something like chronic bronchial asthma. He himself also knew a little medicine. It is recorded in Zhenguan’s Main Politics that “I suffer from a qi-breath disease, which will become severe as soon as the body gets hot.” “I have a qi disease. How can it be suitable to live down in a wet or damp place?” He and his Empress Zhangsun were both uninterested in immortality. Zhenguan’s Main Politics records, “The second year of Zhenguan, Emperor Taizong said to his courtier: Immortality is fabricated and a deception. The first Emperor of the Qin loved immortality so much that he was deceived by occultists and sent thousands of virgin boys and girls to sea with the Taoists to search for immortality — and they remained there to avoid his tyranny! The Emperor waited and waited at the seaside for them to return, and finally died at He Qiu on the way back to his palace. As he was interested in seeking immortality, Emperor Wu of Han married his daughter to an occultist. When his son-in-law did not succeed in the test, he killed him. So I do not trouble myself with immortality.” “The Empress Zhangsun got sick and it became more and more serious. The Crown Prince said to her: ‘All medicine has been tried, but you are not well. I’ll beg Father to pardon all prisoners and send people to join with the Taoists to pray for your health.’ The empress said: ‘Life and death are predestinated and cannot be changed by humans. If cultivating good fortune can prolong life, I never did any evil. If good actions do not work and create good fortune, then what can I do? Pardoning offences is very important for a country; the throne every time tolerates the existence of Buddhism and Taoism, such two different religions. I often worry about malpractice in the regime. How can one woman break the law or regulations of the country? I cannot permit you to do this.’” This was one aspect of the clear administration of the Zhenguan Period. “No whipping on the back” also influenced later generations. A New History of the Yuan Dynasty – Criminal Annals records that “I have read Zhenguan’s Main Politics, which says that Emperor Taizong inspected a

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bronze figure and saw the five zang-organs lying on the back and told people not to whip the back any more. Such a wise monarch understood that the root lies in loving the people. This also presents us with an instructive mirror for later generations.”1 Empress Wu Zetian also paid rather more attention to medicine. The Old Tang History – Biography of Zhang Wenzhong records that as she knew imperial physician Zhang Wenzhong who was good at treating wind disease, she commanded him to “collect all the famous doctors’ prescriptions for wind-qi disease and Lintai inspector Wang Fangqing to supervise the compilation.” Zhang Wenzhong, Li Qianzong and Wei Cizang were three famous doctors at that time. Wei Cizang was known as the King of medicines. The Three-volume Prescriptions for Emergencies written by Wenzhong was popular for several generations. On the contrary, some innocent royal physicians were killed by their Emperors — because their medicines did not work. For instance, during the Tang Dynasty, there was Emperor Yizong: “In August of the eleventh year of Xiantong (870), Princess Tongchang died. Emperor Yizong was extremely grieved. He put imperial physicians Han Zongzhao, Kang Zhongyin, etc. in prison because their treatment had not been effective. Also more than threehundred from their clans were put into prison as well. The prisons were overcrowded. Liu Zhan called for a remonstrating official to write to the Emperor, but none dared to do so. So Zhan wrote to the Emperor personally: ‘I heard that life and death are of destiny, whether in ancient times or now, whether one is wise or foolish… A few days ago, Princess Tongchang suffered from a serious malady, which made you very sad. But the medicine did not work and the princess has gone to another world. Your Majesty loved her so much, you are in distress and trace it back to her. You then blame the imperial physicians and mete out severe punishment. Han Zongzhao and the others had been favored by you because of their medical skill, and they must have tried their best in diagnosis and treatment, hoping the disease would be eliminated by magical medicine — just as snow melts. However misfortune cannot be changed and finally this disaster happened. It is pitiful, but this is just according with the conditions. They did not perform their duty in a perfunctory manner and did not shirk their responsibility. Your Majesty is so furious you put nine clans in prison, which shocks the whole court. For two people’s mistake, more than three1

 Note: “Bronze figure” is a mistake, it must have been an acupuncture channel diagram he saw. There were no bronze figures made in the Tang Dynasty, only in the Song.

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hundred people are in chains, the old and the young. Everyone says: ‘When you showed them favor, their relatives did not enjoy your favor. As these doctors gave medicine to the Princess, they did not consult with their relatives either. This is indeed a disaster from heaven but not their doing.’ Everyone is talking about it. They are all very unhappy and sigh about it!… I sincerely hope your Majesty can turn the anger into happiness and release them…’ On reading this, the Emperor was even more furious and dismissed Zhan from his post the same day (The Old Tang History – Biography of Liu Zhan). Emperor Yizong made innocent people suffer, which shows he was a bad Emperor.

89.  Emperors and Medicine During the Song Dynasty Emperors in the Northern Song Dynasty were most interested in medicine. Professor Li Jingwei has explained this in detail.2 The brothers Emperor Taizu Zhao Kuangyin (reigned 960–976) and Emperor Taizong Zhao Guangyi (reigned 976–997) both knew medicine well. Volume three of The History of the Song Dynasty says, “He changed the first year title of his reign to Qiande, following an order from his mother, Empress Du, and handed over power to Emperor Taizong. Taizong frequently suffered from serious disease. Taizu went to see him and burnt mugwort for him personally. As Taizong felt pain, Taizu burnt himself too. He often said to his favorite officials: Taizong walks with a majestic gait like a dragon or tiger, he will be an Emperor of peace and tranquility in the future. I am not as lucky and do not have the high prestige he has.” Zhao Kuangyin performed acupuncture and moxibustion for Guangyi personally. Zhao Gaungyi himself said, “Before ascending the throne, I was living in seclusion and collecting famous prescriptions, I studied this marvelous medical art and abstruse needling skills in order to get their essence. I have collected more than a thousand prescriptions and tested them on myself. I have set the criteria for their use. Of most importance is to remove diseases and save peoples’ lives… Now that I take a position respected by millions of people, I often put myself to think like the common people and worry that the five qi may be out of order. I also worry and fear being remiss — which is improper for life and wellbeing. I have very great compassion for them. So I have to read these books of prescriptions myself, personally…” (from the imperial preface to the Taiping Royal Prescriptions). 2

 Li Jingwei. Emperors and Medicine in the Northern Song Dynasty in Historical Chinese Technology, No. 3, 1989.

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The History of the Song Dynasty – Biography of Wang Huaiyin also says, “In former times, Taizong was a military governor at a border area and paid great attention to medicine in his spare time. He collected and stored more than one thousand famous prescriptions, which all were proved to be effective. He now ordered all imperial physicians in Imperial Medical Academy to present their own family inherited, experiential formulae — in all more than ten-thousand inherited empirical prescriptions… edited in one-hundred volumes. Emperor Taizong wrote the preface, and entitled it the Taiping Royally Favoured Prescriptions and also ordered it printed from woodcut blocks that it might be issued and enforced all over the country. So every medical doctor in every state was able to administer its prescriptions.” So we know Zhao Guangyi loved medicine, collected descriptions and tried them personally, long ago. The Picture Record of Guo Ruoxu says, “As Emperor Taizong was living in seclusion, and looking for famous doctors everywhere, Wenjin (Gao Wenjin) went to him.” As mentioned before, Gao Wenjin was also a famous doctor. Unlike the two founders of the Song Dynasty, the next seven Emperors did not know any medicine, but they inherited and expanded the tradition and cared about it a great deal. In the fourth year of Xianping, Emperor Zhenzong (reigned 998–1022) saw a sergeant hit through the cheek to the ear by an arrowhead. No doctor could draw the arrowhead out — but Yan Wenxian applied some medicine to the wound and the arrowhead came out after a single night. Emperor Zhenzong praised him greatly and awarded him a sash of red silk. Zhao Zihua was head of the imperial physicians. He died in 1005. Before dying, he presented his Illustrations of Wellbeing during the Four Seasons to the Emperor, and it was renamed Illustrations of Food Regimens and prefaced by the Emperor. Volume 45 of Verification of Chinese Medical Books records, When Emperor Renzong (reigned 1023– 1063) had “married Empress Guangxian… the Empress fell ill and the imperial doctors treated her but without effect. The Emperor asked: ‘Who treated you at home?’ The empress answered: ‘When I was ill, I took Sun Yonghe’s medicines and I would be alright.’ Then Yonghe was quickly called to treat her and his medicine was really effective. Yonghe was promoted to Shangyao Fengyu (imperial medical official).” It is recorded as well in Vol. 101 of Added Sequential Editions of History as a Political Mirror that Rezong ordered the following: “Since now in the name of some evil gods, sorcery deprives the invalid of clothes, food, or decoctions, and separates them from their relatives, those who aim to deliberately trap their patients, he and his accomplices will be put in prison — just as accords with the law

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against cursing.” Volume 507 of Whole Records in Medicine of Collections of Ancient and Present Books states, “At the beginning of Jiayou (1056– 1063), Emperor Renzong was sick in bed. He called in a grass-roots doctor to needle him in the back of the head. Just after the needle was drawn out, he opened his eyes and said: ‘So xingxing!’3 The next day, he was well and called the point the ‘Xingxing Point’ (i.e. Fengfu, wind-mansion point).” “So xingxing” means “so now I am sober or very comfortable.” The Compilation of Anecdotes in the Song Dynasty also says, “Emperor Renzong always had backache. Princess Li recommended a ‘face-cut’ sergeant (a kind of convict who served in the army) to him. The servant needled the waist and said to the Emperor ‘Please walk’ as he just took the needle out. The Emperor did as he was told and walked as well as before, so he called the point the ‘thriving-dragon point’.” It seemed that Emperor Renzong did not look down on either the grassroots doctor or the “face-cut” sergeant. Volume 462 in The History of the Song Dynasty records, “Emperor Renzhong did not feel well and imperial doctors gave him medicines several times, but they did not work. Everyone was worried and scared. Princess Dazhang of Ji recommended Xu Xi who needled his pericardium channel and he got well. He appointed Xu Xi Imperial Medical Official. Xu Xi asked him to build Bianque Temple as the reward. The Emperor agreed to build the temple in the West City… and also put the Imperial Medical Bureau beside it.” Volume 178 in The History of the Song Dynasty records, “Plague broke out in the capital and the Emperor commanded the imperial physicians to make up medicines. The imperial storage specially took out two rhinoceros horn to make medicines. The doctors cut them open and found that one was ‘celestial rhinoceros horn’. Chamberlain Li Shunju requested to retain it, as only for the Emperor’s use as a preventative medicine. The Emperor said: ‘How can I treasure these things more than my people?’ He cut it into pieces and mixed it with the others. He also ordered the suspension of rent in the town-hostels for ten days, and commanded the imperial physicians to choose some who were good at pulse-taking in the county to work with the magistrates to give out medicine, according to each invalids’ symptoms. This would prevent the poor being killed by quacks and dying young.” Emperor Renzong cared about his people; he saved them from the plague with his medicines and built Bianque Temple. He really did well in the medical field. During the Song Dynasty, Emperor Yingzong (reigned 1064–1067), Emperor Shenzong (reigned 1067–1085) and Emperor Zhezong (reigned 3

 Xingxing — “I am sober!” or “I wake up!” or “I understand!”.

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1086–1100) all made some contribution to medicine. Emperor Weizong Zhao Ji himself even compiled the Classic of Royal Benevolence and published it in the first year of Chonghe (1118). He wrote in the preface that “One Yin and one Yang make up the Tao. Excessive Yin or excessive Yang mean one is ill. If one does not understand the Tao, he will not possibly cure any disease… once the people can be made to live long, using the popularization of Huangdi’s medicine, is this not wonderful?” (Vol. 47 Verification of Chinese Medical Books) Volume 224 of Imperial Decrees of the Song Dynasty mentions that Emperor Weizong also said, “issue this decree by the Emperor himself: promulgate it to all schools… test questions in the schools should all come from the Classic of Royal Benevolence.” On this basis, he summoned all doctors to compile a book, the General Medical Collection of Royal Benevolence. This book might actually be the largest compendium of Chinese prescriptions. The Song government collected, emended and published quite a lot of medical formulary and Chinese materia medica, which may well be due to this tradition — the Emperors loved and paid attention to medical matters. Official medicine was most prosperous during the Song Dynasty.

90.  Emperor Kangxi and Medicine Some Emperors in the Yuan and Ming dynasties were also friends with doctors and paid great attention to medicine. The History of the Ming Dynasty – The Biography of Dai Sigong reads, “Emperor Taizu was very ill. After getting a little better, he went to the Right Shun Gate to blame his doctors for their halfhearted treatment of him, but consoled Dai Sigong: ‘You are good and kind! Don’t be afraid.’ Not long after that, Emperor Taizu died and the crown grandson succeeded to the throne. He punished the imperial physicians but promoted Sigong to be head of the Imperial Hospital.” There was friendship and trust between Emperor and physician. Unfortunately, this could not be handed down from age to age, just as in the Song Dynasty. Medicine was not favoured by the Emperor until Emperor Kangxi of the Qing Dynasty. Kangxi made great contributions to the acceptance of quinine (cinchona) and the popularization of variolation. Unlike Emperors in other dynasties, he had a general understanding of traditional medicine and cared about it a lot. There were many instructions in Emperor Shengzuren’s Family Educational Maxims edited by the Emperor himself. Some excerpts follow.

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Concerning well-being, he said, “Proper diet and a regular life-style are the best way to keep illness away.” “When living outside one should first keep the place clean. If one keeps it clean, clean qi will lie within one’s body. If one comes near filth, one will be contaminated by filthy qi. Thus the clean qi will gradually be overshadowed by the filthy qi.” “Diet is most important in the way of wellbeing. If one does not feel well, one should eat less, but only slightly less than usual. Nowadays, the doctor just tells patients not about diet but only to take medicine. This could be sufficient if one suffers from an internal injury of the stomach and spleen caused by food or drink — then he should not eat. Otherwise, he should explore the reason for his illness, take care to look after himself in a relaxed manner and eat a proper diet to supplement the blood and qi. If one overemphasizes stopping food and only takes medicines as a supplement, very few patients could get adequate qi and blood. Those who excel at keeping healthy must know this.” Emperor Kangxi was very particular about drinking water. “Drinking is essential to one’s diet; water for drinking is the most important. I have much experience of this. I always weigh water from different places. The best water weights most. If one meets with poor water, distill it and use the condensed ‘dew’ to make tea. This is the ‘dew’ that Jebtsundamba Khutughtu4 has been taking for many years — just steamed water.” Emperor Kangxi reigned long (his sixty-one-year reign was the longest of all the Emperors) and this had much to do with his diet, sanitation and healthcare. He also made a good study of Taoist self-cultivation. He cited Zhuangzi who said, “Don’t overstrain your body, don’t exhaust your essence.” He also cited Geng Sangzi: “Don’t think or worry too much. Thinking less can nourish the spirit, less desire for sex can nourish the essence, speaking less can nourish the qi. Understanding this, one can keep fit. So the body is a device to live by; the heart is master of the body; spirit is the understanding of the heart. A calm spirit leads to a peaceful heart; a peaceful heart leads to a wholesome body. Be quiet and nourish the spirit, the insides will be at peace, a clean and empty heart cannot be seduced by the outside. A calm spirit and easy heart will not exhaust the body.” Emperor Kangxi also had a good understanding of the properties of medicines. He said, “I have read a lot of medical books since I was very young, so I have a thorough understanding of medicine and can identify the authors of books written under the name of the ancients. Nowadays, doctors have learned little but want too much profit. If they do not have a kind 4

 Tibetan Lama and member of the Mongolian nobility.

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heart, how can they treat patients? How can people understand the properties of various drugs? All have been taught to us by the ancient sages. So I must tell people of all the drugs I have tried and all the prescriptions I have used to cure diseases. I must explain where their prescriptions come from and record them — hoping that then they can help more people.” “Drugs are used in different ways. Ancient doctors, some used the fresh herb, some used those dried by exposure to the sun, some chewed or broke them by hand and mixed them together. However, today everybody just dries them by exposure to the sun and everywhere they use the same weight. Is this the ancient system? If someone is wounded or fractured in Mongolia, the root of Chuo’erhai, a green grass, will be helpful but it is not permissible to let another person see where it is being picked. I ordered people to test this and it is true. It has been proven that this is the herb know as the ‘teasel’ inland. From this I know that the Mongols keep to the ancient medicine system. Anyway, if the medicine is suited to the disease, even a toxic drug can save a life. Again, even Ginseng is harmful if not suitable. So it is most valuable for the medicine to be suited to the disease.” Emperor Kangxi had a clear head and paid much attention to the verification and testing of medicines. He pointed out the key to drug application. Emperor Kangxi also did a sensible analysis of clinical diagnosis as well as treatment. “Medicine is crucial for human beings. The ancients formed a definite opinion before prescribing; they had a thorough understanding of the source of the disease before giving treatment. Nowadays they often claim to have a marvelous inherited prescription which is useful for a certain disease, and patients rush to ask to take it. However, the drug is actually not often related to their symptoms, which can easily lead to serious troubles. Also, a pill can be the size of a millet-seed but its function could be as powerful as that of a much larger formula, such as one using drastic metal or minerals as ingredients, or a very toxic herb… its devastating effects on life are beyond imagination!” “If people go to see the doctor, they must tell the doctor about the disease in detail, from start to finish. Then the doctor can give a sensible treatment. However, some people freely don’t tell their doctors all about the disease, to test whether or not he can understand their disease. It seems that they want to embarrass their doctor, but in fact, they are making trouble for themselves. Diseases are different for different individuals. Someone can be cured with one or two doses, but others cannot. If one or two doses cannot make the disease better, some anxious people will change doctors frequently. This does harm to the patient himself. Everyone should remember it.” Kangxi did a penetrating analysis of the patient’s

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psychology and behaviour when he saw a doctor. What he said about doctors was that “The ancients said that taking no medicine is as good as seeing a middling doctor. But this did not mean taking no medicine, but being afraid of taking the wrong medicine. The pulse is subtle; medicine is profound. The ancient medical sages and wise doctors probed deeply into many theories and wrote many books… Today, if a doctor can save the time for social activities, to read, to explore the mysteries, to study subtleties, to examine medical records and research the pulse; if he treats others as if he treats himself, seeking neither fame nor profit, making no distinction between those in high positions and those low on the social ladder, and he must also take time for clinical practice and make the right judgment in diagnosis and medical usage, then his treatment must be effective, and one can reasonable say he will do well without exception. Consider carefully, when seeing a doctor.” This is a penetrating comment made on the relationship between medical ethics and medical technology. Emperor Kangxi seemed to have had a poor impression of moxibustion because of his own experience. “Moxibustion does nothing wonderful and is painful. When I was young, I was often given moxibustion for an illness. It did a lot of harm to my body. Even the smell of mugwort disgusts me and gives me a headache now. Only to treat with moxa is not useful. You must remember this. Don’t use moxa rashly.” Emperor Yongzheng, his son, said he “had just listened carefully and silently remembered” the above-mentioned “Family Educational Maxims” for forty years. Emperor Kangxi himself never practiced medicine, but his deep understanding and subtle analysis of medical practice showed that he was a sober Emperor. The Uncensored History of the Qing Dynasty – Anecdotes records, “Emperor Kangxi took care of medical theory and was proficient in the properties of medicines. He once said to his doctors: ‘Ancient sages had the final say on things. But listen to the common person talk about medicine, divination and astrology and telling fortunes, and everyone has a different formulation. A quack cannot even distinguish between cold and hot syndrome, deficiency and excess syndrome. Southerners like reinforcing, but northerners like reducing. Neither are moderate ways. Most warm tonics have a little effect and a drastic drug has a quick effect. The medical formularies record many formulations but if one prescription can cure a disease, why change prescriptions again and again! In the West, there is a bark called cinchona bark. It has a marvelous curative effect on malaria and you only need one dose. So it is important for the medication to be symptomatic.’” It seemed he not only accepted Western drugs but also

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hoped to reform medicine so that one used one prescription (one medicine) for one disease (one pattern). It was a new way of thinking. In addition, Emperor Kangxi worked hard to promote smallpox inoculation. His great contribution will be discussed later. Unfortunately, the Emperors after Kangxi failed to understand his intent. A revolutionary opportunity in traditional Chinese medicine most unhappily slipped away due to the later closed-door policy.

B. The Governmental System and Organization of Medicine and Health Emperors had differing attitudes towards medicine; so every government could also have a differing policy which often paid more or less attention to medicine. China was a feudal empire with thousands of years of history, mostly following along with the customs of former dynasties. So even if some made occasionally great achievements, it was impossible for them to further develop. In the second year of the Daoguang (1822), acupuncture and moxibustion in the Imperial Hospital were banned permanently. It was absurd. Fortunately, folk acupuncture and moxibustion lingered on in a steadily worsening condition.

91. The Governmental Medical Organizations and a Doctor’s Social Position The earliest establishment of a Chinese governmental system of medicine and health can be read in the Zhou Rituals: “The head-doctors are in charge of medical policy and medical decrees and they collect drugs for treatment. People who suffer from disease, from skin scaling to sores come to see the doctor and they should be separated out — so that the doctor can treat them respectively. At the end of the year, an assessment of medical achievement determines their level of remuneration. If all treatments are successful he is the best; if one fails once in ten, he will be the second; if twice in ten, he will be the third; if three times in ten, he will be the fourth; if four times in ten, he will be the worst. Doctors of diet are in charge of the diet for the King, including the six kind of grains, six drinks, six meals, hundred dainties, hundred jams and sources that are used to prepare the eight rare delicacies. Physicians are in charge of treating disease amongst the people. Diseases happen in every season, headache in spring, scabies in summer, cold disease

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and malaria in the autumn, coughs and asthma in winter. Diseases are treated with five flavors, five cereals and five medicines. To judge whether a patient will live or die, first observe his five qi, five sounds and five colors, next observe the change in the nine orifices, finally diagnose the activities of the nine internal organs. Invalids and patients are to be separated and treated respectively. As a patient dies, his physician records the cause of death and reports to the head-doctor. Surgeons are in charge all of formulae, scraping pus, clearing away ulceration, and dressings for patients suffering from swollen ulcers, common ulcers, metal injury ulcers, fracture ulcers. To treat an ulcer one should attack it with the five ‘toxic medicines’, nourish it with the five qi, treat it with the five medicines, and regulate it with the five flavors. Sour medicine nourishes bone; pungent medicine nourishes tendons; salty medicine nourishes veins; bitter medicine nourishes qi; sweet medicine nourishes flesh; smooth agents nourish the orifices. All patients suffering from ulcers are treated with medicine from the surgeons.” The above-mentioned “head-doctor” was the general medical manager of the whole country, equivalent to a “health minister”. “Physicians” were responsible for the treatment of internal diseases. “Surgeons” were responsible for the treatment of external diseases. They were not specifically designed for royalty, but were general doctors for all people in the country. Only “doctors of diet” were dedicated dietitians for the King’s nutrition. Under every general doctor, there were top shi (士, here means a noncommissioned official), middle shi, lower shi, a fu (府) or a host of storage, a shi (史) or a document official, and tu (徒) or disciples. Their number was different and each one’s responsibility was defined. There was an assessment system at the end of the year as well. This was the basis for the establishment of governmental medical institutions during later dynasties. The Qin Dynasty set up a chief imperial physician to take charge of national medicine. The term yushi (“Head-doctor”) from the Zhou Rituals has been used ever since. An attendant physician was also specifically appointed for the Emperor, namely a shiyi (“attending physician” or “imperial physician”). Top/middle/lower shi (士) became yishi (医士), i.e. “medical assistant”. These names have been used as official titles ever since. In the Western Han Dynasty, the governmental medical organizations belonged to Taichang Temple (in charge of national medicine) and the shaofu (exclusively managing the medicine of the nobles). In the Eastern Han Dynasty, the position of imperial medical assistant under a shaofu branched into medical assistant and drug assistant, respectively called formulary cheng (medical assistant officially in charge of prescriptions) and medicines cheng

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(medical assistant officially in charge of medicines). Besides this, there was an imperial medicine inspector, a head of medicine official in the imperial harem, a medicine-tasting official, a medical foreman, medical workers, etc. An unearthed copper basin found recently was engraved “medical worker”, probably a pharmaceutical utensil. In the Wei, Jin, Southern and Northern Dynasties, there was some change, setting up the title “doctor” or bo (similar to a PhD nowadays)： doctor or imperial physician, and immortal doctor (in charge of making all the drugs). The Northern Wei Dynasty began to establish a royal medicinal inspectory, and the Southern Song Dynasty began to establish the Imperial Medical Administration, a Bureau for the Administration of Medicines, a Bureau of Drug Storage Administration and a Bureau for the Administration of Royal Dietary Affairs. These institutions had a relatively independent function. Although these mechanisms were still under the jurisdiction of Taichang Temple and the shaofu, this was a big difference compared to their former administration. The Imperial Medical Administration, especially, was now rated a “Central Medical University”, as it had become a special educational institution — a custom followed by the Sui and Tang dynasties. This was a big leap forward in medical management and the division of labour. The Song Dynasty began to establish an Imperial Medical Bureau (太医 局) to take charge of medical education and an Imperial Medical Officials Academy (翰林医官院) to take charge of medical decrees and policy (the Five Dynasties had started to set up an imperial medical officer earlier), while the Imperial Medicine Academy (御药院) was especially for the Royal family. Under central and local governments there were bureaus for public health such as a Benevolent Bureau (惠民局) for medical care, a Bureau of Patent Formulary Products (和剂局) for patents and purchase, a Hospice for the Homeless (安济坊), a Hospice for Patients (福田院), a Bureau for Orphans (慈幼局), a Hospice for the Old and Homeless (养济院), a Hospice for the Disabled (福泽院), etc. The Imperial Medical Bureau was renamed the Imperial Medical Hospital (太医院) during the Jin and Yuan Dynasties. A Medical advisor (院判) and medical official associate (院使) were set up to manage general medicine and medical education. A Medical Administration was set up in every province to govern local medical administration. The Imperial Medical Hospital became the highest medical authority. The Ming and Qing Dynasties generally continued to adopt the system of the Imperial Medical institutes. There were also an Imperial Pharmacy and a Benevolent Pharmacy. In general, administrative and medical care advanced greatly. The levels of organization were clear. Medicine serviced mainly the royal

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court, concurrent with serving the common people. In effect, it depended on being cared for by local governors at different levels. However, many care homes were established for the weak and sick, which had never been done before. It was a new idea. On the contrary, if we also take into account the political system, the organization and management of health must still have been fragile and confusing. The social status of doctors had been promoted so that they were on an equal footing with other civil and military officials, which indicated that they received relatively special attention. Doctors were called Hanlinyiguan (翰林医官 imperial medical officer), Baohe Daifu (保和大夫), Bao’an Daifu (保安大夫), Baohe Lang (保和郎), Chengquan Lang (成全郎), etc. which explains maybe why a doctor was later called “Daifu 大夫” or “Langzhong 郎中”. In the Jin and Yuan dynasties, doctors had the highest official rank, even ranking as second-class officials. The Ming and Qing dynasties had the same bureaucratic system, but doctors only ranked at the fifth level at the most and are not mentioned in the higher ranks. A doctor could be called a Taiyi (太医), Shiyi (医), Yuyi (御医), Yiguan (医官), Yigong (医工), Yixiao (医效), Yiquan (医痊), etc. It varied according to position and there was no fixed title. Generally, the status of doctors was not high, apart from those favoured by the Emperor and high officials.

92. Supporting the Disabled, Visiting the Sick and Policies of Medicine and Health In the above-mentioned system, the Emperor and the whole government devoted great attention to health matters and the treatment of the public. But some executive bodies and local authorities were always disorganized, and actions were spontaneous, acute, temporary and improvisational. Some effective medical systems mainly depended upon tradition. Some temporary measures showed solicitude for the people thanks to the “consideration of the Emperor” or some “high official”. For instance, supporting the disabled and visiting the sick had been noted in the ancient Guanzi – Five Assistances, where it says, “Supporting the old, loving children and orphans, sympathizing with the widowed, visiting the sick and condoling with people suffering from disasters, and mourning the dead are called ‘assisting and saving someone in a desperate situation’.” Also this text points out the “nine benefiting policies to be taken into consideration in training” (from the Into the Nation section): “The first is to take care of and support old people, the second should be to kindly

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look after children, the third to compensate orphans, the fourth to raise up the disabled, the fifth to marry off the widowed, the sixth to visit the sick, the seventh to report on the poor, the eighth to relieve those in disaster, the ninth to mourn the dead.” These policies were really beneficial to people’s health. The “Policy for the Disabled” meant that “a nation should be equipped with officials in charge of the disabled. These comprise the people who are deaf, blind, mute, dumb, the lame, the crippled, the half-paralyzed, those with contracture of the hands etc. whose difficult lives cannot be settled by themselves. The government has to take in and support them, giving them food and clothes until their death. This is called ‘raising up the disabled’.” It was similar to “free medical care” in hospitals or “free supply” in sanatoria. “Visiting the sick” meant that “a nation should be equipped with officials to visit the sick on behalf of the monarch. Those bachelors above ninety-years old are visited once a day, those above eighty visited every two days, those above seventy years old visited every three days. The rest of the multitude are visited every five days. Serious patients are reported to the monarch and the monarch should visit them personally. These officials should make a circuit all over the nation — as ‘visiting the sick’ becomes their sole duty.” This was the utopian ideal postulated by Guan Zhong, but was never seen in reality. The Book of Rites also has similar words: “The three wise kings supported the old according to the great age. If one was eighty years old, his one son need not serve in political work; if one was ninety, his family need not serve in political work. The disabled who can not take care of themselves need someone to look after them, who does not need serve in political work.” “All craftsmen have to give food in containers to the mute, the deaf, the lame, the crippled, those with a broken arm or leg, dwarves, etc.” These were possibly empty words because there is no circumstantial evidence that this happened in either history or folk tradition. If a new Emperor ascended the throne, he might issue a temporary edict to support the disabled and visit the sick — from a sudden impulse or because of popular dissent. But it was just a one-time government measure. For example, in the second year of Yuankang, Emperor Xuan of Han informed the people, “Epidemic disease is now rampant everywhere. I am very sad about this. The people in disaster-affected counties needn’t pay the farm rent or taxes this year” (The History of the Han Dynasty – Record of Emperor Xuan). “If someone suffers from an epidemic disease, the local government would let them live in a house that was abandoned and give medical treatment” (The History of the Han Dynasty – Record of Emperor Ping).

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On a bing xu day during March in the fourth year of Huangxing (470), an imperial decree was issued: “I lament that so many people suffer from disease and die. I am so sad that I cannot sleep until dawn. I have called up skillful doctors from far and wide, and collected well-known medicines from great distances in order to save my people. I declare here, that: if someone is ill, his local government will send a doctor to see him and give him the medicine he needs — this should be the doctor’s decision” (The History of the Wei Dynasty – Record of Emperor Xianzu). In the December of the 17th year of Taihe (493), an imperial decree was issued: “Console the sick soldiers. They should be given priority for special care” (The History of the Wei Dynasty – Record of Emperor Xianzu). On a bing shen day during October in the third year of Yongping (501), an imperial decree was issued: “… Taichang Temple is ordered to set up a house in a spacious area and let all patients who are dwelling around the capital live there. The Imperial Medical Agency must send doctors to treat them. Patients will be separated out — for different doctors to treat. The assessment of their actions will decide their reward or punishment. Though our life-span is limited and how long we live is predestined, there are a certain number of causes for disease. These may be treated by needling or other ways. Various sayings of Bian Que of Qin should also be verified today. Besides, classical prescriptions are plentiful and widely spread and giving medicines should be aimed at the illness — although it is difficult to decide upon which medications. I have commanded responsible department to summon all medical professionals together to search the medical books, simplify them and extract their essence and edited them into more than thirty volumes. These will now be promulgated to all countries, counties and to those of all different religions that people can know the skills to treat disease and save life” (The History of the Wei Dynasty – Record of Emperor Shizong). This was almost like a government hospital. Many medical books were written and widely read at this time; it was a bit like the modern popularizing of health knowledge. In the first year of Yanchang (512), an imperial decree read, “An earthquake has happened in Sizhou and many people have died and are injured. I am very concerned about it. The dead can not come back, but the sick should be treated. Send imperial physicians and surgical doctors to treat them and give them the medicine they need.” (The History of the Wei Dynasty – Record of Emperor Shizong). This was earthquake relief. The Emperors of the Northern Wei Dynasty seemed to be very greatly concerned about people. The imperial edicts were favourable to the development of medicine and health at this time.

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Imperial edicts like this were especially popular during the Song dynasty. For example, it is recorded in the Imperial Great Edicts of the Song Dynasty that Emperor Taizong of the Song made an edict in the third year of Chunhua (992): “Many people suffer from disease. Now I order that the Imperial Medical Agency selects ten good doctors, sent to important places in the capital to give out decoctions for people who claim to be sick and diagnose people who are supported by others. Give the imperial physicians five-hundred-thousand cash to buy medicine. Send one zhong-huangmen (eunuch) to supervise them, in this business.” As another example, an imperial edict was made in the second year of Dazhong, the Xiangfu Emperor of the Northern Song, saying, “Command the Imperial Medical Academy to prescribe and fulfill medical prescriptions for the plague victims from Hebei.” According to the statistics of Professor Li Jingwei, the health decrees of the Northern Song Dynasty Emperors alone amounted to two-hundred and forty-eight.5 Therefore medicine and health in the Northern Song Dynasty was relatively flourishing. To a certain extent, the Emperor boasted of “loving his subjects as his own children”, but people really did benefit. There were positive outcomes. Emperors in the Northern Song Dynasty issued health decrees so frequently it showed as well that there was no routine health management or medical institutions such as hospitals in government departments. Some local administrative officials also promoted health development or published medical books. For example, the Old History of the Five Dynasties – Biography of Chen Xuan records, “Chen Xuan came from the capital. His family had practiced medicine for generations. At first, he waited upon Wang Zhongrong in Hezhong. In the mid to late period of Qianfu (874– 879), Emperor Wu of the later Tang led an army to attack Wang Hangyu from Taiyuan. When he passed through Puzhong, Xuan served him up a herbal decoction. Emperor Wu thought highly of him. During the reign of Emperor Mingzong, he was Shaoyin in Taiyuan and then promoted to Taifuqing (an official in charge of finance) in the palace. In the middle of the reign of Changxing (930–933), he collected his seventy-five life-long, empirical formulae and wrote up one-hundred different methods of making up formulae and called them These Important Arts. He engraved them on stone slabs and had the stones set left of the door into the Taiyuan government building — in order to help and instruct the people. The sick relied on them.” The Valuable Prescription Monument on Yaowang (“King of Medicines”) 5

 Li Jingwei, The Emperors in the Northern Song Dynasty and Medicine.

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Mountain is a more well-known example of engraving on stone to spread medical practice. At first, Guo Si in the Song Dynasty extracted some contents of the Invaluable Prescriptions by Sun Simiao, sorted them out and then engraved them at Huazhou’s government office. During the Longqing period of the Ming Dynasty, Wang Shouzhong of Xian engraved them again on four stones arranged at the eight aspects (directions). They have been kept in good condition till now. There is also an example in The History of the Song Dynasty – Biography of Zhou Zhan. “The custom in Rongzhou was to neglect medical knowledge and patients were preyed upon by witches and wizards. Zhou Zhan engraved the ancient formulae on stone slabs to teach people, and witchcraft was prohibited. Then people began to use medicine.” Some local officials supported physicians in publishing their medical books, which played a great part in spreading the medical knowledge of an author who lacked money for publication. The Complete Works of Jingyue was one of them. Lin Riyu, Zhang’s grandson, recorded that “The manuscript of this book was finished in the last years of his life by my grandfather, but he couldn’t afford the fee to publish it, so he gave it to my father and my father now passes it to me… In the Geng Chen year, I carried it to Eastern Guangdong and told the local headman Mr Lu about it. Mr. Lu said: ‘This worldly treasure of compassion, it concerns saving lives and relieving the world and should be shared by all people’. So he donated money from his salary to print it. After several months, the book was published. Thus I can console my grandfather in his grave and he will become immortal.” There were quite a few physicians like Zhang Jingyue who could not afford to publish their works whether they were alive or dead. Thanks to some government officials, their work could be passed down. From the Emperor down to all levels of government, public health seems not to have been taken seriously. But Emperor Ling of the Han had a very good scheme: The History of the Later Han Dynasty – Biography of Zhang Rang records that in the third year of Zhongping, Emperor Ling of the Han “commanded the Yetingling (an official in charge of the imperial harem) Bi Lan to construct a rolling carriage and kewu (an ancient Chinese siphontube). This was used to sprinkle the suburban road, south and north of the city, to free the people from the work of sprinkling the road (to settle the dust).” This was one example. The History of the Southern Qi Dynasty – Biography of Wang Jingze records that “A thief was arrested. Wang Jingze called his relatives to whip and punish him by getting him to clean the streets. After a long while, the thief was commanded to inform against

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previous thieves — who would replace him.” Public health matters such as cleaning streets were used as punishments. There was even such a wonder as this: Liu Cheng, the governor of Sui’an had a favourite hobby; it was cleanliness. His county was cleaned so much there was no grass, no insect or other dirt on the roads. People could not bear so much work — just to keep the roads clean — and Liu Cheng was dismissed. But as he was upright, faithful and skillful in medicine, he was as famous as Dr Xu Sibo (History of Southern Dynasties – Biography of He Tongzhi). So a county magistrate was removed from office for paying too much attention to public hygiene, which showed that the whole nation did not understand the importance of public health. Chinese public health has always been weak, whether in medicine or politics, that is, until the public health theory of Western medicine was introduced into China. On the whole, the administration of medical and health matters was unsatisfactory in many respects.

93.  The Imperial Medical Agency and Official Medical Education Since the earliest days, the basic educational model in Chinese medicine was “master to apprentice”, in the traditional manner — sometimes in the nature of a secret society. Such was the case in Changgong’s group. Some ideas were not secret, but the relation between master and apprentice was special — for “a teacher for a day is a father for a lifetime.” The apprentice “must be the right man, it could not be imparted to the wrong man.” According to the Lingshu – Assignment According to Ability, disciples should be selected, classified and taught according to aptitude. “A disciple with acute vision can be taught to observe a patient’s complexion; one with acute hearing can be taught to distinguish a patient’s voice; one good at talking can be taught to discourse on the Confucian analects to encourage patients; one quiet and slow, careful and deft can be taught acupuncture and moxibustion for regulating the qi and blood, and various disorders, to observe Yin and Yang and a variety of formulaic medical treatments; one gentle in manner with his hands can be taught daoyin to conduct and move the qi; one with sharp language, and those shouting persons can be taught to ‘revile carbuncles and curse the illness’; an unkind one with sharp nails and rough hands can be taught to massage away masses and bi-syndrome. Everyone’s ability can be used in a special way, and benefit practice — then he can get a reputation for himself. But if he is not the right man, he will not achieve success and his teacher will not win fame. That is why it is said one

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should ‘gain the right man to teach, do not impart it to any unsuitable person’.” “You can recognize one with rough hands by letting him press on a tortoise as a test. Put a tortoise under a utensil and tell him to press on top of it. Fifty days later, if the tortoise has died, he is too rough and has cruel hands; if the tortoise is still alive, he has soft hands.” So governmental or imperial physicians were selected from the popular masses during earlier times — there was no official medical education. In the Northern Wei Dynasty, the rank of imperial doctor (lower seventh rank) and imperial medical assistant (middle ninth rank) appeared in the official system, and professional medical education began. Both doctor and assistant were to instruct in medicine. Medical education was officially established during the Southern Song dynasty. “In the twentieth year of the Yuanjia period (443) during the Song Dynasty, an imperial physician headed up a report to set up a medical school in order to expand medical education” (Noted in Six Laws in the Tang Dynasty – The Doctoring Dr). “Medical school” here translates to yixue (医学). Liu Yu and his successors all paid much attention to education. They commanded officials to initiate many schools and collect disciples to study under them. History says that “the customs south of the Yangzi River were the best; later people commended education, particularly during the time of Yuanjia (424–453).” Medical schools were thus set up. However, the medical condition of the time did also make the government believe that it was necessary to set up a formal office of medical education: “Acupuncture and medicine have not been studied for ages, and it is rare for people to reach the highest skill in pulse-taking, as they did in earlier days. Therefore, popular morale increasingly turns to believing in ghosts and abandoning medicine. Perversely such a cause means premature death will come to more than half of them. The Royal Medical Institution should now train men and women in medicine, local governments should also have an official in charge of medical education. Thus this foolish behavior of ‘flattering the gods’ can be stopped and we can check these unhealthy tendencies” (History of the Song Dynasty – The Biography of Zhoulang). Due to these two companionate factors, the Song of the Southern dynasties began to establish an Imperial Medical Agency, namely “The National Medical School”. It was subordinate to the Mengxiasheng (equivalent to the state organ directly under the central government) and trained medical workers for the court. During the later Sui Dynasty, the Imperial Medical Agency became a subordinate unit to Taichang Temple and was enlarged

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somewhat. The History of the Sui Dynasty – Official Record says, “Taichang Temple was in charge of the mausoleum, the temple, mass sacrifice, rituals, the etiquette system, astronomy, the arts and skills of number, and clothing, etc.” The Imperial Medical Agency was thus freed from serving only the palace and the number of people increased sharply. It included two senior pharmacists, two-hundred doctors, two herbal gardeners, two medical doctors (医博士), two assistants, two massage doctors (按摩博士) and two exorcising doctors (祝禁博士), about two-hundred and fifteen people altogether. Medical students numbered one-hundred and twenty and massage students were one-hundred, making two-hundred and twenty in all. Presumably, the Imperial Medical Agency was jointly organized by the national central hospital and medical school, equivalent today to a medical university with four departments: medicine, materia medica, massage and zhujin 祝禁. A medical student was called a yisheng 医生 or “student of medicine”. The Tang Dynasty took over the system of the Sui. The Imperial Medical Agency had been enlarged again. The faculty of acupuncture and moxibustion was added, and the subjects it covered branched out. For example, the medical faculty branched into five majors: physical therapy (internal medicine), infant therapy (pediatrics), therapy for sores (surgery), therapy of the ear, eye, mouth and teeth (ophthalmology and otorhinolaryngology), and horn therapy (cupping and external treatment). The longest school system was seven years, the shortest was three years. Following this example, a local medical school was also set up. It is recorded in the Old History of the Tang Dynasty that during Emperor Taizong’s reign, “On a Gui Chou day during September in the third year of the Zhenguan period, a medical school was established in every state.” Every state was equipped with one medical doctor (医学博士), one assistant, ten or thirty medical students, etc. There were several reforms of medical education made during the Song Dynasty, but none of them very successful. An Imperial Academy, equivalent to a Central College, was established in both the Song and Tang Dynasties. It enrolled the children of officials above the seventh rank in the capital. The Imperial College enrolled the children of officials below eighth rank and the ordinary people. In the early Song dynasty, the Imperial Medical Agency was subordinate to Taichang Temple. In the third year of Chunhua (992), it was renamed the Imperial Medical Bureau, and only took charge of medical education and helped make diagnoses and carry out some treatments. Volume II of The Works of Fan Wenzheng says Fan Zhongyan once reported that a doctor “cannot be permitted to enter the Imperial

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Medical Academy” unless he has studied in the Imperial Medical Bureau. This reflected the trend — medical administration and education were moving towards standardization and regulation. A Collection of Imperial Edicts of the Song Dynasty records that the Emperor made an imperial edict in the fourth year of Qingli (1044) that the Imperial Academy should select three to five learned medical research fellows from the Imperial Medical Academy as yishi (the teacher of physician), to teach about the Suwen, Nanjing, etc. in Wucheng Temple, for the benefit of medical students in the capital.” However, this edict met with opposition from the Imperial Academy. They considered that Wucheng Temple was for the learned and for Confucians who wanted to study. They should not be humiliated by letting craftsman in. So it is plain that medicine was still despised by intellectuals and there were problems in classifying it along with Confucianism. Due to the political reforms of Wang An-shi (1068–1085), the Imperial Medical Bureau became independent from Taichang Temple during the ninth year of Xining (1076). Following the San-She (三舍，three-hostel) teaching system, medicine was also reformed. The nine branches of adult medicine (internal medicine), wind illness medicine, young medicine (pediatrics), obstetrics, ophthalmology, acupuncture and moxibustion, stomatology and throat, metal wounds and forbidding, and sores and traumatology were combined along with the study of formulae, pulse taking, acupuncture and sores. Three-hundred students were enrolled spring and autumn, including forty upper-hostel (senior) students, sixty inner-hostel students and 200 outer-hostel (minor) students. A temporary test was held once a month, an official test once a year. Results were graded into excellent, middle and bad. Excellent students were promoted to the inner hostel. Tests in this hostel were held every two years. Excellent and middle students were promoted to the upper hostel. Students of the upper hostel were classified three ways. Students with two good marks were excellent; students with one good mark and one moderate mark were ordinary; students with two moderate marks or one good mark and one bad mark were classed as of lower rank. They treated the students of the imperial college, the school of statutes, the military school and camp soldiers. The treatments were taken in turn and the results recorded and printed. These medical records were then used for the annual exam. Good students could be promoted and rewarded. If this reform had continued and been made successful, the doctors’ skills would have been very greatly improved. However, Wang Anshi was removed from office before long and medicine recovered its nine subjects of study — this was during the Yuanfeng

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period (1078–1085). In the eighth year of Yuanfeng (1085), Sima Guang became prime minister and completely abolished the three-hostel system. In the eighth year of Yuanyou（1093), Empress Gao died, and Emperor Zhezong of Song restored its statutes. Then in 1100, he died and the new law was abolished again. In the first year of Chongning (1102), Emperor Huizong restored it, but it was abolished in 1120 all over again. In all, finally this new legislation failed on the verge of success. The three-hostel method of education was followed by the Southern Song Dynasty, and only retained in the southern area beyond the Yangzi River — but the Southern Song was declining and it was not revived anymore. Then during 1103, the Song Emperor Huizong commanded the establishment of an Imperial Medical Bureau as a wholly independent sector of medical education. It was to be subordinate to the Imperial Academy instead of Taichang Temple, which improved the status of medicine and strengthened the teaching of theory, such as five-phase and six-qi theory. As a result of these reforms, Confucian scholasticism infused the whole of the medical field, and because of this, medical systems in all became more comprehensive and well regulated during the Song dynasty. The Yuan, Ming and Qing Dynasties followed the old system of medical education, without innovation. Chinese medical education remained much the same — the method of master to apprentice. From the above-mentioned text, we can see that the ancient system of Chinese medicine, its decrees, education, etc. started to take shape during the Spring–Autumn period; the Qin and Han Dynasties established the ranking of doctors; the Liu-Song set down medical schools which turned into a system of proper medical education during the Sui and Tang; the Song Dynasty tried a great reform and established a consummate and regular system of medicine that continued into the Ming and Qing. However, the tradition of master–apprentice still occupied the mainstream.

C. Governmental Materia Medica, Medical Books and Bronze Acupuncture Figures 94.  National Pharmacopoeias Issued by the Government Chinese governmental materia medica began in the Tang Dynasty. The Tang Newly Revised Materia Medica was the first pharmacopoeia in China — even in the world. Then the Emperors in the Song Dynasty revised these pharmacopoeias every few years and the national pharmacopoeias progressed in sequence down to the Song Dynasty as follows:

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The seventh Kaibao year of Emperor Taizu of the Song (974): Materia Medica Revised in Kaibao (Materia Medica in Kaibao). The second Jiayou year of Emperor Renzong of the Song (1057): Supplement to Shengnong Herbal Classic (Materia Medica in Jiayou). The sixth Jiayou year of Emperor Renzong of the Song (1061): Materia Medica with Illustrations. The seventh Jiayou year of Emperor Renzong of Song (1062): Great Supplement to Shengnong Herbal Classic. The second Daguan year of Emperor Huizong of the Song (1108): Classified Materia Medica in Daguan (Classified Materia Medica). The sixth Zhenghe year of Emperor Huizong of the Song (1116): Classified Materia Medica Newly Revised in Zhenghe (Materia Medica in Zhenghe). During the Shaoxing period of Emperor Gao of the Song (1131– 1162): Classified Materia Medica Verified in Shaoxing (Materia Medica in Shaoxing). A Newly Revised Materia Medica was produced in the second to fourth Xianqing years of Emperor Gaozong of the Tang, which was an age of bright politics and a prospering economy following on from the Zhenguan Period. “Su Jing, senior official in charge of the guard of the ‘right gate in the palace’, reported that the materia medica of Tao Hongjing had many errors.” So the Emperor commanded the zhongshuling (an official transmitting the imperial decrees) Li Ji, Xu Jingzong, Lu Cai, Li Chunfeng, the libu shilang (an imperial ride attendant) Kong Zhiyue and other famous doctors, a total of 24 people in all, to rectify the old version and the sikong Li Ji (an official in charge of lands and construction) to supervise and finalize the draft. It was fifty-four volumes with illustrations in all.” It was referred to as the Newly Revised Materia Medica of the Tang Dynasty. Li Ji was general manager of this edition but actually a high-ranking military officer; however, he also wrote a few medical books (later lost). He was greatly trusted by Gaozong and became chief editor. From the following anecdote we can see his personality: (Li Ji) fell ill. If Emperor Gaozong and crown prince presented him with a medical potion, he would soon take it. But if his family called any doctors or shaman to attend to him, they were not allowed to come in. His family members kept on at him to take medicines. Li Ji said: ‘I was only a peasant from Shandong, but I met a wise monarch and then became very wealthy and achieved high rank, holding the three privileged positions of the Santai (the three top authorities). I am now going to be eighty-years old. Was this not all predetermined? Long life or not, we all have a fixed term. How can I allow myself to

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see a doctor and survive?’ He just refused to take any medicines. (The Old History of the Tang Dynasty – Biography of Li Ji) A national pharmacopoeia really needed a senior administrative official like Li Ji to preside over it, who “could convey regal intention, and ask for all the views from the people” and “seek all medicines from the whole country, and collect medical books with illustrations from all counties.” Otherwise, such a large-scale national medical investigation could not be carried out. There were thirteen main highways, and one-hundred and thirteen separate states, which could not all be mobilized by a medical officer, but must be organized by government officials. It took two years to finish the book in 659. Comparing it to Tao Hongjing’s Annotated Shen Nong’s Herbal Classic, the medicines in it totalled eight-hundred and fifty and many errors were corrected. This Newly Revised Materia Medica was perfect at that time. It is said in the New History of the Tang Dynasty – Biography of Yu Zhining that “Emperor Gaozong once asked Yu Zhining: ‘Materia medica are respected by people. Now this one has been revised. What is the difference between the two?’ The answer came back: ‘Tao Hongjing annotated and combined Shen Nong’s Herbal Classic and Medical Records. But the folk prescriptions collected from south of the Yangzi River were interpreted by people who did not understand medicine very well, so they made many mistakes. More than four-hundred medicines have been verified and more than one-hundred medicines broadly added to the new book. This is the difference between them.’ Emperor said: ‘Fine.’ Therefore, the book was widely distributed everywhere.” This book is worth its evaluation as the world’s earliest pharmacopoeia by the standards of its time, organization, content and quality, because of its promotion by the Emperor and because of its implementation all over the country. It was similar to the revision named A Kaibao Materia Medica. According to the History of the Song Dynasty – Biography of Liu Han, “I have been decreed to revise in detail the Newly Revised Materia Medica of the Tang Dynasty with the Taoist Ma Zhi, medical official Zhai Xu… (nine people in all). So we have been ordered to examine and correct carefully any mistakes, and then publish a definitive edition… remove the wrong, keep the right, and add the new… I myself corrected a lot of errors as well innumerable mistakes. We adopted many people’s advice and printed it all in this book. White words reveal the sayings of Shen Nong, black words present the sayings of famous doctors, the attached words are from this age or from the Tang Dynasty, and all are marked clearly. We made a detailed interpre-

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tation, tested the forms and properties of their nature, consulted and discussed them all with Zhang Su, Wu Fugui, Wang Guangyou, Chen Zhaoyu… and decide to add one-hundred and thirty-three new medicines. After that, the Hanlin academician and zhongshusheren (the official writing the imperial decrees) Li Fang, the yuanwailang of the Ministry of Revenue (imperial attendant), the zhizhigao (official writing decrees) Wang You, the yuanwailang (an important provincial official) Zuosi and zhizhigao (official writing imperial decrees) Hu Meng had it re-checked in detail and examined carefully. Then it was presented to the Emperor.” Li Fang wrote in the preface that “Shennong’s book is one of the three we have unearthed. Materia medica records the differentiation of hundreds of medicines… its definitions are all judged carefully and its reasoning detailed. Now we have nine-hundred and eighty-three new and old medicines all together, cataloged and recorded in twenty-one volumes. These will be published and promulgated to be used all through the country.” Undoubtedly, Li Fang, Wang You, Hu Meng, etc. were government supervisors and officers. Li’s preface was magnificent; it was not that of a general physician. Among all the many governmental Materia Medica, the Classified Materia Medica merits special attention, as one of its chief sources was written by the folk doctor Tang Shenwei in Sichuan. According to Zhao Yushi’s Records Made after my Guests Retreat (about 1225), Mr. Tang from his hometown Jinyuan County of Shu Zhou (now Chongqing County of Sichuan) moved to Chengdu and acknowledged Li Duanbo as his master during the Yuanyou period (1086–1094). His family practiced medicine for generations. He was proficient in classical prescriptions and skillful in medicine. Yuwen Xuzhong was treated by him in his childhood. In 1143, Yuwen Xuzhong wrote the following in a postscript to the Materia Medica in Zhenghe: Tang Shenwei, alias Shenyuan, was from Huayang town near Chengdu. He was ugly to look at and slow in speech and action, but quick and witty inside. Almost all diseases were cured by him, no one was left behind. He could make a pointed comment about the disease in only a few words. If he was asked again, he would be angry and give no answer. Whether his patient was poor or rich, whether it was hot or cold, rainy or snowy, he would go and see them as if he had been summoned. As he treated scholars, he did not take any money from them but asked to be given their kept famous prescriptions and secret records, which made the scholars love him

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very much. So if they got the name of a medicine or description of it from the classics, they had to write it down and tell it to him. Thus this book was collected and put together. Tang Shenwei added 526 medicines. If the new medicines in the Materia Medica with Illustrations are included, the new medicines amounted to 629. The total was 1,746. Although just a collection, they added 374 medicines — more than Li Shizhen added in his writing of the materia medica during the Ming Dynasty, in fact nearly twice as many. The Classified Materia Media became the original source for Li Shizhen’s Compendium of Materia Medica. Tang Shenwei’s great contribution should not be ignored. However, actually for hundreds of years, his contribution had been erased and his name almost forgotten. There were two reasons for this. One was that Tang Shenwei was a folk doctor and could not afford to print such a monumental work; the other was that his copyright was encroached on by the government. Soon after the book was finished, an academician Sun Di, of the Intellectual Academy, attained a good version of the draft and ordered officials to emend it. The second year of Daguan (1108), Ai Sheng (the official of Tongshilang and Xianwei in charge of education in Renhe County of Hangzhou) revised it and reported it to the court. The Emperor commanded it to be printed formally and renamed it the Classified Materia Medica of Daguan, and it became the national pharmacopoeia of the Song Dynasty. Several revised pharmacopoeias were later made based upon this book. Recently, Professor Shang Zhijun and other scholars have considered that “it was the last large-scale consolidation in long-hand, and written copy of a materia medica made in historical times and a compendium of all the materia medica known up to the Northern Song Dynasty.”6 The tradition of amending and enacting pharmacopoeias in the Song Dynasty made a great contribution to the development of traditional Chinese materia medica.

95.  Officials Emending Medical Books Large-scale emendations of medical books during Chinese dynasties were mostly carried out by officials. The History of the Han Dynasty – Book Record says “Imperial physician Li Zhuguo emended books of methods and 6

 Shang Zhijun et al. The Essence of Chinese Ancient Literature, Science and Technology Literature Press, 1989, p. 221. This is indeed true.

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skills.” Li Zhuguo was physician to Emperor Cheng of the Han (33–29 BCE). He emended 216 volumes of medical classics from seven schools, 274 volumes of classical prescriptions from eleven schools and 392 volumes from eighteen schools — all concerning methods and skills of immortality and coition. This great work could not be finished without an official organization. It had to be presided over by one such as Li Zhuguo. Unfortunately, all these emended books, except the Huangdi Neijing, were lost and we can no longer read or study them. In the fifth year of Yuanshi, Emperor Ping of Han (5 CE) “summoned all scholars in the country who had mastered the lost books of the classics, ancient records, astronomy, calendar, the tempering and calculation of time, philology, historical works, methods and skills such as astrology, and materia medica, also those who taught The Five Classics, The Analects of Confucius, The Book of Filial Piety, The Elegance, that they should be sent to the capital by post-horse carriage. Thousands of people arrived.” They should have been able to collect and sort out the medical books, but there is no detailed record of this in the history. It can be speculated that the Sui Dynasty government was responsible for the emendation of some medical books. After the end of 400 years of division and war, Emperor Wendi of Sui worked hard to consolidate and unite his nation. The Sui system created by him was followed by later dynasties. A collection of books from the whole country was one of his ideas. He adopted Niu Hong’s suggestion of searching for lost books. Each volume would be awarded a bolt of silk. After emendation, the book would be returned to its owner. In this way, many rare books were presented. In addition, Emperor Wu of the Northern Zhou had accumulated more than 10,000 books and got 5,000 new books when the Northern Qi dynasty met its doom in 577; all of these were added to the collection of books in the Sui dynasty’s library. These books totalled more than 37,000 volumes and 80,000 volumes along with their counterparts. Emperor Wendi of the Sui sent officials to arrange them in order and called them “old versions”. In addition they restored and revamped worn-out books, as well making counterparts. Though historically, the next Emperor Yang of the Sui is believed to have been a dissipated debauchee, he still made some contributions to this — in particular he had a literary talent and longed to emend and make copies. All these counterparts were stored in the Literature Palace in Luoyang, the eastern capital. The premier Wei Zheng of the Tang Dynasty wrote a History of the Sui Dynasty – Book Records mostly referring to the bibliography in the Literature Palace. This proves that the collections of books were organized during the Sui dynasty. Therefore, it

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is not impossible that the Sui Dynasty also summoned doctors to edit medical books. The present surviving version of Treatise on the Causes and Manifestations of Various Diseases is very like the one compiled by the government. Here is the preface written by Song Shou in the Northern Song Dynasty: “The Treatise on the Causes and Manifestations of Various Diseases was written by the imperial physician Chao Yuanfang, etc. following the Emperor’s orders, during the Daye period in the Sui Dynasty. He collected and compiled the pith of the various scholarly opinions by an intensive study of them and sorted them all out; this work consists of symptoms, pulse, diagnostic patterns, etc. all collected together.” The phrases “following the Emperor’s orders” and “collect and compile the pith of the various scholarly opinions” suggest this book was organized by the government and that many people joined in the task, by order of the Emperor. A History of the Sui Dynasty – Book Record states that “The Treatises on the Causes and Manifestations of Various Diseases with five volumes (and one volume of catalogue) was written by Wu Jingxian.” Some people considered that “xian 贤” was a mistake for “jian 监”, so Wu Jing might have been the supervisor and Chao Yuanfang, the chief author. However, the titles, 诸病源候论 and 论病源候论 are different although similar, and Wu’s book had only 5 volumes while Chao’s had 50. These are clearly two books. But now Wu’s shorter book has been lost and we cannot read it. There is a saying about Wu Jingxian in the History of the Sui Dynasty – Biography of Mai Tiezhang: “He turned to Wu Jingxian and said: ‘One is predestined to die or live. How can he do moxibustion with a moxa cone or spray the melon pedicle in my nose? That will not cure my jaundice — am I now to die at the hands of children!’” It seems that according to this, “Wu Jingxian” must have been a doctor and it is impossible that he was just a supervisor. As to whether or not he helped write the Treatise on the Causes and Manifestations of Various Diseases, we have no evidence. But on the contrary his book seems to be a commentary on Chao’s work. There are few records of Chao Yuanfang in history. The Canal Record says he was imperial physician during the Daye period, where Emperor Yang of Sui was building the Great Canal. In short, this should be seen as the first great book on the etiology and manifestation of illness organized by the government in Chinese medical history. It consisted of 50 volumes, 67 categories and 1,739 treatises. It included all diseases and had a great influence on later generations. The encyclopedic General Category and Summary of the Imperial Collection in

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Four Divisions calls it “a bridge and ferry to all patterns and treatments”. Zhou Xuehai said, “During this period between the Han and Jin Dynasties there were many wise and famous doctors. They generally inferred ideas from essential medical theory and gave effective treatment, and most of their work could be adopted. However, many years later, their books were lost and so were not accessible — except within Chao Yuanfang’s Treatise on the Cause and Manifestations of Various Diseases. This is the only book that can help us examine the theoretical methods of the most famous doctors before the Sui and Tang… It had been widely researched and was a collection of almost all known diseases in the world. How diligent they were!” (Mr. Zhou Medical Series of Books). However, the Treatise on the Causes and Manifestations of Various Diseases, contains only theory and has no descriptions of formulae — which could also prove that it was organized by the government. Supporting this is the fact that the History of the Sui Dynasty – Book Record has documented the 2,600 volumes of Collected and Classified Prescriptions in the World and the 300 volumes of Ingredients for the Collected and Classified Prescriptions in the World but these no long existed. They must have been lost at an earlier time, else medical history would have been different. From these titles, we can infer that these listed prescriptions might have been appendices to the Treatise on the Causes and Manifestations of Various Diseases. In a manner of speaking, the Treatise on the Causes and Manifestations of Various Diseases was about the theory of illness exclusively, while the “Prescriptions” were about formulae for treatment and this idea was first put forward by my classmate Hu Naichang 10 years ago. Here, I record it to honour and commend him. Another point is that the following words were often read in the Treatise on the Causes and Manifestations of Various Diseases: “… herbal decoctions, hot compress, acupuncture are in another formulaic book; with suggestions for nourishment and physical exercise attached at the back.” Later a section on health regimes listed treatments such as daoyin. “Formal recipes” such as herbal prescriptions and suggestions for acupuncture and moxibustion were written about elsewhere, and edited by other people. The Prescriptions Worth a Thousand Gold Pieces (千金要方) and the Supplement to Prescriptions Worth a Thousand Gold Pieces (千金翼方) written by Sun Simiao during the Tang Dynasty must also have included almost all medical achievements before the Tang Dynasty, but cited little about the causes of disease — as in Chao’s Book. Mr. Chao’s name did not appear in Sun’s two books either. So it can be assumed Mr. Sun did not read

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this book. However, a contemporary work Arcane Essentials from the Imperial Library (外台秘要) by Wang Tao cites the theory from the Treatise on the Causes and Manifestation of Various Diseases and prescriptions from Sun’s two books. This fact might be because Sun lived and worked in the fields — and had no chance of reading books possessed by the government, while Wang Tao once worked as a head of Hongwen Library House and could read the government books. However, we can also be sure at this time that the above-mentioned Collected and Classified Prescriptions in the World no longer existed in this library. The editing of medical books by the government was popular in the Northern Song Dynasty. It established a particular Bureau for Revising Medical Books in the years 1057–1069 and ordered Zhang Yuxi, Gao Baoheng, Lin Yi, etc. to revise “all medical books professionally”. Over more than ten years, besides Classified Materia Medica, the government corrected, supplemented and sorted a large number of important medical works from before the Song, such as the Suwen, the Acupuncture Classic, a Treatise on Febrile Diseases, the Jade Classic in the Golden Chamber, the Pulse Classic, the ABC Classic of Acupuncture and Moxibustion, the Treatise on the Causes and Manifestations of Various Diseases, the Important Prescriptions Worth a Thousand Gold for Emergencies, the Supplement to Prescriptions Worth Thousand Gold Pieces and the Arcane Essentials from the Imperial Library. At the same time, the government also edited other important medical works, such as a Materia Medica with Illustrations, Experiential Prescription Collections, How to Keep Fit in Four Seasons, the Book of Nanyang for Life Saving, etc. The work was huge and cost a lot of time. These books did a great amount for the development of medicine then and for hundreds of years later. Six-hundred years after the Song Dynasty, the Qing Dynasty again paid attention to book revision and compilation. During the Ming Dynasty, Emperor Yongle ordered an edition of Yongle’s Great Classical Books to be named the “largest encyclopaedia in the world” but it was burned, the library sacked and scattered and it has disappeared; only its medical books have survived. During the Qing dynasty there were also the Imperial Collection of Books in Four Divisions and the Integration of Ancient and Modern Books — and although not designed specifically for medical books, these included a wider range of materials, matters and medical authors than ever before. For the medical work Emperor Qianlong (1736–1795 reign) assigned Wu Qian and Liu Yuduo as chief editors to edit The Golden Mirror of our Medical Ancestors. About 36 people participated in this. They col-

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lected all the medical books kept in internal libraries and recruited from the folk world in order to “classify and simplify them by cutting out the superfluous, adopting the succinct and elaborating on any parts unclear, to replenish inadequacies.” It was completed with a total of thirteen parts and ninety volumes, and finished in 1742. Just as it says in the Catalogue Summary of the Four Divisions, “The Song Dynasty paid the greatest attention to medicine since ancient times. However, Gao Baoheng, Lin Yi, etc. merely revised the ancient books — there was no invention. The governmental medical books, such as General Records of Royal Benevolence Formula and Prescriptions of Peaceful and Benevolent Dispensary of the Official Bureau etc. are extensive but they did not help the key points stand out, or were partial, and some deviated from principle and cannot really be said to be helpful for treatment. As a result General Records of Royal Benevolence was only an abridged edition and Prescriptions of Peaceful and Benevolent Dispensary was castigated by Zhu Zhenheng. These books… should modify the ancient meanings and be flexible; test specifically before referencing, and be appropriate to the occasion; without prejudice as to heat or cold when diagnosing disease, and without bias against the methods of supplement or attack in treatment.” This comment points out some omissions and deficiencies in the former medical books edited in the Song Dynasty. However, The Golden Mirror of our Medical Ancestors was not only edited but also included elaborations and additions, and was improved and tested, so that this book was much better than anything that had come earlier. Zheng Tang’s Reading Notes praises this book: “The theory demanded was mostly accurate and appropriate, it sought no florid language and its words were plain. It deliberates when comparing the situation today with the ancient one and simplifies complicated material in order to get to very gist. It is the best edition and collection made among all ancient and modern medical books.” Thus, a great contribution was made in the Qing Dynasty. Xu Dachun further pointed out in Be Careful when Treating Disease that “Even medical students can not read all the books there are, this book is enough to make them famous…” The Golden Mirror of Our Medical Ancestors really deserves to be recognized as a comprehensive standard textbook of traditional Chinese medicine from that time on.

96.  Casting Acupuncture Figures in Bronze The Song government not only amended pharmacopoeias and revised medical books but also cast bronze acupuncture figures for teaching. This had

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never happened before. According to Xia Song’s preface to the Illustrative Classic of Acupuncture Points on the New Cast – Bronze Figure, in the fourth Tiansheng year of Emperor Renzong, “The Shangyao fengyu (imperial physician in charge of medicines) Wang Weiyi was first taken on to teach rare prescriptions, but he was actually best at acupuncture. Following the Emperor’s order, he worked hard to grasp the essence of the meridians and marked the route of the channels on both sides of the human figure… His Majesty was worried that the profound medical classics had been deeply criticised so that scholars, weak, stubborn and conservative, had then lost the essence. And observation is better than oral teaching and tacit understanding; touching a model is better than just recording words. Thus he ordered him to invent and cast a bronze figure as a teaching model. Inside the bronze body were the viscera, beside which the acupuncture points were marked on the surface… With the book named the Illustrative Classic of Acupuncture Points on a Newly Cast Bronze Figure, it was published all over the country and set a good example for later generations.” This was the result of Wang Weiyi’s research into acupuncture and so he cast a bronze acupuncture figure. The Imperial Medical Academy cast two bronze figures. One was set up in the Imperial Medical Academy, another in Renji Hall at Daxiangguo Temple. At the same time, the Illustrative Classic was published and its access granted to all states. This acupuncture classic was also engraved on stone tablets and titled by Emperor Renzong personally. These carved stone tablets were excavated in Beijing in the 1950s. The unearthed stones had broken into several pieces, but there was enough to prove that the historical record was not false. Wang Qi7 said that “During the Zhenyuan period, the Three King’s Temple was set up in Mingzhao Fang, where images of the three Emperors and famous doctors of all dynasties were found. To the east was Shenyi Hall, where there were twenty-four acupuncture illustrations on bronze figures. Acupuncture points were marked beside a particular viscera on the bronze figure. The places where points lie were cut by making little holes directly into the figure, to connect with the inside of the body. Each tablet was given a title and engraved also for printing in manuscript form by the Song Dynasty Emperor Renzong personally. They were moved from Bian (now Kaifeng) city to Beijing during the Zhiyuan period of the first Emperor during the Yuan Dynasty.” These bronze figures were truly exquisite. Under the heading “acupuncture” in Qidong’s Digressive Stories by Zhou Mi in the Southern Song Dynasty it says, “I once heard my uncle Zhang Shugong say he was tested 7

 A Continuation of Document Records in General Textual Research.

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on bronze figures when he worked in Xiangzhou, as assistant. The figure was made of refined copper, with all its organs intact. On the outside were acupoints, while beside them were inlaid in gold their names. Back and front were combined perfectly to form a whole body. It was used to test a medical practitioner in the old times. Coated with yellow wax, it was filled with water.8 The medical practitioner was tested by needling the point. If the point was needled, water came out. If slightly missed, the needle would not move in or out. This was an ingenious model. Zhao Nanzhong presented it to the Imperial Storehouse later. Shugong drew two pictures of them, and had them engraved on wood and block-printed to pass down.” Because of war and the moving of the capital, these bronze figures were sent to Xiangzhou and then finally back to the Imperial Storehouse. It was said that another bronze figure was stolen by the Jin troops, but sent back by special envoy Wang Ji when they negotiated peace. In the Yuan Dynasty, it was sent to Beijing. After going through all these sufferings, its surface was so worn that much could not be distinguished and it was beyond repair. So a new copy was made. The New History of the Yuan Dynasty – Biography of Aniko records, “Aniko came from Nepal… He was good at drawing, molding and casting metal figures. The Emperor ordered the bronze figure in the Imperial Bright Hall to be taken to him, and told him: ‘It was presented to Wang Ji when he served as envoy during the Song. After many years, it has become worn and spoiled. Nobody can repair it. Can you make a copy?’ He answered: ‘I have never tried before. Please let me try.’ In the second year of Zhiyuan, a new figure was made. Joints, diaphragm and organs, collaterals and meridians were all intact. His superb skill surprised and convinced all those experts in cast-bronzes, who gasped in admiration.” Probably Aniko was a skilled craftsman used to making figures of the Buddha, so he was praised for copying the bronze figure. There were also several imitations made during the Ming and Qing dynasties. Bronze figures were used by Emperor Xiaozong of the Ming to test physicians. “Emperor Xiaozong heard Ling Yun’s name mentioned and summoned him to the capital. He ordered the imperial medical officers to take out the bronze figure with a cover over it to test him. All the acupoints were pointed to correctly and Emperor Xiaozong appointed him imperial physician” (History of the Ming Dynasty – Biography of Ling Yun). Moreover, The Whole of the Medical Records cites the story told by a visitor to Chang’an: “There is an ancient bronze figure in the Imperial Medical Agency. It can be filled with water and water can move 8

 Some sources say it was filled with mercury.

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through all its open joints. It is said to have washed up with the tide, and is antique-green all-over and brilliant.” This also must have been a bronze acupuncture figure. After finishing The Golden Mirror of our Medical Ancestors, Wu Qian and others were each awarded one small bronze figure by the Qing royal court — as well as one copy of the book describing it. One was bought by medical historian Wang Jimin in the 1940s, and is now housed in the Medical History Museum in Shanghai University of Traditional Chinese Medicine. It is the figure of a woman, 46 centimetres high, with a solid inside. On its surface are engraved the acupoints. It cannot be used to test students, but is just like today’s soft plastic human models. In recent years, Nanjing University of Traditional Chinese Medicine copied and made several large copper figures. It is said that Japan has one copper figure which perhaps is the Tiansheng bronze figure from the Song dynasty, robbed during the rebellion in Gengzi during the Qing Dynasty. It is regarded as a secret national treasure and never shown to people. This remains to be verified.9 Bronze acupuncture figures show that the government attached great importance to acupuncture and confirmed its science and progress in technology. They became a glory of Chinese culture.

D. The Formulation of Medical Law and Progress in Forensic Medicine 97.  The General Situation of Medical Law The formulation of medical law and the establishment of an examination system for forensics had much to do with the government’s medical administration. In ancient China both made remarkable achievements. Law making is a great event for any country. The Codex Hammurabi from the 18th century BCE in ancient Babylon and the Manu Smriti in Ancient India (finished around the 2nd century BCE) were the earliest legal documents in the world. They include many medical laws. For instance, the laws in the Codex Hammurabi are as follows: Law 215: A doctor should earn ten silver coins if he cures a fullfreemen (diviner, nobleman, etc.) of a serious wound or eye cataract with a bronze knife. 9

 Recently, Huang Longxiang, researcher at the All-China Academy of Chinese Medical Science, conducted a though investigation on the evolution of bronze acupuncture figures. Please refer to that.

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Law 216: If the patient is not a full-freeman, his doctor should earn five silver coins. Law 218: If the doctor cause a death or eye injury when treating a freeman with a bronze knife, he shall have his finger cut off. Law 219: … If a slave dies due to treatment, the doctor should compensate with a slave. No law similar to the Codex Hammurabi was found in China. But there must have been laws earlier than the Manu Smriti. For example, surviving bamboo slips found in Shuihudi in the Yunmeng area of Hubei Province in December 1975 include ten legal documents, such the Eighteen Law Cases from the Qin Dynasty, Sealing Law and Legal Questions — which are mainly records of cases taken in court, and laws about storage with explanations of such laws. They are probably as old as the first Emperor of the Qin Dynasty or older, that is to say, 3rd century BCE Actually, they might be much earlier than that. There was a “local official managing bandits” mentioned in the in Rites of Zhou, who was the official managing the implementation of laws. The Book of Rites – Every Month records, “The first month of autumn… officials are commanded to study the law system, repair prisons, prepare fetters and handcuffs, prevent crime from occurring and bring criminals to justice. Judges are commanded to examine suspects’ wounds, injuries and fractures. Trial and judgment must be fair.” This also shows the state of rule by law, which contained forensic procedures of identification. In 407 CE, Duke Wen of Wei appointed Li Kui and enacted the Law Classic, which was a definite statute. Though it was lost long ago, it took as its basis the reform made by Shang Yang (359–350 BCE). So the making of laws in China was not much later than the Manu Smriti. At present we cannot infer whether these books contained medical law or not and what they were. But at least there is enough cause to say there was an assessment system for physicians, medical decrees and imperial edicts in the Rites of Zhou and all dynasties had effective civil and legal cases. Here are a few examples: To prevent pestilence, Empress Song and her family were innocently killed. But their bodies were not permitted to be buried, so plague broke out. They should be buried to comfort their wandering souls. (The History of the Later Han Dynasty – Biography of Lu Zhi) The Emperor loved the imperial physician Li Xuanbo so much, he employed him along with seven-hundred thousand others…

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Xuanbo presented dan to the Emperor. After taking the dan, the Emperor suffered a subcutaneous ulcer on the back. Emperor Yizong put Xuanbo, and all the occultists Wang Yu, Zi Zhi, etc. in prison and executed them. (The New History of the Tang Dynasty – Biography of Bi Cheng) The above two examples were single cases. Generally, similar cases were handled a little like the Common Law in the UK now and previously. In addition, imperial edicts were equivalent to laws: (The first year of Huangqing, 1312) “If a medical worker did not pass the examination or had not registered, he cannot be permitted to practice medicine” (History of the Yuan Dynasty – Emperor Renzong). (The second year of Zhizhi, 1322) “On a bing chen day it is ordered: any official doctor, diviner and artisan cannot be allowed to leave their post for a funeral, nor retire at the age of seventy. Their descendants also cannot inherit their positions except those qualified to practice medical work, else they should be assigned work according to their competence” (History of the Yuan Dynasty – Emperor Yingzong). There is extant a definite written law called the Tang Dynasty Law. The following are a few examples: Procure an abortion, a sentence of two years’ imprisonment. Anyone poisons someone or sells poison, the poisoner and the poison seller will both be hanged. If the poison is not used, both buyer and seller will be exiled two-thousand miles. If someone buys poison to kill, and the seller knows his intent but the poison is not used, both buyer and seller will be exiled two-thousand miles. If the dried meat turns poisonous and is sold to make people sick, the remainder should be burnt soon after. The offender to be beaten ninety times. If it is intentionally given to people to eat, or sold to people and makes them sick, he will be sentenced to one year imprisonment. If it kills them, he will be hanged. If a physician kills a person by a mistake in fashioning a drug, or uses acupuncture without following the notes, he will be sentenced to two and a half years imprisonment. If one deliberately makes a medicine that does not accord with the prescription and kills or injures a person, he will be punished for

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intentional killing. Though the wrong medicine did not hurt anyone, he will be beaten sixty times. If one sells the wrong medicine or does not follow the prescription and the person dies or is injured, he will get the same punishment. There are many more examples. For instance, if a physician defrauds people of money, or uses the wrong prescription in treatment, an amount will be calculated and it will be punishable as larceny. If one treats the Emperor with the wrong medicine which does not accord with the original prescription, he will be hanged. If even the selected medicines are not accurate, he will be sentenced to one and a half years of imprisonment. The law in the Tang Dynasty was indeed comparatively detailed and complete, and this system was followed by dynasties increasingly. In the Yuan Dynasty, laws forbid Taoists who had not studied from practicing medicine or acupuncture, and also forbid persons from inducing others to buy drugs in the street or give acupuncture on the street. Pregnant woman after their delivery could be beaten or sent to prison. There is an interesting clause about a medical dispute in The Qing Code: “If someone dies (through treatment), and his family does not report it to the government but carries the dead body to the suspect’s house, and then robs him of his property or wounds him, the family should be tried with reference to this case as well as compensated.” This accords with the Chinese system even now. But the legal system in all dynasties was not perfect, nor was the medical law. Today much still happens in hospital, and there is no definite law established at present. This must make every medical worker feel threatened!

98.  Medical Jurisprudence and Legal Forensic Examination The ancient Chinese system of medical jurisprudence and legal forensic examination was affirmed and praised by the whole world. This was achieved by the administration of government officials and the hard work of local criminal investigation officers. Toxicity testing was created in the Spring and Autumn Period, as at that time quite a few people died after drinking wine which had been poisoned. The method of examination was to sprinkle the wine on the ground and observe the reaction. Animals and people were sometimes used to test it as well. “When Duke Xian of Jin returned, Li Ji put poison into his wine and meat and presented them to the Duke. The Duke sprinkled the wine as a libation on the earth and the soil was disturbed; he gave the meat to a dog and the dog died; he gave it to a servant and the servant died too” (Zuo’s Spring and Autumn).

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The Qin Bamboo Slips found in Shuihudi are the earliest known forensic document. The owner of this unearthed tomb was called Xi, and was born in 262 BCE and died in 217 BCE. He was once appointed censor and document officer to Anlu County, and document officer and prison officer at Yan County, all posts related to the judicature. Bamboo slips were found in his coffin. Some were on his abdomen, some on his sides, which implies they must have been used and treasured by him while he was alive. We can also deduce the political laws of that time from them. As far as forensic medicine is concerned, there are investigations of killings, injuries, infanticide and leprosy in the Legal Questions, and investigations of leprosy, miscarriage, cursing (one of witchcraft), homicide, hanging, etc. in the Sealing Examinations. The division of labour, format and procedure during the investigation are described in detail. There is a foetal corpse examination in a miscarriage case, where two people had been fighting. One of them had abdominal pain and a foetus was aborted. This was reported to the government and officials were sent to investigate the case and examine the foetal corpse. “The fetus had been sent wrapped in a cloth, with a blood coagulation as large as a hand. It could not be distinguished whether it was fetus or not. Immediately it was put into a tub with water and the tub rocked to-andfro. The blood coagulation was indeed a fetus, the head, body, arms, fingers, and part from thigh to feet, and toes were all like a human figure, but the eyes, ears, nose and genitals were as yet indistinct. Out of water, it shaped into a blood coagulation again. Another procedure was to order the wives of yamen runners with much experience in helping delivery to examine the woman. They all reported that there was dried blood in her private parts and a small amount of blood was still coming out, which was not menstrual. One of the women had once experienced an abortion and had the same symptoms.” The final conclusion was that the abortion had been induced by the fight. It was quite an advanced and scientific method to use “floating in water” to judge the coagulation of blood and the investigation of the foetus. Examining the woman’s vaginal bleeding proved it further. Take hanging as another example. It was being judged if a man had hanged himself. The evidence of the hanging was as follows: “… The head is two feet away from the beam, the feet two inches from the ground, the back and head against the wall, tongue stretched to the lips, faeces and urine out of the body staining the feet. Untie the rope, and gas comes out of the mouth and nose, like a sigh. The rope mark on the neck is black but not circling all the neck, just two inches. On all other parts of the body, there is no mark of a weapon, stick or rope…” “Rope mark” suggests the congestion and haemorrhage spots left by the rope. “Not circling all the neck”

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means the mark is not in a circle, which is the main difference between suicide and murder. In the absence of the above two signs and the “tongue not being stretched out, the nose not letting out a sigh, the cable tying the head so tightly the head could not come out”, it meant such a case was not suicide. The standard of judgment was very definite. From the above, we can conclude that there was a considerable level of forensic examination during the Qin dynasty, which perhaps retained more definite regulations and detailed documents. In other cases, “drops of blood penetrating the bone” was used as confirmation of paternity and was popular in ancient times. The History of the Southern Dynasties – Biography of Sun Fazong records, “… His father’s body could not be found and he went to the sea to look for it. Sun Fazong heard that the blood between nearest relatives could penetrate the bone of one dead. He would look for his father along the sea-shore, taking a knife. Upon seeing a skeleton, he would cut himself and drop some of his blood onto a bone. More than ten years later, he had no intact skin left any more on his arms and legs and his blood was short — he still had not met his father.” This is a case of negative identification. There is also a case of positive identification. It was a person called Chen Ye. His brother and fifty or sixty passengers all died when they sailed across the sea. The bodies were so decayed they could not be identified. Chen Ye cut his own arm to drop his blood onto several of the dead bones. None of the bones were penetrated except one. Another such example is Zong, the King of Yuzhang, the third son of Emperor Wu of Liang. Zong’s mother slept with Emperor Gao of Qi, then with Emperor Wu after Qi had fallen. Seven months later, Zong was born. The palace suspected that he was not the son of Emperor Wu. Hearing that drops of blood could penetrate the bone of a direct relative, he secretly excavated the grave of Duke Donghun of Qi, cut his own arm and his blood really penetrated into the skeleton of Donghun. He did not believe it, so he killed his own son, buried him for a long time and then unearthed the grave to take out a bone and test it again. The result was confirmed and he finally believed it. Though the truth had been proved, the method was indeed cruel. There is still not enough research today on such methods of “drops of blood penetrating the bone” of a direct relative. Most people deny its effectiveness. But it was always regarded as an ordinary method in forensic work in China — as well as in foreign countries. It was 1,400 years earlier in China than in Europe and America.10 At present, we use DNA tests for confirmation of paternity. 10

 Jia Jingtao. Chinese Ancient Forensic History, The Mass Press, 1984, p. 46.

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Law books from the Han Dynasty to the Sui are unknown to us. According to He Ning’s Doubtable Cases in Trail (951), there must have been such books at that time. Here is an example. “Zhang Ju, from Wu, was magistrate of Juzhang County. A woman killed her own husband and then set fire to their house and lied that her husband had been killed in the fire. Her husband’s families were skeptical and went to the government to make a complaint against her. She did not plead guilty. Zhang Ju brought two pigs, one was killed; another was left alive. He gathered firewood and then burnt the two pigs and then examined them. The living pig was burnt but had ash in its snout; the other originally dead one had no ash in its snout. Zhang Ju examined the husband and found there was no ash in his mouth. So he judged that the husband was killed and then burnt. His wife pleaded guilty.” This is the famous story about “Zhang Ju burning the pigs.” The method is certainly exceptional. He Ning lived in the period between the late Tang Dynasty and the early Song. What he recorded happened at the end of the Han Dynasty and during the Three Kingdoms. Mr. Chao’s Treatise on the Causes and Manifestations of Various Diseases also records a method to test poison: “To judge if one has been poisoned or not, first wash a piece of processed silver clean with ash, then clean the mouth and teeth with a twig of poplar-willow. Keep the silver in mouth for one night and spit it out the next morning. If the silver has turned black, the drug may cause impotence; if the silver became purple-spotted, the drug is a pyrophosphate copper medicine. Also boil a hen’s egg, peel its shell, tell the patient to bite the white until moisture appears. If the tooth mark is black, the drug taken is a poison.” By the Tang Dynasty, the method of testing had further developed into “testing with a silver hairpin”. It is moreover stipulated in Tang Law that “If the doctor falsifies one as sick, dead or injured, he will be punished by having his grade reduced one lower; if one really is sick, dead or injured, but examination falsely denies this, the examiner will be punished as the guilty one.” Following the formulations of Tang law, the examination system during the Song Dynasty became more definite. It specified an initial examination, a reexamination, the examiner’s duties, an autopsy file, etc. On the basis of such forensic investigations as those mentioned above, several systemic forensic works were compiled. Doubtable Cases in Trial by He Ning and his son (930–990), the Classical Mirror of the Trail (1131– 1162, written by Zheng Ke) and Similar Cases in Comparison (published in 1208–1211, written by Gui Wanrong) are three great works of criminal investigation in the Song Dynasty which include forensic medicine. Earlier monographs such as Be Generous and The Examination Method have been

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lost, while the Records of Redressing Cases Treated Unjustly by Song Ci was a collection of general cases (published 1147). He wrote in the preface that “I collect the essence of all works since Be Generous, A Daily Dairy, and corrected the mistakes in them, added my own thoughts and finished the work, naming it Records of Redressing Cases Treated Unjustily.” Song Ci (1186–1249), styled Ci Fu, came from Jianyang County in Fujian Province. He was a Jinshi (a successful candidate in the highest imperial examination) during the 10th Jiading year of Emperor Ningzong of the Southern Song (1217). He once served as Zhubu (official in charge of documents in county office), county magistrate, Tongpan (an official under the magistrate, in charge of lawsuits, etc.), and concurrently was in charge of the events of the shire. In the sixth year of Jiaxi (1239), he was promoted to be responsible for investigations, trials and prisons in Guangdong Province. He had judged more than 200 pending cases in eight months. Later he was shifted to the same position in Jiangxi Province and concurrently was shire magistrate at Ganzhou Shire. During the Chunyou period (1241–1252), he was promoted to the central imperial secretariat as well, in Jiangxi for the whole of Hunan Province. However, his masterwork was finished during this period. It is not difficult to understand therefore that Song Ci had served as a professional officer in charge of investigations and trials for many years; he himself had accumulated vast experience. At the same time he also referred to many earlier materials so that he could write his Records of Redressing Cases Treated Unjustly by referring to ancient records. This book is a great achievement. Forensic historian professor Jia Jingtao has said the following11: Records of Redressing Cases of Treated Unjustly is a systemic work of medical jurisprudence… because it has used related scientific knowledge to create a unique scientific system, different from other sciences.” “In a manner of speaking, Records of Redressing Cases Treated Unjustly is a forensic work collecting all the greatest achievements in the examination of the body, during and before the Song. Records of Redressing Cases Treated Unjustly is a book of medical jurisprudence guiding the exterior examination of the body. This is its essence. The specific achievements of this book are not listed here.12 Song Ci said himself, “In all cases, the most serious is the death-sentence; the most important thing for a death sentence is to find out the initial testimony; to find out 11

 Jia Jingtao, Chinese Ancient Forensic History, pp. 69–70.  Please read Jia Jingtao’s works.

12

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The Emperors, Their Government and Medicine  597

the truth, the thing of first importance is the examination. This is the key point in judging whether the prisoner will live or die, as well as the judgment being fair or not, whether the wrong will be redressed or not, it all depends… I was appointed to high position and served in these trials four times; I had no other skill but making the judgment. When necessary, a case will be examined again and again, one should not be even the slightest bit sloppy or sluggish in one’s treatment… It is like when doctors discuss ancient medicine — they will first make a correct identification, and clarify the meridians, then get a diagnosis of the disease, whether it is exterior or interior — then the acupuncture can be directed and the treatment be exact. A judgment may be likened to the effects of medical treatment, a fair judgment can also make the dead come back to life.” These words come from the bottom of his heart. This book was much attended to by the Emperors and their governments. It was repeatedly engraved and revised, nearly forty times. At the beginning of the Ming Dynasty, it is passed to Korea, then Japan and Europe, and the United States. Not long ago, a new version in translation was printed in USA, which shows its great influence and significance. However, ancient Chinese forensic medicine only developed through visual examination. Without anatomy, there was an unreasonable division in the examination and some inappropriate statutes hindered the progress of forensic medicine, which failed to progress into modern forensic science. This was the drawback of the Chinese regime. It is regrettable that although the Chinese forensic examination already had a considerable foundation in experiment and analytical thinking, there was no thinker or theorist in China like Francis Bacon, who could transform investigation into experimental method and into the analytical thinking of the natural sciences. This is the reason why Bacon was appraised as “Father of Scientific Experimentation” by Engels. Perhaps therapists in ancient China never noticed that forensic examination had a role to play in the clinic. Experimental medicine missed this opportunity which could have promoted traditional Chinese medicine greatly. Anyhow, the influence of the Emperors, government officials and decree systems on the development of traditional Chinese medicine went further than this. I cannot describe it any further here.

Conclusion of Part Two The theoretical foundation of traditional Chinese medicine was established in the Qin and Han Dynasties. Medical experience combined with the natural and philosophical theories of Yin and Yang, qi and the five elements

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advocated by the Taoists, Confucians and Yin–Yang naturalists — all were extant by the pre-Qin. Their natural philosophy infiltrated deep into medicine. Its best representative was the Huangdi Neijing. Finished during the period from 239 BCE to 179 BCE, this book records the master-to-disciple teaching prevalent in the medical secret societies of the time. A clinical system of treatment based on the classification of syndrome differentiation was formed at the end of the Han Dynasty. Zhang Zhongjing and Hua Tuo realized and put together a perfect combination of medical theory and clinical practice. Chinese medicine thus embarked on a broad road from then on. The philosophical schools of Taoism, Confucianism, the occultists and metaphysics of the Wei and Jin, Buddhism, etc. deepened and enriched Chinese medicine during the ensuing eras in different forms. Government and Emperor played a large role. Medicine was very successful during the Tang Dynasty and gradually matured during the Song. “Inside I’m a Taoist and outside a Confucian” — this became a tradition for Confucian doctors. Scholars were proud of their knowledge of medicine. “Medicine is humanism” was the basic principle for medical workers. The essence of traditional Chinese medicine is simply its pan-ecology (including natural ecology, social ecology and psychology environment), and involves both medical theory and clinical practice.

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b3657   A History of Medicine in Chinese Culture

About the Author Boying Ma is an internationally celebrated medical historian with expertise in medical cultural anthropology. He has published 10 books and more than 300 articles in Chinese and English. In particular he was a co-worker with Dr. Joseph Needham and Dr. Gwei-djen Lu in Cambridge, UK, during 1985–88 and 1993, contributing to Volume VI of Science and Civilisation in China. Dr. Ma graduated from Shanghai Medical University in 1967 and received a master’s degree from the China Academy of Traditional Chinese Medicine (Beijing) in 1981. He was a full Professor of Shanghai Medical University and a Committee Member of the Academic Experts Board of the Shanghai University of Traditional Chinese Medicine. Since 1995, he has practised medicine and trained Chinese medicine doctors in the UK. He was elected Life Fellow of Royal Society of Medicine in 2005. He was appointed Honorary Professor at the University of Paris Bobigny Medical School and received an honorary doctorate from The University of Cape Town, South Africa. He has founded the Xinglin Graduate School of Traditional Chinese Medicine in the UK. Dr. Ma was a visiting professor at the University of Kingston, UK, a consultant to the Confucius Institute of Chinese Medicine at London South Bank University and a visiting professor at the following Chinese universities: Heilongjiang University of Chinese Medicine, Yunnan University of Traditional Chinese Medicine, Hunan University of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine. He was also an honorary visiting professor at the Chinese University of Hong Kong. Prof. Ma is the chairman of the Federation of Traditional Chinese Medicine Practitioners, UK, and is currently the executive chairman of the Pan-European Federation of Consultants in Traditional Chinese Medicine and executive director of the World Federation of Chinese Medicine Societies.

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中 国 医 A History of 学 Medicine in 文 Chinese Culture 化 VO L U M E 2 史

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中 国 医 学 文 化 史

A History of Medicine in Chinese Culture VO LU M E 2

Boying Ma Federation of Traditional Chinese Medicine Practitioners, UK; Life Fellow, Royal Society of Medicine, UK

World Scientific NEW JERSEY

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Published by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE

Library of Congress Cataloging-in-Publication Data Names: Ma, Boying, 1943– author. Title: A history of medicine in Chinese culture / Boying Ma. Other titles: Zhongguo yi xue wen hua shi. English Description: New Jersey : World Scientific, 2019. Identifiers: LCCN 2019020532| ISBN 9789813237971 (hardcover) | ISBN 9789813237988 (hardcover) | ISBN 9789813237964 (hardcover) Subjects: | MESH: History of Medicine | China Classification: LCC R601 | NLM WZ 70 JC6 | DDC 610.951--dc23 LC record available at https://lccn.loc.gov/2019020532 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library.

《中国医学文化史》 Originally published in Chinese by Shanghai People’s Publishing House Copyright © 2010 by Shanghai People’s Publishing House English rights arranged with Shanghai People’s Publishing House

Copyright © 2020 by World Scientific Publishing Co. Pte. Ltd. All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. ISBN 9789813237964 (set) ISBN 9789813237971 (vol. 1) ISBN 9789813237988 (vol. 2) For any available supplementary material, please visit https://www.worldscientific.com/worldscibooks/10.1142/10932#t=suppl Typeset by Stallion Press Email: [email protected] Printed in Singapore

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Contents Volume I Part One The Cultural Background to the Origins of Chinese Medicine  rimitive Human Beings, Their Health, Culture P and Ecological Environment in China A.  Primitive Culture and Ecological Environment    1.  The Origin of Human Beings in China   2. Chinese Culture and Its Natural Ecological Distribution During the Paleolithic Period   3.  Neolithic Culture and Its Natural Environment in China B. The Physique and Diseases of Primitive Human Beings in China   4. The Evolution of the Physical Constitution of the Ancient Chinese    5.  Discoveries of Archaeological Pathology C. The Culture and Conditions of Hygiene Among Primitive Humans in China   6. The Residential Culture of “Nest-Living & Cave-Dwelling” and Its Significance for Health    7. Striking Flints or Drilling a Log to Get Fire & the Significance of Cooked Food to Health    8. The Culture of Dietary Hygiene and Its Influence on Other Things   9.  The Culture of Hygiene in Clothing  10.  Primitive Dance, Music and Sports 11.  “Cannibalism” and Funeral Sanitation

1

Chapter 1

3 3 3 6 13 19 20 24 28 29 33 35 39 41 43

v

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Chapter 2

Primitive Thought, Worship and Medical Culture

47

A.  Primitive Thought and Medical Culture 47 12. The “Collective Unconsciousness” and Mysterious Feelings48 13.  The Concept of “Soul” 56 14. The Experience of Using Objects as Tools and Cumulative Thinking 62 B.  Primitive Worship and Its Association with Medicine  66 15.  The Worship of Nature 66 16.  The Worship of Totems  76 17.  The Worship of Reproduction 84 18.  Ancestor Worship 88 19.  The Worship of Ghosts and Gods 92 Chapter 3

 he Primitive View of Life, Getting Old, Illness T and Death: The Pursuit of Longevity

A.  The Earliest View of Life and Death 20.  The Original Understanding of Human Life  21.  The Origins of Birth 22.  The Meaning of Death 23. Primitive Knowledge of the Human Body and Its Anatomy B.  The Earliest View of Illness and Etiology 24.  What Is Illness? 25.  Diseases Involving Gods, Spirits, and Others C.  The Pursuit of Immortality 26.  Longevity Involving Gods and Spirits 27.  The Immortal Regions and Their Medicines Chapter 4

Treatment in a World of Wizardry 

A.  The World of Wizardry 28. The “Blocked Way Between Heaven and Earth” and the Wizard 29. The Behavioral Characteristics of Sorcery and Its Psychological Foundations 30.  Sorcery, Religion and Science B.  Sorcerous Doctors and Sorcerous Medicine 31.  Sorcerous Doctors in Ancient Times 32.  Zhu Taboo, Divination and Medicine

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Contents  vii

33.  Horoscopes, Divination by Dreams and the Yarrow Stalks 34.  The Great Exorcism and Fu Xi Sacrifice 35.  Massage? Moxibustion? Herbal Medicine? 36. The Medicine of Witchcraft in the Mountain and Seas Classic Chapter 5

The Origin of Medicine 

189 195 201 209 213

A. A Definition of the Origin of Medicine and Other Relative Factors 213 37.  To Identify the Conception of Medicine’s Origin 213 38.  Animal Instinct and Human Love 214 39.  Primitive Thinking and the Functions of the Witch 218 40. The Relationship of Life and Labour to the Origins of Medicine  221 B.  The Beginnings of Early Medicine and Health Care  225 41. Massage, Daoyin, Hot Compresses, Moxibustion and the Discovery of the Meridian 225 42.  From Stone Needling to Acupuncture 228 43.  The Growth of Medical Knowledge 235 44.  The Bud of Prevention 243 45. The Famous Doctor Bianque: A Step Up from Witch-Doctoring250 Conclusion of Part One 260 Part Two  Chinese Medicine Under the Influence and Permeation of Philosophy, Religion and Politics Chapter 6

 he Heavenly Law (Tao) of Nature T and Medicine in Deference to Nature

261 263

A.  “Tao Qi” Theory and Medicine 263 46.  From Ji Zi to Lao Zi, Zhuang Zi and the Jixia 263 47.  Qi as the Root of Medical Theoretics 274 B.  The Medical Theories of the Yin–Yang and Five Elements  279 48. The Formation of the Yin–Yang and Five-Element Theories279 49. The Golden Mean, the Three Talents, Image and Number, and the Correspondence Between the Human and Natural 290 50. From the Mawangdui Medical Books to Huangdi’s Inner Classic (黄帝内经)296

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Chapter 7

 ccultist Culture and Medicine Under the Impact O of the Confucian Classics and Chenwei Philosophy

305

A.  The Fangshi Culture and Some Secret Medical Groups 305 51. Research on the Date of the Composition of Huangdi Neijing (黄帝内经)306 52. Medical Schools, Lord Cang, His Masters and Apprentices311 53. The Huangdi Neijing (黄帝内经) and Secret Medical Schools 317 B.  Another Side to Taoist Medical Science 324 54.  The Occultist’s Art of Well-Being  324 55. Occultists in Search of Elixirs and the Immortal Alchemy of the Yellow (Gold) and White (Silver)  331 56. The Compositional Background to Shen Nong’s Classic of Materia Medica (神农本草经)340 57. The Calamity Due to Witchcraft Gu, Chunyu Yan Killing the Queen and Their Involvement with Occult Physicians 345 C. The Impact on Medicine of the Study of the Confucian Classics, Chenwei Theology and Anti-Chenwei Philosophy 349 58. Studies of Two Types of “Ancient” and “Present” Confucian Classics and Chenwei Theology 349 59. Anti-Chenwei Philosophy and Thoughts of a Primordial Qi 355 D. The Background for the Medical Achievements of Zhang Zhongjing and Hua Tuo 362 60. The Confucian Tradition of Zhang Zhongjing, a Medical Sage 362 61. Hua Tuo, a Miraculous Doctor, His Occult Elements and Demeanour  366 Chapter 8

Religious Taoism and Medical Culture 

A. The Inherited Relationship Between Religious Taoism and Medicine 62. The Role of Occult Medicine During the Establishment of Religious Taoism 63.  The Origins of Alchemy and Medicine 64. The Development of Internal dan and Its Influence on Medicine

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B.  A Taoist’s Magic and Medical Skills  65.  The Taoists Holding Some Medical Skills  66.  The Taoist’s Magical Arts of Forbidding or Incantation 67.  The Art of Taoist Talismans 68.  The Taoist’s Magic or “Supernatural Power” C.  Taoist Doctors and Their Grand Contribution 69.  How Ge Hong Dabbled in Medicine 70.  The Taoist Naturalist and Leader Tao Hongjing 71.  The Great Sun Simiao in Medicine and Taoism 72.  Contributions from Other Taoist Doctors Chapter 9

 eo-Taoism and Medicine During the Wei, N Jin, Southern and Northern Dynasties

407 408 411 418 422 426 426 432 437 444 451

A. Neo-Taoist “Idle Talk” and the Fashion of Taking Stone Powders 451 73. Neo-Taoist Idle Talk and a Comprehensive View of an Undisciplined Life 451 74. The Prevailing Fashion of Taking Medicines such as Wushi San 461 B. The Prospering of the Medicine During the Wei and Jin Dynasties 472 75. Huangfu Mi and The Classic ABC of Acupuncture and Moxibustion (针灸甲乙经)472 76. On Material Things (物理论), The Theory of Spiritual Perishability (神灭论) and Views on Life and Death 475 77. Medicine Prospers in the Wei, Jin, Southern and Northern Dynasties 481 Chapter 10 Confucianism and Medicine A.  A Medicine Dominated by Feudal Ethics 78. From Licking Piles and Sucking Carbuncles to “Cutting the Flesh of His Thigh to Cure His Parents” Not Daring to Damage Any Part of the Body 79. The Monarch’s Medicine Tasted by Officials, Understanding Medicine as Filial Piety and Feeling the Woman’s Pulse Through a Gauze B. Neo-Confucianism, “Down-to-Earth” Learning and Medicine 80. From the Taiji Diagram to the Innate Root — The “Kidney’s Life-Gate”  81.  Zhang Jiebin’s Taoist Medical Theories 

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82. Medical Reflections on Acquiring Knowledge by Probing into Things 83.  The Medical Tradition of Abiding in the Classics C.  The Rise of the Confucian Doctors 84.  To Be a Good Prime Minister or Excellent Doctor 85.  Various Yongyi (Quacks)  86.  Kindness in Medicine

521 526 532 532 540 547

Chapter 11 The Emperors, Their Government and Medicine

553

A.  The Emperors and Their Medicine 88. The Emperors of the Han and Tang Dynasties and Their Dealings with Medicine 89.  Emperors and Medicine During the Song Dynasty  90.  Emperor Kangxi and Medicine B. The Governmental System and Organization of Medicine and Health  91. The Governmental Medical Organizations and a Doctor’s Social Position 92. Supporting the Disabled, Visiting the Sick and Policies of Medical and Health  93. The Imperial Medical Agency and Official Medical Education C. Governmental Materia Medica, Medical Books and Bronze Acupuncture Figures 94.  National Pharmacopoeias Issued by the Government 95.  Officials Emending Medical Books 96.  Casting Acupuncture Figures in Bronze D. The Formulation of Medical Law and Progress in Forensic Medicine  97.  The General Situation of Medical Law 98.  Medical Jurisprudence and Legal Forensic Examination Conclusion of Part Two

553 553 558 561 565 565 568 573 577 577 581 586 589 589 592 597

Volume II Part Three Medicine in Social Life, Epidemics and the Invention of Variolation

599

Chapter 12 Medicine in Different Social Environments

601

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Contents  xi

A.  Medicine in War and Turmoil 601 99. Medical Conditions During War and Periods of Historical Turmoil  601 100.  Health Organization in the Army 603 101.  Surgery in the Army 608 B.  Medicine in the Heyday of Peace 623 102.  Peaceful Eras and the Conservation of Medicine 623 103. Concerning the Books: Treatise on the Causes and Origins, and Manifestations of Various Diseases, Important Prescriptions Worth a Thousand Gold Pieces and Arcane Essentials from the Imperial Library626 104. Compilations, Compendia, Medical Cases and Rudimentary Verses 632 C. The Relationship Between Population Statistics, Natural Ecology and Diseases in History 639 105.  Geography and Diseases of the Five Directions 639 106.  The Theory of the Five Circuits and Six Qi 644 107. The Relationship Between Population Statistics and Diseases in Ancient China 652 108.  Diseases in Relation to Social Ecology 655 Chapter 13 Epidemics and the Triggering Mechanism of Disaster

661

A.  Ancient Epidemic Diseases and Epidemiological Factors 109.  The Historical Background to Epidemics 110. Major Epidemics During the Zhou and Qin Dynasties, and at the Beginning of the Han  111. The Main Epidemics of the Han, Wei, Jin, Northern and Southern Dynasties 112.  Epidemics During and After the Sui and Tang Dynasties 113. Conducting Textual Research on the Epidemicity of the Plague and Cholera B.  The Evolution of a Theory of Epidemics  114. The Evolution of the Etiology of Seasonal Qi, Pestilent Qi and Other Qi 115. The Impracticality of Ancient Prescriptions for Curing New Diseases, the Theory of the Fire and Heat Mechanism, and the Theory of Attacking the Pathogenic Qi 

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116.  The Theory of Internal Injury and Yin Syndrome Theory 117. The Theory of Epidemic Febrile Disease Put Forward by Ye Tianshi and Others

710

Chapter 14 Smallpox Remedies and Variolation in Ancient China

717

A. Outbreaks of Smallpox and TCM Treatment in Ancient China 118.  Textual Research on Outbreaks of Smallpox in China 119.  Smallpox Treated by Chinese Medicine (1) Origins of the Theories and Treatments for Smallpox: A Summary (2)  Comparatively Mature Treatments for Smallpox (3)  Curative Efficacy B. The Invention of Variolation and Its Promotion by Emperor Kangxi  120.  The Origins of Variolation (1)  Ideas of Prevention and Initial Therapies (2)  Legends of Variolation’s Origin  (3)  A Literature Review of Variolation Therapy  (4)  Stories on Variolation’s Origin (5) Research into the Beginnings of Variolation in the Regions South of the Yangtze River in the Middle and Late Ming Dynasty 121. Views on the Popularization of Variolation by Emperor Kangxi C.  The Theory, Technology and Success of Variolation  122.  The Theory and Technique of Variolation (1) Foetal Toxin and the Theory of Variolation Being Used to Discharge Foetal Toxin  (2)  The Variolation Method and Its Improvement (3) Efficacy and Safeguarding Measures During Variolation (a)  Selecting the Seedlings (b)  Seedlings, Their Storage and Management (c)  The Timing of the Variolation (d) Suitable and Unsuitable Constitutions for Variolation (4) Observation and Recuperation with Herbal Medicines After Variolation 123.  The Success Rate of Variolation

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718 718 727 727 731 739 744 744 744 747 754 762

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Chapter 15 S cience, Technology and Medicine: Ancient Occupational Disease, Its Prevention and Treatment A. The Development of Science and Technology and the Progress Made by Medicine During Ancient Times 124. Time Medicine, Biological Rhythm and the Theory of the Midnight-Midday Ebb and Flow  125. Simple Systems Theory and Experimental Thought in Traditional Chinese Medicine 126. The Identification, Processing and Refining of Medicines 127. Other Effects of Scientific and Technological Progress on Medicine  B. The Prevention and Treatment of Ancient Occupational Diseases 128.  Occupational Poisoning and Damage 129.  Occupational Diseases Chapter 16 The Culture of Reproduction and Medical Science A.  Pregnancy and Delivery 130.  Conception and the Pursuit of a Boy 131.  Antenatal Training and Eugenics  132.  Delivery and Midwifery 133.  Spontaneous Abortion and Aborticides B.  The Culture of Child-Rearing and Science of Medicine 134.  Premature Infant Death and Baby Care 135. The Theory of Congenital Foetal Toxin and Diagnosis Through Pediatric Finger Veins  Chapter 17 Sexual Culture in Medicine A.  Ancient Sexology 136.  Sexology in Books and Paintings 137. The Growth of Knowledge of the Sexual Organs and Sexual Skills 138. The Initial Theory of Sexology and the Method of Storing Essence and Promoting Qi 139. “Picking and Fighting” and the Inner Alchemy of Chinese Sexology B.  Sexual Perversions and Disease 140.  “Lovesickness” and Various Sexual Perversions

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141.  Diseases of the Sexual Organs and Functional Disorders  142.  A Study of Venereal Disease in Ancient China 

956 968

Chapter 18  Medical Science, the Culture of Food and Other Things

975

A.  The Culture of Food and Medical Science 143.  Fine Foods in Health and Nutrition  144. Medicated Foods Based on the Homology of Medicine and Food B.  Cases in Literature, Art, the Physical and Medical Sciences 145. The Relationship Between Music, Poetry and Medical Science 146.  Kongfu and Medical Science

975 975

Chapter 19 A Glance at Altar Medicine

990 1001 1001 1009 1015

A. Sacrificing to the Three Sovereigns, the Specialty of Supplication and Divination Prescriptions  1015 147. Sacrifices to the Three Sovereigns and the Deification of Famous Doctors 1015 148.  Supplication as a Specialty 1025 149. Holy Water, Bringing Down the Gods and Divination Prescriptions 1031 B. Gu Insect Witchcraft, Physiognomy and Taisu Pulse Necromancy1038 150.  Gu Insect Witchcraft 1038 151.  The Taisu Pulse and Art of Physiognomy  1045 Chapter 20  The Mentality and Behaviour of Physicians and Patients in the Tradition A.  The Cultural Psychology of Chinese Medicine 152. The Medical Expert’s Pursuit of Personality — “A Superior Physician Treats a Country” 153. “Medicine, It Is Mental”: The Physician’s Logic and Way of Thinking  154. “Using Medicine Is Like Deploying the Army” — The Behavioural Psychology of the Clinical Physician B. The Psychology of Behaviour During the Pursuit of Medical Help 155. “Seeking No Treatment Is Equal to Seeing an Averagely Skilled Physician”

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156. The Patient Seeking Medical Help and Selecting a Physician 1091 Conclusion of Part Three1103 Part Four The Cultural Process of Chinese Medicine in History and Its Crystallization

1105

Chapter 21 T  he Essential Stream of Chinese Medicine and Its Outcomes

1107

A. The Main Developments and Characteristics of Chinese Medicine Through the Ages 157. The Beginning of the Basic Theory of Traditional Chinese Medicine in the Pre-Qin Period 158. The Medical Classics and Classical Prescriptions as They Formed and Fell into Disuse Among the People 159. The Foundation of a System of Treatment According to Syndrome Differentiation in the Late Han Dynasty 160.  How Chinese Medicine Bloomed During the Wars  161. Great Achievements Made During the Prosperous Sui and Tang 162. Chinese Medicine Takes on an Organizational Structure During the Northern and Southern Song Dynasties  163. Chinese Medicine in Contention During the Jin and Yuan Dynasties and Its Superstable Formation During the Ming and Qing B. Important Works and Famous Doctors from the History of Chinese Medicine  164.  Three Shi Chinese Medicine and the Four Classics 165. The Works Extant in Chinese Medicine Worth Reading 166.  Famous Doctors in Chinese Medical History  C. Eight Major Contributions and Mysteries Concerning Traditional Chinese Medicine 167. The Five Elements, Yin–Yang & Qi and Blood — A Basis for Theory  168. The Four Examinations and Eight Principles — Keys to Pattern Identification 169. The Toxicity-Relieving and Property-Enhancing Qualities of TCM

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1128

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170.  The Magic of Compound Prescriptions 1217 171. The Undetectable Nature of the Acupuncture Meridians1220 172. The Endotherapy of Exogenous Disease Without an Operation  1222 173.  Variolation — A Way of Keeping Well 1223 174.  Turning to TCM When Western Medicine Fails 1226 Chapter 22 The Root of Life and the Future of Chinese Medicine 1229 A. The Essence of Chinese Medicine: A High-Quality Ecological Medicine 1229 175.  Chinese Medicine, Is It Scientific or Not? 1229 176. Comments on the Transforming Modes of Biomedicine and Evidence-Based Medicine 1236 177.  The Ecological Medical Theory of Chinese Medicine 1242 B.  The Vital Source of Chinese Medicine 1257 178.  The Cultural Soil of Chinese Medicine 1257 179. Die-Hard Chinese Medical Practitioners Providing Effective Treatment, with Less Toxicity and Fewer Side Effects 1259 180. Theoretical Advancement and Foresight: “Creativity” as the Motive Force Within TCM 1264 C.  Puzzles and the Future 1266 181.  Puzzles: Turmoil and Swirls 1266 182. Research Methodologies and Research into Methodologies1269 183.  An Evergreen Life 1275 Conclusion of Part Four1277 General Conclusions1279 About the Author1285

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PART THREE

Medicine in Social Life, Epidemics and the Invention of Variolation In addition to the influence of philosophy, religion and politics mentioned in the previous few chapters, Chinese medicine, having a kind of social existence, was also impacted by the natural and social environment, and multiple cultural factors. This part discusses some of these factors in general.

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Medicine in Different Social Environments A.  Medicine in War and Turmoil 99. Medical Conditions During War and Periods of Historical Turmoil Wars are disasters that bring hunger, poverty, disease and death to human beings as well as creating extensive epidemics. A tumultuous state in society may be a time that the social environment is seriously impacted by artificial human factors. In the history of ancient China, there were six such seriously tumultuous periods, each of which lasted decades or even hundreds of years. However, among these six periods of turmoil, in five of them the theory and practice of Chinese medicine made great breakthroughs and innovations — the only exceptions being the period at the end of the Tang dynasty and during the Five Dynasties: 1st Period

From the Spring The first real doctor Bian Que appeared and Autumn, and ended the era of witchcraft Warring State to The formation of fundamental medical the Qin and Han theories: Yin–Yang, qi and the five Dynasties elements, represented by Huangdi’s Inner Classic (黄帝内经) (Continued)

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(Continued) 2nd Period From the end of The establishment of clinical treatment based Han dynasty to on pattern differentiation, represented by the period of the the Treatise on Cold Damage and Wei, Jin, Miscellaneous Diseases (伤寒杂 Southern and 病论), The Pulse Classic (脉经), the Northern Central Organs Classic (中藏经), the Dynasties Handbook of Formulae for Emergency to Be Carried in the Sleeve (肘后备急方), the Familiar Formulae (小品方) and so on rd 3 Period In the Jin and Contention of the Four Great Schools Yuan dynasties of the Jin and Yuan, and the theoretical formation of these Four Great Schools th 4 Period From the end of The emergence of the School of Warm Ming to the Epidemic Diseases beginning of the Qing dynasty th 5 Period At the end of Qing The emergence of the School Combining dynasty Chinese and Western medicine The tumultuous period at the end of Tang dynasty and during the Five Dynasties lasted for up to 60 years, and is comparatively the shortest. As a result, no great medical breakthroughs occurred in this period. It seems the length of turmoil is also an important factor. Wars and turmoil themselves are surely not the mothers who give birth to medical innovations and breakthroughs. They do not even have a direct contributive effect on their development. The problem was that China was always ruled by governments which tended to be lengthy and strictly feudal. It is possible that only the chaos of war could open a window for the people. On the one hand, fresh air can flow in. On the other hand, thought and communication become free and loosen up. With regard to philosophy, people could at least demonstrate their ideas as they wished — and what they wanted to say they were able to, regardless of idealism, materialism, metaphysics, Confucianism, the Confucian classics or elegant idle talk (清谈). There were many breakthroughs, taking advantage of the loopholes created by the chaos — and the religions such as Buddhism, Taoism, Islam and others also arose during these periods. Medical ideas broadened in thinking. Meanwhile,

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the long period of wartime chaos displaced people from their homes and caused many kinds of new diseases. Some epidemics occurred that had not been seen before; infectious diseases were brought in from foreign countries, and other originally disseminated diseases became epidemic and fulminating. Just as Lao Zi (老子) states in his 30th Chapter, “There must be bad years after a war.” As for doctors, they had to face the patients and administer remedies. Older experience and classical articles were tested by reality and might either be discarded or altered. With the accumulation of new experience, novel thoughts concerning medical theory were put to the test. Moreover, war drove many talents into the field of medicine. Some, who originally might have become government officials, were forced to become doctors. Or, due to the turn of events, some loyal officials and senior Confucian scholars from the conquered country became hermits in the forest and among the common people. They practiced medicine to cover up the part they played in the revolt. Some famous doctors at the end of the Ming dynasty, such as Fang Yizhi, Lu Wancun and Fu Qingzhu, are examples of this. In any case, all the abovementioned factors contributed indirectly to the development of new medicine.

100.  Health Organization in the Army Wars require the involvement of armies and the establishment and building of health organizations, which are all directly influenced by the factors of being at war. The army needs doctors. At the beginning of the establishment of the army in ancient China, militarists had noticed this. Jiang Ziya, a famous militarist and prime minister in the Zhou Dynasty, also named Lu Wang, stated in the Six Strategies (六韬) that “the three Fangshi (occult doctors) applied all kinds of medicines to treat incised wounds and many other diseases.” The term fangshi here refers to army doctors during the Western Zhou dynasty. Mo Zi – Temple of Confronting the Enemy (墨子·迎敌祠) states, “We must find appropriate houses to stay in for those who are good at witchcraft, medicine and divination. Prepared medicines should often be put and stored in these houses. The house should be build well. Wizards must live close to places where the ‘gods of the earth’ are sacrificed to publicly, and they must respect the gods. Wizards and diviners must be guarded there.” These three were in charge of different events in the army. The wizards and diviners were responsible for praying to the gods and observing the appearance of the qi in the sky, while doctors prepared medicine for treatment. They were arranged in certain lodges. Mo Zi – Order (墨子·号令)

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states, “Soldiers who are injured seriously, take good care of them at the rear of the army. Ask the doctors to give them medicine and grant them 2 liters of wine and 2 jin of meat. Officials are required to visit them regularly. If they recover from the disease, they must go and serve in the army again.” “At the rear of the army” meant something similar to a “base hospital”, but at that time, the troops were not gathered in one place. Therefore, military officials were needed to supervise them. The chapter on “Marching” in Sun Zi’s Art of War (孙子兵法) also states, “In terms of the garrison, it is favorable to stay in a high place, and bad in a low place; stay at a place which is Yang, it is not good if it is Yin; stay where there may be a reliable living for healthy men and horses. If there is no disease appearing in the army, victory will be guaranteed.” This tells us that proper places were to be selected for camping the troops, and medical workers accordingly should be arranged to ensure no occurrence of disease, thus guaranteeing victory in the war. In Ju Yan’s Bamboo Slips of Han Dynasty (居延汉简), records have been found of the army’s morbidity statistics, the attendance of medical workers and a register of injuries (a soldier sustaining an injury that included treatment such as plasters). In addition, a medicine box, with the inscription “Distinct Medical Case (显明对药函)” on it, has been found in a beacon tower, which indicates the presence of daily medicines for beacon guards at that time. The Book of the Han Dynasty – Biography of Li Ling (汉书·李 陵传) even has a record of special vehicles being made available for medical rescue: “For soldiers fighting continually, if someone has been struck by 3 arrows, they can be carried by an imperial carriage. If struck by 2 arrows, they can ride in any vehicle. If struck by one arrow, they should take up their weapons to fight.” The Book of the Later Han – Biography of Huangfu Gui (后汉书·皇甫规传) records in the 5th year of Yanxi (162 CE) that Huangfu Gui went on an expedition to Longyou. There, “pestilence occurred in the army and one to three of every ten soldiers died. Huangfu Gui entered their straw huts in person and made an inspection tour of officials and soldiers. The whole army was inspired by his enthusiasm.” The straw hut was a kind of temporary quarantine. During the Sui dynasty, the official rank “Army Governor of Medicine” was established, equal to the 9th Grade of military medical officer. At the beginning of the Tang dynasty, Tiance’s Upper General Mansion was established, in which two officials, a gongcao and a canjunshi, were concurrently in charge of medical affairs. There were also gongcao and canjunshi officials responsible for medical administration in the prefectures

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and in all the governmental states, shires and counties over the country. After these official ranks were removed, local medical administrators took charge of military medical care. For example, in the 643 local military organizations in the Tang dynasty, there were altogether 211 imperial doctors, associate medics, acupuncture students and others, generally about three medical workers to each organization. In the Kaiyuan period (713– 741 CE), according to Zhao Rui’s Long and Short Chapters on the Confucian Economy (儒门经济长短篇), there were “three occultists in charge of medicine to cure injures or diseases of the soldiers”. The General Dictionary (通典) cited Li Jing’s military strategies and that a “Patient Supervising Official” was to be established. This was something like the establishment of field forces. It stipulated who was camp leader and that the Patient Supervising Official must tend to sick soldiers, according to the severity of the injury. For those who could walk, only one healthcare worker was arranged. For those who could not walk, a donkey was added. For those who could not ride, two healthcare workers and two donkeys were arranged to carry them on a stretcher. If the Patient Supervising Official and healthcare worker could not take good care of them, they would be punished by being beaten 100 times with a rod. If they buried sick soldiers who were still alive, they would be beheaded. The establishment was rather strict. In the 3rd year of Qingtai during the Five Dynasties, He Ning presented a memorial to the throne hoping that the Bureau of Imperial Doctors could compound medicine for diseases such as cold damage, pestilential qi and dysentery and then distribute them to the army. Moreover, Key Collections of Five Dynasties – Medical Skills (五代会要·医术) states that the Emperor “ordered that the military establishment should have a military surgeon in every main part of army.” Thus, the term “military surgeon” came into being. A History of the Song Dynasty – Biography of Feng Wenzhi (宋史· 冯文智传) records, in the Song dynasty, “since the year of Jianlong (960 CE), when the Emperor’s close official and royal relations suffered illness, the imperial guards along with their doctors were sure to be sent… Commanders at the border often had medical officers and professionals follow them and change every three years. When the Emperor sent out or marched an army, or visited foreign countries, medical officers were ordered to follow the army and the examination halls closed. On the four sides of the capital, members of the Imperial Academy were asked to visit and treat diseases of the officers and soldiers. In the summer, medical officers were asked to supply appropriate decoctions. Together with the imperial guards, they scattered throughout

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the temples and city gates to distribute medicines to the army and citizens. Every time the Emperor reviewed the troops, if there were soldiers wounded by weapons, medical officers were ordered to cure them immediately.” Later, students in the three she of the Imperial Medical Bureau were asked to treat diseases among Martial Art students and soldiers. When there was pestilence in the army, additional imperial doctors would be dispatched. There were also professional military doctors in the army. Xu Dong’s Tiger Seal Classic (虎钤经) states, “Military doctors must be above 20 years old and the number should be proportional to the scale of the army.” Both this book and A Synopsis of Martial Classics (武经总要) have records of medical care given to the army and precautions taken with poisonous substances. The military healthcare organization of the Yuan dynasty was somewhat influenced by the Arabians. The Guanghui Division managed by Ai Xue mainly offered treatment to soldiers back from western expeditions. Later, the Hui People’s Pharmacy Yard and the Darughachi were similar organizations, but they provided medical treatment for both soldiers and common people. In the 7th year of Zhiyuan (1270 CE), Emperor Shizu of Yuan ordered local governments to provide medicine and food to soldiers back from expedition; the establishment of so-called “Happy Halls” in more than thirty supplementary branches of the armies in Mongolia, in the Han nation and the newly affiliated army was similar to a hospital taking in sick soldiers. The government would administer and give punishment or reward according to the effectiveness of treatment and how many died. During the Ming and Qing dynasties, the forces behind military healthcare were not effective enough and doctors were temporarily sent out, mainly from the Imperial Hospital. Many local doctors didn’t want to serve in the army, so some sections of the army wanted doctors they had educated themselves. For example, in the years 1,408 and 1,454, schools for training military doctors were established under the request of garrisons in Shaanxi, Ganshu, Shanxi and other provinces. Sanatoriums were also established for old, weak, sick or disabled soldiers. The organization of military doctors in the Taiping army was more rigorous. “There are four physicians in the army with a rank equaling zhongzhi (commander in general); fourteen with a rank equaling junshuai (commander in chief). A medical superintendent-general was also specially appointed. There are twenty-five main surgeons with a rank equaling zhongzhi; numerous doctors, with a rank equaling jianjun (army supervisor), also included for emergency treatment and responsible for external medicine and injured soldiers.” The wounded soldiers were firstly treated in the “Zhen Wei Ji”

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(emergency room), and then transferred to the “Neng Ren Guan” (Hospital for Wounded Soldiers) in order to rest. If the “Neng Ren Guan” was full of patients, citizens’ houses were used instead. After they had recovered, they were discharged and continued to serve in the army. There were also rules that “the camps must be clean with no arbitrary pollution going into the roads and they were not allowed to urinate or defecate just in any place, without being shamed.” As a result, within the Taiping army, “medical care and drugs were sufficient for the sick officers and soldiers. There were often attendants around them.” On the contrary, in the Qing government army, “pestilence prevails and deaths are common… dead bodies are scattered around without being buried. This is because of the lack of health workers delivering drugs to patients. There is not even a cook to each division.” Wang Xungao, a famous doctor, was once a military doctor in the Taiping army. Hong Xiuquan, the leader of the Taiping Army, earnestly warned the generals and officers in a Heavenly King’s Empathizing Order as follows: Every general or officer should cherish his soldiers. Take when marching, or in a quartering area as an example. If there are injured soldiers, or old and young people along the way, who are unable to climb mountains and cross rivers, we must instruct all officers that the horses — no matter who owns them — should be used for such people to ride. If there are not enough horses, ask the soldiers to carry them. No letting-up allowed. When it comes to time to camp, healthcare officers must check over the patients and those recovered whenever there is a Christian service. Then report back to the zaifu (official rank for butcher) to arrange meat to be provided according to the number of patients, each two or three days for recuperation. Surgeons and doctors should be especially careful always to use well-chosen fresh medicines in treatment. They shouldn’t feel disgusted because of the stinking pus and blood. When generals and officers have time, they must visit the meritorious but worsening soldiers in person. If the sick soldier has relatives in the army, camp comrades should take care of them as if they had the same father and were kindred. Hong Rengan, the Gan king of the Taiping army, concerned himself a great deal about medicine because of his communication with Dr. Benjamin Hobson (1816–1873), a Missionary Physician, when he was young. Hence, he set up a hospital in the King’s Mansion which was also available for treating sick soldiers.

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With the reorganization proposal by C.G. Gordon, a Gun Captain, Li Hongzhang’s Huai Army established hospitals, and Beiyang Medical College was founded for training military doctors. Generally speaking, the healthcare organization in the army was relatively comprehensive and progressive. It was totally different from the healthcare organizations in local areas, which were not organized by the government. However, unlike during the Crusades in the West, the Chinese army did not develop a hospital organization with a military hospital as the base and the involvement of all the people. Hospitals in the army and in localities were separate. Eventually, this meant the system of medical care in the army was never normalized, just like the whole logistical system, and it remained relatively undisciplined overall.

101.  Surgery in the Army Trauma was the most common injury in the army during ancient times, especially incised wounds made by a knife, arrow or sword — as well as falls and knocks. Therefore, surgery was greatly influenced by warfare. The earliest record in the history books is the story of Guan Yu’s “Scraping Poison off the Bone” from Records of the Three Kingdoms (三国志), though the technique of treating trauma had developed before. The Records of Guan Yu (关羽传) states the following: Guan Yu was once hit by an arrow through his left arm. Though the trauma later healed, his arm often ached when the day was overcast and rainy. The doctor said, ‘This arrow was poisonous and the poison has entered the bone. We should cut the arm open and scrape the poison off the bone. Then the symptom will go.’ Guan Yuan thus stretched out his arm and asked the doctor to cut it open. In the meantime, he just invited many generals to drink and eat together. With the blood dripping from his arm and filling a basin, he was able to still keep on talking and laughing as usual, quite unperturbed, cutting meat and drinking wine. This story was later altered into an operation carried by Hua Tuo in the Romance of the Three Kingdoms (三国演义), a story told in an earlier chapter. No anaesthetics were used, and the principle of debridement was correct. This operation was conducted by a military doctor in Shu (Sichuan Province). Cutting meat and drinking wine had the function of diverting attention and

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alleviating pain. This kind of operation was perhaps quite common during the Wei, Jin, Northern and Southern Dynasties. For example, the Book of the Jin Dynasty – Records of Jingdi (晋书·景帝纪) states, At the beginning, a tumor grew out of the Emperor’s eye, so the doctors were asked to cut it out. Then, when Yang came to do it the Emperor was so scared his eyes almost popped out of their sockets. As he was afraid his army might see he was scared, he covered his head with a bed-quilt. He bit so hard the quilt tore through without him knowing whether the pain was bad or not. His illness became critical in the leap month of that year. Though this was not a battle wound, it occurred during wartime. The doctor must have had a well thought-out plan to carry out the excision of the eye tumour. Another example is recorded in the Book of the Jin Dynasty – Biography of Wei Yong (晋书·魏咏之传). It states, “At that time, Yin Zhongkan was Prefecture Governor of Jing Zhou. His subordinate doctor was able to repair a harelip and said, ‘It is possible to cut and repair it. But it is necessary that the subject should only eat porridge and not laugh, smile or talk for a hundred days.’” This showed that a harelip neoplasty (dentofacial surgery) was possible at that time. It is not a common or easy operation but some doctors could do it even then. Again the Book of the Song Southern-Dynasty – Biography of He Shangzhi (宋书· 何尚之传) records, “When the sting of a poisonous insect is in the hand, remove it at the wrist to ensure full survival.” It seems extreme to amputate just for a poisonous sting, but it shows the doctor was confident and reveals the common occurrence of surgery in those times. Xu Zhicai, a famous doctor, was also good at performing surgery. The Book of the Northern Qi Dynasty – Biography of Xu Zhicai (北齐书·徐之才传) states, “A patient suffered from heel-ache and it was so swollen no doctor could cure it. Zhicai said, ‘It is a disease from ‘clam-essence’. You must have travelled in the sea and put your feet in the water’. The patient answered, ‘I did indeed. Zhicai cut the heel open and withdrew two small ‘clams’ the size of elm-seed pods.’” The disease of “clam essence” was so named because of their clam-like shape. Xu Zhicai diagnosed it and carried out the surgery, indicating a great advancement in surgery during that period. The Confucian discipline of “body, hair and skin are all given to us by our parents. They cannot be damaged” had not been abided in firmly.

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The above-mentioned records show considerable advances made in surgery during wartime; but this not only occurred in the army — surgery among the common people was also affected. A technique of wound haemostasis developed. However, it involved taking a kind of oral medicine not ligation or suture for stopping the bleeding. The Book of Wei – Biography of Yueban Country (魏书·悦般国传) states, In the 9th year of (Taiping) the Zhen monarch (448), the King of Yueban Country sent envoys to present tributes to the imperial court of Wei. One of them was a conjuror, who was said to be able to stop bleeding from various causes — such as cut vein in the neck or a broken skull that could losing liters of blood. His method was to ask the subject to chew on a kind of herb. The bleeding could be stopped after a while and they could recover — without any scar — after a one-month rest for the wound to heal. Emperor Shizu of Wei was doubtful, so he ordered it to be tested on convicts, sentenced to death. It proved effective in all cases. It is said that this herb existed on all the famous mountains in China. The Emperor then asked people to learn from the conjuror and offered him generous rewards. This story seems fantastic, but a haemostatic herb is possibly real — it may have been the hairy-veined agrimony (Herb Agri), flos sophorae, pollen typhae, radix sanguisorbae, rhizome imperatae, etc. which can be found in mountains and are still commonly used, both internally and externally for stopping bleeding. The above-mentioned herb was perhaps brought by a minority ethnic group to be tested by Emperor Shizu. It would have been urgently needed during wartime. There is a case on record from the Book of the Northern Qi Dynasty — Biography of Ma Siming (北齐书·马嗣明传) about an external application used for trauma and infection. “Yang Ling was afflicted by a back swelling, Siming used smelted stone to smear the affected area and it soon recovered. The method was to get a kind of thick yellowish mineral stone the size of a goose or duck egg, then to use intense fire to heat the stone until it reddened and then put it into strong vinegar so the stone would break into chips. Repeat the above procedure again and again until the stone disappears. Collect the stone chips and dry them under strong sunshine. Pound them thoroughly and sift. In application, mix with vinegar and smear over the wound of the swelling. None are uncured.” This stone powder was probably something like powdered sulfur, which is effective for ulcers and

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sores. Ma Siming, an official-ranking imperial doctor was also imperial bodyguard, riding with the Emperor — so was perhaps concurrently a military doctor. The famous literary masterpiece of surgery, Liu Juan-zi’s GhostBequeathed Formulae (刘涓子鬼遗方), was also a product of these chaotic war periods. Gong Qingxuan lived during the Qi and Liang periods, at the end of 5th century. He wrote the following in his foreword: At the end of the Jin dynasty, Liu Juanzi once practiced archery in the outskirts of Danyang. He suddenly saw a creature as high as two zhang (more than 4 meters), so he shot at it and it was hit — there was sudden thunder, flashes of lightning and a sound like wind and rain. As it was night, he was frightened to chase it. When the sun came up, he led several followers to track it to the foot of the mountain, where they saw a child carrying a pot. He asked the child where he was going, and the child said: ‘my master has been shot by Liu Juanzi, so I am ordered to fetch water to wash his wound’. ‘Then, who is your master?’ he was asked. The child answered: ‘Huangfu’s Ghost’. They followed the child to the gate and heard the sounds of pounding herbs. They saw at a distance there were three persons inside, one chanting from a book, one pounding herbs and one lying down. This time they shouted and made a surprise attack, and the three screamed and fled away, leaving a volume of Carbuncle Formulae (痈疽方), and some herbs in a mortar behind. At that time, the Emperor Songwu with his army marched north and many of his soldiers were wounded. With this herbal cream smeared on their wounds, they soon recovered. People said the actions of this sage would certainly have been assisted by Heaven. This was Heaven’s willingness for Songwu to succeed. Hence, the herbal formula was used for treatment, and not one out of a thousand was left uncured… I am in favor of formulae and therapies, so I accept this book of formulae with pleasure. I have had it five years, and every time I used its formulae, the patient is cured. It can be regarded as a magic effective throughout the world. In the past, Liu Juanzi sent me this book in script, without any instructions. Now, I have tried to compile and order it by categories so to spread it to all folks. Any intelligent man of insight would be fortunate to have the same for self-treatment. Written on the 5th May, the 1st year of Yongyuan of the Northern Qi Dynasty (499 CE).

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It can be inferred that this foreword is telling the truth. The story that Liu Juanzi met Huangfu’s Ghost is a little made up, but he might have panicked, especially if it had happened at night. They found nothing as tall as two zhang the next day. In addition, they saw someone chanting from a medical book, reciting the prescription, and another preparing herbs, which shows it was a human rather than a ghost. A book written without instructions tells us it was a collection of particular experiences. Gong Qingxuan contributed to the compilation of this book. The story in the foreword related to an arrow trauma, and also belongs to the category of war injuries. This story is very similar to the tale of Liu Jinu recorded in the History of the Southern Dynasty – Biography of the Song Emperors (南史·宋本纪). It generally goes as follows: Emperor Song Gaozu was named Liu Yu, alias Deyu or Jinu, being the 21st offspring of Chuyuanwang Jiao in Han Dynasty. He was from Suiyuli, Pengchen city. Our Emperor was originally poor… once when he was cutting reeds at a new islet in the river, he encountered a large snake several zhang long and injured it by shooting an arrow. The second day, he returned to the place and heard a pounding sound inside. He peered in and saw several boys in green clothes pounding herbs. He asked why they were doing that. One answered, ‘Our king was shot by Liu Jinu, so we are making powder to put on the wound!’… He shouted back at them and they scattered. Then he took the herbs away. One day, on his travels he passed by an inn in Xiapi and met a monk, who said to him ‘that area south of the Yangtze River will soon become chaotic. But its pacificator can be you!’ As he had had a wound in his hand for many years, the monk gave him a yellow powdered medicine — and then suddenly disappeared. He applied it and the wound was very soon cured. He treasured both the rest of this powdered medicine and the herbs he had taken from the boys. Every time there was an incised trauma, such medicines were applied and were effective every time. Liu Jinu was the first Emperor of the Song kingdom (420–479) during the South–North Dynasties; he was on the throne from 420 to 422. His official name was Liu Yu but his personal name was Liu Jinu. The abovementioned story is an excerpt from the history of the Southern Dynasty regarding how he occasionally found medicines for the treatment of incised trauma, ulcers or carbuncles. Among the medicines, one herb has been discovered to be Liujinu. Liujinu (Artemisia anomala) was later listed

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in the Newly Revised Materia Medica (新修本草) where it says “Liujinu grows south of the Yangtze River. Its stem resembles mugwort and can be as long as 3–4 chi (90–120 cm)…” Its functions are just as those noted in an Alternative Record of Famous Physicians (名医别录): “treating lower body bleeding and relieving pain, curing postpartum diseases and stanching incised-wound bleeding.” It is a herb for external trauma. The story also contains an injury from being shot, and pounding herbs, the same as previous one. The story of Huangfu’s ghost has probably transformed into one of a yellow medicine powder given by a monk. Liu Juan-zi’s GhostBequeathed Formulae (刘涓子鬼遗方) originally was in ten volumes — but only a few survived the Song dynasty. In 1902, two remaining pieces of Liu Juan-zi’s Formulae (刘涓子方) were unearthed from Turpan, in Xinjiang Region, the contents of which confirm earlier versions. At present, there are five volumes surviving which include the following: causes and differentiation of ulcers and carbuncles; external methods of treatment for incised trauma; treatment for ulcers and carbuncles; Huangfu’s treatise and formulae for ulcers and carbuncles; medicinal formulae for the miscellaneous treatment of diseases like ulcers and carbuncles, scabies, mammary mastitis, infantile toxic sores, stabbing by bamboo or wood, burning injuries, etc. The ulcers and carbuncles mentioned in the book were probably related to the purulent skin ulcers that were rather prevalent at that time, especially the carbuncles and ulcers due to the oral intake of some kinds of stone powders. However, treatment for incised trauma is definitely a summary of experiences got from applying external medicines to war injuries. The Formulae included are generally as follows: Bleeding:

Wuzhanggen Blood-Stopping Powder (乌章根止血散); Shock: Amber Powder (琥珀散); Pain, dysphoria, insomnia: Chinese Angelica Powder (当归散), Ephedra Powder (麻黄散), Cynanchi Baiwei Powder (白薇散) and so on; Rectal prolapse of intestine: Wheat Beverage (小麦饮) sprayed on the sore, Magnetite Powder (磁石散); Arrowhead entering the flesh being Ampelopsis Powder (白蔹散), Dianthi unable to draw out: Powder (瞿麦散) and so on; Contracture and pain of tendons Damaged Bow Powder (败弩散); and bones:

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Tonics for weakness due to blood loss:

Cistanche Powder (苁蓉散), Angelica Powder (当归散) and Dianthi Powder (瞿麦散); Inadequate drainage of incised Bugleweed Powder (泽兰散), Astragalus sores: Powder (黄芪散); Abdominal blood stasis: Cattail Powder (蒲黄散), Black-bone Chicken Soup, Peach Pit Decoction (桃核汤), White Horse’s Hoof Powder (白马蹄散); Incised sores, ulcers and carbuncles: Dipsaci Muscle Regenerating Ointment (续断生肌膏), Flesh Regenerating Ointment (生肉膏); Fistula: Bat Blood Dissipating Powder (蝙蝠消 血散), Cattail Powder (蒲黄散). All the above-mentioned Formulae are for oral intake or external use. There is no record of surgery in the whole book, though it may exist in the five lost volumes. At least, the formulae listed are evidence of an important part of military surgery — the professional application of internal treatments for incised wounds. We can consider this to be the origin in China of internal treatment for the traumas of external medicine. Such developments may well be related to unsolved problems of sterilization and infection control during surgery, and associated with unsatisfactory measures and effects of operation techniques, analgesia, haemostasis, etc. Almost all the Formulae for incised wound in the extant Liu Juan-zi’s Ghost-Bequeathed Formulae (刘涓子鬼遗方) can be found in the Supplement to ‘Important Prescriptions Worth a Thousand Gold Pieces’ (千金翼方) with perhaps minor alterations. For example, Dianthi Powder (瞿麦散) was altered to Dianthi Pills (瞿麦丸), with the same major ingredients and differences only in the dose and the form of drugs in preparation. Here is a case record: During the middle years of the Zhenguan period (627–649) of the Tang Emperor Taizong, an outstanding soldier was hit by a stray arrow in the back during an expedition. The arrowhead went 4 cun (about 12 cm) deep into the flesh. All the famous doctors in the country were at their wit’s end on how to pick it out, as it was still

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held in the flesh. It had no influence on movement and sitting, but there was often pus oozing out. In the autumn of the first year of the Yonghui period (650–654) of Tang Gaozong, I was asked to treat it and prescribed Dianthi Pills (瞿麦丸)… After a whole winter and spring, the arrowhead came out spontaneously. It measured as long as 3.5 cun. We can here understand the influence on later generations of the formulae for trauma treatment recorded in the book Ghost-Bequeathed Formulae. In terms of surgery during the Sui dynasty, the Treatise on the Causes, Origins and Manifestations of Various Diseases (诸病源候论) contains lots of records and statements. Professor Li Jingwei has illustrated them in detail.1 Altogether 23 patterns of incised wound are recorded, such as the following: Pattern of tendon injury and bone fracture due to incised wound: This refers to an incised wound and broken bone in any part of the body. For a fracture in the elbow, wrist, knee or thigh, it is just like an ankle fracture in that the broken bones can be connected again. It is a must to apply a hot application immediately and take advantage of the still hot qi and blood, remove the bone debris and suture the tendon and skin. After recovery, it will become stiff, and one will be unable to bend or straighten it. If the bone debris has not been removed, it will cause pain and constant production of pus, making the patient restless and unsettled. Pattern of arrow or metal weapon retained in the bone and flesh: If an arrow or metal weapon hits the bone and breaks it, it is a must to get the arrow or weapon out. Removal of bone debris is still required and only after that, can medicines be applied. If not, the wound will never heal and even if it heals, pain will exist forever. It is fair to say one should remove all bone debris, otherwise necrosis of the bone would be caused, inducing secondary infection. It is also correct to suture the muscles and tendons, but since the operation at that time was not expertly done, they shortened after recovery, which contributed to being “unable to bend and straighten” the joint. 1

 Li Jingwei. Achievements of Surgery in Ancient China, published in Collected Papers of Science History, 1963, Vol. 5.

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Here is another example: Pattern of broken intestines due to incised wound: For patients suffering from torn intestines caused by an incised wound, the prognosis could either be favorable or unfavorable according to the severity of the illness. If only one end of the intestine can be observed, connection is impossible. If there are manifestations of abdominal pain and shortness of breath, those with a torn large intestine will die one and a half days later and those with a torn small intestine will pass away three days later. If the two ends of the intestine can be observed, connection should be carried out as soon as possible. At first, use a needle to suture the two ends, smear chicken blood on the suture in order to prevent the outlet of qi, and then put the intestine back into the abdomen. If the intestines have dropped out of the abdomen but not yet torn, wash them with the juice of barley porridge… If the greater part of the omentum has come out of the wound, some patients will die while some will not, depending on their specific state. If it has come out looking like a ‘hand fastened below’, and there are signs of vexation, shortness of breath occurring regularly, the patient will surely die within three days. If it has come out totally and there are signs of quietness, no vexation, normal breathing and only a painful wound, the doctor should use raw silk to suture the blood-vessels first and one night later, cut off the greater part of the omentum. Do not close the opening immediately, but use a little grease to lubricate it first. This record describes a kind of intestinal anastomosis, which could be regarded as the most advanced operation in the world at that time. Using barley porridge to wash the intestines is better than spraying the wound with just wheat juice because, for one thing, barley porridge is disinfecting if boiled for a long time and, for another, the porridge is colloid-like, with lubricating and isotonic functions. With regard to the operation, although one night is too long to wait before performing the excision (after suturing the blood vessels with raw silk), the purpose is to identify the range of blood supply of the ligated blood vessels, thus preventing bleeding after the operation. This is a good point. In addition, the “pattern of wind-attackcaused convulsions due to an incised wound” and the “pattern of convulsions due to fright after a incised wound” are also mentioned in the book, which suggest tetanus. These records of treatment for an incised wound in the Treatise on the Causes and Origins and Manifestations of

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Various Diseases (诸病源候论) are possibly a collection of experiences on surgery for an incised wound developed during the war in the Wei, Jin, Northern and Southern dynasties. Surgery developed along with the advancement of internal medicine. The New Book of the Tang – Biography of An Jincang (新唐书·安金藏 传) also has records of military surgery, which indicate the actual development of surgical procedures. It was the 2nd year of Changshou (693 CE), when Empress Wu Zetian suspected Prince Ruizong was plotting a conspiracy against her, so she killed several of his imperial bodyguards and interrogated some of the rest. They were so afraid of the consequences they wanted to plead guilty. However, An Jincang, an official with the rank of taichang, “claimed loudly ‘if you don’t believe my words, please take out my heart to show my innocence before the prince’. Then, he drew out his ‘walking sabre’ and cut open his own abdomen. His intestines fell to the ground and he also fell down unconscious. The empress was shocked and asked subordinates to carry him in a vehicle back to the imperial palace to be treated by the very best doctors. The doctors put the intestines back in and used thread made by white-mulberry bark to suture the seam of abdomen. He resuscitated a night later.” This shows that there were brilliant doctors during the Tang dynasty who were able to perform operations on abdominal trauma. The use of white mulberry bark thread to suture the abdominal wall would offset the opening tension of the abdominal muscles — so the skin would not easily pull apart. This method of “putting the intestines back” is also found in the Concourse Recording the Royal Benevolence Formula (圣济总录): For intestines coming out an incised wound… if the intestines are not impaired, put them back into the abdomen immediately. Then, suture the abdominal skin with thread made from the soft white bark of the mulberry. Smear some medicine on the suture line and the patient will survive after the bleeding has stopped. If you do not have white-mulberry bark, you can use raw ramie thread instead. It was common to see arrow wounds during military surgery. If the arrowhead had hit deep into the bone, it was necessary to remove it by pincers and chiselling into the bone. Records of Unique Strange Things (独异志) records: At the end of Sui dynasty, the king Gao Kaidao was hit by an arrow which went deep into the bone. He ordered a doctor to pull it out, but

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in vain. Kaidao asked for the reason and the doctor said he feared the pain caused. Kaidao thus killed him and ordered another doctor to do it. This doctor said he could draw it out. He used a small axe to knock a little stick into the wound and 2 cun deep into the bone. Then, he pulled it out with pincers. Kaidao drank and ate unperturbed through. After that, he rewarded the doctor with three hundred bolts of silk. He was later killed by his general Zhang Jinshu. The Old History of the Five Dynasties – Biography of Chang Congjian (旧五代史·苌从简传) and A History of the Five Dynasties – Miscellaneous Notes (五代史记·杂传) state the following: Congjian was once hit by a stray arrow which went deep in, the metal arrowhead deep into the thighbone. Doctors were ordered to remove it. As they didn’t have much medicine with them, they wanted to chisel the bone, which was considered unsuitable by others. Congjian hastened them to chisel it, but doctors were hesitating and could not bear to do it… After chiseling a long time, the arrowhead still couldn’t be rocked, so Congjian said angrily with eyes his wildly open, ‘Why not chisel in deeper? Deep enough, so the arrowhead will come out.’ As the arrowhead was withdrawn, everyone felt compassion and was astonished by Congjian’s calm demeanor. Apart from the operation, herbal applications and oral medicines were also used to get the arrowhead out of the wound. Dianthi Pills (瞿麦丸) were named in a formula for internal treatment. In terms of external application, the History of the Song Dynasty – Biography of Feng Wenzhi (宋史· 冯文智传) records, In the period of Xianping (998–1003), a soldier was hit by a stray arrow which went into the cheek through the ear. Doctors were unable to get it out. The medical official Yan Wenxiang applied medicine externally onto the wound. One night later, the arrowhead came out. The doctor was rewarded with a red silk sash by the Emperor who appreciated his ability. The medical scholar Liu Yun was also good at this. At that time, Han Zheng, a general commander of Tianwu Youxiang, was hit by an arrow in the left thigh — when he followed Emperor Taizu on his march into Jinyang. The arrowhead remained in his thigh for nearly 30 years. At the beginning of the Jingde period (1004 CE), Liu Yun was ordered by

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the Emperor to see to Han Zheng’s problem and he applied medicine externally to the wound. The arrowhead came out and Han was able to walk as normal. Han Zheng asked the Emperor to see Yun and express his deep gratitude. He asked for a burial place for him as well. He greatly praised Liu Yun’s proficiency. The Emperor rewarded Liu with white golden pieces and promoted him to the rank of medical official. The medicines used for external application may have been something like Ampelopsis Powder (白蔹散) or Dianthi Powder (瞿麦散) that has the effect of helping an arrowhead come out. There were also formulae for treating arrow wounds. For example, the Red Powder Formula (红散子方), mentioned in a Concourse of Recording the Royal Benevolence Formula (圣济总录), is for arrow wounds. This formula includes mandala seed, the end tip of kusnezoff monkshood root (Radix Aconiti Kusnezoffii), Xuejie (血竭，dragons blood) or Qilinjie (麒麟竭 Chinese Unicorn Dry Blood, Sanguis Draconis), eggplant flowers, castor bean and so on. The ingredients are ground into a fine powder and smeared on the wound after being concocted with wine. This formula is mainly to stop bleeding, relieve pain and as a local anaesthetic. The ingredient Xuejie (血竭) or Qilinjie (麒麟竭) may be translated as “dragon’s blood” (Sanguis Draconis). Actually it is a kind of coagulum of the latex from arbor trees growing in a tropical area. If the skin of the tree is cut, the coagulum can flow out and is named xuejie. It is red in colour like blood. The best is called qilinjie. It is often applied for incised trauma. It has a strong effect on stopping bleeding, invigorating the circulation of blood and transforming stasis, and engendering tissue formation. The New History of the Yuan Dynasty – Biography of Zhang Xi (新元史·张禧传) records, “… After a long battle, he was hit by 18 arrows with one going into his abdomen. After falling unconscious, he came to. It was said ‘his life can be saved by having Xuejjie (dragon’s blood，Sanguis Draconis) and by bleeding’. So Emperor Shizu ordered some to be fetched instantly.” Moxibustion was also applied for the treatment of trauma. A History of Liao Country – Biography of Ma Renwang (辽史·马人望传) records, “As he was hit by an arrow in the right arm, he was treated by moxibustion. His strength recovered and he galloped away at full speed.” The following is an example of treatment after being hit by multiple arrows. The History of the Yuan Dynasty – Biography of Hu Linshi (元史·忽林 失传) records, “… Arrows came down like rain from the enemy camp and he was hit by 33 arrows. Emperor Chengzong ordered attendants to draw

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out the arrows under his own supervision — and asked doctors to treat the open wounds.” The “attendants ordered to draw out the arrows under supervision” were surely not doctors. Thus, there were also cases of poor practice during treatment. The History of the Yuan Dynasty – Biography of Zhang Rong (元史·张荣传) records, “… He was once hit by a random arrow in the corner of his eye and it couldn’t be drawn out. Someone was ordered to draw it by pushing with his foot against his forehead.” We can thus see there were no norms of surgery in the army and medical skills were intermingled, good and bad. At the end of the Tang Dynasty and during the Five Dynasties, there was a case of a fistula formed after the removal of an arrowhead from the flesh. The Old History of the Five Dynasties – Biography of Pan Huan (旧五 代史·潘环传) records, “Pan Huan in battle always charged at the head of his soldiers to meet an approaching enemy head on and he had many incised wounds over his body.” The Digression of Jade Hall mentions that “Pan Huan had once been hit by a stray arrow in the face which went into the bone. He was seriously injured. After years of treatment, the arrow was removed, but a fistula formed and he never recovered from it, his whole life.” It seems it was rather difficult to treat fistulas. With the idea of “discarding the dross and selecting the essential”, Wei Yilin during the Yuan Dynasty accurately summarized and standardized various trauma therapies in his Effective Formulae from Generations of Physicians (世医得效方) written in 1337. Moreover, he renewed or summarized anaesthetic formulae. The ingredients were mainly empirical, such as mandara (Datura Stramonium) and kusnezoff monkshood root (Radix Aconiti Kusnezoffii). The book records, “for trauma causing bone dislocation, apply this mixture to create anaesthesia and then use the hands to deal with it.” “After the anesthetic the pain cannot be felt so then cut the skin, using scissors to annihilate the sharp points of bone, then re-tidy the broken bones and put them back into their original position.” It seems the anaesthetic effect was quite good. The anaesthetic formula used by the Japanese Hanaoka Seish (华冈青洲 1760–1835) and renowned the world over also came from this book. Wei Yilin’s contribution to treating military wounds and bone setting was quite outstanding. In the Yuan Dynasty, a method was applied of forcing open the teeth in order to drink a decoction for emergency suffocation. The New History of Yuan Dynasty – Biography of Hao Jing (新元史·郝经传) records, “Hao Jing’s mother was hiding in a cellar, but her enemies created a fire to choke

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her. She was suffocated. She was resuscitated a short time after by having her teeth forced open and being made to drink a Hanjue decoction mixed with honey.” A special therapy from Mongolia was used for treating traumatic shock. The New History of Yuan Dynasty – Biography of Bu Zhier (新元史·布智儿传) records, “Bu Zhier followed the Emperor to take part in the wars fighting foreign countries. He was always wild when fighting the enemy. He had thus been stricken by several arrows at once. The Emperor Taizu visited him in person and ordered others to draw the arrows out, but the bleeding was so profuse it made him fall over and almost die. The Emperor ordered them to kill a cow and put Bu Zhier into the cow’s belly with hot blood around him. He resuscitated some time later.” People during the Qing Dynasty also applied this therapy and it was praised by Emperor Kangxi. Jueluo Isangga, a famous orthopedist, was good at this kind of thing and used it to treat brain trauma. The Historical Scripts of the Qing Dynasty – Biography (清史稿本传) records the following: Jueluo Isangg became a very wealthy man through his orthopedic treatment in the middle of the Qianglong period (1736–1795). He imparted his recipes to his apprentices as follows: Cut a stick into several sections and wrap them together, being covered by paper. If you rub the paper for some time, all the sections will join again — as if un-broken. When such a method is applied to reconnect bones, the cure is always efficient. Therefore, soldiers aware of this therapy were selected from the Upper Three Banners, ten from each Banner, being affiliated to ‘upper horses’ Court. There were trained as ‘mongolian’ medical practitioners. When officials in the court had fractures, they were asked to give treatment. They had to heal the condition in a certain time, or they would be punished. Qi Zhaonan, an Assistant Minister, once fell from a horse and broke his skull and some part of the fluid leaked out. A ‘mongolian’ medical practitioner used a cow’s bladder to cover up his head and the trauma quickly healed. At that time, these were secret recipes that could be effective right away; Isangga was most famous at it. Some treated the trauma by cutting open a white camel’s belly. The Historical Scripts of the Qing Dynasty – Biography (清史稿本传) records,

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Chao Erji, surnamed Moergen, was a Mongolian. He took the lead in submitting to the Qing government in the Tianming period (1616– 1626). He was good at treating trauma. At that time, E Shuo, a pioneer of the White Banner, fought with the enemy and was at the point of death after being hit by an arrow. Chao Erji withdrew the arrow and applied good medicine externally to the wound. The wound soon healed. Wu Bai, had the rank of Dutong general, and was hit by more than thirty arrows, becoming unconscious. Chao Erji ordered subordinates to kill and cut open a white camel’s belly, and put Wu Bai into it. He resuscitated soon enough. If someone was incapable of stretching his arm, he would fumigate the affected arm by steam from a hot kettle first. Then, he would tap the arm-bone with the haft of an axe and soft sounds could be heard. It healed right away. There was a doctor named Zhang Chaokui, whose surgical skills were almost equal to those of modern medicine. He was also named Dwarf Mao. He was from Hunan province and when he was only 28 years old, he claimed he had leant recipes from beggars — for treating ulcers, carbuncles, scrofula, falls and knocks, and in cases of emergencies. Historical Scripts of the Qing Dynasty – Biography of Zhang Chaokui (清史稿•张朝魁传) records the following: … He was able to cut skin and flesh open with a knife, and get rid of stuck blood from the internal organs, also connect tendons and set bones. When he carried out this operation, onlookers were all shocked, while the patient felt no pain. After the operation, he would apply some medicine externally. At that time, Liu was afflicted by abdominal pain and collapsed. He was in a critical state and nearly died. Chaokui inspected him and said ‘The lesion is in the small and large intestines’. Then he cut into the abdomen about 2 cun and put his fingers in to rectify it. The patient recovered several days later. A magistrate of Chenzhou prefecture once passed Silver Pot Mountain by carriage and fell suddenly from the cliff. His shoulder-bone was broken. Chaokui inserted a knife into the lesion and set it. Then he applied medicine externally. The magistrate recovered and was able to move the arm as usual. It seems Zhang Chaokui’s medical skill in anaesthesia, debridement, bone setting and laparotomy was brilliant, just as if he had been the great doctor Hua Tuo reborn!

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According to the history of military surgery in the ancient China, we can see different doctors at different periods, to a certain extent, made breakthroughs or developments in three critical surgical areas, namely analgesia, haemostasis and infection. However, no theoretical summarization was carried out and there was no formal system. The experiences of operation, analgesia, haemostasis and tackling infection were sporadic and scattered, and fell short of being integrated and inherited as a tradition. Relatively speaking, internal treatment was more systematic and theoretical, and was the guiding therapy. As in the organization of military health, military surgery somewhat lacked theoretical research — which might have led to the chance of making a breakthrough. Hence, it could not become a leading force in the surgical or health system of China.

B.  Medicine in the Heyday of Peace 102.  Peaceful Eras and the Conservation of Medicine After the Spring–Autumn and Warring State periods, there were several relatively stable, peaceful and long-lasting periods in Chinese history, such as the Qin and Han, the Sui and Tang, the Northern Song, Ming and Qing dynasties, which lasted for 441 years, 326 years, 167 years, 276 years and 196 years, respectively. Also, there were many “golden ages” during these times, including the rule of the Wen and Jing Emperors, the rule of the Zhenguan Period, the rule of the Kaiyuan era and the heyday of the Kangxi, Yongzheng and Qianlong Emperors — all of which have been praised by later historians. During these peaceful and prosperous times, people were allowed to live and work in peace and relative contentment, different aspects of society developed, and medicine was no exception. Developments in medicine during these periods mainly reflected the trend of comprehensive summarization — and innovative and creative achievements were rather rare. In other words, the times were characterized by an air of “sluggish conservation” (孱守).2 2

 The term “sluggish conservation” or chanshou was put forward by Mr. Fan Xingzhun. He applied this concept when summarizing the medical features from the Ming Dynasty to the period of the Opium War. See his book An Outline History of Chinese Medicine, p. 196. He held that “the medical history of China was as stagnant as the economy at that time and in a state of sluggish conservation.” I don’t agree with his view, but his term is adopted here to generalize a relatively stable development — with no major breakthroughs or innovations happening during these different periods of peace.

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624  Chapter 12

Dynasty

Medical Book

Eastern The Yellow Emperor’s Inner Classic (黄帝内经) and Shen Nong’s Classic of the Materia Medica (神农 Western 本草经) Han Classic Challenges (难经)

Sui and Tang

Northern Song

Unknown Medical Experts

Collated Formulae and techniques of the 36 schools involving medical classics, classic Formulae, sexual practice, life cultivation and so on

Li Zhuguo, et al.

Treatise on the Causes and Origins, and Manifestations of Various Diseases (诸病源候 论), Categorized Collection of Formulae in the World (四海类聚方)

Cao Yuanfang, et al.

The Grand Simplicity of ‘The Yellow Emperor’s Inner Classic (黄帝内经太素)

Yang Shangshan

Important Formulae Worth a Thousand Gold Pieces (千金要方)

Sun Simiao

Arcane Essentials from the Imperial Library (外台秘要)

Wang Tao

Newly Revised Materia Medica (新修本草)

Su Jing, et al.

A Second Annotation to ‘Plain Questions’ (次注 素问)

Wang Bing

Various proofread and corrected books from the Bureau for Revising Medical Books Books on the Pharmacopoeia of Materia Medica: Taiping Holy Prescriptions For Universal Relief (太平 圣惠方), A Concourse Recording the Royal Benevolence Formula (圣济总录), Beneficial Formulary of the Bureau of Taiping People’s Welfare Pharmacy (太平惠民和剂局方) and so on The Mapped Classic of Bronze Acupuncture Figure Collective monographs from different medical departments

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Compiler/ Proofreader

  Presided by the  over government   Individual medical experts

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(Continued) Dynasty Ming

Qing

Medical Book

Compiler/ Proofreader

The Grand Compendium of Medicine (医学纲目), Lou Ying, Li The Grand Compendium of Materia Medica Shizhen (本草纲目), etc. The Encyclopedia of Ancient and Modern Medical Works (古今医统大全), A Criterion for Pattern Identification and Treatment (证治准绳), etc.

Xu Chunfu, Wang Kentang

The Classified Classic of the Neijing (类经), The Complete Works of [Zhang] Jing-yue (景岳全 书), etc.

Zhang Jingyue

A Comprehensive Medicine According to Master Zhang (张氏医通)

Zhang Lu

The Taiping Imperial Encyclopaedia (太平御览)

Government Compilation

The Golden Mirror of the Medical Ancestors (医宗金鉴)

Wu Qian et al.

A Variorum of Plain Questions (素问) and The Spiritual Pivot (灵枢)

Zhang Zhicong et al.

A Complete Encyclopedia of the Imperial Ji Yun et al. Collection of Books in Four Divisions (四库全书) A Complete Collection of Medical Works within the Grand Compendium of Ancient and Modern Books (古今图书集成医部全录)

Chen Menglei et al.

Sluggish conservation has its own advantages. T. Kuhn, an American historian of science and technology, divided the history of science and technology into the various stages of paradigm, breakthrough and so on. “Sluggish conservation” is actually the consolidating stage of a paradigm state or the conservative and stable stage prior to any scientific revolution. If such a period of sluggish conservation was missing, medicine might be deprived of its spiral of advancement, and innovative and revolutionary attributes might also be lost. As the social environment was peaceful, the government thus had spare force to organize and implement a comprehensive project of classification. Medical experts could also set their minds on writing monographs. The above-mentioned table more or less covers those classified medical books compiled or proofread during these periods of peace.

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Among these largish monographs, about half were compiled under the instruction of the government. As for those written by individuals, they could not have been complete without several decades of endeavour and a peaceful environment. These medical monographs form the cornerstones of the grand mansion of Chinese medicine. They made theoretical succession possible and raised one high point after another. Moreover, they were beneficial to the spread of medical knowledge and the impartment of official teachings between master and apprentice. “Classification” and “conservation” didn’t actually mean collection without theoretical innovation. These various classified monographs developed previous ideas anew. Their theoretical development and recording of new clinical experiences also had a great impact on enlightening medical students and promoting practice and theory among the experts of the time. For example, while recording new explanations of both classic and novel topics, Zhang Jiebin put forward his own personal opinions on many problems — combining his own experience and understanding. He even developed a new school, namely the “school of warming and tonifying”. Being armed with logical theories, he denied that “Yang is always abundant and Yin usually insufficient”. Instead, he proposed that “Yang is not always abundant and Yin not usually insufficient” and that “ministerial fire is the root of the original qi”. He advocated treating Yin deficiency and Yang weakness by warm reinforcement. This is a typical case of supplementing or rectifying previous theories through the work of classification. Medicine during these periods of “sluggish conservation” was not characterized by breakthroughs made in revolutionary times, but development and innovation certainly still existed.

103. Concerning the Books: Treatise on the Causes and Origins, and Manifestations of Various Diseases, Important Prescriptions Worth a Thousand Gold Pieces and Arcane Essentials from the Imperial Library The most renowned monographs created during times of peace were the classified works produced during the Sui and Tang Dynasties, namely the Treatise on the Causes and Origins, and Manifestations of Various Diseases (诸病源候论), Important Prescriptions Worth a Thousand Gold Pieces (千金要方) and A Supplement to ‘Important Formulae Worth a Thousand Gold Pieces’ (千金翼方), and Arcane Essentials from the Imperial Library (外台秘要). They contributed a very great deal to the mainstream development of Chinese medicine.

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Generally, Huangdi’s Inner Classic (黄帝内经) is regarded as laying the foundation for Chinese medical theory and Zhang Zhongjing’s Treatise on Cold Damage and Miscellaneous Diseases (伤寒杂病论) as the initial establishment of a system of pattern identification. Such an idea is surely correct, but their theoretical innovations were not really widely adopted for a considerably long period from the Eastern Han Dynasty to the Wei, Jin, Northern and Southern Dynasties. At that time, the practical use of Huangdi Inner Classic hadn’t solved the difficulties of herbal practice, and the influence of the Treatise on Cold Damage and Miscellaneous Diseases was minor until the Tang dynasty. Masses of clinical practitioners emerged who did not take the theories of the Inner Classic as their major guide — nor did they use the principles of pattern identification identified by Zhang Zhongjing through practice. A great number of formulae books appeared based upon clinical experience and with the purpose of making simple, cheap and practical applications available. However, their theories were so ambiguous they were like a heap of loose sand — and could only be used as “building materials”. Though some had “theories”, they were rough and unsystematic. Exceptions to this were the Treatise on the Causes and Origins, and Manifestations of Various Diseases (诸病源候论), Important Formulae Worth a Thousand Gold Pieces (千金要方) and a Supplement to ‘Important Formulae Worth a Thousand Gold Pieces’ (千金翼方), and Arcane Essentials from the Imperial Library (外台秘要) — these were integrated mansions of Chinese medicine, enjoying grand content, systematic structure and explicit order. Let’s take a look at the Treatise on the Causes and Origins, and Manifestations of Various Diseases (诸病源候论) first. Its contribution lies contained in its 50 volumes, classifying diseases into 67 categories and patterns, listed altogether in 1,739 articles. Thought it hadn’t yet branched out into sections on internal medicine, external medicine, gynaecology, pediatrics and ENT, it managed to amass a relatively dense number of records. Moreover, it applied the concept of Yin–yang totally and other theories from the Inner Classic in order to explain systemically its content and clinical practice — creating a systematized monograph on clinical practice. This was its real contribution. In terms of systematic records, the following categories of disease were discussed: exogenous infectious and febrile diseases, diseases of different body parts or internal organs, particular diseases (such as beriberi and “dispersing the heat created by taking stone powder” disease), external diseases (such as incised wounds, carbuncles and goiter), gynaecological and pediatric diseases, and ENT problems. In terms of each disease, it was analysed in an ordered

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fashion from general characteristics to specific features and the causes and origins of disease. For example, wind disease is subdivided into wind stroke, wind spasm, hemiplegia, wind bi and wind dampness, all of which contain different patterns. For instance, wind stroke has patterns of wind stroke in the lung, wind stroke in the heart, wind stroke in the spleen, wind stroke in the kidney and wind stroke in the liver, each having different symptoms. Key points for identification and prognosis are also provided. Although this kind of classification is not explicitly perceived by modern scholars, it was a great achievement at the time because students were able to get at the wellembedded concepts and clinically apply them to differentiate differing patterns of disease. This book had a direct guiding influence — in its practicality and methodology. It was the outcome of Cao Yuanfang’s summarization of the experience of medical experts during the Wei, Jin and former dynasties, under the guidance of the Inner Classic’s theories. Zhou Xuehai wrote the following in its preface, made for a newly carved woodblock version: There have been numerous wise doctors from the time of the Han Dynasty to the Jin. They were able to study the why’s and wherefore’s of disease according to the great theories of the time, and administrate effective therapy; so most of their treatises can still apply. However, that was a long, long time ago and their sayings have been lost and we can no longer discover them… Therefore, if we want to investigate the statements of these wise doctors before the Sui and Tang, this is the only book available. This comment actually only shows half the significance of Cao’s book. Without it, few medical statements before the Sui Dynasty would have survived and clinical medicine in China would have been unable to develop into such a grand system. However, a defect in the book is that throughout it only describes causes and origins and no formulae (except those for the lifecultivating methods of Daoyin). However, this defect is compensated by Important Formulae Worth a Thousand Gold Pieces and Supplement to ‘Important Formulae Worth a Thousand Gold Pieces’ written by Sun Simiao during the Tang Dynasty, which had both theories and formulae. Hence, in terms of its contribution to classifying previous medical statements and the grand system of Chinese medicine, this book is superior to the Cao’s Treatise. People generally think Cao’s book had an influence on Sun’s, but by reading them carefully, we cannot find many similarities between them. Sun Simiao might never have read the Treatise on the Causes and Origins, and Manifestations of Various Diseases, because he never mentions Cao

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Yuanfang, or his book, when he lists previous medical experts. All his cited medical theories or methods of diagnosis came from other books of the Wei and Jin dynasties. Moreover, his writing style is unique and quite different from Cao’s. Medical divisions are more significant, highlighting diseases of gynaecology, pediatrics and even the seven orifices. Dietary therapy, the cultivation of temperament and secret recipes were also stressed. His collection was carefully selected by him, more holistic and all-embracing — without being disordered. It contains more than 6,500 formulae, including those from foreign countries, folklore and empirical cases. Xu Dachun in the Qing Dynasty wrote in his Treatise on the Origin and Development of Medicine (医学源流论) as follows: Zhongjing’s medical doctrine was transformed during the Tang. When he talked about treating disease and the viscera, channels and disease transmission during treatment, Zhongjing’s statements were based on the Inner Classic. All the formulae he applies are classical prescriptions ‘handed down by the ancient sages’ and not created himself, privately… each formula has no more than 5 to 6 ingredients, but their efficacy is always good. This medicine is the essential mechanism of the heaven and earth, the ingenious usage of the sages and immortal. The Important Formulae Worth a Thousand Gold Pieces, however, is not the same. In this book, though the statements about treatment are still, as yet based on the Inner Classic, they are also mixed with conjectural suppositions made by later generations; and though the formulae are adopted from ancient times, some of them are biased towards and mixed with folk-formulae; the medicinals are not all listed in Shen Nong’s Classic of the Materia Medica (神农本草经), and there are others from sources in common use. Hence, there are cases where several formulae are prescribed for one disease, and one formula could be administrated for several different diseases. The number of ingredients in any single formula may reach as many as a dozen or more. Surely, many of them are effective, but formulae which lack of efficacy are also not rare. Therefore, treatment is sometimes effective and sometimes ineffective. Generally, the focus is on medicinals. As a consequence, methods of prescribing formulae given by the ancient sages have been lost. This is a drastic turn of events in medical practice. However in spite of the above, this book has its own special style that is still indelible on the mind — because it has a uniqueness in its ingenious and exquisite application of medical practice.

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Dachun sighed over the fact that “methods of prescribing formulae given by the ancient sages have been lost.” Actually, Simiao’s extensive collection of medicinal formulae was a development of the “methods of established formulae given by the ancient sages” — and had not been lost. He made a great contribution to preserving the ideas of the Inner Classic; he was an advocator of Zhang Zhongjing’s ideas and spread the theory of treatment based on pattern differentiation from the Treatise on Cold Damage. We can often find therapies from Important Formulae Worth a Thousand Gold Pieces being used for treating strange and difficult cases even today. This is truly a book that “collected the medical achievements before the Tang and established the medical trends which came after the Tang.” As for the treatise on Arcane Essentials from the Imperial Library (外台 秘要), it was written by Wang Tao and completed in 752 CE. He wrote the following in his preface: Since the works compiled by those ancient medical experts such as Leigong, Qibo, Canggong and Yihuan, and since the rise of ancient doctors such as Wupeng, Bianque, Huatao and Zhang Zhongjing, thousands of years have fled away — with the emergence of numerous kind and wise, medical practitioners and more than ten-thousand volumes of formulaic books which exceed the capacity of a large cart or mansion. However, those records are from times long gone and many of the bamboo slips used for recording them have become fragmentary. Their detailed records cover a wide range, while concise statements often have meanings which are profound. To straighten up these slips needs twice the effort and trouble, and it is extremely hard work to think up which should be selected and which omitted, making me sometimes happy and sometimes pained inside. I am always talking about emending and compiling these medical classics — that need to be polished up and improved more and more, and I never have time to rest. I was susceptible to illness while I was still a child, and in favor of medicine when I grew up. I was fortunate to live in an era of political rigour and able to have a successful official career. I once served in Nanggong Administration seven times, Dongye Administration twice, and worked in these administrative jobs for more than twenty years. So I had the charge of Hongwen Library and its collection of books and files for many years. The result was I could investigate the profound mysteries of medicine and understand medical knowledge, to a high degree of proficiency.

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Later, due to a marriage problem, I was degraded to the post of prefectural governor in Fangling and moved to Daning shire. At that time, I had to preserve and retain the river bank under the intense heat of summer. South and North there lay many remote and infertile areas. Six or seven out of ten people were afflicted by contagious, and other diseases. Their life and death were dependent only on heaven. Luckily some of them were saved by taking advantage of classical medical formulae. It was like having a magical skill — due to their superb effect — it is difficult to describe it here in detail. Therefore, I made a firm determination to emendate and compile these medical matters, hoping that perhaps they could make a small contribution. Altogether I collated ancient formulae from fifty or sixty medical experts, and made a collection of new works that had presently-used formulae from thousands of other volumes. The gist of this study and purpose of these books was finally verified. In modern times, dozens of medical experts have compiled medical books for later generations, such as Shi Sengshen (a Buddhist), Cui Shanshu (a famous minister), Sun Chushi (the recluse), Zhang Wenzhong, Meng Tongzhou, Xu Renze, and Wu Sheng, etc. — more than a dozen of whom are current in the contemporary era and been edited. Their writings of course are glorious, but not perfect. Why? Because all of them display their own style arbitrarily and make contradictory remarks. Moreover, some of the chapters and titles have been mixed up and repeat themselves, and some are tedious and disarrayed. Now, I have tried to compile them so as to bring out the very core of them, pick out the best and key points. I engaged in this day and night, discarding the dross and selecting the very essence. All these factors I considered repeatedly, again and again, over many years. I searched through the large amount of data I had in stock and gathered together any fragmentary records which had been lost — and verified the profound and intricate written words from the periods of Shennong and Fuxi in order to present them to the Tang. I’ve tried my very best and have no qualms now about my work. The remarks made in his preface are generally true. Wang Tao was competent enough to be titled a “Master of Medical Literature”; he was not a practicing doctor, but he compiled the book Arcane Essentials from the Imperial Library (外台秘要), which is perceived as a comprehensive collection

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of ancient medical literature made during the Tang Dynasty. Its method of classification derived from that of Cao Yuanfang, while the formulae recorded in the book came mainly from the two volumes of Important Formulae Worth a Thousand Gold Pieces (千金方), adopting the strong merits of each. It also collected together contents from other medical experts, which made the book rich in content. Xu Dachun comments in his Treatise on the Origin and Development of Medicine (医学源流论), The book Arcane Essentials from the Imperial Library compiled by Wang Tao in the Tang Dynasty contains prescriptions collected since the Han times and is a great reservoir of formulae used during successive dynasties. However, he was not a medical practitioner himself, so unable to have any particular criterion for examination, revision and selection. It is therefore a kind of reference book of medical formulae. Certainly it made a contribution — as many formulae before the Tang Dynasty depend on it for their survival. However, when reading it, if someone did not know for certain that it contained various opinions and muddled formulae they would become confused and further ignorant. It seems Dachun is just making a mediocre comment on this book. Actually, Wang Tao not only collected medical Formulae but his way of compilation, classification and selection was also acutely followed and adopted by medical experts in later times. If he had put too many of his own ideas into it, the book would be one-sided, depriving it of being such a monumental work. The above three great monographs made in the Sui and Tang dynasties were comprehensive, establishing a properly integrated system of clinical practice in China, which later generations simply had to follow and enrich.

104. Compilations, Compendia, Medical Cases and Rudimentary Verses Though books like the Taiping Holy Prescriptions for Universal Relief (太 平圣惠方) and Concourses Recording Royal Benevolence Formula (圣济 总录) were great classified books produced during the Song Dynasty, they actually follow the same stylistic rules and layout as Arcane Essentials from the Imperial Library (外台秘要). To be part of and complement the medical system, more compendia and pandects emerged during the Ming and Qing

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dynasties. Works comprising essential collections and rudimentary verses also came into being — as time demanded. In addition, compilations of medical cases appeared to testify to the truth of medical theory. This is a picture of the heyday of Chinese medicine, with its functional reference books, standard textbooks and books instructing one in universal medical education. The Grand Compendium of Materia Medica (本草纲目) written by Li Shizhen in the Ming Dynasty is well known. Even Darwin was enlightened by it and called it “The Chinese encyclopedia of 1596”. This book reached new heights in the number of listings of medicines and in its taxonomy. Its taxonomy was the clearest before the Linnaean became the international standard. In this book, just like when the head rope of a fishing net is pulled up, all its meshes open, so the taxonomy of class (gang 纲) and order (mu 目) was applied — with the names of each medicine listed as class, and its detailed records creating the order as follows: in short “order is listed under class. There are altogether sixteen classes and sixty orders to show clearly the general classification”; “each medicinal has a generic term, which is called its ‘formal larger class’. Its taste and indication is recorded and termed its ‘formal smaller class’. Annotation and detailed explanation for each medicinal is given, just to illustrate its order”; “each animal is listed as class, while its tooth, horn, bone, brain, fetus and saliva are as its order; grain is listed as class, while red and yellow grains are the order.” We can see here that the taxonomy of class and order did not proceed in a single straight line and was not just a simple tier. The terms “class and order” were not invented by medical experts but originated from the Compendium of Reflections in General (通鉴纲目). At that time, Zhu Xi and his disciples such as Zhao Shiyuan compiled the book Compendium of Reflections in General based on Si Maguang’s Historical Events and Reflections in General as a Mirror for Ruling (资治通鉴) and Key Points to Reflect On (举要历), Hu Guoan’s Supplements to Key Points in Reflections in General (举要补遗) and so on. This book took “class” as the key, just as the Han writing in the Spring and Autumn Annals (春秋) had, and “order” to illustrate its contents, just like the previous Commentary of Zuo (左传). It applied the writing methods of “identifying a person’s status to justify guides and virtues” in order to advocate Confucian cardinal guides and constant virtues, and later even evolved into the Chinese “annalistic style”, the so-called “class-order style”. Books such as A Continuation of Reflections in General (通鉴续编) written by Chen Cheng during the Yuan dynasty also follow this style. Large characters were used to identify

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key points such as class, and small characters to narrate the order, with the class mentioned in each narrative as well, as a convenience when looking anything up. The formation of “class-order style” went in step with the social stability of the times, a well-organized governmental structure, just like the Confucian system of “monarch orders official, father orders son and husband orders wife”. The first medical expert to apply this style was Lou Ying (1320–1389 CE) during the Ming Dynasty. He compiled A Compendium of Medicine (医学纲目), which made medical theory and clinical practice more systematic. Later, Li Shizhen compiled his Grand Compendium of Materia Medica (本草纲目) with its numerous medicinals. It was compiled in 1578, about 200 years after A Compendium of Medicine. Wang Shizhen (1526–1590 CE), a great litterateur, wrote in its preface as follows: By opening this book and reading it carefully, I noticed immediately its distinct writing style: the formal name of each medicinal listed as ‘class’ and notes to it listed as ‘order’. Then collective annotations, identifications of doubts and corrected errors are written in the same area and shaped in detail. Following this, the medicinal odor, taste, main cures and indications and attached formulae are recorded to show its clinical use. From the classics of ancient times to the age of legend, all is adopted. It is like entering a country of golden grain, filled with shining categories and colors; like visiting a dragon’s palace, storing all kinds of treasures; like an ice-holding jaden kettle or bright jaden mirror, showing everything clearly, even to a single hair. The writings are extensive but not tedious to read, detailed but make a few key points, truly comprehensive and so profound they allow the reader to directly perceive through his own senses a great ocean. You can recognize it not only as a medical book, but actually also an exquisite composition. It shows the mind and nature of neoConfucianism, a general classic in the investigation and research into things, the secret principles of the Emperors, the great treasures of the officials and common people. Mr. Li has been such a diligent fellow — to do this so kindly for the benefit of others! Wang Shizhen points out that The Grand Compendium of Materia Medica was a Confucian work and an achievement that affected all medicine and illustrated the features of the “class-order style”. Actually, works with names such as Pandect (全书), Comprehensive Record (总录), Golden

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Mirror (金鉴), Precious Mirror (宝鉴), Standards (准绳) and Complete Medical Works (医统) all show a class-order style. This style of book served to modify and consolidate the Chinese medical system. Another kind of book, that had the function of fulfilling and complementing this system, was the casebook. Chun Yuyi wrote a Diagnostic Book (诊籍), and later medical experts included individual cases, while in the Ming and Qing dynasties, a large number of medical casebooks appeared, such as Jiang Guan’s Classified Case-Records of Famous Physicians (名医类案) in 1549, Wei Zhixiu’s Supplement to ‘Classified Case-Records of Famous Physicians’ (续名医类案) in 1770, Yu Chang’s Implied Meaning of Herbs (寓意草) in 1643, Ye Gui’s Case-Records as a Guide to Clinical Practice (临证指南医案) in 1764, Yu Zhen’s Comments on Ancient and Modern Case-Records (古今医案按) in 1778 and Liu Baoyi’s Liu’s Selected Case-Records of Four Physicians (柳选 四家医案). These medical cases amassed a lot of new experiences, supplementary to medical theory and indicated a developmental trend in clinical medicine. Ye Tianshi’s medical cases had just such a function. The real development of medicine now relied on clinicians rather than documental philologists. Books of medical cases could be regarded as “clinical literature” in their own right and find their own unique significance. After the formation of a comprehensive system of medicine, education and popularization became inexorable trends. Especially during the late Ming dynasty, a tide of introductory books — one aspect of medical popularization — came into being. For instance, Li Chan’s Induction to Medicine (医学 入门) states in 1575, “This book searches out formulae and their discussion, by ancients and moderns. The vital points of each doctrine along with ‘concise phrases’ are put in, and hidden meanings explored through the form of annotations, the whole edited classically.” “Medical pupils can thus find access to medicine through the inner and outer gates, and get the general idea — and so are able to practice without prescribing by mistake or treating patients incorrectly — which could result in a death. So, I entitled this book as Induction to Medicine.” Li Zhongzi’s Required Must-to-Reads from the Medical Ancestors (医宗必读) was written in 1637, and states, “Mediocre medical books are not worth reading, shallow ones fail to illustrate points clearly, those over-simplified always miss something, and complex ones are hard to understand. I have studied medicine with my heart for more than 30 years and begin to understand the changing circumstances. However, beginners are troubled by a lack of appropriate books… Thus, I compiled this book and entitled it Required Must-to-Reads for the guide of others.” Xiao Jing commented in A Treatise on Xuanyuan and Qibo’s Remedies (轩歧救正论) that “The book Required

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Must-to-Reads from the Medical Ancestors is in only 5 volumes, but the words are concise and clear, the remedies refined and detailed. It could be regarded as a standard textbook nowadays.” Li Zhongzi also wrote some other introductory books such as An Essential Knowledge of the ‘Inner Classic’ (内经知 要) and Master Lei’s Discourse on Medicinal Processing and the Properties of Medicines (雷公炮炙药性解). During the Qing Dynasty, the most typical books popularizing medicine were the Three-Character Classic of Medicine (医学三字经) written in 1804 and Versified Prescriptions (汤头歌诀) in 1694, among others. The author of the Three-Character Classic of Medicine was Chen Xiuyuan (1756–1823), who once passed the provincial imperial exam, became a county magistrate and then resigned from his official post in 1819 to give lectures at Songshan’s Cottage School (嵩山草堂). He also wrote 16 other books, such as Reading Shen Nong’s Classic of the Materia Medica (神农本草经读), Ingenious Uses of Timely-Formulae (时方妙用), Summary Verses for ‘Ingenious Uses of TimelyFormulae’ (时方妙用歌括), Easy Access to Medicine (医学实在易), A Simple Annotation to the ‘Treatise on Cold Damage’ (伤寒论浅注) and Summary Verses of Formulae from the ‘Treatise on Cold Damage’ (长沙方歌括), all of which were easy to read, remember and understand, and served as fundamental books for beginners. The Three-Character Classic of Medicine, written in the form of the Confucian Three-Character Classic (三字经), was the easiest for beginners to accept. He wrote in the preface that “when children enter private school, the teacher uses the Three-Character Classic to teach them Confucian doctrines first, because it is easy to read and understand. As beginners learning medicine, we have no books set for learning. They are any number of books, many, many like a vast sea. If we misunderstand their words, we will be at a loss and walk into places full of monsters and demons. This is why I wrote this book The Three-Character Classic of Medicine.” For such reasons, the book is precise and clear, and it is easy to chant and remember. For example, in the first chapter on “Sources of Medicine”, he writes the following: The originators of medicine were Qibo and Huangdi; The Spiritual Pivot and Plain Questions were written; Yet the Classic Challenges is imposingly done. The End of the Han, there was Zhang Zhongjing, He identified Six Meridians, And demonstrated his Saintly Theories; Cold Damage and Golden Chamber were written, Their Methods and Principle imparted…

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As another example, in “the 11th Chapter on Edema”, he writes the following: Edema can be both Yin and Yang: Urine clear and profuse is uncontrolled Yin water; Urine scantily produced means Yang damaged. The Five Peel Decoction, Was invented by Hua Tuo… Wang Ang’s Versified Prescriptions (汤头歌诀) was a predecessor to Chen’s work. In his book, Verses are not limited to Formulae, and Formulae are not limited to sentences; the main ingredients and those guiding them are all clearly included. Therapy for disease is relatively briefly mentioned. Sometimes one formula is linked to many others, omitting verses for the sake of simplicity. It also shows how the ancients understood by analogy and lets the reader make his own mind up.” For example, the verses of “Dayua’s Decoction for the Beginning of the Plague” are as follows: The Dayuan Decoction contains hou po and chang shan, Accompanied by cao guo and bing lang, Together they can clear up phlegm; Also plus huang qian and zhi mu, Chang pu and gan cao should be not neglected. In another example, there are also verses for the “Yinchenhao Decoction for Jaundice” as follows: Yinchenhao Decoction is for jaundice, But Yin or Yang, cold or heat must be carefully identified. Use da huang and zhi zi for Yang jaundice, And fu zi with gan jiang for Yin jaundice. Also as an alternative, apply Zhangjing’s Bopi Zhizi Decoction. Wang Ang, from Xiuning, Anhui province, and a Confucian, abandoned the imperial examinations aged more than thirty and began to immerse himself in studying medicine. We can see that only those with a basic knowledge of Confucianism could write versified Formulae in such a concise and clear form. Works of medical discourse require clinical experience, belonging to the category of the “empirical voice” — and are supplementary to medical practice. Works such as Lu Yitian’s Medical Discourses made from a Cold Shack (冷庐医话), Wang Shixiong’s Qian-zhai’s Medical Discourse made in

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a Solitary Home (潜斋医话) and Wei Zhixiu’s Liu-zhou’s Discourse on Medicine (柳州医话) all fall into this category. Through these books, they taught and guided others untiringly with sincere speech and earnest wishes, through their elegant and witty conversation. They helped learners with basic knowledge of medicine go further and perceive its more profound aspects. Though written in a light manner and seemingly to be read at one’s leisure, they were also beneficial to medical education. As a result, medical practitioners spread unchecked among the people of the Ming and Qing dynasties. Taking advantage of these introductory books, they got involved in the medical field as soon as they could recognize Chinese characters. We shouldn’t blame this on these books — it also had a connection to the peace of the times, and extensive reading of such literature. No wonder Xu Dachun was critical in his Treatise on the Origins and Development of Medicine — On how the Desultory Reading of Medical Books Harms People (医学源流论 — 涉猎医书误人论): Three out of ten patients died due to their practitioners; three out of ten patients died due to themselves; and three out of ten patients died due to the laymen’s desultory reading of medical books… Laymen try to treat people when they have only a smattering of knowledge. They may succeed in simple and mild cases. But when it comes to those serious and complicated, they also apply medicine absurdly guided on by their one-sided opinions. If a mistake occurs, life or death show instantly… There are still yet men of literature and writing, wealth and prestige, who have made some good progress in these arts. They sometimes read books of formulae and consider themselves always in the right, because of all they have learned. Others trust them greatly as they have knowledge and prestige in the usual way… They follow their bigoted course and are self-assured by the superior quality of their productions… yet they write medical books expounding their own opinions and leave a legacy of troubles to later generations. There are numerous people like this. Alas, all the medical doctors of old learned from masters… However, present practitioners hardly read a single qualified book and are lacking in skill. So it means those who don’t learn from masters but from their own desultory reading of such books have the advantage over real doctors. Patients look down upon real doctors and believe in the desultory reading of some laymen. Hence, they commonly harm people. The core reason for this calamity lies in the lack of medical

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mastery — which means everyone has a hand in manipulating medicine, right or wrong. These phrases show that during these times there was a massive introductory movement of books and indeed the popularization of medicine created some problems. Xu Dachun even said as much in his chapter “On Not Everybody Being Able to Learn Medicine and It Having Its Own Source”: “Doctors at present are so pathetic, they just practice medicine to earn a living… Hence, in earning a living, they just need to remember a few formulae in order to treat all diseases of the world rather than pursue other therapies. Misfortune results in just such a manner.” This statement could be regarded as the exact opposite to the true Confucian saying “no son should be ignorant of medicine”. Things always turn to the opposite, in extreme conditions.

C. The Relationship Between Population Statistics, Natural Ecology and Diseases in History We have seen social ecology’s influence on the medical aspects of China during times of war and peace. Since humans have become socialized, almost all elements relating to natural ecology have become socialized as well. But for the convenience of discussion, we now select the more natural traits in the ecological environment — such as climate, geography and population growth. Hopefully, this will not prevent us from understanding that the human ecosystem is a socialized entity and that medicine developed under the influence of just such a system.

105.  Geography and Diseases of the Five Directions The ancient Chinese people recognized the influence of natural ecology on the human body and disease very early on — and indeed had special theories describing its true aspects, namely the “diseases of the five directions” and the “five circuits and six qi which cause disease”. The Plain Questions – A Discussion on Different Therapeutic Methods Suitable for Different Diseases (素问·异法方宜论) states, The region of the east is the area where heaven and earth start life. It is near the sea and rich in fish and salt. People there prefer eating fish and salty tastes. They live in satisfaction and enjoy rich delicacies. But excessive fish as food tends to accumulate heat in the body

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and excessive salty flavors are likely to impair the blood. That is why people there look black on the skin and are slack between the muscles. They frequently suffer from carbuncles and ulcers that can best be cured by bianshi (砭石 stone-needle). Hence, it is certain that therapy with stone-needles originated from the east. The west, rich in metal, jade, sand and stone, is where heaven and earth contract and pull things in together. People there live by hillsides where the wind is always blowing. The water and soil in the west are indomitable in nature. People there do not wear normal clothing but coarse fabric made of animal-hair, flax and grasses. They eat fresh and rich foods. So they are fat and strong. That is why pathogenic factors cannot attack the body. Their illness is usually endogenous and can be treated by strong herbal drugs. Hence, it is certain that treatment with herbal medicines originated in the west.” The north is the region where heaven and earth conclude and store up. Inhabitants live there in high places and it is very cold, and icy. They happily wile away their time in the wilderness, drink milk and eat milk products. So they easily store cold in the inner organs and as such suffer abdominal fullness and flatulence. Such an illness can be treated by moxibustion. Hence, it is certain that moxibustion originated in the North. The south is the region where heaven and earth bestow growth and nourishment; it is the place where Yang is present in abundance. But its land lies low; the water and soil are barren. There are often fog and dew gathered together. People living in the south prefer sour flavors and fermented food. That is why their skin is compact and reddish. They tend to suffer from contractions and cramps which can be cured by acupuncture with small needles. Hence, it is certain that the nine kinds of needles originated in the south. The central region, level and humid, is the place rich in a variety of products. People living in the central region eat various kinds of food and do not need to do much work. Therefore, most of their diseases are similar to muscular flaccidity or wilting, and coldness of the extremities; but also cold-heat syndrome, which can be treated by daoyin (breathing exercise) and anqiao (tuina or massage). Hence, it is certain that daoyin and anqiao originated in the central region. The sages made use of various therapeutic methods and select that most appropriate for the pathological condition of the patient.

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The reason why different methods can cure the same disease is that the doctor fully understands the condition — thus grasping the essential principle of treatment. This record shows the influence of geographical environment, dietary habits and physical labour on the human physique and the onset of disease. Though it was not totally correct, it is the first time humans had observed and recorded these results, and was generally accurate at the time. These factors thus affected the development of Chinese medicine, through perpetuating an understanding of individual and local characteristics. Geographical conditions can actually influence the occurrence of illness. The Commentary of Zuo – 15th Year of Duke Xuan of Qi (左传·宣公十 五年) states, “As the proverb says: People should be in mind of the topography, high or low. Lakes and rivers can gather dirt, mountains could hide illness…” This shows how mountains and rivers have an influence on disease. Minister Lu’s Spring and Autumn Annals – For Longevity (吕氏春秋· 尽数) states, “People living near ‘light’ water (water with a lack of minerals) tend to suffer baldness and goiter; people living near ‘heavy’ water (water rich in minerals) tend to suffer from foot swellings and claudication; people living near soft and pleasant water are usually fit and beautiful; people living near pungent water tend to suffer from ulcers and carbuncles; people living near bitter water tend to suffer skeletal deformation and hunched backs.” Dadai’s Book of Rites – Theory of Changes for Life (大戴礼·易本命) states the following: “People living on hard land are fat; people living on soft and loose land are big; people living on sandy land have slimy skin; people living on pleasant land are beautiful; and people on infertile land are ugly”; “animals which swallow water are good at swimming and tolerant of cold; animals which swallow what lies on the earth have no heart and move constantly; animals eating what lies in vegetation have great strength and are easily stroked; animals eating grass are good at running but foolish…” Trivial Records (琐碎录) also states, “People living in mountainous places tend to have male babies; in the marsh they tend to have female babies; in watery places they tend to suffer aphonia; in windy areas they have a tendency to deafness; in woody places they tend to suffer a hunchback; in stony areas they tend to have more strength; in treacherous places they tend to suffer goiter; in places with summer-heat they tend to be disabled; in an area with much cloud they tend to live long; in areas rich in cereals they tend to suffer bi-syndrome (numbness and pain); in undulating places they tend to be narrow-minded; in fertile places they tend to be benevolent; in hilly places

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they tend to be greedy…” Some of these statements are surely absurd or the result of the lasting influence of “mystical mutual permeation”,3 but they reflect factors of ecology and food preferences having an influence on the bodily constitution and different degrees and aspects of disease. From a modern prospective, certain endemic diseases are often caused by certain geographical environments, ecological conditions or the intake of trace elements, which verifies the observation of ancient peoples. For example, in some areas of southwest China, people suffered from natural fluorosis and lots of them were bald. Keshan disease was common in some areas of northeast China, which was probably related to a lack of rare-earth elements like germanium, so there were many cases of swelling or lameness. Endemic goiter was prevalent in the region of Shaaanxi, Ganshu and the Sichuan mountains, relating to a lack of iodine and other trace elements. A Sketch of Formulae (小品方) states, “Barbarians in Chang’an and Xiangyang like drinking water in sandy areas and tend to suffer goiter, which is like a rootless nodule floating under the skin. Women in that area also easily suffer.” Ji Kang’s On Human Wellbeing (养生论) states, “People living in Shanxi, their teeth become yellow”. This is endemic dental fluorosis. This kind of tooth condition can even be found in fossils of ancient human beings in Xujiayao and Yanggao city, Shanxi province. Moreover, there were some local epidemic diseases. For instance, people in the network of rivulets south of the Yangtze River tended to suffer schistosomiasis; south of the Five Ridges, malaria; in China’s South-East coastal areas, filariasis; and in Shandong province, black fever (kaka-azar). The Cantonese like having porridge with raw fish, so they are susceptible to clonorchiasis. People in Shaoxing city in Zheijiang Provence like having their wine-preserved crab without it being cooked, so they tend to suffer paragonimiasis. People living in regions of rivers and lakes like having raw water nuts, so they tend to be afflicted with fasciolopsiasis. These are examples of diseases associated with food intake. In Supplement to ‘Important Formulae Worth a Thousand Gold Pieces’ (千金翼方), Sun Simiao recorded under “selection of place” that the living environment should “face water, with hills at the back, have clear and refreshing air, fertile soil, and a limpid and sweet spring.” This is a particular case of ecological micromanagement. Even geomancy had a take on factors beneficial to health. “Genuine regional medicinals” are also emphasized in Chinese medicine. For example, the Supplement to ‘Important Formulae Worth a Thousand 3

 See Ch. 2.

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Gold Pieces’ specially listed “Key Records of Medicinals”, in which places producing the best medicines are listed clearly. It holds, “those products of other places are not good enough to be given as tribute to the Emperor, so I will not take the time to record them.” The prime time to pick herbs is also recorded, “the earthly qi is not the same at different times, and the order of nature moves on.” These show a recognition of natural ecology and its influence on medicinal actions. It is traditionally believed that the theories and formulae put forward by medical doctors of those times were also related to local conditions and people’s physique. For example, Zhu Danxi’s Yin-nourishing therapy is associated with the geography and climate of regions south of the Yangtze River. Yu Genchu (1734–1799) wrote in a Popular Guide to the ‘Treatise on Cold Damage’ (通俗伤寒论) that “Zhejiang province is generally damp, so cold damage usually combines with pathogenic damp.” “Hunan is high and very dry, so cold damage is most susceptible to transform into dryness.” Even nowadays, doctors in northern China are in favour of applying drastic ingredients like gypsum and aconite root, which doctors in the south refrain from. What’s more, a Supplement to the Statement of Medicine (续医说) records, “Natural conditions are different around the world. For example, in northwest China, there are numerous mountains and the soils are thick. People commonly take sufficient millet, wheat, sorghum and meat, so they are generally strong but tend to suffer from wind bi-syndrome. In southeast China, the soil layer is thin and the waters run deep. They commonly have rice, fish and shrimps, so their physique is weak and tends to disorders in the spleen and stomach. If you can be clear about this before administrating medicine, you are then almost qualified to be a doctor.” In such a manner, geographical ecology had an indirect influence on the theories of medical experts and clinical practice. However, we should not rigidly overstress the importance of geographical medicine. In terms of this, Xu Dachun had a brilliant insight. His Treatise on the Origin and Development of Medicine – Discussion on Different Therapeutic Methods for Diseases in Different Areas (医学源流论·五方异治论) states the following: The human body comes into being through natural qi, so bodily qi varies in different areas. People of the northwest have deep and heavy qi. When they are afflicted by wind-cold, the pathogens are difficult to expel, so they should be treated by drastic evacuative herbs. People of the southeast have floating and light qi. When they suffer from wind-cold, the pathogens are easy to expel, so they should be treated by mild evacuative herbs. In addition, the northwest region is cold, so

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warm and hot herbs should be usually applied. However, if pathogens hide in the middle, interior heat can become intense, so instead it is better to use pungent cold medicinals. The southeast region is warm, so cool herbs should be used. However, if qi dissipates with the dispersion of pathogens, a Yang collapse easily happens, so it should be treated with pungent warm medicinals. On the border of Guangdong, Guangxi and Jiaozhou provinces (the northern and central Vietnam area), people sweat a lot, so they easily suffer from Yang collapse and aconite root and cassia twig should be commonly prescribed. As for the damp, low-lying lands in the central plains or the dry, highlands of Shanxi and Shaanxi, it is the same — treatment should be applied according to local conditions. Hence, doctors entering another region must have a clear understanding of the natural environment, climate and customs of that place. These factors are different not only in varying states, but even within one county. What’s more, the produce and water of the springs in any one area may also contribute to differing diseases. Therefore, these factors must be studied and investigated in detail. Local doctors have their own extremely effective formulae. If some non-native doctors come in and act self-assured and stubbornly hold to their own ideas, the treatment will be ineffective, and they will be laughed at out loud, by the locals! Dachun’s statement can be regarded as partly connected to Qibo’s words in the Spiritual Pivot – Records of Imparting (灵枢·师传): “Ask for the customs when you enter a country, for taboos when enter another’s home, for the rites when meeting others in their room, and for their habits when treating a patient.” Thus, gradually the recognition of the impact of geographical environment on disease and medicine generally became more thorough.

106.  The Theory of the Five Circuits and Six Qi The theory of “wuyun-liuqi” (五运六气 five-fold circuit or movement, or six changes of qi) is also one that may be applied to the causes of disease and its treatment. The theory of “yun–qi” （运气 circuit or changes of qi）originates from seven chapters and broad treatises which were added by Wang Bing to the Inner Classic (内经) in the Tang Dynasty. The “five-fold circuit or

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movement” refers to the movement of wood, fire, earth, metal and water which are five-fold in phase order, while the “six qi in change” mean wind, heat, damp, fire, dry and cold in combination with the three Yin and three Yang of the time base. They are matched with the Heavenly Stems and Earthly Branches, respectively forming the “transforming circuit of the ten stems” and “transforming qi of the twelve branches”, and are closely related to astronomy, geography, meteorology and climate. Together they construct a meticulous and miraculous theoretical system able to explain both the occurrence of disease and its treatment. It is impossible to outline clearly the theory of the five circuits and six qi here. We can even say there is not one person who has ever truly mastered it — or been able to illustrate it comprehensively, totally and accurately. It is advisable to refer to Prof. Ren Yingqiu’s book on this matter.4 The theory can either be regarded as “meteorological”, or more correctly, “ecological” medicine. That this theory was critically important was recognized by Gui Yuqu’s in his Plain Questions – A Major Discussion on the Law of Motion and Change in Natural Heaven and Earth (素问·天元纪大论): The five-fold circuit or movement of Yin and Yang is the great and basic law of heaven and earth, the fundamental principle of all things, the parent of change, the beginning of life and death and the storehouse of spiritual activities. One must be aware of these tenets. When a being comes into life, this is called ‘transformation’. When a being reaches the extreme point in its development, this is called ‘change’. Undetectable changes of Yin and Yang are called shen (subtle changes, spirit) and those who can master and control such shen (subtle changes) everywhere are called sages.5 The contents of five-fold circuit or movement and six changes of qi theory are very complex. Concepts such as “dominant circuits”, “guest circuits”, “starting five movements”, “guiding five movements”, “celestial control”, “terrestrial effect”, “celestial correspondence”, “convergent year”, etc. all belong to 4

 Ren Yingqiu, The Theory of Five Circuits and Six Qi, Shanghai Science and Technology Press, 1982. 5  Please note here the translation of shen (神) and sheng (圣) – where shen is a kind subtle change. It is not as in the later common translation “god”. In same way, sheng (圣) did not mean a “saints or sages” but those having an ability to control shen , a kind of application.

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the “image-number theory”6 of ancient China. This was a medical theory evolved from astronomical and meteorological observation — together with mathematical calculation. The zĭ wŭ liú zhù (the ebb and flow of midnight and midday (子午流注)) mentioned in my Chapter 15 can be regarded as another aspect of the system. Its core idea lies in how changes in the natural and ecological environment, such as those observed in astronomy, meteorology and climate, contribute to disease — and how doctors should recognize and utilize their rules to prevent and treat disease. The basic principles of this theoretical system are consistent with other chapters in the Huangdi’s Inner Classic, but its concrete illustration of ecological change and influence is unique. This was decidedly a development of the base relationship between solar terms and diseases as recorded in the Records of the Rites – Climate and Phenology7 in the Lunar Month (月令). We state one passage here: The Plain Questions – A Discussion on the Most Important and Abstruse Theory (素问·至真要大论) states the following: “Huangdi asked, ‘Does the movement of the overcoming qi and retaliating qi follow a certain time? Does the qi abide by any rules when it comes?’ Qibo answered, ‘The timing of the four seasons has definite phases, but the movement of the overcoming and retaliating qi is not certain.’ Huangdi asked, ‘I’d like to know the reason.’ Qibo answered, ‘The period from the initial stage of qi to the third stage of qi is dominated by heavenly qi and is the time when the overcoming qi is often seen. The period from the fourth stage of the qi to the terminal stage of qi is dominated by earthly qi and is the time when the retaliating qi is often seen. If the overcoming qi emerges, the retaliating qi certainly follows; if the overcoming qi does not appear, the retaliating qi never shows up.’ Huangdi said, ‘Good! Sometimes when the retaliating qi has already receded does the overcoming qi emerge again?’ Qibo answered, ‘When the overcoming qi emerges, the retaliating qi certainly follows. Such a cycle continues without any definite rules, until the decline of qi. If the retaliating qi does not appear when the overcoming qi has already emerged, calamity will be caused and the body impaired.’ Huangdi asked, ‘Why does the retaliating qi cause disease?’ Qibo answered, ‘Because the retaliating qi does not come at the due time and host qi and guest qi do not respond to each other. When the retaliating qi is superabundant, the overcoming qi has to subdue it. That is why disease is caused. 6

 See earlier Ch. 6.  “Phenology” — the study of cyclic (seasonal) natural phenomena.

7

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This is the period when the so-called ‘fire, dryness and heat’ predominate.’ Huangdi asked, ‘How do we treat it?’ Qibo answered, ‘The disease caused by an overcoming qi can be treated by ‘conforming therapy’ if it is mild; and ‘inhibiting therapy’ if it is severe. The disease caused by a retaliating qi can be treated by ‘balancing therapy’ if it is moderate; and ‘reducing therapy’ if it is serious. All in all, the treatment should deal with conforming to the overcoming qi and calming the inhibited qi — without any limitation in the time needed to treat it. The goal of the treatment is to obtain balance. This is the general principle.’ Huangdi answered, ‘Good!’” In this statement, the principles of balance and the changes in the Yin–yang are illustrated, with given rules for any abnormal conditions: “treat by balancing therapy if it is moderate; and reducing therapy if it is a sudden or serious attack” or “the treatment is to maintain balance”. In addition, concepts such as there being a given time to follow the overcoming qi or retaliating qi, the initial stage of the qi and terminal stage of the qi are outcomes of image number theory. Expressing medical laws in such a manner, through formulized calculations to explain the relationship between ecology, disease and treatment, is unique — both in modern and ancient times. The value of understanding the five-fold circuits and six qi lies simply in this single fact. Though we are unable to confirm the exact era when the seven chapters of theory on “Yun–Qi” were written and added by Wang Bing, they actually take on the strong character of the age. The above-mentioned quotation is taken from the Records of Rites – Climate and Phenology in the Lunar Month (月令), which was written about the Warring States period (475–221 BCE) — the earlier Han dynasty; it contains seven chapters particularly involved with astronomy and the ephemeris, so that we may probably infer they are contemporary with the period of Zhang Heng (78–139 CE), who made the armillary sphere and established the theory of the spherical heavens, and developed its influence. There are straightforward records of the “theory of spherical heavens” in the Plain Questions – A Major Discussion on the Changes of Five-Motions (素问·五运行大论) which is one of the inserted seven chapters: “… the heavens display images while the earth demonstrates forms. The seven stars orbit in the empty sky and the five elements affiliate to the earth. So the earth supports all generated things with form and the empty sky is full of the essential qi of heaven. The motion of forms on the earth and essence in the heavens is just like the root and twigs of a tree. Though located far away, they can be understood by observation of their shape, when looking up into the sky. Huangdi asked, ‘Why is the earth

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mostly below?’ Qibo answered, ‘The earth is located below us, in the center of a great void.’ Huangdi asked, ‘How is it supported?’ Qibo answered, ‘It is raised up by a great atmosphere’.” This shows that the earth floating in the air assumes a theory of the spherical heavens. This is the earliest correct recognition of the position of the earth. It is certainly worth mentioning that some scholars consider the theory of “wuyun-liuqi” to have been established by the people of the Song Dynasty or Five Dynasties.8 The view holds that the seven chapters and broad treatises supplemented by Wang Bing were actually written by someone at the beginning of the Song Dynasty. Chu’s Posthumous Papers (褚氏遗书) also proposed they were forged by Xiao Yuan. To say forged is too strong. It is better to say influenced by Zhang Heng’s astronomical theories, and that the theory of “wuyun-liuqi” was also greatly influenced by the theories of “image and number” along with divination combined with a mystical Confucian belief. The theory of “yun–qi” was not very popular to start with, probably due to its extreme complexity and the fact that no medical experts without a profound knowledge of astronomy and “image and number” theory could apply it. Inaccurate calculation failed to correspond with the clinical data. Then during the Northern Song Dynasty, this situation changed. Shen Kuo, the famous polymath and scientist who was proficient in astronomy, meteorology and the calendar, verified it personally, as recorded in his Dream Pool Essays (梦溪笔谈): Medical exports have a kind skill which is theoretically called ‘wuyun-liuqi’. On a grand scale, it can calculate the changes of the sky and earth, cold and heat, wind and rain, flood and drought, the time of the calamitous snout-moth or even the locust. The method is quite straightforward. On the small scale, it also includes the various diseases that change with a flourishing or decline in the moving qi. At present people don’t know how to apply this skill and are just confined to following fixed rules, without any flexibility — so the result deviates away from the reality and their art is ineffective. Just presume that the Jue Yin is working predominately at a given period, its qi easily causes wind and people are susceptible to pathogenic dampness and diarrhea, but is 8

 Refer to Fan Xingzhun. The Origin of Five Circuits and Six Qi, Journal of Medical History, Vol. 3, No. 1, 1951.

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the whole world windy, all over and people all around afflicted by pathogenic dampness? In terms of different areas, in one city, sun and rain could be different, so what’s the point in having circuits and qi? Mistakes are inevitable if we can’t answer these questions. The truth of all material things can be both constant and changeable. Things dominated by yun–qi are constant; otherwise, they are always changing. A normal condition is one in which the original dominant qi is constant. While a changeable one is one which is not under a dominant qi. Constant situations go with the overcoming qi, but changeable situations are ubiquitous. Both are a part of nature. Therefore, the climate can be following, going adverse, excessive, gloomy, overcoming, retaliating, overdoing it, and inadequate, all of which are creating different causes. For example, when the Jue Yin is predominating, if the sky is windy and the woods flourishing, it is called ‘following’; if the sky is bright, and it is clear and dry with no wind, it is called ‘going adverse’; if the sky is gloomy and running water does not freeze, it is called ‘excessive’; if a high wind is toppling over the trees and the sky is very cloudy, it is ‘gloomy’; if mountains and lakes become scorched and the woods wither and fail, it is ‘overcoming’; if it is a very hot summer, almost burning, and the snout-moth and locust are a disaster, it is ‘retaliating’; if landslides and earthquakes occur, and the sky is frequently gloomy, it is ‘overdoing it’; if the sky is dark with heavy cloud all night and day, it is ‘inadequate’. With these changes, disease and pestilence correspond to a certain time and place. But just several miles away, the weather would be different, so the correspondence to the situation would be different as well. How can we just apply fixed rules without any flexibility? In the middle of the Xining period, the capital suffered a long time of drought, and the people prayed in every possible way. For days a succession of heavy clouds appeared. People all said the rain would certainly come, but the next day the sun burst out, burning high in the sky. On that day, I went to court for some event, and the Emperor asked me when the rain would come. I answered there had been signs of rain, and the time meant it would come tomorrow. The other people all said the rain hadn’t occurred even on continuous, cloudy days, so there was no hope it would arrive when there were such sunny and dry conditions. However, heavy rain fell as a result. At that period, there was a dampness

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predominating in the earth. Continuous cloudy days meant the sequential qi had been in action. Yet the Jue Yin was exuberant and surpassed it, so the rain failed to come. Later, a burst of sun on a single day was a result of ‘dry metal’ becoming predominant, which broke up the Jue Yin and thus the Tai Yin was able to come out and the qi movement be restored, so I knew the rain was sure to come. It was judged according to local conditions — but in another place, the deduction would be different. These subtle changes are so wonderful and yet also so extremely critical. Only by such deductions can we reach the core of this theory. Shen Kuo here illustrates the application of “wuyun-liuqi” to the prediction of the weather and especially points out the following: “With these changes, disease and pestilence corresponds to a certain time and place”; “If it had been another place, the deduction would be different”; “how can we just apply fixed rules without any flexibility”. It is the same in ecological medicine. Ecological, environmental and climatic changes have a certain influence on disease, but a flexible approach is needed — to understand how they affect all and how to select which laws are valid, and in order to deduce the correct formulae. A Comprehensive Recording of Divine Assistance (圣济总录) listed a section on “wuyun-liuqi” and gave it prominence and Liu Wenshu propagated it in his Discussion on the Profound Yun Qi (运气论奥). Liu Hejian even wrote a Treatise on Essentials of Inner Classic’s Yun and Qi (内经运气要旨 论), a Treatise on Clear Explanation of Essential of Medical Formulae (医方 精要宣明论) and An Explanation of Mysterious Pathogeneses and Etiologies Based on the ‘Plain Questions’ (素问玄机原病式) all in order to explain the theory of the “circuits and qi”. In An Explanation of Mysterious Pathogeneses and Etiologies especially, he tried to summarize its theory using the 19 principles mentioned in the Inner Classic and established the theory of “fire-heat pathogenesis”, setting a precedent for developing theories such as those of the Jin-Yuan schools. In his preface, he writes as follows: Whether a doctor is successful or not, we can clearly know by his ability to deduce from the theory of yun–qi. At present, there have been a lot of books about the theory of yun–qi passed down from our ancestors. However, most of them just illustrate it in general terms and are introductory, mentioning only key points and are full of praise. In the end they fail to show its true essence and function. Though they may contain a few good points, misunderstandings

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exist and confuse people. These authors only know just one or two percent of the original text, and go on blindly to write books on the theory of yun–qi. Then these books are passed on to later generations — just to glorify the authors themselves and bewilder their readers. They will never expound it clearly. As a result, readers fail to know the fine points and the subject becomes more and more unfamiliar, so those who can learn it are few. What a pity! Folks either think it is a nonsense and baffling — as its theory cannot be verified — or hold that it is so profound they can only understand it if they are born into it. Hence, students are few and people who understand it are rare. Some are able to study the classic, and they also may markup some mistakes in the carving of the characters, but still it has never been that the original and profound theory of the original creator of this system has been fully and clearly annotated, showing all its imagery in detail. This shows the level of importance of the prevailing theory of yun–qi during the Song Dynasty. There was a proverb, “If you don’t read wuxingliuqi, what use is it searching all the formula books!” These are not empty words; actually they show the importance of clinical work conforming to a theory of natural and ecological medicine. Later, experts in Jin and Yuan Dynasties always held that “yun–qi is not the same everywhere, the ancient and the present run on different tracks” — and used this as a basis to explain their own theories. In any case, discussions on ecological medicine are good for the development of medical theories. However, while we may be sure that factors in the changing ecological environment can definitively influence disease and medicine, it is still puzzling and difficult for common people to achieve results with yun–qi theory. As a result, later generations of medical experts were not unanimous — and both agreement and opposition existed. Miao Zhongchun wrote in his Commentary on ‘Shen Nong’s Classic of the Materia Medica’ (神农本草经 疏) that “I believe there is a principle in the movement of heaven and motion of the qi, but there is no book to serve as advisor for medical experts treating disease” and talked of a “jumble of words with just misleading offshoots and diversions”. Also, Chen Xiuyuan wrote in his Three-Character Classic of Medicine (医学三字经) that “it actually has no relation to medical truth” and “it is feasible to take counsel from those who are familiar with it, but to worship it just as a method of treating diseases, this is nonsensical!” Both wanted to exclude the theory of circuits and qi from medicine. Contrariwise,

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Feng Zhaozhang wrote in Secret Records of Formula in a Embroidered Bag (锦囊秘录) that “Those who find it easy to explain using yun–qi theory can suit this action to the changing conditions and acquire the potential implications of the ancient peoples.” Moreover, Wu Tang wrote in his Book on Treating Malpractice (医医病书) that “Those who are proficient at yun–qi theory can know things in advance; and are often experience for themselves the qi’s arrival or non-arrival, its excess or inadequacy. They understand using different ways to feel the states of qi, such as the arrived qi, the not yet arrived qi, the excess qi, and inadequate qi, and how it can become the overcoming qi, the central qi, the retaliating qi and transforming qi. Again as they are able to detect the absence or presence of qi, and apply approaches accordingly for deficiency or excess of qi, they can find a norm in clinical practice.” Opinions on the application of yun–qi theory still vary today. This is an unresolved question in ecological medicine. We believe that with further research, the evaluation and application of the yun–qi theory may well become more accurate.

107. The Relationship Between Population Statistics and Diseases in Ancient China It is difficult to put forward a comprehensive history of the population in China and raise a single factor out of it with relation to disease, but some of its profound mysteries are no doubt worth exploring. For instance, the chickenpox virus only thrives in a human settlement with a population above a few dozen; the cowpox virus exists in a human settlement with a population above 1,000; the herpes virus requires a human settlement of 2,000; echinococcosis disease can only exist in a settlement with a population above 200,000; the measles virus requires a human population above 500,000. For other epidemic diseases caught from animals, such as rickettsia, rabies, Japanese encephalitis and typhus fever, their occurrence depends on the distribution and aggregation of the animal community. Research shows infectious disease from a human source, such as measles, smallpox, cholera and typhoid fever, only occurs alongside the accumulation of people in cities, while diseases from an animal source only occur proportional to the neighbourhood size and focus of the animal epidemic. Besides, ancient peoples had more cases of malnutrition, endemic diseases, parasitic diseases, abortion and difficult labour than hypertension, cardiopathy and cancer. Therefore, a certain relationship existed between the population density and the occurrence of disease.

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The population situation in ancient China is worth noting.9 Dynasty (Year) Eastern Zhou, Spring and Autumn, Warring States (about 390 BCE) Western Han, Gaozu’s 1st year (206 BCE) Western Han, Pingdi’s 2nd year of Yuanshi (2 CE) Eastern Han, Hedi’s 2nd year of Yongxing (105 CE) Jin Dynasty, Wudi’s 1st year of Dakang, (208 CE) Tang Dynasty, Xuanzong’s 1st year of Tianbao, (775 CE) Song Dynasty, Shenzong’s 1st year of Yuanfeng, (1078 CE) Ming Dynasty, Shizong’s 1st year of Jiajing, (1522 CE) Qing Dynasty, Shizu’s 18th year of Shunzhi, (1661 CE) Qing Dynasty, Gaozong’s 6th year of Qianlong, (1741 CE) Qing Dynasty, Gaozong’s 51st year of Qianlong, (1786 CE) Qing Dynasty, Xuanzong’s 20th year of Daoguang, (1840 CE)

Population (Million) 10.00 30.00 55.59 53.26 16.16 52.92 33.30 60.86 21.07 143.41 291.11 431.81

Note: The population in each dynasty is calculated within each dynasty’s territory.

There is not enough here to analyse the relationship between population and changes in the disease spectrum solely through the above-mentioned table. As we are unable to obtain more detailed, ancient statistical data, let’s just ignore this intractable problem and not speculate. However, the above data indicate that during about the first two millennia of ancient China, the population fluctuated more or less around 50 million. There were two peaks, in the 2nd year of Yuanshi (2 CE) and 1st year of Tianbao, (775 CE). The population jumped up in the Ming Dynasty, 1st year of Jiajing, (1522 CE), and dropped greatly at the beginning of the Qing. In the Qianlong period, the population broke though 100 million. In the final 100 years (1740–1840), the population quadrupled to reach more than 400 million. Even so, the yearly growth rate was only one thousandth of this from the time of Emperor Han Pingdi to the Opium War. Many factors can affect population growth, among which the major ones are war, disaster, hunger, pestilence, state of marriage and so on. In the population graph, a low ebb occurred twice, in the Wei-Jin and at the end of the Ming dynasty, greatly related to war and pestilence. In the 109 years 9

 Refer to Yang Deqing. Overview of Demography, Hebei People’s Publishing House, 1982, pp. 124–125.

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from 1840 to 1949, the population only increased by 130 million — with a lower yearly growth rate of 0.26%. It is obvious that frequent war and prevailing pestilences were present during these years. However, it is still an unsolved mystery why the population could recover so quickly after such a drastic drop in a short time. Likewise, there is still no reliable answer to the soaring population during the Qing dynasty. My personal opinion is that it mainly lay in the popularity of human variolation against smallpox. We can find out something about population growth through the study of genealogy. Guo Songyi once calculated 33 genealogical records from birth and death dates during the Qing Dynasty — and found out that the peak death rate among adult males was between 50 and 69, making up 46%, while among the adult female it was between 60 and 79, or 38%.10 The physique and health of the adults at that time were not really poor. The death of young adults and the sudden decrease of members in any one family were mainly related to war. For example, Feng’s and Zhao’s Genealogy – An Era Introduction (凤氏赵氏宗谱·世表引言) from the Fenshui County, Zhejiang province, records, “A family of Ruqiao’s Tianshui thrived generation after generation since Mr. Daoqing’s initial immigration. In the Xianfeng period, members of their family increased to no less than a thousand. However, an unexpected ‘red sheep’ war occurred and disaster came as family members died at all ages, in the end leaving only about a dozen alive.” In the Pan family from Jing County, Anhui province, there were altogether 419 members from the 29th to 31st generations with 96 dying from accidents or unknown causes, making up 22.91%. It seems illness was not the main reason for young people dying. The genealogical records did not show an accurate death rate for infants, but we can speculate that the rate was very high. According to the common rules of genealogy, children below seven or ten are excluded from the record. However, judging by the statistics of 18 provinces and districts in 1938, the average death rate of infants reached 16.38%, and in Suiyuan province, its rate was as high as 42.99%.11 Hence, we can infer a high death rate for infants at that time. Young people who died between seven (or 10) and 19 years of age have no exact birth and death dates recorded in the genealogy, only notes such as shang, yao, zao shi or you wang, which all mean “died young”. Statistics 10

 Guo Songyi. Investigation on the Population and Marriage States in Qing Dynasty. Chinese History Research, 1987 (3). 11  Refer to Liu Changxin, Cang Kaiji. Demographic Statistics, China Financial and Economic Publishing House.

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from genealogical records of 16 families show the number of males who died young made up 1–37% (an average of 20.8%) for all males. The rate was quite high. Certainly, we are still unable to tell the ratios of various reasons contributing to death, although disease was always one factor. It is a pity we are limited in talking about the relationship between population and disease, but this is also a problem with the ecology of disease. We also do not have enough data to explore the factors of social ecology from a financial aspect. Those who have this in mind might learn something through the spectrum of diseases and medical conditions in all history.

108.  Diseases in Relation to Social Ecology In his book An Explanation of Disease Names and their Manifestations in Ancient China (古代疾病名候疏义), Mr. Yu Yunxiu summarized 180 names for disease. He found this out by investigating the meanings of characters recorded in the Thirteen Confucian Classics (十三经), the Dialects (方言), Character Explanations (释名), Talking About Characters (说文解字) and so on, from which we can get an overview of the disease spectrum from the pre-Qin to the Han dynasties. Together with the diseases mentioned in the Mountain and Sea Classics (山海经) and Huangdi’s Inner Classic (黄帝 内经), there are 323 diseases recorded in all during that period. As there have been many books written describing these, we do not want to discuss them further here. However, several diseases in the record are noteworthy and the author himself thinks they are much related to factors of social ecology. Take the disease of xiao ke (wasting thirst) during the Han dynasty for example. There was a saying “don’t marry a man with xiao ke” at that time, which probably indicated an increase or abundance of such cases. Even the idiom “Xiangru suffered from ke” meant the well-known man Sima Xiangru had the renowned illness of xiao ke. Xiao ke meant in general diabetes — with sugar present in the urine and manifest as profuse drinking and urination, heavy eating, fatigue and emaciation. Zhang Zhengjian’s poem Good Wine in Majesty’s Palace (置酒 高殿上) states, “Even Changqing (Xiangru) suffered from xiao ke, and returned to Chengdu penniless.” Undoubtedly, Sima Xiangru was very thin. The characters xiao and ke (wasting and thirst) show the symptoms of profuse drinking and urination, and heavy eating. Xiangru drank wine a great deal, and Zuo Wenjun, his wife, sold wine while Xiangru washed the wine

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vessels. Lu You wrote in his poem Thoughts in Autumn (秋思) that “Xiangru’s ke disease became more and more serious with the years, and the wine brewers were afraid of being short in supply.” Li Shangyin wrote in his Han Palace Poem (汉宫词) that “the writer and courtier Sima Xiangru specially suffered from Xiao Ke, but Emperor Hanwu was not willing to grant a cup of longevity dew for him.” Li Shangyin himself had once probably suffered from xiao ke as well, because he wrote in his poem The Official Linghu Tao Sending Pei Shisi Back to Hua State (令狐八拾遗绹见招送裴十 四归华州) that said, “It’s a pity that I have for such a long time been with xiao ke, the problem which Xiangru suffered from before me; but I did want to ask you where on earth is that fishing rock?” These poetic words hint at the sense of a link between xiao ke and drinking wine. In the Inner Classic, xiao ke has three causes. The Spiritual Pivot – Five Changes (灵枢·五变) records, “People whose five zang organs are all weak, tend to suffer from xiao dan (pure heat and exhaustion)… They are staunch in mind but then easy to be angry, which makes the qi flow adversely upwards and accumulate in the chest… It transforms into heat which consumes the flesh and skin, becoming xiao dan.” Plain Questions – General Discussion on Deficiency and Excess (素问·通评虚实论) records, “Xiao dan, Fuji (apoplexy), are problems in noble and fat people, caused by the excessive taking of rich food.” Plain Questions – Discussion on Special Diseases (素问·奇病论) records, “fat causes interior heat. Sweet flavors cause abdominal fullness. Therefore the qi flows upwards and changes into xiao ke.” Hence, xiao ke is ascribed to anger, obesity and excessive nutrition in the Inner Classic (内经). The disease was more common among rich and noble families; in peaceful periods such as during the Han and Tang Dynasties, xiao ke could thus be more prevalent. Carbuncles and swellings could be a secondary infection for diabetics. Important Formulae Worth a Thousand Gold Pieces (千金要方) points out that xiao ke patients should take precautions against skin problems. After the Wei and Jin Dynasties, people suffering from carbuncles and xiao ke were great in number, which was probably related to the intake of mineral stones and excessive wine drinking. The Treatise on the Origins and Manifestations of Various Diseases (诸病源候论) states, “Xiao ke means constant thirst and profuse urination. It is caused by taking ‘five stone’ pills or powder since childhood for many years — so that minerals accumulate in the kidney and cause deficiency-heat in the lower jiao… Thus, these patients drink more and have more urination. They tend to be afflicted by carbuncles later on…” This can be proved by the record in Important Formulae Worth

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a Thousand Gold Pieces (千金要方) which states that “No people who drink wine over a long time can escape xiao ke.” At present, Western medicine is still unable to find the ultimate cause for the destruction of the pancreatic islets in Diabetes I (apart from necrotic pancreatitis) and why in Diabetes II insulin is not produced. According to the above-mentioned records, we can at least perceive that factors of social ecology, including the intake of mineral stones, wine drinking, over-nutrition and emotional factors, play an important role in inducing xiao ke. Modern medicine now also has similar opinions. Likewise, the high incidence of jie san disease in the Wei, Jin, Southern and Northern Dynasties was a reflection of increased intoxication induced by the taking of mineral powders, which could also be regarded as being caused by a factor in social ecology.12 Beriberi, namely an avitaminosis of vitamin B1, causing edema and cardiological symptoms, also occurred during the Wei and Jin periods. Sun Simiao wrote the following in his 7th volume of Important Formulae Worth a Thousand Gold Pieces (千金要方): By investigating various classical medical formulae, I found that a discussion of foot weakness (beriberi) was often present, but the ancient people seldom had this disease. Since the immigration to the South in the Yongjia period (307–313), the wealthy and high-ranking officials and intellectuals tended to suffer it. A monk and a doctor, Zhi Facun and the Taoist Yang, who lived beyond the mountain ridge and south of the Yangtze River, paid attention to classical formulae and were specially good at treating this disease. Officials and other famous and prestigious people who had this disease were generally well-cured by these two doctors. During the Song and Qi period (420–501), the Buddhist doctor Shen Shi Daoren explained to Zhi Facun and others about the old formulae and wrote altogether 30 volumes, which included one hundred formulae for beriberi. However, this disease might not have been present in the Northern Wei and Northern Zhou states, because Yaogong’s Collected Experiential Formula has few records of it.13 Neither did Xu-King’s writings pay attention to this disease. So, there are only the above three scholars who have evident prescriptions of beriberi. With differences in education, and without 12 13

 For this, refer to Chapter 9.  Yao Sengyuan (499–583) wrote a book of 12 volumes.

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the same climatic conditions everywhere, people in the Western Pass of Hangu, north of Yellow River didn’t recognize this disease. Since the establishment of the great Tang Dynasty, all areas have been as one. In the utmost south of China, there are places such as remote border areas where soldiers have to move to — where they are unaccustomed to the environment and not acclimatized. All of them suffer from beriberi. In recent years, although officials and outstanding intellectuals tended not to go to the area south of the Yangtze River, some of them are still afflicted by it. This is because climatic pathogens are distributed everywhere and people suffer it equally. This passage gives us three important bits of information: the prevalence of beriberi only began after the immigration to the South during the Yongjia period (307–313); it occurred mainly in the area south of the Yangtze River and among officials and intellectuals, but not in areas of the Northern Wei and Northern Zhou states, west of West Pass and north of the Yellow River; it was prevalent in the Tang dynasty not only in the south area of the Yangtze River, where people failed to acclimatize, but also in other areas, though patients were still mainly those officials and intellectuals. Ge Hong’s Emergency Formulae to Be Carried in the Sleeve (肘后备急 方) states, Beriberi occurred initially south of the Five Ridges, and then was found in some places south of the Yangtze. It onsets gradually and symptoms can be a slight pain or impediment, or fullness in the shin regions, or weakness in walking or standing, or an uncomfortable lower abdomen, or alternating chills and fever. If not treated in time, it enters upward into the abdomen and causes qi swelling, which is deadly. The Treatise on the Origins and Manifestations of Various Diseases (诸病源候论) also states, South of the Yangtze River and south of the Five Ridges, the geography of low-lying places and pathogenic wind-damp means that people easily succumb to pathogens. The disease often begins from below to above — so that the feet initially become weak and then the toxic qi gradually invades the internal organs, moving along the channels and collaterals. After the internal zang-fu organs are

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affected, panting and fullness result. As it onsets from the feet, it is called ‘feet qi’ (beriberi). All these records are basically similar. Obviously, the spread of beriberi was related to the massive southward migration caused by the turmoil of war and change in diet. Northern people were used to having coarse food, while regions south of the Yangtze River were abundant in refined rice. When they came south and had rice as their main dish, they lacked vitamin B1, which existed largely in bran. In the Tang Dynasty, the country was very rich and polished rice in the South was transported to places all over the country. Hence, beriberi became widespread. Sun Simiao had a formula for this disease in his Important Formulae Worth a Thousand Gold Pieces (千金要方): For beriberi, it is quite possible to cook a porridge of the white skin of the rice-grain to prevent or treat it. Take just five sheng of the white skin (do not use the coloured variety, which is toxic.) and one dou of water and boil the rice into a porridge until seven sheng of the mixture are left. Remove the solid mass and drink the remaining fluid. You should eat such a porridge often. “The white skin of the rice-grain” refers just to a kind of fine bran, effective in preventing beriberi. The recipe for boiling it into a porridge shows that people in the Tang Dynasty were in favour of having refined rice. People in other countries did not know this treatment and it was not until the end of the 19th century that the Dutch doctor Eijkman discovered that bran can treat beriberi. At the beginning of the 20th century, Dutch scientists extracted the white crystals of vitamin B1 for treating the disease. In the 1930s, the Cambridge professor Lu Guizhen (Lu Gwedjun) at Shanghai Lister Institute researched the mechanism whereby vitamin B1 treats beriberi, thus being a true successor to Sun Simiao. In conclusion, natural or social-and-natural ecology had a great impact on the occurrence of disease. Several examples have been given here to illustrate this. The occurrence or spread of diseases encouraged doctors to search for new methods of treatment and prevention, and promoted the development of medicine at the same time.

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Epidemics and the Triggering Mechanism of Disaster I would like to note here that the term “triggering (mechanism) of disaster” was first brought to my notice by my friend Professor Zhang Wen, of Xi’an Medical University (now named Xi’an Jiaotong University School of Medicine), in our discussion on some special medical phenomena during a trip from Dunhuang to Xi’an. His view was based on actuality — while mine is on history.

A.  Ancient Epidemic Diseases and Epidemiological Factors 109.  The Historical Background to Epidemics The prevalence of epidemics in history reveals that the most likely triggers, on a broad scale, were natural and social factors such as war, peace, disasters, economic growth, the migration of the population, etc. However, the relevant historical records are incomplete. What’s worse, owing to such historians who said, “we do not need to record outside disasters” (as in the Spring and Autumn Biography of Gongyang 春秋公羊传), some missing data are unavoidable. Accordingly, in some readily available local chronicles from the Ming and Qing dynasties, and contemporary medical records, data on epidemics are missing in a great number of the official historical documents or private editions, as they were inattentively or unsystematically put together. According to the surviving records, the number of outbreaks of epidemics was approximately as follows: 17 in Han Shu (汉书); 18 in Post Han Shu (后汉书); 16 in the Records of Three Kingdoms (三国志); 40 in the Jin Shu (晋书); over 50 in the Song Shu (宋书); over 20 in the combined Book of the Southern Qi (南齐书), Book of the Liang (梁书) and Book of the Chen 661

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(陈书); 16 in the Book of the Tang (唐书); over 50 in the History of the Song (宋史); 12 in the History of Yuan (元史); 23 in the History of the Ming (明 史) (64 according to a count in other relevant books); and more than 300 in the Draft History of the Qing (清史稿). Dr. Zhang Zhibin has done thorough research into the frequency of epidemics in all the centuries.1 The conclusion drawn from Dr. Zhang Zhibin’s research is a quasi-result — which may be used for reference, because there were fewer records in ancient times and many more in modern times. But, the lows during the period from the 5th to the 10th century, a period with a relevantly peaceful society, national unity and when medical science had high status, and from the Sui and Tang (581–907) to the early Song Dynasties (960–1127) expose its probable objectivity. Therefore, it seems that the trend of epidemic outbreaks could be curbed by the development of and manipulation made by medical science. There are two ancient Chinese sayings, “Wherever an army goes to war, lean years follow”2 and also “wherever a disaster takes hold, there follows a severe epidemic”. Therefore, war and disaster play a crucial role in the outbreak of epidemics — the causes being the famine, drought, war and other human plagues. The History of the Northern Dynasties (北史) records, “Plague prevailed and caused a lot of deaths when famine occurred in Jiangsu and Zhejiang provinces,” What’s more, “there were over 50,000 people gathered together, living in mountain forests, beyond the confines of the local government; yet 3 years later, an epidemic broke out and brought over half of them to their deaths,” according to the History of the Post Han Shu (后汉书). In the Record of the Three Kingdoms (三国志), “Ma Yuan’s army was conquering Jiaozhi and in all 40–50% of his soldiers died from miasmic diseases.” During the “Battle of the Red Cliffs”, “Cao Cao, a distinguished Chinese commander, voluntarily retired his troops, because sickness caused great fatalities among his soldiers.” The soldiers of the Jin besieged Kaifeng (capital of the Southern Song) three times, during which millions died of epidemic diseases, quite similar to the time when the Black Death prevailed in Europe. Differences in geographical environment and population distribution made a great impact on the outbreaks of epidemics. “Because of the warm climate to the south, during the Taiyin period, (winter) plants do not wither 1

 Zhang Zhibin, A Prime Exploration into the Triggering Factors of the Ancient Epidemics, Chinese Journal of Medical History, vol. 1, 1990. 2  The Daode Jing.

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and insects are not dormant — so a mixed toxic miasma haunts the area,” records the General Treatise on the Causes and Manifestations of All Diseases (巢氏病源). Dr. Zhang also made a comparison of the frequency of outbreaks in the north and south, as against the frequency of outbreaks in the 12 provinces during the Ming and Qing dynasties. The range of epidemics expanded as did the development of transport — over 5 provinces, dynasty by dynasty. Su Shih, a distinguished literary figure and politician during the Song Dynasty, said that “people died of epidemics in Hangzhou, an intersection of water and land with heavy traffic, more than anywhere else.” On the contrary, the History of the Song Dynasty (宋史) notes that Wang Mengying, the great physician, held the opinion that the factor behind the cholera epidemics in Shanghai was its busy port, flooded with merchants. The above infectious factors are drawn from a macroscopic view. In this chapter, the socio-ecological impact of epidemics is mentioned simply for reference. There are some direct infectious factors, mostly related to having a poor knowledge of disease prevention and hygiene, in some areas. Such could be the former-stated cases of dung tasting, which can cause dysentery. Also the County Annals of Baoshan (宝山县志) records that “many dead bodies were afloat on the river, so many that no boats could sail during the severe epidemic of April 1510.” Corpses floated down the river, which would promote further outbreaks. Again Xiong Lipin points out in his Compilation of Infecting Illnesses of Pestilence (瘟疫传证汇编), “Others gossip a great deal when a man gets ill, and some propose inviting in witches and wizards all of whom have magical features, or incantations about them, also setting out ostentatious and decorative items… often we see them do this through overnight rituals and turn out exhausted, and this means that unfortunately everybody gets tired out, and sick from eating too much, and the family and neighbors are infected the very next day. This is another reason it was hard to prevent one person’s illness from infecting another.” Zhou Yangjun also wrote in his Encyclopedia of the Warm Febrile Disease and Summer-heat Pestilence (温热暑疫全书), “The qi of dead bodies suffused the air among the tombs — because they were buried too shallow, or would float out and in, along with the tide, so people who lived nearby would no way be able to avoid them. They became infected and died.” In a nutshell, there were quite a number of severe pestilent outbreaks in ancient China, as a result of many combining factors. Generally speaking, these would be reined in when the government took note and the medical conditions

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improved. However, this did not work well enough — for there were many that still occurred before there were effective measures of prevention.

110. Major Epidemics During the Zhou and Qin Dynasties, and at the Beginning of the Han During ancient times, the history of disease, especially that due to epidemics, changed along with the ecological transition and the people’s recognition of disease and their depth of knowledge about it. Hence, it is a tough task to do research on this subject in ancient China. Fortunately, thanks to the historical chronicles, we can draw some clues as to when and how outbreaks of pestilence occurred, and to some extent discuss them according to the classification of epidemics in Western medicine. From the Zhou and Qin Dynasties to the beginning of the Han, a majority of epidemics were upper respiratory infections (including the common cold) and malaria. The Rites of Chou (周礼) states, “Pestilence is there throughout the year. It is caused by xiaoshou disease in the Spring, yangjie disease in the Summer, nuehan disease in the Autumn and soushangqi disease in the Winter.” Nuehan disease, mainly describes malaria, and its cordial symptoms are periodical cold and fever; soushangqi disease, referring mainly to cold, is related to bronchitis, bronchial asthma, pulmonary infection, etc.; yangjie disease, at the very least involving skin troubles such as tinea, is an infectious skin disease caused by parasites (the sarcoptic mite), while xiaoshou mostly refers to a head-related disease with symptoms of headache, for Zheng Xuan in his annotations said that “xiao meant sore while shouji was a headache.” The ancient Chinese categorized disease by way of the season that occurred, while a “pestilences of the four seasons”, also reveals the features of a seasonal epidemic. Plague is used as a term for seasonal pestilences prevailing on a large scale. Mr. Fan Xingzhun has explained that the character “疫” (plague) originated from “役” (military or penal service), which means “soldiers living together in one place… the character ‘疫’ was at first formed by changing radical ‘疒’ to a ‘X’; then it being simplified into ‘疫’ by adding a radical ‘疒’ (which referred to disease).”3 This makes sense of the former point. The ancients considered that seasonal pestilences were febrile illnesses caused by getting affected by cold. The Huangdi Neijing Plain Questions (黄帝内经) states in the chapter “On Fever” (素问热论), “Those who get 3

 Fan Xingzhun, New History of China’s Diseases (中国病史新义), TCM Ancient Books Publishing House, 1990, p. 264.

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febrile diseases nowadays are categorized as shanghan (cold damaged).” It also says that “people who catch febrile diseases are damaged by the cold, but their severe symptoms do not cause death”; so, shanghan originally was seen as the cause of the febrile disease, later on it became the name of the disease. Also in the chapter “On our Living Qi Corresponding to the Heavenly Qi” (素问生气通天论), a particular kind febrile illness has an incubation period — as the text states that “attacked by pathogenic cold in the winter, one will contract warm disease in the spring.” But warm disease was divided in two — “people who get ill before the Summer Solstice, contract warm disease; people who get ill after the Summer Solstice, contract summer-heat disease.” Therefore, there were two terms — warm disease (bing wen 病温) and summer-heat disease (bing shu 病暑) — and both appear in the chapter “On Fever”. They also could be subdivided by their symptoms: “When the skin of the antero-lateral side of the forearm is hot like fire, and then becomes cold, it is a disease of han-re (cold and heat); when the cold comes over the skin of the forearm first, and then turns to heat, it also can called han-re” (Lingshu – Disease Diagnosis Related to the Forearm 灵枢·论疾诊尺篇). “The pulse of the chi (a place on the forearm) is rough and often accompanied by fever, which means re-zhong (热中 heat attack)” (Suwen – On Common Person’s Pulse 素问·平人气象论). So such names as “cold-heat disease” and “heat-attack” occurred. Moreover, in the Huangdi Neijing (黄帝内经) febrile diseases are divided among the six phases and the viscera into the following: Tai Yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin, Jue Yin, Er Yang, Double-Invasion or Liver Heat, Heart Heat, Spleen Heat, Lung Heat, Kidney Heat, etc. If very serious, the patient would die during the last period of the disease; most would survive. As is universally known, malaria is caused by mosquitoes, relating closely to gathered rainwater or swamps, especially during the seasons of spring and autumn. The early human genetic makeup gave some resistance to malaria (involving the composition of the blood and haemoglobin C in the red-blood cells). In Western history, malaria was named “marsh fever”. A particularly devastating malarial epidemic spread though the Roman Empire during the 3rd century, contributing to the decline and fall of the empire.4 Attacks of malaria contributed to some of the earliest epidemics in history, East and West. The Shuowen Jiezi (说文解字), one of the earliest Chinese dictionaries, defines “疟 (malaria)” as “getting fever and then cold in turn, regularly”, which exposes its features. The character “疟” was written as “虐” or “痁” 4

 Gerard Venzmar. 5000 years of Medicine. Macdonald, London, 1972, p. 102.

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in early documents. Because the climate in those times was similar to today’s temperate zones, rainy and boggy and with many ponds, it created suitable beds for mosquitoes to thrive in and spread. Unfortunately, the ancients overlooked this relationship and only thought of the impact of the seasons and climates. So they said “there were more malarial and cold diseases in the autumn.” It even rendered us a name — shuiyigui (the “ghost of a water pestilence”) — who was one of the three sons of Zhuanxu (a legendary monarch), also called nuegui (“ghost of malaria”). A special chapter “On Malaria” in the Neijing (内经) ascribed it to the fact that people are invaded by the pathologic qi of wind, cold, summer-heat and fire. The Historical Records – Biographies of Ancient Yue (史记·古越列传) states that during the 16 years of Emperor Han Wen (164 BCE), “warriors were attacked by a serious epidemic in the damp and hot weather and could not mount or climb the hills.” This might refer to a serious malarial outbreak. The south of China, a place shrouded by toxic miasmas, is the prevailing zone of malignant malaria (caused by such poisons). People with poor immune systems who travelled there could die. Besides these frequently occurring diseases, there was also rabies, named “痸 (zhi)”, “猘” or “瘈”. The Zuo Zhuan – 17th Year of Lord Xiang (左传·襄十七) said, “The country people expelled all the mad dogs from the district.” The Zuo Zhuan – 12th Year of Lord Ai (左传·哀十二) noted, “A mad dog would bite everyone it sees.” Though there were few written records made about the symptoms and process of being bitten, the Suwen – Gukonglun (素问·骨空论) states that “burning three moxa cones on the bitten spots, implies applying moxibustion to them,” This shows that the dog-bitten wound had drawn attention from ancient physicians. The Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方) also recorded some healing methods such as applying the mashedup dog’s brain to the bitten spots, and A Sketch of Formulae (小品方) told of a way of sucking out the blood from the wound in an emergency. Both of these prove that it was not a new or severe epidemic. These were some of the simple methods of treatment. Leprosy was another one of the epidemics. Ran Geng (Po-niû), one of Confucius’s disciples, “suffered from a horrible disease, and Confucius went to see him. Taking hold of his hand through the window, Confucius said, ‘Is this his destiny? Such a good person to have such an evil illness? How can he have suffered such ill-fortune!’” (from the Historical Records – Biographies of Confucian Disciples 史记·仲尼弟子列传). This story is also recorded in The Analects – Yongye (论语·雍也) in slightly different words.

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This “horrible illness” is thought to have been leprosy, caused by the bacterium mycobacterium leprae that attacks the peripheral nerves and causes loss of feeling, numbness, leontiasis, flat nose, hair loss, skin sores, nodes, etc. which make the face extremely ugly. There are two common forms: tuberculoid and lepromatous. Skin lesions are the primary external sign on the deformed face and can also create contagious infection. So, at that time it was called a pestilent illness such as Li (疠, 厉) or Lai (癞) — equal to “leprosy” now. But its long period of incubation does not impact the patient’s daily life and work. Therefore, some faked being ill by painting themselves with dermal lacquer marks which appeared to be leprosy. Such stories are recorded by Jie Yu during the time of the Chu kingdom and Yu Rang in the Jin kingdom — which proved a fine knowledge of its symptoms. Yu Rang was a roving brave who acted as an assassin, and wreaked vengeance for his master Zhibo, “by painting lacquer on his body and shaving his eyebrows and moustache to disguise his features — and pretending to be a beggar. His wife remarked, ‘He, indeed, does not look like my husband, but why does he sound like him?’ Rang then altered his voice by swallowing a burning coal.” (Strategies of the Warring States 战国策) Rumour had it that the Chu state, the homeland of Lao Zi, was haunted by leprosy. The Chinese character for leprosy “疠 (pronounced li)” was also rendered “疠风 (lifeng)” or “大风 (dafeng),” meaning a severely infectious skin disease where the character “风 (feng, wind)” refers to “麻风 (mafeng)”, namely leprosy with loss of feeling and numbness called ma. So the Suwen – On Wind (素问·风论) states “Li is caused by the rong-qi heating up and turning rotten, then becoming unclear. Such turbid qi causes the collapse of the nasal columella and corrupts the color of the face, producing skin ulcers.” The Suwen – On Changcijie (素问·长刺节论) mentions a “patient suffered from dafeng (大风) where the symptoms are a heavy feeling in the bones and drooping eyebrows and mustache.” The ancient Chinese must have been highly aware that leprosy was epidemic. Dadai’s Rites – Benming (大戴礼·本命) records that “there are five kinds of women one cannot get married to; one is she who has a terrible disease.” Such a disease could be leprosy. Some were even afraid that their offspring might get it so “when a woman suffering from leprosy gave birth to a baby at night, her newly-born would be carefully looked over, for fear that it might have a similar problem” (Zhuang Zi – Heaven and Earth 庄 子·天地). The fact is that leprosy did not usually infect other people, unless there were cuts in the skin or they were in close contact with the patient. Leprosy was quite common during later eras. Wang Can, one of the Seven

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Talented Writers during the end of the Eastern Han Dynasty, had leprosy, and Liu Biao refused to marry his daughter to Wang Can because of his ugly face; Lu Zhaolin during the Tang dynasty, also a leprosy patient, had asked Dr. Sun Simiao for treatment, but later committed suicide by drowning himself. Incidentally, Sun once accompanied a batch of leprosy patients into the mountains for he deemed them people who would later turn into immortals. Gastrointestinal diseases also prevailed during the period of the Qin and Han. Huoluan (霍乱 a euphonic translation of the western term “cholera”) is recorded in the Huangdi Neijing (黄帝内经), but strictly speaking, it was acute gastroenteritis with emesis and diarrhoea. In this book, it says “the clear qi is placed in the Yin, turbid qi placed in the Yang, nutrient-qi flows down along with blood in the vessels while the defensive-qi flows along adversely. When the clear qi is intervolved with the turbid qi it causes disturbance… If it is in the gastrointestinal part, huoluan will occur.” From the Lingshu – Five Disturbances (灵枢·五乱), “the Taiyin phase arrives and then can cause abdominal fullness, huoluan with vomiting and diarrhea” (Suwen – On Liuyuan Zhengji 素问·六元正纪大论). In this chapter it also says, “the bursting out of the suppressed Earth Qi is like an earthquake… people can contract distension of the chest and abdomen, there are peristaltic sounds, and they pass loose stools frequently. Some have serious cases of heart or chest pain as well as vomiting and huoluan.” Obviously, not all these were real cholera. Some light vomiting and diarrhoea could be due to chronic gastroenteritis or chronic bacillary dysentery. As for “intestinal afflux, or defecation with pus and blood… death will come when the deadly-weak pulses appear, while vitality goes with slippery and strong pulses” (Suwen – On General Comment of Deficiency and Excess 素问·通评虚实论). “Symptoms of the Jue Yin in charge means there is lower abdominal pain, and red and white diarrhea” (Suwen – On Truth and Essence 素问·至真要大论). Here, the words “intestinal afflux with pus and blood” signify a disease such as red and white bacillary dysentery. While other cases were “when a man got attacked by the wind in spring, he would suffer from weakening diarrhea in summer” and “excessive dampness causes weakening diarrhea” (Suwen – On the Relationship of the Figures of Yin and Yang 素问·阴阳应象大论), or “excessive cold would make a peristaltic sound with weakening diarrhea as well as indigestion” (Lingshu – Chapter on the Origins of Diseases 灵枢·百病始生篇), these might be a kind of chronic enteritis or dysentery. Also in the Zuo Zhuan – 12th year of King Zhou-Xuan (左传·宣十二), when Shen Shuzhan, a minister in Chu State, mentioned that the soldiers suffering from diarrhoea

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called it “a river fish”, this might be collective food poisoning or infectious diarrhoea, in my opinion. Jaundice sometimes occurred. The Chinese character “疸” (dan in the 1st tone) was sometimes written “瘅” (dan in the 4th tone), and the difference between them was that the latter describes a more varying kind of disease. Regarding these, some were not infectious — such as obstructive jaundice and hemolytic jaundice. However, this term may also refer to hepatocellular jaundice mainly caused by infectious hepatitis or liver cirrhosis, or also leptospirosis jaundice. Examples of acute jaundice might have been described as follows: “the patient has a poor appetite, is upset, and suffers from sudden pain below the heart, sloppy stool, abdominal mass, diarrhea, anuria, jaundice and cannot sleep well…” (Lingshu – Chapter Channels 灵枢·经脉篇); “the disease attacks the lung… without effective treatment, it will transfer and infect the liver… and then the spleen, and thus gets the name Spleen Wind, which will cause severe jaundice and heat in the abdomen, with annoying and yellow-tinted skin” (Suwen – On Treasure of Pulses in Different Seasons and Organs 素问·玉机真藏论). Both the above were acute conditions. According to the Suwen – On Liuyuan Zhengji (素问·六元正纪大论), “in the sweltering summer weather, dampness and heat compete against each other, and, accumulating on the left, eventually cause people to fall ill with jaundice and swellings.” This disease was epidemic. The Lingshu – Diseases Related to the Forearm Skin (灵枢·论疾诊尺篇) states that “when making a diagnosis of the blood through its vascular conditions… if a patient has mostly red, black, and blue-colored veins and that is all one can see, feels cold and hot, and pain on his body together with a yellowing of the face, teeth, and nails, he definitely suffers from a case of jaundice. The other symptoms usually involve fatigue, a need to stay in bed, yellow and red urine, weak and uneven pulses and no appetite.” This must be chronic jaundice or liver cirrhosis. In the Book of Diagnosis (诊籍) by Cang Gong, a female patient named Bo Wu was suffering from “Nao Jia” (‘parasitic mass’), a disease with symptoms of “severe cold and hot, a large abdomen, yellow and coarse skin, and always in a depressed state when touched.” This might be jaundice caused by cirrhosis with the ascites triggered by a parasitic disease, or cirrhosis due to schistosomiasis. In general, problems of jaundice were mostly of an infectious nature. Besides this, cases of tuberculosis also occurred as epidemics. “The Shao Yang is in charge of the action of heaven, so fire overdoing it comes with predominantly Yang symptoms. People who get ill, cough and spit blood” (Suwen – On Essence and Importance 素问·至真要大论). “The pulse in the lung position feels a little quick — which is the omen of a lung suffering both

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cold and heat. The patient, always tired, would cough and spit up blood” (Lingshu – Diseases in the Internal Organs from the Pathogenic Qi 灵枢· 邪气脏腑病形篇). It seems that hemoptysis, accompanied by a slight fever and tiredness, together with weakness, are the symptoms of tuberculosis rather than of bronchiectasis, pneumonia or a lung abscess. One case history states that “after being depressed and unhappy for several months, the patient died of haematemesis,” as recorded in the Historical Records – Biography of Han Changru (史记·韩长孺列传). Haematemesis might be hemoptysis and “being depressed and unhappy” could be one symptom of tuberculosis. According to the Hanshu – Biography of Xiongno (汉书·匈奴传), “With constant rain and snowy days for months, livestock died and people fell ill with the pestilence.” Such things happened in 90 BCE, and that people and their livestock died of the same disease might be due to an outbreak of anthracnose.

111. The Main Epidemics of the Han, Wei, Jin, Northern and Southern Dynasties There are no detailed records of epidemics during the Zhou, Qin, Western Han or Eastern Han Dynasties. Descriptions became detailed during the Wei, Jin, Southern and Northern States and these descriptions still had an intimate connection with the Han. Therefore, they will be stated together. According to the Hanshu – Records of the Five Elements (汉书·五行志), “The Yu (蜮), a pest, was first recorded in the Autumn of 695 BCE. Liu Xiang (刘向), a famous ancient writer, considered it came from south of Yue state — where the number of women was more than the number of men and they took to playing lewdly in the same river, thus the qi of obscenity was generated and the Yu pest came into being. The sages named it yu — meaning ‘the baffler’. The tantalizing Yu could shoot at people beside the waters, hitting them at a certain place on the body. At worst, some of them would die. In the south, it was called the duanhu. If a person was shot by such a demon it brought about death.” Shi Gu noted that “it shoots people with its qi” and “it is named the Shooting Demon, alias the Water Crossbow.” Therefore, the disease was called the Shooting Demon’s Water Crossbow disease. A Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方), written by Ge Hong, recorded the following: There is a kind of Shooting-demon’s Water-crossbow toxic insect south of the Yangtse River, also named a Duanhu, or Yu, which lives

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in the waters of the mountain. When people there walk and bathe, this insect has a bone-crossbow in its mouth; it will pump water and squirt it at a person’s body or at their shadow and then they fall ill. Its diagnosis at the beginning is similar to cold-damaging fever, or like being attacked by summer-heat and then losing the ability to speak, or having an aversion to cold and heat, or having the limbs cramp up. In most cases, it is slight in the morning but turns worse in the evening. After three days in trouble, bleeding occurs between the teeth and the patient will die without immediate treatment. If you make an overall examination of the whole body there could be four types of skin impairment: (1) there is a right black spot circled in the margin and stabbing pain; (2) some will have sores which usually break open as ulcers before long; (3) they can be protuberant with edges looking like rocks or crusts; (4) one type is the worst and needs urgent treatment which is when the patient feels burning in the wound and it suddenly bubble outs in sores. This can often be fatal. People who live along the stream or near wet land have a larger chance of being shot when there is a cloudburst — the Yu would come with the flowing water and, on the person get into the house and shoot people. There is a paragraph in the Baopuzi Neipian – Climbing and Wading (抱朴子内篇·登涉) describing this disease similarly: During recent days the countryside of the Wu and Chu States, has been hot and muggy with summer-heat and damp, even in the Holy Hengshan, and Huoshan Mountains there are hiding many toxins. Among them, one is called the Duanhu, or Yu, also named Shooting Demon, or Shooting Shadow; actually it is water-insect pest living in the water, shaped like a cicada or a trinitarian cup. It has wings and can fly. It can hear, but has no eyes, with something like a crossbow in its mouth, and when it hears the sound of men approaching, it gathers air into water like ‘an arrow’ and shoots at people. People who get shot at on the body bubble out in sores immediately; while even if it is only their shadow, they fall ill although the sores which come later. If it is not recognized how to cure it, the patient dies within ten days. In all, some conclusive features of the Yu disease (“shooting demon” or water “crossbow”) are as follows: (1) The infectious agent is a flying pest or

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“water insect” living in water. (2) The syndrome is similar to a serious cold, accompanied by symptoms of chill and high fever. (3) After three days, the patients will have cramps and bleeding between the teeth. (4) On the skin there appear sores, most probably from ulcerous papulosa, and they are circled in the margin by a round of black spots, they would break and sink indicating symptoms of eschar ulcer. However, some people may produce none at all. (5) Within ten days no patients with this disease can escape death. (6) What makes it epidemic is that it is closely related to the pouring rain, people walking through the wetlands, water inundating into houses, bathing in river water, etc. all of which are quite common occurrences in eastern and southern China, a network of rivers, lakes and ponds. Actually, the above-mentioned features are similar to those of scrub typhus (tsutsugamushi disease), which spreads by the chigger larva, a parasite living in the bodies of mice, birds, geese, ducks, etc. which live in the wetlands, marshes and river areas. In ancient China, it frequently broke out during the farming seasons, summer and spring, especially in a flood disaster, in the eastern and southern provinces of China. It was an acute disease with symptoms of high fever, chills, cramping and soreness of the four limbs, fatigue, sleepiness, nausea and vomiting, flushed face, conjunctiva congestion, in some cases bleeding, maculopapules all over the body (those whose disease was in an early phase might have none) and the enlargement of the liver, spleen and lymph nodes. The disease course lasted around 13 days. Some severe cases might die within ten days. The most obvious feature of the chigger bites are crusts and ulcers, which at the beginning are red papules, then turn into blisters and eventually break into small flesh-red ulcers with mounting rims circled in red. Then one or two days later, necrosis of the centre will take place and they turn into black crusts with round or elliptic shapes. Then small ulcers, whose bottom is made up of pink granulated tissue with clear percolate, merge again after the decrustation. These symptoms coincide with Ge Hong’s description of “burning wounds with bubbling out sores.” On these grounds, Yu disease, or Shooting Demon’s Water Crossbow toxin, is scrub typhus, belonging to the oriental rickettsia infection. There were lots of recorded cases of this disease especially after the Jin Dynasty, probably owing to its frequent outbreaks. As to the Yu or Duanhu or Shooting Demon, as it is called a “water insect pest” instead of a chigger, it might be guessed to be a kind of little biting midge. It was possible that when patients saw such insects they then simply mistook the flying bug to be the cause of the disease.

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The most confusing disease is the Shashibing (沙虱, chigoe illness) caused by a chigger, as it has always been taken as scrub typhus, since the record of it made by Fan Xingzhun.5 In his latest version of A New History of China’s Diseases (中国病史新义),6 he further deems it to be a chigger poison, shooting demon toxin, due to the warmth of the stream. Yu disease was commonly known as Sha (沙) disease south of the Yangtze River. But this is wrong. What was called Sha (i.e., 痧) in that region was mainly summer sunstroke — one can see many small blood points on the skin which were called “coming from Sha”. Actually, the Sha Bing chigger disease was not, as Fan said, always thought of as a kind of acute disease even before the Song Dynasty. Zhang Gao, in his Medical Talks (医说), shows how to discriminate Sha (沙) disease, quoting from Ye Mengde’s Record of Effective Prescriptions (叶氏录验方): Sha (沙) disease, originally non-existent south of the Yangtze River now prevails everywhere from east to west, and it was not in the former medical books either. Patients with this disease, in most cases, would feel a chill and such symptoms such as those of shanghan (cold damaged fever) — but similar to malaria with a headache, the whole body being very hot. Yet the four limbs felt cold. In remote villages, people tried moxibustion to treat it and the ‘Sha’ blood-points out on the skin, hoping it would get better. Sometimes it could cause pus and blood to gush out, because of the moxibustion and after a while, some would die. It was really rather pathetic. Here, such symptoms are more like those of sepsis which is different from common Sha illness. The Handbook of Prescriptions for Emergencies (肘后方) described it thus: Sha Shi (沙虱) was quite common in regions between waters and mountains. It was almost invisible owing to its minuteness. When people took to washing their bodies in the waters anywhere, or drew water from the river for a bath where the chigger hid, these insects would stick to the human body; or when people walked through grass where there was water on cloudy, rainy days, these insects 5

 Fan Xingzhun, Preventive Medicine Thought in China (中国预防医学思想史), p. 105.  Fan Xingzhun, New History of China’s Diseases (中国病史新义), TCM Ancient Books Publishing House, 1990, pp. 279–289. 6

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would stick to their skin and pierce them. Once in, they would find a scarlet spot, tiny and round like a small bean or a millet, which when rubbed on their red skin, would cause a stabbing pain when touched. Three days later, patients would feel stiff all over with pain, and turn cold and hot, and the scarlet spots would turn into sores. If the insect had reached the bones it would kill the patient. Therefore, those who bathe in open waters in mountainous regions should rub their bodies with a clean cloth repeatedly after washing and use old silk-wipes, to dry the body… If the insects had buried themselves quite deep in the skin, they could be picked out with a needle. Those picked out were exactly like scabies mites which would move if put on a fingernail under a light. Then three or four moxa-cones on the skin and the insects would be killed and the patient cured. If the patient still felt dizzy, it must be that the insect had pierced the skin too deeply… Thereafter in seven days it should be better. If then the symptom remained, it meant that the insect was still living in the body and once it sucked at the heart, the patient would die. Therefore, these cases should not be neglected. Some earlier researchers quote Ge Hong’s “picking out scabies-mite-like insects with a needle” as proving his keen observation with his own eyes. However, this is misunderstood — because the truth about the chigger mite is that people got infected after being bitten by the larva of the chigger, not the adult. The adult is incapable of causing infection and differs from the larva in living in the wild and taking the eggs of other insects as food. Also its size is about 1 millimetre, while the larva of chigger mite is around 0.6 millimetre, and it is parasitic on ducks and chickens, which can live around people, and its bite causes them to fall sick. What’s more, the larva of chigger mites would fall to the earth and become nymphs immediately — which then grow into adult chiggers after biting. They would not stay on the human skin. Therefore, it is beyond any possibility that chiggers or “scabies-like mites could be picked out with a needle” after biting a human. So there must be something wrong in what Ge Hong has written. It could be some other mosquito or small midge. The eschars caused by the larva of chigger bites were dark with black spots which Ge Hong had seen with Shooting demon disease, but he did not mention a word about them here with Sha Shi toxin. The symptoms were scarlet maculopapules accompanied by pain and fever, and stiffness in all joints, three days later. This along with the illness often linked with water could especially suggest it to have been acute schistosomiasis.

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If we look at the Taiping Guangji (太平广记 Wide Records of the Taiping Era), we see that Sha Shi disease was quite likely to have been schistosomiasis, instead of scrub typhus: Sha shi, i.e., the Shi (虱 louse) lived between the scales of serpents in Tan, Yuan, Chu, Ji prefectures, and was too tiny to be found. In the summer, snakes would hang upside down in running waters or lie in the sand in order to get rid of those small annoying lice. The bitten passers-by usually had spots as tiny as pinholes, circled with colored lines — the marks of which were the toxin. Through using the ‘praying taboo’ and by scooping out the bitten part and applying some Shengjigao cream (生肌膏 wound recovery cream ) a skilled man could promote granulation, and the patient recover promptly; otherwise they would die within three days. One thing that must be noted here is that the most widely spread disease during the Wei and Jin Dynasties, which disseminated all over the country, was neither scrub typhus nor schistosomiasis, for they were region bounded and related to a particular epidemic source. It was Shanghan (cold damage fever) that prevailed in most regions as an epidemic and broke out many times during the Jianan period (196–220) and lingered on afterwards. It was one of most important reasons why Zhang Zhongjing wrote about it in his Treatise on Febrile and Miscellaneous Diseases (伤寒杂病论). In Zhongjing’s own preface, he mentioned that his own clansmen had suffered this illness and that many had died: “I had originally a large family with numerous clansmen, but now only about two hundred are still alive. Two thirds of our clansmen died in less than ten years during the Jian-an Period (196–220). Among them, seven out of ten (70%) died of Shanghan.” His clansmen could originally have been 600 — and about 400 died in ten years. A 70% death rate due to Shanghan means about 280 dead. This striking death rate was around 47% in a rough analysis. But this was moderately acceptable — for the average death toll was only 28 persons annually, out of the 10 years. It has to be pointed out that “伤寒 shanghan” in the ancient Chinese language was not the same as typhoid fever or paratyphoid fever — which is the Japanese translation, by borrowing the same term in Chinese “伤寒 (Shanghan)”. According to what Zhang Zhongjing has described, I think that it possibly was influenza: those affected severely would die. Moreover, it could also involve the common cold (coryza, upper respiratory infection),

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which, with a natural course of 7 days, would disappear without any treatment. Yet some other epidemics were mistaken as the common cold too in their prodromal phase, and thus were called “deviated” or “deteriorated” diseases when severe symptoms arose during the latter phase. The pathogen in influenza is the influenza virus, with its antigenicity and pathogenicity prone to heteromorphosis, which meant that it could cause a widespread outbreak every ten to fifteen years. A little heteromorphosis would trigger a battle against flu every year. At the end of the 1950s, the flu broke out again first in Asia, and thus got the name A2 (H2N2). Quite a number of people contracted it, dying due to the lack of a cure. But if they could live through the high fever, they would soon recover. With a disease course of around 7 to 14 days, just the same as that of the general cold, it intermingled with the latter — and both epidemics could have repeatedly prevailed over the years and become quite common. It was this which no doubt drew the attention of Zhang Zhongjing, who then wrote the Treatise on Febrile and Miscellaneous Diseases (伤寒杂病论). It is no wonder that the same thing happened among physicians of later ages. There were also the “yin–yang toxic diseases” mentioned in the Synopsis of Golden Chamber (金匮要略). These can be recognized as a kind of serious pestilence: “People who got yang-toxic symptoms would have a flushed face interspersed with spots like brocade, a sore throat, and spit pus and blood. It could be cured within 5 days. Otherwise, the patient would die by the seventh day.” “People who got yin-toxic symptoms would have a purplish face, pain all throughout — like being flogged over the whole body, and a sore throat. It could be cured within five days. Otherwise, the patient would die by the seventh day.” These two could be pneumonic plague or septicemic plague if the patient also got the complications of enlarged lymph nodes, and if it was when the “rat plague” prevailed. However, these yin–yang toxic diseases were placed under the category of “miscellaneous” in the Synopsis of the Golden Chamber, and owing to the lack of precise descriptions of other symptoms we cannot make a proper judgment. Moreover, they also might have been typhus fever, the haemorrhagic purpura of acute fulminating meningitis, septicemia or DICs (Disseminated Intravascular Coagulation) from other serious diseases. There were other clues that these diseases could have been a pestilence similar to typhus fever. According to the historical records, in Jian An’s 13th year (208 CE), Cao Cao’s army failed in the battle of Red Cliffs — not because he was defeated by Zhuge Liang through his burning of Cao’s fleet

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(as he knew the wind was to blow from the east, as artistically rendered in the Romance of the Three Kingdoms (三国演义), one of the four great classic novels of Chinese literature), but because of something else as seen from the following quotes: The July of the Autumn-tide, the Lord Cao marched south to fight against Liu Biao. Then Biao died in August. His son Liu Cong succeeded him and was stationed at Xiangyang, while Liu Bei, a relative of Liu Biao, was stationed at Xiangfan. In September, when Lord Cao arrived at Xinye, close to Xiangyang, Zong surrendered. Thus Liu Bei was forced to flee to Xiakou. Lord Cao’s army then advanced to Jianglin… In December, Lord Cao launched an attack against Bei who then fled to Baqiu… When the Lord’s army arrived at the Red Cliffs to fight with Bei it became quite unfavorable for him, as the plague prevailed and lots of his soldiers died. Eventually, Cao withdrew his troops. (Records of the Three Kingdoms – Records of Wei – Biography of Emperor Wu (三国志·魏志·武帝纪)) Sun Quan sent Zhou Yu, Cheng Pu and others to form an alliance with Liu Bei in order to counter-attack the Lord Cao at the Red Cliffs. At that time Cao’s army had just suffered this illness. Seconds after the battle began, Cao’s army retreated in defeat… Lord Cao then ordered the remaining boats to be burnt, and yet the deaths of more than half his soldiers were due to hunger and epidemic disease. (Records of the Three Kingdoms – Records of Wu – Biography of the King (三国志·吴志·吴主传)) (Liu) Bei and (Sun) Quan’s army, by way of both land and water, chased Cao’s army to the area of Nanjun. Cao’s northern army had to retreat because a pestilence appeared at that time and most of his men died of the epidemic. (Records of the Three Kingdoms – Records of Shu – Biography of the Late King (三国志·蜀志·先主传)) So Cao Cao’s army failed due to an epidemic — not due to the mistaken tactics — according to similar records of The Three Kingdoms period. Cao, in his letter to Sun Quan, also pointed out, “When at the Battle of the Red Cliffs, illness just happened (in my army). I purposely burned my boats and retreated, which unexpectedly resulted in Zhou Yu (the chief commander of Wu and Shu kingdoms) assuming a false reputation.” What a tragedy for such an ambitious man as Cao Cao!

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Mr. Li Yousong has inferred that the pestilence prevailing in Cao’s army might have been acute schistosomiasis.7 As mentioned above, there might have been some similarities with Sha Shi disease which prevailed at the same time. Schistosomiasis appeared along the Yangtze River as early as the Western Han Dynasty. This can be proved by the ova of schistosome found in the corpses of Mawangdui Tomb (a female) and Jianglin Tomb (a male). For ages, a water-rich area was a perfect place for schistosomiasis, which has been testified by tens of years of investigations. Immigrants were more likely to be infected, which most probably happened to Cao Cao’s troops. A glance at Li’s speculation does make some sense, but a fundamental problem is the season. Cao lost his battle in December, i.e., winter, not summer or autumn, which is far from the right time for a schistosome outbreak. So it really made sense when Ji Shirong, Tian Shuren and others argued against Li Yousong, with their Discussion on ‘A Probe into the Relations Between Cao Cao’s Defeat in the Red Cliffs and Schistosomiasis’ (对〈曹操兵败 赤壁与血吸虫病关系之探讨〉一文的商榷)8 and Tian Shuren’s Another Probe into the Relations between Cao Cao’s Defeat in the Red Cliffs and Schistosomiasis (也谈曹操兵败赤壁与血吸虫病之关系).9 However, when Ji presumed it would be malaria, he did not know that it could not break out in winter; Tian supposed it to be a typhus epidemic, which is more likely. Epidemic typhus fever, also named “war fever” or “famine fever”, whose etiologic pathogen is R.prowazekii, mainly prevails in cold areas or during cold seasons — so winter and spring are its peak time. People who were over-exhausted with weakened immune capability were vulnerable. In times of war or famine, this disease would largely break out — with names such as “war fever” or “famine fever”. As Cao’s troops had been marching south since July, by December, the whole army was fatigued after battles in different places, and winter was the best time for an epidemic “so, lots of soldier contracted the epidemic and died”. However, it is a pity that the symptoms were not listed in the records. Most probably, the symptoms of high fever, chills, coma and maculopapules on the skin (scarlet at first and could disappear when pressed, and later turning dark red, might be haemorrhagic spots, which could not disappear when pressed) were the exact 7

 Li Yousong, A Probe into the Relations between Cao Cao’s Defeat in the Red Cliffs and Schistosomiasis, Chinese Journal of Medical History, vol. 2, 1981, p. 87. 8  Ji Shirong, Discussion on ‘A Probe into the Relations between Cao Cao’s Defeat in the Red Cliffs and Schistosomiasis’, Chinese Journal of Medical History, vol. 2, 1982, p. 124. 9  Tian Shuren, Another Probe into the Relationship between Cao Cao’s Defeat in the Red Cliffs and Schistosomiasis, Chinese Journal of Medical History, vol. 2, 1982, p. 126.

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expressions of yin toxin and yang toxin. In 209, according to the Records of the Three Kingdoms – Book of Wei (三国志·魏书), Cao Cao, the King Emperor of Wei, said, “Our troops have marched out many times in recent years. Some of the soldiers got epidemic fever, died and never returned. Their families were deeply resentful and people were forced to leave home and wander about as refugees. What man of benevolence would be pleased at such a tragedy? Only we had no choice, we had to do it…” This tells us that epidemics prevailed during these years. Yet, the King of Chensi, Cao Zhi, the third son of Cao Cao, was a well-known literary writer and stated in his On Plague (说疫气), Pestilence prevailed in the 22nd year of Jian An (217). There were dead bodies in every family, it was so sad, people weeping and crying in several rooms of my own house. Some families lost all their members, while some patriarchal clans completely collapsed. Some believe the pestilence was launched by gods and ghosts. However those families who suffered the disease were mostly the poor who had only cheap clothing and lived in crudely built houses. Few of the rich with magnificent palaces, gorgeously attired and eating rich and delicate food, suffered this disease. This pestilence was actually caused by the breakdown of balance between yin and yang, and the season being out of order. Some foolish men hung magical figures and incantations up against this pestilence, how ridiculous! According to the former analysis, this would be epidemic typhus fever, as well. As for the poor, “when you’re covered in lice, you do not itch; when you’re up to your ears in debt, you stop worrying”, as the folk saying goes; so they were unaware that the insect was the carrier of exact etiologic and fatal factor. Cao Pi, the first emperor of the Wei, Cao Zhi’s old brother, also said in his Letter to Wu Zhi (与吴质书) that “In the past year, many of my relatives and old friends suffered from the pestilence. Xu, Chen, Ying and Liu, all died at the same time. What a bitter sorrow!” Here, Xu (Xv Gan), Chen (Chen Lin), Ying (Ying Yang) and Liu (Liu Zhen), four of the seven great writers of Jian’an, all died of epidemics which could have been the louse-spread typhus fever. Judgment must be suspended due to insufficient details of the symptoms. Yet there were in Ge Hong’s Handbook of Prescriptions for Emergencies in Sleeve (肘后方) descriptions such as the following: “when Wen-toxin causes spots on body, that is a serious epidemic pestilence, hard to cure”; “people

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who get Shanghan at the beginning would feel heavy in the whole body and have back pain, and constant internal irritation. A floating and rapid pulse, a red face with spots like brocade, a sore throat or diarrhea, or they become raving and want to run about; these symptoms show that the patient is attacked by a Yang-toxin which could be cured within 5 days; otherwise, they will die”; “if the patient feels heavy in his body and stiff in the back, suffering prickling pain just as if he had just been severely beaten, together with pain in both the abdomen and gastric area, short of breath, vomiting and a burning sensation, purplish lips and a dark face, cold limbs, with floating, thready, rapid and tense pulses, then he is attacked by a Yin-toxin which could be cured within 5 days; otherwise, he will die.” Thus, among them, the yang toxin patients suffered symptoms similar to that of typhus fever, while the yin toxin ones might have been suffering from epidemic cerebrospinal meningitis. His “warm-damp disease” might be epidemic haemorrhagic fever, due to both groups of symptoms being similar.10 There are also more descriptions in the Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方) which can be identified, than in the Neijing (内经), besides the acute infectious diseases mentioned above. Examples are as follows: “There was a yellow skin disease around in recent years. The patient felt heavy and uncomfortable in all the limbs at first, and then the white part of the eye turned yellow which expanded to a yellow face, and at last to the whole body. When passing urine onto a white piece of paper it immediately turned as yellow as huanglian (Rhizoma Coptidis), which meant toxic heat had pierced the inner body and immediate treatment was needed.” This is likely to have been acute infectious jaundice hepatitis — with an objective method of testing the urine’s colour using white paper. Other examples are as follows: Acute dysentery: “A toxic epidemic disease with heat and abdominal pain. And it has diarrhea… with endless purulent blood.” Acute tonsillitis: “a sore throat with swelling caused by an attacking toxic disease…” Malaria: It was recorded in many early documents including the Huangdi Neijing. It could be divided into “aged malaria” (chronic malaria), warm malaria, miasmic malaria (malignancy malaria), etc. and treated usually with Chang Shan (常山 Radix Dichroae), Chai Hu (柴胡 Radix Bupleuri), Qing Hao (青蒿 Herba Artemisiae Chinghao), etc. Using Qing Hao in the freshly picked form to treat malaria was firstly recorded in Ge Hong’s 10

 Smallpox also prevailed during this period, but this will be analysed in Chapter 14.

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Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve. The contemporary chemist Tu Youyou extracted Qing Hao Su (青蒿素 artemisinin) from freshly picked Qing Hao in 1972. She also proved its effect through experiments. Artemisinin was the only antimalarial medicine without the structure of quinoline ring recognized by the WHO and became a new medicine. Tu Youyou was therefore awarded the Nobel Prize in 2015. Rabies: “Being bitten by mad dogs, or zhi (猘): people who get rabies mean it will break out once every 7 days, but they will be safe after three lots of seven days (21 days) without rabies outbreaks. If it is still not present after a hundred days, they will be free of rabies.” This record made quite an accurate recognition of its incubation; it is similarly recognized in modern medicine that the incubation period takes from 10 days to 3 months. As to treatment, one must “extrude the toxic blood” from the wound first, then “kill the mad dog and take out its brain to apply to the bitten wound, and the illness will not relapse.” Generally speaking, this could be seen as a first attempt at creating passive immunity. Anthrax: “When skinning a dead horse, the man, if hurt by its bones, could be made seriously ill by the toxin attacking him.” Tuberculosis: “It (尸注 Shi Zhu) can be varied, changing from 36 to 99 types. The patient will in general feel cold then heat, strangury, fatigue and be listless, without knowing where the illness is exactly but feeling uncomfortable in every part of the body. So it gets worse after months, and years later they will die. Family members will be infected when he dies; later the whole family suffer greatly and all die.” This was the earliest detailed description of tuberculosis. Filariasis: This is also worth mentioning. “It is some kind of evil vascular disease caused by the bad spring and winter wind piercing the vascular collaterals, then blood stagnation in which they suddenly plump up into a scarlet color, shaped like earthworms… I always catch such a disease when I clamber through the mountains. A dose of Wuxiang Tang (五香汤) soup to drink and red bean cream put on it will take it out.” Here, the symptoms suggest acute lymphangitis. If it is “‘bad pip’ disease, patients suddenly have plumped-up things like pips in the vessels, large as plum stones, those small like a bean, which cause unbearable pain in the skin. The pips can move left or right a little and you can feel fiercely hot in the body and averse to the cold. This disease usually begins quite abruptly and its toxin in the abdomen can kill people. It is quite common in the south.” This could be lymphadenitis which

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is associated with an acute parasitical infection, at least in part. If the lymphadenitis takes place deep in the abdomen, it is most likely to be mistaken for an acute abdominal disease, because of its severity. Fan Xingzhun traced it back to what is described as zhong (尰) in the Book of Songs (诗经): “a filariasis with elephant-skinned legs”.11 He also stated that some kinds of beriberi produced swollen feet caused by filariasis. Other parasitic diseases like ascariasis (roundworm infestation) have already been fully elaborated on in Chapter Seven. Hua Tuo was a specialist in this kind of disease. In short, the periods until the end of the Han and during the Wei and Jin Dynasties were haunted by epidemics that broke out frequently; it was a period during which a great deal of epidemic and pestilent diseases were recorded in ancient China.

112.  Epidemics During and After the Sui and Tang Dynasties The overall frequency of epidemic outbreak in the Sui and Tang Dynasties, as well as during the Northern Song, was steady. Some were recorded in more detail during this period. Apart from the so-called “Nine Worms Disease”, diseases such as tapeworm, enterobiasis (pinworm infection), etc. received scientific recognition. For example, the General Treatise on the Causes and Manifestations of Various Diseases (诸病源候论) records, “The manifestation of White Cun-worm (寸白虫): White Cun-worm is one of the nine worms, white, small and flat with a length of one cun (寸). It manifests in diseases when the Fu and Zang organs are weak. Some say the cause is linked to drinking white wine and eating pieces of beef on sticks of white mulberry cooked over a fire, together with uncooked chestnuts.” “It also occurs when having raw fish and then yogurt immediately afterwards. When it happens, it damages your essential qi, causing pain and weakness in the waist and feet.” “If the worm in the body grew to one chi (尺), it would kill people.” “The White Worm delivers offspring, generation after generation. As they grow up and reach four or five chi, they kill patients, too.” One chi (尺) is equal to ten cun (寸), about 1.09 ft or 0.33 metres. Obviously, the White Cun worm here is a tapeworm with a total length of four or five chi, i.e., 1.3–1.6 metres. Each segment of the Worm was one cun long, and the cause was closely related to eating raw beef and other foods. This is just the character of a tapeworm. Its features had been described completely. 11

 Fan Xingzhun, New History of Chinese Diseases (中国病史新义), pp. 346–365.

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“The manifestation of Nao-worm (蛲虫)… With the small size and shape of a euplanaria (flatworm), it also causes pinworm and people fall sick because of the weakness in their Fu and Zang organs. If it worsens, it can cause various kinds of sores such as an anal fistula, acariasis, leprosy, ulcers, and so on. The Nao-worm is very tiny, the shape of a cabbageworm, and it usually stays in the large intestine causing hemorrhoids in most cases…” This description conforms to what modern medicine defines as enterobiasis. “Very much the colour of raw flesh, red-worms can cause peristaltic sounds when they move.” This might be hookworms which turn fleshy pink after sucking blood and cause discomfort. As for the “maw-worm, in the shape of toad”, which “causes vomiting and burping”, they might be fasciolopsiasis buski. And, “hui-worms” are without doubt roundworms. The disease of tuberculosis (TB) was originally named Zhu (注), Shizhu (尸注), Feishi (飞尸) or Chuanshi (传尸) in China. In Chao’s Treatise on the Cause and Manifestations of Various Diseases (巢氏病源), its name was changed to Guzheng (“bone-simmering”), which visually pointed out its syndrome: a chronic process piercing the bones, heat-like simmering and hard to cure. There were quite a lot of outbreaks of “bone-simmering” in the central plain according to the Book of Tang – Biography of Xu Yinzong (旧唐书·许胤宗传). At that time, people who got sick could not avoid dying and the disease would infect others, one after the other. None of the physicians could help. But it was said that Xu Yinzong could cure every patient. This story shows evidence of a wild and widespread prevalence of tuberculosis, starting in Sui and Tang dynasties; afterwards “bone-simmering” became common. However, to say Dr. Xu Yinzong could cure everybody seems an exaggeration. Manifestations of sores and maculopapules in the Key to Children’s Diseases (小儿药证直诀 edited 1107–1110) by Qian Yi, during the Northern Song Dynasty, were divided into five types: Manifestations of sores and macula-papules: children suffering from it had flushing and a dry face, bloodshot eyes, continual yawning and low energy, coughing and sneezing, and the limbs felt a little cold, slept more but always woke startled, with palpitations and fear at night. All these conditions were epidemic illnesses and can only be cured by warming and cooling medicines. Any abuses of the medical prescription, making it offensive or eruptive, must be rigidly avoided. Do not catch a chill or draught. There is one syndrome for each of

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the five internal organs: liver blister, lung abscess, heart spots, spleen rashes, and blackening of the kidneys. All these together are given the common term chuangzhen (疮疹 sores and maculopapules) and include chickenpox, smallpox, typhus fever, measles, etc. Chickenpox was never mentioned in the former medical books, while smallpox was categorized under pediatrics only after the Taiping Holy Benevolent Prescriptions (太平圣惠方), and as a major pediatric epidemic particularly by Qian Yi — which indicates that smallpox perhaps confronted quite strong resistance among adults. Measles had not been separated from Shanghan and Wenbing diseases in the Treatise on the Causes and Manifestations of Various Diseases (诸病源候论). In a General Discussion on Cold Damage (伤寒总病论) written by Pan Anshi (about 1042–1099), it was identified clearly as “Mazi” which “caused exuberance of internal heat toxin till the Zang-fu viscera were attacked and the remainder of the foul qi flowed up through the flesh tissues… There were two kinds of symptoms: one caused erupting macula-papules, called mazi, which was the result of a light toxin; the other made larger ones the size of a pea or bean, as a result of its severity…” Here, a clear distinction between measles and smallpox has been made. Both together were named zhen (疹 maculopapules), a term used by Qian Yi. “Mazhen (麻疹 measles)” as an independent disease was not adopted until the Measles Encyclopedia (麻疹全书) written by Hua Shou in the Yuan Dynasty, which also stated that it had another name “cu” in Jiangsu and Zhejiang Provinces. When the Complete Works of Zhang Jingyue (景岳全书) appeared it had a special chapter “On Measles”. This had been a long process and there must have been a better recognition and richer experience of this disease by then. On the contrary, we know it also must have been widely epidemic and quite common. Diphtheria seemed to have been epidemic during the Song Dynasty, as Pan Anshi said: “In 1090, from the spring to the autumn, people in the two prefectures of Qi and Huang suffered from acute Hou Bi (喉闭, suffocation) and nine out of ten died of it, some even died within half a day.” This must have be pharyngeal diphtheria or laryngeal diphtheria, or the like. In Zhou Mi’s What Folks Say in Eastern Qi (齐东野语) it was recorded: The Hou Bi disease was very acute and severe. Our predecessors told us of Zhangdaisan’s prescription, containing only the one medicine baifan (alumen or alum) which, however, did not work all the time. In 1241, when I escorted my parents back from Fujian province, I

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had seen lots suffering on this trip. The most terrible casualty was one family with more than ten members, all dying overnight. We were restless and unsettled the whole way, with the roads almost deserted until Nanpu, where an old physician taught me the prophylaxis — that is to put bluestones into a duckbilled-ladle grinding them into a fine powder, mixed with strong vinegar. Then the rest of our trip we would be safe. Yet still we were not sure whether it would really work, until my father took his position of governor in Linting. There, a senior soldier in the district, who had always been very restrained, suddenly burst into tears and stated: ‘My wife is old and now suffering houbi, and she has not had water or food for three days. I’m really worried she is dying.’ By chance some of the drug had been left over in the box, so we just gave it to him and told him how to take it. The next day, he came happy and knelt down in our court to thank us, and merrily said, ‘my wife began to vomit instantly she took the drug and after spitting out liters of adhesive sputum, she was completely well!’ Later the treatment was given to others and they all got well very soon. Yet real bluestone is so hard to get and health practitioners must always make a point of preserving some, for standby applications. Here, what Zhou Mi recorded might have been some disease such as diphtheria of the tonsils. Diphtheria, in its acute state, can cause marked hyperemia and edema in the tonsils and pharynx. The large sheets of swelling made it quite difficult to swallow and breathe, and could even suffocate the patient. Concurrent diphtheria myocarditis could also kill people. For patients with diphtheria, the symptoms usually include swollen cervical lymph node, accompanied by inflammation in the surrounding tissues, both of which caused a swollen neck like “the neck of a cow”, hence the names da tou wen (大头瘟 large-head pest) and ha ma wen (虾蟆瘟 toad-head pest) which occur in later medical books. Yu Chang in his Yuyicao (寓意草) said, “ha ma wen causes a swollen neck, throat paralysis and loss of voice.” So this was very much like cow neck diphtheria. Wu Youke, in his Treatise on Pestilence (温疫论), stated, “at that time many patients had something like acute parotitis; while some head and face edema. The disease with these symptoms is called da tou wen in the folk population.” Zheng Meijian described in the 1815 version of his Key to Throat Diseases (重楼玉钥), “a disease with white rot in the throat which was quite common, especially in children, and capable of infecting others,” and thus named it “white-twined

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throat”. So it seems that it was Zheng Meijian who made the first clear and comprehensive description of the classical symptoms of diphtheria. Pestilence prevailed during the periods of the Jin and Yuan, intertwined with the frequent wars. One most impressive description was made by Li Dongyuan (李东垣) in his Distinguishing Internal and External Injuries (内 外伤辨): In the Renchen year (1232) the title of the imperial reign was changed, and a curfew imposed in the capital city, because the enemy encirclement had lasted half a month, till the last ten days of March. After the siege was lifted, people almost all fell ill; no more than one or two in every ten thousand did not suffer an illness; and death and disease followed each other recklessly. The two gates of the capital city witnessed dead bodies sent out every day, and on average every gate up to two thousand, and no less than one thousand. Such events continued for almost three months. How could all these millions of people die of cold, or external injuries of the wind? Most probably, these people had been living in the besieged city with an imbalanced diet and clearly been injured through their travails. They were particularly tortured by frequent hunger and had an irregular life-style, not being able to keep warm etc. for about three months, which resulted in a long deficiency of stomach qi. Therefore, once they were over-fed, or hurt by a change, accompanied with improper regulation, they were actually close to death. This happened not only in Da-Liang city (i.e., Kaifeng 开封, the capital of Northern Song), but also in regions as far away as Zhenyou and Xingding (1213– 1221), such as Dongping, Taiyuan, Fengxiang, and so on, where none of the people there could avoid death through sickness or injury, after rescue came. I have seen myself in Da-Liang that some patients took drugs in order to sweat out the cold; some tried to aid it with croton-bean to bring on a fever; some drank Cheng-qi soup ( 承气汤) decoction to bring it out; but quickly, all of them were greeted by ‘chest binds’ (结胸 jie xiong) and yellowing skin. Then they took Xianxiong (陷胸汤) decoction or pills and Yinchenhao (茵 陈蒿汤) decoction together to repair the damage. This eventually brought death to them all. We cannot know how many people were in the capital Keifeng, but to say millions died in three months seems perhaps an exaggeration. But even so, there is no doubt there had been a serious pestilent epidemic in 1232.

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These epidemics were also recorded in the History of Jin – Biography of Aizong (金史·哀宗本纪): “In the first year of Tianxing (天兴元年 1232), pestilence prevailed in Bianjing（汴京, i.e., Kaifeng 开封). Within fifty days, the number of the dead bodies sent out of the city gates reached over ninehundred thousand, excluding all those who were too poor to afford a ritual funeral.” “In the first year of Zhenyou (1213), September, the Yuan troops besieged Bianliang (i.e., today’s Kaifeng in Henan Province) and when it became worse due to a serious pestilence, over a million people died, which was exactly what the empress had seen with her own eyes.” This is recorded in the History of Jin State – Biography of Empress Xuanzong (金史·宣宗 皇后传). The same thing happened again just twenty years later, and again. Considering the death toll of a million each time, there must have been quite a large number of people living in Kaifeng in those days — many might have come to the city to escape the wars, but the exact figure is unknown. Mr. Fan Xingzhun12 deems it to have been the Plague (or Black Death) which prevailed at that time. But there is lack of evidence for this. Li Dongyuan was living in the besieged city and had a chance to see with his own eyes and treat the patients himself, so he must have been very familiar with the symptoms. What is recorded above as well as in his other work A Treatise on the Spleen and Stomach (脾胃论) did not mention any symptoms of lymph node sores, hemoptysis, dermatorrhagia or blood stasis, or even the numbers of rats which died at all. If it was truly the plague, how could there be no clues to it? Li Dongyuan had mentioned in A Treatise on Spleen and Stomach (脾胃 论), some “heat diseases caused by foods, or fatigue” all focussed on such symptoms as aversion to cold, fever, pain in body and head, impairment of qi and deficiency in whole body, accompanied by stomachache, constipation, diarrhoea, etc. Acute cases would die within a few weeks or a month, contributing to a high death rate. Purgative methods usually would speed up the death and often brought on complications like “chest bind”, jaundice, etc. All these symptoms were much more similar to typhoid fever. Typhoid fever once occupied the second or third place on the billboard of disease with its fatality rate in China. It was a disease which could prevail all the year round and one could get infected by either water or food. Young and middle-aged adults were most susceptible and it was more likely to break out during wars, or during years of natural disasters. Its symptoms included aversion to the cold, headache, lack of strength, fever, together 12

 Fan Xingzhun, A Brief History of Chinese Medicine (中国医学史略), p. 183.

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with continuous fever, loss of appetite, polydipsia, abdominal distention, stomachache and constipation. A keen observation could reveal a few abdominal rose rashes, a relatively moderate pulse, hepatosplenomegaly, etc. The severe phase of the disease often met with a dull expression, loss of sense and deafness, or even delirium or coma. Deaths were often caused directly by fulminating conditions or complications such as enterorrhagia, intestinal perforation, myocarditis and toxic hepatitis. Complications usually arose in the second or third week, when the fever had gone and a good appetite was regained — to the extent that the patient, if a sudden meal was taken, would suffer enterorrhagia and intestinal haemorrhages. All these descriptions are in accord with the course of the disease mentioned during the clearance in Kaifeng, especially those occurring when taking in too much food. The symptoms of fatigue and feebleness both were also similar to those of idleness and indifference. Meanwhile, “chest bind”, jaundice and so on might be related to concurrent toxic myocarditis or hepatitis. Based on the above-mentioned descriptions, it can be deduced that the pestilences which Li Dongyuan had experienced and described were severe outbreaks of typhoid fever. It is not correct for Ren Yingqiu to say it was a “gastrointestinal epidemic”13 for there could not be such a high death rate caused by a gastrointestinal condition. Pestilences became quite common and varied during the Ming and Qing Dynasties. Diseases which had formerly been epidemic still occurred during this period; but there were also new ones coming in from outside China — and some old ones which became more epidemic and turned up more frequently, such as other plagues and cholera, which will be presented later. Another example was scarlet fever. In the Song Dynasty, there might have been descriptions of macular epidemics not identified as “scarlet fever” (called Lanhou Sha 烂喉痧), even until the Qing Dynasty. In Medical Cases Recorded as a Guide to Clinical Work, Ye Tianshi stated that “since the Quiqiu year (1733) of Yonzhen, the disease called Lanhou Sha had been prevalent usually at the end of winter, and at the beginning of the spring, and all, young or old, could be infected. When it breaks out, the patients would feel hot and have polydipsia, their skins turning red with maculapapules on the skin in quite profuse numbers, the throat swollen up and oozing pus” (quoted from Hua Juyin, Secrets of Experience and Treatment of Lanhou Sha). The Handbook on the Plague-Sha (疫痧草) written by Chen 13

 Ren Yingqiu, A Brief History of Chinese Medicine (中国医学史略), p. 139.

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Gengdao in 1801 is in reality a special monograph on scarlet fever and the epidemic which broke out several times during this time.

113. Conducting Textual Research on the Epidemicity of the Plague and Cholera Not only did some medicines disseminate into China from foreign lands but epidemic diseases also came this way. The former could be a kind of cultural communication — but the latter were a catastrophe. They triggered many troubles in healthcare, causing distress among the population and social upheaval, which then indirectly made an impact on the development of medical science. These incoming diseases are generally acknowledged to include smallpox, the plague, cholera and venereal disease. Plague and cholera are discussed here, with smallpox and venereal diseases in later chapters. The first plague (shuyi 鼠疫) epidemic accurately described in the history of World Medicine is presumed to be the Justinian Plague which broke out in the Eastern Roman Empire in the 6th century CE. According to the records it caused more than ten thousand deaths in Constantinople alone. However, 800 years later the plague took place again — the well-known historical “Black Death”, lingering almost 2 years from the summer of 1347. In 4 months, 42 million people died, and of these 25 million alone were in Europe.14 The famous novel Decameran (十日谈) dealt with stories during this period. Boccaccio (1313–1375), its writer, described the following: “in 1348, in the most beautiful city among all cities in Italy, the glorious Florence, a horrible pestilence broke out… people, who were infected by it, men or women, had tumours swelling up in the groin or under their armpits. The tumours gradually grew as big as even a small apple or egg, and were called by the common people a ‘pestilent tumour’. Within a short period of time, the omen of death, the pestilent tumour, soon expanded to other parts of the body. After that, the symptoms changed again. Maculae, black or purple, appeared first on the chest, legs and even other parts of the body. Sometimes in several clusters, quite sparsely distributed, but sometimes small and very close to each another. Either way, it was all the same, as the pestilent tumour in its early phase, was the omen of death… No matter how hard you tried various doctors and medicines, it was incurable… In daytime or at night, people regularly died on the roads. Many also died at home and 14

 Gerhard Venzmer: The Five Thousand Years of Medicine, Macdonald & Company of Publishers Ltd, London, 1972, pp. 122–123.

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their neighbors did not know it until the smell appeared from their rotting bodies… Corpses lay in the streets in every city… and at daybreak each day, dead bodies piled up in front of the door of every house… From March to July, in Florence one hundred-thousand people died.” Such descriptions of the terrible plague are typical and largely reveal the symptoms of lymphadenectasis — ending with death by toxemia or septicemia. Though this description is made by a writer, it was not an exaggeration at all. This plague was said to have appeared during the dry summer — related to the besiegement of Cafta (now Feodosiya, a seaport city on the southeast tip of the Crimea beside the Black Sea) by Tartar (i.e., Mongolian) troops. The Christians were on the point of surrendering. However, they found the Tartar troops had fled back from whence they had come, retreating completely overnight, leaving thousands of dead bodies. But before they moved off, the Tartars used their siege machines to catapult a number of corpses into the town. Refugees began to flee by boats, and they unwittingly brought the plague along with them to the rest of the Europe. In fact, Tartar troops were the first to catch the infection — for its birthplace was in Tartary in Central Asia. It was about the time of the end of the Yuan Dynasty in China, and between 1352 and 1359, there were several severe epidemics beginning first in the northwest and then reaching into the central plain. The symptoms were not recorded, but it is a reasonable supposition that this was precisely the plague, brought by the retreating Tartar troops. Xu Shupi in the Ming Dynasty stated, “At the start, the Geda Wen (疙瘩瘟) appeared in the imperial city. Because people who had it all bore blood lumps on their bodies, it had the name Geda Wen. In the spring of the Jiashen year (1644), it was rampant again in the central part of Wu. It had by then another name ‘Watermelon plague’ as the patients, every time, spat out blood as red as watermelon juice. They would then immediately die” (from the General Small Records 识小录). Such symptoms were similar to that of the plague. And yet, Zhu Xiao’s Formulary for Universal Relief (普济方), which was published in the early 15th century, also states, “The Seasonal Epidemic: Patients suffer the poison of a Geda tumour, which had never been recorded before in the classical books… In the years between Tianjun and Huangtong (1138–1153), people living in the countryside and mountainous regions were infected, quite a number; firstly in Linbei (north of Qin mountain), then Taiyuan (now the capital city of Shanxi Province in China), and finally in Yanji (Hebei province, more to the north) where it is now. People are infected by one another, and most of them die.” Therefore, we can assume

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that the time the plague broke out in China could be earlier than that of the Black Death in Europe, but further evidence is still required. Another serious type of infectious disease was the pneumonic plague, which was acute, with such toxic symptoms as high fever, collapsing, etc. Coughing and rapid breathing were both typical respiratory symptoms in the first phase of the disease; one or two days later, frothy bloody sputum in large amounts sprang up; in two or three days, the patient would die of heart failure with cyanosis over the whole body. Septicemic plague was much more acute and involved a high fever or even no fever at all, systemic poisoning and striking symptoms affecting the central nervous system accompanied by a tendency to systemic bleeding, causing death within hours or two or three days. What Wu Youke had described in his Treatise on Pestilence (温疫论) was also quite similar: “with this disease the patients either have macular spots, or sores or malignant boils or furuncles, and infect others giving them red and swollen eyes, or they vomit blood terribly.” There were also other names commonly used — such as guanian wen (瓜瓤瘟 melon-pulp pestilence) and tangtou wen (探头瘟 crane-neck pestilence), as well as geda wen. It is really hard to make a list of so many names. He also states, “regarding the guanian wen, or geda wen, some would die within a day, but some died instantly.” Therefore, we can be certain that the Guanian Wen or Tangtuo Wen Wu Youke is describing was indeed either the pneumonic plague or septicemic plague; but the geda wen must belong to the category of glandular plague. The only factor which we do not understand is that there were no records of troubles with or deaths of rats mentioned in the ancient documents. The plague among rats, was the natural focus of the epidemic, the disease first occurring among rats and wild rodents like marmots. It is then usually transmitted from wild rats to house rats. The fleas which bring the plague are mostly the “Indian rat flea”. After the infected rats died, the fleas would find other hosts such as the human body, which is then infected after being bitten. Glandular plague is, for the most part, the early phase of an epidemic which would trigger septicemic or pneumonic plague if not treated. Pneumonic plague could produce human-to-human infection via respiratory droplets and cause a sudden epidemic of primary pneumonic plague. Even those who breathed in infected dirt could catch the disease. Probably due to the rapid progression of the disease as well the terrible breakouts of humanto-human contagion, the initial rat trouble was overlooked, that is, until the years of Qianlong (1751–1811), when Shi Fan in Zhaozhou collected into

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his book his son Shi Daonan’s poem On Dead Rats (死鼠行), which contained the following lines: Dead rats in the west, Dead rats in the east, People were frightened like seeing tigers. For no days after the death of rats, Dead people piled up like a dam. … Corpses filled up everywhere, nothing living, Only bones left in the wind. Such facts are quite true, as can be proved by what was said by Hong Liangji in his Beijiang Shihua (北江诗话): At that time, the evil rats appeared in Zhaozhou. If those rats entered the house in the daytime they could be seen lying all over the ground and dying instantly, spitting blood. People who were infected by its qi, also died instantly… Within days, Daonan himself was dead of the evil rat disease, too. So it was rat plague that killed Shi Daonan shortly after he composed his poem. The Zhaozhou referred to here is the town Zhaozhou in Yunnan Province, now in the region between Xiangyun and Midu. It was recorded in the Heqing County Annals (鹤庆县志) that “in the thirteenth year of Qianlong (1722), rats brought plague to the people and it happened again the next year.” The plague recorded here broke out on the Sino-Burmese border and the plague was possibly from Burma — from whence it spread into central China. The Bamboo Leaves Pavilion Miscellanies (竹叶亭杂记) also has a record of this. Similar things happened again during the years of the Tongzhi reign, from 1861 to 1874. Yu Yue records, At the beginning of Emperor Tongzhi’s reign, Yunnan area had fallen into chaos… At the same time, a severe epidemic broke out. Before the pestilence came, house rats starting dying themselves for no reason… People who smelled their stink could hardly avoid falling ill. The disease, abruptly attacked them, causing swellings and lumps on the skin, hard as a rock, slightly red, and extremely distressing when

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pressed upon. The patients would suffer from fever and delirium. Some died in a day, and some the next day. Physicians were hopeless in giving out prescriptions… Those who did survive were only one or two out of hundreds and thousands of patients. The pestilence occurred in the countryside and spread to the cities. If one family had someone sick, tens of the neighboring families would migrate to avoid it. Yet still there were countless numbers who died on the roads and death was unavoidable. Sometimes the disease would take out every single member of a family. Houses were deserted, and no trace of people could be seen in some small villages… Some Yuannanese told me that they had seen all this, with their own eyes. Wu Zicun also states, “during the years of Tongzhi, the disease began in Annan and then spread to Guangxi and finally reached the seaside cities such as Lei and Lian. Then, again it prevailed in Fucheng, Wuchuan County.” (All the above quotations are from A Study on the Plague 鼠疫 抉微.) These descriptions are clearer and more exact — suggesting that this rat plague came in from Vietnam, as proven by Dr. Wang Jiming and Dr. Wu Liande in their book of A History of Chinese Medicine: “According to records keep by Catholic priests, this disease invaded the Manchen city of Yunnan in 1866.” Later, there were other plagues coming in from outside the country. In 1910, a plague, originating in Russia, prevailed in the three northeastern provinces of China. It was eradicated under Dr. Wu Lien-teh’s leadership, at the beginning of 1911. This is the first time a human being had vanquished the “rat plague” and so he gained the good name “Plague Fighter”. In the years 1941 and 1942, Japanese Air Force planes sprayed plague bacillus in the regions of Ningbo, Jinhua and Quzhou of Zhejiang Province, causing an epidemic plague in the three provinces of Zhejiang, Fujian and Jiangxi, and many people died. In 1945, a plague prevailed south of Harbin caused by the polluted leftovers of the Japanese Army Unit 731 after the Japanese withdrew, and again many Chinese died. Clearly, the last two plagues were caused on purpose by an aggressive imperialist bloc. That was a Japanese war crime, as they had used biological warfare. Of course, to be assertive and say that all epidemic plagues in China came from foreign countries is a bit arbitrary, but it is approximately the truth that the latter plagues certainly did. It was the same for cholera. Huoluan (霍乱) is a relatively ancient name and is recorded in ancient Chinese documents — but it is not an exact equal to the Cholera of

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modern medicine. It was defined in the following way in the Huangdi Neijing (黄帝内经): The clear qi stays in the Yin, while the foul qi in the Yang; nutrient qi circulates with blood in the vessels, while defensive qi retrogrades. When clear and foul qi mess up the intestines and stomachs, Huoluan occurs. (from the Lingshu – Five Disorders 灵枢·五乱) If you are heedless in keeping heat away then fever comes, a hot body, vomiting and diarrhea, and Huoluan appears. (from the Suwen – Liuyuan Zhengji Da-Lun 素问·六元正纪大论) These lines tell us that Huoluan was only a disease or “disorder in the intestines and stomach” with symptoms of fever, vomiting and diarrhoea. Luan means simply “out of order”, and appearing in the stomach and intestines in general is called Huoluan. In his chapter “A Diagnosis of Huoluan and its Treatment” in A Treatise on Febrile Disease (伤寒论), Zhang Zhongjing states, Question: what disease does the patient get when he suffers from fever, headache, whole-body pain, aversion to cold, vomiting and diarrhea? Answer: This is Huoluan which causes vomiting and diarrhea, and even when the diarrhea stops, the fever will come again. Huoluan, which brings the patient headache, fever and whole body pain, and fever causing a thirst for water, can be treated mainly by Wulin Powder. Such a disease, with headache and fever accompanied by vomiting and diarrhoea as its major symptoms, and in severe cases cold limbs and a weak pulse, could have been cholera but is more likely to have been some kind of acute or infectious gastrointestinal inflammation. Huoluan had been described in A Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方) as “caused mainly by improper diet, or eating too much cold and raw food together with something fatty or dirty, or fish kept in alcohol, when open to the wind and dew, or sitting outside while the clothing is thin, or sleeping at night without a cover.” Its symptoms included a cold body, vomiting, diarrhoea, thirst after vomiting or diarrhoea, depression, stomach pain, spasm and so on: “The prescription for Huoluan patients who suffer from spasms of the limbs, and sides of the chest… some severe cases could attack the genitals and must

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cause death if the privates are constricted.” Here, the symptom “spasms” seems to suggest cholera. The Qianjin Yaofang (Important Prescriptions Worth a Thousand Gold Pieces 千金要方) states that “what causes Huoluan is all related to food and drink, not ghosts and gods” and “the Yin and Yang diverge, and then turn into vomiting and diarrhea, a headache like it is broken, all the joints as if dismembered, with spasms in the whole body’s muscles. Though it not much to speak about the condition is a most frightful one, for at such a critical time it is as if one was on the brink of a chasm, and there is great risk in doctors treating it.” All these descriptions are true — especially in stressing its dangerous spasms; this Huoluan is the real cholera. Arcane Essentials from the Imperial Library brought together all the ancient texts on this disease, and later books mostly followed its example. According to modern medical science, Cholera is an epidemic, mostly related to diet, especially polluted water; in most cases, it firstly causes diarrhoea and then vomiting without nausea; the vomit can be as often as ten times a day with vomit like clear water or pig swill; the diarrhoea can be from several to tens of times a day or even more; the patients are usually dehydrated and prostrate, with muscle spasms, especially the gastrocnemius and abdominal muscle, and fall into a coma due to anuria; there will usually be no fever or stomachache, but the mortality rate is extremely high. Judging from the above-mentioned opinions from different sources, it can be understood that cholera existed in both the Northern and Southern Dynasties in China. In the west, this disease is named cholera and believed to break out mostly in tropical countries, especially in India. Therefore, in The Oxford Illustrated Dictionary it is termed “endemic to India” — meaning an endemic disease occurring in India. With the introduction of Western medical science, the name was transliterated as huliela (虎烈拉), later changed to Huoluan (霍乱), a phrase similar in sound and meaning. This made sense. However, it would be quite wrong to take all those illnesses named Huoluan in traditional Chinese medicine as cholera, even those whose names contain Huoluan which appear in the famous On Huoluan (霍乱论) rewritten in 1862 by Wang Shixiong. Such an intelligent person did not really describe any real choleras, but diseases such as heatstroke, acute gastroenteritis, severe diarrhoea, food poisoning, etc. Wang stated that “this summer I travelled where Huoluan, Choudu, and Fansha etc. prevailed. And the characters in Choudu (臭毒 bad smell and toxin) exactly tell of the causes of the diseases here.” However, it was really brilliant of him to realize

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that the epidemic of Huoluan in Shanghai was related to the wars, as well as to “the expansion of foreign businesses” so that “rivers in the suburbs were all full of dirt and filth, the water is foul and should not be taken”. What’s more, he also wisely pointed out that “each summer, the water in the wells should be disinfected with alumen and realgar… to relieve the poison in the water… and it is best to soak acorus root and dalbergia odorifera in the water vat” — all of which were effective methods of prevention. It was not until 1860 that Xu Zimo used “Diaojiao Sha” (吊脚痧) to name the real cholera in his On Diaojiao Sha and Its Formula 吊脚痧方论), in which he stated, It was between the summer and autumn of the xinsi year of Daoguang (1821) that the illness broke out and caused either vomiting, diarrhea or both — and symptoms also included stomach-ache, although some patients had no pain. After vomiting and having diarrhea several times, spasms of legs, or both arms and legs began. Some were quite twisted up. If the pain was deeper, the spasms were more severe. All the muscles seemed to disappear swiftly. Patients were short of breath and hoarse, the muscular regions of the leg reduced, a thirst for cold drinks, their whole body sweating but icy-cold and their pulses weakened into almost not being there at all. Some patients would die within half a day, or catch it at dawn and die at dusk. Even some would abruptly fall down while still walking along the roads; or sometimes people in service or doctors would die while dealing the patients. Doctors used all kinds of prescriptions and methods to treat Huoluan, but actually they could not save even one in a hundred… Xu was the first to describe the most typical symptoms in these accurate words. His work on cholera is a classic in Chinese medicine. However, it is still inappropriate to adopt Diaojiao Sha to distinguish it from Huoluan. Diaojiao means spasm of the legs and Sha means pest, and its sense is actually derived from a folk word for a kind of spasm called zhuanjin (转筋). According to research made by Dr. Wu Lien-teh (Liande), it was in 1817 that cholera first prevailed in China — when southern Bengal in India was attacked by cholera, which spread along the roads to the south of China. In 1820, while Britain raged war in Burma, cholera broke out and, following the sea lanes, attacked Guangzhou, then Ningbo and Wenzhou, and the following year triggered a widespread epidemic within China’s borders. This was what Xu Zimo had seen and it was also recorded in Chen Xiuyuan’s

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Really Easy to Learn Medicine (医学实在易), Wang Kai’s Sha Syndrome Encyclopedia (痧症全书), Wang Qingren’s Correction of the Errors in Medical Works (医林改错) and Lu Dingpu’s Medical Talks in a Cold Cottage (冷庐医话), as well as in the local annals such as County Annals of Kun and Xin (昆新两县修合志), County Annals of Nanhui (南汇县志) and the County Annals of Shanghai During the Tongzhi Period (1862–1874) (同治上海县志) put together by Fang Zhizhong. After that, in 1826, cholera once again spread into China from India and caused several widespread outbreaks, including one in 1842 when Britain sent allied forces from Britain and India to invade China. In 1888 and also in 1932, cholera again came from outside the country. All these outbreaks occurred within about a hundred years of the present day, and were related to the invasive movement of troops.

B.  The Evolution of a Theory of Epidemics Physicians over the centuries, aware of the harmful effects of ancient pestilent epidemics, their frequent outbreak and their serious consequences, actively sought new ways of containing them — thus creating the birth of new theories, among which was the idea of the “triggering (mechanism) of disaster”.

114. The Evolution of the Etiology of Seasonal Qi, Pestilent Qi and Other Qi Generally speaking, febrile infectious diseases were caused by the cold, but this was actually an attack by “wind”, in that “wind is the easiest cause of the many diseases” (Suwen – Yujizhenzang Lun 素问·玉机真藏论). “Wind” as a factor in infection refers to the abnormal qi of the seasons as it departs from its usual way, and thus can be called a“zeifeng 贼风” (wicked wind), which means it carries an inherent pathogenicity. In their folk thinking, people rightly called a cold disease “shangfeng 伤风” — “wind damaged”. They believed shangfeng to be a light condition, but shanghan was serious with high fever, and often fatal. The Neijing Suwen – On Fever says, “Nowadays a febrile disease is mostly of the shanghan type. Some are cured and some die. Death often follows after 6 or 7 days — while recovery has to be ten or so days later.” The Neijing sketches out a rough outline of a febrile epidemic. It was in the chapter on the Great Theory of Yin and Yang (阴阳大论) that a partial summary characterized how seasonal and abnormal qi acts as an inducement to a warm heat disease. But these writings had been long lost. Now we can

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only quote a few of the sentences from the Treatise on Cold Damage – Notes (伤寒论·伤寒例). Here, we read how febrile disease could be divided into two forms: (1)  The Seasonal Unhealthy Qi of Disease: This would cause many diseases, mainly Shanghan: “In winter people are attacked by cold and then get ill instantly — that is Shanghan. This is most dangerous because it is often fatal.” The formal name Shanghan was definite about this. However, “if people did not immediately fall ill but the cold toxin hid in the skin and muscles, then the illness would break out in the spring as a Wenbing (温病 warm illness). If the illness appeared in the summer, it would be a Shubing (暑病 summer-heat illness).” These warm and febrile diseases “were always caused by being attacked by the cold in deep winter, when the susceptible population were at their wearisome labor.” In the event that they “usually kept themselves in deep hiding during the freezing winter, they would protect themselves well, and would be able to ward off the Shanghan.” These are traditional descriptions of Shanghan, Wenbing and Shubing diseases. (2)  The Seasonal Qi of Disease: When an inappropriately placed qi (unhealthy qi) moved out of season, it was called “pestilent qi”. “Normally the spring weather should be getting warmer but suddenly it turns back to freezing cold; the summer should be hot but on the contrary it turns quite cool; the autumn should be cool but inadvertently becomes extremely hot; the winter should be cold but on the contrary turns warm. All these signify a qi coming at an inappropriate time.” “The seasonal qi does not come at the right season — or arrives before its corresponding time, or even comes with overwhelming force, all of which are the origins of a pathogenic qi.” These explain not only those damaged by cold, but also by the pestilent qi. According to the 24 traditional Solar Terms in China, people who are touched by frosty weather and dew during the period from Shuangjiang (霜降 Frost’s Descent) to Chunfen (春分 Spring Equinox) would get Shanghan, from being attacked by the cold, while inappropriate warmth flowing in the winter caused diseases such as Dongwen (冬温 winter warmth). After Lichun (立春 Beginning of Spring) the hidden cold emerges as Wenbing (温病 warm diseases). Unexpected sudden cold during the period from Chunfen (春分 Spring Equinox) to Qiufen (秋分 Autumn Equinox) would cause seasonal cold epidemics — “these diseases possess symptoms similar to Wen and Shu Bing but they have their own counteracting differences.” All in all, “in the same year, if young and old get similar diseases it is what is called ‘seasonal qi’. Infants who catch it must come out in many rashes. The treatment shall

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be made according to where the strongly toxic qi lies — on which Channel — and each special illness is to be examined carefully.” From this, we know that here the concept of febrile disease was different from the one earlier. The above could be deemed an outline of the causes of warm febrile epidemics. They occurred mainly according to the season; solar terms and intermittent periods then gave different names to the pestilence. That Zhang Zhongjing quoted these words means he accepted them. Actually they boosted many theories, made by different schools, in the centuries that followed. We should acknowledge that this was a new theoretical summary, made by the author of The Great Theory of Yin and Yang (阴阳大论), new conclusions drawn from the obvious connections being made with the frequent outbreaks of epidemics not being confined to the winters and springs at the end of Eastern Han Dynasty. However, Ge Hong tossed out a contrasting idea concerning their etiology, in his Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方): Shanghan (伤寒), Shixing (时行) and Wenyi (温疫, pestilence) epidemics are all of the same kind, only their origin is a little different. In winter if people are attacked by the cold, or labor so hard then they sweat, while the cold wind pierces their bodies, but the problem lies hidden until summer. Then the cold breaks out into a disease that is called Shanghan. If they are not attacked by the cold in the winter then, when the warmer west wind makes the body weak and heavy, the illness breaks out in spring — when it is called Shixing (时行 seasonal). In some years, there is a Liqi (疠气 pestilent qi) along with ‘ghost toxins’ going around, and infecting others (xiangzhu 相注), which is called a Wenbing (温病 warm disease). All such similar conditions go under one elegant name — generally Shanghan — while other folk commonly call them Shixing (seasonal). Yet their treatment is the same — either by Taoist skill or magic figures or incantation, these so-called five different kinds of wen (瘟 pests), can be taken care of. However, they are also different ideas regarding the channels affected, the yangming, shaoyin, and yin and yang toxins. Shaoyin diseases, which usually do not cause fever, but abdominal distension and diarrhea are the most difficult to treat. Ge Hong’s idea of there being “several names for one thing” and the difference between Shanghan and Shixing epidemics lies simply in a difference

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between the “elegant” and “vulgar” in their naming; what does matter is that the Wenbing (warm epidemic) “along with the Liqi (疠气 pestilent qi ‘ghost toxins’) is going around, and infecting others (xiangzhu 相注).” What does require a physician’s attention is when it starts to break out, that is, which Channel is affected and what kind of symptoms. Thus, Ge Hong had in fact touched closely upon the theory of there being one cause for an infectious, febrile epidemic disease, i.e., “Liqi theory (疠气说 the theory of pestilent qi)”. In particular he pointed out that the Liqi which caused infection was “transmitted to others” (xiangzhu 相注). This was really a penetrating analysis. However, it is a pity that Ge Hong, in his Handbook of Prescriptions for Emergencies to Be Carried in the Sleeve (肘后方), did not develop his theory further; he did not improve his theory of Liqi and “transmitting pestilent qi”, while his book is still messy in classification. As a result, his theory of pestilent qi was not carried on. Almost one hundred years later, Chen Yanzhi in A Sketch of Formulae (小品方) criticized Ge Hong’s theory, and again upheld views put forward in the Great Theory of Yin and Yang (阴阳大论) chapter. Then, there appeared Chao Yuanfang’s Treatise on the Causes and Manifestations of Various Diseases (诸病源候论) which as a collective book, took in everything — and classified them into Shanghan, Shiqi, Rebing (热病 fever), Wenbing and Yili (疫疠 pestilence), altogether five categories. Yet, in its general outline it copied and followed the Great Theory of Yin and Yang (阴阳大论) and there was lots of duplication. For example, under the category of “Yili disease”, it said, “This disease, similar to Shiqi, Wenbing etc is caused in a single year, when there is disharmony in the seasons, distorted winter cold or summer-heat, either storms or heavy rain, or the fog and mist do not dispel — which makes people sick or suffer an epidemic irrespective of age. Usually the symptoms are alike — it just seems as if they are being tortured by some Guaili qi (ghostly pestilent qi). Thus it is called a Yili (pestilent) disease.” Here, the term “ghostly pestilent qi” is taken from Ge Hong. It also had a similar sense to the Shixing qi (时行气 seasonal qi) mentioned in the Great Theory of Yin and Yang (阴阳大论). But in Chao Yuanfang’s case he also called it a Guaili Qi (乖戾之气 perverse qi), putting it in the category of Shanghan, Shiqi, Rebing, Wenbing and Yili diseases. Cao also pointed out the features of “infection”, as well as the possibility of “avoiding infection”: Keeping Shanghan patients away from infecting another: with a Shanghan patient, if on his own a cold-toxin qi it will not infect

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another person; but if he catches it through the disharmony of the year, there is a distortion of warm and cool, he may be attacked by the Guaili qi and then start an illness, and it is more likely to infect others. Therefore, people have to take preventative medicines and use skills to prevent this. Keeping Shiqi patients away from infecting another: Shiqi epidemics, they are all because in the disharmony of the year there is a distortion of warm and cool. Patients are attacked by the Guaili and always likely to infect others, therefore they have to take preventative medicines and use skills to prevent this. Keeping Wenbing patients away from infecting of another: This is all because of the disharmony of the year which brings a distortion of warm and cool, and the Guaili qi attacks people which means they must infect each other — not only killing the whole family, but also spreading to outsiders. Therefore you have to take preventative medicines and use skills to prevent this. According to the above, Chao’s theory may be called the “theory of Li qi” (or “theory of Guaili qi) as it causes pestilences to break out and infect others during a disharmony of the year and season. Meanwhile, Chao Yuanfang made unprecedented progress both in describing infection and in the idea of prevention and methodology. He also divided Shanghan into two types: one type capable of infection and the other incapable of infection (in fact we should say just has a lower possibility of infection), while the other pestilent qi were all infective. The theoretical progress made by Chao Yuanfang was actually a result triggered by the outbreaks of pestilence during the Wei and Jin Dynasties, as well as the development of a variety of theories and opinions. During the prosperous Tang Dynasty, neither Sun Simiao nor Wang Tao made great changes to Chao’s ideas, except for some modifications in his categorization — for instance, changing “Shiqi” into “Tianxing” (天行 heavenly moving qi) and categorizing jaundice as a Wenbing disease. But they added some prescriptions to get rid of Yi-qi (疫气, pestilent qi), Wen-qi (温气), Wenbing (温病), etc. It was a real pity that Wang Tao did not recognize the important of the feature of infection. Later during the Song Dynasty, the study of epidemics made little further progress. During the Jin and Yuan Dynasties, the theory of Wuyun Liu Qi (the Five Circuits and Six Qi) was what most learned physicians focussed their time on, and I will describe this in the next section. Anyhow, Li-qi theory

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attracted little attention, that is, until the end of the Ming, when Wu Youke (1592–1672) again raised the banner of the theory of Li-qi causing pestilences, and made great progress in describing its specific features. Seeing that pestilence attacked his home­ town, Wuzhong (in the middle of Jiangshu province) but there were no potent formulas for treating it, he wrote A Treatise On the Febrile Pestilence (Wenyi Lun 温疫论) which drew upon the theories of his predecessors, and proposed a comprehensive theory of epidemics, founded upon his own personal clinical experience. He said, “The Wenyi (febrile pestilence) is not caused by the wind, cold, summer-heat, or damp, but by another particularly strange qi lingering between heaven and earth. There are nine ways in which it passes and changes. They are the key points in dealing with a pestilence, but what a pity that until today, no one ever discovered them. Zhongjing, although he wrote his Treatise on Febrile Disease (伤寒论)… was only describing externally contracted febrile diseases, which have a way of passing and changing totally different to Wenyi. As for later generations, although there were any number of schools, all adopted the scope of the Shanghan — quite omitting the symptoms of Wenyi epidemics. So what these working physicians wrote and read about in their piles of books was all in fact related to Shanghan; while, through their clinical experience, we can see that the symptoms were in fact those of Wenyi epidemics — and the real Shanghan only occupied perhaps one or two in a hundred. Although ‘having skill enough to catch a dragon, they found nowhere to apply it, mistakenly making the deer out to be a horse!’” The truth is that both Ge Hong’s “theory of Li-qi” and Chao’s descriptions of the causes of disease never occupied a predominant position, although in fact they had even then raised the idea of the pathogenesis of epidemic febrile disease to a fairly high level. The book a Treatise on the Causes and Manifestations of Various Diseases (诸病源候论) only contains theories of manifestation and no prescriptions, which was far from sufficient for clinical practice. Sun Simiao, Wang Tao and especially the school of Shanghan during the Song Dynasty were all devoted to spreading or recovering the original form of Zhang Zhongjing’s Treatise on Febrile Disease (伤 寒论). As a result, that which indeed dominated traditional Chinese treatment of clinical fevers was still the Treatise on Febrile Disease (伤寒论). At that period “Shanghan” actually referred to Shang Feng (伤风) disorders, mostly upper respiratory infections, largely due to wind and cold with weak infectivity — and not serious enough to cause a pestilent effect. However, the opposite was the case during the end of Ming and beginning of the Qing dynasties. It was a period when pestilence broke out widely, and this was

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why Wu Youke wrote in his book that what physicians “wrote and read about in their piles of books was all in fact related to Shanghan; while through their clinical experience we can see the symptoms were in fact those of Wenyi epidemics.” Therefore, there was an urgency for a breakthrough, both in theory and clinical treatment. When pestilence broke out, people died through the futility of those physicians’ treatment with Shanghan prescriptions. Wu Youke, stirred by this, realized that these Wenyi epidemics were not Shanghan, but caused by a kind of “particular strange qi”, which uprooted the prevailing etiological theory of the Six Qi from thousands of years ago. It was quite correct that after one thousand three-hundred years, Wu brought people back to the original theory of Ge Hong by stating that “Both Shanghan and sunstroke were caused by the common qi of heaven and earth; and pestilence by the Li-qi which was more or less different in different years, according to the Yun-qi (moving qi); and it could also differ — being thick or thin, strong or weak — according to season and place. However, everyone, young and old, strong or weak, would fall ill confronting this qi… Some caught it directly from heaven, some by infecting another. But although they caught it in different ways, it was one single disease.” Wu Youke made a further conclusion that Li-qi was actually one of the “Za-qi (杂气 Miscellaneous qi)” which, occurring in different ways, could cause different diseases that could by no means be treated as one. The great contribution made by Wu Youke in the field of epidemic research was that his “Theory of Miscellaneous Qi” overturned all the one qi causing disease theories, such as the theory of Liuqi (the Six Qi), of Shiqi (Seasonal qi), of Li-qi epidemics, pointing out that there must be distinctions between the qi causing the disease, if the symptoms are different. The epidemics he mentioned, such as mumps, diphtheria, cholera, typhus fever, plague, poliomyelitis, epidemic cerebrospinal meningitis, erysipelas, dysentery, encephalitis and so on, according to modern science, are caused by different viruses or bacteria such as the mumps virus, polio virus, diphtheria bacillus, vibrio cholerae, yersinia pestis, etc. It is a pity that without a microscope or other tools to help, Wu Youke could not go further into recognizing such bacteria or viruses as causative agents. Despite this, Wu Youke, a keen clinical observer, noticed the differences between man-to-man epidemics and epidemics among animals, or between man and animals, which bore the specific features of species and genus selectivity. He pointed out that “Cows suffer from this epidemic but sheep do not; chickens suffer but not ducks; humans suffer but not animals. We should search out the reason that different pestilent qi’s damage different

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objects.” What is more, he also saw that epidemics spread sporadically. There might not be a full-blown epidemic, but the symptoms were the same. There would be more twists and turns in the development of epidemic theory in China, but there now opened up a new road for the development of theories of febrile pathogenesis (“the theory of the fire and heat mechanism”), of internal injuries and so on, all of which had a larger influence than those of Wu Youke, during that era of Chinese medicine.

115. The Impracticality of Ancient Prescriptions for Curing New Diseases, the Theory of the Fire and Heat Mechanism, and the Theory of Attacking the Pathogenic Qi The theory of Wuyun Liu Qi (五运六气, five circuits and six qi) prevailed in the Northern Song Dynasty, marked by A Probe into the Mystery of the Theories of Moving Qi in the Suwen (素问运气论奥), finished in 1099 by Liu Wenshu. Liu, who worked for the medical bureau, was a high-up public figure in medicine and wrote this book with the aim of popularizing the theory of the five circuits and six qi. But it was really Liu Wansu, a physician, who adopted the theory of the five circuits and six qi to explain epidemic pathogenic theory. Liu, born in approximately 1110 and dying in 1200, was also named Shouzhen, with the self-made title of Tongxuan Chushi (“the scholar who penetrated the mysteries”). In his hometown of Hejian, Hebei province, he was also called Liu Hejian. He declined Emperor Zhangzon’s requests to serve in the Jin Dynasty government three times, and then devoted himself to medicine. Shocked at the unnecessary deaths brought about by using inappropriate remedies, such as strong warm and dry medicines for febrile epidemics, derived from the government’s own Hejijufang (Formulary of the Bureau of Pharmacy), he studied the nineteen categories of pathogenesis using the theory of “moving qi” (yunqi 运气) — and extracted out the two characters “fire” and “heat” as the key to febrile epidemics. Such was the prevalence of febrile epidemic disease at that time that it forced Liu Wansu to find new lights among existing theories. Without a thorough penetration into and understanding of the “five circuits and six qi”, he would never have done this. For example, in his Explanation of the Mysterious Pathogenesis and Etiology of the Plain Forms of Disease in the Suwen (素问玄机原病式), completed in 1186, he says the following: Wind, originally born of heat, takes heat as its basis and shows its sign in wind. So speaking of wind, speak of heat. Where there is

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heat, there is moving wind… it is having too much so-called wind qi which causes the feeling of dizziness or floating, that is because of exuberance of the ‘wind and wood’ qi. The reason behind this is that the weakened gold cannot restrict the wood, so the wood then again produces fire. Both wind and fire belong to Yang which is in charge of movement. The competition between the two, moving in opposite directions, creates a spinning. Heat causes shortness of breath with a loud noise like asthma. Fire and heat both belong to the Yang, which controls acute conditions. Too much heat in the stomach causes vomiting, which is a symptom of the fire flaring up. Too much pent-up heat can change the symptom to aversion to cold, that is, into liking warmth. This so-called ‘sthenic’ (hyper) function then causes harm, and it has to be drawn away and inhibited. So the extremity of Yang turns out to be like Yin. Liu Wansu tactfully used the principle, “harmful hyper-function has to be drawn away to be inhibited”, and made a one-to-one correspondence between the lines describing the 19 categories of pathogenesis (in the Suwen) and the sequel of five circuits and six qi, resulting in a conclusion that “the six qi can all be transformed by fire”. In this way, the Theory of Heat Pathogenesis was created. As for treatment, cold and cooling medicines naturally come to the fore. Hence, the school of cold and cooling medicines was established. From a theoretical aspect, Liu Wansu’s book was full of loopholes, or can even be said to be made up or just hearsay — which would make it exactly opposed to the theory of five circuits and six qi. But the interesting point is that on the one hand, Liu had a firm belief in himself and was unaware of his theoretical flaws and on the other hand, when febrile epidemics prevailed, the newly prescribed cold and cooling formulae, such as Double Dissolution Powder (shuangjie san), and others did work — and even sometimes could avert a seriously ill condition. Therefore, the Hejian school rose to fame, and Liu Wansu was regarded as an eminent physician of the time. Zhang Yuansu, Liu’s contemporary, but a little younger than him, was born in Yizhou, in today’s Hebei province, and also called Jiegu. At the age of eight, he took the imperial examination for qualified children under ten; but aged 27, he was dropped from the Jinshi imperial examination, the highest for a successful candidate, because of his violation of using similar names as the late emperors. So then he shifted to medicine, but still made no name for himself. One day, he learned that Liu Wansu had been seriously ill with

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a Shanghan condition for eight days, suffering from “a headache, tight pulses, vomiting, and loss of appetite. Liu had no idea how to heal it himself. Yuansu then went to visit him, but Liu turned to face the wall and ignored him. Yuansu asked, ‘How could I be treated in such a despicable way?’ Then it was agreed he could feel the pulses and he said, ‘The pulse and disease are such and such.’ Liu answered, ‘Yes.’ ‘Have you taken medicines first?’ The answer was ‘Yes’. Then Yuansu says, ‘You have been mistaken. That herb is cold which helps the sinking action and goes along with the Taiyin Channel. As the weakness of Yang is very great, you could not sweat. Now that your pulse is just like this, such-and-such a medicine will be effective for you.’ Wansu was very convinced and followed his suggestion, and immediately recovered. After that, Yuansu became famous” (History of Jin – Biography of Zhang Yuansu (金史·张元素传)). Clearly, Zhang Yuansu criticized Liu Wansu’s prescription of cold medicine and took the opposite view in their academic argument. Such was the only face-to-face dispute recorded — when there was ushered in the contention of the so-called Four Great Schools of the Jin and Yuan Dynasties. The truth is that Zhang Yuansu did not really place less emphasis on the theory of five circuits and six qi. He finished his Medical Origins (医学 启源) in about the latter part of the 12th century, and Professor Ren Yingqiu in his preface to his 1964 edition of this work points out, “(Zhang Yuansu) not only absorbed the complete contents of Liu Wansu’s Explanation of the Mysterious Pathogenesis and Etiology of Plain Forms of Disease in the Suwen (素问玄机原病式), but also expanded the theory of the five circuits and six qi into the field of making prescriptions with medical herbs. He divided his prescriptions according to the six qi, i.e., wind, summer-heat, dampness, fire, dryness, and cold; and his medicines were categorized into the five circuits, that is wind upward moving and generating growth, heat floating and growing, dampness ripening and completing, dryness falling and withdrawing, and cold concealing deeply. What’s more, he created prescriptions based on the hypostasized five-element system of wood qi involved the liver, fire the heart, soil the spleen, metal the lungs, and water the kidneys, and developed concurrently two prescriptions, to explain this: a ‘pain-reducing angelica decoction’ and a ‘gastrodia-tuber pinellia decoction’. So it is obvious that while Liu Wansu’s used the theory of the five circuits and six qi to probe into the pathogenesis of the six qi, and create an etiology of disease, Zhang Yuansu used the same theory for writing prescriptions, and the making and usage of medicines. Comparatively speaking, Liu and Zhang differ from one another and, though linked in

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their influence were not equal in their approach. Yet, from his use of the pathogenic mechanism of chills and fevers, and a deficiency or excess in the zang-fu organs to make a pattern diagnosis, and from understanding the transforming effects of the five circuits and six qi which making prescription medicines, there is enough here to see the general pattern of Yuansu’s academic thought.” One of Zhang Yuansu’s famous sayings goes as follows: “The moving qi is always out of order, ancient and modern follow different tracks. Therefore ancient prescriptions cannot totally suit new diseases” (A Biography of Jin History 金史本传). This shows that he preferred being flexible and in accordance with symptoms to making prescriptions under the general major premise of the five circuits and six qi. In his Medical Origins (医学启源), he states his opinion on Treatment Guidelines (治法纲要): “The prescriptions made by our predecessors and their methods were actually appropriate for the diseases of that time. When the later generation adopts the same prescriptions, they should make some additions and deletions according to their feeling of the pulse, otherwise, there will be no effect. It is not that I despise my predecessors or am self-willed. It is because the five elements are a system which contains mutual restriction and interaction as both cause and effect; which means that generating and transforming, it often diverges from its normal order, due to the time. In fact, the method of feeling the pulse and making a prescription are the same as those of the ancients. Those of you who think what I’m saying makes sense, should take my advice.” He also said, “Later generations using ancient prescriptions must feel out what the good points are and be very clear on their essence; then mistakes can be avoided.” So we can understand that the difference between Zhang Yuansu and Liu Wansu lay only in their viewpoint. Zhang upheld not only the mechanism of “just fire and heat” and treating all fire and heat diseases with cold and cooling medicines but also flexibly differentiating between them and applying the appropriate treatment. All in all, Zhang became an admirer and flexible user of the theory of five circuits and six qi. However, because of this discrepancy, Zhang Yuansu is categorized as being from another school; the Yi-shui school, as he was from Yi county. Born in Kaocheng, Suizhou, today’s Shangqiu city, Henan province, Zhang Congzheng (1156–1228), another follower of the Hejian School, whose other name was Zihe, was a more radicalized medical exponent than Liu Wansu. Rigidly referring to and “sticking to the ancients” were what he most severely despised, while the meaning of “ancient prescriptions not

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totally suiting new diseases” was more to his interest. In his academic opinions he made further progress on the basis of Liu Wansu’s usage of cold and cooling medicines — and evolved a theory of “offensive precipitation” and deemed the method of treatment to be “sweating-vomiting-purging”. He believed that “diseases are not born inherently, but caused by an evil qi — either from outside or inwardly generated. Whenever an evil qi encroaches on the body, immediately the body can attack it.” This view tactfully took the “evil qi” as an extra something outside the body or something generated within, a pathogenic factor or product, as in the theories of Li-qi and Za-qi pestilence. Zhang Zihe was exactly correct in his logic when he believed an evil qi could be offensively driven out the body, through the methods of sweating, vomiting or purging. What’s more, he looked dialectically at the relationship between the healthy qi and evil qi, stating that “first attack the evil, after the elimination of the evil the original qi will recover itself.” Even judged from the viewpoint of modern medical science, this is correct. Those who criticized him later were probably overly conservative — and while they believed there was good in the counterattacking methods of sweating, vomiting and purging, these might not alone drive out the evil qi. In brief, the Four Great Schools of the Jin and Yuan all contained revolutionary spirits. Zhu Danxi, from the Hejian School, also held the view that “using ancient prescriptions for present-day diseases does not work at all.” Therefore, he made contributions in theoretical research and triggered a great expansion in clinical technique. In short, the frequency and complexity of the pestilent diseases during the Jin and Yuan Dynasties pushed physicians to think of some new angles, which would have been unimaginable in a time of peace.

116.  The Theory of Internal Injury and Yin Syndrome Theory It was during this time that epidemics ran riot — while new theories were also burgeoning at the same rate. Li Dongyuan’s “Theory of Internal Injury” was put forward in this age, and met the criteria. Generally speaking, the prevalence of epidemics lured medical people to pursue and construct theories more out of external causes, exogenous pathogenic factors, out in nature. However, Li Dongyuan on the contrary, tried to seek the cause of a disease from the perspective of “internal injury”. As a follower of Zhang Yuansu, the founder of the school of Yishui, Li learned from his Medical Origins (医学启源) and was profoundly influenced by such principles as “ancient prescriptions for present-day diseases does not work”. He was

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inspired by Zhang Yuansu’s view on pattern diagnosis, through using the zang-fu viscera and created a Theory of Internal Injury. His theory was triggered by witnessing a severe outbreak of epidemic fever during the clearance in Kaifeng, an outbreak which caused millions of deaths. I have also quoted him in section 112: “How could all these millions of people die of cold or external injuries of wind? Most probably these people had been living in a besieged city with an imbalanced diet and needless to say they clearly were injured by their hard labor. They were particularly tortured by starvation and an irregular life-style, cold and warmth, and homelessness etc., all of which lasted two or three months, resulting in a long-time deficiency of stomach qi. Consequently when they were overfed, the contraction of the stomach could hurt them; and without appropriate treatment, death was unavoidable.” Such were his motives and the factual basis on which he wrote his Identifying the Puzzle of External and Internal Injury (内外伤辨惑), which was finished in 1247. His ignorance of the severity of epidemic qi might be criticized by the modern world, but what is true is that traditional Chinese medicine had always placed great emphasis on social ecological factors as well as natural ones, and the relationship between damage to the healthy human qi and the disease pathogenesis. Therefore, from this angle, Li’s theory was truly original and creative. Therefore, his logical analysis did make some sense. In short, his Theory of Internal Injury was a summary of his clinical experience as he had been through the epidemic and had experienced treating common febrile diseases after the pestilence. Yet as he did not discriminate between disease entities, specific states of different diseases, or between sporadic cases after the epidemic and diseases encountered during the pestilence, in some ways, the parochialism based on his experience caused a misconception. Probably his Theory of Internal Injury as well as his methods of nourishing spleen qi and relieving fever with sweet and warm medicines could not work during an epidemic. However, he still quoted from classics such as the Neijing to justify his theory — based especially on theories of the five circuits and six qi. Thus, both the theory of “internal injuries” and “spleen gastric theory” were interpretative. This was a queer combination but also a common way of thinking for physicians. Li’s main contribution was not in the field of infectious diseases, but in the treatment of general internal disease, and it was surely of pioneering significance. Based on this theory, Wang Haogu (1200–1264), Li’s fellow student, another disciple of Zhang Yuansu, who took Li as his mentor after Zhang died, developed another theory of Yin Syndrome. In his On Yin Syndrome

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(阴证略例), which he finished in 1236, he stated that “since there are methods of draining the precipitation of the Three Yin, there also must be methods of supplementing them. Therefore, I would very much like to find such a formula in Zhang Zhongjing’s book, as people would not think much of a method if Zhongjing had not presented it; if they knew that it was Zhongjing’s formula, everyone would understood that the Three Yin could be treated in a separate way.” He also stated, “some people get inwardly hurt drinking cold drinks as their Yang qi vaporizes within. A cold body and limbs together with a deep and thin pulse are all symptoms of Yin Syndrome, which can be easily diagnosed. If a patient with a warm body and limbs, a heavy head which cannot be held up, a pulse floating on the surface and stringy, but so weak when pressed down on that the doctor can hardly notice it, just adopts medicines of exterior effusion or double strong potions to bring out the cold through making them sweat, this will cause the qi to empty out the Sanjiao (三焦 triple-warmer). In this way, many will be killed.” These opinions were both an extension of Li Dongyuan’s theory of internal injuries and a compensation for the weakness of the Hejian school, which commonly misused cold medicines in treating this condition. Wang said that the essential mechanism of Yin disease was “that when the patient becomes weak with an already hidden Yin disease within and there is a concerted cold attack outside as well, then having disorder both within and without makes it incurable.” Such an opinion really required keen insight. In creating new schools of theory, Li Dongyuan and Wang Haogu also opened up new fields of clinical treatment. One thing especially must be pointed out — that Li Dongyuan made a profound contribution with his theory of injuries to the spleen and stomach, by helping the proper establishment of a theory of original qi (vital qi) in Chinese medicine and its practical use in treatment.

117. The Theory of Epidemic Febrile Disease Put Forward by Ye Tianshi and Others The separation of the Wen-Bing School (温病学派 school of epidemic febrile disease) from the Shanghan School (伤寒学派 school of cold damage disease), although of great importance, nevertheless progressed with some initial difficulty. This is because people all worshipped the ancients and everything had to be “according to the canon”, especially since Zhang Zhongjing was acknowledged to be the “medical sage”. It seemed that any

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discussion about “heat disease” was “departing from the classics and rebelling against orthodoxy”; in other words, a heresy of medical science was being formed with no basis in the theory of “cold damaged diseases (Shanghanlun)”. In fact, Ge Hong, Chao Yuanfang and others had already stated that febrile diseases could not only be perceived of as “getting hurt (i.e., shang) by the cold (i.e., han)” but also as being infected by a kind of Li-qi (epidemic pathogen), or some peculiar and abnormal qi. In reality, the diseases and syndromes of the Taiyangjing (太阳经 Greater Yang channel), which occupied a large part of the Treatise on Cold Damage (伤寒论), had long ago been relegated to secondary position. The severe prevalence of epidemics during the time of the Jin and Yuan actually built up the basis for a theory of epidemic febrile disease, although the Treatise on Cold Damage was not made the focus of criticism by the four great physicians. Making sense of this issue was Wu Youke who really “enlightened the benighted” when he wrote, “how to discriminate Shanghan from Wenyi epidemics?”, stating that in his opinion Shanghan had as a cause the cold, while Shiyi (时疫 seasonal epidemic) had none; Shanghan had the symptoms of fever and aversion to cold, while Shiyi only fever with no aversion to cold; Shanghan could be cured by sweating, while Shiyi could not be cured through sweating; Shanghan was uninfectious, while a Shiyi epidemic infected one person after the other; Shanghan invaded the human body through the pores, while Shiyi through the mouth and nose… These facts explained clearly the differences between Shanghan and Shiyi and categorized them into completely different systems by pathogenesis, diagnosis and treatment. Thus, Wu could propose a theory of Wenyi epidemics completely separate from the theory of Shanghan fevers. Wu Youke “correctly named” them, saying that “warmth is the beginning of heat and heat is the end result of warmth, warmth and heat are head and tail, of the same thing, and thus Rebing (hot febrile diseases) were just Wen-bing ones, and also epidemics are called Yi because they can spread between different families, while also the character Yi (疫, pestilence) is actually similar to that for Yi (役, forced labour) which everyone is equal to.” But it was a real pity that Wu’s influence on the population at that time was not great. On the one hand, this might have been due to the low efficacy of his prescriptions in treating epidemic fevers; on the other hand, as the epidemics were gradually wiped out there were no more serious infectious diseases, and Wu Youke placed too much emphasis on the features of Yi (疫) — while most ordinary physicians usually chimed in with “Shanghan”. It was the same for both Dai Tianzhang (17th century, Kangxi period) and Yu Shiyu (18th century, Qianlong period); neither of them could

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create a new school of epidemic febrile diseases powerful enough to compete with the school of febrile diseases (Shanghan). It was not until the emergence of Ye Gui, also named Ye Tianshi (1667– 1746) that the situation began to change. Gui, born in Suzhou, learned medicines from his father who also studied with his grandfather, and both were professional physicians. When his father died, he continued his study with Dr. Mi, his father’s follower. He was so keen on taking on other men’s views, those skilled in medical science, that within 10 years he had studied with 17 teachers. Moreover, he was also good at poetry and letters, Confucian classics, history, philosophy and literature, and in clinical practice he was so effective that by the age of 30 he became famous the whole country over. Diseases of Sha, smallpox and Shiyi epidemics were what he was most skilled in, which showed his expertise in treating febrile diseases. His biography in A Draft History of the Qing Dynasty (清史稿本传) praised him as “making prescriptions, but never rigidly adhering to past opinions” and “always making a miraculous cure of his patients”. His On Treatment of Epidemic Febrile Diseases (温热论治) was first printed in the very first issue of the Wuyi Huijiang (吴医汇讲 The Journal of Jiangsu Medicine), the first periodical in the history of Chinese medicine, compiled by Tang Dalie. It was later published as the preface to A Guide to Clinical Practice with a Record of Medical Cases (临证指南医案) collected by Hua Xiuyun, under the title A Treatise on Epidemic Febrile Diseases and is still a good summary of his theory of epidemic febrile diseases. It may be summarized as follows: “Wen Xie (温邪 pathogenic heat) entering up into body will first attack the lungs and then reverse direction, and transmit to the pericardium. The Lungs govern the qi with a defense function belonging to the Wei; while the heart governs the blood and vessels, for circulation and nutrition, belonging to Ying. The symptoms related to the Wei–Qi–Ying and Xue (卫气营血) use a method of judgment quite similar to that of the Shanghan school, but their treatment is quite different.” “Generally speaking in diagnosing the course of a Wenbing disease, the Wei is the first stage and then the Qi stage follows. After the Ying stage, one can say the Xue stage follows. At the Wei stage, encouraging sweating is alright — but only at the Qi stage can you clear qi. At the start of the Ying stage you can still make the heat return back from the Ying to the Qi stage. Medicines such as rhinoceros horn, scrophularia, antelope horn, etc. could have the above effect. At the Xue stage it can be harmful, and one should move and dissipate the blood, meaning one should directly cool it and dissipate the blood stasis. Medicines like fresh rehmannia root, the moutan

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root-bark of the tree-peony, donkey-hide gelatin, the root of the red peony and so on, can be applied. Without a consideration of the disease situation, and an adoption of the treatment priority to reduce the imminent danger, I am afraid one will make mistakes.” This is the doctrine of Wenbing diagnosis and treatment which in clear and concise speech explains that knowing the causes, pathogenesis and diagnosis as well as treatment is like knowing one’s own hands and fingers. What’s more, the difference between Wenbing and Shanghan fevers was placed on clear and solid ground in just a few words. Being a famous clinical physician, Tianshi had gained lots of cases histories, not just during severe epidemics but also during more peaceful times. All these were enough for him to make a breakthrough by establishing the “School of Epidemic Febrile Disease”. His descriptions of the severity of epidemic disease, and the symptoms of the coagulation of nutrient blood, and blood spots (stasis) on the skin were similar to what modern Western medicine describes as DIC (disseminated intravascular coagulation). Therefore, Ye Tianshi was, from very early on, one of the best of those who observed the common course of this serious disease. Regarding Ye Tianshi, there were lots of stories, some clearly propagandistic, rather than simply entertaining. Lu Yitian (1802–1865), also named Lu Dingpu, in his Medical Notes made in a Cold Cottage (冷庐医话) recorded some “Anecdotes of Ye and Xue”: During the reign of Emperor Qianlong (1736–1795), a serious pestilence broke out in Wumen (苏州, Jiangsu province) where, to help the poor, the government set up a medical bureau which required famous physicians to provide a service, once a day. One day, there came a night watchman who suffered from edema on his face and body, while his skin appeared yellowish and pale. The physician who first came in was Doctor Xue Xue who felt his pulses and let him go, saying as he left, ‘Your edema is too serious to be cured.’ So the patient left. At the same moment, Ye Tianshi had just arrived and, seeing him from his palanquin called out, ‘Is that the nightwatchman? Your disease is simply caused by a toxin vaporized through burning mosquito repellent. Two doses can cure it.’ He then prescribed for him. Seeing all this, Doctor Xue turned pale. Thus there came the stories about ‘Swept Leaves Cottage’ (Ye in Chinese means leaves) and ‘Trampled Snow Room’ (Xue in Chinese is homophonic to Snow) which reflected the conflict between these two famous doctors.

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However, according to research by Zhang Xiaofang,15 this story is not true. Xue Xue (1681–1770), also named Shengbai, alias Yipiao, was younger than Tianshi and both were born in Suzhou. He immersed himself in medicine when his mother fell sick and as a result was a well-read man, clever and skilled at medicine. When a patient named Dongting Shanren suffered from severe Shanghan, he prescribed three doses for him and he recovered immediately, hence the name of this medicine “Three Miracle Soup”. It is generally acknowledged that Xue never wrote any medical books and the surviving Systematized Identification of Damp-Heat (湿热条 辨) was probably written by someone else. Yet this book replenished one aspect of the theories of epidemic damp febrile diseases — especially focussing on how to cure damp heat diseases, and thus made up for this not being included in Tianshi’s Treatment of Epidemic Febrile Diseases (温热论). The Unofficial History Observation of Qing (清朝野史大观) describes Ye and Xue telling their stories without anything relating to there being a conflict between them. Shen Deqian, a classmate and good friend of Xue Xue and something of a literary celebrity, in his Collectanea of Guiyu (归愚文钞) told the “Story of Swept Leaves Cottage”. It briefly states, “Swept Leaves Cottage, located at Yujia Bridge in the southern part of the prefecture capital, is where Mr. Xue Yipiao used to read and write. A stream flowed beside it towards the city, and leaves from lush trees covered the path, so people would get lost in the uninhabited woods. Asking his servant boys to sweep them all up, Xue would be quite busy in such solitude for long periods of time and hence made many great achievements… Now Yipiao, while annotating The Book of Changes (易)… made repeated corrections to wipe out any flaws — just as he swept up leaves. Is this the reason his cottage was named Swept Leaves Cottage? Also I’ve heard that Wei Zuosi once wrote a poem to his friend which read, ‘I would like to hold a gourd ladle of wine, for a far-off friend made comfortable in this evening’s wind and rain; leaves cover the empty mountain, where can his tracks be found!’ This really recalls nature uninfluenced by man. In other words, sweeping is for man, while leaving alone is for nature. Swept or not, Xue Yipiao seemed to have grasped the essence of this entirely.” Here is the origin of the name “Swept Leaves Cottage”. In Yipiao’s Notes on Poets and Poetry – Own Preface (一瓢诗 话·自序), Xue states that “Swept Leaves Cottage is the place for Yipiao to labor and study.” The Prefecture Annals of Suzhou – Biography of Xue Xue 15

 Zhang Xiaofang, On “Leaves-sweeping” and “Snow-trampling” (“扫叶”“踏雪”辨), Chinese Journal of Medical History, No. 2, 1985.

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(苏州府志·薛雪传) also states, “Each time seeing the prescriptions of Ye, I often tap on the table, admiring him.” Both these stories are good proof that there was no conflict as to “leaf sweeping” or “snow trampling” between Ye and Xue at all. These stories made up by later generations might have been solely aimed at sowing discord between the different Wenbing schools. The most prosperous time for these schools of Wenbing disease came after the time of Ye and Xue, when Wu Tang (1736–1820) and Wang Shixiong (1808–1890), respectively wrote A Treatise on Differentiation and Treatment of Wenbing Epidemic Febrile Disease (温病条辨), published in 1798, and A Compendium on Wenre Epidemic Febrile Disease (温热经纬), finished in 1852. Both books gave a comprehensive explanation of the theory and clinical experience of Wenbing disease, thus creating together the Sanjiao pattern diagnosis (a pattern following the “triple burner”) along with the Wei-Qi-Ying-Xue pattern diagnosis, one the warp and the other the weft — and thus together perfecting the Wenbing doctrine of epidemic febrile diseases. “Temporal Qi Theory”, “the Theory of Heat Pathogenesis”, “Internal Injuries Theory” or “Yin Syndrome Theory”, and the establishment of the school of Wenbing epidemic febrile disease, were all theories describing epidemic heat diseases which, although original in their own aspect, were related to repeated epidemic outbreaks. Therefore, because different people have different opinions, and different diseases had different ways of arising, and the experience and observatory angle of all these physicians were different, it is common that every school made up its own opinion. As a result, there arose a multitude of views. However, the schools of Wenbing disease at last became comprehensive and a powerful rival to the school of colddamaged disease (Shanghan). Yet from the perspective of modern medicine, there is a common natural law behind epidemic heat infection — and whether it belongs to either the Shanghan school or epidemic Wenbing school touches only part of it. All in all, there are some good points in one aspect but other good points in another aspect which coming together means there is no sharp difference between these different schools and theories. Some arguments were created only because of sectarianism. What needs to be mentioned here is the great contribution Chinese traditional medicine made to the theory and clinical treatment of infectious diseases in human medicine. Before the appearance of the microscope (Antonius van Leeuwehook (1632–1723)), no one could see a pathogen; Robert Koch (1843–1910) would not have been able to find any bacteria without the microscope, and there were no methods of sterilization before

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Louis Pasteur (1822–1896) and Joseph Lister (1827–1912). No doubt if Alexander Fleming had not inadvertently discovered penicillin, nobody would know that antibiotics can treat infectious disease. Humanity must have felt helpless facing a severe epidemic mainly by microbes. However, in China, far away from the West, many wise doctors never stopped exploring the way to check an epidemic. Li-qi as carrier and causative agent held an important role in epidemiology, explaining the disease through the features of natural law. Regarding treatment, they created a pattern diagnosis according to the mechanism of the disease, and found many quite effective herbs and prescriptions. This was a different approach to that of western allopathy which uses antibiotics to treat infectious bacteria — rather looking to change the internal environment of the body, and improve immunity. Such therapies were proven effective during the treatment of SARS in China in 2003. Mortality was much reduced, compared to using only western treatment such as steroids. This was its most recent contribution to world medicine.

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Smallpox Remedies and Variolation in Ancient China* People at present still fear severe acute respiratory syndrome (SARS) which occurred in the spring and summer of 2003. According to the statistics, about 8,880 people worldwide were infected with SARS and about 850 died of it. In inland China, 5,327 were infected and 346 people died.1 Moreover, there had also been the dreadful British “mad cow disease” in various countries towards the end of the 20th century, bird flu in 2006 and swine flu in 2009. However, people may not know that all these cases are actually dwarfed by other epidemics in history, which have killed millions, not hundreds, of the population. People generally think the Black Plague (or Black Death) was the most horrible epidemic in history, but scholars list it as the third among the seven most deadly in all history — while smallpox ranks first. The order is as follows: 1. Smallpox: Purportedly, just among the aborigines of the American Continent, 300–500 million died when it was brought in by Europeans and Africans. In the 18th century, about 60 million Europeans died of

* Note that in this chapter some medical terms may need a clearer explanation: In ancient China variolation used a source of the smallpox virus from affected patients, a practice which started in China; but vaccination began in 1796 when Dr Edward Jenner (he learned from variolation) used the cowpox virus as his source. 1  See Du Song, Cao Hongxin et al. An Overview on Comprehensive Efficacy of Chinese Medicine for Preventing and Treating SARS, from the Development of Chinese Medicine and Human Health 1st Volume, Edited by the Academy of Traditional Chinese Medicine. Beijing: Ancient Books Publishing House, 2005, p. 670. 717

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2.

3.

4. 5. 6.

7.

smallpox. The WHO estimates that about 2 million people around the world died of smallpox in 1967. Spanish Flu: In just the 2 years between 1918 and 1919, 50–100 million people died. Just in America, 0.5 million people died, surpassing the total number killed by Hitler, nuclear weapons and terrorists put together. The Black Death or Plague: It was a pandemic in Europe from around 1340 to 1771. In just the 14th century, about half of the European population was killed by it. Later, it broke out at other times, killing probably 75 million people in total. Malaria: From 1600 to the present, 2 million people have died on average annually. AIDS: From 1981 to the present, about 25 million people have died and about 40 million people carry HIV. Cholera: It originated in India. In 1871, 10,000 personnel of the British garrison in India died of the cholera, but it is unknown how many Indians were killed by it. In 1947, there were still 30,000 Egyptians who died of it. Typhus Fever: From 430 BCE to the present, it burst out many times, though there is no calculation of the death toll. Between 1918 and 1922, 3 million people died of it, with a death rate of 10–40%.

Among the above, the seven most deadly fulminating diseases, we have been able to prevent and effectively treat most of them, except flu and AIDS, due to the invention of antibiotics and the development of preventive medicine. Only smallpox has been wiped out — as announced by the WHO in 1981. In this announcement, credit was ascribed to the invention and spread of the cowpox vaccination. So then, what is the part that variolation played in all this? How should we record and evaluate its medical history?

A. Outbreaks of Smallpox and TCM Treatment in Ancient China 118.  Textual Research on Outbreaks of Smallpox in China Many books about medical history often call Egypt or India the “Homeland of Diseases”. It is true that the earliest records of some diseases are found there among their ancient civilizations, but we can’t say that most diseases in the world

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derive from these places solely on this account. However, the earliest related evidence of smallpox is still from Egypt — in a mummy with smallpox scars. We can clearly see the smallpox scars on the face of Pharaoh Ramses V, who died in 1157 BCE.2 Ancient India also had records of smallpox very early on. Ancient China has many early detailed records of disease, but a recorded case of smallpox did not appear until Ge Hong (283–363) in his Handbook of Prescriptions for Emergencies Carried in the Sleeve (肘后备急方), written around 303 CE during the Jin Dynasty (265–420 CE). Its present version published by the Commercial Press in 1955 has the following passage: There was an epidemic disease appearing spontaneously in recent years with sores that covered the whole head and body of patients. Immediately, the base of the sore was surrounded by an outer edge, which was reddish as if burnt. They were filled with a white serous fluid, which refilled straight after being drained. If it was not treated in time, in severe cases the patients died. If the patient recovered after the treatment, the scar would be purplish dark and linger until a year later. This is because of the vicious pathogenic qi. People said this kind of sore had spread from the West (outside China) and was widespread in the 4th year of the Yonghui period. It could be cured quickly after having a mixture of cluster mallow along with salted chives and garlic. If at this initial stage, the patient can solely have this therapy as soon as possible, with a little rice and other food. This disease came from battles when taking captives in the Nanyang area during the middle of the Jianwu period, and so it was called ‘captive sores’. Many doctors observed it carefully and have described some treatments. Some effective ones are: · Rub good honey on the body or decoct honey with cimifuga and drink it little by little; · Decoct cimifuga with water to get a dense decoction. Use the decoction to wipe the body slowly. The effect could be better if wine is added, but the pain would be unbearable; · Rehmannia Black Ointment is also good for it. The above passage explicitly describes the symptoms of smallpox (it was called “captive sores”, lu chuang, 虏疮 as the sores were carried by captured 2

 Haggard. Devils, Drugs, and Doctors. New York, 1929, p. 220.

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personnel) and indicates that a single outbreak occurred during the life of the author. Doctors therefore had some experience of treatment and put forward preventive measures. However, the present version of Ge Hong’s text was completed by Tao Hongjing (456–536) and some of the words above were added by him. Again Mr. Fan Xingzhun believes that the whole paragraph on smallpox was added to by Tao or even that the whole passage was written by him.3 Based on textual research, he says this happened during the Yuanhui period (473–477 CE) rather than the Yonghui period, and he further points out that the “Jianwu period” was another Jianwu period which occurred from 494 to 497 CE at the time of Emperor Qiming or Xiao Luan and that the “recent years” refer to the 4th year of Jianwu (497 CE) around 500 CE, when Tao Hongjing made his addition. He thought smallpox came from the minority Xianbei group living in the Western Regions of China during the Liusong period. Thus, he contradicts Ge Hong’s record, but this is very likely untrue. According to Wang Tao’s later Arcane Essentials from the Imperial Library (外台秘要), we can decide that a part of the above quotation was written by Ge Hong — and that Tao added some parts later. The Arcane Essentials from the Imperial Library records the following: Ge Hong’s Handbook of Prescription for Emergencies Carrying in the Sleeve also records: There was an epidemic disease in recent years that epidemic sores appeared spontaneously all over the head and body of patients. Immediately the base of sore was surrounded by an outer edge, reddish as if burnt. There were filled with white serous fluid, which refilled straight after being drained. If it was not treated in time, the patient died in a severe case several days later. If the patient recovered after the treatment, the scar would be purplish dark and linger until 1 year later. This is because of vicious pathogenic qi. People said this disease came from battles with taking captives at Nanyang area in the middle time of Jianwu period, due to which it was called ‘captive sores’. Many doctors observed it carefully and have drawn out some treatments. Some effective ones are: · Rub good honey on the body or decoct honey with cimifuga and drink it little by little; 3

 ibid., pp. 106–110.

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· Decoct cimifuga with water to get dense decoction. Use the decoction to wipe the body slowly. The effect could be better if alcohol is added, but the pain would be unbearable. The above record must surely be Ge Hong’s original text, because Tao Hongjing’s words are shown added below: Zhang Wenzhong quoted Tao Hongjing’s words: Epidemic sores appear spontaneously and immediately all over the head and body of patients. The sore base was filled with a white serous fluid. This is because of vicious pathogenic qi. People said this kind of sore was spread from the West Regions of China to the east and center China in the 4th year of Yonghui period (655). It could be cured soon after having a decoction of cluster mallow or salted garlic and chives. It could also be stopped quickly by having fresh goat blood. If it is at this initial stage, the patient can just have this therapy with a dish with rice right away. It is obvious that Tao Hongjing and Zhang Wenzhong recorded another outbreak of smallpox which was not in Ge Hong’s original book — Tao mentioned it and added it on. If the record of the Yonghui period is a written mistake, it was not the done by Ge Hong. Therefore, the Jianwu period can only have occurred earlier than the period in which Ge Hong lived. A Handbook of Prescription for Emergency Carried up the Sleeve was written by Ge Hong around 303 CE, and has been textually studied in the 8th chapter — it belongs to his early stage work. The period of Jianwu before this time could only be the period of the Guangwu Emperor during the Eastern Han Dynasty from 25 to 56 CE. That was a prosperous time, the beginning of the long period of the Eastern Han dynasty that had a great influence on history. Wang Quan during the Ming Dynasty said, “Smallpox was brought back by Ma Yuan’s expedition to Jiaozhi.” This is reasonable, in regard to the time, because in the 17th year of Jianwu (42 CE, the “middle time of Jianwu”), Ma Yuan and his army battled in Jiaozhi (now Vietnam) in the south — under the emperor’s order. The Book of the Later Han Dynasty – Records of Ma Yuan (后汉书·马援传) states, “In the Autumn of 20th year (45 CE), he led his army back to the capital city and 4 or 5 out of 10 soldiers were killed by an epidemic pestilence.” This southern expedition lasted 3 years altogether and went through an epidemic disease, which was most probably smallpox. Battling with a foreign enemy

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meant there were battle captives, so it would have been reasonable to call these sores as “captive sores”. However, the name “Nanyang” in the earlier quotations is a mistake. Nanyang was the hometown of the Guangwu Emperor, located in the middle of China and not a place to have a battle with invading enemies. Even in later periods of the Jianwu (304 CE; 317–318 CE, etc.), no battles happened at that place. “Nanyang” is probably a mistake for “Nanjiang” (the “southern foreign regions”). According to Li Daoyuan’s Commentary on the Waterways Classic (水经注), A Record of the Lin Regions (林邑记), “In the 19th year of Jianwu, Ma Yuan established two bronze posts on the southern edge of Xianglin, a boundary that separated the Nanjiang area within Xitu country.” Foreign Regions (外域记) also records the following: When Jiaozhi was not yet established as a county, there was Luo’s Field… the prince of the Later-Shu State led 30 thousand soldiers to conquer it and the King and Lords of Luo submitted before them. The Luo generals called the prince of Shu the King of Anyang. Later Weituo, the King of Nanyue (southern Yue), called up a mass of people to attack the King of Anyang… then the King of Nanyue knew it was impossible to win, so his army retreated to Wuning county. Zhao Tuo was a name for the King of Nanyue. He lived during the periods of the Emperors Hangaozu (206–195 BCE) and Hanwendi (179–157 BCE). We can see that Jiaozhi is located in Nanjiang, which was also called Anyang, and probably mistaken for Nanyang. Therefore, it is credible that smallpox was brought into China from Vietnam by Ma Yuan’s expedition to Jiaozhi, and Ge Hong was the first one who described the symptoms and its treatment. If the words “this kind of sore was spread from the West Regions of China to the east and central China in the 4th year of Yonghui period…” were added by Tao Hongjing, then Yonghui could be a clerical error for Yuanhui or Yongjia. Therefore, Tao Hongjing was the second person who recorded smallpox after Ge Hong. There certainly were several serious outbreaks of smallpox during the Wei, Jin, Southern and Northern dynasties, which impacted the Chinese medical world greatly — so that great changes occurred in the deeper

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understanding of epidemics, their prevention and treatment.4 A description of smallpox during this period occurs in A History of Northern Dynasties –Records of Cui Zhan (北史·崔瞻传): Cui Zhan, self-styled Yan Tong, had a fair complexion and features; he was smart and dignified… After suffering from a febrile disease, he had many scars on his face. These scars left by his suffering could probably have come from febrile smallpox. Cui Zhan died in the 3rd year of the Wuping period (572 CE). Also, the “blister sores” (bao chuang, 皰疮) or “pea sores” (deng dou chuang, 登豆疮) recorded in Cao Yuanfang’s Treatise on the Origins, Causes and Manifestations of Various Diseases (诸病源候论) could be the “captive sores” referred to by Ge Hong as “burned reddish sores”. This book contains a summary of the symptoms of smallpox during the Wei, Jin, Southern and Northern dynasties. It states the following: Pea sores of cold damage: People tend to develop blister sores if the heat toxin of cold damage is intense. This kind of blister is white or red in color, and occurs in the skin. The toxin is moderate if the head of the blister forms only white pus, while it is serious if the blister is purplish-dark and rooted in the flesh. In most severe cases, the sores occur all over the body including the organs and seven apertures. The sores like the shape of a pea are called ‘pea sores’. Timely Qi blister sores: People tend to suffer blister sores if the pathomechanism is “exterior deficiency and interior excess”, and there is exuberant heat toxin within. Sores can be reddish like burn sores and all over the body in severe cases. If the blister root is red and the head white, the toxin is mild; if the blister is purplish dark, the toxin is intense. As the sores are shaped like peas, they are called “pea sores”. In addition, “febrile blister sores” and “pestilence blister sores” (but not “warm-disease blister sores”) have a similar description. It is correct that the haemorrhagic smallpox sore (the “purplish dark” one) was distinguished as being critical. 4

 For example, the present use of the term “disaster intrigue mechanism”.

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In the book, blister sores (pea sores) are discussed with a differentiation also into “spotted sores”. Syndromes of “timely macular eruption”, “febrile macular sores”, etc. are also listed: Timely macular eruption: For patients with unresolved febrile disease in the exterior after perspiration or with lingering heat toxin manifested as vexation and delirium after vomiting and diarrhea, it is a ‘exterior deficiency, interior excess’ condition with vexing heat on the surface, so the body has a macular eruption making a variegated picture. In cases of macular eruption, do not apply exterior relieving herbs, which would cause erosion of the sores and make the macules more serious due to the exterior deficiency. Therefore, we believe “red macular”, “macular sores”, etc. were not merely alternative names for smallpox. It was a mistake when Mr. Fan Xingzhun decided that the disease mentioned in the Book of the Southern Qi Dynasty (南齐书) that occurred in Shan County was smallpox5: “there was an eight-year-old child, who suffered from a red macule together with his mother”. The name “豌豆疮 pea sores” is carved with a few strokes missed in the Chinese character as “climbing bean sores” (登豆疮) in the extant version of the Treatise on the Causes, Origins and Manifestations of Various Diseases. This can be confirmed by the cited words from Cao’s book Arcane Essentials from the Imperial Library (外台秘要) as “豌豆疮 pea sores” but not “登豆疮”as well as the same name in Important Formulae worth a Thousand Gold Pieces (千金 要方). There is a pea but not a “climbing bean” among bean plants, and the smallpox sores are like peas. Many people in China still believe that smallpox in ancient times was called “climbing bean sores”, which is a complete mistake. The children of Li Yishan, a famous poet during the Tang dynasty, might have suffered from smallpox. The 5th volume of About Outer Cities (说郛) cited words from the Miscellaneous Compilations (杂纂) that said, “my children were shy to come out because of the scars of bean sores.” We know from this that the name “bean sores” (pea sores) was still commonly used then. In Tao Yue’s Supplementation to a History of Five Dynasties (五代史补), Volume 1, there is a poem: Chen An, from Dongou City, was smart and astute. At the age of 13, he brought some writings to a local magistrate. He was just recovered 5

 Fan Xingzhun’s A History of Thoughts of Preventive Medicine in China.

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from macular sores at that time and the traces of the sores were obvious. The magistrate joked by composing with him a poem: ‘Literarily talented and so flowery a face, why don’t you chant a song?’ Chen also responded in a poem: Certainly I am no hawksbill turtle, But no better than a variegated rhinoceros! Heaven dislikes my appearance, So it decorates with flowers my whole face. The record in the Whole Poetry of the Tang Dynasty (全唐诗) and Essential Literary Garden (文苑英华) is slightly different. Yuan Mei’s Casual Jottings in a Sui Garden (随园随笔) record the same story. Judging from the above, smallpox was mixed with macular sores in the Five Dynasties. But it is inferable from “Heaven (天) decorates my face with flowers (花)” that at that time the folk term 天花 (tianhua) “heavenly flowers” (smallpox) was implied. The term “heavenly flowers” in the folk tradition may be also related to Buddhism, introduced from India. The “Heavenly-flower Goddess” was a goddess in charge of heaven’s flowers and then was taken on for smallpox in China. At the beginning of the Northern Song dynasty, people started to use “痘疮 douchuang, pox sores” for smallpox, or the term 痘症 (douzheng, pox syndrome. Formulae from Benevolent Sages Compiled during the Taiping Era (太平圣惠方)) began to include it and it was uniquely included in lists of pediatric disease. It is thought that as smallpox at this time mainly attacked children, adults already had immunity to it. During the Song and Yuan dynasties, massive books about pox sores emerged, which might be connected to the prevailing incidences of smallpox. However, as historical books generally used “pestilence epidemic” to describe it, we are unable to judge how many times it meant smallpox. But remoter areas of Northwest China didn’t have smallpox until the later period of the Ming dynasty. A History of Ming Dynasty – Record of Du Tong (明史•杜桐传) states the following: There was originally no pox syndrome in Northwest China. Since the Jiajing period (1550 CE), the disease was spread in Shizhou City and people died after being infected. Daerhan, who come from a tribe in the Northwest, paid tributes several times to the emperor and was promoted to associate prefect. One day, he and his fellows came back from market all infected with the deadly pox.

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The Record of Guan Bingzhong (官秉忠传) states, “Tielei from Huita section died of pox sores and it was rumored that border officials killed him by poison.” Northeast China also didn’t originally have smallpox. The Historical Scripts of the Qing Dynasty (清史稿) states the following: Manchurian (Northeast China) soldiers were afraid of the pox when they marched into central China at the beginning. Lots died due to this infection. If people in the capital city were infected by the pox, they had to move out the city to stop it spreading. Special officials hurried them to do it and ordered them to abandon infected infants and children at random. Zhao Kaixin petitioned to set up four villages at each side of the capital as suburb for people who were not infected to live in. (Xiliang’s Biography) According to my order from the deceased emperor, the lords and dukes of Mongolia do not need to come to the capital city if they have not had the pox. He Shen decided presumptuously that all those who have not had the pox need not come. This was the tenth most serious crime. (He Shen’s Biography) A Record of Haohan Vassal Kingdom (浩罕属国传) states, “As the heads of Haohan vassal states have not suffered from the pox, they are scared to enter China. Therefore, they dispatched others to come…” Shunzhi, the first emperor of the Qing dynasty died of smallpox in 1661 CE. This is recorded in Wang Xi’s Chronicle (年谱) and other books. Later, it was stipulated that princes who had not suffered and recovered from smallpox were not allowed to inherit the throne. The Kangxi Emperor hence advocated variolation. The above evidence is enough to prove that there was no spread of smallpox in Northeast China originally.6 Smallpox, a disease transmitted from abroad to China, not only caused epidemics that made many people suffer and die but also brought about drastic changes in the medical culture: the invention of smallpox inoculation — variolation. Then variolation spread to other countries, being a special case of cross-cultural communication that stimulated and 6

 Research into smallpox and smallpox inoculation is increasing in recent decades and textual research is also much more meticulous, especially in Taiwan. Refer to Qiu Zhonglin’s Smallpox Inoculation in the Ming and Qing Dynasties – Distribution, Knowledge Transmission and Vaccine Production. Taibei, Journal Collection of Historical Language Research Institute, 77th Volume, 3rd Section, 2006, pp. 451–516.

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changed into “cowpox vaccination”, which later in turn came back to China. Such a process and sense of cross-cultural communication is valuable. Thus, we must record and research it.

119.  Smallpox Treated by Chinese Medicine (1)  Origins of the Theories and Treatments for Smallpox: A Summary Treatment for smallpox was lacking in ancient Western countries and there are scarcely any records of it happening. Even in modern times, we have no antiviral medicines for smallpox. There is no choice but to apply conservative treatment. People have neglected the great achievements made by Chinese medicine in the past and few papers or monographs on medical history mention it. It can’t be said that this is not a pity. But we have evident reason to think that Ge Hong was the first medical expert in the world to describe smallpox. His description was 600 years earlier than that of Ar Rhazi (Rhazes 864–935 CE), who has been wrongly affirmed to be the earliest to identify this disease. Not only this, but Ge Hong was the first doctor who applied herbs to treat the “small pox”. Following Ge Hong, ancient Chinese doctors began to study its treatment. There are so many monographs on smallpox that they are unparalleled — except for those on “Cold Damage”. According to entries in A Literature Lexicon of Chinese Medicine (中医文献辞典), there are more than 250 monographs on Cold Damage, more that 90 on smallpox and more than 50 on Warm Diseases. On others topics, the monographs are generally no more than ten.7 The therapies and herbs applied for treatment were quite simple during Ge Hong and Tao Hongjing’s time, as stated above. Ge Hong mainly used external applications, such as rubbing with honey, washing with cimifuga decoction or wine, or an external paste made of Rehmannia Black Ointment. He also applied methods taken from the Treatise on Cold Damage to eliminate toxins. However, Tao Hongjing applied oral medicines, such as having a decoction of cluster mallow, minced garlic or fresh goat blood. These can be seen as empirical methods of the time. In Important Formulae Worth a Thousand Gold Pieces, Sun Simiao classified pea sores under “diseases of cold damage” and treated them as a 7

 Yu Ying’ao, Li Jingwei. Literature Lexicon of Chinese Medicine, Beijing: Science and Technology Press, 2000.

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“seasonal qi febrile disease”. This should be seen as a continuation of Ge Hong’s approach as it has not been distinguished from diseases due to cold damage. Basically, it is correct to list smallpox as “a seasonal qi febrile disease”. In this book, it is also not included in pediatric diseases (though there is a smallpox formula for cold damage relating to children), from which we can see that smallpox presented at all ages, and was not just limited to children afterwards. Treatment methods were miscellaneous. In volume ten, “Pea-Sore Formulae for Seasonal Qi Febrile Diseases in Man and Livestock”, there are fifteen entries containing approaches of external application and fifteen formulae for oral intake. There had been more medicinals for application, such as huáng lián (coptis), qīng dài (natural indigo), dà huáng (rhubarb root and rhizome), mŭ lì (oyster shell), shí gāo (gypsum) and zhū dăn (pig gall). They were often applied singly in a decoction. It is clear that these medicinals were intended for clearing heat and removing toxins, showing that great strides had been made in the theory of treatment and practice. There is a formula in this book: “A Prescription for Pea-Sores with Pain and Vexation: apply Mù Xiāng Tāng (Costus Root Decoction). It has five ingredients, namely qīng mù xiāng (Radix Aristolochiae), rŭ xiāng (Olibanum), dīng xiāng (Flos Caryophylli), míng fán (Alumen), and shè xiāng (Moschus). Break them up and boil them with 4 liters of water until 1.5 liters left. Drink the decoction two times. If the heat toxin is serious, add xī jiăo (Cornu Rhinocerotis) 50 g. If there is no xī jiăo, use shēng má (Rhizoma Cimicifugae) instead. If the case is mild, remove míng fán. This formula’s effect is magical.” This is obviously for smallpox patients in an acute phase. Most of the ingredients are aromatics for resuscitation — in particular for emergencies. This is the first compound prescription for treating smallpox. A moxibustion therapy is also included: “For pea sores after having febrile disease, apply moxibustion on the wrist with three moxa cones, the left hand for male and right for female.” This is the first record of moxibustion treatment for smallpox. The Formulae from Benevolent Sages Compiled during the Taiping Era (太平圣惠方) in the Northern Song dynasty (978–992 CE) listed pox syndrome under pediatric diseases and put forward many new formulae. This implied that smallpox at that time mainly existed among children and it is included in a system of treatment based on pattern diagnosis. Medicinal formulae were applied to treat different patterns, accompanying symptoms and complications. This was a great progression and treatment efficacy became enhanced greatly.

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Qian Yi’s Key to the Diagnosis and Treatment of Children’s Diseases ( 小儿药证直诀) was compiled according to the pediatric theories and formulae created by Yan Xiaozhong during the Daguan period (1107–1110 CE). This book was a milestone in Chinese pediatrics. But as for “pox syndrome”, its value mainly lay in the attached chapter, Dong Ji’s Formulae and Theories for Emergent Pediatric Macular Rashes (小儿斑疹备急方论), in which a specific theory was established. As for theory, Qian Yi’s “Fetal Toxin Theory” had a great influence on later generations. He said the following in the book: For 10 months in the uterus, the fetus takes in blood toxins from its mother’s five organs and the toxin must be expelled after birth. The symptoms of sores and rashes are all due to the lingering fluids of this toxin. Medical practitioners afterwards all regarded it as the norm to treat the syndrome of the pox. However, it is actually wrong from the perspective of modern medicine. Smallpox is a kind of infectious disease, so it is generally correct to classify it as a “seasonal febrile disease”. Since Qian Yi, although some experts regarded smallpox to be a “pestilent pox”, the thinking of many was still confined to the theory of “fetal toxin”. Though such recognition was flawed, it was because in that era almost no children could avoid suffering from smallpox and Qian Yi thought a foetal toxin could be the cause. They should not be criticized harshly as they had just started to explore the causes of this disease. The smallpox pathogen is confirmed to be the smallpox virus, which could only be figured out by finding the virus strain and its infectivity through modern virology. Therefore, if we perceive “fetal toxin” from another angle, we can regard it as a congenital immune deficiency to a certain disease. The lack of immunity to the smallpox virus gave the disease an opportunity at a weak point to attack those susceptible. After the Jin and Yuan dynasties, theories of seasonal febrile diseases and being “not acclimatized” spread widely. The theories of foetal toxin, seasonal qi and strange qi, as pathogenic factors, gradually merged. They became a Chinese version of an explanation characterized by immune deficiency and external contagion of pathogenic factors. This is still larger than the belief in modern theory. The endeavour had begun to point in the right direction and come someway nearer the truth.

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In the Ming and Qing dynasties, experts on pox syndrome formed relatively coherent viewpoints. For example, Wan Quan’s Essential Methods for Pox Rashes (痘疹心法) in the Ming dynasty states, It occurs at a special time and is due to fetal toxin. It may be either acute and dangerous, or slow and moderate, or fulminating and deadly — according to the severity or lightness of the toxic qi. The eruption released is such toxic a toxin that people will only suffer it once in a lifetime and never be infected later. Zhang Yan’s New Book on Variolation (种痘新书) (1741 CE) in the Qing dynasty states, Pox syndrome is basically due to fetal toxin that is endowed in the inborn and no one is exempt from it. When natural epidemic factors prevail around a residential quarter, the fetal toxin must gradually interact and increase… it becomes excessive and the fetal toxin turns to pox sores. The toxin like a tiger hides deep in the mingmen (lifegate), and when a natural epidemic pestilence prevails, is triggered to harm the body. The Golden Mirror of the Medical Tradition (医宗金鉴) also states, Smallpox is a result of fetal toxin. It incubates initially in the fetus and bursts out as it interacts. No one can avoid it. This Chinese medical theory which started in the 12th century could be compared to the modern theory of there being a causative agent in smallpox. The “timely seasonal pathogenic qi” admits exogenous factors, and is a similar idea to infection by an exogenous smallpox virus. Chinese medicine also had the idea of an endogenous factor — the existence of a natural foetal toxin, while modern medicine believes it to be due to people’s immune deficiency. Such recognition in Western medicine came much later, during the middle of the 19th century. This theoretical recognition in China played a very important role in preventing and treating smallpox. Since the Yuan and Ming dynasties, famous doctors treating pox numbered more than a hundred, and related monographs and new formulae cropped up one after the other. These formulae were formulated by the guidance of above theories and were a kind

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of further accumulation of experience. There is no record of the treatment of smallpox in western medical history — and in this respect China was unique.

(2)  Comparatively Mature Treatments for Smallpox Take Zhang Yan’s New Book of Variolation (种痘新书) for example; 249 medicinals and more than 200 formulae for smallpox are included. His stage-to-stage treatment was very developed. He pointed out, For the pox, a normal duration is the 3rd day starting a fever, the next 3 days a full eruption, followed by 3 days swelling, then 3 days of fluid-filling, and the last 3 days the fluid drying-out and crusting, altogether 15 days. Such a description of the course of the disease is exactly the same as that in modern medicine. This was the normal procedure and there was a routine treatment. However, there were also variable and adverse patterns, which should be treated differently. He further states, The prognosis of the pox lies in the six days of full eruption and swelling which is a critical moment for good or ill fortune to intervene, a time that is most important and can never be neglected. In mild cases, the duration cannot be given with any certitude of dates but the pox may shrink and dry over twelve or thirteen days. In serious cases, the duration will exceed this and the pox will shrink totally perhaps even more than 20 days later. However, if the pox is bright with a red root and the patient has normal urination and defecation without other complications, there is no need to worry if the term exceeds several days. But if the pox doesn’t erupt or shrink, closer observation is required. It may probably be due to weak primordial qi failing to promote it, which should be treated by supplementing qi. It may also be caused by other complications that prevent it shrinking, which should be treated by eliminating these other complications right away. In addition, it is normal that the pox will not erupt totally within six days for patients with these complications as six days later, the toxin will come out totally and the complications be resolved as well. If those complications still linger as they should not, it is an adverse case, and has to be treated immediately.

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This is not only a summarization by an experienced doctor of treating pox but also a description of the natural course of the disease. Based on the above, he proposed different principles of diagnosis and treatment, with different medicinal formulae for the many stages of the disease, as shown in the following: (a)  The first three days of fever: “It is better to wait a while and not take medicine on the first day of fever as other symptoms haven’t shown up. This is because the diagnosis is still not clear and because of being cautious, the medicine cannot be applied arbitrarily. The next day, the fever should have been able to be differentiated from other sources like external contraction of wind-cold, and Su Jie Wan (Relieving Pill) can be prescribed to induce mild sweating. If the patient is weak, prescribe Qian Jin Wan (Valuable Thousands Gold Pill) additionally to make good the body’s strength and expel the toxin. Also, tuina can be used to relax the skin and muscles on the body surface, thus opening orifices and promoting qi movement without impairing primordial qi. On the third day, if the fever is intense and the tongue coating has been yellow, it means the toxin must be fairly strong and can’t be repelled merely through pills or powders. It is appropriate to ‘harmonize the middle’ and disperse the toxin immediately by frequent does of Qing Jie San (Clearing Resolved Powder), with large doses, and then it should easily break off. Use modified Sheng Ma Tang (Cimicifugae Decoction) to ‘relieve the exterior and expel toxins’. For weak patients, apply Fu Yuan Xuan Jie Tang (Reinforcing Energy and Ventilating Decoction) or Shen Su Yin (Ginseng and Perilla Beverage).” He also said, “At the initial stage of the fever, the severity of the toxin and its prognosis can both be detected. If the fever is light, the toxin must be mild and the pox must be sparse, which is favorable. If the fever is high, the toxin must be intense and pox dense and outspread, which implies critical condition. This way doctors can know predict what is going to happen.” He believed that correct and appropriate diagnosis and treatment at this stage would lay a good foundation for full recovery. Whether complications should be treated or not also required great deliberation, for example: “If there is vomiting or diarrhea when the fever onsets, it should not be stopped immediately. For those with vomiting, the pathogens are getting out from above; and in diarrhea, the pathogens are fleeing below. If the toxic symptoms are relieved through vomiting and diarrhea, the prognosis will be favorable. If we try to stop the vomiting or diarrhea at once, it is a kind of closing the door for the exiting pathogens — so that even a mild case will

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become a serious one. Since this vomiting and diarrhea are ways the toxins exist, they will stop spontaneously without medication after the eruption of pox. There is no need to apply treatment. If a case were treated arbitrarily where there is no need for treatment, I’m afraid other problems would arise.” However, for high fever and the accompanying aggravating symptoms, it was appropriate to use Jie Du Tang (Toxin-Resolving Decoction) or Tiao Yuan Jie Du Tang (Energy-Regulating and Toxin-Resolving Decoction) right away. For various dangerous manifestations, select Su Jie San (Relieving Powder) with tian ma (Rhizoma Gastrodiae), or Er Bao Yin (Two Treasures Decoction), Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction), Fu Yuan Qu Feng Tang (Energy-Reinforcing and WindExpelling Decoction) and so on, according to specific conditions. He listed altogether 53 miscellaneous symptoms, such as convulsions, abdominal pain, vomiting, diarrhoea, blockage, purulent sputum, panting, various pains and bleeding, and prescribed formulae for each treatment. He also listed 19 unfavourable patterns, most of which would become deadly if no treatment was administered in time. (b)  Third day of starting the pox eruption: Skin rashes of smallpox often occur on the third or fourth day of fever, which are spotted and reddish purple. Zhang Yan pointed out that we must differentiate this from the “biting of a mosquito or flea” and “macules, erysipelas, sores and scabies” to avoid misdiagnosis. After determining it as an initial eruption of the pox, he said “the application of medicine at this time is a little similar to that at the initial onset of fever”; however, It is proper to remove toxin and assist in lifting the qi. At this stage, be cautions the use of tonic, stagnating, acrid or heating medicines. So such ones as rou gui (Cortex Cinnamomi), fu zi (Radix Aconiti Lateralis Praeparata), ding xiang (Flos Caryophylli), gan jiang (dry Rhizoma Zingiberis), zhi huang qi (Radix Astragali), zhi gan cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle), lu rong (Cornu Cervi Pantotrichum), deer blood, bai zhu (Rhizoma Atractylodis Macrocephalae), fu ling (Poria), huai shan yao (Rhizoma Dioscoreae), suan zao ren (Semen Ziziphi Spinosae), yuan zhi (Radix Polygalae), shu di huang (Radix Rehmanniae Praeparata), huo xiang (Herba Agastachis), sha ren (Fructus Amomi), dou kou (Fructus Amomi Rotundus), he zi (Fructus Chebulae), and wu wei zi (Fructus Schisandrae Chinensis), should be applied with great caution. Even if

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huang qi and gan cao were to be applied, they can only be used raw without being prepared by frying with honey; use chi shao (Radix Paeoniae Rubra) instead of bai shao (Radix Paeoniae Alba); and raw di huang rather than shu di huang which is being prepared by frying with honey. The consideration is that they could make the toxin linger, which would boost toxic fire and cause the patient to deteriorate. The key points to observe here are the red spots looming under the skin (often seen on the head, face, hands and feet, and then the whole body) that do not erupt as they should and symptoms like a fever, which is very serious. It is a situation where the “toxin attacks the interior and worsening can occur at any time, and be incurable.” He said, All the medical books since ancient times focused on smallpox after its eruption and neglected or only sketched out the symptoms before the eruption. They talked more about the dangers of dense distribution after eruption — but didn’t mention the hazards of lingering pathogens. They did not know that the exited toxin is the external enemy, while the lingering toxin is the internal enemy. If the eruption onsets quickly and has a dense distribution, it is a kind of attack from without; if the eruption lingers without eruption, it is an internal attack. Which enemy is the more dangerous? Which kind of attack is more serious? Those who died of the pox after its eruption had their doom 15 days later, while those who died of the pox before its eruption inevitably had their doom within 6 days. That’s what I deeply worry out and long have wanted to repeatedly admonish the people in this world. As in measles, Chinese medicine sees the key to prognosis as lying in whether the smallpox erupts smoothly or not. Smooth eruption suggests a favourable turn, and means the internal toxins are being excreted and various attendant symptoms will diminish accordingly, so the patient safely survives the critical stage. On the contrary, if the case takes an unfavourable turn the threat to life is critical. Hence, it is very important to observe and judge the conditions of the eruption. If such an eruption is unsmooth, Zhang Yan suggested instantly using shēng má (Rhizoma Cimicifugae), chuān xiōng (Rhizoma Chuanxiong), chán tuì (Periostracum Cicadae), niú bàng zĭ (Fructus Arctii) and so on for the promotion of its eruption. Meanwhile, medicinals like huáng lián (Rhizoma Coptidis), huáng qín (Radix Scutellariae),

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lián qiào (Fructus Forsythiae) and chuān shān jiă (Squama Manitis) should also be applied to clear away heat and remove toxins. This treatment principle is always grounded in the idea that smallpox occurs when the foetal toxins are stimulated by timely pathogenic factors. The patient cannot recover if the toxins are not eliminated. This idea is totally different from that of western medicine. He also said, “After the eruption of the smallpox, if the tidal fever fades, miscellaneous symptoms recede, appetite improves and vomiting and diarrhea disappear, and 5 to 6 days later, the pox having totally come out together as well as the fever remitting, other symptoms go away, the appetite becomes normal, and the spirit is as usual, then it is favorable. This is because all the toxins have come out of the muscles and skin without lingering in the internal organs. Then you can expect good health!” Foetal toxin was a kind of internal toxin, which should be expelled for health. This idea originated from the theory of foetal toxin, but its accompanying symptoms, dangerous symptoms and various adverse symptoms seem to be related to external timely pathogenic factors. Some Chinese names are (translated literally) “attack by a dirty pathogen”, “thief pox” and “pox furuncle”, and are a reflection that “clearing heat” and “removing toxins” should be the treatment principles. Besides this, the bodily constitution is also relative. If the patient has insufficient primordial qi (vitality), the pox loom without erupting, and complications such as fever become serious — then the treatment should take into account these excess and deficient conditions and apply formulae accordingly, such as Ping He Tang (Pacifying Decoction), Ren Shen Bai Hu Tang (Ginseng Hundred Tiger Decoction), etc. He listed 38 different pox, about 30 dangerous symptoms of smallpox, 9 miscellaneous symptoms and 30 adverse symptoms. (c)  Three days of swelling: When the spots of the pox appear, the skin rash in patients with a favourable prognosis swells quickly, namely turning from papules to swellings containing fluid that is clear and they fill up. He noted the following: When the pox erupts, the skin should swell gradually. The more the swelling, the more the toxins are expelled. As the pox swells to its fullest, the toxins come out to their largest extent. If the pox doesn’t swell, then the toxin will remain in the internal organs although spots are visible. Several days later, when the toxins attack the insides, it is impossible to save their life. The duration of

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three days from the onset of the swelling to the fullest swelling is very important. One should urgently inspect the patient’s manifestation of sores at this time and administrate medicinals according to the specific pattern. It is just like saving a drowning person or a person in a fire, you do not without hesitating… After the pox has erupted, the tidal fever recedes and the other symptoms disappear. The pox are then clear and few with round tips and a ruby color. In a strong patient with thick and tough skin, the pox can swell undoubtedly as the qi and blood are both abundant and the toxin has been expelled outwards… If the eruption is not smooth, the fever doesn’t recede, or other symptoms remain, the pox will be weak and crimpy, obscure at the edges, dark and unclear, or not round, lingeringly-purple, dry as if burnt and not moist, pale without being red, thin and not solid. This is either due to exuberant toxins not being expelled, or because of the weakness of the qi that requires reinforcement. If no medicinals are applied, the pox will surely fail to swell and be not filled with fluids, which can be predicted. Therefore, one must seek treatment at this time… Any prognosis depends on the eruption state of the pox. If the pox swells, the disease turns out better as the toxin is expelled; if the toxin lingers inside and attacks within, the condition worsens. Hence this is to say, the swelling of the pox ensures life, while if the opposite happens, the patient will die. There was no need to use medicine if the swelling process was smooth. Just give the proper care and let it progress to the next stage. If it is accompanied by dangerous symptoms (more than 20 are mentioned and 5 “sinking, dangerous” symptoms listed) or miscellaneous symptoms (of 12 kinds), intensive care is required. For the 27 adverse symptoms, treatment is very difficult. In general, it requires noticing and finding problems early. If the toxin is full and lingers within, prescribe Tiao Yuan Hua Du Tang (Regulating Primordial Qi and Resolving Toxin Decoction) and so on. If the body is weak and the toxins remain within, use formulae such as Qian Jin Nei Tuo San (Valuable Internal Withdrawing Powder). Careful identification is especially needed for those with dangerous symptoms and considerate determination to find out which method of treatment is best, along with an understanding of daily life care. He then lists more than 20 medicinal formulae for reference.

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(d)  Three days of a thick fluid filling: “Thick fluid filling” refers to the fluids in the pox transforming into pus. This is a natural process in the course of the disease. Zhang Yan believed the following: In smallpox, it is best if the thick fluid can be filling by the 7th day, full by the 8th day and transformed into pus by the 9th or 10th day. At the beginning, the fluid is blood. Then the blood transforms into fluid and later to pus. After the pus is formed and thick, the toxin has been expelled totally. If the pox swell, but don’t transform into pus, it means though the toxin has come out, it has still not transformed, which means it will disturb the skin and flow back inwards. The reason why the pus has not formed is because the toxin hadn’t been resolved 5 to 6 days earlier, leading to an accumulation of toxins causing flaming fire to dry up the blood, so it congeals and the stagnant qi turns weak. In the 9th or 10th day, the internal organs are weak, so the treatment should be to ‘supplement’. In addition, since the healthy qi has struggled with the toxin a long time, the primordial qi must have been in decline, so the main therapy is to boost the primordial qi. As pox is a toxin coming from the internal organs, the body urgently needs to expel it out the skin — and thus the internal organs must be insecure. If the treatment remaining focused on expelling the toxin instead of strengthening the internal qi, I’m afraid the toxin will reenter the interior by taking advantage of its deficiency. That’s what the ‘reversed collapsed and dimple syndromes’ come from. ‘Reversed collapse and dimple syndromes’ mean the toxin going back in to attack the interior. At this time, even good doctors can never rescue a life. Therefore, by the 9th day, the treatment principle is always to prefer warming and supplementation — and not to use cooling and cold therapies. At this stage, securing the muscles and strengthening the interior are essential, and reinforcing the spleen and qi should be routine. Following this, he points out a selection of specific processing methods for medicinals and some formulae, cautioning that patients and doctors should pay attention to them, and the requirement that great care is needed when approaching this disease. He requests,

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Advanced consideration is a must for treating this pox, so as to prevent sudden developments and being caught unprepared by its variable symptoms. Therefore, when the fever onsets, one needs to think about possible symptoms of pox eruption; when the spots show, it is better to consider the situation and prepare a plan of period of swelling; when the eruption has come to its fullest, think about the filling period of the thick fluid… Hence, the families of patients afflicted by the pox should always seek help from doctors within 6 days and never delay. And doctors treating the pox must try their best to rescue a life within 7 days, without making any delay. He then lists nine dangerous symptoms, 24 miscellaneous symptoms and 18 adverse symptoms — with their relevant medicinal formulae and prognoses. (e)  Scabbing: It seems that the disease process of smallpox comes to an end when it enters the scabbing phase. However, doctors still can’t make light of it. Zhang Yan said, By the 13th or 14th day, the pox toxin has come out the blood and the pus gradually dries turning into a color like grape-colored pale wax. The pox shrink orderly from the two sides of the mouth and nose, around the philtrum groove, the cheeks both sides, chin, nape, chest, abdomen, lumbus region and back, gradually downwards and then to the skull above and feet below. The scabs are thick and round, red or yellow, and there are no other miscellaneous symptoms. This is favorable. However, there is yet danger at the scabbing stage. Zhang Yan describes 30 dangerous symptoms, 17 miscellaneous symptoms and 11 adverse symptoms (including six deadly symptoms), all occurring at this stage. He also listed a series of medicinals and formulae for selection. (f)  Miscellaneous symptoms after recovery from the pox: After recovery from the pox, there are also some variable symptoms, complicated symptoms, complex symptoms and accompanying sequelae. If these are not treated with great caution, the doctor will fall short of success — for lack of making a final effort, leaving deep regret. He said, By the 15th or 16th day, all the pox are dry and a recovery has been achieved. Though there is not much to worry about, if the pus is still

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loose and the scabs thin, toxin could remain and cause more trouble… It is best if the pox are dry with thick scabs and drop off spontaneously within 3 days at the most. If the scab color is lustrous or bright and the scar a red color and they have a normal appetite and no other symptoms, it is favorable. He lists altogether 31 miscellaneous symptoms with relevant formulae and therapies, as well 12 adverse symptoms including some which are deadly. In addition, he discusses smallpox in females, especially the pregnant women. Though Zhang Yang expounds all this material in great detail, it was still in some way a restricted view. However, we can clearly understand much about the various symptoms, sequelae, risks and prognoses from his statements. He was so considerate and careful about the selection and application time of his medicinals and formulae for favourable or unfavourable conditions. Comparing his approach with Western medical records at this time, his viewpoints and observations are second to none. Among all previous studies in medical history, scarcely any had any involvement with Chinese medicine, with regard to the diagnosis of and treatment for smallpox. I put the above forward especially since more attention needs to be given to those ancient Chinese doctors who made such marvelous contributions to its treatment, both before and after the invention of variolation.

(3)  Curative Efficacy As for the results of the treatment of smallpox by Chinese medicine, there is no statistical data or material for reference remaining from ancient times. But we can make a reasonable guess from the preface to Zhang Yan’s book. He wrote, I have studied my father’s book and have seen various cases about smallpox, almost ten thousands in all. I also spent decades in careful and industrious thought on treatment for it every day… By applying the appropriate medicinals and prescriptions according to the diagnosis of specific patterns of disease and its syndromes, we can make the severe conditions become milder, adverse states become more favorable, danger turn into safety. Even when a supposedly incurable case is encountered, some lights can be shed on treatment. I am now old

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and weak, and have no strength to go around the country anymore. So I have just written down all what I have studied and treated all my life. I dare not say this is a new invention and there has never been such a marvelous thing in history, but it is my original and unique understanding. I want to publish it so as to supplement present treatments for children and add something new to Huangdi’s and Qibo’s medicine. This is a self-confident statement. He would not dare write such a book, pass on such therapies or claim such efficacy without a high rate of effectiveness. We can also learn from the tribute to his book written by Wu Shiyu, a famous scholar of the times: My friend Mr. Xunyu Zhang… devotes himself to medicine and particularly to smallpox… (he says) the situation of symptoms usually necessitates treatment will not allow any delay. Cases are often very complicated and it is difficult to find the appropriate medicine. But he alone is specialized in this miraculous therapeutic skill. He has visited states and counties all around to succor patients and rescue them from precarious situations. This is why people far and near praise him as a ‘second heaven’… The term “second heaven” refers to “the heaven of rebirth” — and the people praised Zhang Yan highly for giving a second life to their children. We can see here how his reputation for treating smallpox among the common people was extremely high. It is not difficult to imagine the good curative effect. Judging from other records, good curative effects were actually achieved not only by Zhang Yan. For example, Hu Jing, who wrote A Collection of Secret Recipes for the Pox in Children (秘传痘疹寿婴集) in 1491, said it just as well: I have had 10 sons and daughters and almost half of them died of smallpox. In the very 1st year of Hongzhi (1488 CE, Ming Dynasty), one son and two of my daughters in their infancy all suffered from smallpox. I was cautious because of the deaths of my previous children and feared the same thing happening again, so I sought help from several scholars of medicinal formulae — including Dr Qian Yi and others. I treated the pox carefully according to the treatment sequence provided. Thereafter severe cases became milder — and

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milder cases turned around and were cured. All of them came through after being treated for no more than a month. This shows that people during the Ming dynasty cured smallpox with medicinal formulae which had been established since the time of Qian Yi of the Song dynasty, as well as others. Cai Weifan, a contemporary fellow who lived during the Hongzhi period of the Ming (1488–1505 CE), wrote four volumes of A Look on Collections of Pox Treatments (痘疹集览) and one volume called A Treatise on Formulae for the Pox (痘疹方论) — also named A Treatise on Handy Valuable Formulae for Pediatric Pox (小儿痘疹袖金方论) published in 1518 CE. He as a doctor aimed to test the effects of previous pox formulae by trying to practice medicine while pursuing his official course around the country. His conclusion was, These formulae were effective when applied again and again in the southern and northern areas of Huaihe river, the district in and around the capital, northern Hebei province, and southern Hunan province. He travelled and practiced medicine in the southern and northern areas of Huaihe River (Anhui province), in the district in and around the capital city, and areas of the Hebei and Hunan provinces. This covered a really wide area and he very often had good results. He thus wrote these two books and wanted to “further prove their effects around the world”. His endeavour was on the one hand to spread methods of treating smallpox and on the other to emphasize the clinical efficacy of these treatments and verify them. This evidence deserved great praise in the ancient world. Moreover, his attitude was scientific — as he tested all the formulae for their efficacy and wrote books to inform others. His conclusions therefore could be trusted. Essential Teachings on Treatment for the Pox (痘疹正传指心法) written during the Ming dynasty by an unknown author claimed that the author began to practice medicine about the 12th year of the Wanli period (1584 CE) after he learnt from many pox doctors — such as Chen Shouquan, Chen Jiantian and Cao Xingquan in the villages. His curative effect was noteworthy: More and more smallpox patients took a turn for the better and got out of a dangerous state. In the Wuzhong area, people were aware that critical cases of smallpox could be rescued through this medicine. Hence, people generally believed in the efficacy of taking this medicine.

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This occurred in areas around the Suzhou and Jiangsu province. Though the above cases might have taken place at different areas and times, the efficacy of the formulae was evident. During the Qing dynasty, Ye Tianshi of Wuzhong, Jiangsu province, was made still more famous due to his proficiency at treating smallpox throughout the whole country. A Great View and Unofficial History of the Qing Dynasty (清朝野史大观) records a story of him treating smallpox. His daughter said, “My father always says there are no fatal cases of smallpox”, which reflects his great confidence and skill at curing this disease. Therefore, there is no doubt that Chinese medicine has the ability to treat smallpox. However, I actually do not think these medicines had 100% efficacy. Wang Qingren mentioned in the section “About Smallpox not the Fetal Toxin” in A Correction of Errors in Medical Works (医林改错) that pox “is classified into favorable, dangerous and adverse cases, denoting its severity.” He also states, “It is nonsense saying that curing dangerous cases of smallpox is ‘a piece of cake’!” He also states, “When once you meet an adverse case, there is no effective cure. Then all we can say is it is up to fate” and he spoke about “that certain predestined day of death”. From these sentences we can see that most adverse cases of smallpox resulted in death. Nevertheless, Wang Qingren formulated the formulae Tong Jing Zhu Yu Tang (Channel-Unblocking and Stasis-Expelling Decoction), Hui-Yan Zhu Yu Tang (Epiglottis Stasis-Expelling Decoction) and more to rescue patients from severe cases: As for severe cases, all of them have a specific root. If the root is found, how can they not be cured? For example, I have treated some cases where latent smallpox does not erupt fully, but appears all over the body in clusters, thin and dense like silkworm eggs and flat as a snake skin. It then erupts when there is no fever and the pox tips are purplish dark. The pox cover the whole body, the head, mouth, nape and cheeks, compactly — without gaps, and are purple, white and gray, here and there. The skin and flesh do not swell. Blisters come out all over the body and they do not swell either, they create thick fluid, which changes into pus and then turn into scabs. When the pox tips show, the patient suffers constant convulsions and bleeding from all the orifices. The cough is horse and there is choking whenever the patient drinks. Itching occurs six to seven days later and there is no blood if the pox are scratched. Seven or eight days later, there is diarrhea, vomiting and no appetite. In the critical stage, the patient is unable to raise the head, the feet are deflected, the eyes

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looking up constantly and opisthotonos starts to show. If the deficiency and excess of the symptoms can be sorted out at the beginning, all these patients may yet recover. Those who understand this are aware that I have just added to what has been mentioned by previous people, but those who don’t understand criticize arbitrarily and think I’m conceited. However, they don’t understand — I’m not conceited, but just know the root of it. We can say that the authors of works treating the pox were all masters; they include Qian Yi, Dong Ji, Chen Wenzhong and then Zhu Danxi, Huang Shifeng, Cai Weifan, Wan Quan, Guo Zizhang, Gao Rushan, Chen Wenzhi, Wang Ji, Zhu Donglong, Wu Mianxue, Tang Yunlong, Zhu Xun, Wen Zhongren, Nie Jiuwu, Qu Liang, Lu Xiance, Zhu Yilin, Huang Xun, Chen Raodao, Song Linxiang, Shen Juyuan, Wu Sunwen, Zhang Lu, Zhu Chungu, Ye Dachun, Wang Hu, Dong Weiyue, Yuan Daxuan, Huang Yuanyu, Wu Qian, Ye Tianshi, Song Banghe, Xiong Lipin, Jiao Xun, Zhou Guan, Tian Zhifeng, Zhang Wuyun, Zeng Ding, Chen Qisheng, Wen Mengbi, Xu Dachun, Zhang Chaoqing, Yang Zhuxi, Hou Baili, Zhu Chufen, Wang Qingren, Cao He, Tang Weiyuan, Ye Xiangchun, Chen Qiyun, Fei Qiheng, etc. During the Ming and Qing dynasties, a very impressive number of doctors and medical works describing smallpox appeared. Compare this to the Western world where doctors made little or no progress in treating smallpox — they would be at a loss as to what to do. Even today, as smallpox is a viral disease, Western medicine has no antiviral drugs and has to fall back on conservative therapies. How big a gap this is! Smallpox occurs abruptly and is accompanied by serious symptoms and so is listed as a critical emergency in modern medicine. Furthermore, beside smallpox, there are very many formulae and techniques in Chinese medicine applicable in critical emergencies — whose effectiveness can be proven. This goes far beyond the common misunderstanding that “Western medicine is for acute diseases, while Chinese medicine works best for chronic ones.” From these historical achievements when treating smallpox, we should clearly understand that now and in the future, when an acute epidemic disease suddenly attacks (that has never happened before) and Western doctors feel at a loss as to what to do, they should try the option of Chinese medicine. Anyway, Chinese medicine has a system based on pattern differentiation and has many unique medicinals and formulae — there is usually more than one way to tackle it. Again the evident efficacy of Chinese medicine for SARS and bird flu has proven itself more than once.

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B. The Invention of Variolation and Its Promotion by Emperor Kangxi 120.  The Origins of Variolation (1)  Ideas of Prevention and Initial Therapies The age-old tradition was always to value the preventative stages of a disease, in Chinese medicine. Without exception, this aspect of Chinese culture highlights the prevention of smallpox — due to the meticulous treatment of the disease. Preventative therapies were boosted under the guidance of such preventive ideas as “excellent physicians stress the preventive treatment of disease beforehand”, as proposed in the Neijing (内经). The thought of treating before morbidity sets in is shown by Zhang Zhongjing speaking in his Synopsis of the Golden Chamber (金匮要略): “Those who aim to make a preventive treatment for a disease should, in dealing with liver diseases, put a stronger spleen as priority for there is a distinct possibility of the liver infecting the spleen…”, that is, in the next stage. Similarly, Ge Hong proposed “purposely exposing oneself to some toxin, in order to counter it” in his description of smallpox. Also Zhu Chungu proposed a “theory of variolation” in his 1713 edition of The Pox’s Final Solution (痘疹定论): The theory of variolation means creating a preventive treatment for such-and-such a disease, one that happens before it occurs, and aims at ‘having it out’ while someone is healthy or wholly curing them when they are suffering. Accordingly, almost all preventive therapies for smallpox mention first the “Prescriptions for Alleviating Smallpox (Xidou Fang)” — which aim to wholly cure the disease by alleviating the pox of the patients. Xidou Fang can usually be found in books on smallpox like Zhang Yan’s A New Book on Variolation (种痘新书) which, in its last chapter (Chapter 12), lists some 21 prescriptions for Alleviating the Pox, for example: · A “Magical Disinfecting Pill for Children: Take one pill respectively on the day of the spring equinox and autumn equinox, each year; it can clean out smallpox toxin. In the next 3 years, taken six times, it can completely eradicate the toxin and thereafter the pox will be no trouble at all.” (This prescription uses Douteng (bean rattan), Shanzha (hawthorn), Shenma (cohosh), Shengdi (radix rehmanniae), Duhuo (radix angelica

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Duhuo), Niubang (arctium), Heidou (black soya bean), Chidou (rice bean), Danggui (angelica sinensis), Lianqiao (fructus forsythia), Jiegeng (platycodon), Shensha (cinnabar), Chuanlian (coptidis), Fangfeng (ledehourielia), Jingjie (herba schizonepetae), Ku Sigua (bitter gourd) and others.) A “Prescription for Rabbit Blood Pills: Grind the same amount of cinnabar, licorice, and Liuan tea together into a powder and at noon on the eighth day of the last month of the Chinese lunar year, mix it with fresh rabbit blood into pills, each as big as a parasol-tree seed. Taken on the third, sixth or ninth day of each month, the pill can help children avoid the smallpox.” A “Prescription for Four-Shed-Skin Pills: Grind the same amount of the shed skins of a cicada, a snake, egg-shells and nails of one’s parents into a powder, and mix them with honey into pills, as big as a green bean. Take no more than 1 qian (= 5 g) of the pills on New Year’s Eve, for 3 years consecutively, and smallpox can be eradicated forever.” A Prescription for “Calabash Flower Soup: Collect calabash flower in August (lunar calendar) then dry in the shade by any amount. During the eve of a New Year it can be boiling with water for children to take bath to avoid smallpox.” A Prescription for “Toosendan Soup: Take toosendan seeds, any amount, and boil in water for children to take baths in to avoid smallpox. Even when suffering it can also alleviate the pox.” A Prescription for “Snakeshead Mullet Soup: On the eve of the New Year, put one or two large snake’s heads into a soup, which can be used for little children to take baths in from head to toe, without missing out the ears, nose, mouth or any other aperture. No more showers with clean water after that even though there will be a fish-like smell. If you refuse to believe this, if you keep one hand and foot out of the bath, without washing it, then when they meet with the pox these areas of body will have more sores. The rest of their bodies will have fewer pox. This has really been proven. The washing can be done any time — there is no limit to the number of baths.” A Prescription for “Smallpox Pills for Children: Wine-wash 4 liang (1 liang = 50 g) of dodder and 4 liang of lac in containers (not ironware), prepare 2 liang of ledebouriella (fangfeng), without tops, 1 liang of schizonepeta tenuifolia (jingjie), and 2 liang of cimicifuga (shengma) and fry all the above ingredients with saline water. Prepare 2 liang of fried burdock (niubang), 2 liang of peeled fine licorice root (gancaoshao), 3 qian

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of cinnabar (zhusha), 1.2 qian of bamboo sugar (tianzhuhuang), 1.2 qian of bovine bezoar (niuhuang), 1.2 qian of toad venom (chansu) together with 49 grains of black beans, green beans and red beans respectively. Grind all the above ingredients into powder. Then decoct the powder together with water, with 3 liang of lithospermumi (zicao) until it turns into paste. Mix it up with a half-cup of brown sugar and make it into tiny pills as big as a red bean. The final step is to coat the pills with cinnabar. Before smallpox breaks out, make licorice soup and drink it together with the pills. If the patient has got a high fever, change the licorice to ginger. After drinking the soup, the patient should lie in a warm bed with covered with quilts to sweat. This can greatly reduce half the disease. If the smallpox spots are already out, the patient can directly take powdered licorice together with the pills, which can help reduce the disease and the patient recover. Remember not to take too many pills.” · A Prescription for “Three-flower Pills: This pill can alleviate the pox if taken just before it attacks. Take buds of the flowers — plums, peaches, and pears — by the same amount, dry them in the shade and make into a powder. Mix the powder with rabbit’s brains and make into pills coated with realgar. In treatment, take the pills together with a decoction made from red, black and green beans.” · A Prescription for “Six-Flavor Smallpox Alleviating Decoction: For preventative use before eruption of the pox. Decoct 1 qian respectively of crataegus, puccoon, and arctium, 1.2 qian respectively of ledebouriella and schizonepeta, 0.5 qian of licorice together with ginger and take the decoction.” Furthermore, there is a type of therapy of making a sponge bath with sesame oil which on the whole aims to reduce the toxin formation on the skins by dissipation. Such a type of prescription, mostly adopted before the smallpox attack, will normally work. As for their long-term preventive function, there is some evidence for using snakehead mullet soup and although it might not seem conclusive, there is sufficient truth in the testimony of ancient people to try it. Special work on prescriptions for alleviating pox was done by Guo Zizhang, in his Rare Prescriptions for All Kinds of Pustules (博极稀痘方论) compiled in the 5th year of Wanli (1577) during Ming Dynasty. In 1601, Wu Mianxue compiled them into his Eight Categories of Smallpox (痘疹大全八 种) which not only collected all the smallpox prescriptions then known but also drew on Qian Yi’s theory of “smallpox caused by fetal toxin” — which

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advocated that pregnant women be careful in their daily life and diet to avoid attacks on the foetus by the pathogenic qi, that efforts must be made to deprive newborns of their foetal toxin and in addition that their place of residence should be changed during any epidemic. Such were the valuable conclusions made on preventive therapy — to avoid, expel and reduce the effects of the smallpox. So even in perinatal medicine Guo’s advice was valuable. Behind all these preventive ideas for “rare prescriptions for pustules” lay the foundation for the invention of variolation. It might have been after or just around this time that variolation first came into existence.

(2)  Legends of Variolation’s Origin As for the origins of variolation, Dong Yushan in his A New Book on Variolation (牛痘新书) (published in 1884) mentioned, There were no method of variolation until the years of Kaiyuan (713–741) in the Tang Dynasty when a Mr Zhao in a region south of the Yangtze River began to disseminate the method of variolation through the nose, to prevent smallpox. A single mention such as this cannot establish with certainty the date of variolation. However, Qianjin Yaofang (Important Prescriptions Worth a Thousand Gold Pieces for Emergency 千金要方) did record a method of “plant eruption” in the following: “to treat scarlet and dark spots on children’s skin: needle the foot of the father and take the blood which comes out to paste on the spots, and it will work instantly;” “to treat babies’ warts: use a needle or small knife on the skin around the sore to let the fluid come out and paste it on with yellow pus from the sores of a patient suffering from skin sores”. This has the same meaning as the saying, “use poison to treat poison”. Also in “the prescription of using rabbit skins to treat ‘pea sores’” found among the prescriptions found in Dunhuang, it seems to suggest the idea of “dressing them with clothes that have touched the pox” which means to let a healthy child wear the underwear from children suffering from smallpox. All in all, one thing is clear — that idea of prevention or “active immunization” for smallpox sprang up in the Tang Dynasty. Another story links to the early years of the Northern Song Dynasty, when variolation appeared in the regions around Mt. Emei in Sichuan Province. Can this be true? It first appeared in his essay “On Variolation”

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by Zhu Chungu in his The Pox’s Final Solution (痘疹定论) published in 1713 (Kangxi’s 52nd year during the Qing Dynasty) which the emperor Kangxi asked him to write for the throne. However, it is now hard to find an original version of this work. However, Ji Baozhong8 records that “On Feb. 26th, 2006, some manuscripts were found during the dismantlement of some farmers’ houses in Beichen district (of Beijing). These manuscripts had been prepared for a carved woodblock-printed version revised by Zhu’s second son, Zhu Zhaozhong, Zhu Zhaohan, his third son and Qin Chaoguang, his son-in-law, in regular script and small characters on writing paper made from bamboo, cream-colored and book-bound with thread. These could have been up-graded ancient texts, which had become fragmented owing to poor preservation. The original book must have contained four chapters, but now only the majority of the first two chapters are preserved, made into one book without a cover. The last part of chapter two: ‘on the spirit, qi and body during variolation’ is also missing, which is really a pity.” An earlier story of variolation appeared in Shen Dacheng’s block-printed edition of this book prefaced by Wang Mingsheng in 1769. In the chapter “On Variolation” it states: During the reign of Emperor Renzong in Song Dynasty, all the sons of Wang Dan, the prime minister, suffered from smallpox. Later, when another son named Su was born, Wang Dan gathered physicians around him and asked them for medicines and formulae for a cure. Then a man from Sichuan Province came to tell him: ‘In the regions of Mt. Emei, there is a godlike physician who can perform variolation and never fail. His method is to select those scars which have four main characteristics: sharp-pointed on top, red, round and shiny — then make them into a powder to put into the noses of the children, the left nostril for boys and the right for girls. For babies under one year old, use thirty grains of the scabs, which can be crushed with a wooden stick in a clean ceramic container. Drip into the container some three or five drops of clean water, warm in the spring and autumn, cool in the summer, and slightly warm in the winter, adding more drops if it gets too dry, to keep the mixture 8

 Manuscripts of Zhu Chungu, Emperor Kangxi’s Royal Physician’s ‘Conclusions on Smallpox’ (康熙御医朱纯嘏《痘疹定论》手稿), Beichen Writings (北辰文史资料), compiled by Beichen District Committee of Literature and History of CPCC Tianjin, vol. 10, Beichen Cultural Relics (北辰文物), p. 118.

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smooth. Do not let it dry out. Make it into a tiny ball the size of a date-seed and tie it with a red thread 1 cun long. Put the ball into the nose of the baby, leaving the string out to avoid the ball being breathed in. Take the ball out after twelve hours for babies under one year old, or after twenty hours for children two to three years old — sometimes you can leave it in twenty four hours. The scabs which can be used should be thirty-day old scabs in the spring and autumn; fifteen or twenty day-old scabs in the summer; and forty or fifty day-old scabs during cold winters. This is because the qi gathers together in cold days — while it dissipates during those that are hot, and therefore the time and day for variolation depend on this. Normally the ball should be taken out on the fifth day for that is long enough for the five zang organs to be affected. Then on the seventh day there comes a fever which lasts for three days until the pox appear — and remain for three days, filling with liquid. After another three days, all the sores with pus show signs of scabbing. The fever for three days closely relates to the second and third month of the lunar year, i.e. the spring; the pox coming out fully and completely relates to the fourth, fifth or sixth months of the year the time of maturity in the summer; sores with lots of liquid relate to the tenth, eleventh or twelfth months of the year, the time of storage and preservation in the winter. If the pox have not completely grown, or the pox’s liquid is not sufficient, the process can last one day longer, just as we have an extra day in the leap month. This is an enlightened truth given to us by the gods. In the regions around Mt. Emei, from east to west, south to north, people come to him for variolation. He is just like a god, blesses everybody, is worshipped as a god-like physician and his variolation of the pox is just magical. If your prime minister wants help for your son, I can go to Emei to ask him to come. Within a month, the godlike physician came to the capital city and when he saw Wang Su, he rubbed his top head and said, this boy can be inoculated. Then the very next day, the variolation was done. The seventh day, the boy had a fever, and after another twelve days, the sores scabbed. Thus Wang Dan was both highly pleased and gave many thanks to the physician and lots of gifts. Yet the physician, nearly ninety years old, refused his gifts and said, ‘What’s the use of these things for a practicing man like me? You, as our prime minister, help our emperor and assist him, set a good example for all the other officials, rule our country and deter us from the troubles of

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other kingdoms, ultimately bringing peace to all people in the world. Such is the best thank you for me, much more than gold or silk!’ These words spoken, he returned to Emei and called upon his disciples and told his people, ‘I am an incarnation of the Goddess Guanyin who instructed you in the method of variolation to keep you well and give longevity to all children in the world. Now I’ve taught this method to you, you should widely pass it on evermore.’ After these words, he passed away in a seated position. We are not sure whether this is an adaptation or the original story because of the missing sections in the recently discovered version by Zhu Chungu, mentioned above. But big differences can be found in the later editions by Shen Dacheng. For example, “On Variolation” in Reprinting the New Edition of “The Pox’s Final Solution” (重订痘疹定论新编) published in 1870, puts it this way: During the reign of Emperor Renzong of the Song Dynasty, Wang Dan, the prime minister, had sons who all suffered from smallpox. When another son named Su was born during his quite senior years, Wang gathered together all the pediatric physicians and asked them, ‘Are any of you good at treating smallpox?’ and he was answered: ‘We dare not say we are good but we know some therapies for it.’ Wang continued, ‘If you know you must be able to understand. So I’ll provide you each with ten liang of gold a year. And you just wait until my little son is attacked by smallpox. Then together, you see him and discuss about which therapy to use. When the sores scab and my son recovers, I’ll give you a big thank and lots of gifts. Please do not turn me down.’ At that time, an official in the capital city who came from Sichuan Province heard about this and came to Wang to tell him of a godlike physician who was good at variolation and curing smallpox, with some kind of magical prescription. Whoever this physician treated they all recovered without exception. Wang Dan was so pleased at this, and asked, ‘What is his name? Where does he live? Since you know him, please ask him to come to me.’ The man answered, ‘The physician is not a male, but a female, who by legend, is said to have been born somewhere in Xuzhou city, south of China. She practices abstinence from meat and prays to Buddha every day since she was a child. When she grows into an adult, she does not marry anyone, nor does she make tonsure. She just has wandered the world until she settled down on top of Mt.

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Emei living in a Buddha convent, she built herself. She has attracted to herself all the kind women happy to pray for people in the area of Shangqiao, Zhongqiao and Xiaqiao. They follow her practices, praying to Buddha and all vegetarian. Later, she appeared to teach the method of how to treat smallpox, and how to do variolation. She says to all the women there that after twelve days, the pox scab can be used for ‘growing smallpox’. For babies under one year-old, use thirty grains of these scabs and grind them up with a willow stick in a clean ceramic container. Drip into the container some three to five drops of clean water, warm in the spring or autumn, cool in the summer, and slightly hot in the winter, adding more drops if it gets too dry, to get a mixture. Make it into a tiny ball, covering clean cotton and tying up with a red silk thread — and a sling as long as 1 cun coming out of the nose, to avoid it being breathed in. Put the ball into the nose of the baby, leaving the sling out in case the ball is taken in. Take the ball out after twelve hours for babies under one year-old, twenty hours for two or three year-old children. Yet a complete twenty four hours can be also fine. These scabs which can be kept for using thirty days in spring and autumn; fifteen or twenty days in summer; and forty or fifty days in cold winters. This is because the qi gathers together in cold days while it dissipates in the heat and therefore the time and days for the variolation varies. Normally the ball should be taken out on the fifth day after the seedlings of the pox have circulated into the five zang organs. Then on the seventh day comes a fever and the seedlings all appear fully for three days and then the sores caused by the smallpox rise up, one by one. After another three days, all the sores fill up with pus and then show signs of scabbing. The fever for three days is closely related to the second and third months of the lunar year, i.e. when it is spring the beginning time of growth; the seedlings all coming up usually coincides with the fourth, fifth or sixth months of the lunar year. the time of maturity in the summer; while sores with lots of pus can be connected to the tenth, eleventh and twelfth months of the lunar year, the time of storage in the winter. If the seedlings have not completely grown, or pus is not sufficient, the process can be one day longer, just as in the leap month. This is truly an enlightened truth given to us by the gods. Follow these procedures and inoculate your own children. It works without exception.’ All the women did as she told and their children all recovered well. Since then, in the regions around Mt. Emei, from east to west, south to north, people all come

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to her for variolation. It was just like being blessed by the gods — and so the variolated pox was called the ‘god-pox’ and she was called a godlike physician. If the prime minister wants her to variolate your son, it is no problem for me to arrange a sedan chair and go to Emei to ask her to come. Within two months, the godlike physician came to the capital city and when he saw Wang Su, she rubbed his head and said, ‘This boy can be inoculated.’ The next day, the variolation was done. Seven days after that, the boy had a fever, and after another twelve days, the sores scabbed. Then Wang Dan was highly pleased and gave a big thank to the physician with lots of gifts. Yet the physician, nearly ninety years old, refused his gifts and said, ‘What’s the use of these things for a practicing woman like me? You, as our prime minister, associating with the emperor’s kindness and disciplining himself, can set a good example for all the other officials, rule our country and keep it inviolate from others, and ultimately bring peace to all our people. Such is the best thank to me, much more than things like gold or silk.’ These words spoken, she returned to Emei. The next year, she called upon all her disciples from Shangqiao, Zhongqiao and Xiaqiao and told them, ‘I am not mortal, but an incarnation of Goddess Guanyin who taught you the method of variolation to keep healthy all children in the world and longevity. Now I’ve taught you and you should pass this on.’ All the women bowed and prayed to her for blessings. When they praised her and asked her by what name they should call her and pass her name down on forever, the physician answered, ‘I am the Goddess Tianmu. If all families who have had variolation performed can burn incense and worship me as Tianmu, I’ll come from the sky and do my magical tricks to save lives and bring luck to you, bringing the dead back to life.’ After these words, she passed away in a seated position. This latter version, compared with the former one, is about 450 words longer and especially embellished with Buddhist colours. Here, Emperor Renzong of the Song Dynasty must be a mistake for Emperor Zhenzong of the Song, an error which appears in both versions. Considering the fact that Wang Dan (957–1017) was a renowned and “peaceful prime minister” and occupied his position for 12 years during the reign of Emperor Zhenzong — and his son Wang Su (1007–1073) was born in the 2nd year of him being a prime minister — my surmise must be true.

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The Yizong Jinjian (医宗金鉴 The Golden Mirror of Medical Ancestors, published in 1742) records, There is an ancient method of variolation which sprang up in Jiangyou (today’s Jiangxi province) and spread to the capital (near Kaifeng). Yet it can trace back its origin to being created by some godlike person from Mt. Emei, during the reign of Emperor Zhenzong of the Song Dynasty. Thus variolation was originally born and worked on the son of Wang Dan, the prime minister at the time, and later spread on. Judging by this, variolation seems firstly to have appeared in the region of Mt. Emei in the 11th century and then spread into Kaifeng, Henan, at the request of Wang Dan for his son. Here, Wu Qian, the author of the book, obviously made a story based on that of Zhu Chungu and therefore his story is simply repeating the legend. Wu’s words “sprang up in Jiangyou (today’s Jiangxi) and spread up to the capital” must refer to the incident of Zhu Chungu doing variolation in the capital and so it went on. Published in 1727, the Douke Jinjingfu Jijie (痘科金镜赋集解 Collections of Explanations for the Golden Mirror Poetry of Smallpox), written by Yu Maokun and republished in 1885, contained additional words: I have heard some others say that the variolation appeared in Taiping County, Ningguo prefecture during the Longqing years (1567–1572) of the Ming Dynasty. Someone unknown learnt it from an extraordinary pellet-making person and then spread the method everywhere. Nowadays, the majority of practitioners of variolation have come from Ningguo — although recently quite a few Liyang people also took it over. It is said that there are still some smallpox seedlings preserved by the family of the first pellet-maker — and only with three liang of gold one can buy one. Of course the buyer can make a profit from these seedlings. It is quite common for those who want to have variolation in winter or summer to take the scabs from the children of their relatives. The scabs then are made into seedlings to be preserved for future use, which is called ‘seedling preservation’. When the seedlings are all finished, they have to go to Taiping County to buy some more. So it was that no harm came through variolation. However, in recent years, some profit-makers that are really dark-hearted, steal the scabs which no longer have the

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function of making seedlings, and these are called ‘bad seedlings’. The epidemic period now has passed but still a few toxic areas could exist — so that several among hundreds of children, will unavoidably become their victims. Taiping County in Ningguo Prefecture is today’s Huangshan city in Anhui Province. Such descriptions as “learnt it from some extraordinary person” refer to the passing on of the godlike person in Mt. Emei, which belongs to the great inventions and achievements of Taoist medical scientists. This was agreed on by Dr. Joseph Needham who believed in the invention of variolation by the Taoists.9 So it is the Taoist culture that nurtured this great invention. However, the practice of variolation was carried on quietly and secretly in the folk world. Zhang Yan discussed this in his A New Book on Variolation (种痘新书 published in 1741): No records of variolation can be found in the published medical books. We have got meticulous prescriptions for smallpox treatments and have spread them out to the whole world, but why is this method of variolation not described to other people? The secret of this method is not written in a book because they want only for private use — and then their valued skill means they get the benefits and it is not spread to the public world… Among the mountains of medical books, only the method of variolation is nowhere to be found. This is simply because those who know it want to reap the profit on their own, and therefore they keep it a secret…

(3)  A Literature Review of Variolation Therapy Reviewing all these written accounts, we find that the two characters 种痘 (zhongdou, “growth pox”) appeared earliest in the “Smallpox Experiential Therapies (痘疹心法)” originally published in 1549 in Wan Quan’s The Medical Encyclopedia of Wanmizhai (万密斋医学全书), republished in 1663, which is the earliest surviving edition. In Vol. 8 it states, Some people ask, ‘Why are there some who have never been attacked by the smallpox?’ The answer is, ‘smallpox, also named Baisui Chuang, is 9

 Joseph Needham. The Origin of China and Immunology (中国与免疫学的起源), Science & Civilization in China, Volume VI:6. Cambridge University Press, 2000, pp. 114–174.

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caused by fetal toxin. How can there be people who are born without parents and free from heaven’s arrangement? But it is simply because these people are nurtured by the clear qi both of nature and their parents, and thus they are pure and clean, bearing no dirty toxin within. When they reach the year for growing the pox, they may have some fever but they do not feel it — and there are only one or two pox springing up on their body. How can it really be they escape the pox all their lives?’ In Vol. 21 it also says, When a woman has just taken the ‘growing pox’, when her period is starting and she is stricken with a sudden dumbness… she can be treated firstly with Dangui Yangxin Tang (Angelica Nourishing the Heart Decoction) to nurture the blood so as to help the heart. Until they can speak again, use also Shiquan Dabu Decoction (Perfect Major Supplementation Decoction). Some people argue that this book has much more on how to treat smallpox but not on the “growing pox” which is touched upon briefly only in a couple of places. It seems, they say that the “growing pox” this book deals with is quite different from “variolation”. For example the term is used by Hong Ruogao. This was recorded earlier in the Qing Dynasty in his Nansha Collection Works (南沙文集): “During the epidemic time of the smallpox, folks say it is like growing green beans which sprout in warm weather and not in cold. Such is its nature.”10 Here, he uses the metaphor of “growing beans” and so he talks of “growing pox”. But what Hong refers to are the conditions for the attack of smallpox, and so the term means “growing” the pox, which is not the same as Wan’s “growing pox”. According to the quotation from Wan’s book, he must refer without doubt to variolation. Furthermore, in a following paragraph in the 8th chapter he clarifies the preservation of the pox seedlings: Some say, ‘the folk way of preserving pox seedlings is just like asking Buddhists or Taoists to spray holy water on them, together with incantations. Can this work?’ The answer is, ‘it is an age-old custom which cannot be changed easily. No matter whether it works or not, 10

 Hong Ruogao. Nansha Collection’s Work (南沙文集), Vol. 5, “Biography of Quacks (庸医 传)”，p. 388 (based on 255th section of the photocopy of Kangxi’s version The Siku Quanshu Cunmu (四库全书存目丛书)).

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just follow their preference and do not hold back. Otherwise if some change brings about a bad result the doctor could be blamed — as well disgrace for not following the tradition and letting the Taoist monks get involve.’ “To preserve the seedlings” means to preserve the seedlings for variolation. From these words it would seem there has been a long practice of variolation and seedlings preservation — and it did not begin with Wan Quan. As for “the folk way of preserving pox seedlings”, did he aim to differentiate this from other medical traditions? Wan did not write a special chapter on variolation. Does this mean he had some secret? This will be discussed later. In all, up till now, an overview of the medical books which mentioned “variolation” includes the following, in chronological order:  1. Ming Dynasty, Wan Quan: Smallpox Experiential Therapies (痘疹心法 also named A Hereditary Physician’s Smallpox Experiential Therapies 痘疹世医心法, 23 volumes, published in 1549). The book was later included in the Smallpox Encyclopedia (痘疹全书) (published in 1610), Essentials of Smallpox (痘疹心要 also named the Encyclopedia of Smallpox Essentials 痘疹心要全书, published between 1573 and 1620) and Wan’s Medical Encyclopedia (万密斋医学全书 published in 1663). It mentions variolation three times.  2. Ming Dynasty, anonymous author: Method of Variolation (种痘法). This book was compiled into the Category of Xuanshangzhai Compilations (玄赏斋书目) by Dong Qichang (1555–1636).  3. End of Ming and beginning of Qing Dynasty, Fang Yizhi (also named Mizhi, born in 1611, died in 1671): Small Knowledge on Nature (物理 小识), published in 1643 and supplemented in 1649. The book discussed a method of treating “the magical growing pox” (through the nose, clothing or quilt).  4. Qing Dynasty, Fu Zhengchu et al.: The Kind Skill of Treating Smallpox (天花仁术), written in 1683, prefaced by Huang Baijia, the third son of famous Huang Zongxi (1610–1695).11  5. Qing Dynasty, Zhang Lu (also named Zhang Luyu, 1617–1699): Zhang’s Medical General Book (张氏医通), published in 1695. The part “Growing Pox” was attached as Vol. 12. 11

 Huang Zongxi, a great thinker of the last years of the Ming Dynasty and the beginning of the Qing Dynasty.

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 6. Qing Dynasty, Gui Yunsu: A Book on Growing Pox (种痘书), one volume, completed in 1700.  7. Qing Dynasty, Shi Xijie (Lord Jin): An Encyclopedia on Smallpox (痘书 大全), published in 1707. Its “On the Origins of Smallpox” (原痘论) mentioned variolation.  8. Qing Dynasty, Zhu Chungu (also named Zhu Yutang): The Pox’s Final Solution (痘疹定论 also named An Encyclopedia on Variolation 种痘全书, four volumes), published in 1713.  9. Qing Dynasty, Jiang Liangchen (also named Jiang Lianggong): Immortal Variolation (种痘仙方), three parts, published in 1732. This book was previously the one copied by Xu Wutian in a handwritten copy without naming author or time of completion. It was found by Jiang, a physician practicing over many years, who was then amazed at the magical method of variolation, which Zhu Shengxue12 performed successfully on over twenty people in one family. Later Jiang gained an original copy and through tidying and rewriting, completed this book. Yet because it was attached to a block-printed edition of Fu Maoguang’s Questions on Medicines (医学疑问) and since Fu lived during the Ming Dynasty, it was mistaken as being from the Ming. 10. Qing Dynasty, Zhang Yan (also named Zhang Xunyu): A New Book on Variolation (种痘新书), 12 volumes, published in 1741. The third roll specialized in discussions on variolation. 11. Qing Dynasty, Wu Xuekong (changed to Li Renshan after he moved to Japan): Li Renshan’s Probe into Variolation in Japanese (李仁山种痘和解), originally named On Variolation (种痘说) in Chinese. The book was translated by Shigesaburou Hirano (平野繁三郎) and Jinbee Hayashi (林仁兵卫) and published in Japan after Wu gave variolation there in 1744 and had great success. 12. Qing Dynasty, the lay Buddhist Yulan: The Method of Variolation (种 痘法 also named Essentials to Protect Babies 保婴要旨), approximately complete by 1750. It enclosed at its end Zheng Wangyi’s On Variolation (种痘论) from the Ming Dynasty. In 1843, it was published with a new name the Essential Method of Variolation (种痘要法) with an enclosure of “The Methods of Alleviating Smallpox”. Considering that Xuansongting once copied a summary of this book in the Essential Safety Way of Variolation (种痘万全要法) which was said to be originally written by

12

 For this story, see Section 122(2).

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Chen Fu, Chen must be Yulan himself. Yet whether he was also the Taoist Feixia still remains a mystery. 13. Qing Dynasty, Wu Qian (also named Wu Liuji) et al.: Essentials and Experience of Variolation (种痘心法要旨), one of the 15 fascicules of the Yizong Jinjian (医宗金鉴), expatiating variolation, and published in 1742. 14. Qing Dynasty, Ye Gui (also named Ye Tianshi, 1667–1746): A Guide to Clinical Practice with Medical Records (临证指南医案), collected by his disciples, published in 1760. Vol. 10 Essential Cases of Pediatric Smallpox collected quite a number of variolation cases. 15. Xu Dachun (also named Xu Lintai, 1702–1780): On Medical Origins and Development (医学源流论), published in 1757; Lantai’s Criteria (兰台轨范), published in 1764; and Probes into Medicines (医砭), compiled into Eight Medical Books of Qianzhai (潜斋医学丛书八种) during the years of Daoguang (1821–1850). All three books discussed variolation. 16. Qing Dynasty, Wang Zhu: A Variorum of Variolation Essentials (种痘 心法要旨集注), published in 1781, annotating and explaining “Essentials of Variolation and Experience” (种痘心法要旨) of Yizong Jinjian (医宗 金鉴). 17. Qing Dynasty, Zeng Ding (also named Zeng Yiluan): A Guide to Understanding Smallpox (痘疹会通), completed in 1786, containing the method of adopting smallpox seedlings for variolation. 18. Qing Dynasty, Zhou Guan (also named Zhou Zhentao, ?–1803): A Detailed Annotation on Smallpox (痘疹精详), published in 1794. He learnt from Nie Jiuwu, the expert on variolation.Vol. 1 has a review and extraction of the theories of variolation given by Zhu Chungu and Zhang Yan. 19. Qing Dynasty, Jiao Xun (also named Jiao Litang, 1763–1820): A Book on Variolation (种痘书), completed in the last years of Emperor Qianlong’s reign (probably 1795). The original is nowhere to be found, but in his Diaoguji (雕菰集) there is “A Preface to a Variolation Book” which told of his collecting ten chapters of A Book on Variolation (种痘书) based on descriptions made by Cheng Weizhang, a physician excelling in treating smallpox. Later Jiao himself inoculated his own son, Tinghu in 1791, and his grandsons Shouyi in 1809, Shoushu and Shoushi in 1816 using what he had learned from Cheng. 20. Qing Dynasty, Wen Qi (also named Wen Mengbi): Abstracts of Pox Diseases (痘科辑要), six volumes, completed in 1801. It expatiated

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upon variolation in the books The Pox’s Final Solution (痘疹定论), A New Book on Variolation (种痘新书) and others. 21. Qing Dynasty, Huang Chaofang (also named Huang Miaoshan): A Key to the Synopsis of the Golden Chamber (金匮启钥), published in 1804, containing 37 volumes in nine categories, among which are six volumes on “the category of the pox”. 22. Qing Dynasty, Zhu Yilin: Experiences of Variolation in Mind (种痘心 法), containing only one roll, published in 1808. An extract of this book once was found in the appendix to Vol. 18 of the reprinted edition of Zhu Yilin’s An Encyclopedia of Smallpox from the Star-picking Pavilion (摘星楼治痘全书). This must be have been added by someone in the late Qing Dynasty, but not by Zhu Yilin himself. 23. Qing Dynasty, anonymous author: An Operation Guide to Variolation (种痘指掌), the author and time both unknown, published in 1808 with help from Huang Tingjian who also made a preface for it. The latter half of this book recorded the whole writing of Gui Yunsu’s A Book on Variolation (种痘书). 24. Qing Dynasty, Zhiyu Qiaoke: Pediatric Enlightenment (儿科醒), published in 1813, with an appendix of On Variolation (种痘说). 25. Qing Dynasty, Wang Qingren: A Correction of Errors made in of Medical Works (医林改错), published in 1830. It said that “all variolation practitioners work very successfully; there is never one that does not take.” 26. Qing Dynasty, Zhu Chufen (also named Zhu Chenbing): Collections of All the Books on Smallpox (痘疹集成), four volumes, published in 1837, including the method of variolation. 27. Qing Dynasty, Cao He (also named Cao Ji’an): A Tiny Collection of Smallpox Treatments (痘医蠡酌录), published in 1844, discussing the choice and preservation of smallpox seedlings. 28. Qing Dynasty, Chen Dongling: Magic Liu’s Book on Variolation (刘神 医先生种痘书) also named A Magical Book on Variolation (种痘奇书), and Chen’s Book on Variolation (陈氏种痘书) which must be written by a magical physician Liu whose name, hometown, birth and death dates are unknown. A cousin of Chen Dongling learned the method of variolation from a magical physician “Liu” in Guangdong Province and then passed it on to Dongling. Completed in 1846 and published the next year. 29. Qing Dynasty, Wang Shixiong: Anthology of Ancient and Modern Medical Cases and Comments (古今医案按选), four volumes, com-

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pleted in 1853, discussing the harm brought about by the adoption of inefficient seedlings during variolation. 30. In 1899, Katsuaki Kogn (久我克明): A Mirror for Variolation (种痘龟 鉴), two volumes. The book was completed in 1871 in Japan. 31. Qing Dynasty, Gao Peiyuan: Magical Prescriptions for Smallpox in One-Month Babies (经验小儿月内出痘神方), reprinted in 1887. The first edition was brought to light in 1836 with its author unknown. Gao made a preface for the reprinted one and said, “The origin of variolation, although I have searched through almost all the medical books, still remains a myth. There must not be any truth in the saying that it was created by someone living in Mt. Emei during the reign of Emperor Zhenzong in the Song Dynasty, because this was simply added to some of the given prescriptions and not recorded in any classical works.” 32. During the Republic of China (1912–1949), Xu Lizhou: Treatments of Measles and Smallpox (痧痘证治), its completion year unknown. Xu (1892–1962) was good at preventing smallpox by variolation. The above books help figure out a rough list of the origins and development of writing on the prevention of smallpox by variolation. Yet one thing must be made clear — in fact there are two books which are not in the above list, but generally considered the earliest. One is An Encyclopedia of Smallpox from the Star-Picking Pavilion (摘星楼治痘全书) written by Zhu Yilin (also named Zhu Yingwo, with “Host of the Star-picking Pavilion” as his alias) during the Ming Dynasty. Published in 1789, the 54th year of Emperor Qianlong’s reign, the book, in Vol. 18 “Appendix”, contained Supplemented Extracts of Variolation Methods (附摘钞种痘心法), which is generally considered to be a reprint of Zhu Yilin’s original book, with its discussions on variolation copied as well. The original was named Collections of Treatments of Smallpox (治痘大成集) and published in 1620, the 48th year of Wanli of Ming Dynasty, which boosts the surmise that the first book on variolation appeared around this period. Yet in fact, An Encyclopedia of Smallpox from Star-Picking Pavilion (摘星楼治痘全书) is a reedition made by Zhu Zunxian, a descendant of Zhu Yilin. What is added to the reedited one is fairly identical to what’s described in the Pediatric Variolation Essentials (幼科种痘心法要旨) of Yizong Jinjian (医宗金鉴 published in 1742). Furthermore, the book title was also changed, which eventually caused later generations to mistake the material as being already contained in the original book published during the Ming dynasty.

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The other one is the Douke Jinjingfu Jijie (A Golden Mirror of Prose Poems from the Variorum Edition on the Pox 痘科金镜赋集解 also named the Douke Jijie or A Variorum Edition on the Pox 痘科集解 and the Shadou Jijie of A Variorum Edition on Measles and Pox 痧痘集解) written by Yu Maokun (also named Yu Tianchi) and first published in 1727, the 5th year of Emperor Yongzheng’s reign in the Qing. Aiming to criticize and explain the Douzhen Jingjinlu (痘疹金镜录) written by Wen Zhongren and published in 1579, the book cites different thoughts and arguments, collected prescriptions and appendixes describing effective cases. Today’s editions of this book are mostly later reprints. For example, the edition of 1885, the 11th year of Emperor Guangxu’s reign during the Qing Dynasty, was renamed A Variorum Edition of Mr. Yu Tianchi’s Measles and Pox (俞天池 先生痧痘集解) and in it variolation was expatiated and proposed using “mature seedlings”, while “bad seedlings” were to be rejected. What’s more, when it says “… some say that the method of variolation appeared in Taiping County, Ningguo prefecture during the Longqing years (1567– 1572) in the Ming Dynasty…”, which is commonly referred to as early proof for the origin of variolation, and some even trace this back to Wen Zhongren. Some believe him to have recorded it in his Douzhen Jinjinlu (痘疹金镜录). But the fact is that when reviewing early editions like today’s extant edition of 1787, published in the 52nd year of Emperor Qianlong’s reign, no records of variolation can be found. Obviously, these are additions made by Li Yun in Yangzhou City when he reprinted the book. What’s been added into the edition of 1885 includes “On Variolation”, “Methods of Variolation” and “Six Points on Variolation”, and these are there to let readers know clearly the origins of variolation, as being close to the Wanli (1573–1620) and Longqing (1567–1572) reigns, but this is not at all greatly reliable evidence. These books are not the only two — additions inserted into later editions were common. For instance other books include Key Points on Smallpox (痘科扼要) written by Chen Qisheng and reprinted by Zeng Yiguan in 1755, Zhai Liang’s Collections of Easy to Learn All Treatments of the Pox (治痘 十全便读) with additions and supplements by Huaiyou Xueren in 1768 and Cui Yue’s A Detailed Discussion on the Pox (痘疹详辨) reprinted by Cui Xinlan in 1820.13 Essential research must be made to determine the differ13

 Qiu Zhonglin. Geographical Distribution, Dissemination and Vaccine Production of Variolation in Ming and Qing Dynasties (明清的人痘法: 地域流布，知识传播与疫苗生产), Taibei: Biology by Institute of Philology and History, Book 77, 2006, p. 478.

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ences between the originals and the reprints, because sometimes the additions and deletions in the reprinted ones could be important — they do not tell the reader clearly what has been added or deleted, what the reason for doing this were, or the sources.

(4)  Stories on Variolation’s Origin So when did the preventive method and skills of variolation arise? Is the story about Wang Dan welcoming the godlike physician from Mt Emei during the Northern Song reliable? Lots of arguments have appeared already. As for me, I also once believed that the story told by Zhu Chungu must be true because he, as a specialized royal physician for Emperor Kangxi, was fully trusted, or else if he had created false information how could he dare to commit the crime of “cheating the emperor”? Yet on probing into these questions again, there might be a different answer. First, no records of variolation can be found in either historical books, notebooks, fiction, or classical medical writings for more than 400 years from about 1110 CE when the prime minister’s son, Wang Su, was given variolation to the middle years of the Ming Dynasty. This latter date is based upon the first appearance of the term “variolation” (种痘) in Wang Quan’s Smallpox Experiential Therapies (痘疹心法) in 1549, the 27th year of the Ming Jiajing years. This is really unimaginable. In particular almost all emperors of the Song Dynasty had a special liking for medicines. The Emperor Zhenzong, whose story of his favourable medicines has been discussed in previous chapters, was so interested that he lay on herbs to get an arrowhead out of his flesh and was always concerned about keeping healthy. If there did rise a story of a godlike physician who gave variolation in the house of his prime minister, it would be impossible for Zhenzong not to get the news; on the contrary, Wang Dan also dared not miss a report to his emperor — who would no doubt praise and reward him for it. Meanwhile, men of letters would of course write down what they knew and there must be some of this kind among Wang Dan’s disciples. As described in the previous chapters, the storyteller was an official himself in the capital city and probably a disciple to the prime minister. If he could get news to Kaifeng, the capital city, that there was a godlike physician in Mt. Emei, it could not be kept a secret. The story says, “in the regions around Mt. Emei, from east to west, south to north, people all came to him for variolation. He, just as if blessed by gods, is worshipped as a godlike physician.” If this is true, the fame of the godlike physician must have spread all over the regions of the

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southern part of Sichuan Province. And, since Mt. Emei was a famous spot for Buddhism which attracted numerous pilgrims, how can such a miraculous story of a godlike physician have been ignored? Therefore, there being no spread of this story and no record of it both prove its unreliability. This is one item of proof. Second, medical science during the Song Dynasty reached a peak — with the continuous springing up of outstanding physicians and medical texts, so how can it be true that a godlike physician visited the house of the prime minister while everyone was kept in the dark? How could the Wang’s physicians be insensitive to such a godlike one moving among them all? The time of Wang Su who lived from 1007 to 1073 was in reality around that of Qian Yi (about 1032–1113) who, as a pediatric specialist, was called upon by the royal medical bureau to cure the daughter of the princess royal Chang, and awarded the high position of Hanlin Medical Officer in the Imperial Academy and since then settled down to live in the capital city for the rest of his life. So Qian Yi must have been aware of the affairs of the time — especially such an important event as variolation. But in the Keys to Pediatric Diseases (小儿药证直诀) compiled by Yan Xiaozhong in 1114, not one word was said on variolation. The same goes for Dong Ji’s Emergency Prescriptions for Pediatric Maculopapules (小儿斑疹备急方论). Some evidence relates to Tang Shenwei who was living in Chengdu city, in today’s Sichuan Province, not far away from Mt. Emei: He and his forefathers were all physicians who were expert at using classical prescriptions. And he never failed in his treatment of disease. When he made a diagnosis, often it could do it well in a few words. In his eyes, there was no difference between the privileged and the humble so he would go to see any patient, summer or winter, rain or snow. If the patients were learned, he would ask for no pay — but asked for famous prescriptions and secret records. The learned patients were especially pleased at this and when they did readings, they would write down such stuff as herbs, or prescriptions and tell him. Tang therefore collected all these into a book named Materia Medica Arranged According to Patterns (证类本草). These collected writings of widely ranging materials became a medical encyclopedia at that time. The book was complete in 1082 and revised and finalized between 1098 and 1108, which was around the time of Qian Yi. However, it contained no words describing variolation either. Suppose

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variolation had taken place in the regions of Mt. Emei and “in the regions around Mt. Emei, from east to west, from south to north, people all come to have variolation”, how could Tang Shenwei be exclusively kept in the dark? When it is said he often “asked for famous prescriptions and secret records” but not money from patient’s disease treatments, it would have been impossible for so many learned patients not to tell him if they had heard about variolation. No record of variolation can be found either in Chen Wenzhong’s Prescriptions on Pediatric Pox (小儿痘疹方论) printed during the Jin Dynasty. How can it be that pediatric specialists on smallpox like Qian Yi, Dong Ji and Chen Wenzhong, outstanding folk physicians and personages of encyclopedic knowledge like Tang Shenwei, and local physicians and learned people from the capital city Kaifeng to Sichuan Province all remained ignorant of variolation? This could not happen. The only reason must be that there was no variolation around at that time. This is the second item of proof. Similarly, with the continued prosperity of medicine after Northern Song dynasty, and the movement of spiritual liberation ushered in by medical physicians during the Jin–Yuan period which followed, is it really possible that such a therapy as variolation remained unknown? What’s more, in the above story, the “Goddess Tianmu” clearly instructed “the women from Shangqiao, Zhongqiao and Xiaqiao” in a “method of variolation to keep healthy all the children in the world. Now I’ve taught you, you should pass it on”, which was by no means asking them to keep it a secret. Therefore, no matter whether in Kaifeng or Mt. Emei, there was no artificial obstruction to the spreading the news of variolation. Meanwhile, judging from the story, variolation was a great success — which defeats the idea of the suspension of its popularization owing to some technical problem or poor effect. In short, it is fairly unimaginable that a great technique, a historical and life-affecting medical invention, could be kept silent and unknown to the whole of society for hundreds of years. This is the third item of proof. Added to this, in the story from On Variolation (种痘论); “the method of using scabs of pox from smallpox” was taught by the godlike physician from Mt. Emei but nothing else was mentioned. But the fact is that this method was a product of a progressive technique of variolation, and did not appear on its own at the very beginning.14 This is the fourth item of proof. 14

 See Section 122.

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There were many editions of The Pox’s Final Solution (痘疹定论) in each of which the story about the origins of variolation has its own splendid flavour — with lots of optional add-ons and deletions. On the one hand, this highlights its reliability to physicians at the time, but on the other, it exposed its unreliability to those verifying its history, and eroded their trust. According to all the above-mentioned points, the story of variolation in the Northern Song Dynasty is nothing but a fabrication by busybodies from a later age. Fan Xingzhun quoting the words of Zhang Cigong said that the story of the godlike physician from Mt. Emei was in fact made up by Hu Pu, a scholar from Deqing County in Huzhou Prefecture (Zhejiang Province).15 This is not impossible. Similar stories also included the following: the one told by Fang Xiangying in the early years of Emperor Kangxi’s reign which talked about the enlightenment in a dream of a Taoist from Jiangxi Province, in his practice on Mt. Emei; the one by Gui Yun-Su who heard it from a Sanbai immortal; the one by Zeng Yandong on variolation by the goddess Guanyin; the one by Li Renshan on the teachings of variolation given by Goddess Mazu.16 All these are simply “gilding the truth”, just as some religious disciples in the West like to fabricate stories of miraculous apparitions. In Immortal Variolation (种痘仙方 1732), a passage within “After Variolation” is also worth reading: Once there was a wealthy merchant in the regions of Hunan and Guangdong Provinces whose sons all died of smallpox. As he very mercifully liked to do kindnesses to other people, in his later years, he was blessed by the Goddess Guanyin and finally got a son. His son eventually survived after his acquaintance with a Taoist who taught him small pox variolation. From then, he passed on the method of far and wide. This method is extremely simple, authentic and never fails either. Yet those who recently practiced it fear it being ignored so they made up a magical story. Such a mention might provide something for the understanding of the variolation story in the Northern Song Dynasty, later described and changed a little in the book by Zhu Chungu. Or it is quite probable that the earlier one was the original version later rendered and exaggerated by some busybodies 15

 Fan Xingzhun. History of Preventive Medical Thoughts in China (中国预防医学思想史), p. 113.  Reference to Note 1 on page 465: “written by Qiu Zhonglin, pp. 460–461.

16

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into a new tale in which the Goddess Guanyin is changed into a godlike physician (said to be Goddess Tianmu, a transformation of the Goddess Guanyin) invited down by Wang Dan from Mt. Emei. Such a colourful and vivid story triggered a firm belief in Zhu Chungu — who then wrote it into his book. However, this is not the end of the process. It had become hard to find the original story in The Pox’s Final Solution (痘疹定论), published in 1713, and in the 1769 version of Shen Dacheng; the story described is somewhat different to that in the 1870 reedited edition — for there is an addition of some 450 words (a single chapter).17 It is no doubt a Buddhist addition — made due to someone’s belief.

(5)  Research into the Beginnings of Variolation in the Regions South of the Yangtze River in the Middle and Late Ming Dynasty Supposing the legend from Mt Emei of the Northern Song Dynasty was true, then there is a “blank window” of 440 years between 1110 and 1549, while a few records of the appearance of variolation can be found in the middle and late years of the Ming Dynasty which, although said to be secretly passed on, actually spread rapidly and widely. Just as we said above, Wang Quan’s Smallpox Experiential Therapies (痘疹心法) is the first book containing the characters 种痘 or “variolation”. This book, published in 1549, the 28th year of Jiajing during Ming Dynasty, actually did not describe in detail the method of variolation, but proposed some treatments and prescriptions on deteriorating cases after variolation during menstruation — while he also gave his ideas on whether “worshipping the gods” should be used when preserving smallpox seedlings. For the latter, Wan himself pointed out it is not necessary, but could be simply providing mental relief. It is probable that Wang himself never performed any variolation so he was not exaggerating in his book. Wan Quan (1495–1580), was born in Nanchang, Jiangxi Province. Settling down in Luotian, Hubei Province, he lived through the five dynasties of Hongzhi (1488–1505), Zhengde (1505–1521), Jiajing (1521–1567), Longqing (1567–1572) and Wanli (1573–1620) (all names of the reigns of five different Ming emperors). His grandfather and father were both famous physicians and Wan himself was especially good at pediatric and pox diseases. Yet it is quite strange that he knew about variolation but did not perform it. One possible answer might be that without experience himself he did not want to act rashly. Under these circumstances, it is really valuable that he, a physician 17

 See Section 120.

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making famous the first treatments of smallpox, mentions variolation in his book. However, in 1522, the 1st year of Jiajing, Zheng Shanfu (1485–1523), in a letter to Ying Nanzhou, said, “in the spring, I have learned from two persons and heard that Xianren performed variolation in Ji’nan.”18 Xianren was a son of Ying Nanzhou who practiced variolation in Ji’nan, Shandong Province. The time here is so close to that of Wan Quan (1495–1580) that variolation must have been practiced in the folk world despite there being no official records to prove this. Wan Quan wrote down the characters for “variolation” in his own book. But it is not that simple. The fact that he did not make any exaggerations about it owing to his own lack of practice in variolation showed his careful attitude towards it as a science. One thing we can be sure about is that variolation appeared earlier than the time he completed his book (published in 1549). Nie Jiuwu (also named Nie Shangheng, probably born in 1572), should be seen as the first actually known physician to have practiced variolation and passed on the method to others. However, in his book A Kindly Guide to Treating the Pox (痘疹慈航) (also named Therapies to Save Children 活幼心法 and Encyclopedia of Therapies to Save Children 活幼心法大全, published in 1616, the 44th year of Wanli), not a word is said on variolation. But Zhang Yan divulged in his book A New Book on Variolation (种痘新书 published in 1741, the 6th year of Emperor Qianlong) that it was from Nie Jiuwu that he and his forebears learnt variolation. In his own preface, he says, My ancestors received their education from a Mr. Nie Jiuwu and had adopted variolation as their profession over a few generations. Having read the books passed down by them, I now have treated various smallpox patients, nearly ten thousand of them… Wu Zhuozhang (also named Wu Shiyu), one of his friends, also wrote a foreword: I then asked him (Zhang Yan), ‘From whom did you acquire this marvelous skill?’ The master answered, ‘Once a Mr. Nie Jiuwu arrived at an official post in Ningyang, and my ancestors learnt from him as his pupils and eventually received both books written by him and also his oral instruction on the pox. After that, my family took 18

 From Zheng Shanfu. Shaoguji (少谷集), Jingyin Wenyuange Si Ku Quan Shu (景印文渊阁 四库全书), Section 1269, Roll 20, p. 29.

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up the profession of variolation carrying it on for three generations.’ I asked again, ‘you hold such a secret skill, why not reveal it to the public for the people’s benefit?’ The master sighed, ‘Among millions of medical books, variolation only was kept a secret. This is because some practitioners wanted to reap the benefits only for themselves. I have been practicing for tens of years, have acquired boundless experience and witnessed many varied cases… Now I’m getting old, and I want to pass on this skill to the world. So collecting some medical fragments and making reference to them carefully, I wrote down what my grandfather once passed on to me as a secret, and put it in this book and got it carved and block-printed. Such a good prescription to help people all over the world…’ Mr. Qiu Zhonglin, writing in this century, quotes part of the above, “Once a Mr. Nie Jiuwu arrived at an official post in Ningyang… carrying it on for three generations”, but not the rest after that, and his ignorance of such sentences as “received their education from a Mr. Nie Jiuwu and had adopted variolation as their profession over a few generations…” in Zhang Yan’s own preface means he then declares that “the forefathers of Zhang Yan must have received variolation from someone other than Nie Shangheng”.19 But this really was an incomplete study on the related materials. Therefore, I myself believe that judging by Zhang Yan’s own preface and the foreword by Wu Shiyu, Nie Jiuwu first taught the skill to Zhang Yan’s ancestors who then passed it on to their descendants until it reached Zhang Yan, in the third generation. Mr. Nie Jiuwu must be the first person recorded to have practiced variolation. One other thing should not be ignored — that part of getting an education was oral transmission. Such words as “got both books written by him and also his oral instruction” during the whole teaching process between Mr. Nie Jiuwu and Zhang Yan’s forebears possibly refer to details in the practice of variolation which simply did not appear in their writings. Niu Jiuwu was born in Qingjiang, Jiangxi province, and his birth year, according to Zhu Chungu, was 1572, the last year of Longqing. In the years between 1573 and 1620 of Wanli, Nie was appointed to work in the county government of Ninghua county at Tingzhou Prefecture in Fujian Province after he passed the last round of imperial examinations. This provided an opportunity for Zhang Yan’s forefather to become a pupil of Nie. In his own 19

 See earlier note on Qiu Zhongling’s article.

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foreword, Zhang Yan signed it with the title “Zhang Ya–Xunyu of Ningyang, Sanshan Ting Prefecture”. Here, the place Ningyang, Sanshan Ting Prefecture, is the town mentioned above where Niu Jiuwei held an official post. Yet the Dictionary of Biographies in Traditional Chinese Medicine (中医人物辞典) said that Zhang Yan is born in “Ningyang, Shandong Province”,20 which is a mistake. Since Zhang himself said he was “in his later years” or “getting old”, taking the age of 70 as a mark of old age, Zhang must have been around seventy when he wrote the foreword in 1741, the 6th year of Emperor Qianlong’s reign. So his birth year can be traced back to around 1671, the 10th year of Emperor Kangxi’s reign. One generation usually is 20 years and three generations are 60. So his grandfather could have been born around 1611 (39th year of Wanli). Therefore, when Niu Jiuwu took his official post in the government at Ningyang, Zhang’s grandfather was no more than 9 years old, who at such a young age could not have been his pupil. So “the three generations” mentioned by Zhang Yan must refer to his great-grandfather, grandfather and father, and judging from such words as “adopted variolation as their profession over a few generations”, it must be his great-grandfather who was the pupil of Nie and he learned variolation which was then passed on down, over three generations. Nie Jiuwu, in doing his official job, spent his spare time studying medicine, which was also described in the Dictionary of Biographies of Traditional Chinese Medicine (中医人物辞典)21: When he was free, he devoted himself to tracing medical skills, reading, observing patients’ conditions, and specializing in treating pediatric and pox diseases. His treatments diversified, not being restricted to traditional theories and prescriptions and always worked very well. For tens of years, he absorbed the essence, collected those of good effect and finally compiled them into two volumes, named Magical Medical Treatment Skills (奇效医术 published in 1616). Besides this, in reviewing the experiences of smallpox treatments, he wrote An Encyclopedia of Therapies to Save Children (活幼心法大全) (also named Therapies to Save Children 活幼心法 and Guide Kindly to Pox 痘疹慈航) for nine volumes. His first purpose was to probe 20

 Institute of Chinese Medical History and Literature, China Academy of Traditional Chinese Medicine, Dictionary of Biographies in Traditional Chinese Medicine (中医人物辞典), Shanghai Lexicographical Publishing House, 1988, p. 342. 21  ibid., p. 479.

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into the origins of the disease, second to give an analysis of different doctors’ ideas, correcting the fallacies from those who were merely superficial, to discriminate between deficiency and excess, hot and cold diseases, and to clarify the laws behind the waxing and waning, growth and decline of qi and blood, in order to perfect the selection of medicines. Meanwhile on the subject of smallpox, he proposed different therapies for smallpox in different phases, expatiated vital prescriptions, making six categories of question on smallpox, listed all the therapies and discussed miscellaneous diseases and many more as well. At the end of it, all the important prescriptions of therapies were discussed in detail.” Zhu Chungu called it “a comprehensive book on smallpox which opened a clear window for pediatric medicine — with its keen analysis, accurate discrimination, appropriate selection of medicines, neither too cold, or too hot, fairly attaining the law of neutralization.” Besides this, Nie also wrote a Collection of Medical Classics (医学汇函) in 14 volumes with the first listing the names of outstanding physicians, methods of Daoyin, Yun-Qi, etc., the second discussions on Wang Shuhe’s Pulse Classic (脉经) Nan Jing (难经), diseases of different clinical sections, Chinese medicines and herbs in general, etc., and the others including eight volumes of Key Prescriptions for the Pox (痘门方旨)… Yet it is rather strange that he, who had written so many classical books and was specialized in pediatric and pox diseases, did not himself write a single word on variolation, especially as Zhang Yan described “the teachings of his forefathers” as being received from Nie Jiuwu and spoke of “adopting variolation as their profession for generations”. So, was variolation in reality passed on to him from Nie? Such a fact is clearly true — these words could not just be gossip! However, there is also some criticism (from Zhang Yan): … in all the medical books, there are no records of variolation. We have got meticulous prescriptions for smallpox treatments and have spread them out to the whole world, but why is this method of variolation not described to other people? The secret of this method is not written in a book because they want only for private use, it is so precious. Now I am exposing such secrets which they would not expose, and pass on what they would not pass on…22 22

 See quotation from Zhang Yan in his A New Book on Variolation (种痘新书 published in 1741) mentioned earlier.

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Did these words drive Mr. Nie to teach variolation without writing it down in his books? This is truly beyond comprehension. Zhang Yan’s ideas, quoted above seem rather ignorant — as he never knew Zhu Chungu’s book The Pox’s Final Solution (痘疹定论) published 28 years earlier, nor did he hear of the imperial edict issued by Emperor Kangxi asking smallpox practitioners to give variolation in the palace. It might be owing to some geographical reason as Zhu, living in Jiangxi province, was specially selected by the emperor, while Zhang from Fujian province, a comparatively remote area, was devoid of the latest information. Or it might be some other reason such as that Nie taught his variolation not simply to Zhang Yan’s great-grandfather but also to others who might have kept it a secret or even kept it for their own gain, a practice which was vilified by Zhang. Is it due to him being careful that Nie did not write about variolation in his books? Yet in his A New Book on Variolation (种痘新书), Zhang Yan mentioned his friends doing variolation many times, which shows that variolation was not taught to only one person. Zhu Chungu had read Nie’s Experiential Therapies to Save Children (活幼心法) and had a high opinion of it and was greatly influenced by it. In his own foreword to The Pox’s Final Solution (痘疹定论), he said the following: Up till now, after fifty years of doing variolation, I have acquired the subtle rules of fetal toxin as well as understanding the essence of their theories; so that in my practice, I always try to abide them by these rules and successfully treat the pox. There were quite lot of famous specialists treating smallpox among my predecessors, but their diagnosis and selection of medicines often was either too cold or too hot. Only Nie Jiuwu, also known as Nie Shangheng from Qingjiang, who, born in the last years of Longqing, wrote a book The Experiential Therapies to Save Children (活幼心法) talked of the pox and measles providing very detailed evidence as well as accurate and appropriate guides on the formula and medicines needed. I hereby abide by his principles, replenishing what was not described and to deleting what was inappropriate in the formulae. However, this book although completed in draft before the 20th year of Emperor Kangxi’s reign, was still far from perfect… Our majesty has ruled for 52 years now… I myself question on silent nights, as I fall into deep thought that with the coming of my age, I am afraid of not being able to in return in gratitude his great grace. Thereby I carefully now collect what I have attained in my medical practice and put it into this book named The Pox’s Final Solution (痘疹定论) — with

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a clear classification and then am determined to get it published finally so that others can read it and understand it for themselves… Judging from this, Zhu Chungu must have had very deep respect for Nie Jiuwu. Zhu was also from Jiangxi Province, and his hometown Xinjian was not far from Qingjiang, Nie’s hometown, with only one county between them — a distance of 50 km. So it must be quite possible that Nie’s variolation and treatments of smallpox became well known locally. When Li Yuegui, the official in charge of transporting grain in Jiangxi Province, was appointed to select good physicians on variolation, there were many such practitioners in the province. According to Zhu’s own foreword, in 1681, the 20th year of Emperor Kangxi’s reign, Just at that time, Mr. Xu Tingbi, who was a senior official in the imperial household department originally and on duty as guangchusi, in charge of ‘repertory’, was appointed as imperial commissioner and sent to Jiangxi to supervise the production of imperial utensils. He also ordered the provincial governor to conduct an examination to select two physicians who were good at variolation and specialized in medicine. Then numerous physicians were recommended to Li Yuegui, an official in charge of transporting grain in Jiangxi Province. Li asked them questions such as ‘when smallpox firstly appears, where does the fetal toxin hide?’, ‘who was the first man to do variolation?’, ‘who wrote books on smallpox?’, ‘whose opinion on smallpox was appropriate?’, and ‘whose discrimination was the most detailed?’ He also explicitly stated that he would only choose those who could explain clearly in words questions about smallpox’s properties of ‘deficiency and excess’, as well as ‘cold and heat’. How to use of medicines in reinforcement and reduction according to their properties of hot and cold, the prescriptions’ use of sovereign, minister, assistant and guide, and signs of root and branch, first and last in treatment and cure. Finally, from a big crowd of physicians, he chose Chen Tianxiang and myself to be sent from Jiangxi Province on July 22nd to the capital — we then arrived on August 14th. Then the next year, we were ordered to opt for pox seedlings and make trial variolations which turned out all to be effective. After that, we began to do this within the palace on every newborn… From “a crowd of physicians”, only two were chosen. This shows that there must have been many who could perform variolation in Jiangxi

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Province. So variolation was not a secret — at least in Jiangxi. Maybe things were different in Fujian Province, which explains the sarcasm behind Zhang Yan’s criticism. The Pox’s Final Solution (痘疹定论) was first drafted by Zhu Chungu before 1681, the 20th year of Emperor Kangxi’s reign, and finally printed in 1713. Judging from his own words in the chapter “My Intentions and Gratitude” he says, “I am now seventy-seven years old this year and have served in the imperial court for twenty five years”, so Zhu must have been born in 1636 (the 9th year of Emperor Chongzhen during the Ming Dynasty) when Nie Jiuwu was still alive. Both came from the same province of Jiangxi, so it is by no means strange that Zhu fell under his influence. Another physician Wan Quan, whom I have spoken of earlier, with his ancestors living in Jiangxi Province as well, had a father, the author of Essentials of Smallpox (痘疹心要), who specialized in pediatric diseases and moved to Luotian in Hubei Province because of the 1480 war, the 16th year of Chenghua, during the Ming Dynasty. Yet the hometown of his ancestors, Nanchang, was next to Xinjian, not far from Qingjiang. Wan’s Smallpox Therapies (痘疹心法), published in 1549, the 28th year of Jiajing during the Ming Dynasty, might have been compiled based on his father’s Essentials of Smallpox (痘疹心要), which came out earlier than the years of Longqing. If we make a bold guess that variolation appeared in the region between Jiangxi and Chenghua, in the middle years of the Ming (around 1465) to the era of Longqing (it lasted until 1572), we can see a strong possibility here, because between the years of Tianqi (1621–1627) and those of Chongzhen (1628–1644), variolation is mentioned quite a number of times in written notes as well as letters.23 Based on the above analysis, it is most probable that the place and time fixed in Zhu Chungu’s own foreword worked as the foundation for such opinions as Wu Qian’s “… (the) method of variolation sprang up in Jiangyou (today’s Jiangxi province in China) and spread to the capital” which occurs in his Yizong Jinjian (医宗金鉴) as well as in some other books (for example Douke Jinjingfu Jijie (痘科金镜赋集解) published in the years of Emperor Guangxu), “variolation appeared… during the Longqing years”, both of which followed Zhu’s self-preface which was not so accurate. So it is definitely true that Nie Jiuwu together with other physicians from his family performed variolation in Jiangxi Province and furthermore spread it to the neighbouring counties and prefectures as well as Fujian Province. Yet, this practice might not be restricted only to Nie for there is a possibility 23

 Reference the article by Qiu Zhonglin, pp. 461–464.

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of the coexistence of various origins of this method — either at an earlier time or during the same age — since some early variolation did appear in provinces along the Yangtze River, like Anhui, Zhejiang, Jiangsu, Hunan, etc. However, as for when variolation’s popularity travelled beyond the folk world and was recruited into the mainstream of medicine, this was the moment Emperor Kangxi issued an edict to gather physicians such as Zhu Chungu, and the like — and the time when Zhu’s The Pox’s Final Solution (痘疹定论), Zhang Yan’s New Method of Therapy of Variolation (种痘新 法), Wu Qian’s Yizong Jinjian (医宗金鉴) and other texts were published. But as well as these eminent physicians, Emperor Kangxi can take a larger share of the credit.

121. Views on the Popularization of Variolation by Emperor Kangxi Most Chinese people do not know that Emperor Kangxi was a pockmarked man — as no senior official dared talk about it, nor were records made of it. However, it was another thing outside the country, owing to the leak by P. Ferdinandus Verbiest (1623–1688), a Belgian missionary who was once quite intimate with the emperor.24 P. Joach Bouvet (1656–1730), a French missionary also wrote, “some pox after having smallpox remains on the slightly crooked nose of Emperor Kangxi but it doesn’t impair his handsomeness at all.”25 So it must have been quite slight and not serious. Yet no records can be found on when he caught smallpox. However, as Emperor Shunzhi, his father, died of smallpox, Emperor Kangxi was so aggrieved at his father’s short life that it became the greatest regret of his life. Vol. 1 of Si Ku Quan Shu (四库全书) records an “Admonishment from Emperor Kangxi”: On the 29th December, 1720, all the princes and aristocrats, all the civilian officials and military officers, either of Man nationality or of Han, presented a memorial to the emperor for a jubilation to celebrate the 60th anniversary of his majesty’s enthronement. 24

 Ferdinand Verbiest. Tartar Traveling (鞑靼旅行记), translated by Xue Hong, from A Sketch Book of Westerners in Qing Dynasty (清代西人见闻录), compiled by Du Wenkai, China People’s University Press, 1985, p. 84. 25  J. Bouvet. The History of CangHy, The Present Emperor of China, F. Coggan, London, 1669, p. 2.

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Then the Emperor told the grand secretaries: All these jubilations and celebrations are not always to my liking, so a routine salute without feasts on the first day of the New Year will do — but stop the banquet. Even if it is for a ‘long life birthday’ I do not want celebrations for a long period of time. Today, when the kings, ministers etc. asked for jubilation for the 60th anniversary of my enthronement, I could not stop myself recalling my childhood — when my father, Emperor Shunzhi, ordered my nanny to take me outside the Forbidden City owing to the fact that I had not had smallpox in my infancy, so I was deprived of the opportunity of accompanying my parents and making them happy, even for a single day, which is truly the most sorrowful thing about my 60-year reign. The 7th day of the first month in a year is the death-day anniversary of my father, and the 21st day of the second month, that of my mother. How dare I celebrate the 60th anniversary of my enthronement prior to either the 7th day of the first month or the 21st day of the second month! Thereby I disapprove of this memorial to me. Yu Zhengxie (1775–1840) also recorded this in his Kuisi Cungao (癸巳 存稿) Vol. 9: In reading the collected imperial works of Emperor Kangxi, I found some speeches he made for the sixtieth anniversary of his enthronement: ‘Today, when the princes, kings and ministers asked for a celebration of the 60th anniversary of my enthronement, I could not stop myself recalling my childhood — when my father, Emperor Shunzhi, ordered my nanny to take me outside the Forbidden City owing to the fact that I had not had smallpox in my infancy, so was deprived of the opportunity of accompanying my parents and making them happy, even for a single day, which is truly the most sorrowful thing about my 60 year reign.’ In an elegiac address at the Xiao tomb (to his deceased parents), Kangxi wrote, ‘Recalling my past when I was still in the childhood, I was looked after by the nanny outside the Forbidden City to avoid the smallpox so that I could not to accompany my parents and to make them happy even for a single day, which is truly a feeling of the utmost compunction and a sorry thing in my 60 year reign. So before the 7th day of the first month, the death-day of my father, and

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the 21st day of the second month, the death-day of my mother, any celebration would be not dare to be accepted.’ These records used to be considered as proof of Kangxi not suffering from the pox when his father Shunzhi was dying of it. This had made him flatly refuse the ministers’ suggestion that he celebrate his 60th anniversary and caused him more bitter memories of him being powerless when wanting to give presents to his parents as he was separated from them, and looked after outside the Forbidden City. The ultimate cause of this was the smallpox. His father died of smallpox and he, on the contrary, had a pox on his nose. Such a double attack unavoidably cast a shadow over his mind, which must have formed some kind of intimate connection with his decision to issue an edict and send officials in the year 1681, the 20th year of his imperial reign, to select and bring together skilled physicians who knew about variolation. Emperor Shunzhi died of smallpox at the age of 24 in the year 1661 when Kangxi was eight years old. Whether Kangxi had suffered from smallpox or not is really a mystery worthy of further study. According to the above speech made by Kangxi himself, it is generally believed that he had not caught smallpox at that time. However, in the Chronological History of the Qing Dynasty (清史编年) and the Biography of Johann Adam Schall Von Bell (汤若望传 1591–1666), it says that Kangxi could be enthroned because he already had the pox. Johann Adam Schall Von Bell, at the age of seventy, was very much trusted by Emperor Shunzhi and his mother the Queen Dowager Xiaozhuang, who both had a high opinion of him. At the last gasp of Shunzhi, the question of who would be the next emperor was discussed among those who had been called into the palace. Johann Adam suggested Xuanye (Kangxi’s name), the third son of Shunzhi, with the reasoning that “this younger prince had already suffered from smallpox during childhood so he will not be attached again by it later in life while the others, though older in their age, have to keep alert to this horrific disease their whole lives.”26 It is certainly accurate that Johann Adam Schall Von Bell was called in when Shunzhi was dying of the smallpox — since Johann was a missionary trusted by Shunzhi. Among the published biographies of Von Bell, the most reliable is Johann Adam Sehall von Bell S. J. written by Alfons Vath S.J.,27 a German, who recorded the exact words of Johann’s proposal to Shunzhi — 26

 Bai Xinliang et al. Biography of Emperor Kangxi (康熙皇帝传), Baihua Literature and Art Publishing House, 2007, p. 1011. 27  Alfons Vath S.J. Johann Adam Sehall von Bell S. J., Verlag J.P. Bachemg. M.B.H. Koln, 1933.

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among which, one of the reasons for the enthronement of Xuanye was that he had already suffered from the smallpox. Vath based his writings on Historia Tataro Sinica nova, a book on the contemporary history of Tartar China, by Francois De Rougemont, one of Johann’s best friends, who had travelled to China with Michel Boym (1612–1659). So this must be true. Therefore, it is true that Kangxi had suffered from the pox when he was a child. In tracing back Kangxi’s family admonishment, he said, “I had not caught smallpox in my infancy” and in his elegiac address that “I had not caught smallpox when I was a child”; but he did not say clearly his age or the time, neither did he say that he was taken outside the Forbidden City when his father was seriously ill. What he said was “when I was a child” and “in my infancy” — as well as his being taken outside the Forbidden City to avoid the pox. These might all refer to a time prior to that of Shunzhi’s smallpox infection, not to the time of his sickness. So it is reasonable for us to believe the following things: (a) Kangxi had caught smallpox before his enthronement when he was eight years old; (b) Shunzhi died from smallpox and Johann Adam Schall Von Bell suggested letting Xuanye (Kangxi’s real name before he became emperor) be the next emperor; (c) in the 60th year of his reign, Kangxi felt very sorry for his failure to be with his parents when he was a child for fear of him getting smallpox. Regardlessly, among all Chinese emperors, Kangxi is undoubtedly one of the few great emperors — one who was bravely able to face reality and always keen on new things. When he once got information on variolation, he could not ignore it. He took action immediately. He sent imperial envoys to Jiangxi to select two masters of variolation who arrived in Beijing in 1681, the 20th year of his reign — this is made clear in Zhu Chungu’s own foreword mentioned above. The two selected were Zhu Chungu and Chen Tianxiang, who arrived in the capital on 14th August, 1681. Yet variolation was not carried out immediately afterwards. There might have been a period of testing. The next year, “we were ordered to make trial variolations which turned out to be all effective. After that, his majesty, the emperor Kangxi ordered us to begin doing this within the palace for the newborn.” So Kangxi was quite careful about this. Here, “to make trial of variolation” sounds like to perform human experimentation, which can be the first time in the world medical experiments on human beings were directed by an emperor. The success of these experiments easily earned his complete trust — and a handsome reward was given to Zhu from the emperor. Zhu continues in his own foreword: “Later I was sent to the outer margins of our country, to places in Mongolia and on the like, and all my variolation were successful… I gained the emperor’s special graces even

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more than other doctors. The emperor rewarded me houses, and aristocratic titles as an imperial physician… Another day, I was called in to perform variolation for the princes and princesses, for his aristocratic sons, grandsons and daughters…” According to a study by Zhang Jiafeng, before Zhu Chungu, Fu Weige was called by Emperor Kangxi into the palace to perform variolation for the crown prince and the other princes, respectively in 1678 and 1680.28 Here, there could be some doubt about this; for example, the crown prince has the same name as that of the oldest prince, and we do not know whether the crown prince had smallpox or received variolation. There could be some errors here. There is a record in the December of the 19th year of Kangxi’s reign: In Wuchang prefecture, there is a magistrate called Fu Weige who is especially good at variolation for children. When the crown prince was attacked by the smallpox, Fu was called on to diagnose him and finally cured him. Now as all the little princes in the palace need variolation, an order has been issued for him to come.29 Whether Fu arrived in the capital in time or not is not described in the record. Maybe he did not make it, which boosted the edict issued afterwards to select physicians on variolation in Jiangxi Province. Yet it was also in Jiangxi that Fu learned variolation from two masters named Wang and Tang. In short, Emperor Kangxi was seriously determined to popularize variolation. He sent Zhu Chungu “to the outer margins of our country, to places like Mongolia and so on” to do variolation as previously mentioned. Wang Mingsheng wrote the following in his foreword for The Pox’s Final Solution (痘疹定论) a republished edition in 1768, the 32nd year of Qianlong: In the 20th year of Kangxi, the Emperor sent Xu Dingbi — who was senior official in the imperial household department originally and on duty then in Guangchusi, a department of the government in charge of repertory — to Jiangxi to find physicians who were good 28

 Zhang Jiafeng. A Probe into the Time and the Reasons for Variolations Adopted by Emperor Kangxi (清康熙帝采用人痘法的时间与原因试探), Chinese Journal of Medical History, vol. 26, No. 1, 1996, pp. 30–32. 29  Compiled by the First Chinese Historical Archive, Notes on Emperor Kangxi’s Living Daily (康熙起居注), Zhonghua Book Bureau, 1984, pp. 645–646.

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at Variolation. Li Yuegui, the official in charge of transporting grain in Jiangxi Province, then recommended Zhu Chungu. Zhu was ordered to firstly make some trial variolation which turned out to be effective. Then he was called to the palace to do variolation on the princes and all recovered. Later he was sent to cure the smallpox of duke Badema in Korqin Mongolia; of a prince in Erdos… As for Zhu’s being sent to the outer margins of the country, to places in Mongolia and the like, to do variolation for princes and princesses, it has been mentioned in an English book on Kangxi’s, the Diary and Notes on Emperor Kangxi’s Life (康熙起居注): … I kept the regular troops working at drill to perfect their formation marching; had them inoculated against smallpox as I did my own children…30 The overwhelming success of variolation both within the palace and in the outer margins of the country and in every vassal state, in all the 49 Flag Sections (Qi, military unit in Qing Dynasty), truly made Kangxi overjoyed. He said in Admonishing Ideas within the Royal Family (庭训格言) that At the beginning of the Dynasty, our people very greatly feared the smallpox. But I gained the method of variolation, which helped both my children and other children keep healthy after using it. So now I issued an order for all the 49 Qi including those marginal places and vassal states like Karka to take variolation as well, and all of them have been perfectly healed. To recall the very beginning, I still remember when those seniors looked on variolation as something strange but I insisted upon them doing it, which finally saved millions of lives. How could this be simply fortuitous luck? These words reflect how Kangxi was quite pleased and gave a high selfappraisal of his own popularization of variolation. This must also be true then. Kangxi’s replenishing ideas were made with the aim that his descendants would all continue with variolation and thereby prevent an infection of 30

 Jonathan Spence. Emperor of China: Self-portrait of Kanghis, Harmondswoth, UK: Penguin, 1977, p. 18.

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smallpox. This perhaps did happen within one and two generations. The book Yizong Jinjian (医宗金鉴) compiled during Qianlong’s reign probably carries on the idea. It had a special section Pediatric Variolation Essentials (幼科种痘心法要旨) within its Key Smallpox Therapies (痘疹心法要诀), which said, Today with a careful and deep look at this method of variolation, this book hereby was compiled with a thoroughly keen viewpoint as well as it being a guide of variolation — reaching down lots of generations that everyone can get a long life. Yet the book also made some critical remarks such as: As there were no records (of variolation) in the medical books… after a long, long time, the textual study of it became just a fantasy, and this gorgeous method fell into disuse. What a pity that such a miraculous skill fell into oblivion! So Kangxi’s ideas did not continue till the third generation after him. His descendants did not follow his ways. Even Hongli, his favourite grandson, the Emperor Qianlong, who was said to be quite respectful to his grandfather Kangxi, did not follow his ideas. His secretly chosen crown prince Yonglian (his second son) died of smallpox at the age of nine; the following crown prince Yongcong (his ninth son) died of it when he was 2 years old.31 If we count Kangxi as the first generation, the seventh generation is Emperor Tongzhi (1862–1874) who also died of the smallpox, which reflected the fact that later generations of emperors did not follow Kangxi’s ideas and have themselves variolated. When Tongzhi fell ill, there was a mistaken diagnosis and it was thought to be a cold — until the ninth day when pox burst out, then it was diagnosed as smallpox. Then Empress Dowager Cixi along with all ministers, even the military, made sacrifices to the “gods of smallpox” inside and within the palace, enshrined and worshipped the “goddess of smallpox”, with scarlet couplets hanging up, dressed in “smallpox coats”, performing worshipping rituals in the Shouhuang palace in Jingshan all to gain blessings from the ancestors…32 What a noise! What a joy! Superstition stepped forward because Kangxi’s ideas had been forgotten or neglected. Just because they did not let their children be variolated! 31

 Yan Chongnian. The Twelve Emperors in Qing Dynasty (正说清朝十二帝), China Book Company, 2005, p. 124 & 141. 32  ibid., p. 223.

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Coincidentally, Tongzhi died in Yangxin Palace, the same palace where Shunzhi had died of smallpox years before. With so many vivid records of medical cases preserved in the Qing palaces, how could such a tragedy happen? Would it have happened if Tongzhi had not died at such a young age? There would be no farce like Cixi reigning “behind a curtain” as she did and so on and so forth. Yet despite all this, Kangxi’s contribution to the popularization of variolation could not go unnoticed. At least during the period up to Emperor Qianlong, his grandson, the preventive function of variolation on the people of the imperial family, as well as on soldiers of different Flag Sections, was undeniable. It was also at this time that variolation spread to the West. According to the “Officers working on Smallpox Registration”, the Kui Si Cun Gao (癸巳存稿 Files of Proper Literature in1833) Vol. 9 written by Yu Zhengxie states the following: Early in the year, there was an official checking the bureau in charge of the state of ‘small pox affairs’ — whose duties included treating smallpox in the regions as well as people living in the capital, issuing rules for people’s migration and so on. It took a long time to complete their efforts. And during Kangxi’s reign, some Russians physicians were sent to China to learn how to do smallpox prevention. At the beginning this was in the Court of Sanet, but then it transferred to the Court of Lifanyuan, and finally settled down in the capital. As it was cold in the west, some people who went abroad to trade would sometimes catch smallpox. When they returned, they were ordered to wait for their health to recovery — and then were permitted in. Such a fashion began with people coming back from the Southeast Asia to China — but it has now spread all over the world. Physicians working with smallpox during Kangxi’s reign must have earned worldwide fame if smallpox therapies could attract Russians to study (in 1676, the 26th year of Kangxi’s reign). The bureau of Officers on Smallpox might have been set up prior to their completion. When they should have returned to their home country after they had become smallpox physicians, these Russians seemed to have no intention of going back home — but stayed to treat smallpox in Russian merchants in the capital and stop it from spreading. They learnt the treatment of the disease as well as variolation, a fact not recorded in Yu’s book. Yet after this, Kangxi’s Imperial Collection on Smallpox followed almost immediately, which showed the importance of

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variolation at that time. It must have been during Kangxi’s time, when the emperor popularized variolation, and Yu reported that “Russia sent men to China to study smallpox therapy”. All of them could either treat smallpox or do variolation, or both. There are no written records of Kangxi popularizing variolation for the common people, but this omission should not be seen as a flaw. One thing is clear: variolation was still being used for preventive purposes and being popularized in both Zhu Chungu’s The Pox’s Final Solution (痘疹定论) and Wu Qian’s Yizong Jinjian (医宗金鉴). Both books function as evidence of this, as they did as textbooks for the common folk. During Qianlong’s years, Pingze Yuankai 平泽元恺, a Japanese medical scientist, wrote in his Qiongpu Jixing (琼浦纪行), I asked ‘if variolation, recorded in detail in the Yizong Jinjian (医宗 金鉴), was not being carried out here? I wonder if it was also commonly adopted in the middle plain of the country?’ Wang answered, ‘The method of variolation has a long history. And in those rich families, variolation was made to over ninety percent of them.’ At that time, variolation was by no means restricted to only “rich families”. The regions around Qingjiang Prefecture in Jiangxi Province were believed to be the birthplaces of variolation; the region of Tingzhou in Fujian Province became an important centre thanks to Zhang Yan, and Beijing, called on by Kangxi, turned out to be another centre of variolation in the north — with the books and actions of Fu Weige, Chen Tianxiang and especially Zhu Chungu. Taiping County, Ningguo prefecture of Anhui Province, functioned as another centre, according to Mr. Yu Tianchi’s Shadou Jijie (俞天池先生痧痘集解) published in the 11th year of Emperor Guangxu, while Anqing prefecture in Anhui might have been one earlier; in Huzhou Prefecture in Zhejiang Province, variolation began with Hu Pu and then moved to Jinhua, Hangzhou, Ningbo, Shaoxing and so on; in the areas of Hunan and Guangdong, there appeared a tribe doing variolation with a unique style of their own. It is a pity that no proof has been found of the direct relationship between Emperor Kangxi and the popularity of variolation in the folk world during the Qing Dynasty. That is, he did not popularize the progressive variolation of the people, or prevent smallpox via government decrees in order to benefit the common people, but used it to protect his royal bloodline. However, his descendants did not follow this with a proper

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understanding. On the contrary, his popularization of variolation on soldiers in the outer margins of the country and on people from the 49 regions resulted in its westward spread — and finally mutated into cowpox vaccination in the West. As is said, “what flowers within is fragrant without”, but this will be explained and discussed later. One thing must be pointed out: that the spread of variolation was not pushed onto the folk world by government measures, but spread due to spontaneous behaviour in an uneven manner, i.e., more in the south, less in the north. It was welcomed comparatively well by intellectuals, but sometimes met with resistance as well. In deprived villages lacking transportation and information, it was difficult to do because of the expense. Some unqualified or untrustworthy physicians caused deaths by inappropriate variolation; wars and other events could also impair the popularity of variolation. On this, Qiu Zhonglin has conducted various studies (see writings by Qiu, pp. 488–495). He once quoted the descriptions from Zeng Ding’s On the Pox (痘疹会通) telling of the differences between the south and north in the last years of Qianlong’s reign — when the dead bodies of children were piled up in carts, owing to an epidemic of smallpox in the north: In the years of Emperor Kangxi, both Zhu Chungu and Chen Tianxiang, my country fellows went to the capital to perform trial variolations. After that, they all went into service. Right up to now, there are still physicians performing variolation in our country. But in the capital city it is not so — every year it is attacked by an epidemic which then caused mutual infection, and as a result the dead bodies of children lie piled up in carts. What a miserable sight!

C.  The Theory, Technology and Success of Variolation 122.  The Theory and Technique of Variolation The Chinese people have always had an ingrained idea of working to prevent disease. Ge Hong says of smallpox that “each and every case that creates toxin should be guarded against,” which is the implementation of this preventive concept. Ge Hong often mentions “avoiding the pestilence” by moving to remote mountains in his book Just Be Simple. There was also the idea of “pestilence-expelling” in ancient times. These may be the toxinpreventing methods referred to by Ge Hong. But Ge Hong does not express what he means clearly in his book, so we cannot make a wild surmise. Folk

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“not-acclimatized” means that people often feel uncomfortable or suffer illness and should know to avoid traders and officials to work in a strange place. During the Ming and Qing Dynasties, northern Mongolian people outside the pass were very afraid of the pox as they came to the central plains. They practiced methods of “avoiding the pox” and “expelling pox” to prevent infection, which were in line with the previous ideas. The establishment of a “smallpox sanctuary” and having an “official checking on smallpox” were the measures taken by the Qing Dynasty troops before and after they invaded the mainland. However, these were only passive preventions measures. They were not enough to form a theoretical basis, nor to explain the art of variolation against infection by the pox.

(1)  Foetal Toxin and the Theory of Variolation Being Used to Discharge Foetal Toxin It has already been mentioned that the idea of “fetal toxin” was used to explain the pathology of macular disease since the time of Qian Yi. Naturally this also extended to the pathological explanation of smallpox. Chen Wenzhong in the Jin Dynasty believed that the foetus was nourished by the mother’s five-zang organs. If the mother does not restrain herself, has unbridled desires, even eating pungent or acid food or anything toxic, the filthy qi will gather and tangle up in the uterus and the foetus then also receives it. “Not restraining oneself, having unbridled desires” refers to unrestrained sexual activity during pregnancy, and along with eating the wrong sort of food these are called the “three liquid filthy toxics” — all contributing to the foetal toxin. This theory is introduced to explain the etiology and pathology of smallpox. Since everyone has some of these “three liquid filthy toxics” inside them, none can escape the smallpox, as it is naturally connected to being human. The New Book on Variolation Vol. 2 by Zhang Yan says, Common secular people always feel difficult and rather prudent when mentioning the smallpox and scared there is no way to avoid such a disaster when it comes. But they do not know it is congenital fetal toxin. Everyone has this toxin, so none can escape this disease. If at the time of the pestilent qi, when it is attacking people everywhere, their fetal toxin must also be affected with serious results. Physicians thus explained that people could not be free from smallpox. Thus, connecting together the etiology of the disease and variolation, prac-

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titioners could give a further explanation of the vaccination principle: because of the foetal toxin in everybody’s body, people cannot be free of smallpox. But once the foetal toxin is eliminated through smallpox, they will never suffer from it again. This explains why people suffer from smallpox only once in their life. But this was not quite enough — the question must be why people suffer from the smallpox in the first place. Wan Quan (1495– 1580) during the Ming Dynasty said, Fetal toxin bides its time before it breaks out. The toxic qi may be weak or strong, so the disease also presents different. Sometimes it is rapid and dangerous, sometimes gentle and safe, sometimes violent and deadly. As the pox come out, the toxin is eliminated too. Therefore, once one had suffered from smallpox, he will not be infected with it forever. These explanations are self-consistent. First, the theory suggests a method of diluting smallpox, which could make the symptoms less serious as stated before; second, it gives guidance as to a treatment that might make the smallpox come out more gently, thus discharging the toxin; life goes unthreatened, while fatalities and sequelae are reduced too. People will not suffer from smallpox anymore. This was certainly a great achievement. Furthermore, a principle explanation of smallpox was deduced. The book Immortal Variolation (published in 1732, the 10th year of Yongzheng period) says, Smallpox is a fetal toxin, which is congenital. It is triggered by epidemic pathogenic qi. It can put every family, family by family, even the whole country in danger, just like the plague. In most cases, it is accompanied by wind-cold outside, food stagnation inside and many other unpredictable problems, such as stumbling and panic. It has killed many since general Ma Yuan’s army carried the smallpox into our country. Heaven gives us life, and heaven takes it away — there is no way to change it. But in recent years, people have been talking about variolation. It originated in Central Chu and Jiangxi Province and came to Yan (Beijing) and Qi (Shandong province), now almost covering the whole country, north and south. It is said that variolation comes down by divination, through the method of ‘observing the dark birds’. You must fumigate the particular child who has smallpox, and make the toxin discharge — creating a healthy and

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peaceful state. Then it can be handled with ease. This is not the same as the case caused by the toxic qi of both heaven and man together, where it is difficult to sort out internal and external problems together. To “make the toxin discharge creating a healthy and peaceful state, then it can be handled with ease” means the discharge of the foetal toxin comes about and you can rely upon the variolation — through its flexible control in the hands of the doctor. The principle of variolation is to make the foetal toxin discharge safely and properly, before the child is infected with pestilence pathogens. Thus, the symptom will be mild and the child cannot be infected by smallpox again. This is the principle of discharging toxins through variolation. At the same time, it also reveals that the idea “fetal toxin” was not enough to guide people to a method of preventing smallpox through advance detoxification. So variolation is said to have come “down by divination, through the method of ‘observing the dark birds’”. This is the same as some other far-fetched interpretations, such as the impartment of immortal skill to the doctor from Mountain Emei, or the Goddess Tianmu. However, this theory did provide a convincing explanation at the time. Foetal toxin is eliminated in healthy conditions in advance — so that one can avoid being in the serious situation of being attacked by the seasonal epidemic pathogen outside and the foetal toxin inside, both at the same time. Immortal Variolation again says, It should be known that fetal toxin is limited, but the epidemic pathogen is endlessly harmful. Besides, the pox induced by variolation is the outer evil qi which agitates the normal qi and blood of body, so it can not usually cause serious side-effects such as itch, pox, chest obstruction, coma and other disorders. If the healthy qi is protected in the body inside, then the immoderate drinking or even ‘filthy qi’ cannot really harm it. After the scabs drop off, no scar are left. Neither the mouth nor nose will be deformed either. This really is the quickest way to safety. It is very interesting to read that the “fetal toxin is limited” but the “epidemic pathogen is endlessly harmful.” This explained how variolation could discharge a foetal toxin mildly and people would not be infected with smallpox anymore.

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Zhu Chunjia says in his section Essence, Spirit, Body and Qi in The Pox’s Final Solution, Variolation in theory means to treat smallpox before it happens. If smallpox has not happened, you must make it happen; if it has happened, then make it heal. This is a definitive preventive conception. The phrase bibing 必病, “you must make it happen/you must be ill” perhaps could be a slip for bubing 不病 “you are not ill”. However, variolation should bring about a slight fever and a light pox. So it is surely proper to say “must make it happen/ must be ill” means to recover from the disease. After decades of thinking and clinical practice of variolation, he gives a full description of foetal toxin theory. His own preface to The Pox’s Final Solution says the following: What is smallpox? It is a pattern that originates from fetal toxin, has the symptoms of pox and rash after being triggered by seasonal epidemic pathogen qi. What is my final conclusion? It refers to a conclusion which I was uncertain a while ago but am certain of now. Why was I uncertain of it ago but am certain now? Here is the reason. Previously, fetal toxin was said to be caused by a mother in pregnant having unrestrained sex, or an unrestricted pungent and spicy food, or by the filthy blood in the baby’s mouth swallowed into the stomach at birth. However, this is untrue and unreasonable. The Zhou Yi (Book of Change) says: ‘Great Heaven-the-Qian essence is the source of all things and begins with qi’. It also says: ‘Great Earth-the-Kun essence generates all things, and is in charge of their formation’.33 So man attains qi from father and it forms in his mother. So fetal toxin also follows — beginning with the giving of the yang and the acceptance of the yin. Fetal toxin is not because of indulgent sex, or an unrestricted died or at the moment of being born, the fetus swallowing filthy blood. Previously fetal toxin was said to be stored in the five zang-organs, so the pox were came from the five zang-organs and the rash from the six fu-organs. People do not know the vitality of the fetus begins with the giving of yang and the acceptance of yin. The ‘life gate’ is 33

 From the Tuan (“Boar’s Head”) Commentary.

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first formed and fetal toxin stored in it along with the gasification of the qi. This is indeed true. Water, fire, earth, wood and metal are produced by the static yin and active yang of the life-gate day by day, month by month. Heaven first gives birth to the ‘water kidney’; the earth secondly gives birth to the ‘fire heart’; the heaven thirdly to the ‘wood liver’; the earth fourthly to the ‘metal lung’; the heaven fifthly to the ‘earth spleen’. They form one by one, day by day and month by month. Five zang-organs and six fu-organs of fetus are formed through the five months. How can we say that the ‘life-gate stored fetal toxin’ then removes the yin toxin to the five zang-organs to become the pox and the yang toxin to the six fu-organs to become the rash? This is untrue and unreasonable. The Gate of Life (‘life gate’) is corporal; the five zang-organs are functional. The six fuorgans function under the five zang-organs. Fetal toxin stores up in the life-gate, which also stores the yin qi and yang qi. They are very deep and tight together. If the qi is used up, the ‘life-gate’ must rely on the viscera to transfer the seasonal qi. As it passes through the life-gate, the pox qi becomes pox and the rash qi becomes rash. Other diseases, such as pediatric diseases are irrelevant to the life-gate. So we can see that the five zang-organs and six fu-organs all serve the ‘life-gate’. Previously, the kidney has been said to be ‘the unique one, without symptoms’. Later, some said ‘the darkening of the pox should be blamed on the kidney’. How unreasonable! These people do not know that the five zang-organs are interdependent and each one indispensable. The liquid in the pox is transformed from blood, which cannot be produced without water. Since blood is produced from the water which came from the kidneys, how can the kidney be said to have no symptoms? The pox become black due to the toxic fire burning and then changing their color. How can we blame it on the kidney? It has been said previously that a serious pox and rash will be unfavorable. People do not know that fetal toxin is actually favorable and not unfavorable, just as man is kindhearted and not evil by nature. Man becomes evil due to social customs; the pox and rash became unfavorable due to the seasonal pathogen of the filthy qi. If one has a little understanding of yin and yang, he can understand that gasification actively transforms the yin and yang. They have a

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clear qi and a turbid qi, a healthy qi and an evil qi. It is proven that if the qi is clear and healthy, the variolar crust is healthy and the variolation will be favorable. So the transformation of the fetal toxin is only favorable and not unfavorable. Though the rash has no variolar scab, the clear qi will still make it favorable. With more than fifty-years experience of variolation, I have a good understanding of fetal toxin and its essence. Fetal toxin is not unfavorable but favorable. This is completely true. Zhu Chunjia is saying here that foetal toxin is part of life: that it is the congenital qi of yin and yang and nothing to do with lust, or toxic food during pregnancy or filthy blood at birth. This is to say, foetal toxin is normal. He differentiates variolation pox from epidemic smallpox in order to explain that variolation is to extract the foetal toxin in healthy conditions so that it may be favourable and safe, while epidemic smallpox is the foetal toxin triggered by an unhealthy epidemic so that it is unfavourable and dangerous. Zhu Chunjia partly overturns his predecessors’ theory and advocates variolation. He makes his statements consistent in themselves. He also distinguishes between a “smallpox qi” and a “rash qi”, which shows that he is somewhat aware of the difference between smallpox and measles. He also points out that variolation is feasible with variolar crust scabs, while variolation of measles is unfeasible as it has no variolar crust. We cannot but believe that Zhu Chunjia’s theory is positive and therefore valuable — coming as it did before modern etiology and the pathology of infectious disease was properly understood. All in all, foetus toxin theory made the following contributions to variolation: Variolation causes pox which is different from epidemic smallpox. Variolation was opted into at a “good healthy time”; “if smallpox has not happened, you must make it happen”. Foetal toxin is discharged first; the children then will not be infected with smallpox and kept away from danger when epidemic breaks out because foetal toxin in the body has been discharged. Compared with modern immunological theory, traditional Chinese medicine removes the basis of the disease, but Western medicine induces the body to produce antibodies. There is a sharp contrast between them. We may gain a general idea of the imaginative power of the ancients from this one small example! How to study traditional Chinese medicine? Modern researchers might as well learn their lesson here. Zhu Chunjia also knew that smallpox would not necessarily happen if there was only foetal toxin. He says in Smallpox of the Adult Male, concern-

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ing variolation performed outside the borders in the forty-nine “banner states”, Beyond the border… people often change their residence and tribes are scattering all the time. The smallpox qi does not spread, and people are not infected with smallpox even when they are old. But some ignorant persons say there is no smallpox because they are in the cold north. Why can they not see the truth here? Zhang Yan also noticed that some people are not infected by smallpox their whole life. How can we explain this by the idea of “fetal toxin”? The following interesting text is of note: Smallpox may be a fetal toxin, which is hidden in the seventh spine of backbone. If it is not triggered, it will not break out all one’s life. It must be because the external epidemic smallpox qi rushes to the ‘life-gate’ to trigger the fetal toxin, just as like draws to like. New seedlings have a strong qi. Once blown into the nose, they will go straight to the viscera. This is why variolation is successful and the smallpox mild. The toxin of the seedlings does not stay in the body long either. It only serves as an envoy to draw the toxin out — instead of helping the toxin. Thus when the symptoms arrive, how will this be unfavorable? (from his On Old Seedlings Cheap but New Ones Expensive) This may be regarded as a supplement to Zhu Chunjia’s theory. An external factor (seedling or epidemic smallpox) works through internal factors (foetal toxin) and an internal factor (foetal toxin) may not work without an external factor — No pox out. This agrees with the idea of modern infections and the immune theory of smallpox. The smallpox virus (external factor) attacks a person without antibodies (internal factor) in the body, and the person is infected with smallpox; but if there is neither immunity (internal factor) nor smallpox virus (external factor), there will be no smallpox. Nearly 100 years later, the medical innovator Wang Qingren cried out that “smallpox is not due to fetal toxin” in A Correction of Errors in the Medical Classics (published 1830). He said, … All theories attribute smallpox to fetal toxin. Books also say there was no smallpox before the Han Dynasty. Since smallpox is

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due to fetal toxic, then were people before the Han Dynasty not born from their parents? How ridiculous. Some ancestors said that fetal toxin is hidden in the viscera. Then why are the viscera safe before the smallpox appears? Some said fetal toxin is in the muscle. Then why is there no sore on the skin before the smallpox appears? Some said fetal toxin is in the bone marrow, which is triggered to become smallpox by fright, falling down, overeating or the cold. If it is true that smallpox is triggered by oneself carelessly, set off by fright, falling, overeating or cold, how come the smallpox attacks not only one person but all the people in a place, even in several provinces? Is this because they are all, in the several provinces careless at the same time? This is even more ridiculous! On the other hand, the present practitioner is giving the seedlings to the people and no matter how many people take variolation, they are all favorable. If variolation is trying to get the fetal toxin out, that some cases must come out badly, and some not. A serious fetal toxin must be dangerous. Why are none of them unfavorable? Therefore, thinking about these points, the theory of fetal toxin is not watertight. People hardly realize that smallpox is not a fetal toxin but turbid qi in the fetal blood. An infant grows from a little essence in the womb of the mother, whose growth of viscera and limb all depend on the mother’s blood. The turbid qi in the fetal blood is still stored in the blood after birth. If meeting with the heavenly epidemic pestilence this turbid qi breaks out, enters into the trachea through the nose and mouth and then into the blood, it will drive the turbid qi in the blood out into the skin. It is red and looks like a flower, so it is called 天花 (tianhua, ‘heavenly flowers’, i.e., smallpox); the round shape looks like a bean, so it is called 痘 (dou, ‘bean pox’). In a word, if the infection is mild, pestilent toxin will be discharged with the smallpox and the course will be favorable; if the infection is serious, pestilent toxin will stay in the body and cannot be discharged together with the pox, and the course must be unfavorable; if the infection is very serious, pestilent toxin is fired in the body, and the blood must clot… whether the smallpox is favorable or unfavorable depends on whether the infection is serious or not. The key to treating smallpox is the method of removing pestilent toxin. If pestilent toxin is not removed, even if the smallpox is little, the patient must die; if the pestilent toxin is removed, even if the smallpox is strong the patient will not suffer. The book on smallpox discuss do not

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talk about ‘pestilent toxin’ but ‘fetal toxin’. Or else although physicians know how to treat pestilent toxin, they do not know its home lies in the blood. Only if one makes it clear whether the pestilent toxin is serious or not, the blood is blocked or not, the qi is insufficient or excessive, can he save an unfavorable smallpox changing into a favorable smallpox easily. As is said: ‘one sentence can end the problem, if people only understand the key points’! Wang Qingren’s writing is very powerful. He has realized that pestilent toxin is the main factor in smallpox. However, he still bases his theory on “turbid qi in the fetal blood”. This theory along with foetal toxin theory is just like “the pot calling the kettle black”.

(2)  The Variolation Method and Its Improvement Foetal toxin theory explains variolation. But it is not difficult for us to notice that theory does not go ahead of method here — and may not guide the invention of a method of vaccination. As a preventive measure against smallpox, it can still be haphazard. But inevitability can still be contained within contingency. A wealth of accidental experience may give birth to a new concept. Why were “clothing variolation” and “quilt variolation” the initial variolation methods? They are the simplest and most likely to be observed. People observe that healthy children are infected with smallpox after they have used the quilt of a child with the pox or worn the clothes which a child with the pox has worn next to the skin, but the smallpox is much less serious. Also if children were infected with smallpox in that way, they would not be infected with smallpox again in their lives. This naturally suggested that people might get a mild infection with a smallpox quilt or clothes. They will then avoid a serious infection and never get infected with smallpox again. Variolation with a quilt or with clothes was not recorded in the early medical books. They might have been folk discoveries and spread among the people. Later medical books hold a definite attitude of denial towards them, such as Yulan Jushi’s Variolation Essence and Wu Qian’s The Golden Mirror of Medicine. But some learned men make a record of them, such as Fang Yizhi’s A Little Knowledge of Laws in the World. They were mostly seen in remote areas. For instance, in the 9th year of Shunzhi, Dong Han (1624–?) wrote in his Hometown Record that “a Mr. Zhang’s family in Anqing city has taught variolation for three generations.” The method was to collect thin pox

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fluid first and store it in a little porcelain bottle. If there was a child to be variolated, take out the pox fluid and smear it on his clothes, then let the child wear them.34 Mr. Zhang’s method improved on the earlier method of directly of using “pox-ed clothes”. It says it has been around been “for three generations”, which indicates that this method appeared very early. This was the first stage of variolation. Fang Xiangying in Sui’an County in Zhejiang Province also said in the 5th year of Kangxi that “If people share their clothes and porridge with the patient who has fortunately recovered from smallpox, they will be infected with a ‘favorable’ pox.”35 Quilt variolation had not caught people’s attention earlier. Qiu Zhonglin found Zhang Fuyi recording quilt variolation in his Preface to Seeing off the Variolation Doctor Song Tailai in the Wangshan Hall Collections, Vol. 1, during the beginning of the Kangxi period. When he served as magistrate to Qianyang County of Yuanzhou in Xiangxi, he saw “quilt variolation” in which “covering the going-to-be-variolated child with the quilt of a have-been-poxed child” “made him attain the qi.” Seven or eight days to fifteen days later, the child would have a fever; another one or two days later, the pox would appear. It is wonderful that one quilt can inoculate one or two children at least and continue affecting tens to hundreds at most”. Also he said, “Among the people infected, six or seven out of ten can be inoculated successfully and three or four out of ten unsuccessfully.” With this method, Song Tailai successfully inoculated Zhang Fuyi’s grandson and other children in the family. “They are inoculated with smallpox painlessly.” Doctor Song went to the neighbouring Liping County of Guizhou Province to perform vaccination as well: “it works every time.”36 The methods of clothes variolation and quilt variolation actually had been mentioned as early as in Fang Yizhi’s Small Knowledge on Nature: Make a pill with pox-fluid (wrapped cotton) and stuff into the nose. So long as one breathes, it will work. Or use clothes or a quilt. It is said that if one in twenty or thirty people suffer an unfavorable pox then the pill needs to be changed anew. The “pox-fluid pill in the nose” should be understood as the skill of fluid variolation: take pox fluid from a sick child, wrap it in cotton and 34

 See the works of Qiu Zhonglin, p. 463.  ibid., p. 466. 36  ibid., pp. 467–468. 35

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stuff it into a child’s nose. This method could directly harm the child. At the time, the virus in the fluid is still active and has strong toxicity. This is very risky for children. Clothing and quilt variolation are also similar to the contact of natural infection. According to Zhang Fuyi, “six or seven out of ten can be inoculated successfully and three or four out of ten unsuccessfully with this method.” He seems to be very satisfied with this variolation rate. But compared with the improved method later, the rate was still rather low. Therefore, “dry seedling” variolation appeared. The seventh version of The Annals of Jieyang County in the Yongzheng period records, The Dingyou year, the fourteenth year of Shunzhi (1657)… folks began to ask the doctor to perform variolation. His skill was to stuff good variolar crusts into the children’s noses to breathe in all its qi. All the pox were favorable, without exception. This method has been passed down generation after generation and become a constant welfare for all. No smallpox mark is left on the face of the variolated children, and no child dies due to the pox. In the 10th year of Yongzheng (1732), Jiang Lianggong compiled his predecessors’ writings and published Immortal Variolation. It advocated “fluid seedlings” for variolation. The method of variolation was as follows: Use ‘fluid seedlings’: Moisten the pox with clear water and break it into a wrapped cotton. Stuff it in the nostril for ‘half a cun’. Left nostril for a man and right for a women. Then stuff up the nostril with clean dry cotton again. If you use crust seedlings, wrap them up with a piece of paper, then grind up the crust into a powder with a smooth and hard gavel. Cut a piece of loose cotton into a thin slice as big as a chessman. Wet the cotton slice and wrap six li (0.3 g) of smallpox powder inside and make it into a ball. Don’t be rough with it. Bind it with a thin silken thread and stuff it into the nostril, the left nostril for a man and right nostril for a women. Don’t do it carelessly. The end of the thread hangs outside the nose so it can be taken out easily and the child easily looked after. Don’t let the child pull it out. Stuff cotton into the nostril well to prevent the qi leaking. If it leaks, there will appear a flat pox under the nose. If the child’s nose is small, the seedling should be reduced accordingly. In the youngest child it

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should be reduced by 50%. Take it out after twenty hours. If it falls out accidently or is sneezed out, stuff it back in the nose again at once, or as soon as possible. I saw Zhu Shengxue perform vaccination in Hangzhou City. He did not do it as the mentioned above but in the following manner. He ground crust seedlings with a small mortar. Then used a little curved bamboo or silver tube to blow two or three li (0.1–0.15 g) of crust seedlings into the left nose of a boy and the right nose of a girl. Then he dipped into a little of the crust seedlings a clean wet piece of cotton to stuff up the nose. As such fluid seedlings work better than crust. Take them out after a day and night. Then take some antitoxic dan. Here, fluid seedlings, water seedlings, nose-stuffing skills and noseblowing skills are all described and fluid seedlings are considered to be better than crust (variolar scab). Jiang Lianggong, the compiler of this book, was a celebrity who lived in seclusion and practiced this medicine. In the 7th year of Shunzhi (1650), he was employed in Mr. Shi’s mansion house in Hangzhou. In the 17th year of Shunzhi, he met Zhu Shengxue from Yuhang county, who had gone to Shi’s mansion to perform variolation. He had seen Mr. Zhu practice. He said, The spring of the Gengzi year (1660), Mr. Shi engaged Zhu Shengxue to perform variolation in our mansion. His sons, daughters, and other children in the family, more than twenty in all, were all variolated. Variolation by ‘putting in seedlings’ seems to be very easy. I asked him about this skill. He said: ‘It is a immortal art. I dare not reveal the secret.’ It is easy because there are none of the six evil pathogens mixed in with it. Later he received the book Immortal Variolation from a friend Xu Wutian: A few years later, I met with my classmate Xu Wutian. He is a type of person who loves to copy medical books. In his travelling bamboo-suitcase was Immortal Variolation in three volumes. I edited them, put them in order, deleted the repetitions, supplemented the omissions and completed the book. All immortal methods of variolation are included in this book. Nothing is missing.

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So the original text of Immortal Variolation was written earlier. Zhu Shengxue’s method of nose-blowing scabs was more advanced than the fluid variolation mentioned in the original book. However, Jiang believed in the book instead of the person. He still believed “fluid variolation is better.” What a pity! Immortal Variolation reveals the mystery of fluid variolation and why it was replaced by the use of variolar crust: Variolation is just using smallpox-fluid which is the ‘stolen fluid’ of the good pox from poxed children. Wrap it in cotton then insert it into the left nostril for a boy and the right for a girl. After seven days, the qi will flow freely in the body. After a fever, the pox will appear, sometimes a few, sometimes as many as one or two hundred. Some will make a little swelling in the face. Then the fetal toxin will be discharged. In general, favorable seedlings will lead to successful variolation. It is inevitable. If smallpox-fluid cannot be taken, variolar crust can also be used. If variolar crust cannot be found, a child can wear the clothes of a child who has just suffered from the pox. The clothes can also make the variolation successful. The dense smallpox qi guides the fetal toxin out. Nobody can understand how this ‘stolen fluid’ method works. But it works just great! Zhang Yan came later than Jiang and so on. Apparently, he did not agree with Jiang. His New Book on Variolation, Vol. 3 said in the section on Secret Key Points in Variolation, People in the past variolated with a cotton ball dipped with smallpox pus then inserted into the nose, which was called fluid variolation. Later, children’s family did not let people break the pox to take fluid from their children, so they changed to using smallpox crust instead. Grind it into dust, mix with some milk and a little Tongguan powder. Put these into a little bamboo tube; blow it into the left nostril for boy and the right for girl. Clean the nostril before blowing in the seedlings. Put the head up straight; blow straight into the orifice. Then the seedlings will not fail to get to the whole body. If the seedlings are too little, the qi will be weak and variolation will fail. So it must be sufficient and new, then every attempt will be successful. It is good to close the nose for a while with the hand to ensure it is breathed into the windpipe.

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Tongguan powder: An equivalent amount of Fructus Gleditsiae and Asarum. It is also good to add realgar too. Zhang Yan describes the improvement process from the fluid skill of variolation to the dry skill. But variolar crust mixed with milk put into the nostril is very similar to using water. The bamboo tube has been replaced by a silver tube. One needn’t be exact about this. He adds Tongguan powder, which shows that he was considerate as well. Zhu Chungu’s The Pox’s Final Solution came out earlier than Zhang Yan’s New Book on Variolation but later than the original work Immortal Variolation. His skill has been described in the above quote from Vol. 2, On the Variolation about the impartment of Goddess Tianmu. He also says the following in Continued Complementary Variolations in that same volume: The impartment of Goddess Tianmu about variolation has been described in detail in On Variolation. Now I add a few methods of variolation created by later generations. They seem to be workable too. If variolation is carried in imperial palace, the method of Goddess Tianmu must be used. In remote poor areas, the added methods also can be used. Let silversmith make a five-cun-long silver tube with fine silver. The hole of the tube can be put into the nostril. First put some variolar crust powder in a silver tube, then insert into the nostril, gently blow the powder into the nostril. This is the first added method. Another method is variolation with clothes. Fluid will become abundant in three to four days. At this time, smallpox qi is most abundant too. Place the pox child’s clothes next to the skin to the child without pox and let him wear them for two to three days. Don’t take them off even at night. At the ninth day or eleventh day, the child begins to have a fever. Some people begin to have a fever at the seventh day, but these are two in ten people. This is clothes variolation. If qi is insufficient, the child will not have a fever and smallpox will not appear. Some arrogant people prick the pox for variolation. They are unkind and we don’t talk about them anymore. Variolation on the same day in the left nostril for a boy and the right for a girl and should be taken out after twelve hours for the child under one year; twenty hours for the child over one year…

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So Zhu Chungu believed in Goddess Tianmu’s method, namely that water variolation was the best, which was the only method used in the imperial family. Common people can use nose-blowing variolation with dry scabs, but its weaknesses are not discussed. Variolation with clothes did not seem to have a high success rate — for “many children do not develop a fever and the pox cannot appear.” These two methods may have been used as substitutes in remote villages. Fluid variolation is rejected by him. So Zhu Chungu believes Goddess Tianmu’s method, namely water variolation, is a more mature method. We can therefore infer that water variolation appeared much later. Someone like the Goddess Tianmu was probably a myth. Yulan Jushi made a comment on methods in his Variolation, its Essence: Some people are variolated by filling the nostrils with pox-fluid on cotton, which is called ‘fluid variolation’. This method is to squeeze the pox and take the fluid, which leaks out healthy qi and can harm the child. So it is most cruel. Some are variolated by wearing clothes, which are worn next to the skin and contaminated with smallpoxfluid. This method is called ‘clothes variolation’. It is not effective due to insufficient qi. Some are variolated by blowing powdered variolar crust into the nose, which is called ‘dry variolation’. It is too strong for the child to endure and sometimes goes into the brain, along with pathogenic ‘wind’ and makes the variolated child ill. Furthermore, blowing will make the child sneeze and this variolation often does not work. So these three methods should not be adopted. He advocated water variolation as the best method. The Essence of Variolation chapter in The Golden Mirror of Medicine also says, I have studied all methods of variolation. Some use smallpox-fluid, which is ‘fluid variolation’; some use wearing a poxed child’s clothes; some use blowing dry variolar crust powder into the nose, which is called ‘dry variolation’; some use inserting wet variolar crust powder into the nose, which is called ‘water variolation’. Comparing these four methods, water variolation is the best; dry variolation is the next. Clothes variolation is often ineffective. Fluid variolation is too cruel. So the people of old only used water variolation. In general it is safe and gentle. Dry variolation has also been used recently. It can be a short cut, but it is going too far to use clothes variolation or fluid variolation.

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Water variolation is good because it is gradual, safe and gentle, neither too fast nor too slow. The child will not be injured and the fetal toxin will have an opportunity to be discharged. All water variolations are successful, without exception. It is effective, perfect to practice and teach. It is the best variolation… Dry and water variolation are similar. If child is strong, he can also be variolated with either. So water variolation has been basically regarded as the best method, over the course of time. However, when mixed with milk, it must be used up the same day and should not be kept for longer. Zhang Yan points out, First list the names of children before performing any variolation. Then mix scabs with milk according to the number of children. But it is easy for the mixture to lose qi. The herbs of Tongguan powder are active but not good for retaining qi, so be aware that qi is easily lost. Therefore, the mixture is only prepared for one day. Otherwise the next day the qi is gone, and variolation will fail. (A New Book on Variolation) All in all, from clothes and quilts to fluids, dry-blowing and water-insertion methods, the practice was in continuous improvement. Variolar fluid being replaced by variolar crust was to avoid damaging the poxed child, who was the donor. At the same time, the smallpox virus becomes less active and less toxic after incrustation. Dry crust variolation replaced by water variolation into nostrils can reduce both the dose entering the body and toxicity. These are good for furthering safety, and the store of seedlings can expand variolation to more people. However, this does not mean that water variolation was used everywhere after that time. My father (1911–1990) told me that he was variolated with the nose-blowing method. In those days, there was no standardization of variolation among the people. By the way, did the Chinese really also prick the skin to variolate? According to Qiu Zhonglin’s research, “dotting variolation” appeared in Hunan Province after the Jiaqing period (1760–1820) during the Qing Dynasty. “They neither select seedlings nor instill anything into the nostrils but prick the quwai acupoint by the side of the humerus,37 put seedlings in and apply special medicine.” This was actually learnt from cowpox vaccina37

 quwai was an alternative name for quchi 曲池, or Co 11.

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tion. Because cowpox vaccine was not easy to get in China at that time, it was replaced by human pox.38 At this time, pricking the skin was not a taboo for TCM doctors, although the tradition of “do not damage the body, skin and hair which come from the parents” did persist. The method of “growing a rash” previously quoted from the book by Sun Simiao was also probably one of pricking the skin. But we can’t find any record proving that the Chinese spontaneously used arm-pricking variolation during the Qing Dynasty.

(3)  Efficacy and Safeguarding Measures During Variolation Chinese variolation took particular care. Methods were different, as mentioned earlier. But safety and efficacy in practice were of the greatest importance. At the same time, there developed a series of methods, such as selecting and storing seedlings, choosing suitable times, opting to take from and variolate the right people, and also how to care for the patient after variolation, all of which could ensure effectiveness and reduce toxicity, so as to avoid the malignancies of the pox and its complications.

(a)  Selecting the Seedlings There were three principles. First, don’t use “epidemic seedlings”. These were called “common seedlings” in Immortal Variolation, but may also be called “ominous vaccines” in Zhang Yan’s book and “bad seedlings” in the Collection of Smallpox and Measles. Zheng Wangyi says in Variolation Methods that “The crust from epidemic smallpox is called ‘epidemic seedlings’.” Yun Su says in his Variolation Book, Don’t use ‘epidemic seedlings’. It brings about bad consequences and destroys reputation. All in all, immortal seedlings are the best. Immortal seedlings are fluid seedlings or crust seedlings from a variolated pox. First, you are not to use the fluid or crust from spontaneous smallpox, especially “ominous seedlings” from any epidemic smallpox. Second, don’t use the fluid seedlings directly taken from a child. The above citation of Yun Su says fluid seedlings can be taken from variolated pox, but this is denied in other books.39 38

 See the works of Qu Zhonglin, pp. 480–481.  This will be described later in detail.

39

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Third, the variolar crust must come from fully fluid or round pox, whether they are associated with spontaneous or variolated pox. You must not use any kind of fluid as seedlings but the crust — this was an important toxin-reducing process because the virus in the fluid would be very active, virulent and infectious. Do not take seedlings during the epidemic season or area. This was in order to avoid a real infection caused by their strong virulence. This is also considered a wise measure to reduce or even totally avoid toxicity. Good mellow, round and full pox indicates that the virus is active and strong, without variation or cross-infection. Thus, accidents could be avoided. This was also a necessary measure to reduce side effects. Of course, these are just some of the principles. The actual operation meant one had to be flexible. Everyone’s experience was also different. Vaccine Selection in Immortal Variolation records, Seedlings used for variolation are not those from common epidemic smallpox — but given by a god. They must be taken from a variolated pox. Make a cotton ball as big as a green bean and dip it in some fluid from good, mellow and pointed pox of the right date, or from pox whose fluid begins to turn thick. Variolar crust is also good. Ordinary variolar can do if there is no immortal seedlings, but the fluid or crust must come from sparse or favorable pox… Fluid variolation was still seen as the best choice in the above book. Common “seedlings” can be still used when necessary. However, it is agreed that seedlings must be taken from good mellow, round and full pox. Zhang Yan is particularly cautious about epidemic seedlings. Volume 2 of his New Book of Variolation says, “I have worked with smallpox for tens of years and did not see one die from variolation if the seedlings were favorable. However, only eight out of ten will survive if the seedlings are unfavorable. Smallpox doctors have to take favorable seedlings — then all will turn out right!” He says in How to Differentiate the Seedlings again: Variolators entirely depend on favorable seedlings. Favorable seedlings are just like disciplined soldiers, who progress in order and act according to rules. They make toxic qi discharge in an orderly way through the channels- instead of flowing about in disorder. Toxic qi comes to the skin and leaves the pores or orifices in its own way. Furthermore, toxin is not retained in the blood phase, so blood

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grows luxuriantly; toxin does not stagnate and qi moves freely. Free qi and luxuriant blood must make the pox mellow and full. When the pox start suppurating, they will not be gray-white or purple black. Unfavorable seedlings are just like a disorderly crowd, advancing and retreating immoderately and in disorder. Toxic qi flows about in disorder and rushes away down the channels in no special way. So the pox appear scarlet or as thick as silkworms’ eggs. Furthermore, if the toxin is not discharged, it will disturb the blood and qi and the five zang-organs will soon be in danger and the pox itself indented. So the variolator should use favorable instead of dangerous seedlings — to avoid harm to himself and others. Do remember this! Years ago, one of my friends performed variolation in Jian County. At first, he performed variolation with favorable seedlings and all the variolated persons were safe and sound and he was well-known, far and wide. Later he went on to Dongxiang. There many people needed to be variolated, but there were few seedlings. As he was greedy for profit, he used epidemic seedlings. When the pox appeared, most were unfavorable, dozens of children died. It aroused discontent and the indignation of many. He could only flee at night. The people did not know the truth — and believed that the timing had been unfavorable. How could they know that it was due to taking dangerous seedlings! Some people also started talking, they said: ‘Though his vaccine was from epidemic smallpox, the seedlings he selected were all favorable. Why was the variolation unsuccessful?’ I answered: ‘That year, pestilent qi was epidemic in Jian County. Some people’s pox worked because their toxic qi was weak and their blood qi strong. However, they still came from epidemic pox after all. If the variolated people had had a slightly stronger toxic qi, they would have been in danger.’ Therefore, do not take seedlings from an epidemic — it piles trouble onto itself. There is no special skill but only using good seedlings when performing variolation. Skillful variolators keep this a secret for fear that people will think little of their skill, after they know the truth. Beginners, you must carefully select your seedlings. Do live up to my earnest instruction. So we can see both Zhang Yan and Zhu Chungu advocate using variolar crust instead of variolar fluid as seedlings. They were strict about which pox

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can be taken from where. Zhu Chungu describes it simply. In his chapter Essence, Spirit, Body and Qi, he says, Firstly, select the seedlings cautiously. The pox must be thin, full of fluid, pointed, red and mellow. The variolar crust must be thick and waxy. These seedlings have got a clear qi of yin and yang in the universe, and this means that the variolation made with it will never fail. An anonymous book called the Variolation Guide records the different variolar crusts: Black, dry and thick variolar crust is unsuitable; thin, filmy and small crusts are unsuitable too. Thick seedlings can make variolation successful even after being kept for more than a month; but thin seedlings will lose their qi after half month and variolation will fail. If someone suffers from smallpox because he is infected from the variolated people near him, the toxicity of the smallpox is similar to that of epidemic smallpox. The seedlings from these pox are called ‘wild seedlings’. They are unsuitable too. Zhang Yan describes this in detail in Secret of Vaccine Selection: Seedlings refer to using variolar crust. When taking seedlings, one should clarify the origin of the pox. Most pox in the countryside is favorable and has no adverse symptoms. Seedlings can be taken from it. Secondly, check if the pox is clear and mellow, if they are sparse and few and far between on the head, face, chest and back, if they are bright, mellow and thickly crusted after the fever. If the patient recovers from the pox without medical help, it means they had a good origin, enough qi and blood and the toxin already discharged again means good seedlings. Although there are many types of pox, these are the best. The whole body and limbs have good scars, which are thick and bright. When taking the scabs, one must tell the child’s parents to shake off the crusts from the night-clothes onto the mat, pick them up, wrap them up very well and put them beside one’s own body, not to let the qi discharge. If the crust is filmy and white, it is too weak for variolation even though it has come from a good source.

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If the child has a continuous fever even after all the pox have appeared this is a dangerous situation and the crust cannot be used as seedlings. If crust is black, heat toxin must be excessive and its crust cannot be used for variolation either. Red crust is best, yellow one is better. Don’t take seedlings carelessly. Remember! Carelessness will be harmful to oneself. Otherwise, it is too late to regret. According to these texts, you could still actually use epidemic seedlings. But they were known as “favorable seedlings” by Zhang Yan. If you did not do this, then keeping seedlings would be a big problem. Wu Qian’s Golden Mirror of Medicine is addressing much the same point when he says: Careful observation is needed in seedling selection. Some are usable, some are not. The difference between them is that they turn out favorable or unfavorable… favorable ones which create no complications have pox that are pointed, red, mellow and full of fluid. The crust is big, thick, bright and waxy. It holds in the healthy qi of yin and yang of the universe, so it is very favorable and very effective in variolation. But this kind of crust is rare and not commonly met with. If one cannot select seedlings personally and has to entrust it to others, he must witness it. Otherwise, put it aside rather than use it. Do not abuse your position. Variolators must consider this point carefully. One had to be cautious so as to select only mildly toxic seedlings. After selection, one had to refine them. Zhu Yiliang’s Variolation Experience states, Epidemic seedlings can become mature seedlings after being seven times continuously variolated, and so carefully selected. That you must know. The more times they are used for variolation the greater the pure power of the seedlings. They are man-made and more mature. Fire toxin is eliminated but essential qi left behind, so they are very safe. Obviously, this process is the equivalent of modern self-cultivation. In this process, toxicity decreases gradually from generation to generation, but antigenicity remains. Such seedlings are safe.

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(b)  Seedlings, Their Storage and Management Vaccine storage is done to maintain the biological activity of the vaccine, so that antibodies can be produced to create active immunity. Once the vaccine is preserved improperly, the vaccine will lose its activity and vaccination will be ineffective. Furthermore, preservation somehow can reduce toxicity. Joseph Needham said,40 Thus the general system was to keep the inoculum sample a month or more at body temperature (37 degrees C) or rather less. This mild heat would have deactivated some 80% of the living virus particles. Since their dead protein would have been present, inoculation would have strongly stimulated interferon production as well as antibody formation.41 It is not easy to handle the balance between ensuring variolation activity and reducing toxicity to avoid malignant smallpox. Retention period and storage temperature were the key. The Method of Seedling Selection in Immortal Variolations records, When taking common seedlings, one must select the fluid or crust of sparse or favorable pox. Pack them in cotton paper, write on the date. Make about one fen (0.5 g) of musk into a pile and pack it into a little bamboo tube, then pack the crust inside. Cover it tight and carry the bamboo tube with oneself day and night. Don’t be exposed to contact with any pregnant woman. Also it could be done with the musk. Fluid seedlings can be kept for fourteen days and the crust can be kept for twenty-eight days. If in December, seedlings can be kept for more than forty days; if in November or lunar January, for more than thirty days; in Doctor or February, for one month; in September or March, for more than twenty days; in April or August, twenty days; in May or July, for half month and in June, only for seven or eight days. If this limit is exceeded, the seedlings will grow bad and useless. 40

 See Joseph Needham. China and the Origin of Immunology, Journal of Traditional Chinese Medicine translated by Ma Boying et al., No. 5, 1983, p. 10. 41  Joseph Needham et al. The Origin of Immunology. Science & Civilisation in China, Vol. Vl:6. Cambridge University Press, 2000, p. 143.

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New crust cannot be used in the first three days. Seedlings from variolated pox are not troublesome, but seedlings from epidemic pox are a little fiercer. So this text specifies the storage method and period of storage. The text “new crust cannot be used in the first three days. Seedlings from variolated pox are not troublesome, but seedlings from epidemic smallpox are a little fiercer” is about toxicity reduction. However, what variolators really cared about was how to keep the seedlings active during preservation. Zeng Ding is a little conservative. He says in his Smallpox and Measles: If it is winter, seedlings will be effective even after a month. In spring and autumn, they can be kept for half month to twenty days. If hot summer, it is appropriate to keep them for eleven to twelve days. Otherwise, the seedlings will lose qi and become useless. In the Variolation Experience, Zhu Yiliang goes further: If the scabs are big and thick, they can be kept for more than one month in winter and early spring; for half a month in late autumn and early summer; for only six to seven days in a sweltering summer. If the scabs are smaller and thinner, they cannot be kept for so long. There is a difference also between the north and south of the country in Zheng Wanyi’s Variolation: The north is cool, so spring seedlings are still usable for a month and in winter usable for forty to fifty days. In the south, summer seedlings are usable for four to five days, in spring for twenty days and in winter thirty days. Beyond that period, their qi will become weak and friable, so the variolation will not succeed. Zhu Chungu also describes the instruction of Goddess Tianmu in his discussion On Variolation. “Variolar crust is usable for a month in spring and autumn; half a month to twenty days in summer; but forty to fifty days during a cold winter.” This is in accordance with the story told earlier when it speaks about the time being “… not more than two months, a skillful doctor arrived in the capital to variolate Wang Su”. It must have been winter. This measure can ensure that the seedlings remain effective. The longer the time, the less toxic they were. Attenuation of function is displayed in this case.

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Zhang Yan expresses his own opinion in “Variolation Preservation”: Fetch seedlings, wrap them in paper, then put them in a small bamboo tube and plug its mouth to keep the seedlings’ qi in. Put it neither in the sun nor near fire. Carry them on oneself and let them dry by themselves. Mark the date on the package. The yang qi of seedlings stays inside in winter so that you can make the most of the variolation succeeding even after thirty to forty days. The yang qi of the seedlings leaks out in the summer so that it will make most variolations fail even after twenty days. All in all, seedlings should be fresh and new. New seedlings have abundant qi, nine out of ten vaccinations with them will succeed; slightly old seedlings have weak qi, only half of the variolations with them will succeed; old seedlings have no qi, no variolation with them will succeed. If the new seedlings are few but the people are many, old seedlings must be used mixed together with new ones. These seedlings also should be blown much more inside the nose, then the variolation will succeed. Apparently, he had rich experience in judging if the seedlings were active enough to variolate with success. Attenuation could be seen as the by-product of a “lucky stroke”. These experienced variolators were very confident about the safety of their method. At the same time, Zhang Yan especially warns variolators about old vaccine. He says in Old and New Seedlings that: The symptoms will be mild if the pox appears seven or eight days after inoculation. If old seedlings with weak qi cannot get to the life-gate successfully, variolation will fail. Variolators will not only be sneered at, the external toxic will also stay in the viscera and strengthen the internal toxic. So if the smallpox appears more than ten days after variolation, its symptoms will be severe. The symptoms will also be serious if seedlings are added later. All these are due to using old seedlings. Beginners must be careful! Years ago, one of my friends asked me for seedlings in Tai County. However, he did not variolate until thirty to forty days later. All the variolations failed except one. Epidemic smallpox happened to break out there. Unfavorable pox appeared on variolated persons one after another. None was favorable. There was a rash of complaints. This is a lesson to learn about using old vaccine.

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Some other variolation masters also had similar methods of preservation. For instance, Yun Su said in his Variolation Book, “Place it in a bamboo tube with a joint, plug the mouth. Carry it with oneself all the time to supplement it with one personal qi.” Zeng Ding said, “Fetch scabs, wrap them with black golden paper, adding Beijing and Sichuan paper, then put them in a bamboo tube or small can, carry it near your body every day to keep in the qi.” Zhu Yiliang’s Variolation Experience gives a more detailed description: First select proper smallpox crust, clean it with your fingers, wrap it in clean bamboo paper… Do not wrap it in red-alum paper for fear of damaging the crust. Keep it on yourself for some time to remove the moisture in the crust so that it will not become mildewed. Keep it in a clean china bottle and place the bottle in a cool place. If it is hot, seedling qi is easily consumed; if the place is filthy, it is easily contaminated; if the place is not dry, it is easily attacked by dampness; if the bottle is not covered properly, seedlings will be stolen and damaged by rats and other insects. So these cases should be avoided. If it is summer or epidemic smallpox occurs, prepare a thick bamboo tube. Wrap the seedlings up, after being cleaned and dried. Put them in a bamboo tube and plug its mouth. In this manner, the seedling qi will not be lost and will not be attacked by the epidemic qi. Even in a cold winter, seedlings can only be kept for no more than forty days. How to make seedlings available all the year? This seems to be a problem. The Guangxu version of the Smallpox and Measles Collection mentioned above says, Some masters’ families keep smallpox seedlings even today. One perfect seedling will cost three pieces of gold. Variolators make large profits from seedling transactions. If people need to be variolated in winter or summer, they use the seedlings from the children of their clan or relatives. Seedling reserve is called seedling cultivation. If seedlings are used up, doctors must go to Taiping County to buy them. This way no accidents happen. There seems to have been a supply centre supplying seedlings for variolators in Taiping County at Ningguo Prefecture, so they seem not to worry about getting seedlings. But how can Taiping County supply smallpox

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vaccine all year? This is a mystery. There is no record about the method of preservation. Yun Su’s Variolation Book records, “Choose one or two children to be variolated in a big house, and the seedlings can be kept available.” The Treatment for Children records, “In May, June and July, borrow a big house and variolate a few children to have a supply of seedlings.” The Complete Collection of Smallpox Books says “Variolation workers look for families in remote mountain areas. They supply these poor families with money and medicine to variolate the children for supplying them with seedlings.” Zheng Wangyi also mentions in his Variolation Methods that “Some enterprising variolation doctors look for some poor strong children to variolate in May and June. The variolation is free. Besides this, they give these families some money. Children are variolated one after another until July. Thus seedlings are available all the time.” This must be the method used to preserve the seedlings — so that variolation can be performed even in hot summers. The supply in Taiping County must have been larger. Did they have a better method of preserving seedlings? Was it not spoken about because it was so profitable?

(c)  The Timing of the Variolation Primarily, variolation should not be carried out during the epidemic season. Immortal Variolations says, People should understand that fetal toxin is limited, but epidemic qi inexhaustible. Moreover, the pox induced by variolation neither adds evil nor disturbs the qi or blood, nor makes for itching or an ‘oppressed chest’. Healthy qi defends the body inside. Neither liquor nor filthy qi can harm it… When smallpox breaks out, the epidemic pathogen is very rampant. People should avoid disturbing it at this time. When the situation becomes a little better, variolation could then perhaps be performed. Perhaps some variolated pox do not have the right outcome, this must be because the seedlings were not good, or the doctor is unfamiliar with the skill. It is pitiful to help shoots grow by pulling them upward. Such as this is done by the alchemists. People know there is magic, but don’t know why they is magic. Zhang Yan makes it clear that variolation should be performed before the arrival of any epidemic smallpox.

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I warn people that no children can be exempt from smallpox. It is best to ask the doctor to variolate children before the arrival of the epidemic smallpox. This is the wisest plan. If one does not ask the doctor to variolate his children until the epidemic arrives, the children might have already been infected with the pathogenic qi. At that time, doctors do not dare perform variolation. Even if variolation has been done, it is still hard for it to work. I am fearful of it all going bad, so I give you my preventive advice here. (Proper Variolation) Variolation only can be performed in a family where the members are not infected with epidemic smallpox. If someone there is infected with epidemic smallpox, his serious symptoms must frighten others from asking for variolation. Without an interview or investigation, a doctor does not know the children have been infected by the epidemic and variolates them. When their variolation does not work out, they will blame their doctor. With such unjust treatment even using all the water in Western River cannot clear his name. But then, what is the use of remorse? When I lived in Tai County, a Mr. Yan asked me to perform variolation. Without a careful investigation, I went to his house to variolate his children. Then he told me that epidemic smallpox had been in his family for more than twenty days. He had led me to take a visit. A stinking smell rushed to me as I went to the door. The smallpox looked like a snake skin. It was really an unfavorable symptom. I regretted variolating his children. However, it was too late. Less than three days later, all the children had a fever. Some children even came to be variolated with a fever. Most of the variolations were unfavorable. I could do nothing but let them blame me. Just like saving a drowning person or a person in flames, not all survived. His neighbor was surnamed Zhu. His family had not yet been attacked by the epidemic. Dozens of his family had no unfavorable results, although the two families had been variolated on the same day. Therefore, people should not ask a doctor to variolate when epidemic smallpox is in the house. Doctors should also visit to see if there is epidemic smallpox present, before variolating people. But smallpox becomes contagious only as it begins to suppurate and the toxin transforms into pus. If a doctor finds the pox just coming

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out with the fever, he can perform variolation for the child because the smallpox is not yet contagious. The variolations will also be favorable. So if epidemic smallpox comes, a doctor should visit as soon as possible. The variolation doctor also should make an investigation. Do not be in a hurry. But delayed variolation will bring trouble to oneself. (Secretary to Variolation) Zhang Yan stresses in his preface, “In peacetime, use good seedlings to guide in the fetal toxin, then it will do no harm and the pox be favorable. Human design can overcome destiny, turn ill luck into good luck and keep people away from danger. It is kind to both grown-ups and children.” It is scientific to request that one should be a good master in timing the moment of variolation. In addition, you should also be particular about the season. Immortal Variolation records, “February, March and April are the best times for variolation; August, September and October are the next best. Severe cold and severe heat are unsuitable.” Yulan Jushi’s Variolation Essence also records, “Both freezing winter and scorching summer are unsuitable for variolation.” However, he also says the lunar months of January, February, March, August, September and October are the best months for variolation, which can also be performed in April, July, November and December if there is no other choice; but variolation cannot be performed in May or June. These texts are inconsistent.

(d)  Suitable and Unsuitable Constitutions for Variolation Not all children are suitable for variolation. Sickly and weak children should not be variolated. This was a precedent of modern immunization. Immortal Variolation says, Variolation should not be given rashly to children after illness, or to those too young with weak bones and muscle. If a doctor is unaware that the child has been attacked by exogenous pathogens or suffered from internal injuries and gives him variolation when he has a rash, the variolation will be as harmful as epidemic smallpox. Doctors must observe and consider carefully! The following persons should not be variolated: persons with injured spleen qi, persons not recovered from illness, persons with an insufficient yin phase, persons with the ‘steaming stone’, frightened persons, persons with internal

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stagnation, worm stagnation or a mass in abdomen, persons fond of uncooked or cold food. If they are variolated, their smallpox will be unfavorable. The following persons are also unsuitable for Variolation: persons suffering from sores, persons injured by hot water, fire, or a knife. If they are variolated, toxic qi will gather in the wound the pox will be unfavorable. They should not be variolated until they have recovered. The ear is the orifice of kidney. Smallpox toxin must be discharged through the kidney meridian. So first check the ear. If the child suffers from kidney heat or liver heat, that will be manifest in the vein behind the ear. If the vein is reddish, its texture is in order, the pox will be sparse. If it is red, that is good too. If the vein is red and blue, the pox will be a little serious and the child will suffer from convulsions as he has the fever. But do not worry about it. If the vein is pure blue, the pox will be serious. The child should not be variolated rashly. If the blue vein is mingled with black or if the vein is all black, the pox will be very unfavorable. Do not variolate the child! The end of the quotation is a little similar to the prognosis made through observing the microcirculation today. Zhu Chungu also believes in the theory of there being “no variolation for the offspring of heartless and immoral persons”. They are not blessed, and their smallpox will be unfavourable. So they should not be variolated. This was the idea of retribution, coming from Buddhist practice. His Essence, Spirit, Body and Qi is all about indications and contraindications. A one year-old child is the most suitable for variolation; a six monthold child the next; two to three year-old children are the last. At the age of five or six, children begin to know something and become difficult to restrain. They neither follow the advice of the doctor nor take the medicine, so they are difficult to variolate. Variolation beginners should know this in advance. Differentiate the child’s essence and spirit before giving him variolation. If he has good essence and spirit, he looks glowing and healthy. The yintang (point between the eyebrows), shangen (nose bridge) and nianshou (between the yintang and shangen) are all bright. A radiating and pure face is good. Spirit refers to the eyes looking peaceful and glowing. Solid spirit refers to the child not being frightened at the sight of something strange and easily happy at the sight

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of something familiar. A bright look is good. If the eyes are dim and spiritless, the child should not be variolated. Body and qi should be examined too. ‘Body’ consists of head, face, chest, back, hand and leg, etc. Different people have different bodies. Doctors should examine whether the child is in balance, between bone and muscle. They should be neither fat nor emaciated. Muscle should be firm. Purple-dark is good. If his muscle is as loose as leaven dough, variolation should not be performed. Qi makes the body vigorous. It is good if the ear is regular, the neck not crooked, the hands can grasp forcefully, the feet strong to stand on, the pee is far and long, the scrotum tight and darkish, just like lychee peel. If the child looks tired, or breathes irregularly, they should not be variolated either. The following children should not be variolated: a child with languid eyes; a child without a smile; a child with muscle like leaven dough; a weak child; a child with malnutrition and stagnation; a child recovering after an illness and weak; a child with unrecovered primordial qi due to vomiting and diarrhea; a child with scabies; a child not recovering from serious toxicity; a child with a soft and over-quiet voice. Zhang Yan had a more complete idea about “variolation after examination”: The pox-toxin comes from the five zang organs, just like a robber entering a house. When it is discharged from the body, healthy qi fights with the evil qi. If the primordial qi is strong enough to overcome the smallpox toxin, the toxin will be driven out and disappear naturally even if it is excessive. If the primordial qi is too weak to defeat the toxin, excessive toxin must attack the body. The toxin in an adult body cannot be anticipated, but the qi and blood in children can be known by examining their body and countenance. Make an examination before the variolation. A good complexion indicates sufficient blood; a dull complexion indicates insufficient blood. Dry hair indicates insufficient blood; black hair indicates sufficient blood. Scanty and brittle hair indicates insufficient qi; thick and dense hair indicates sufficient qi. Then examine the fontanel. A large fontanel indicates that insufficient fetal qi has made the skull hard to close; a small fontanel indicates that sufficient fetal qi brings about yang qi,

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so the fontanel can close easily. Furthermore, the essence of the five zang-organs gathers in the eyes. So glowing eyes surely indicate sufficient essence and blank eyes indicate insufficient primordial qi. A greenish nose-bridge indicates that the child has a weak constitution, often suffers from convulsions and is bothered by much phlegm in the body. A greenish complexion indicates a weak constitution and deficient primordial qi due to vomiting and diarrhea. Blanched hair suggests the child suffers from malnutrition and stagnation. Pale and sluggish lips indicate asthenia syndrome. A loud and long voice indicates sufficient qi in the dantian; low and rapid breathing indicates an insufficient ‘sea of qi’. Thick purple lines in the fingers indicate that accumulated heat will be discharged soon. A hard and swollen abdomen with green veins indicates retention of food. So only a strong and healthy child can be given vaccination and a sickly child with deficient qi cannot be variolated. The constitution of children under one yearold may be weak. Children nourished by a nurse or with fresh milk should be paid attention to - that they do not suffer from malnutrition. Tiangui (a girl’s ‘period’) begins for girls above 14. Variolation should not be performed during a menstrual period. At the age of fifteen, boys may have very great sexual desire and this should be considered when variolating them. Variolation may upset the fetus in a pregnant woman. Children without a family are often weak and if without a strong waist must be deficient in the kidneys. Children with weak knees must have insufficient marrow. Children with an evil look will be in danger if they are variolated. It is not auspicious for children if their parents have a sharp tongue. Do not variolate an over-cautious family. Do not try it on a destitute or disordered household. These are the secrets of variolation. I have proved them many times. Young doctors should follow my advice. These are the wise remarks of experienced masters, indicating a careful and scientific attitude.

(4)  Observation and Recuperation with Herbal Medicines After Variolation It has been mentioned that Zhang Yan mixed seedlings with Tongguan powder to blow into the nose. Tongguan powder passes through all the meridians

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and helps to make the smallpox favourable. Taking detoxification dan or pox-promoting dan after variolation is recorded in Immortal Variolation: … has been inserted for one day and night. Take it out and then take detoxification dan. A Detoxification Dan: At noon on the Dragon Boat Festival, take earthworm feces from a leek growing in the soil, make them into a pill as big as a soybean and cover with cinnabar. Take the pill with boiling water or Lonicera and Licorice Rare Decoction at the time of variolation. Take one again the next day. A Pox-promoting Dan: take cinnabar (three qian of very fine powder from a large piece of transparent cinnabar), green cimicifuga (three qian of powder), dry white dry poeraria (three qian of powder) licorice (three qian of powder) and a fen of borneol and grind very fine. Seal it in a pot. Take it with Juncus Decoction a day and night after variolation. For a one year-old child, one fen. Only take one qian for a child if even 15–16 years old. Zhu Chungu said, “… fry scutellaria root and coptidis with wine. They clear the toxin and make the qi and blood flow freely, and transform the fire toxin into pox fluid. How considerate and careful Mr. Nie is! I have understood the key. It is because the unprocessed astragalus root, unprocessed rehmannia root and Chinese angelica guide the scutellaria and coptidis fried with wine into the qi and blood, which transform the toxic fire and create fluid. Here I specially put this truth down.” Immortal Variolation also records a “bump” appearing after vaccination, which is actually the swelling of the submaxillary lymph nodes. It goes as follows: A bump will appear under the cheek on the sixth day after vaccination. The size differs. Perhaps a toxin is in the body gathering in the yangming channels so it will not spread and the pox will be sparse. This is the advantage of variolation. It is not as rambling or changeable as epidemic smallpox. The bump will disappear after the pox appear and are filled with fluid, and the fever has gone. However, some bumps do not disappear until the pox have disappeared. Do not treat it as toxic or apply medicine to the rash. Some people have no mass due to incorrect variolation, which often brings about serious trouble.

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Zhu Chungu describes it as follows: … Three to five days later, a man has a little mass on the left side of his neck, not far away from the throat. It indicates the pox will come out. If a woman has a little mass on the right side of her neck, not far away from the throat, that also indicates the pox will come out. However, it defies generalization. Some variolations will also work, even without a mass. I fear that variolation beginners will be surprised and bewildered at the sight of a mass, so I put it down here to broaden the vision of learners in the future. If the mass appears during the fluid-filling period, use medicine to promote adequate fluid and the mass will disappear naturally. If the mass does not disappear totally, the remaining toxin must turn into smallpox toxin. It seems that Zhu Chungu’s idea is the more mature one. Swollen lymph nodes appear on the left for a man and on the right for a woman because the seedlings are plugged into the left nostril for a man and the right nostril for a woman. Immortal Variolation describes the smallpox process after variolation: There will be a mass under the cheek the sixth day after Variolation42: … People will have a fever on the seventh day, some even a headache. But it is unlike the fever of epidemic smallpox. On the tenth day, pox can appear. If the pox are sparse, there will be only a few pox. It is called flowering. These pox will be filled with fluid as expected. The toxin is mild too. If the pox are thick, there will not be more than two hundred or three hundred. Thick pox will be filled with fluid, thin ones will disappear naturally. It is easy for them to be filled with fluid and form a crust. It is not as changeable as epidemic smallpox. Medicine is not needed. The growth and fluid-filling of the variolation pox are almost like a ‘favorable epidemic’. However, some pox may occur sooner or later, sometimes even fail to appear, but that is only one or two cases in a hundred. It is destiny. If people only have a fever but no pox, is called ‘scatter pox’, the fever disappears along with the sweat and the toxin is discharged with the sweat. It can be regarded as smallpox and will never occur again. 42

 See the text on lymph nodes mentioned earlier.

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If one has neither fever nor pox, he must be variolated again. If the pox still do not appear, the toxin must have been locked in. It will not come out unless it meets an epidemic toxin. So, a mild fever, the appearance of pimples and pox, filling with fluid and scab formation will occur on different days after variolation. This process is basically the same as in epidemic smallpox, but the fever in variolation is milder. The pox of variolation is not so deep as in epidemic smallpox in the dermis, so there is no scar after the scabs fall off in most cases. Though some variolations have no pox but only fever, such as in “scatter pox”, they will be as preventive as variolation where the pox does appear. They can also prevent people from any further infection. This is consistent with what my own father told me about the “blowing variolation” he was given in his own childhood. There was no scar on his body. Some people may suffer from serious smallpox with residual symptoms after being variolated. At this time, doctors should give them conditioning treatment. Immortal Variolation describes it in detail. There are various concoctions: cimicifuga and pueraria decoction, smallpox-promoting dan, muscle-passing powder, blood-cooling and detoxification decoction, fluidfilling powder, vitality-preserving and middle-regulating decoction, ginseng-astragalus four-Sage powder, immortal treatment decoction, vitality-regulating decoction, bezoar detoxification dan, cooling and detoxification decoction, tooth powder, etc. They are used at different periods based on syndrome differentiation. Besides this, there is needling, pricking, hot needling, medicinal applications and so on. In the books of Zhu Chungu and Zhang Yan, variolation smallpox is discussed as a variety of natural smallpox. It is treated with the same formulae and therapy. Immortal Variolation also mentions the special nursing needed after variolation. It says, “After variolation, overeating, wind, cold stroke, heatstroke, sha disease, alcohol, spicy food and poison, all should be avoided. People should also not be frightened by cats, dogs, falling, quarreling, fighting, etc. If people are frightened, the mass will disappear and the toxin become excessive. The pox must be widespread.” This book also reminds people that: Some bad pediatricians try to slander variolation because they say it obstructs their own methods. They say families are destroyed because of variolation, or someone suffer serious symptoms, as if this really happened. Some bad pediatricians even bribe diviners to

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make people doubt variolation, which makes some babies suffer endless pain and even lose their lives. During vaccination, one must visit the same doctor. Don’t change doctor. One should guard against bad doctors who secretly hurt children by putting croton into the medicine or smearing their hands with dog’s-blood. Some bad doctors even deceive people with fake medicines. They deceive them, saying the medicine will make them never suffer again. This will cause serious trouble. Folk customs and superstition also infiltrated variolation. This cultural phenomenon is worth mentioning here. After finishing the Essence of Variolation in Vol. 3 of New Variolation, Zhang Yan also describes “Setting up an Altar”, “Removing Suppression” and “Taking down an Altar” as follows: Setting up an Altar: Select a lucky day to set up an altar after variolation. Prepare an ox, sheep, pig and five kinds of fruit to sacrifice to gods. Put four chi of red cloth on a god tablet. Write down the god’s name on a piece of red paper and write the child’s name under the god name. Select a clean room to set up the altar. The gods are aligned in the following order from left to right: “the virtuous god, all highly skilled doctors enshrined in the Medicine King’s Temple Fair, talented Zuofu, the God Boy in Charge of Fluid-Filling, qi and blood, the Smallpox God in his Green-Cloud Palace of the Ninth Heaven, the Merciful Smallpox Goddess in her Fairy Palace (a smallpox god and goddess are in the middle), the Variolation God in charge of health, Mighty Youbi, god in charge of scattering flowers, removing suppression and misfortune in the smallpox palace, the Inductive God in his native temple”. Judging from these names, these gods belong to Taoism rather than Buddhism. Altarsetting rituals, amulets, chanting words, mantras and sword techniques are Taoist. They are used by Taoists in their magic. There is also one a mention of Prajnaparamitahrdayasutra. But most gods here are Taoist, except for the “Apperceptive Bodhisattva of Emei Mountain”. Again, occasionally Buddhist gods may also be included. But most are Taoist, seen as follows: The Taoist’s skills are not many, the Southern City watered by a Northern River. Three Words are enough to overcome All Demons in the world. Your disciple sends down his holy, magical and

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Buddhist water. It is Heavenly Water in the heaven and Earthly Water on the ground. In the hall, it is the Holy Water to remove evils, suppress evil, kill evil spirits and break suppression. Sprinkle the water to the sky, the sky will open; sprinkle it to the ground, the ground will crack; sprinkle it on man, man will live forever; sprinkle it on a ghost, the ghost will die. Here is the mantra of Profound Taiyuan in the Cave for catching and killing demons and evil spirits in every mountain. Chant this magical writing once, the ghost will be kept away, life prolonged, evils in the Five Mountains and Eight Seas caught and eliminated! Guard my home! Tao will be everlasting! Then take down the altar following the setting-up ritual. Prepare three sacrifices, various golden flowers and other offerings, then burn incense and worship to all gods, finally burn two paper boats and throw the ash into a river. This practice is also recorded in Mao Zedong’s poem as “The sky is lit by a fire of paper boats and candles”. The above rituals are not recorded in Immortal Variolation, The Pox’s Final Solution, etc. It is understandable that some doctors believed in Taoism and Buddhism besides performing variolation because our ancestors felt less confident about what they were doing — and needed to find some kind of psychological support in the face of the dangerous pox, during unenlightened times. However, Taoism and Buddhism were so rampant that they could overrun smallpox variolation itself. As I said earlier, Emperor Tongzhi set up an altar and prayed instead of being variolated. Finally he died from smallpox. How wrong was he!

123.  The Success Rate of Variolation There is no statistical method available nor detailed records of the success rate of variolation, as early as the Ming and Qing Dynasties. However, many suggestive clues lie in literary works — and medical books about variolation can be used as references. For example, Vol. 5 of Healthcare in Wushan Mountain by Lin Yunming during the period of Kangxi mentions when a child died from variolation in Fujian, “There are fewer than one or two dead among a thousand people,” and so on. These can be used as reference. However, all books praise their own method of variolation. Maybe they are a little boastful, but they are basically realistic. Some famous doctors, such as Xu Dachun and Wang Qingren, did not perform variolation themselves, but they all give a commentary about the effects of variolation — based on

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their own observations. Wang Qingren’s Correction of Errors in Medical Classics records, “No matter how many variolations there are performed by doctors, none are unfavorable.” Though this saying may not be accurate, it is probably coming from his experience and objective. Some non-medical literati’s comments can also be used as circumstantial evidence. For example, Wang Shensi says in the preamble to his Immortal Variolations, An ‘immortal variolation’ is very popular method recently. After being examined for deficiency, excess, yin and yang, the child can be variolated in good condition. None of variolations will fail if the child is kept from the wind and cold, nursed carefully with medicine and attention is paid to his diet. Man is the master of his own fate. Variolation is a wonderful skill… It takes away bad luck and brings people back to life. People are not afraid of smallpox any more. I cannot help but exclaim: this is true magic. Although it is only a small trick, it has made a great contribution to human life. Mr. Wang witnessed it also. This source also says, “The pox induced by variolation do not disturb the qi or blood, so variolated persons will suffer from neither itch nor chesty oppression’. Healthy qi defends the body inside. Neither liquor nor filth can harm it. There is no scar after decrustation. People do not suffer from disfigured mouths and noses, either. It is really a safe shortcut. Some variolations may fail, but they are only one or two in one hundred.” The authors are very confident that 98–99% of variolations will be successful. Besides, it has no such sequelae such as pockmarks, disfigured mouths and noses, etc. The description finally concludes, “Our children can survive thanks to variolation, which is now widespread. This skill is really very simple and safe.” Zhu Chungu mentions variolation efficacy many times in The Pox’s Final Solution. He said in On Variolation, I follow the advice of Goddess Tianmu when performing variolation and follow the pediatrics of Mr. Nie when nursing my patients. Sure enough, it is a very safe and sound method and no variolation fails. Most are favorable. If the children are nursed properly, none of them will die. This is certainly the truth. His document Faithfulness in the Heart also confirms, “I am in my seventy-seventh year. I have worked in the inner court for twenty-five years. All variolations performed by me are successful, without exception.”

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The discussion Essence, Spirit, Body and Qi emphasizes again, “In the mid-autumn of Xinyou year, I passed the examination and came to the capital to variolate for the emperor, prince and princess. Blessed by the emperor for twenty-five years, all variolations I performed were safe… All were successful, without exception.” All these statements must be true. Else, how could he dare to deceive the emperor? In fact, Emperor Kangxi saw with his own eyes these variolations. He recognized and appreciated the variolation efficacy of Zhu and others. So he said in his own Aphorisms on Family Education, “At first, people all feared smallpox. But when I obtained smallpox variolation, all my children became safe and sound thanks to it. Today among the forty-nine flags of the northern frontier states, Khalkha and the other vassal states, people are ordered to be variolated and they are all in sound health. I remember that the elderly felt strange about variolation at the beginning. But I persisted with it and thousands of people survived. This was by no means fortuitous.” The good preventive effect of inoculation was also pointed out by Zheng Wangyi in his Variolation Methods: Suppose there were one hundred children suffering from smallpox in a village. They are all treated in time. If eighty or ninety children can survive, the epidemic will be called a ‘peaceful pox’. Yet sometimes without variolation almost half the children will die even if treated the best and nursed carefully. Yet doctors are not blamed… Now when four or five out of a hundred children are injured due to variolation, the doctor must be blamed and cannot find shelter in the village anymore! This text reflects the public evaluation of the method at that time. Treatment could be as successful as 80–90%. The worst was 50%, but the failure rate of variolation was required not to be more than 5%, otherwise the variolation doctor would be punished and even lose his job. So the success rate of variolation had to be above 95%. Zhang Yan also talks about his own experience in his New Book on Variolation. I have travelled many states and performed more than eight or nine thousand variolations. Counting on my fingers, unsuccessful variolations were not more than twenty or thirty. If it were epidemic smallpox, could children be so lucky?

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By this calculation, his variolation failure rate was only 0.25%. Xu Dachun was a very strict medical critic. It was impossible for him to praise the effects of variolation unless he himself had witnessed them. He says in his Lantai Criterion, No one can be exempt from smallpox. Since variolation has been created, children have now a way to avoid this danger. Heaven is so kind that it sends down an outstanding person to create variolation to save human beings. However, some are doubtful about variolation and do not dare be variolated because some die from it. They do not understand that it is because of bad seedlings instead of the bad method. Furthermore, the death rate is only 1%. Compared with 80–90% of epidemic smallpox, variolation is much safer than epidemic smallpox. Without treatment, the mortality rate of natural smallpox would be as much as 80–90%. Wan Quan also says in his writing Smallpox Experience of a Physician from a Family of Generations, “In the spring of Jiawu year during the Jiajing period, smallpox broke out. Eight or nine in ten died from it.” So the rate is accurate. But unsuccessful variolations are fewer than 1%. Besides that, Dachun even believes that unsuccessful variolation is due to “seedlings instead of method.” Seedlings are bad possibly because they have lost antigenicity and do not have an immune effect anymore; or because the seedlings are from epidemic smallpox, their virulence is too strong. According to the records of a foreign missionary Dyer Ball,43 smallpox mortality in the Chinese Shanxi Province decreased from 20% to 30% (perhaps even 50–60%) to 1%. As variolation spread, the control of epidemic smallpox is also obviously effective. In 1722, according to the statistics of London from 1667 to 1721, Dr. James Jurin of the British Royal Society found that one in six died from epidemic smallpox in unvaccinated children, but only one in 91 from vaccinated children. Rev. Cotton Mather also made a statistical survey during a smallpox pandemic in Boston in the USA in 1721, which also proved that the mortality rate was 1/6 for unvaccinated people and 1/60 for three hundred vaccinated people.44 43

 Wang Jimin, Wu Liande (Wong and Wu): History of Chinese Medicine, The Tientsin Press Ltd., 1932, p. 141. 44  See Wang and Wu’s History of Medicine in China.

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Table 14.1   Inoculations on 653 Elderly People Born Before 1919

Example Smallpox Cowpox Smallpox Cowpox

Serious Sequelae

Not Not Inoculated Inoculated Without with Smallpox Smallpox Smallpox

Subtotal Cowpox

Not Inoculated

187 (84.6%)

9 (4%)

65–69

221

23

184

0

3 2 (1.60%) (Smallpox)

9

0

25 (11.3%)

70–79

311

53

239

0

8 (3.23%)

0

9

2

53 247 (17.04%) (79.42%)

11 (3.53%)

80–89

111

30

69

1 (3.22%)

5 (6.75%)

0

5

1

31 74 (27.93%) (66.67%)

6 (5.4%)

10

6

3

0

0

0

1

0

6 (60%)

3 (30%)

1 (10%)

653

112

495

1

16 (3.1%)

2

24

3

115 (17.6%)

511 (78.25%)

27 (4.13%)

﹥90 Total

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Age

Unsuccessful First Inoculation

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Successful First Inoculation

Age

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In 1984, I made a retrospective random sample of about 653 people in China aged over 65 at the end of the 19th and early 20th century.45 In the results of the survey, smallpox after inoculation and serious sequelae were taken as two “evaluation indicators” for these living elderly people. Two failed and the efficiency was 98%. Around 16 failed among 511 cowpox vaccinations; the efficiency was 97%, p ＞ 0.05. About 24 suffered from smallpox among 27 unvaccinated people, an attack rate of 89%, p ＜ 0.01. So there is great disparity in smallpox resistance between the vaccinated and unvaccinated. However, there is no difference between variolation and vaccination. Although inoculation is so successful, it still has its drawbacks. In fact, variolation doctors themselves do not deny there are examples of failure. They actively look for and find out the causes. Zhang Yan’s New Variolation records this many times: 1. When an emergency occurs during variolation, the doctor can easily lose his head. He must keep his head to find a solution to the problem. “Years ago, I gave variolation to a family surnamed Jiang in Tai County. Three days later, one child’s pox looked just like silkworms. They seemed to be incurable. I went to see him and told Mr. Jiang that the child was in a very dangerous state and a better doctor was needed. Mr. Jiang replied: You are the best variolation doctor in Tai County. If you have no idea, how can anyone else? Even if the child cannot be saved, we will not blame you. On hearing this, I was immediately relieved and became calm and brave. I gave the child several liang of drastic medicine to clear the toxin and activate the blood. The next morning, I went and saw that the smallpox was sharply outlined, the high fever gone and all the pox beginning to be filled. The child unexpectedly recovered.” (Do Not Blame the Doctor) He gives three similar examples. Good skill is important for a doctor, but so is keeping his head. Otherwise, if the doctor is too panicked to think of a method, he can do nothing but wait for the patient to die. 2. Using inauspicious seedlings or epidemic vaccine. It makes variolation dangerous and out of control. “Years ago, one of my friends performed variolation in Jian County… Later he went on to Dongxiang. There many people needed to be vario45

 Ma Boying. History as a Mirror, Reflecting the Vicissitude of Life-Retrospective Survey of Anti-Smallpox Vaccination at the End of Nineteenth Century and Early Twentieth Century. Shanghai Journal of Traditional Chinese Medicine, No. 1, 1991.

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lated, but seedlings were few. As he was greedy for profit, he used vaccine made from the epidemic. When the pox came out, most of them were unfavorable, and dozens of children died… So do not take seedlings from epidemic smallpox — it is asking for trouble.” (Seedling Differentiation) Seedlings taken from epidemic smallpox are as toxic as epidemic smallpox. They will kill children. 3. Seedlings lose their active state and make variolation unsuccessful. “Years ago, one of my friends asked me for seedlings in Tai County. However, he did not perform variolation until thirty to forty days later. All the variolations failed except one. Epidemic smallpox happened to break out there. Smallpox appeared on variolated persons one after another. All were unfavorable. There was a rash of complaints. This is a lesson about using old vaccine.” (Old Seedlings Are Bad so You Have to Use New Ones) 4. Not knowing that the child has been infected with epidemic smallpox and is in the incubation period — but giving him variolation. Natural smallpox brings about unfavorable symptoms due to variolation. “When I lived in Tai County, a Mr. Yan asked me to perform variolations. Without a careful investigation, I went to his house to variolate his children. Then he told me that epidemic smallpox had been in his family for more than twenty days… I regretted variolating his children. However, it was too late. Less than three days later, all the children had a fever. Some children even came with a fever to be variolated. Most of the variolations were unfavorable. I could do nothing but let them blame me. Just like saving a drowning person or a person in flames, not all of them survived.” (Secrets of Variolation) 5. Disrespecting the gods. “Once I performed variolation for a family surnamed Yuan in Jian County. The family did not respect the gods. They even did not sacrifice incense, light lamps or burn paper money. One day, the paper money on the altar burned for no reason. Nothing but the paper money burned. The family was really unlucky later. When performing variolation for the Ding family, someone stole the incense from the altar. When the pox appeared, the child had a fever and said two-hundred paper money were burning in his belly. The child died. These examples all prove that the gods can make their power felt. The examples here warn the people in the world not to disrespect the gods.” (from Be Pious)

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Except for the fifth example, the above cases are all reasons for the doctor to perform the variolation properly. As for being pious, it is enough for gods to take the paper money away from the altar. Why kill the child cruelly? Isn’t this too heartless? One cannot bear to think about it. All failures in variolation can be put down to the eight words, “seedlings not good enough; doctor not skilled enough.” Variolation doctors must master the variously mentioned techniques of variolation. There must be no negligence. Wang Shixiong notes in the margin concerning the unsuccessful variolations in Mr. Wang’s Medical Cases: Variolation is a wonderful method. But we must carefully choose the right time. When pestilence breaks out, people will perhaps suffer from swollen cheeks and sore throats. Is this due to added foetal toxin? It should rather be attributed to the unwise doctor, not the variolation. This saying of Wang Shixiong is pertinent. In modern times Cao Bingzhang (1878–1956) also has a note in his New Pediatrics: There are many skilled variolation doctors in the world. They can make a judgment if the child can withstand the smallpox, before giving variolation. So their variolations are infallible. Some doctors fail because they are partial to riches. They are not unwise, but are eager to make much money. They know variolation is not good for the children, but they leave it to chance, so they fail. These doctors are to blame, or perhaps the rich bring the trouble on themselves. If the child is blessed by fate, a skilled doctor still can save it from even a serious smallpox attack by rectifying its healthy qi. If the life root is taken away, the child cannot survive. How sad! He is right. It is not good but bad for a child if the doctor gives variolation without differentiating the constitution or the rich family does not follow the advice of the doctor and insists on variolation. So it is better “to be given no treatment than to visit a common doctor.” The invention of variolation was a great contribution to Chinese medicine, to the Chinese people and even to people all over the world. It is truly fascinating exploring its medical and cultural significance.

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CHAPTER 15

Science, Technology and Medicine: Ancient Occupational Disease, Its Prevention and Treatment A. The Development of Science and Technology and the Progress Made by Medicine During Ancient Times In terms of their natural philosophy, ancient Chinese medicine and science belonged to the same system. Their development was also basically synchronous. Scientific development and technological progress undoubtedly had a positive influence on and promoted medicine. However, from the point of view of the development of a practical system, progress in medicine seems to have been faster and more accelerated.

124. Time Medicine, Biological Rhythm and the Theory of the Midnight-Midday Ebb and Flow The theory of the Five Circuits and Six Qi, on the one hand, reflects the relationship between ecology, disease and treatment, the so-called “meteorological medicine”, and on the other hand, was also deeply influenced by astronomy, the calendar and the “image and number” system.1 This was an important example during ancient times of an alliance between science and medicine. At the same time, Time Medicine (or chronomedicine) was developing rapidly in traditional Chinese medicine as well. The formation of “time” as a concept, in ancient times, had a direct relationship with the observation and understanding of the alternation of 1

 See Chapter 6. 827

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day and night, the wax and wane of the moon, movement of stars and change in seasons. The History of the Han Dynasty – Five Elements says, “If the Big Dipper’s handle points to the east, it is spring; if the handle points to the south, it is summer; if to the west, it is autumn; if to the north, it is winter.” The Big Dipper’s handle refers to the link between the stars Megrez, Alioth, Mizar and Alkaid, while Megrez, Phecda, Merak and Dubhe make up the “body”. Connect Dubhe and Merak, extend the distance five times and you then come to Polaris. The Big Dipper rotates around the Polaris star. The Xiaxiaozheng says, “As the handle points down, it is New Year’s Day.” A new year begins. Originally a year was divided into 10 months, every month had 36 days and the remaining five or six days were used for sacrifice and special productive activities, so it was called a “10-month Solar Calendar”. The Shang Dynasty used a lunar–solar calendar, which divided a year into 12 months, every month into three xun, every xun having 10 days. There were seven intercalary years in 19 years. Every year had 365.25 days on average. At the same time, the Heavenly Stems and Earthly Branches with their sixty jiazi were used to record time. This astronomical knowledge had been in use during the time of the Huangdi Neijing. For instance, read the following: “Large months and small months have 365 days in all, which make up the year; the surplus time is accumulated in an intercalary month.” The creation of 24 solar terms within the year had already been seen in Lu’s Spring and Autumn Annals. However, its most complete record occurs in the Huainan Zi – Astronomy. The ancient mathematical text Zhou Bi Suan Jing records, “There are eight jie. The Summer Solstice is the hottest time and the Winter Solstice the coldest. The Spring Equinox and Autumn Equinox are a time of harmonious Yin and Yang. The ‘four beginnings’ are the beginning of birth, growth, harvest and storage. Every jie consists of three qi, so there are twenty four jieqi (solar terms) altogether.” The Neijing says in the Suwen – Visceral Manifestations in a Year that “Five days are called a hou; three hou called a qi; six qi called a season; four seasons called a year. The four seasons wane and wax along with the five elements.” It also says, “The beginning of a year is determined at the Winter Solstice, the middle time measured with the guibiao,2 the remainder of time is reckoned, and then a year worked out.” Thus, it can be seen that scientific time measure2

 Guibiao: the ancient Chinese sundial consisting of an elongated dial (gui) and one or two gnomons (biao) used for measuring the length of the year and of its 24 solar terms.

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ment with astronomy and the use of the guibiao had already then been introduced into medicine. According to the Huainan Zi – Astronomy, the guibiao was also used to divide the days and hours. The division into days and hours in the Neijing connected time with susceptibility to disease, in particular death. They both seemed to be most closely linked to the “moment”. For instance, If the pulses in the nine subdivisions are deep, thready, and suspended with a broken Yin pulse standing for winter, the patient will die at midnight; if the pulses are big, agitated, and rapid with a Yang pulse standing for summer, the patient will die at midday. So a patient suffering from alternating cold and heat will die at dawn; a patient suffering from an inner fever will die at midday; a patient suffering from wind disease will die in the evening; a patient suffering from water disease will die in the middle of the night. (Suwen – Three Divisions and Nine Subdivisions) The symptoms of a disease will be different at different times: Most patients feel good in the morning, become stable in the daytime but worse in the evening and worst at night… In the morning, healthy qi begins to wax and pathogenic qi to wane, so patients feel good; at midday, healthy qi flourishes and overtakes pathogenic qi, so patients become stable; in the evening, healthy qi begins to wane and pathogenic qi begins to wax, so patients will be worse; at night, healthy qi is stored up and pathogenic qi controls the body, so patients will be worst then. (Lingshu – The Yang Qi Having Four Phases in a Day) This describes a general case. However, as disease in the five-zang organs differs, its symptoms differ too: Patients suffering from liver disease feel good in the morning, become worse in the late afternoon and stable at midnight; Patients suffering from heart disease feel good at midday, become worse at midnight and stable at dawn; Patients suffering from spleen disease feel good in the afternoon, become worse at sunrise and stable in the late afternoon.

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Patients suffering from lung disease feel good in the late afternoon, become worse at midday and stable at midnight; Patients suffering from kidney disease feel good at midnight, become worse at chen (7–9 am), xu (7–9 pm), chou (1–3 am) and wei (1–3 pm) and stable in the late afternoon. (Suwen – Zang – Organs and Time) The above describes a “time pathology”. “Time physiology” is also touched upon: Yang qi is in charge of the bodily surface in the daytime. In the early morning, Yang qi becomes active; at midday, Yang qi is most exuberant; when the sun is sinking in the west, Yang qi becomes deficient and the pores begin to close. (Suwen – Vital Qi and Nature) Nutrient qi endlessly circulates in the veins and defensive qi endlessly circulates outside the veins. They meet after fifty circulations. Yin and Yang intercommunicate like an endless ring. Defensive qi circulates twenty-five times at night and twenty-five times in the daytime… At midnight, Yin qi is most prosperous; after that, it begins to decline; at dawn, Yin qi declines while Yang qi begins to rise; at midday, Yang qi is most prosperous. When the sun goes down in the west, Yang qi gradually declines. When the sun sets, Yang qi declines while Yin qi begins to rise. At midnight, nutrient and defensive qi meet and people go to bed, which is called the ‘Yin meeting’. At dawn, Yin qi declines while Yang qi begins to rise. Yin qi and Yang qi circulate endlessly, just as Yin and Yang do in the universe. (Lingshu – Meeting of Nutrient Qi and Defensive qi) If this was the earliest crude description of blood circulation (blood and qi circulation) in traditional Chinese medicine, then the concept of “circulation” derived from the cycle of time, the stars, the sun, the moon and other astronomical phenomena. Directly affected by astronomical science and a theory of time, it was much more effective than the idea prevalent in ancient Greece and Rome that blood rises and falls like the Mediterranean tide in the sea, without there being any circulation. Harvey (1578–1657), the famous British doctor and founder of experimental physiology, discovered the circulation of the blood — because he was also influenced by Copernicus’s “theory of celestial bodies” and thought that

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blood might also “cycle”. At the western and the eastern ends of the earth, at an interval of more than 1,800, an ancient Chinese medical scientist and modern British physiologist both discovered the circulation of the blood — both of them inspired by astronomy. Furthermore, human physiology and pathology were considered to be associated with time and phases of the moon. The Lingshu – Astronomical and Meteorological Changes on the Human Body says, There is a correspondence between man and the universe, the sun and moon. Therefore, when the moon is waxing, the water in the western seas is abundant, human blood and qi adequate, the muscles strong, skin tight, hair firm, the striae closed, and dust and dirt easily attach to the surface. At that time, even if one is taken by an evil wind, he will not be attacked deeply. When the moon is waning, the water in the eastern seas is abundant, human blood and qi deficient, defensive qi gone, the body left alone, the muscles wasted, the skin loose, the striae open, the hair withered, and dust and dirt hard to attach to the surface. At that time, if one undergoes an attack by an evil wind, he will be attacked seriously and suddenly. All the above shows an understanding of biological rhythm — and the biological clock. The reality is actually more interesting. China was the first country in the world to invent the mechanical clock. The giant astronomical clock made by Su Song in the Song Dynasty3 had a five-storied wooden pavilion in its lower part called the “Timing Wheel”. There were “timed wooden figures” appearing at different times to measure the twelve periods and hundred partitions during the day. The Armillary Sphere and Celestial Globe in the upper part were precision instruments able to observe the earth, sun and moon and the relationship between the timing and location of astronomical objects. Every mark (or partition) in the 100-mark method was equivalent to 14 minutes and 24 seconds. It was shorter than the mark of 15 minutes in the 96-mark method. Every mark was divided into 10 separate parts, which meant each was a little more than 1 minute and 24 seconds. We cannot know what any earlier clocks looked like. However, the 100mark method was about the same as the “dripping-method” (of the 3

 In 1088–1090, please refer to The Instructions of Celestial Tower (Yixiang Fayao by Su Song (1020–1101)).

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earlier “water clocks”) because it was also recorded in the Neijing in order to explain the circulation of the qi and blood. The Lingshu – Fifty Cycles says, Huangdi said: I want to know how the meridian qi cycles around fifty times in the body in a single day and night. Qibo replied: There are twenty-eight constellations in the universe and the distance between them is thirty-six fen. The meridian qi runs one-thousand-and-eight fen and cycles through the twenty-eight constellations in a single day. Corresponding to the twenty-eight constellations, there are twentyeight meridians distributed in the upper and lower, right and left, front and back of the body. They are sixteen zhang and two chi long in all. Day and night is divided by the dripping-marks made by the water in the water-clock. One breathes out once, the pulse beats twice and the meridian qi moves on three cun; one breathes in once, the pulse beats twice and the meridian qi moves on three cun again. So one breathes in and out once, and the meridian qi runs on six cun. One breathes ten times, the meridian qi runs on six chi and the sun runs on two fen. One breathes two-hundred and seventy times, the qi runs on sixteen zhang and two chi in the meridian, circulates about once in the body, the water drips on two marks and the sun runs on twenty-five fen. One breathes five-hundred and forty times, the meridian qi circulates about twice, the water drips on four marks and the sun runs on forty fen. One breathes two-thousand and seven-hundred times, the qi runs through the body ten times, the water drips on twenty marks, the sun runs through five constellations and twenty fen. One breathes thirteen-thousand and five-hundred times, the meridian qi circulates fifty times around the body, the water drips on one-hundred marks, the sun runs through twenty-eight constellations, all the water drips away, and the meridian qi also finishes fifty circulations of the body. The term ‘corresponding’ above refers to the number of constellations corresponding to that of the meridians. Therefore, if one’s meridian qi can keep circulating fifty times, eighthundred and ten zhang, in a single day and night, one will live out one’s natural lifespan. Matching the twenty constellations, time was measured by the “hundred-mark dripping”. There must have been an astronomical clock existing during the era of Neijing, similar to that made by Su Song, for it to

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have been cited in medicine. According to the quotation above, human blood and qi only circulate fifty times a day, but modern medicine measures one circulation as generally taking only 10 to 20 seconds. So “fifty-times” must have come from the measurement and calculation of the length of the meridians instead of the actual study of human physiology. Each Hand Yang meridian is five chi from hand to head, the six Hand Yang meridians three zhang in all. Every Hand Yin meridian is three chi and five cun from hand to chest. Six times three chi is equal to one zhang and eight chi, six times five cun is equal to three chi, so the six Hand Yin meridians make up two zhang and one chi altogether. Every Foot Yang meridian is eight chi from foot to head, the six Foot Yang meridians are four zhang and eight chi in all. Every Foot Yin meridian is six chi and five cun from foot to chest. Six times six chi is equal to three zhang six chi; six times five cun is equal to three chi, so the three Foot Yin meridians make up three zhang and nine chi altogether. Every heel meridian is seven chi and five cun from foot to eye. Two times seven chi is equal to one zhang and four chi, two times five cun is equal to one chi, so the two heel meridians are one zhang and five chi altogether. Both Governor and Conception meridian are four chi and five cun. Two times four chi is equal to eight chi, two times five cun is equal to one chi, so Governor and Conception meridian make up nine chi altogether. Altogether these meridians make up sixteen zhang and two chi. These are the larger meridians for the qi to run through. (Lingshu – Meridian Length) Fifty times 16 zhang two chi is equal to 810 zhang. The 28 meridians correspond to the 28 constellations, which shows also the influence of astronomy. The circulation of the blood and qi in the body forms the physiological basis of acupuncture and moxibustion. The Lingshu – Defensive qi Circulation chapter shows them as materialized on the body surface: So the defensive qi circulates fifty times in a single day and night, twenty-five times in the Yang phase during the daytime and twentyfive times in the Yin phase at night. At night, it cycles amongst the five zang-organs. So, at dawn, when night is over, the defensive qi comes out of the eyes. As the eyes open, the defensive qi goes back

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up to the head, along the neck and down to the foot-greater-Yang meridian, then along down the back to the end of the little toe. One of its branches comes out at the outer canthus, along with the handgreater-Yang meridian down to the lateral point of the little finger. One of its branches also comes out at the outer canthus, along the foot-lesser-Yang meridian down to between the little toe and fourth toe. One of its branches goes down along the hand-lesser-Yang meridian down to space by the little finger. One of its branches goes up to the preauricula space, pours into the foot-Yang-bright meridian with the meridian at the chin, then goes down to the dorsum of the foot and into the toes. One of its branches comes out from the subauricula space, and goes along the hand-Yang-bright meridian to the thumb, then into the palm. The defensive qi goes to the foot, enters into the centre of the sole, comes out of the malleolus medialis and runs into its Yin phase, then going up to eye. This is one circulation of the defensive qi in the Yang phase during the daytime. This is how the qi runs in the meridians. The key to acupuncture is “attaining the qi”. “Qi comes, then needling works.” Acupuncture must be done along with qi. The text continues as follows: If one can needle at the proper time, disease will soon be cured. Otherwise, one loses the opportunity and breaks the law of the qi, and disease is hard to cure. So it is said ‘excess syndromes should be needled to drain, when the qi comes’ and ‘deficiency syndromes should be needled to supplement, as the qi leaves’. That is to say, one should observe the patient’s qi before you give the patient needling. So acupuncture based on a careful observation of the qi is called ‘gaining the right time’. If a patient is ill in the three Yang meridians, he should be needled when the qi is in a Yang phase; if a patient is ill in the three Yin meridians, he should be needled when the qi is in a Yin phase. When the water in the water clock goes down a mark, the defensive qi is in the greater Yang meridians; when the water goes down two marks, the defensive qi is in the lesser Yang meridians; when water goes down three marks, the defensive qi is in the Yang bright meridians; when the water goes down four marks, the defensive qi is in a Yin phase; when the water goes down five marks, the defensive qi is in the greater Yang meridians; when the water goes down six marks, the defensive qi is in the

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lesser Yang meridians; when the water goes down seven marks, the defensive qi is in the Yang bright meridians; when the water goes down eight marks, the defensive qi is in a Yin phase… when the water goes down twenty-five marks, the defensive qi is in the greater Yang meridians again. This is the law of motion for the defensive qi during half a day. The sun runs through fourteen constellations in all from the Fang constellation to the Bi constellation in half a day and the water goes down fifty marks. As the sun goes through one constellation the water will go down three and foursevenths marks. The Great Gist says: when the sun comes to a constellation and the defensive qi happens to be in the greater Yang meridians, as the sun goes through the constellation zone, the defensive qi will go through the greater Yang, lesser Yang meridian, Yang bright meridians and Yin phase. The defensive qi circulates on endlessly just as do heaven and earth. In a single day and night, the water has dripped down one-hundred marks and the defensive qi finished fifty circulations of the body. This “daily rhythm” of the defensive qi running in the meridians corresponds to the 28 constellations. There is another understanding about this temporal rhythm in Mr. Chu’s Posthumous Works: The qi of the universe circulates about once a year while the human qi circulates about once a day. At midnight, the Yang qi begins from the left foot, goes up along the left leg, left finger, left shoulder, left brain, cross over to the right brain, along the right shoulder, right arm, right fingers, right side of the ribs and gets over to the right foot by midnight. At midday, the Yin qi begins from the right palm, up along the right arm, across the left shoulder, along the left arm, left side of the ribs, left foot, testicle, left foot and gets over to the left side of the ribs by midday. The Yang qi moves around the body; but the Yin qi goes neither up to the brain nor right down to the toes. The Yin qi and Yang qi circulate around the body endlessly day and night. These theories of temporal rhythm were the beginning of “midnightmidday ebb and flow” theory,4 which hoped that the best curative effect could be attained through accurate needling based on a relative determi4

 See Chapter 8.

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nation of the time and location of the meridian qi. The ebb and flow of the nutrient qi is the branch of the midnight-midday ebb and flow; the ebb and flow of the defensive qi is the stem of the midnight-midday ebb and flow. In addition to “midnight-midday ebb and flow” theory, there were also the eight methods of the “intelligent turtle” and the “eight flight” method. This theoretical system was established quite some time later. The Needling of the Midnight-Midday Ebb and Flow written by He Ruoyu in the Jin Dynasty was the earliest to refer to it. The MidnightMidday Ebb and Flow and Needling Guide written by Dou Hanqing and the book Complete Acupuncture by Xu Feng of the Ming Dynasty already show it in its maturity. The volume The Essence in Needling by Gao Wu and the Compendium of Acupuncture and Moxibustion by Yang Jizhou epitomized the thought of this school. The idea of there being a “midnight-midday ebb and flow” not only has special application in medicine (acupuncture) but also supports the idea of there being a magical power in using pressure points and in the martial arts. The general principle of biological rhythm has been confirmed by modern science in recent years and is already used in the clinic. Some medicines, such as hormonal preparations, antihypertensive agents, etc. also have an evident time gradient. However, the theory of “midnight-midday ebb and flow” needs to be explored further. Furthermore, there are yearly rhythms, seasonal rhythms and rhythms of disease. They are all part of chronomedicine. We cannot discuss each of them individually here.

125. Simple Systems Theory and Experimental Thought in Traditional Chinese Medicine Systems theory is a very popular scientific theory in modern times. Its plain prototype could be found in ancient China. It was also the skeletal framework of traditional Chinese medicine. Modern General Systems Theory was one of the basic features of science and technology in the second half of the 20th Century. Aiming to make a comprehensive and overall description of the object, it was first put forward by the famous theoretical biologist Von Bertalanffy Ludwig (Von Bertalanffy Ludwig, 1901–1972).5 The main principles of systems theory are wholeness (“the whole is greater than the sum of its parts”), purposiveness (“informa5

 Bertalanffy’s representative work is General System Theory: Foundation, Development, Application, New York, 1968; London, 1971.

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tion determines the behaviour and material of the system and works for the information carrier”), comprehensiveness (“a uniform orderliness”), correlation (“the interactional nonlinear causal principle”) and diachronism (“dynamics”). These can be determined quantitatively by mathematical statistics. Ancient Chinese science might never use the idea of “systems theory”, but these principles more or less guided the formation of its early scientific systems and became its methodological basis (in addition to mathematical statistics and quantitative determinism). Perhaps this happened because the early theoretical systems of ancient Chinese science aimed at observing and exploring the natural laws of big systems: for example, astronomy, geography, phenology, agriculture, etc. The motion of the sun, moon and stars, climatic change within the four seasons, generalization of geographical characteristics in the five directions, grain planting, livestock breeding, social, political and dynastic alternation, all were regarded as an orderly whole. They were layer upon layers, both opposite and complementary to each other… all embodying the methodology of simple systems theory, shown as a crystallizing theory of Yin–Yang, the five elements, etc. But their methodological principle was simple systems theory. In a somewhat similar fashion, the whole of traditional Chinese medicine was formed according to this principle. As a result, holism became especially prominent in Chinese medicine. First, there was the correspondence between man and the universe; heaven, earth and man make up a whole. Second, organs, meridians, blood, qi, etc. make up an integrated human system. Third, the relationship between illness (evil qi) and health (healthy qi), the synthesis of the four diagnostic methods in diagnosis, the principle-method-recipe-medicine method and considering root and symptom in treatment, and even the fact that each prescription includes monarch, minister, assistant and guide, each and every one, play a role as if in a small system, and so on and so forth. Traditional Chinese medicine is vastly different from western medicine, which takes atomism (reductionism) as its basic scientific principle and adopts the ideas of decomposition and analysis. No wonder the Nobel Prize winner Ilya Prigogine in Sweden, another outstanding leader in systems theory, said after visiting China in 1979, “Traditional Chinese academic thought emphasized integrity and spontaneity, studied coordination and harmony. The development of modern science… is more in line with Chinese philosophy.” “A good combination between Western science and Chinese culture would lead to a new natural philosophy and view of nature.”6 6

 Nature, vol. 3, 1980, p. 11.

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Inspection or testing by experience was also included in this simple ancient Chinese system in order to evaluate the system. This also provided for the general development of a natural science. It was recorded in the Xunzi, Han Fei-tzu and Lu’s Spring and Autumn Annals. For example, Lu’s Spring and Autumn Annals says, “If one is good at natural laws, he must confirm it in human affairs and in the world.” This was the method used to test and form theories in the Neijing: Huangdi asked: ‘I heard that if one is good at talking about natural laws, one can confirm it in everyday human affairs; that if one is good at talking about history, one can handle oneself in the present; that if one is good at talking about others, one can delve into himself. In this way, he can grasp the rules of things and not get confused, understand their points and remain sensible.’ Now I would like to consult with you about inquiry, visual examination, pulse taking and palpation to make me experienced, enlightened and remove any doubts. Could you help me? (Suwen – Pain) Qibo replied: … give the patient a comprehensive observation and test by palpation, and then a visual examination will be as accurate as an object seen in clear water or in a mirror… just like the correspondence between a drum and the drumsticks, a beat and its sound, a shadow and its object. Therefore, visceral changes will be inferred from observing external sounds and the complexion from a distance; external manifestations can be inferred from closely observing visceral changes. This is the highest stage in mastering the changes of Yin and Yang, including all the changes between Heaven and earth. Please treasure it in the most precious Orchid Chamber. Don’t let it be lost. (Lingshu – External Inference) This method of external inference, or “testing symptoms”, is today also known as the “black-box” method and is one of basic compositions of cybernetics. Because of its use of this method, TCM needs only a rough understanding of anatomy and not a good mastery of fine structure; its physiological systems theory aims to explore the unity of concepts according to their external function and thus discuss the relationships among them. The diagnosis of disease depends entirely on information gathered from the four methods of diagnosis which allow one to explore the balance or deviation between the internal Yin and Yang, and the degree and nature of this deviation; almost all treatments are tentative. After taking a few doses or making a needling treatment, some readjustment is made to enable it to fit better.

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Of course, this “testing” or arbitrary black-box “experiment” was imprecise, rough and made up out of the doctor’s own subjective approach. The methodology of simple systems theory also has the same defect. Take the medical case of Luo Qianfu (one of Li Dongyuan’s students) as an example: Luo Qianfu treated a visitor, Zhao, from Zhending City. In June, he was attacked by damp as he was tired. He felt full in the epigastrium, sometimes hot and had a restless sleep. He stayed in the temple and a monk gave him a dozen pill to treat serious ‘toxic heat’. After having defecated a dozen times, he felt less full but sleepier the next day. Because of possibly being robbed of his money, he was frightened and worried. He was hot and thirsty and so drank a large cup of water. Again that night, he had abdominal distention and pain. The monk gave him the same pills. After defecating a dozen times, the invalid became sicker: limp, agitated and hot, he had indigestion, his feces like cold water mixed with blood, smelling of rotten fish-guts, he had no appetite, and if forcibly fed, threw up at once, had more serious abdominal distention, keep belching, cold feet, and unbearable pain in the lower abdomen. Mr. Luo felt his pulse: floating, extremely rapid, and empty as it was pressed. Mr. Luo said: ‘I have inquired into the cause of the disease and decided as follows: Summer-heat and damp have injured the healthy qi, the first time he defecated all the bad material without any remaining; the remaining qi of the croton (the drug) then ran between bowels and stomach, so he vomited and could not eat anything, so the stomach qi was injured too. Immoderate discharge of pus and blood wasted the muscles, made the hair lusterless and the spleen qi weak. A red bitter-tasting tongue, dry mouth and throat and deficient fluid are due to too much purgation leading to Yin collapse. The collapse of the Yin leads to excessive heart-fire, so you feel agitated and restless. The Neijing says: if the solitary Yang fails to generate, the solitary Yin fails to grow and the man will die.’ Then he left. Another doctor did not explore the cause of his trouble but gave him Fructus Aurantii as soon as he saw the abdominal distention and fullness. The patient panted more, felt fuller in the abdomen and could not stop his diarrhea and died. The Golden Chamber say: ‘Improper purgation will make the bowels loose, thus the diarrhea cannot be stopped and patient dies’. That is what happened. (Classified Medical Records of Famous Physicians)

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Three physicians examined him. Two of them gave him treatment, but Luo Qianfu did not. The object was the same, the conclusion was different, and the patient finally died of mistreatment. The black-box method relates to an observer’s knowledge on the one hand and his experience on the other, which greatly increases the uncertainty because there is no objective criterion. In this case, the patient was probably suffering from something like bacillary dysentery and died of dehydration and toxicosis. So then we can see that empirical attempts and their verification have always been the basis of TCM. On the whole, it has promoted the progress of traditional Chinese Medicine, but many patients inevitably made a big sacrifice in its course. Shennong started it by tasting many varieties of herbs. There are many prescriptions with the word “try” written in the Prescriptions for Fifty-Two Diseases. For instance, “an easy and painless method to treat a patient bitten by a dog: Let the bitten person lie down, clean the wound many times with wine. As the wound is anesthetized, cut the wound to eliminate the toxin. Try it. Do nothing forbidden.” The prescriptions listed later and the doctor’s note are records of his experiences and testing. As Tao Hongjing said in his preface to Supplement of Prescriptions for Emergencies, These prescriptions contain all the key points. Some are records of famous physicians; some have been passed down for generations; some are widely said to be effective; some from personal experience… “Widely said to be effective” and “personal experience” are both blackbox tests. The more mature a text, the more reliable it is. Thanks to empirical testing, TCM is strong and vital and its practical side well developed. The other side of experimentation or testing is this testing of poisons. Testing on an animal or servant is recorded in the Spring and Autumn – Zuo’s Annals. “When the Duke Xian of Jin came back, Li Ji put poison into the wine and meat and presented them to the duke. The duke sprinkled the wine on the earth as a sacrifice; he gave the meat to a dog to eat and the dog died; he gave it to a servant to eat and the servant died too.” Methods to test toxicity are also recorded in A General Treatise on the Cause and Symptoms of Diseases. “To judge whether one is poisoned or not, first clean a piece of processed silver with ash, then clean the mouth and teeth with a twig of big-catkin willow. Keep the silver in your mouth for a night and spit it out the next morning. If the silver is black, you are poisoned with buqiang medi-

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cine; if the silver is blue-black, you are poisoned with blue medicine; if the silver is purple-spotted, you are poisoned with pyrophosphate copper medicine.” “Boil a hen’s egg, peel its shell, tell the patient to bite into the white of it until moisture appears. If the tooth-marks are black, the patient is poisoned.” Arcane Essentials from the Imperial Library records how to test insect poison: “Keep a silver hairpin or something like a chopstick next to it one night, if the silver hairpin turns black, it is toxic; else, it is non-toxic.” Whether it was an animal experiment or a silver hairpin or an egg test, this was obviously experimental thinking. The latter especially must have had its background in chemical experiments, which might be related to the development of alchemy. Unfortunately, these experiments were not precisely designed, and the actual chemical reactions unknown, so their reliability is still in doubt. Furthermore, these undeveloped, inaccurate methods were only used to test toxicity. All these made it difficult to use them in a broader field, such as testing drugs.

126.  The Identification, Processing and Refining of Medicines As to gathering genuine regional herbs, people identified not only the place of production and the season to collect them but also authenticity and quality. The development of the identification of Chinese medicines relates to the development of related sciences, such as biology, physics, chemistry, etc. Mr. Wu Jialin has illustrated this with many examples.7 Wu Pu’s Materia Medica records stalactite medicine as “an accumulated slippery liquid, milky white-yellow, hollow throughout,” which are the identifying traits of stalactites; sulfur “burns and gives out purple flame” is the identifying flame of sulfur; Cocculus Root outside is “as yellow as Platycodon Root”, while inside it is “as black as a carriage spoke”. This is the identifying feature of Cocculus Root’s cross-section; “good Saposhnikovia Root is as white as enamel” is the identifying quality of Saposhnikovia Root. Tao Hongjing had rich experience in identifying medicines. He said in his Annotated Shen Nong’s Herbal that “Doctors do not know medicines, so they have to follow druggists; druggists can’t identify them, but entrust this to gatherers and those who process them. These people fake medicines and make them hard to identify. So stalactites are cooked with vinegar to turn them white; Manchurian Wild-ginger is soaked in water to straighten it; Milkvetch Root 7

 Wu Jialin. The Evolution of Chinese Medicine Identification. Chinese Journal of Medical History, No. 3, 1985.

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is steamed with honey to make it sweet; Chinese Angelia is embellished with wine; centipede’s feet are made red; the egg capsules of the mantis are stuck onto mulberry leaves, Cnidium Monnieri is disguised as Ligusticum Wallichii, while the root of the Apricot-leaf Ladybell is disguised as Ginseng.” This text shows not only “the cunning skill” of the counterfeiter but also the “greater skill” of the anti-counterfeiter. It embodies the progress of science and technology at the time, as well. But Mr. Tao’s identification goes one step further than Wu Pu’s Materia Medica. For instance, stalactite is good if it is “lustrous, hollow throughout and as flimsy as a goose quill, and if broken and you take up a piece the size of a finger nail, within it, it has something shaped like a goose’s tooth.” Also, the “fossil of large mammals is genuine if someone licks it and it attaches to the tongue” — this is the “attaching identification” of the fossils of large mammals; nitre or saltpeter is good if it is “burnt with strong fire and gives out purple smoke.” This is the flame identification of saltpeter; a bezoar is true if it “is rubbed by the nail and the yellow does not fade even when licked”; amber is true if it “is rubbed with the palm and then it can pick up mustard seeds.” This demonstrates the electrostatic attraction of rubbed amber. Lei’s Treatise on Processing Drugs says, “Amber likes blood. If amber is genuine it can pick up mustard seeds after being rubbed with a piece of cloth,” “the best Eaglewood timber sinks in water; the better type half sinks in water” and so on. These methods of medical identification all came from observing and understanding physical phenomena. Chinese medicines often need to be processed to strengthen their therapeutic effects, reduce their poisonous side and change their medical properties and user-friendliness. Processing is actually a pharmaceutical process following the principles of physics and chemistry. Though not as advanced as alkaloid extraction or the changes made in chemical structures today, it has advantages that extraction and change of structure don’t possess. The appearance of a book on processing technology was thanks to Lei Xiao, also known as Lei Gong, during the Liu Song Dynasty (420–497). Lei’s Treatise on Processing Drugs was not only a summary of his own medical experience but also the result of the development and permeation of technology into alchemy and chemistry since the Wei and Jin Dynasties. It is clear that it has a background in alchemical chemistry for it had already been reorganized by the Taoist Hu Qia during the Liu Song Dynasty — who also referred to the work Processing Medicines by Mr. Qian Ning (Yan Feng) in his task.

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This book made considerable efforts to reduce toxicity, enhance absorption and the storage of medicines as seen from the following examples: When processing Croton Fruit, break it up, and cook it with sesame oil, wine, etc. to make it into a paste for later use. Aconite Main Root should be processed by being stir-fried over both a mild and strong fire, then cut apart. Monkshood Daughter Root must have a flat base with nine iron-black corners. Take one liang that is complete. Process it with willow charcoal, not the wood of any other tree, stir-fried it, scrape the Daughter Root, get rid of its lower end, bury it in the soil, then take it out and dry it in the sun. If processed by the Yin method, peel it, get rid of both ends, slice it thin, mix it with black beans and soak it all in ‘east-flowing water for five days and nights, then dry it in the sun. Both Croton Fruit and Aconite Main Root are extremely toxic. They cannot be used unless they have been processed. The above are some basic methods which apparently can remove certain toxins. Processing medicines can roughly be divided into four categories of 17 methods as follows: burying in ashes, roasting, roasting until it cracks, roasting until it turns yellow, simmering, stir-frying, refining, processing, measuring, grinding with water, processing in fire, flaking, pounding, drying in mild sun, drying in hot sun and exposing in the open. These may also be classified into processing, water processing, fire processing, and fire and water processing. They are quite complex and varied, but generally used in combination. Take cinnabar as an example. When processing cinnabar, one should firstly burn incense, fast and take a bath in a clean room, then take some cinnabar and wash it in sweet-smelling water, dry it and break it up. After that, grind it up in a mortar for three days and nights. Take a pot, put the cinnabar between two layers of chopped Liquorice Root, Begonia Fimbristipula Hance and Purslane Herb. Add eastern-flowing water and simmer it for three days and nights. The water should not be all boiled away. When three portions have been boiled off, add half a liang of Ganoderma Lucidum Karst and Shanxu Grass, cover it, then heat it with ten jin of firewood from before midday to midnight. When cold, grind it into fine powder. Make it into a pill with honey the size

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of a pockmark on the skin, take one pill at a time, on an empty stomach. If used as a medicine, do as follows. Heat and refine it with natural charcoal fire. Five liang of cinnabar needs two liang of Liquorice Root, one yi of Begonia fimbristipula Hance and one yi of the juice of Purslane Herb. They are cooked with east-flowing water. The tools used for processing also developed along with the progress of science and technology. Teeth were the earliest tool used to crush medicines. The researcher Ding Yunkuang tested “a small stone mill unearthed from Liu Sheng’s tomb in the Han Dynasty, whose lower part was equipped with a copper funnel-shaped device. It had been placed next to some golden needles, a decocting device, a medical copper basin, etc. Undoubtedly, these were used for processing medicines.”8 Metal ore is shown being crushed by a machine in illustrations from the book Heavenly Creations. A small amount of medicine was ground by an iron crusher. Cutting was done with a sharp knife, guillotine, etc. In the course of the processing, wine, vinegar, milk, certain grasses, saline water, ginger juice, honey or even the urine of boys under twelve was often added. Some special chemical process or chemical reaction must have been happening. Stir-frying until brown, stir-frying until yellow or stir-frying until scorched preserved different drug properties and might have changed the component structure too. Catalytic agents and catalysis might have been put into use. There were various forms of dosage, such as pills, powders, pastes, pellets, wine preparations, distillations, lozenges, medicinal cakes, medicated tea, medicated rolls, medicated threads, crude medicines, defecation-promoting medicines, etc. The subtle chemical changes and technology in the most-used decoctions and potions were often affected by non-medical technology, some of these technologies even coming from the Arabs. Among medical processing, the preparation of the mineral known as “Autumn Stone” is the most remarkable. Its complicated process of refinement and desired special chemical reactions had a direct relation to alchemy. Shen Kuo records them in The Good Prescriptions of Mr. Su and Mr. Shen: Prescription for Autumn Stone: There is only the fire method used for processing Autumn Stone now. But it is best to process this medicine with both Yin and Yang methods. Here are the two methods. Autumn Stone processed with fire is a Yin within the Yang method, so it will 8

 Ding Yunkuang. Application and Development of Medicine-Grinding Tool in Ancient China. Chinese Journal of Medical History, No. 3, 1984.

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solidify when meeting the fire and disappear when meeting the water. The material is gone but the taste left. It is the void in the ‘trigram Li’. The Autumn Stone processed with water is a Yang within the Yin method, so it will solidify when meeting the water. It will even keep constant for a thousand years in a rainstorm. The taste is gone but the material is left. It is the fullness in the ‘trigram Kan’. They both come from the heart and kidney and flow into the small intestine. The healthy qi of the Winged Snake and the Yuan Wu are solidifies through virtue of the fire and water of heaven and earth. Then they return to tonify the Taiyang and ministerial fire. They are the root of all life. The specific methods are as follows: Yin method: Three or five shi of urine. Though urine easily goes bad in summer, it still can be used. Put the urine in a large basin, add more than half of fresh water, stir it hundreds of times and leave it to clear. Remove the clear fluid and retain the turbid. Add fresh water and stir it again. It is good to add more water. Remove the clear again, until there is no odor left and the remaining turbid substance is like powder. Dry it in the sun, scrape it off. It is alright if it is bright white and odorless. Then add breast-milk to make it into a paste, and dry it in the hot sun. Repeat this process nine times. Milk should be added on a sunny day to borrow the genuine qi of the sun. After doing this nine times, make it into a pill as big as a Firmianae seed, and dry it in the scorching sun. Take thirty pills with warm wine every time. Yang method: Regardless of how much urine you have, about two barrels make up a load. Squeeze out the thick juice of the Gleditsia fruit, and with clear water, remove the dregs with a piece of cloth. To one load of urine is added a small cup of Gleditsia juice. Stir it rapidly with a bamboo comb thousands of times, until the urine becomes clear and the turbid white liquid sinks to the bottom. Remove the clear and retain the turbid, making up a full barrel. Stir it around a hundred more times with the bamboo comb. Wait until it becomes clear and remove the clear liquid again. Only one or two hu of thick sediment will be made from dozens of loads of urine. The urine must first be filtered with a piece of cloth to remove dregs. Put the thick sediment in a clean wok to boil the water away. Scrape the sediment off and pound it up. Put it into the wok again. Boil it up

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with clear water, then put it in a shaukei to filter and then boil dry again. Add water to boil and follow the former method to filter it off again. If it is not white when boiled dry, filter it again until it becomes as white as snow. Put it in a sealed sand box, cover it over. Heat and refine it until it turns liquid with an intermittent fire. Pour it out. If it does not form a shape, heat it again one or two degrees, until it becomes brilliant white. Grind it, put it in a sand box and seal it. Warm it with the end flame of four liang of firewood for seven days and nights (long warming by fire is especially good). Grind it again. Take two qian each time with warm wine, on an empty stomach. Or a pill as big as a Firmianae seed with date pulp, thirty pills each time on an empty stomach. Autumn Stone made by the Yang method is taken at midday; the one made by the Yin method is taken at midnight. There was a Taoist in Guangnan County, who lived by making Autumn Stone and called it Vigor-Returning Dan. My late father always suffered from a wasting disease and coughed for nine years or more. Nothing cured him but this medicine. Langshi Lang Jian went to Nanhai to learn how to fashion it. His wife had been ill a long time. One night, she dreamt of an immortal, who told her: Dianzhong Shen, accompanied by a Taoist will come, who can make a Dan to cure you. You will beg him for this medicine. Then the immortal flung down dozens of Dan and said that they were the Dan of the Taoist. At dawn, more than ten Dan were found on the mat, just the same as the medicine in the dream. When my father went to Panyu, Mr. Lang asked him about the Dan. My father showed one to him, and it was exactly as in the dream. His wife took it and very soon recovered. A child in my clan suffered from vertigo and abdominal distention. He panted more and more and his belly became more and more swollen over three years. He was also cured by this medicine. These Dan were made by the fire method alone. As I was defending Xuan City, I had a serious disease for several years. My son hurried to write to me and persuade me to take this Dan. He said that it really could bring invalids back to life. Then I began to make it. It happened that one Taoist taught me the Yin method. This medicine made by either of these two methods can activate human bone-marrow and cure any disease. The priest kept it secret and promised to teach me after a long time. I followed the method and it really did work. It not only cures disease, but also can be taken for a long time with no toxicity — only good results. I attained it with great difficulty. But it should be used to save a life instead of being

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kept secret. Everyone can make Autumn Stone by the fire method. Take a big stove and a big ding cauldron, and decoct it over several days. The odor will be smelt over the whole neighborhood. The method is very labor-saving. What it needs is only a small pot. It can be as lustrous as gold stone. Other methods are incomparable. Even people with a long-standing illness will recover after several times taking this medicine. I got this wonderful medicine just by chance. Thus, the technology of Autumn Stone had a close relationship with alchemy. However, Autumn Stone is mainly used for medical treatment, especially treating chronic wasting, cough, vertigo, dyspneal fullness, abdominal distension, etc. It “can be taken often, with no toxicity but only good results.” Later, it was used as an elixir. The History of the Ming Dynasty – Biography of Gu Kexue says, Emperor Shizong longed greatly to be immortal and the whole country was under the control of Yan Song. Yan Song and Gu Kexue became jinshi in the same year. The Emperor bribed Yan Song with a lot of money and he claimed to be able to make Autumn Stone with the urine of young boys and girls. It could prolong life. Some people think it also could be used as an aphrodisiac. However, there is no record of this in the ancient books. Shen Kuo, alias Cunzhong (1031–1095), came from Hangzhou City in Zhejiang Province. Dr. Joseph Needham praised him for making a great contribution to the development of ancient Chinese science and technology. Dr. Joseph Needham and Dr. Lu Guizhen thought Autumn Stone was the earliest synthetic sex hormone, and this has been agreed by professors of biochemistry in America and Britain such as R. Short, H. Dixon, H.G. Williams-Ashman and A.H. Reddi. They speculated that the steroidal ring structure in the molecule very likely becomes the synthetic foundation of a steroid hormone after Chinese Honey Locust is added. They hailed this as “opening an exciting new chapter in the history of endocrinology… hundreds of years ago, the Chinese outlined an achievement which was made by outstanding steroidal chemists in the 1930s and 1940s,” believing it to be “an outstanding new chapter in the history of medicine”.9 In 1988, both Professor Zhang Binglun of the Chinese University of Science and Technology and Dr. Huang Xingzong in America presided over a simulation experiment to prove that Autumn Stone can crystallize sex hormones using these tradi9

 Ruan Fangfu. The Discovery of Sex Hormone, Science Press, 1983, p. 130.

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tional methods. However, they both failed. Professor Liu Guangding in Taiwan had earlier denied that it was possibly from his theoretical deductions. I had a special discussion about this with Dr. Lu Guizhen. She believed that there was probably something wrong in experiment, for example, the experimental conditions, method, etc. Any slip in a link in the process might have led to its failure. Furthermore, the methods mentioned in the ancient books have not yet all been tried. So it is premature to make any negative conclusions. She insisted that Autumn Stone was the earliest artificial sex hormone in the world. Professor Meng Naichang of Taiyuan Industrial University in Shanxi also made a special study of the “Autumn Stone”. He said, “Through research, its physical and chemical nature has been revealed after the obscure language and mysterious Taoist terms have been removed. This results in a simple, concise and vivid description of the physiological and pharmacological effect of Autumn Stone. Analysis helps us to understand how Taoism developed and ran alongside generalized chemical and medical practice.”10

127. Other Effects of Scientific and Technological Progress on Medicine The progress of science and technology had a ubiquitous influence on medicine and sanitation, and this has been proven by acupuncture moving from using stone needles to bamboo needles to the bronze “nine needles”, the gold needle and the silver needle (golden needles were found in the tomb of Liu Sheng in the West Han Dynasty), also by the bronze figure and other medical and sanitary devices and products, such as smoking cages, the saliva kettle, the medicine-storing bottle, mosquito-repellent incense, etc. It is an undisputable fact that the invention of papermaking and printing greatly promoted the spread of medical education and medical books. For instance, the iron-attracting behaviour of magnetite was used to attract iron foreign objects in the windpipe, esophagus or ear canal. Invaluable PrescriptionsPrescriptions for Children records, Prescription for children swallowing a needle by mistake: Swallow a piece of magnetite as big as a jujube date-kernel in the mouth, and the needle will be attracted out at once. 10

 Meng Naichang. Shen Kuo’s and Li Shizhen’s Theory about Autumn Stone. Chinese Journal of Medical History, No. 3, 1987.

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Some medical skills also related to people’s daily manual techniques. The text Medicine Theory quotes from Some Famous Physicians’ Medical Records: Skilled craftsman can even take a hook from a person’s throat. During the Xianping period, a Mr. Wei had several young children in Tanzhou. They were playing with a fishing rod… one imitated a fish and swallowed the hook by mistake. He drew it out in a hurry, but it was hooked in and could not be drawn out. All doctors were at a loss what to do… at that time, there was a very clever man called Mo Duliao in that county. He was strongly recommended to Mr. Wei… Mo Duliao had even build a monument in the water, adding concave-shaped upward facing titles, one on the other to make a tiered pagoda… so then he called on Mo Duliao. Mo Duliao thought for a long time and asked for a silk cocoon and a string of large beads. Mr. Wei gave them to him. Mo Duliao cut the cocoon into a shape as big as a copper cash or coin, he softened it and lubricated it well with oil and cut a small hole in the middle. Then he first put a piece of the line through the hole, and then strung on a few beads, ordered the child to sit up straight and open her mouth, adding the beads one by one, and guiding the cocoon on the line down into the throat. When he felt it at the hook, he pushed it down hard, the hook was taken off and pulled out. It was wrapped in the cocoon and did not cause any damage. Mr. Wei was so delighted that he rewarded Mo Duliao with a lot of money. Mr. Wei said: If someone is bright in heart, he must be ingenious in mind; if someone is ingenious in mind, he must be good at medicine. This capable craftsman practiced medicine with a skill almost comparable to the removal of a foreign body in modern hospitals. Volume 13 of Shen Kuo’s Dream Pool Essays records, People used something like bamboo, wood, tooth, or bone to make whistle, which could be put in the throat to imitate the human voice and called it a ‘throat whistle’. There was a dumb person. He was prosecuted for some crime but could not make redress for himself because he could not speak. The judge put a whistle in his throat so he could make a voice like a puppet. Thus the judge had a rough idea of what he was saying said and he escaped conviction. This is well worth recording.

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This “throat whistle” can almost be regarded as the first ever artificial larynx in the world, successfully applied to a “dumb person” (or mute). There are many similar examples. Liu Fang drew diagrams of an infant’s fingerprints in A New Pediatric Book and Shi Fa included drawn pulse graphs within A Guide to the Diagnosis of Disease to explain his medical theories about fingerprints and pulse. Though they were completely different from any measurements made so far by modern equipment, this is also believed to be the outcome of the influence of technological thought on physicians. The “Tianlu” and “Tiger Frog”, the “Turning Cart” and “Kewu” in the Eastern Han Dynasty were even more valuable. Our country has had a very fine sewerage system since the pre-Qin period. Ventilation, lighting, keeping warm and other health factors were also considered in the construction of a house. But water drawn by machine for sprinkling on the road or drinking (similar to tap water) was not seen till somewhat later. The History of the Later Han Dynasty – Biography of Zhang Rang says, (Zhang Rang) ordered Yetingling Bi Lang to cast four bronze figures and set them in front of both the Black Dragon Palace and Basaltic Palace; to cast four clocks holding twenty hu of rice and hang them in front of both Jade Hall and Yuntai Temple; to cast a ‘Tianlu and Tiger Frog’ to draw water to the Palace east of the bridge outside Ping Gate; and to make a ‘Turning Cart and Kewu’ west of the bridge to sprinkle the roads in south and north suburbs — to save on paying a fee for sprinkling the road. Tianlu and Xiamo are the names of animals. A Tianlu looks like a kylin with a horn on its head; a Xiamo looks like a frog. They were used to name devices transporting water from Ping Gate to the Palace, just like running water is transported today. The “Turning Cart” was a wheeled machine used to draw water. The “Kewu” used a bent tube to draw up water automatically, as in the principle of the siphon. It was also called a Zhuzi, Pianti or Guoshanlong. Volume 157 of General Decrees and Regulations says, Connect a large male and a large female bamboo tube together. Wrap the joint with linen and paint it to ensure tightness. Pull it outside the mountain to draw up water. Put the tube five chi below the surface. Stuff pine twigs and hay into the tube’s tail, light them, and the gas produced by the fire makes the water rise upwards.

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These amazing achievements use the mechanical technology of the siphon. It is sanitary to “sprinkle the roads in south and north suburbs to save on a fee for sprinkling the road.” Unfortunately, this mechanical invention was not passed down.

B. The Prevention and Treatment of Ancient Occupational Diseases With the progress of science and technology and the expansion of the handicraft industry, other industries and mining, occupational disease, poisoning and work-related injuries were also increasing. Of course, some preventative measures then must have been also invented.

128.  Occupational Poisoning and Damage Occupational poisoning was often caused by contacting toxic gas or objects during mining, drilling, melting, etc. A General Treatise on the Cause and Symptoms of Diseases records, There is toxic gas in many old wells, old tombs and deep pits, so people cannot enter them in a hurry. Toxic gas is especially rampant in May or June because oppressive qi is then abundant. If people have to go down, they should first test it with a chicken or duck feather. If the feather swirls up and does not go down, there must be toxic gas. Don’t go down. Arcane Essentials from the Imperial Library quotes a method to test for poison with animals taken from Classical Prescriptions: One also can put a domestic animal in there too. If there is toxic gas, the animal will die. The Origin of the Dan House written by Dugu Tao during the Five Dynasties describes the harm caused by lead sulfide (PbS) during mining and sulfur dioxide in a metal smelting plant. Shen Kuo gave a more detailed description of poisoning and its prevention in Lingzhou Salt Well in Sichuan Province: Lingzhou Salt Well was 500 feet deep, its wall was of rock… the wellshelf had decayed after many years. People wanted to replace it. But the Yin qi in the well was so strong people would die as soon as they

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went down. They could do nothing but wait for a rainy day. The Yin qi would descend along with rain so that then people could work a little in the well. As long as it stayed sunny, people had to stop working. Later, someone created a large wooden plate, which was filled with water. At its bottom were many little holes, from which the water sprinkled like rain. The plate, called a ‘rain plate’ was set on the mouth of the well to sprinkle clear water down all day long, for several months. Thus the well-shelves were all replaced, and Lingzhou Salt Well regained its original prosperity. (Dream Pool Essays) This might well have been chlorine gas decomposed from the well salt which became weak hydrochloric acid after being watered, and eliminated the chlorine poisoning. Both A Talk about Chinese Materia Medica by Chen Cheng of the Song Dynasty and The Gengxin Jade Book of Quxian from the Ming Dynasty record the harm done by a gas containing arsenic in Xinzhou silver mine and Shangzhou mercury mine. Talks in the Garden by Kong Pingzhong during the Song Dynasty says of some craftsmen, “their heads and hands trembled because they had been affected by mercury as they gilded silverware in the back garden.” This was chronic mercury poisoning. They were similar to the patients from Minamata discovered recently in Japan. The Compendium of Materia Medica says, Lead grows in rock caves on mountains. People carry oil lamps down to walk along several miles in order to hack at the lead ore, up and down the mineral vein. The gas must be toxic. If people stay in the caves for several months, they become sallow, suffer from abdominal distention and have no appetite. Many people die of disease. These are typical symptoms of acute lead poisoning. There is a quotation from The Record in the Winter of He Mengchun, Lead gas is toxic. Workers must eat fat pig, dog meat… to control it. People with an empty stomach are easy to poison. If the old and young are attacked by toxic gas, most of them will look sallow, become paralyzed and then die. Fatty food was also used to prevent poisoning, as it followed the same principles as “de-leading” used today. One is especially prone to being poisoned when one is hungry or with an empty stomach. This identifies both warning and preventive measures.

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The work Heavenly Creations by Song Yingxing (published 1637) describes, in detail, some workers poisoned by gas in a coal mine: As a coal bed appeared, its gas could be harmful. One method was to make a large hollow bamboo tube, sharpen one of its ends and insert it into the coal bed; thus the toxic gas could be discharged through the bamboo tube and people could dig out the coal with their big hoes. Sometimes, the coal seam extended in all directions below the well, so people dug a tunnel horizontally to excavate the coal. The tunnel should be supported with boards to prevent any collapse. After the coal is finished, the well could be filled with soil. Thus, toxic gas was kept away — it had been discharged. The roof caving in and any collapse or accumulation of poison were also prevented after the well had been emptied. There were also some measures for digging out gems in a deep well: All these gem wells can be very deep, without any water in them… but, the well is filled with gem gas like a fog, which will kill a person if he breathes it for a long time… People going down should be tied by a rope at the waist… there is a big bell on the waist. Once the gem gas becomes unbearable, he will shake the bell. People outside the well should immediately pull on the rope to lift him up. At this moment, although his life may not be any more threatened, he will be unconscious. Only boiled water can be given to relieve him. He cannot eat food — and for three days should be nursed carefully until he recovers. “Arsenic-making” was once a fairly large industry, which still exists in the rural areas of Hunan Province. Arsenic is extremely toxic. Song Yingxing said, As for making arsenic, the operator should stand 10 zhang away windward. Within the reach of an arsenic wind, neither grass nor tree will survive. Mix it with rice to poison a rat. If the poisoned rat is eaten by a cat or dog, the cat or dog will die too. It is much more toxic than common monkshood extract. People must change their profession after making arsenic for two years; otherwise their hair will completely fall out.

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No wonder you had to stand windward to prevent arsenic poisoning. Changing one’s profession every two years was a farsighted idea. Preventive measures for making mercury were much stricter than those for making arsenic. Both a “Guji” and a bulkhead were set up to prevent poisoning. The Compendium of Materia Medica says, “I have been watching the alchemist making mercury powder. If the ding cauldron is slightly misplaced in the ‘Guji’, the stone will be destroyed, let alone the human flesh!” The “Guji” consisted of a crucible, a reaction chamber which had to be fixed in place and sealed. A Complete Treatise on Agriculture also says, Geographical veins are all connected and therein hide a lot of toxic gas. If someone is attacked by it, his nine orifices will be blocked up, he will lose consciousness and die. There is much of this toxic gas in hilly areas and less on lands with rivers and lakes. This gas is produced in an earthquake, so it is called ‘earthquake gas’. If people feel any strong airflow when digging a well, they should hasten away and avoid it. They cannot continue digging until the gas has all been discharged. If someone wants to know whether the gas has gone or not, he can put a lamp down the well with a piece of rope. If the lamp does not go out, the toxic gas has been exhausted. This gas was not necessarily caused by “earthquake”, but it must have been toxic and the well was undoubtedly lacking in oxygen. It makes sense to test before digging a well or exploiting a mine. Mining damage mainly came about through the roof caving in, flood, explosion, etc. Wang Chong says in On Balance that “Taoists imitate thunder by burning a stone until it glows red, then throwing it into a well. When the scorching stone meets the cool well-water, a roar is heard, just like thunder.” It seems that Taoists were studying explosions, such as those that might often happen in alchemy. Wang Chong also says that “Craftsmen make a mold with clay when smelting iron. If the mold is dry, the liquid iron will follow along the mold; otherwise, it will splash round. If someone is splashed, his skin will be burnt.” This was a skin burn made during the forging process. The History of the Later Han Dynasty records that craftsmen’s faces were often burnt and “disfigured”. Wu Qijun’s Mining Map of Southern Yunnan records that “When a hole is dug very deep, the laborers often get stuck in the mud — this is called a drift hole. The trapped person often cannot get out of and is suffocated. Sometimes several people die; sometimes dozens or even hundreds of people.” This happens even nowadays. When Zhou Xiuda and

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Huang Yongyuan carried out an on-site investigation of a silver mine from the Song and Ming Dynasties in Suichang County in Zhejiang Province, they “found two ancient miners’ bodies. They might have died of asphyxia. The two bodies lay in a blind galley and had deformed joints and protruding spines, which proves that they were bow-backed miners.”11 Occupational injuries must have often happened in ancient mines. The remains of 135 agricultural water bicycles were found in this mine as well. They were used to drain water and prevent flooding at every level, so it is speculated that flooding was the main cause of death in these mines. Furthermore, Deng Chun describes suffocation due to gas poisoning in Shaozhou copper mine and how it may be prevented; Zhao Xuemin describes the harm of ammonia and other irritating gases in A Supplement to the Compendium of Materia Medica; Zhang Jiebin mentions coal gas poisoning; Liu Wenfeng records in Travel in East Frontiers how he saw many miners “suffering from cataract, swollen legs, rotten gums which did not heal, etc. as he visited the gold mines in Mohe County.” All these records prove that there were indeed many people poisoned and injured in their workplace, but preventive methods then were also very limited. Drug poisoning also happened during their management. Probably many medical workers and pharmaceutical workers suffered from occupational poisoning. The History of the Ming Dynasty – Biography of Sheng Yin records, One morning, Sheng Yin went directly to the imperial pharmacy. Suddenly, he passed out and fell down, like a dead man. The emperor solicited someone to treat him, but only a ‘grass-roots’ doctor answered the call. Yin recovered after taking only one dose. The emperor asked why. The doctor answered: ‘Yin went to the pharmacy on an empty stomach, so he was suddenly attacked by the toxicity of the drugs. Licorice can detoxify all drug toxicity.’ The emperor then asked Yin. He said indeed he had gone to the imperial pharmacy with an empty stomach. The emperor rewarded the ‘grass-roots’ doctor with a lot of money.

129.  Occupational Diseases Both occupational poisoning and injury are occupational diseases. However, in addition to the above, some diseases are associated with certain occupations. 11

 Zhou Xiuda, Huang Yongyuan. A Preliminary Study on the History of Occupational Disease in Ancient China. Chinese Journal of Medical History, No. 1, 1988.

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The earliest record of occupational diseases and their prevention is the aforementioned record in Zhuangzi that “There was a person in Song, who was good at making medicine for chapped hands. His family had been rinsing silk in water for generations.” It relates to the early silk industry in China. Silk reeling had many processes, such as cooking the cocoons, drawing silk off of the cocoons by hand, rinsing, etc. The hands of workers rinsing silk and reeling silk were easily chapped. This occupational disease often happened to papermakers, peasants and fishermen too. China was also the first country in which lacquer was found and used. According to Dr. Joseph Needham’s research, China had lacquer as early as the 13th Century BCE. Zhuang Zhou once worked as an official, managing lacquer trees in a lacquer orchard. “Lacquer is useful, so people harvest it.” This meant that lacquer dermatitis was first recognized. Being “painted to look like a ghost” was not only for ornaments but also related to lacquer dermatitis — because of the possibility of incurring skin allergies. It was the same with leprosy. The Origin of Diseases has the earliest record of the symptoms and causes of a lacquer allergy: Symptoms of lacquer dermatitis: Lacquer is toxic. Some people are afraid of lacquer because of their natural disposition. As soon as they come in contact with lacquer, they will be poisoned. First, the face itches, then chest, arms, thigh, and calf itch too. The face is swollen, the part around the eyes lightly red. Where there is itching, there is scratching. After being scratched, little red pimples rise. After the little red pimples disappear, a few will suffer from a little millet sore. These are the symptoms of minor poisoning. Severe poisoning has the following symptoms: festering and burning pimples all over the body, the small ones like a hemp bean, the large the size of a jujube or apricot. Sometimes these dimples seem to be better after being scratched, but then new dimples grow again. Fire lacquer is the most toxic and then the poisoning will be acute and serious. However, some people are lacquer-resistant through their natural disposition. Though they make lacquer all day long, they do not get injured at all. This was a brilliant idea. “Non-resistant disposition” refers to an allergic constitution; “resistant disposition” refers to a non-allergic constitution. Since China had a developed lacquer technique, lacquerware was used everywhere and lacquer workers were easy to find. For a common person with

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an allergic constitution, even the smell or touch of lacquer might make them suffer from lacquer dermatitis. Some alchemists, drug users and other persons could be injured by professional contact with corrosive or harmful matter. The Longchuan Record says, “Chen Zao’s father died of finger carbuncles due to making Dan.” The Biography of the Southern Qi Dynasty says Liu Huan in the Sothern Qi “was very filial. His grandmother suffered from carbuncles. He plastered for her for many years and his fingers became quite rotten.” It is recorded in Medical Talks in a Shabby House that the surgeon Chen Tianshi made a secret drug by hand. “In old age, he died of a malignant carbuncle on the middle finger and thumb because his fingers had been stained by toxic gas for so long.” It might have been a skin cancer. Xue Ji’s Abstract of Internal Medicine records a silversmith suffering overstrain, chills and fever, and hand numbness after a long period of manual work. His disease was misdiagnosed as furunculosis and he was given internal and external treatment with cool-cold medicines. However, they did not work. Mr. Xue thought the disease was caused by the occupation, so he soaked the invalid’s hands with “mild center-supplementing and qi-boosting medicine”. The invalid recovered. Sun Tingquan (1613–1674) in Yan Mountain Miscellanies mentioned that “people in charge of firing glaze often suffer from eye disease; people digging coal often are buried or drown; people making alum often suffer from aphonia; people making dan-lead are often afraid of their wives.” Some tin workers can easily fall ill and not be able to get up. It is even said “few sorcerers are fat because of the smoke arising from burning paper money.” This was quite a sensible idea. Silicosis was also a common occupational disease among miners. Kong Pingzhong says in his Talks, Cake sellers become dim-sighted very young due to constantly watching the stove; most quarrymen in Jiagu mountain die of a withered lung because stone powder damages their lungs; few officials supervising the casting of coins can live long — as their hair turns white, for the work is so hard. “Stone powder damages the lungs, a withered lung makes many people die.” Xiao Zhuo of the Qing Dynasty records in Medical Cases that “Miners in coal tunnels suffer from coughing,” which was probably due to silicosis or bronchitis induced by the dust. Even today there is no cure for silicosis.

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The previously mentioned hunchback, spine curvature and sclerosis of the shoulder recorded by Shen Gongchen are all occupational diseases. The fire used when making Dan stone must be blazing hot, so the book Heavenly Creations says, A brick wall should be built near the stove, more than 1 m high and more than 1 m wide. The bellows are placed behind the wall and drawn by two or three people. Thanks to the wall insulating them from the heat, they can gain a foothold. In history, Zhu Geliang and other skilled craftsmen invented the “wooden ox”, the “walking horse”, the “dragon-bone cart”, the “monocycle”, etc. They were of great benefit in reducing labour and relieving some occupational diseases. But “as you attend to one thing you lose another”, and these inventions might have caused new occupational diseases. However, Wang Zhen’s Agricultural Book (published in 1313) records a “seedlings horse”, similar to today’s rice transplanter. It was a very good idea for farmers as it reduced the labour needed during the rice-transplanting season. His book records, When I visited Wuchang, I saw farmers riding on a ‘seedling horse’. Its belly was made with elm date wood so as to be smooth; its back made of catalpa wood to be light; its belly like a boat, with a tilting head and tail; its back made as of overlapping tiles so it could move along easily in the mud. Dried straw bundles were tied in front to tie in the seedlings. It can transplant thousands of rice seedlings in a day. Compared with those hunched workers, how comfortable this work must be! There must be a multitude of other occupational diseases, for instance, hookworm. This has been common in Chinese rural areas over a long period of time. Here, I do not mention any more.

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CHAPTER 16

The Culture of Reproduction and Medical Science In various ways, the ancient worship of reproduction which evolved later into a culture of reproduction had a profound influence upon the people’s ideas in later ages. Generally, this was a complicated web, weaving together scientific knowledge along with the remains of an ancient culture.

A.  Pregnancy and Delivery 130.  Conception and the Pursuit of a Boy Only a few recorded pregnancies have been documented in ancient China. According to the histories, King Zhou, the last king of the Shang dynasty (1600–1059 BCE), once cut open the belly of an expectant mother out of curiosity, simply in the hope of taking a closer look at the foetus — but what the result was is unknown. However, descriptions of embryonic development can be found in the Wenzi (文子), written by Wen Zi, a student of Lao Tzu. It records, In the first month of pregnancy it is like a ball of grease, followed by the formation of blood vessels in the second month; a diffuse mass of cells in the third and then a fetus in the fourth month; muscle in fifth; bone in sixth; while a recognizable baby-shape comes in the seventh. In the eighth month some slight motions begin and the fetus becomes restless in the ninth month just before its birth during the tenth month. (from Jiushou 九守, part of Wenzi) This book drew a stinging rebuke from Liu Zongyuan, a great man of letters during the Tang Dynasty, who in his Refuting Wen Zi (辨文子) held 859

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the view that such descriptions were heterogeneous and plagiarized from the Huai Nan Tzu (淮南子), a Chinese philosophical classic. Yet the truth is that these descriptions were rather more like the descriptions made by Ji Ran, a mentor of Fan Li (a famous Chinese advisor during the Spring and Autumn Period), as well as the records in the Fetus and Birth (胎产书) book unearthed from the Ma Wang Dui Tomb Site. They differed from the Huai Nan Tzu – Instructions on Spirits (淮南子·精神训) and the Guangya – Shiqin (广雅·释 亲), an early Chinese dictionary. In general, all these descriptions about embryonic development are rough and crude, far from being precise and accurate. Concerning this topic, the Guang Zi – A Chapter on Water and Earth (管子·水地篇) makes an earlier interpretation: The combination of a man and woman’s essential qi produces a stream, forming into an embryo. After three months, it grows into a fetus capable of chewing and differentiating the five flavors, and it is this skill that helps generate the five zang viscera, namely the flavor of sour governs the spleen, salty, the lungs, pungent, the kidneys, bitter, the liver, and sweet, the heart. After that, the flesh begins to grow, and the diaphragm grows out of spleen, the bones out of the lung, the brain out of the kidney, the skin out of the liver, and the muscles out of the heart. Then, based on these five, this is followed by the nine orifices whereby the nose grows out the spleen, the eyes out the liver, the ears out the kidney, the mouth out the lung, and the tongue out the heart. By the end of five months, all these organs have been formed so that when the baby is finally born in the tenth month, it can see, hear, and think… Here, the sequential order and interconnection of the formation of the five-zang viscera and other organs were made through conjecture — which, if taking into consideration their physiological function and the relationship between the orifices, raises disparities between these records and other medical works written later, for instance, the Huangdi Neijing. In this respect, the Qianjin Yaofang (千金要方) has made a statement quite a bit closer to the truth: The first month of pregnancy the embryo begins to form; the second begins its fat; the third the placenta; the fourth the whole fetus; the fifth it can move; it is equipped with tendons and bones in the sixth, skin and hair in the seventh, the zang–fu viscera in the eighth and

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sufficient nourishment in its stomach during the ninth; then the baby in the last month is ready to be born. However, pregnancy records in the Huangdi Neijing are nowhere to be found, except in the Miraculous Pivot – Meridians (灵枢·经脉) which says, At its preliminary stage of development, the fetus produces an essence — then the brain marrow. Then the physique will shape gradually, taking the bones as mainstay, the vessels as reservoir to save the qi and blood, the tendons to restrain and strengthen the skeleton, the muscles as walls for protecting the other internals (viscera, bones, tendons and vessels), and the growth of the hair which comes out from the firm skin. When the fetus is born, the cereal-qi gets into the stomach and supplies adequate nutrient, freeing the vessels so that the blood and qi can be sustained. This last stage is somewhat significant as the infant commences to be self-circulating (its qi and blood), after the birth and cutting of the umbilical cord. As for a man’s lifelong growth after birth, comprehensive and accurate details are revealed in the Suwen – Shanggu Tianzhen Lun Pian (literally, A Theory of Kidney Qi in Early Historical Times) (素问·上古天真论篇). It says with respect to reproduction, A girl… at fourteen years of age, her tiangui appears，then the Ren channel thoroughfare is exuberant, the Taichong channel is prosperous and her period coming regularly so she can have a baby… In her forty-ninth year, the Ren and Taichong channels decay, and her tiangui is going to end. Her physique turns old and feeble, and by then she can no longer conceive. A man… at sixteen years of age is rich in is kidney qi, his tiangui appears, is able to father children physically, with the emergence of a reproduction-stimulating essence and flourishing essential qi, when there is harmony of Yin-Yang during coitus… when he is fifty-six, in the wake of his feeble liver qi and the draining of his tiangui, his tendons are no longer flexible, essential qi dwindling, kidney ability on the decline, all of which leads to a downfall in his physical health. At the age of sixty-four, he is bound to suffer from loss of teeth and hair. Since kidney and other zang–fu organs are interdependent, while the other organs are vigorous, the kidney, which governs the

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water, takes in and reserves the essential qi from the organs, and is energetic; yet now the five organs are weary, the tendons and bone no longer useful, and the tiangui drained. So the essence is lessened. His physique is going to the end. So the kidney is exhausted and also his reproduction-stimulating essence, his hair grey and walking becomes difficult. Then he cannot father a child. Under the category of modern medicine, the tiangui (reproduction-stimulating essence) is equivalent to the development and maturity of the endocrine glands, especially the gonads, which both men and women possess. The appearance of menstruation for women and semen for men marks the reproductive age. Similarly, menopause and aspermia indicate that the door for reproduction has been closed. In later years, the medical term “tiangui” only referred to women’s menstruation, rather than the whole endocrine system. In short, men’s yang essence and women’s yin blood are the prerequisite for reproduction. What’s more, sexual intercourse is indispensible, which we humans make through coitus, and other animals through copulation. The Yufang Mijue [Secret Codes of Sexual Activities (玉房秘诀)] says, Lady Su (a legendary sexual goddess) once said that there are some common skills for helping to get pregnant: the couple should have a peaceful mind and dress comfortably… and have sex after midnight before the cock crows but it should be three days after the end of the female’s menstruation. The man should play with the girl, stimulating her to arouse her erotic desires and follow this by having intercourse with her pleasingly, joining together easily and ejaculating boldly. During making love, in the shallow stage, the main-attacking-position for the male should focus on the hymen; when the activity is driven deep, the male’s stimulating-zone can pass towards the door that guards the uterus, but not any deeper into the uterus. If people follow these fundamental principles then they will get a virtuous son who will live long. In the extract above, such remarks as “to play with the girl and stimulate her erotic desires” and “having intercourse pleasingly” describe the sexual skills leading to orgasm, while phrases such as “to follow these fundamental principles” imply offspring as the couple hope to get “a virtuous son who will live long”. However, having sex doesn’t guarantee a child, which explains why our ancestors made various explorations in this field. A General Treatise on Causes and Manifestations of All Diseases (巢氏病源) says,

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Three things are to blame in infertility: first, no sacrifice offered at the ancestors’ tombs; second, mutual restrictions in the couple’s fates; and third, husband or wife with disease. The former two are beyond the power of medicine, but with the last one we can apply suitable remedies to get a curative effect. Yet the Qianjin Yaofang (千金要方, Important Formulae Worth a Thousand Gold) claims, Those who want to get a baby should first know the fates of the couple in the year to see whether their five phases are in an engendering circle, and if their virtues in tune with the time. And if their own fates are dooming them to die in the tomb, babies are sure to come as long as they wish. But if the five phases of their fates are in a restraining circle to each other and even worse perish by ‘crime and killing’, which together mean they are destined to die in the tomb, offspring will become impossible for them and there is no solution. Carefully do not to seek to have one together. Even if they do have a baby, it will do harm to other people eventually. Yet even if the five phases are in an engendering phase and they are blessed by being virtuous and happy people, the couple must still abide by the laws and avoid any meticulous taboos, so that a ‘son of perfection’ comes, and is on the way. Some practitioners, even those who were renowned, believed that whether a woman could have a baby or not depended on the gods, ghosts or fate — not herself and her spouse, but something supernatural with one’s fate being predetermined when we are born. Even now, arranging a marriage according to folk customs such as matching the Bazi (八字, Eight Characters1) or fortune-telling is still popular among Chinese people. In the book Yishuo (医说, Regarding Medicine), there is such a prescription for those who want to get a child: “The lanterns during the Lantern Festival can bring couples babies. What couples need is to steal a lantern from a rich family and keep it hidden; then just bring it home and place it under the bed. Within a month, the woman is sure to be pregnant.” Folk tradition says that those who have trouble having babies should firstly turn to the Gods for help, for instance, 1

 In the process of a traditional Chinese matchmaking, information like the hour, day, month and year of one’s birth will be stated on a paper to see whether the male and the female can be a good match. Such information is called Ba Zi.

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like Songzi Guanyin (a legendary goddess in Buddhism who grants parents children), and after that should examine whether there is any “unhealthy disease in the couple”. According to the Book of Rites (礼记, a collection of texts describing the social form, administration, etc. of the Zhou dynasty), marriage will never happen if the woman is implicated as one of the so-called “five kinds of un-marriageable woman who cannot be bedded”, such as if she has been infected with a terrible disease, or both her and her future husband are of the same surname because “the offspring of such a combined couple will have little success in life”. This is likely to be linked to hereditary factors. Also one should not marry a woman suffering from a vicious disease. Women are helpless in marriage — they always have no alternative but to take the blame when there is no offspring. Zhang Jingyue (a famous doctor during the Ming dynasty) even said one should pay attention to a women’s appearance and looks, and consider these as the foundation or (literally) “field” on which to build a family, to judge whether they have the capacity to give birth to a baby. In his Jinyue Quanshu – About Restrictions on Women (景岳全书·妇人规), he said, If a farmer hopes to reap more melons on a grange, he must give some thought to the ‘base field’ where melons grow well — and because when sowing you have to choose the base field first. In a field covered with greywacke and sand, how can you grow rice or millet? To have a good mother means to have a good son. It is impossible to have a son without a good base. How can you expect a woman, endowed with little good fortune to have a robust child, for instance, like a bear? So, if people want to design a good plan for future generations, but have no fertile ‘base’ it will be impossible — women who are favored are those restful, solemn, thickset, and steady, rather than those restless, skittish, shallow, tender or overyoung. Those women who must not be on the list of marriage include those who are have short lips and small mouths… with little ears and a thin helix… with low and weak voices… with a poor physical frame… with a weak appetite… with dry and sallow hair and teeth missing… with protruding eyes and skinny buttocks… with an over-delicate or charming appearance… with a large and fatty build… with blue veins visible on the nose, lips or mouth… with a tight, rapid, wiry, or unsmooth pulse. All of which indicate the woman is suffering from an impairment of ‘real yin’ and will have irregular menstruation and no life qi. In addition, if women look like they have a ‘tiger’s head’ or ‘bear’s neck’, a transverse flat

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face with vertical pointing eyebrows, or a voice like a wolf, this must mean one welcomes in reputed ‘penalty and misfortunes’ common to all. Better to keep away. Moreover, considering the origin of one’s descendants, could you let women approach and marry men who are cruel, vicious and harsh in character? Still it is said that sagacious King Yao had a vicious son Dan Zhu, and the cruel and vicious Gu Sou (literally ‘blind elder’) attempted to assassinate his own son Shun, who became a very famous and wise King. This is highly probable to be a consequence of the combining together of two separate qi — not because one was good and the other bad. But his ‘crop failure’ would never have happened if yin and yang had been in order, and the ‘seeds’ sown in the right ‘field’. If one side is biased then there will be discordance in the other. So, these options are very important. The poem ‘Ling Chi’ in The Book of Songs is specially noted for this. I often observe that people painstakingly seek a child with little understanding of the agony involved, I sincerely hope that heaven gives them good births. Here, the right “base field” refers to no more than a healthy, wellbehaved and fully grown woman. Yet when it comes to infertility after marriage, many cases are caused by disease in either the male or female or both. This is just as described in the Qianjin Yaofang (千金要方): Couples who cannot have children must seek the cause in the fiveexcessive labours and seven kinds of woundings, or else a serious weakness in their own bodies, when they are cornered by several diseases at once. The treatment for men is to take Seven Seeds Powder — while women can draw support from taking Zishi and Mendong Pills, or Dangbao Decoction as a suppository. Thereby all can have children. Qizi Powder is composed of dodder, antler, Tianxiong (monkshood), fructus cnidii, desert cistanche, Morinda officinalis, stalactite, etc., most of which invigorate the yang. For women, they first take Dangbao Decoction, made up of mainly “blood quickening and breaking stasis” medicines, consisting of impure mirabilite, rheum officinale, peach seed, Chinese angelica, Red Peony Root, radix achyranthis bidentatae, worms, leeches and so on. Then, a thin, three-inch-long silk strip, filled with honeylocust, halitum and aluminite, is placed into the vagina to serve as a passage for the discharge of

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something like red pus. The last step is to take Zishi Mendong Pills, extracted from perilla frutescens, asparagus cochinchinensis, etc. These two formulae are the basis for treating infertility and sterility — but there are many other formulae, based upon these evolved by later generations. All these solutions, together with Baiwei Pills and Chengze Pills, as well as acupuncture when appropriated, suit different cases. The General Treatise on Causes and Manifestations of All Diseases (巢 氏病源) pays some attention to gynaecological diseases, and its treatments did not always use prescriptions, but sometimes the methods of yangsheng (cultivating inner health). It says, Those women, trapped in infertility, may be stranded by their amenorrhea, or metrorrhagia, or leukorrhagic disease, which has caused a disordered harmony between Yin and Yang qi, and irregular menstrual blood flow — or else flooding of uterine illness, often caused by wind and/or cold lurking in the uterus, or when overstrain breaks the balance of blood-qi and harmony between the yin and yang. Prescriptions for Keeping Well (养生方) says: ‘stand to face the moon anew upon it rising and also at sunset, lifting up the head to breathe in the essence of the moonlight, this has a magic in it to enhance a mortal’s yin qi, especially for women. As their yin fluids become more exuberant the route to having a baby becomes unobstructed, and they will be prone to pregnancy. Also it can nourish the brain and essence. No matter whether they are young, or in their teens or over forty-nine years old, even those at the start of the menopause or caught in infertility. Unremitting practice makes it possible for one to turn immortal.’ Undoubtedly the book Prescriptions for Keeping Well is mentioning one of the ranks of Taoist immortal daoyin practices, permeated through and through by witchcraft, showing one how to strengthen the yin qi through breathing in the essence of moonlight. Yet the disease is explained in the right way, such as saying the cause of infertility could be abnormal menstruation, amenorrhea, leucorrhea, cold lurking in the uterus, a lumpen mass in the abdomen, etc. For example, concerning “amenorrhea”, it goes on to say, “blood gathers into a conglomeration, then chunks up and turns into a mass; for patients whose spleen and stomach are feeble and weak, they will suffer edema when the blood and water mix together, the body-fluids block and the watery qi overflows; this can be a nightmare for any doctor and costs lives most often.” These descriptions can be applied perfectly to

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patients with abdominal or pelvic neoplasm, such as ovarian tumours or cancers. No wonder their dream of having a child will be difficult to achieve. Lots of gynaecological diseases could cause infertility, in particular the methods whose internal treatments were developed were highlighted in traditional medicine, and these spilled over into medical works in history. For instance, Fu Shan (a well-known doctor in the Qing Dynasty) in his Immortal Formulae for Gynopathy (女科仙方) analysed the causes of infertility as being “too slim, too fat, having the private parts being ice-cold for a long time, night sweating and hectic fever due to yin-deficiency.” But some doctors believed that, besides disease, there are many other factors resulting in infertility. For instance, Chu’s Posthumous Works (褚氏遗书) records, The King Jianping’s concubines were all very beautiful but they had no children, though he opted for young girls from decent families to have sex with, still without any success. So he asked, ‘Are there any laws concerning fertility?’ Chu answered, ‘Intercourse should occur at the right age. Best is thirty for men though their semen is generated at sixteen; and twenty for women although the tiangui comes at fourteen. When the yin and yang qi on both sides is competent and then you have sexual life, the intercourse means pregnancy, as well as a healthy, strong and long-lived child. Now intercourse with girls under fifteen years old, whose tiangui is just coming in — that will let the yin qi discharge too early and damage her, inviting sterility. Even if pregnancy occurs the child may well be short-lived. That’s why Your Majesty have no children.’ This explanation coincides with the viewpoint of contemporary sexual physiology which argues that early marriage, untimely or over-frequent intercourse halts the progress of pregnancy. Yu Bian, in his Xu Yishuo (续医说) (a sequel to the work Yishuo during the Ming Dynasty), explains, A rich young lord in town, with dozens of concubines only has a few children. But a fisherman who has only one wife can get many more. Why? It owes a lot to the abstinence of sexual desire. Lesser lusts will produce more children — while too much lust will mean no child arrives. Think of this metaphor — it is like salt seasoning soup. Just the right amount of salt makes it taste good; if it is slightly lacking, you can hardly taste it. This informs people that the key-point in

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getting children is that one should be pure in heart and have few desires, and even less sex. Chen Xiuyuan (a famous doctor in traditional Chinese medicine in the Qing Dynasty) quotes Zhongzi Lun (种子论 On Conceiving Sons) written by Luo Longji, a doctor in the Song Dynasty: It’s ridiculous to shift the blame for non-pregnancy onto fate. It is a pity and sad that some people expect medicines and strong tonics to nourish blood and essence — and then wait for the menstruation and pregnancy to come, which is not to have children but harm oneself. Fortunately, I had a master who was a prominent doctor, and imparted me a secret recipe about this. It consists of four things: first the option of the field, i.e., the mother’s blood; second the seeds, i.e., the father’s semen: third the timing; i.e., the moment of interaction between blood and semen, and fourthly the ejaculation, i.e., the initial stage of getting rid of the old to grow the new. My master said: A mother’s barrenness may be linked to her excess qi or blood deficiency perhaps harmed by the cold, and her disordered emotions, while in the wake comes stagnation of qi and blood, a feeble flow, together with a falling-out of harmonious nutrient and defense qi, then hypermenorrhea or hypomenorrhea, traditionally called yin loss, in this case how can have you conceive a child? For a father usually his infertility has something to do with qi-deficiency or essence weakness, triggered by an indulgence in lustful desires impairing his five zang-organs. Those organs’ essences are preserved in the kidneys; so a man’s depleted kidney qi directly weakens his ejaculating function, just like a weak arrow will miss the target. This is named ‘yang loss’ and will fail, however many times you have intercourse. A fertile soil cannot make poor seeds sprout — just as also fine seeds cannot grow in an impoverished soil. That is the theory of ‘the field and the seeds’ — they mutually depend on and complement each other. You should learn this well. When both the yang sperm and yin blood fill up then one needs to bide the time of intercourse — when you take advantage of a weak moment and made the appropriate ejaculation. Mark the exact hour of your partner getting her period, then it is better to hold on and wait until the sixtieth hour after, the right moment when the foul qi has cleared out, and a new flood is refreshing her — which is your

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opportunity for intercourse… If you are still worried that your partner’s sexual interest is not awakened, or yin-yang are in conflict, try some ‘magical powders’ put into her vagina and play with it to boost her libido. By the time she is really sexually excited, it’s your turn to contribute to your future children. This really does work hundred percent of the time! [from Key-points in Gynecology (女科 要旨)] The statements above from the Key-points in Gynecology are correct in principle, but wrong in the calculation of a precise fertile date. The wrong date for falling pregnant is when you have intercourse during the “safe period” just after menstruation. That was a mistake in the theory of the seed (semen) and in the gynaecology of traditional Chinese medicine, because they were choosing the wrong time. Yet using magical powders to arouse a women’s sexual desire was part of sexual technique. However, the view presented by the General Treatise on Causes and Manifestations of All Diseases (巢氏病源) was quite correct: A woman, involved in intercourses in her menstrual period, is at the risk of tarnishing her menses and they could form into mass. That can cause infertility and no more children. Coitus during a women’s period may also induce uterine infection, emmeniopathy and other diseases such as blood stasis, but not necessarily infertility. In addition some methods recommended in works on sexual practice tended to be more helpful than others, especially to conceive healthy children. For example, the Yufang Mijue (Secrets of Sexual Activities 玉房秘诀) says, Peng Zu (a legendary figure who lived for 800 years and a saint in Taoism) believed that the crux in conception lay in preserving the vital essence and then releasing it during intercourse. Do not make several ejaculations. Better to have intercourse twice in the three to five days after the completion of your partner’s menstruation — then the boy you’ll get is born intelligent, long-living and noble, and the girl pure, virtuous and will marry a man both noble and wealthy.

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Also, coitus in the morning is more likely “to bring a blessed child with a wealthy, long life — as the balance of yin and yang is helpful in stretching your bodies and refresh them with more essence.” The Dongxuanzi (洞玄子), an ancient work about the sexual practice of the Tang Dynasty says, During intercourse a man should wait for the lady’s orgasm and then ejaculate at the same time; the ejaculation is of first priority. But before that, he had better guide his mate to lie on her back, her eyes closed, and get her to concentrate on accepting his seminal fluid. Laozi said, ‘conceived at midnight the longest lifespan, before midnight a lesser lifespan, after midnight the shortest lifespan.’ Traditionally, another matter that Chinese people were much concerned about was whether the child was a boy or a girl, or more exactly, how to have a boy. In this regard, the Dongxuanzi (洞玄子) says, “Intercourse taking place on an odd day forebodes a boy, or on an even day a girl.” In addition, the Luxin Jing (颅囟经, an ancient Chinese book on pediatrics written some time between the Tang and Song Dynasties) says, When the pure essential qi protrudes into the uterus of the woman, she will get really excited sexually resulting in a strong Yang being boosted by the work of the Yin. Then what they conceive will turn out to be a boy. All the six meridians are promoting yang symptoms… In those cases where there are pure Yin symptoms on the contrary the Yang for the man’s essence is too weak. Then what they conceive must turn out a girl. All six meridians are boosted by the Yin symptoms. Chushi Yishu (褚氏遗书 Chu’s Posthumous Works) says, In a sexual activity, if yin-blood comes ahead of yang-semen, the latter integrates into the former, turns into the bones and a boy is conceived; conversely, if the yang-semen comes ahead, it turns into blood and they conceive a girl. There is a view of Sun Simiao’s which has been broadly representative, and has prevailed through many generations — that the date and time of intercourse play a decisive role in the gender of a baby. He says,

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If you want a boy, long-living, virtuous and of high-status, then coitus and ejaculation should be performed after midnight on wangxiang days, and the moon is in gui, and it must be the first, third or fifth day of the woman’s post-menstrual period when the qi is refreshed; and for a girl, the second or fourth or sixth day. The dates beyond the sixth day are not a good time to carry out your childbearing plan — because no child will be conceived and if it is, it will certainly not thrive.2 More credence can undoubtedly be gained if the day and hour of coitus is exactly either jia-yin3 or yi-mao4 in the spring, or bing-wu5 or ding-si6 in the summer, geng-shen7 or xin-you8 in the autumn, and ren-zi9 or kui-hai10 in the winter, especially when these dates are consistent with the days of the moon. [quoted from the Qianjin Yaofang – Yangxing (千金要方·养性)] This point of view, maybe a type of “chrono-medicine” for the reproductive cycle, goes hand in hand with the cycling of the hours, days and months. As for terms such as “wangxiang”, “guisu” and so on, these are merely astrologer’s tricks. For example, “dates beyond the sixth day after menstruation being not a good time to conceive babies” is fallacious. On this point, the Chushi Yishu (褚氏遗书) presents another view: It is true that some women produce only boys, while some can only deliver girls. So, Your Majesty, efforts shall be made to seek these type of women, change women more often and move between your palaces, and this will bring you boys. The emperor replied: Alright then. And from then on, beyond any expectation, the emperor had 2

 The wangxiang days are jia & yi days in the spring; bing & ding days in the summer; geng & xin days in the fall; ren ui days in the winter. The days of the moon are the first, sixth, ninth, 10th, 11th, 12th, 14th, 21st, 24th, and 29th days of the first lunar month, and the same for the second lunar month… 3  Yin is the third of the 12 earthly branches, approximately from 3 to 5 am. 4  Mao is the fourth of the 12 earthly branches, approximately from 5 to 7 am. 5  Wu is the seventh of the 12 earthly branches, approximately from 11 am to 1 pm. 6  Si is the sixth of the 12 earthly branches, approximately from 9 to 11 am. 7  Shen is the ninth of the 12 earthly branches, approximately from 3 to 5 pm. 8  You is the 10th of the 12 earthly branches, approximately from 5 to 7 pm. 9  Zi is the first of the 12 earthly branches, approximately from 11 pm to 1 am. 10  Hai is the last of the 12 earthly branches, approximately from 9 to 11 pm.

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three boys. In general, the close sexual relationship between an elderly man and a young woman, or an old lady with a young boy, these could be the way to get a son. Such views practically provided the theoretical basis for polygamy — for the belief was that the gender of the baby was decided solely by the women and some produce only boys and some only girls, and it leads to the conclusion that if the woman cannot produce a boy, exchange her for another! This view did not meet any opposition until the 18th century when the Dashengpian (达生篇) was published in 1715. This was a widely circulated medical work on obstetrics and gynaecology written during the Qing dynasty, by the retied scholar Hanzhai. It states, Having a boy or a girl is all the destiny of the man’s fortune, for his family line is inherited from the sacrificial ceremonies which stretch back, generation after generation more than a hundred generations. It is nothing to do with the women — even if girls seem to be born, in an unbroken succession, as is quite common… It’s rather ludicrous and even detestable that some unreasonable parents-in-law or muddled husbands give vent to complaints and pile their discontent on their daughters-in-law or wives who, as the constant victims, often make light of their lives and risk illness or injury… Or some even, devoid of any humanity, drown any newborn girls. They will be bound to be brought to justice and their family descendants doomed. This perspective, with its false premise, came to a proper conclusion, however. For guaranteeing a boy is beyond the woman’s power. However, in ancient times, if the wife failed to have a boy, this would tag her as exemplifying “one of the seven reasons why a married woman should be abandoned”. Or if the condition was not quite so bad, it at least sowed discord between her and her husband or parents-in-law. As for the behaviour of drowning female babies, it is tantamount to outrageous murder. Nonetheless, our knowledge concerning a boy or girl still leaves a lot to be desired, for even today, in the countryside, the hunger for boys persists and is detrimental to society. According to modern research, a women’s sex chromosomes are XX, while a man’s are XY, therefore eggs provide only X, while sperms produce either X or Y. As a result, it is the man who decides the gender of the baby, which means that a Y sperm combined with

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an egg can produce an embryo containing both X and Y. So, this means that the sex of the foetus is always decided by the man. This is the principle behind reproduction. However, things do not always turn out so. In some circumstances during the fertilizing process some factor might affect the vitality of the Y sperm or its chances of getting into the egg, for example, the pH value of vaginal discharge (if it is alkaline it is good for the movement of the Y sperm). So people try to change the pH value of the vagina in order to get a boy. Hormone levels in the blood can also influence the X and Y factors. The latest research points out that intercourse during the period of ovulation can reach an 80 percent chance of conceiving boys because of the large amount of Y sperm which can move fast but cannot live long. Therefore, the chances are that the closer coitus is to ovulation, the earlier the egg will be fertilized. Here, I want to present another view. Dr. Wang Mingwei, a friend of mine at Cambridge University, found in his research in 1988 that there is a receptor suitable for the implantation of a fertilized egg in the uterine wall and a corresponding mechanism to block it; this means that once the receptor in the uterine wall gets blocked, the fertilized egg cannot implant and resultantly is driven out of the body. In most cases this would lead to infertility. This triggered other thoughts in my mind: “What is behind the selection of whether the receptor in the uterine wall receives or blocks the action of implantation? For example, if X is combined with Y, but the fertilized egg is rejected at implantation, then the question of who decides the gender of the baby is not necessarily up to the male.” It has to be said the ancients were quite smart, and in order to have boys even invented methods of “changing girls to boys” by the guidance of such a theory as follows: When yin and yang are in harmony, with inter-reflection happening between both, the woman will be pregnant after the male’s ejaculation and female’s acceptance of the sperm. Now the combination of the ‘three yin’ usually produces girls. However, in the first two months of pregnancy, the fetus, starting as a ‘fatty mass’, gathers the essence of the qi into the placenta; and in the third month, it starts to build the fetus, but the blood is not flowing yet and its form is not fixed and will change depending on what it might be exposed to. So you cannot tell at this time whether it is a boy or girl. Therefore, within three months of becoming pregnant, medicines can be used to make it a boy.

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This prescription of Danshen Pills is to nurture the fetus and change girls into boys, when a woman gets pregnant: Danshen, teasel root, Chinese herbaceous peony… Another prescription: drink one silkworm excrement together with well-water. Three times a day. Another prescription: wrap a bow string with scarlet cloth, and then either tie it round the left arm of the pregnant woman or round her waist. Take it off after one hundred days. Another prescription: put one liang (ca. 50 g) of realgar into a scarlet bag. Carry it on oneself. Replace the realgar with orpiment gamboges if a girl is wanted. Another prescription: place an axe under the bed of the pregnant woman with its blade downward and tell nobody about it. If you do not believe in this, take a pregnant hen out of its nest and do the same thing as previously mentioned. Then the baby will always be male. [quoted from the Qianjin Yaofang (千金要方)] Such descriptions were made with great certainty. However, except for the “Danshen Pills” which belong to traditional Chinese medical preparations, the rest are all more or less witchcraft, or in other words, the product of the law of “mutual permeation”. These were not invented by Sun Simiao, but had appeared much earlier in The Fetus and Its Birth (胎产书) unearthed in the Mawangdui tomb: The fetus turns into a fatty mass in the third month of the pregnancy like the core of a fruit and at this time, is still unformed and can change dependant on what it is exposed to… If a boy is wanted, make a bow, eat male pheasants, ride stallions, and watch male tigers; if you want to have a girl, carry ear-rings, silkworms, or the like. These methods also appeared in Xu Zhicai’s Prescriptions for Each Month of Pregnancy (逐月养胎方), which testify to their early origin. One case quoted in the Yishuo (医说) from the Records of Things (博物志, written by Zhang Hua in the Jin Dynasty) fully shows the influence of witchcraft: A woman who before her third month of pregnancy wears her husband’s clothes and walks round the well three times and does not

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turn head when catching sight of the reflections on the surface of the water in the well, will absolutely give birth to a boy. One man, named Chen Cheng, had got ten girls already. His wife walked round the well three times and mutters this incantation: ‘the female is yin and the male is yang; the female is most unfortunate and the male most fortunate.’ After that, she locks the well and does not take any water from it for three days. Then she indeed gave birth to a boy. The General Catalogue of Shengji (圣济总录) even tried to explain it away with “manhood” reflections such as, Eating cocks absorbs the essence of yang from something made by heaven; carrying realgar extracts the essence of yang from something made by the earth; and taking bows and arrows, placing axes and other male things by you will toughen it up. If the method of “converting girls into boys” really worked, then today’s China would be a country of men! However, it is worth mentioning the study of making a correct diagnosis by the pulse whether the woman is pregnant or not — and whether she is carrying a boy or a girl. The Neijing (内经) says, “When the Yin is beating strongly while the Yang is not in the pulse, the woman must be already pregnant.” The Qianjin Yaofang (千金要方) says, If the Shaoyin pulse in the hand beats rapidly, she must be pregnant. Shaoyin is related to the heart which controls the blood circulation. The kidney is also in charge as the door to the fetus, and the chi pulse is the pulse of kidney. If the chi pulse is beating rapidly, the woman must be pregnant. And if the three pulses, namely the cun, guan, and chi,11 beat continuously with an even pace, she is pregnant. The Yishuo (医说) says, If the Shaoyin pulse beats rapidly, the woman will have a child. The pulse of the Shaoyin here refers to the inner-lower part of the wrist, like a slight pit at the edge of the palm near the little finger where the pulse can be felt. 11

 In traditional Chinese medical science, pulse taking is quite common. Physicians usually put three fingers on the inner-upper side of the wrist to feel the pulse, with approximately one cun for each finger, and the three corresponding spots are named cun or cunkou, guan or guanshang, and chi or chizhong (middle of chi), respectively from the farthest away to the nearest to the heart.

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Furthermore, there is a method of telling whether it is a boy or a girl by the rule of “left boy and right girl”. This coincides with the philosophy of the Book of Changes (易) which holds that the left represents male and the right female. According to the Qianjin Yaofang (千金要方), In the fourth month of the pregnancy, if you want to know whether it is a boy or a girl, take the woman’s pulses. If the pulse of her left waist beats faster than that of her right, it’s a boy; the right faster, a girl; both beat fast, twins. Another method goes: If the pulse in the left hand feels deep and replete, it must be a boy; if the right pulse is floating and large, it must be a girl; if both feel deep and replete, two boys, and both floating and large, two girls. If the pulse of the chi of the left hand is larger, it will be a boy; if on the contrary on the right, a girl; and if large on both sides, twins. The pulse feels large when it is as if replete. Another method uses the pulse of the middle chi of the left hand, if floating and large, it is a boy; if the right hand is deep and thin, it is a girl. If the pulse beats off and on, the woman must have had some trouble with her menstruation. Also if both the left and right chi feel floating, two boys are expected, or if one of them is created a girl, she will be born a boy; if both left and right pulses at the chi position feel deep, two girls are expected, or if one of them is created a boy, he will be born a girl. Another way to tell is if the pulse of the Taiyin beats it is a boy; while if the pulse of the Taiyang beats it means a girl. The ‘the pulse of the Taiyin beats’ means a deep pulse, while the Taiyang pulse is floating. What a mess the ancient ways of diagnosing the gender of a baby are — unlike the easier modern way using the huamai or “slippery pulse” — appearing in the left hand as a boy or the right as a girl. Surely one cannot ignore personal experience. Some other ways to tell the gender of the foetus were also recorded in the Qianjin Yaofang (千金要方): Let the pregnant woman walk to the south and meanwhile call her name. If she turns round to the left, what she carries is a boy, and if she turns to the right, it’s a girl. In another method, when the woman goes to the toilet, let her husband call her urgently from her behind. If she turns back to the left, it will be a boy; if to the right, a girl. Another method is to examine whether there is a lump or not in the left breast of her husband. If it is so, the woman is carrying a boy; if a lump is in the right breast, a girl.

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Nowadays, according to folk custom, people tell the gender by the shape of the pregnant belly of the woman. If it is like a large pan, it must be a boy while a large bowl means a girl. This is also judged through experience. There is also the most probably forged Chart “Telling of Boys or Girls” said to have been unearthed from the underground Ming Tombs. Incredibility the same goes for the calculation and prediction method based on the Bagua12 (literally “eight trigrams”) in the Zhongzi Lun (种子论) written by Luo Longji during the Song Dynasty which says, After the fetus is conceived, if its gender is to be told, mark down the birth year of the father in a Yao13 placed under that of the mother’s birth year, and the month of the conception in the middle. If there appears Qian, Kan, Gen, or Zhen, which are yang diagrams, the baby will be a boy. If there appear Xun, Li, Kun or Dui, which are yin diagrams, it will be a girl. It is always predictable. (quoted from Secrets for Women 女科要旨)

131.  Antenatal Training and Eugenics Modern studies in eugenics have made it quite popular, and antenatal training is now very much in vogue. Some scientists have even tried to test the ancient Chinese theories and methods of antenatal training — through experiments in the belief that foetuses can hear sounds, “talk” to their mother, move to certain musical rhythms, be affected by their mother’s emotion and other outside factors, and even learn while in the womb. In America, an “antenatal training school” was founded which held that children born after antenatal training were more mature, in that their speaking and learning to read came earlier; what’s more, children who had heard a lot of music as an embryo could show more musical talent after they were born and grew up. In China, antenatal training once was considered “superstition”, and even today although it is spoken about a lot, it still finds itself back where it started without any further research being done on it. But antenatal training can be traced back to the years of King Wen who founded the Zhou Dynasty, 3000 years ago. Lu Bian in his annotation to Da-Dai’s Book of Rites – Baofu14 (大戴礼·保傅篇) said, 12

 Bagua, a divination practice in ancient China, includes eight diagrams, Qian, Kan, Gen, Zhen, Xun, Li, Kun and Dui, respectively, representing heaven, water, mountain, thunder, wind, fire, earth and pool. 13  Yao (爻), a unit of Bagua divination, usually referring to the line of the trigram. 14  Baofu, Bao, was an official title in ancient China meaning “to safeguard” and Fu was used

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When Daren was expecting King Wen, she avoided any bad scenes, hearing lustful sounds, or impolite speech. So people of moral integrity all said that she must have been good at fetal teaching. Ancient rules for a women carrying a baby meant not leaning back in bed, not slouching in your seat, always standing upright, and not tasting of rashly flavored meats. They would not eat meat minced up in the wrong way, nor sit on a mat that was aslant. No bad words were to come from their mouths, no ill scenes to be seen before their eyes, nor lustful sounds come to their ears. They should read the old Book of Songs (诗) and talk about good things. This can help produce a child who will have even facial features, a just and gentle temper and an amazing talent. For when pregnant, a women must be careful of her feelings — which will transform her baby, good for good, and evil for evil. Also in the same book, it is recorded that “when King Cheng of Zhou was still in his mother’s womb, his mother always stood upright, and sat without slouching, and she would never act haughtily, even when there were no servants were around, nor would she scold when angry. This indeed was fetal training.” King Wen, the founder of the Western Zhou dynasty, was grandfather to King Cheng. So it can be seen that antenatal training had already started in the early Western Zhou. The Baofu Books especially talk about educating infants and extreme care was taken early on in the pregnancy, for instance, Be careful when picking a wife for your children or offspring. One only has to choose one whose family has been full of kindness and just behavior, generation after generation — for such a woman can breed good-hearted and filial children who will never be violent, never keep company with bad folk, and find the support of others. So the old saying goes, ‘phoenixes are born to be kind and just; while tigers and wolves are greedy and brutal. They are not equal. Different mothers have different children.’ Alas! Be careful of this! Never breed tigers that will bring harm to the whole world. This is called ‘the outcome of the innate’. The laws of antenatal training are recorded here in those precious books kept in the golden cabinet inside the family temple, and they give warning to future generations. for the official teacher who gave lessons to kings, or the children of dukes or princesses.

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Besides this, Mr. Qingshi’s Records (青史氏之记) also says, Ancient standards of antenatal training were applied for seven months while the queen was pregnant. She had to be placed in a rest room with a Taishi (太史) standing on the left, by the outer door holding a copper shield while a Taizai (太宰) stood on the right holding a grain scoop for a complete period of three months. When the queen asked for some entertainment which was against the code, the Taishi (太师)15 hiding the instrument would say he had not learnt it; while if her majesty asked for foods which were not correct or permitted, the Taizai holding the scoop said, ‘I am afraid I cannot serve this to you, my crown princess.’ Jia Yi in his New Book (新书) presents a similar view. The section Natural History (博物志) says, Pregnant women shall not catch sight of ugly things or strange birds or animals; nor take food which is of an extraordinary flavor. Hunting of bear, tigers and leopards should be kept away from them. Do not eat cattle hearts, white-dog meat and eel heads. People should sit upright on a formal mat and eat the neatly minced meats. Poetry reading and singing is what they should listen to, not licentious sounds. Nor should they see any evil scenes. With just these rules abided to, a baby will be conceived who grows up into a figure of intelligence and justice, and has a long life. This is the renowned rule for antenatal training. These records show that since the later Qin and Han Dynasties, a view of antenatal training had become quite popular, and most people believed in it. As far as the medical books are concerned, in Fetus and Birth (胎产书) there appear such words as “A three months fetus… is still not formed and will alter its body when it sees the sight of something,” “… she should not to be served by deformed servants, or be given a monkey. No foods with scallion or ginger in it, no rabbit soup” and so on. Such beliefs turned into medical rules and were later recorded in the General Treatise on the Causes and Manifestations of Disease (巢氏病源) and the Qianjin Yaofang (千金要方). 15

 Taishi (太史), Taizai (太宰) and Taishi (太师) were all ancient official titles. They were usually given to those in charge of the most important post, and aided the Emperor. But they could have different roles in different dynasties.

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All physicians put stress on the third month of pregnancy in the belief that it was the most sensitive period — when a foetus could become educated. Hence, they repeatedly emphasized this. For instance, Peaceful Holy Benevolent Prescriptions (太平圣惠方) says, Dirt can be molded in pots, and gold put into a smelting furnace. How can a baby be made in a mothers’ womb without any training? So let a virtuous teacher be present at the mother that her baby can know good and virtue. Let her understand the principles of the rites and rituals, so that her baby can learn to control its emotions. Nurture it with harmonious sounds like the tunes made by ‘strings and drums’. If filled with these sounds, it may be enlivened with manhood — like a soldier, or elephant or rhinoceros. If she desires entertainment, then brighten her eyes with jades and pearls, which posses the top essence of yin and yang. Always be reading and reciting poems and books to her — as that her child learns to speak well and furthermore has a knowledge of the characters; keep your mood peaceful, and avoid excessive joy or fury, control your interests and sexual desires, all of which should be directed so that they affect things without to benefit the child within. If there are malformed things, or ugly or strange birds and animals around, try to keep them away from the pregnant women. Also any foods in uncouth forms, or cut untidily, or with exotic, or uncommon flavors — they must not be presented to her. In all things, stress prevention, and be careful; these taboos should everywhere keep you alert. If all these rules are strictly abided by, the baby will be born with intelligence and good-heartedness, with beautiful features, a virtuous character, and sharing in a long life. This book compared foetal development to molding a clay pot or smelting gold in a furnace — both of which share the common attribute that their greater plasticity is decided by the skill of the craftsman, i.e., by their molding. Not only are the first three months of pregnancy referred to but also the whole of the pregnancy. This is made clearer by Zhang Huan, in his New Book on Infants (幼幼新书): In the first one and two months of pregnancy, when the blood flows not so smoothly in the veins, foods of a fishy smell or hot flavor must be avoided and the room where the woman stays should be quiet; in

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the third and fourth months as the fetus is being formed, ginger or rabbit-meat must not be put into the food-list for the woman; in the fifth and sixth months, spicy foods should be avoided; and in the seventh and eighth months, she should not eat melons, fruits or anything sour; in the ninth and tenth months, she should not eat cold or raw food and keep away from oily things, and be quiet in her daily life — with her mind resting in peace, all motions including walking, sitting, living and lying, what she sees, hears, says and does, whether she feels happy, angry, what she thinks of or turns over in her mind, everything must be good, avoiding any evil. Keep her well away from deformed or ugly persons, and close her eyes to wild animals. Because all her motives and what she hears, thinks or feels will affect the baby. If these rules are overlooked, there is no way the child will become intelligent and it could bear a trouble the whole of its life. All in all, the view presented here says that what the pregnant woman sees, hears, eats, how she moves, feels and behaves all have a tremendous impact on the psychological development of the foetus. In 1957, a certain W.R. Thompson, an American psychologist, conducted an experiment on pregnant mice and found that babies born to mothers who lived in fear throughout their pregnancy were more timid and clumsy than those who had lived in normal conditions. So antenatal training does have some practical value, except that some of these views must be said to be close to being ridiculous. It is recorded in the Yufang Mijue (Secrets of Sexual Activities 玉房秘诀) that “When the woman has been pregnant for three months, burn a hat of a man and stir the ashes into wine for the woman to drink. This will bring her a boy who will grow up into somebody wealthy and powerful, and intelligent. Keep this a secret.” Healthy reproduction of course went beyond antenatal training. There are descriptions of the hours, dates, conditions, etc. on which to have intercourse in the Qianjin Yaofang – Yangxing (千金要方·养性) which says, Having sex with a woman one must avoid the bing-ding days, the first and last days of lunar calendar month as well as days when there are strong winds, heavy rain, fog, cold, too much heat, lightning and thunder, with darkness falling onto the world, an eclipse of the sun or moon, rainbows, earth-quakes, etc. If you have sex at this time it will damage both yourselves and the gods, misfortune will fall onto everything, for instance the man will get seriously hurt, the

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woman fall ill. The child, if they can conceive, will be either insane, deaf, dumb, crippled, or blind, with various diseases and a short lifespan, ending up to un-filial and unkind. What’s more, the following must be avoided when making love as well, like having sex under the sun, the moon and the stars as well as beside flames, in temples, near wells or the kitchen, a toilet, tomb, or coffins. Abiding by the rules of sex, they can conceive a baby who finds great fortune, virtue and goodness and who can bring them peaceful moods, harmonious relationships, a prosperous family and all kinds of auspicious things gathered together; if not, they will conceive someone who finds misfortune, folly and evil — and put their parents in danger, their parents will fail in everything they try, causing the family to wane and endless trouble, and who, even though they may grow up, will perish along with their family and country. In such a way the reflections of good and ill fortune, just like any happenings, are bound to happen. There can be no further discussions. You should have thought of it before. This really is the strictest criticism from Sun Simiao. But it is true that many unsuitable conditions are, at least, inappropriate for sexual health. As for their impact on infertility and conception, there is as yet no proof. Yet the time of conception is most likely to play a certain role in the development of the foetus as well as its future psychological, mental and physical conditions. This probably involves the law of the internal biological clock. Recent research shows indeed that there are three evolutionary curves, three cycles of intelligence, physical energy and mood, ticking away in the human internal biological clock. It has been proved that on the day when the six curves of a couple all reach their climax or around the time of their climax, the babies they conceive will be better with respect to intelligence, physical energy, and psychological condition, and worse if this does not happen. Such a conclusion was reached by Mr. Zhao Dezhi — who has researched more than 1300 cases among teenagers.16 The climax is calculated by the functional method, i.e., total number of days after birth/33 = integral number + remainder (linear point of intelligence); total number of the days after birth/23 = integral number + remainder (linear point of physical energy); total number of the days after birth/28 = integral number + remainder (linear 16

 Quoted from The Internal Clock and Healthy Reproduction (生物钟与优生), A Method of Antenatal Training (胎教方法) compiled by Nali, Central Academy of National Minorities Press, 1988, pp. 81–92.

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point of mood); and here each remainder is equal to the linear point of the day plotted out on the curve. So what Sun Simiao has presented here may contain something valuable and deserves further study. Undoubtedly this ancient view is far removed from today’s scientific calculations, but what I mean to emphasize is that it might contain some scientific factors. Though it might have been inappropriate to label days as “bad days” or days unfit for doing some things, it is reasonable to believe that inborn diseases in the newborn may be connected with factors of intercourse and conception. For example, the New Book on Caring For Infants (幼幼新书) records that: Shegong-babies are those who have been conceived when the mothers are still having their menstrual period. According to the quotation in the Xu Yishuo (续医说) which comes from the Xishang Futan (席 上辅谈 ‘Chitchats on the Mat’), shegong-babies are ‘babies who are conceived on a she day (the day for ancient people to worship the gods of the earth) have white brows, hair and skin. And if they are conceived on a she day, they are called she-gong boys or she-po girls.’ However, this is not true. Xu Zhicai in his On Fetal Development and Delivery (胎育产化论) said that ‘When the fetus is conceived, its mother is still in her menstrual period with her menses flowing — and this causes white flesh and skin in the baby.’ This is what the Chushi Yishu (褚氏遗书) describes when it speaks of people whose skin was white because their blood had been formed before their skin. As to the question of ‘why do they have less good eyesight, those people whose hair and skin are both white?’ The Delivery Book (产经) answers: ‘Both hair and skin are nurtured by the blood, and meanwhile the liver nourishes the blood which means that people can see.’ Now when the mother is in her menstrual period, blood is being lost and her liver suffering from a deficiency, so much so that the hair and skin loses their nourishment, as well as the eyes. This is the reason. Yet according to modern science, albinism is a type of genetic disease, i.e., a congenital defect of the general pigmentation. So they were wrong in believing albinism was related to conception during menstruation. Babies with soft and aching bones are because their parents had sex when drunk; deaf and dumb babies have been conceived on a day when the skies were overcast, or the land closed off; babies with short and

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ill-formed hands and feet, without noses or ears, are due to conception when either parent is lying in an awkward position; girls born to be sexually indifferent are conceived when either parent could cannot hold from relieving themselves; babies without an anus are conceived when either parent eats too much toxic food… hairless babies occur because their mothers are ill from toxicity and taking in too much mineral medicine (stone powders)… yellow skin in the fetus is because conception took place irregularly. The Delivery Book (产经) says, Nine factors must be avoided when conceiving a baby: first, having sex mid-day will produce a baby vomiting after delivery; second, conceiving a baby at mid-night will get a baby either deaf or dumb for heaven and earth are closed at that time… and so on. Some of these factors may truly affect healthy reproduction, for instance, drunkenness, fatigue, eating too much poisonous food and taking in too many toxins from precious mineral medicines (powders) for illness before the delivery all of which has also been proven by modern medical science. If you wanted to create a healthy baby, the ancient peoples stressed particularly “fetal nurturing and protecting”, and this can be seen in Xu Zhicai’s Prescriptions for Each Month of Pregnancy (逐月养胎方) and in the “taboos” and discussions on “fetal nurturing” in the Yishuo (医说), both of which describe how to nurture the channels and blood for each month of pregnancy. They go on to describe how to get the “essence” of the five elements, the compatibility and incompatibility of foodstuffs, the main zang-fu organs, where to stay and how to live, how to control the mood, which exercise to take, how to rest, prescriptions for preventing miscarriage, etc. For example, Xu Zhicai said, Before the seventh month of pregnancy, when the fetus is being first nourished by the essence of wood which helps to form its bones, the woman can do some useful work and move the body — and there was no need to stop her stretching the body because this is helpful for making flow the blood and qi. The place she lives in should be dry — and what she eats should be warmed. Eat more crude grain to help form muscles and skin. Such is what is known as ‘bonenurturing and teeth-strengthening’.

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In the seventh month of pregnancy, nourishment comes from the Taiyin hand channel and it is strictly forbidden to acupuncture it. This channel is inner-related to the lung, in charge of the skin and hair. In the seventh month, the skin and hair of the fetus is being formed. The woman must avoid loud speaking and crying. Be careful that her clothes must not be too flimsy. And no bath or cold drink for the woman is best are this time. In this month also there should be no frights, nor big movements which may cause abdominal pain. If the woman feels pain in her belly and blood comes out from her lower body, with cold hands and feet, the pulses like that of the attacking cold, together with dysphoria, abdominal distension and shortness of breath, accompanied by a stiff neck, waist or back, a prescription of white (part of the plant) scallion soup is best for her… If the woman’s health has been damaged during the 7th month of pregnancy, she should be given a soup similar to the prescription for almond soup: “almond, licorice, etc.…” (Qianjin Yaofang, Vol. 2). Such things are described in detail for each month, to protect the foetal qi and help it grow, and meanwhile to prevent miscarriage and premature delivery. However, “resting quietly, in peace” was mostly suggested, unlike the physical work usually suggested during the previous seven months. Yet the General Treatise on Causes and Manifestations of All Diseases (巢氏病源) held a slightly different view: When the mother was pregnant, do often some labour or exercise to help strengthen the qi by the movement of the bone, blood, etc. which nurtures the fetus. If too many servants wait around, the qi of her blood becomes weak, and cannot nurture the fetus. Then the baby will be fragile and easily hurt. The Qianjin Yaofang (千金要方) also stressed the compatibilities and incompatibilities of food: … eating sheep’s liver during pregnancy will bring disaster to the baby; eating goat meat causes sickness in the baby too; donkey or horse meat will sustain the pregnancy and make it longer; mule meat causes a difficult labour; rabbit and dog meat cause the baby to be dumb and have a harelip; eggs and dried carp bring rashes to the

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baby; chicken meat together with sticky rice causes pinworm; mulberry with duck causes a breech presentation and cold within; sparrow with thick bean-sauces cause freckles or black spots all over the face; sparrow meat together with wine makes the child turn out licentious and shameless; eating turtles causes a short neck; iced water, infertility. During pregnancy, do not relieve oneself in uncommon places because it will cause a miscarriage. Although much is due to the magic of “mystical mutual permeation”, some of this deserves further study; for instance, there must be some truth that drinking iced water leads to infertility. Chen Xiuyuan even listed incompatible medicines such as cantharis, leech, snake skin, centipede, mercury, arsenic and other highly toxic medicines which should not be used — as well as other medicines which have incompatibilities. There was also a song of “incompatibilities during pregnancy”: Aconite, monkshood, and tianxiong,17 A bezoar, croton, or peach seed, Mirabilite, Chinese rhubarb and peony laurel, Radix achyranthis bidentatae, Black false hellebore and root of ramie madder, Sophora fruit, safflower and saponin, Trigone, curcuma zedoary and coix seed, Resina toxicodendri, linru, and qu grain, Pinellia ternate, rhizoma arisaematis and ricepaper pith, Dried ginger, garlic and semen canavaliae, Yanhu, antipyretic dichroa and musk she not take. These are what are forbidden for women; They should often be remembered during her pre-natal period. (quoted from Secrets Key Points for Women 女科要旨) This coincides somewhat with the modern view that taking less medicine is best, as well taking no imprudent medicines. Besides this, Chinese medicine always believed that “when a man and a woman have sex, they can conceive a fetus but unfortunately perhaps either of them has been ill; or during conception, one of them is doing too much so they fall ill which causes a deficiency of the zang and fu organs, leading to weakness so that eventually the fetus will not develop easily. In such cases, medicines are given 17

 A processed medicine made out of aconite root.

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to treat the illness and enrich the qi and blood, which then nurtures the fetus” (quoted from the General Treatise on Causes and Manifestations of All Diseases 巢氏病源). In the Suwen (素问), someone asks, “When a woman is pregnant, can she use medicines or not for illness?” Qibo answered, “If it is reasonable to take medicine that is alright — and will not harm the fetus; but for serious cases one should stop just when the symptoms became over half-way better.” These two rules supplement each other. So it is up to the physician to be flexible and make appropriate use of medicines. What’s more, there was a view banning sex during pregnancy. Yu Bian in his Xu Yishuo (续医说) said, When a woman gets pregnant, her man should not have sex with her. If he does, it will cause miscarriage or a difficult labour. That is because when she is love-making, her sexual passion arises and something is being excreted from the body, yet her uterus is shrinking and firm, so miscarriage will be unavoidable. It is often heard that in animals such as a pregnant horse or ox, the female will kick off the male who comes close to her in order to protect the fetus. Therefore there are no miscarriages for these beasts. But humans are full of desire and do not control it, so miscarriages do occasionally occur. Yan Shan in his Huoyou Kouyi (活幼口议 Talking about a Babes Life) says, After the fetus is conceived, it is really not right if the parents do not keep ascetic in their desires. Some even have sex just before the delivery, and as a result the baby has its head covering with something white when it comes out. But this is a sign of disease or severe illness, and should be strictly avoided. Today’s western gynaecology also holds that sexual activity should be forbidden in the early phase, i.e., the second or third month of pregnancy to avoid miscarriage, and the same goes for the eighth month to prevent premature delivery.

132.  Delivery and Midwifery There is a large risk when any pregnant woman delivers a baby — which is well summed up in the folk saying “a woman stands on the threshold of the

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underworld.” The Soviet Union once tried to spread a method of painless labour invented by Caoviryannof, and later a method of “water birthing” was devised because it approached natural conditions more — by letting the newborn infants remain in water, just as they were in amniotic fluid before they were born; some people even believed that humans had evolved from an aquatic ancestor. Anyhow, it was a long time ago that such methods appeared in China: At the moment of delivery, provide water and let it cover the pregnant woman with the baby born in it, and washed it. This is also to let the newborn get accustomed to water. (History of Ming – Biography 明史·沙瑶与呐哔啴传) This method did not spread far. Drugs were commonly used so that the pregnant woman had a smooth and natural labour. The Xu Zhicai Monthly Improving Prescription (徐之才逐月养胎方) says, “The tenth month of pregnancy everything is ready, the five zang organs complete, interconnected with the six fu, which help absorb the qi from heaven and earth into the dantian18 so that the development of the fetus is finished, and the baby waiting to come out into the new world, at the right moment.” Sun Simiao continues by saying “ten months get everything ready and the baby will come out when its time comes. Drugs for a smooth labour should be taken at the beginning of the tenth month.” The prescriptions included Salvia Lotion, Liquorice Powder, Smooth Birth Pills, Steamed Rhubarb Pills, Easy Birth Bolus and so forth. Besides drugs, how the pregnant woman was placed during delivery was considered especially important: Being part of the three essences of the heavens, the earth and the human, floating with the qi of the five elements, we are all the product of yin and yang’s cooperation and therefore can breed offspring. Again the five elements inter-generate and restrict each other with a perfect fusion of softness and strength. As far as the time close to delivery is concerned, there are some taboos such as riyou and fanzhi days19 which would bring disease if these taboos are broken. So 18

 The region around the acupoint, 3 cun under the belly button.  Special days on which something good or bad will happen according to ancient traditional Chinese beliefs. 19

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also the place in which the pregnant woman is positioned to deliver the baby must be in good compliance with the qi of the four seasons and five elements. All these factors make up the well-known ‘methods of delivery’. (General Treatise on the Causes and Symptoms of Diseases 诸病源候论) It is taboo to have labour during fanzhi months. If it so happens to be that month, the mother who is going to have the baby should be placed on a piece of cattle hide, perhaps on the ground. But do not place the bloodied water and other things on the earth, as it could prove fatal. And the water for washing their clothing also must be kept in some utensils until the unfavorable month has passed. Whosoever disregards the ‘birth chart’ and breaks these taboos will cause death for both mother and baby. Even if they do not die, sickness is unavoidable and everything will go wrong. While if you abide by the chart, the mother will not fall ill and the baby will be easily delivered. (Qianjin Yaofang 千金要方) The chart mentioned here, which actually cannot be found in today’s version of the Qianjin Yaofang (千金要方), might be similar to that in the Waytai Miyao (外台秘要) also called Cui’s Chart of the Year, A Chart for the Twelve Months, The Method for Finding the Date Circular Chart, the Calendar Method, etc., all of which set taboos according to ages, delivery months and dates as seen from the following examples: A woman of the age 22, will have an easy birth in a xinhai year, while her taboo months (i.e., fanzhi), are the fourth and tenth month; in addition she will meet ill fortune in the area of the southwest, named Kun (after the Yijing trigram for that direction) and her death in the area of the west, named Dui (the Yijing trigram for the west). To deliver a baby, she must move to the south, the position named Li (the Yijing trigram for the south) to ask the Scarlet-Clothed Master of the South for help. During her delivery, she should wear red clothes and lie with her head pointing southward, and the whole process of delivery involve chouwei, ren and kui days, respectively. For the pregnant woman during the first, third, fifth, seventh, ninth and eleventh month, the bing and ren area is favorable. While in the second, fourth, sixth, eighth, tenth and twelfth month, a jia and geng area is favorable. When they are about to deliver a baby, they must

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avoid all bad and malevolent gods and spirits, and also unfortunate places. If the gods are outside the house, delivery must be in the house; while if gods are inside, the woman must be outside. Erect a labour tent in an auspicious and empty place, for the delivery. If you are inside, erect a delivery tent in an auspicious place as well. There were more charts and taboos concerning other days, as well as directions — all of which were quite complicated. Other methods such as “Tixuanzi’s Method of Borrowing a Place for Delivery”, “A Method for Positioning the Women in Labour”, etc. were much more to do with superstition, but they also reflected the difficulties which commonly occurred, the high death rate and rate of difficult labour, which therefore triggered an appeal to the gods and witchcraft. However, among all these views, there did appear some which could be called scientific, such as those of Cui Zhiti, who lived around the period of the reign of Emperor Gaozong (650–683) during the Tang Dynasty. He invented the two methods mentioned above and had written a roll containing several Delivery Process Charts (产图). He believed the following: We are all mortal and every one of us has their own allotted lifespan which is predestinated. Yet during any lifetime accidents can occur — and one cannot always avoid death. However if one is well taken care of, one might still attain longevity. But if regulated improperly, one will suffer damage in the fetus. What’s more, even the common knowledge of people differs tremendously between one and another. They mostly distain to talk about childbirth and not realize that there really is profound knowledge available in this field and we all widely need help… Think about the birth of animals — why have we never heard of deaths after delivery? Consider those sluttish girls who secretly gave birth to babies on their own, and those ignoble maidservants who also deliver babies secretly and do not have fatalities. The reason must be due to the fact that they had no one around to help them — and had to do what was most natural. As for those who die in childbirth, actually most come from rich families where there are gathered lots of women and helpers, who hurry out to tell others what is happening, and make such a hustle and bustle the minute the first labour pains begin. The hustling crowd frightens the pregnant woman who then falls into a physiological imbalance which causes the pain to get even worse. At the

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sight of such extreme pain, the surrounding people mistake the cause. Some would comb the pregnant woman’s hair, some rub her belly, some spray water on her face. If it were up to their purposeful efforts, the baby would be driven out by force — and the woman who has gathered together her qi cannot control it and bleeds unstoppingly, until she takes her last breath… One day at the ribu hour (3–5 pm) I was told that a pregnant woman had begun her labour pains which were much like stomachache, I asked the women to clear out the bed and desks from the room where some dried hay was placed and a wooden pole hung for the woman to keep her balance. Measuring the height of it, I made it suitable for the woman to take under her arms when she crouched, and to lean over when she needed some support. Soft blankets were placed under her body in case the newborn could perhaps get hurt as it fell out onto the hay. After all these arrangements, I let the pregnant woman stay in the room and told her to sit or lie down, as freely as she liked. I explained to her all the different methods we were using, as well as the reasons behind them. And I told her that a satisfactory outcome would come if she followed the natural process of childbirth; and if not, then she would die. So I told her to be calm and not frightened. Those who have delivered a child can understand what the woman felt… Then I asked the woman at fairly regular intervals, through the doorway, how it went and she answered ‘a little bearable pain’. When it came to around one o’clock after midnight, a hen that had died naturally of old age was stewed and well-cooked, and I used the hen soup to make a congee, mixing it with soft rice. This done, I stirred it quickly to cool to the appropriate temperature. Then I persuaded the woman to take in nearly three liters of the conge. At the end of the fifth hour of the morning, she successfully gave birth to a baby, all by herself. At the sound of the baby’s crying, I let the others into the room and the woman was very well and had nothing abnormal about her. She said that when a little pain came, she would relax herself by taking a long breath in and out, and the pain disappeared. This was thanks to the qi of the ren meridian being in good condition… indeed this was the marvelous skill of midwifery which brings peace and health, wherever it was used… Then even if deities such as the riyou and fanzhi gods and the like appear, they can do nothing! But if the woman had been weak both mentally and physically, frightened and shocked to be in labour — without some useful methods, she would be agitated and not find any peace. As a result, a variety of methods

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which I have gleaned from experienced doctors have been simplified and listed here. The choice is your own decision. All in all, a woman who finds childbirth difficult must first read this list and infer the date and month of the deliveries, in order to be aware of what taboos exist beforehand, and what cautions she must take and never break them. Secondly, her people should prepare enough material things beforehand such as tents, pelts, clothing, etc. at the least, before the tenth month. Otherwise, there is a lack of a thing, in an emergency… What’s more, although for the pregnant woman there is much filth and blood, and maybe fear when she is in labour, from the moment the labour pains began to the end of her delivery, all this time do not allow other people to come in, especially those who have had recent troubles or a death to visit her, otherwise, this will surely cause a difficult labour. Even when she has produced the baby, this will hurt the infant. Besides, during the process, the woman must be patient and wait until the baby comes out — and not try to push it out by force. When the moment the baby wants to come arrives, the midwife should hold her loins. Other persons should not disturb her, with useless actions… Cui Zhiti believed that natural labour was the best and that such factors as riyou and fanzhi should not be involved. So this view took the right course between witchcraft and science. Sun Simiao held somewhat similar views: For those who are going to deliver babies, simply two or three folk with her are enough and after the baby is born just inform people. It is really a bad thing to be surrounded by a huge crowd because almost certainly this will cause a difficult labour. Avoiding haste and fear in the pregnant woman is of foremost importance and the people waiting on her must be very calm, and careful in what they do. Any incompetence or hurried behavior, as well as any bad feelings will lead to a difficult labour. Pain in the belly with a fiery feeling, and light in the eyes, these are signs the baby is turning, but not coming out. It is a taboo for anyone, including the mother herself to ask the gender of the newborn as it comes out into the new world. When the baby has been delivered, just fetch fresh well-water for it to have five mouthfuls, you do not need to give it warm soup or other things. Do not let the mother catch sight of the filth and blood produced during the labour process.

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Yet some witchcraft says that “before the beginning of childbirth, take off what the pregnant woman usually wears, and take it to cover the cooking range as impenetrably as possible. This is believed to make the childbirth go smoothly.” This probably reflects people’s hopes that covering something over will facilitate childbirth. The conflict between science and superstition is especially obvious here — and they coexisted in ancient times. Chen Xiuyuan, in his Medical Classics for Gynecological Diseases (女科医旨), actually made a trusted description of this: What are the cares and treatments necessary during childbirth? The answer is: Just the one book called Dasheng (达生篇 Getting a Natural Labour) which contains a full and complete description of every type of labour. Every word is valuable here, and I will not say more. All husbands, if their wives get pregnant, should take this book and read three or four pages a day to her. Within half a month, what is in the book can all be recorded in her mind. Compared that with what they usually talk about to their wives, or just go out and play chess, and whether they win or lose! So, please have a thorough read of this book. This is really the first time that husbands were to give antenatal lessons to their wives. Nowadays, it is quite popular for there to be “antenatal classes” which pass on delivery lessons taught by professionals in foreign countries, where husbands are also encouraged to stay with their pregnant wives during the birth, because they can help her calm down. The Dasheng Book (达生篇 1715) makes an especially beneficial description of pregnancy and child birth which helps those pregnant to have a smooth delivery. Take the following example: To deliver a baby, here are three golden rules: first — sleep; second — tolerate the pain; third — no hurry, but be patient. When the labour pain first begins, a pregnant woman must be resolved and aware that delivering a child is quite a natural and easy thing in one’s life, and therefore any panic is unnecessary. After a while, the pain will stop and then come again, and then stop and so on and so forth. This will continue and after five or six rounds of this, the pace hastens which means the baby is about to come out. At this moment, she can inform others so they can give some help. If the pain paces up very slowly, it is a ‘trial’ labour pain. The woman can sleep and eat just as usual, but any sudden motion is forbidden… if the trial

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pain is mistaken for the real pain and the coming of the baby, and incorrect aids supplied, it will be completely wrong. At this moment, the foremost thing for the woman to do is to tolerate the pain, and she should continue to eat and sleep as usual — no matter whether it is trial pain or real pain — because tolerating the pain to the extreme end welcomes on an easy and natural delivery… Do not rush to massage the wrists or belly or place dried hay ready for her. Be sure to remember this. Now energy and saving spirit are major things for a pregnant woman. Better to fall tight asleep in bed or to close the eyes to refresh the spirits. If they cannot go to sleep, they can get up and slowly walk a few steps with another’s help, or stand leaning on a table for a while. After the pain is over temporarily, go to bed again. All in all, the best thing is sleep. In their sleep, lying on the back is suggested for it will make the widest room in the belly for the fetus easily to turn. Besides, when the mother is asleep, the baby is sleeping too. So it is no difficulty for them both to turn. The reason for this is that it is beneficial for both mother and baby to save their energy. This can help a lot when delivery eventually arrives. Be sure to remember this too. What’s recorded in these words is earlier than modern painless advice on delivery by at least one hundred and fifty years. So this really was perfect popularizing material for any pregnant woman. Besides this, the Dasheng Book (达生篇) also invented “childbirth kinetics” which proposed that there was a functional reason for the foetal motion, i.e., “the fetuses’ autonomous rotation”, the energy coming from the mother. This has not yet been observed in modern science. Yet it can still be believed to have an objective existence. As far as a difficult labour is concerned, there have been various prescriptions and skills prescribed which can be said to be features of Chinese medicine, for example, the chapter of “labour difficulties” in the Qianjian Yaofang (千金要方) and more inventive listings by Chen Ziming (Song Dynasty) in his Best Prescriptions for Women (妇人大全良方) — which pioneered manual operations just as in modern midwifery.20 Also as to 20

 Zhang Zhibin. History of Gynecological Diseases in Ancient China (古代中医妇产科疾病史), TCM Ancient Books Publishing House, 2000.

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acupuncture, there is the famous story of Pan Anshi, a well-known physician during the Northern Song: Pan once traveled to Tong City, where a pregnant peasant woman was going to have a child but still waiting after seven days, and all ways had proved futile. Li Baiquan, one of Pan’s students, happened to live nearby and asked Pan to take a watch. At the sight of her, Pan said ‘she will not die.’ Then he asked her family to wash gently her waist and belly with warm water and he himself massaged her. Instantly, the woman felt slight pain in her stomach and as she groaned, a boy was born. Her family was so happy that they did not know what to do. Then Pan explained, ‘The womb had been opened, but the baby had happened to accidently grab her intestines and could not get itself off. So this was beyond any medicine’s power. I just touched the belly and felt where the baby’s hand was and acupunctured it on its hukou point21. Feeling hurt, the baby drew back its hand and the delivery came. There actually was no magic at all!’ People looked at the baby, and found an acupuncture mark on its right hukou. Such magic indeed! (A History of the Song Dynasty – Biography of Pan Anshi 宋史·庞安时传) This must be an exaggeration because the hand of a baby could never “grab a mother’s intestine” unless the uterus had been broken which, if true, would have cost the lives of both mother and baby, so how could it have been delivered by acupuncture? However, it is true that acupuncture can help during a difficult labour as described in Excerpts of Prescriptions (小品方): Prescriptions for transverse presentation, lateral or limb presentation: acupuncture on the hands and feet with a bodkin to the depth of about two fen (1 fen is one tenth of 1 cun). And the baby, feeling hurt, will shrink and turn around. There are many other acupuncture methods recorded in medical books. But it is a pity that the histories record these stories almost as myths. Take, for example, the History of the Ming Dynasty – Biography of Linyun (明史·凌云传) which states, 21

 Co. 4 acupoint, commonly used in labour.

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A woman in Linjiang suffered from labour pain for three days but the baby was still not born. She groaned that she’d rather die. Then it is said she was acupunctured by her heart and at the moment the needle was plunged in, the baby came out. The father rejoiced and asked how this happened, and was answered, ‘this is because the baby was hugging the mother’s heart and when it felt the hurt of the needle, just let it go.’ People held the baby’s hand up to have a close look at it; there indeed was the mark of the needle. Such a description was probably just propaganda, and of course cannot be copied in practice. In fact it proves that because of the difficulty in tackling labour, any mystical method might just spring up. In An Annotation of Materia Medica (本草经集注), its author Tao Yinju writes that: When a difficult labour occurs, tie a bowstring around the waist of the woman, while burning the bow till it flames red and then put the ash into the wine — which is to be taken by the woman. This is to aid in a swift letting-go. The Essence of Classical Prescriptions (百一选方) says, Whenever difficult labour occurs, burn some clean paper, on which the name of the local prefecture is written, over a lamp, until it turns to ash. Stir the ashes into a warm soup and there will be a fast and smooth delivery after the woman drinks it. Though you might doubt this, it does work. There even was a specific delivery-expediting charm mentioned in Mr. Cui’s Delivery Book (崔氏产书) and in a medical work found in the Dunhuang caves. However, the mainstream in childbirth and the treatment of difficult labour still flowed towards science. Then there appeared the first book on obstetrics, the Chanbao (产宝), completed approximately between 847 and 859 by Zan Ying during the Tang Dynasty — which was followed by Yang Zijian in the Song Dynasty writing his On Ten Types of Childbirth (十产论) about the year 1078. Yang made quite impressive remarks on the treatment of difficult labour — in which, methods such as “A Turning Method for the Fetus in shoulder presentation” and treatment for there being an umbilical

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cord around the neck were almost exactly the same as those in today’s medical science. Besides this, there are various delivery-expediting drugs mentioned. The Qianjin Yaofang (千金要方) adopted acupuncture, together with the taking of red beans, E’jiao or acacia seeds to deal with prolonged labour, and in the Trivial Records (琐碎录), there was even an “deliveryexpediting song” which goes as follows: One plum, two crotons and seven peppers… By grounding and pounding, a paste is made; Stickered below the umbilicus, balanced with wine and vinegar, It can separate the baby from the placenta. Even rabbit brain was used to make “delivery-expediting pills” during the Song Dynasty: To make delivery-expediting pills, prepare two rabbit brains and smear them onto a clean paper on layue (the 8th day of the last month of the lunar year). Let it dry naturally. Grind the dried mixture together with two liang of frankincense, the next day… Knead the pills with the dried brain into a ball as big as a hen’s head and store it in a paper bag hung up to dry in the wind. Each pill works better taken with vinegar. If the labour is prolonged, add cold wine to it and instantly it will work. This prescription works all the time. What a miraculous one! (Classified Materia Medica 证类本草) This prescription was also recorded by Yu Liu in his Magic Prescriptions for Delivery-expediting Emergencies (备产济用方, completed in 1140) as “magical delivery-expediting pills”. Rabbit brains contain the hypophysis cerebri where the posterior pituitary can release oxytocin. Also purified oxytocin is often used in today’s medicine to expedite child delivery. Of course the ancients had not known about this hormone, they simply put it to use. What’s more, authors of the Yishuo (医说) and Dasheng Book ( 达生篇) must have done their research because they also stressed “do not use delivery-expediting drugs before the right time comes.” This was quite correct. What was also correct was the diagnosis made by the Dasheng Book (达 生篇) about the time of delivery: “Xue Yuanshi said, ‘when the time comes, the pregnant woman will sense a rotation inside, she will change position to be lying on her back. Meanwhile pain occurs from time to time. At this moment,

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try to hold the middle finger-joint of the woman. When the feeling of a pulse comes there then let the woman give birth.’” This method is of some value. Besides this, there are other treatments — such as beginning to take Dasheng Soup or Magic Foetal Protective Soup in the ninth month of pregnancy and so on. When the baby is born, instantly take Shenghua Soup. They are so full ranging and effective that they are still in use today. After the baby is born, the new mother enters the puerperal state — when she must take excellent care to have a good rest after delivery. This is helpful for both baby and mother. In the Qianjin Yaofang (千金要方), it says, The argument goes that good care must be taken of the woman not only before the delivery, but also after it — when her fragile physical condition brings great danger to her. Do not think mistakenly that an alright delivery means everything’s alright thereafter. A minor hurt could become a problem as huge as mountain. Why? Because diseases contracted after delivery are harder to cure than anything else… Therefore, for the first hundred days after delivery, the woman needs to be very carefully looked after. Do not behave recklessly and violate the taboos — such as having sex at will. If such things happen, the woman will become stiff as if she is having an extreme fit — which is called rufeng (i.e., wind-attack during the puerperium) and she is likely to die. So a woman must be extremely careful about this. If she is careless and plays and has fun beyond the limit so as to get sick, once she is confined to the bed, she has no-one to call to for help. Even with gold and treasure, looking everywhere for a doctor, no physician can manage this. Suppose a doctor comes but she dies, her life time has gone and there is no way to get it back. So the prescriptions made by our excellent physicians must be remembered, kept deeply in mind and treated as extra-special. Especially she should never go to the toilet outside — it is better to have a basin in the bedroom. Intercourse can only be after one-hundred days following the delivery. Any violation can cause death or weakness, and bring other diseases. Be careful! All women can suffer such winddiseases as those due to an umbilical deficiency of cold, caused by having sex too early. In these cases, rufeng, i.e., postpartum tetanus, is connected not only with damage during the delivery stage and infection but also with early intercourse. So delivery taboos do make some sense in scientific terms. In fact these taboos

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are quite important in the folk world, involving such things as a “hundred-day blood-taboo” which corresponded to the God of Misfortune and others, which should not concern us here in detail. The care of the newborn has always occupied much attention of the Chinese. It was certainly valuable in the avoidance of suffocation, cutting the cord to prevent “cord-tetanus” and so on. All these have been described in detail in the historical books. Gradually progress was being made, reflecting the people’s fear of reproduction as well as the discovery of scientific methods for childbirth, the mother and child’s care and treatment. Another special problem in the reproductive culture was how to deal with the placenta after delivery. The placenta had always been considered something sacred and holy. According to research22 conducted on the Fetus and Birth Book (胎产书) and Miscellaneous Prescriptions (杂疗方) unearthed in Mawangdui, there were “pictures of Yu’s burials of placenta” — which were made in order to locate where the placenta had been buried. This is because the correctness of the position determined whether the baby would be happy or not, and how long it would live. It is said that such a method of burying the placenta was taught by Yu. The Delivery Book (产经) commented that: The method of burying placentas of lost babies was taught by Yu.23 Once Yu was floating on the clouds when he spotted a woman crying sorrowfully. He asked her why she cried. She answered, ‘I’ve given birth to several babies who unfortunately all have died, with none surviving. So that is why I am crying.’ Then Yu taught her this method and after that all her children lived a long life. The Delivery Book (产经) was completed in the Sui Dynasty, while the books unearthed at Mawangdui were finished during the pre-Qin and early Han periods. So it can be inferred that it is a long time since the first burial of a placenta, although the practice might not have been taught by Yu. Obviously, this was to tackle the quite high death rate of the newborns at that time, when people thought the placenta was where the spirit of the foetus lay — and therefore inappropriate treatment of it could lead to 22

 Pan Yuangen. Researches on Pictures of Placenta Burials in Silk Books Unearthed in Mawangdui (马王堆帛书埋胞图考证), Journal of Chinese Medical History, vol. 4, 1989. 23  Reputed founder of the Xia Dynasty 夏朝 ca. 2070–1600 BCE.

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blasphemy. What’s more, they were also very strict with the locations of the burial, as well as the dates for it, as there were taboo dates and so on. It was really complicated to bury a placenta. Nowadays, in the country folk south of the Changjiang River, this tradition still lingers on. Yet, traditional custom and superstition are one side of it; on the other hand, the placenta was sometimes used as a medicine. The earliest record of this appeared in A Supplement to Lost Parts of the Materia Medica (本草拾 遗) completed in 739 by Chen Zangqi of the Tang Dynasty: Human placenta is used to cure deficiency of both qi and blood, which causes both physical weakness and leanness, a women’s tiredness, a dark face and skinniness, as well as emaciation owing to diseases in the belly. Later the placenta was called the ziheche (“vermilion chair and bucket pump”) which is a Taoist term. Zhang Lu in his Benjing Fengyuan (本经逢原 Origins of the Bencaojing completed in 1695) said, The ziheche, nurtured by the essence of the blood during pregnancy, absorbing much of the qi and blood from the mother, can greatly tonify blood and thus is used to cure an illness of weakness and leanness with a hectic fever — as well coughs and consumption. It is a good tonifying medicine. Since then, human placenta has become a famous tonifying medicine — especially popular in recent times, with many women taking “placental injections” in western medicine, “Qingchunbao” and “Taibao” in traditional Chinese medicine, and other preparations which are also very welcome — as they help in both tonifying deficiency and particularly in curing pediatric fits.

133.  Spontaneous Abortion and Aborticides After 10 months’ pregnancy, childbirth comes in due time. This is known as a “complete birth” (zhengchan), while a “half birth” (banchan) was the name for a miscarriage. Miscarriages have always drawn the attention of physicians. “Fetal movement at an early time” and “fetal leakages of blood” belong to what are today called “threatened abortion”, “fetal death in

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utero” is a “post-term miscarriage” and “repeated abortion” is today’s “habitual miscarriage”. Different medicines and prescriptions were used for different conditions. For example, prescriptions for preventing miscarriage were those such as Tai Mountain Rock Decoction — used to treat threatened abortion; Astragalus Powder and Zishi Mengdong Pills were used for habitual abortion. For post-term miscarriage, though curettage was not carried on like today, both acupuncture and medicines were used to get rid of a dead foetus. Sometimes it could even be pulled out by hand. According to descriptions in the Records of the Three Kingdoms – Biography of Hua Tuo (三国志·华佗传), A lady in Ganling, in the sixth month of her pregnancy, had stomach-ache and was restless all day. Hua Tuo took her pulse and said, ‘The fetus is dead.’ So she let him touch her belly to find where the fetus was. For if it is on the left it is a boy, on the right a girl. The woman said, ‘It is on the left.’ Then Hua Tuo prescribed a decoction for the lady who then did produce a dead boy fetus. After that, the lady soon recovered. Qianjin Yaofang (千金要方) also contained a special section concerning the “dead fetus” which stated, It is really a critical life-threatening time when a woman experiences a difficult labour… When dealing with such cases when the fetus is moving but it is a difficult labour or the child is dead within the womb, or there are twins with one dead and one alive, and you need to deliver them getting the dead one out and the living one born safely, you must remember this magic prescription: boil one dou of water together with one jin of crabs claws and two-feet in length of liquorice until three liters are left — then put in three liang (ten liang is one jin) of Ejiao (donkey-hide glue) to be melted. Then have the pregnant woman take this as a draught. If this does not work, drink some more. If the patient falls into a coma, open her mouth and give her more medicine. She will be able to be resuscitated. The stewing of the decoctions must take place in the eastern part of the room, using dried reeds to heat the pan. What’s more, there are other actions — such as smearing the woman’s belly with cow manure, adding soil from the stewing place into the medicinal

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brew and even drinking mercury or the urine of her husband — which are really strong superstitions. All the above are mentioned mainly for a case of difficult labour. As for a halted abortion, there were other prescriptions, such as, …to deal with fetal death, ‘Dried-back’ (‘dried’ = ‘arid’) Prescription is used: one liter of sunflower seeds, five liang of Ejiao… For pre-term pregnancy when the dead foetus is not coming out and the woman is going to die, the following prescription was used: “stew beans together with any bitter wine and let the woman drink the decoction, one liter at a draught, and the dead fetus will come out instantly…” For low-back pain caused by retention of the placenta after a dead foetus has come out, the prescription goes like this: “one chi of licorice, two he of cattail (typha) pollen… drink the decoction at a single draught, and it will drive all the remainder of the dead matter out. Then is very effective.” Here, all these methods will not only drive out a dead foetus but also a living one, so they might be called ancient induced abortions, but they are not surgery. Some examples of either taking aborticides or acupuncture are as follows: There was a man named Xiaosi, also named Shichang. When his mother was expecting him, his father had been murdered. His mother wanted to get remarried for she was still young. But her pregnancy was in her way and it could hinder a new marriage. So for an abortion, she tried various methods like purposely jumping down from the bed many times, beating her own waist with a washing stick, taking aborticides, etc. but the baby stayed strong inside here so he was nicknamed ‘Yinu’ (meaning a boy left after his father’s death) when he was born. (Historical Records of Southern Dynasties – Biography of Xu Xiaosi 南史·徐孝嗣传) This was an unsuccessful case. A successful case was the one previously quoted from the same book when the Houfei Emperor of the Southern Song Dynasty made a bet with Xu Wenbo who then had no choice but to acupuncture a woman so she gave premature birth to her baby. Yet in both cases these actions were not to cure disease. When Xiaosi’s mother tried jumping, beating her waist and taking drugs, she

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was only doing what common people usually do in such a case. And her failure was considered as “being blessed by the gods” — no one thought the aborticides did not work. Yet in later times, successful cases were increasingly recorded. This was probably due to the progress made in efficacy of aborticides. Both the Historical Records of Ming Dynasty – Biography of Dowager Muji (明史· 孝穆纪太后传) and the Historical Records of Ming Dynasty – Biography of Concubine Wan (明史·万贵妃传) record the following: Then Concubine Wan won almost all the favor of her emperor — and intrigued to have all the other concubines who were pregnant abort, out of jealousy. Then numerous concubines who had become pregnant after the emperor’s visits suffered abortions. Despite this, Emperor Xiaozong was lucky to be born — but even he was bald on the top of his head, because of an aborticide. It seems the aborticides Concubine Wan used were highly effective and only one of the pregnancies went full term. In the Qianjin Yaofang (千金要方), there is “a prescription to get rid of a fetus when the mother is ill” which is not to kill the offspring, but to cure a disease and save lives. This prescription was composed of quite common ingredients, such as, Stew the fluid of five liters of yeasted barley and one dou of wine and after it’s been boiled three times, clear out the residue and divide it into five portions for the patient to drink. The patient should not eat anything that night and the fetus will dissolve — after that, the mother will become healthy and strong, and free from disease. A string of a thousand gold could never buy this prescription. Other ingredients for this prescription included egg with salt, wheat and honey, yeast with vinegar and so on. Whether these work or not still awaits proof. However, there is a very unusual abortion prescription named in the Medical Secrets of an Official (外台秘要) quoted from the Guangji Prescriptions (广济方) which states, Take the root of achyranthis bidentatae (Niuxi 牛膝) with six or seven stalks on it, and wrap it in cotton and beat, and then fill in deep the uterus with it. Meanwhile scallion and pork and beef are forbidden.

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This method is still used by folk women in countryside and it does work. The author once encountered a case — a lady who had had a successful abortion. She told me that she often tucked into her vagina a fresh root of achyranthis bidentatae whenever she got pregnant after adultery. Days later the foetus would be excreted out of her body. Such is what the woman told me herself — and she said each time it worked. Achyranthis bidentatae has the function of invigorating circulation and “breaking up sludge” (poyu) and is commonly used in traditional Chinese abortion prescriptions. Such an aborticide is recorded in Mr. Zhang’s Medical Encyclopedia (张氏医通). The impressive progress of the effectiveness of drugs for abortion might have been related to the application of drugs for invigorating circulation and “breaking up sludge” — at least since the Tang and Song times. The Yijianzhi (夷坚志) records, Pan Jing, also named Wensou, was a famous physician. The wife of Zhang Xianzhi, an official in the construction department, had been said to be pregnant for five years; the wife of Fu Changling, also an official, pregnant for two years and the concubine of Liu Yisun, an official, his wife had been said to be pregnant fourteen months, yet not one of them had given birth yet to a baby. Wensou had seen them and said that ‘they are ill — but the doctor wrongly made a diagnosis of them being pregnant.’ Then he made a large decoction of drugs for them to drink. Zhang’s wife discharged hundreds of pieces of flesh which even had the vague form of eyes and eyebrows; Changling’s wife dreamt she had two little boys, their skin pitchblack, but they hurried and ran away being frightened; while a giant snake was driven out of Liu Yisun’s wife’s body, still alive and moving. Then all three women recovered. Therefore, though it was not a foetus, it was at least a disease of pregnancy or hydatidiform mole or something of the like. It must have been a really powerful medicine to drive all this out. Nowadays, drugs which invigorate the uterine circulation are still used for gynaecological diseases. Another view is that induced abortion is considered always immoral and unacceptable. Zhang Gao in the Song Dynasty, in his Yishuo (医说), quoted what had been said in a Collection of Physicians (名医录): There once was a woman surnamed Bai (meaning ‘white’) living in the capital who was so beautiful she was called White Peony. She made her

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living selling abortive drugs. One day, she felt she had a headache and the top of her head swelled up, growing bigger and bigger by the day. None of the famous physicians could help her. Soon her wounds ulcerated and there was such an unbearable smell. What’s more, people could hear her loud cries, night after night. One day, she said to her family, ‘I have to burn all the abortive prescriptions I have collected.’ She warned her apprentices ‘swear never to train in this job!’ Her son asked her, saying ‘mother, you have done well selling these drugs. Why give up now?’ She answered, ‘Every night, I dream of hundreds of little babies, sucking at my head! That is why I groan out in pain. This must be my judgment — for selling toxin drugs to damage unborn children.’ After these words, she died. This story was also quoted in the more recent Abortion in Premodern China: Ethics and Identity (中国古代堕胎的伦理学特征研究), a report to the Sixth International Seminar on Chinese Science History held in Cambridge, UK, in August, 1990, and was mailed to me by Professor Francesca Bray from the University of California, Los Angeles (except that the quotation was from an English translation by Professor Paul U Unschuld in Germany, so that there were slight differences between the English version and the original). Professor Paul U Unschuld actually mistook these words as written by some physician in the 16th century. But the fact is that the Yishuo (医说) was completed in 1189. So it had been written down in the 12th century. Yet there was some sense in Professor Francesca Bray’s opinion that induced abortion could not progress far in society due to attitudes towards Buddhist karma and the ethical import. These stories tell us that there was much progress made in abortive drugs at that time, and they were quite effective. The woman in the story probably suffered from a heavy psychological burden and her sickness meant she had such dreams, which were utilized by someone to confirm their own opinion. However, we can by no means take this as the whole story. There is another tale in Yuewei Thatched Cottage Notes (阅微草堂笔记) written by Ji Yun, a famous official during the Qing Dynasty, who believed that not all induced abortions were immoral and in some cases, actually a necessity. Such a view was reflected in his own words: Wu Huishu said: physician xxx is a careful, kind and honest person. One night, an old woman wanted to buy some abortive drugs, paying with a pair of golden bracelets. The physician was so frightened

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he firmly refused her. But the next night, she came again with an extra two pearl-beaded flower trinkets. But once more she was rejected by the physician — who was even more frightened. Half a year later, the physician had a dream in which he was arrested by some officials from hell for the crime of killing someone. On their arrival, a woman was crying with her hair disheveled and her neck strangled around by a scarlet scarf, reproving him for not selling her drugs. The physician argued that: ‘Drugs are to save lives. How can I possibly earn money by killing people! You are an adulteress and failed to hide yourself. It is none of my business.’ The woman said, ‘When I first asked for this drug, the fetus was still unformed. If it had been aborted, I could have avoided death; it would have been simply damaging a senseless blood clot and saving a sensitive life. However, I could not get the drug and had to give birth — and then the boy died. Now under compulsion I can only strangle myself by hanging. You meant to save one life, but unfortunately killed two. Who else is to be blamed but you?’ One of the officials sighed and said: ‘Whether what you have said is right or not depends on the situation; what he stuck to was the principle. Is he the only one since the Song Dynasty who has been stubborn on principle, and senseless to the good and bad of the situation? But you are on the way to die…’ and the sound of him pounding the table was so loud, the physician woke up. Here, one is being sued for a killing — and the so-called moral or ethical teachings are promulgated through the mouthpiece of one from the underworld. Even Ji Yun agreed about the legal necessity of some abortions. Compare this to the present world, where people still argue about it and it has become a major topic in legal and political campaigns in America. How sad! Now we come to contraception and sterilization. The books giving sexual advice, such as as “sex without ejaculation”, and child-getting prescriptions, such as those saying intercourse within five days of the completion of the woman’s period would bring about boys, turn out to contain methods of contraception. But there were no classical books which mentioned purposeful contraception. However, there were some prescriptions for sterilization, such as the following: Burn the remains of enough silkworm eggs, about one chi square into powder and drink with wine. It can cause lifelong infertility.

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Another prescription: Fry mercury in oil a whole day without interruption; eat one pill as big as a plum on an empty stomach. This can cause lifelong infertility without any harm to the woman. (Qianjin Yaofang 千金要方) A Sterilization prescription: Burn one square chi of used cloth into pieces and drink it with wine. It causes lifelong infertility. Another prescription which could both abort and sterilize: Stew three liang of Trichosanthes kirilowii Maxim and shaved cinnamon bark respectively, one liter of fermented soya beans, and cut into slices, put all together with four liters of water and stew until one and a half liters of decoction are left, separate into several portions to drink. Another prescription: Pound two monkshood stalks (aconitum carmichaeli) into powder and mix with bitter liquor. Smear onto the right foot. It works. (Medical Secrets of the Royal Library 外台秘要) Whether it does work or not is not known. There were also “methods for inducing infertility” in Zhang’s Medical Encyclopedia (张氏医通) but they will not be explained here.

B.  The Culture of Child-Rearing and Science of Medicine 134.  Premature Infant Death and Baby Care Chinese medicine paid much attention to the medical care of infants, which Sun Simiao was especially good at. In the Qianjin Yaofang (千金要方) he says, The most important thing in reproduction is to raise an infant into an adult because a baby, if ill-raised when young, cannot grow up into an adult. Hence there are such idioms as ‘many small bits make something big’ in the Book of Changes (易); such lines as ‘at the beginning of being human’ in the Book of Songs (诗经) and the record in the Zuozhuan (左传) that: ‘Shengzi gave birth to Lord Yin’.24 One item common to all these phrases is the emphasis on growing something tiny to something big, from young to mature, which is a common rule in the human world — needless to say, there was no necessity this should have been recorded in the classical 24

 Lord Yin, the 13th king of State Lu from 722 BCE to 712 BCE.

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books. This also explains why in this compendium prescriptions for women together with children have been put first, rather than those for men and the old in our priority list, for that is the natural initial state for all humans. Ancient worship of reproduction emphasized especially carrying on of the family line — let alone us so-called sophisticated people! So pediatric care and premature death certainly attracted more attention from physicians. For instance, Sun Simiao presented his own views on newly born babies: After a baby is born, use a finger wrapped in a cotton cloth to clean its mouth and wipe off the filthy dirt and remaining blood on its tongue… If not done instantly, these things can be sucked into the body when the baby cries, causing various kinds of diseases. If the newborn cannot make its first cry on its own, fetch a bottle of warm water and tip a little into the mouth of baby, and it will cry right away. Those who cannot cry after birth have a condition caused by lack of qi during a difficult labour, so massage the umbilical cord in the direction to the body in order to let the qi into its stomach. After a few hundred massages, the baby will cry. Or whip gently and slowly the baby with a scallion stalk and it will cry… As for cutting the umbilical cord, do not use a knife but have it bitten off through a thin cloth instead… The cord must be left six cun long after bitten off… After the cord has been taken off and the baby taken its first bath and covered with clothes, it’s time for glycyrrhiza soup made with a bar of glycyrrhiza one cun long, minced and stewed in two small bowls of water. Then take one bowl of the soup, dip a finger wrapped in a cotton cloth in it, and let the baby suck… until one bowl is finished. After that, if the baby can vomit filthy fluid out, it indicates that the baby is healthy, mentally and physically; but if the baby does not vomit it means there is no filthy blood in his throat, so stop the glycyrrhiza soup but give it a cinnabar and honey mix, to help tranquilize its soul and heart… this ‘honey-tranquility method’ mixes a piece of cinnabar as big as a bean with a spoonful of honey and then wets a finger wrapped in cloth to let the baby suck… yet to overdo is forbidden because it will harm the baby. After the honeytranquility method, a bezoar can be used (just the amount as that used of honey), for a bezoar is beneficial to the liver and gall and can extract heat and tranquilize the soul, as well as void filthy qi —

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therefore it can be used to help get rid of all pediatric diseases. Three days after birth, the baby should be helped get its stomach used to food. So mince rice and stew it into as thick as a cheese, and give it to the baby… breast-feeding is appropriate seven days after birth… and breast-feeding for thirty days after can help the baby avoid many diseases… (Qianjin Yaofang 千金要方) Such a procedure concerning the delivery of the baby and cutting of the cord is quite in accordance with a scientific approach, yet the medicine giving has absorbed the laws of the Taoist Pigu25 and his method for keeping well. He believed that medicines such as glycyrrhiza, a bezoar, honey and cinnabar should be taken to drive out filthy qi and keep away all disease — and that it is well to take precautions, as a delivery brings out not only a baby but also filthy blood. After the taking of the medicine, grain is used to help the baby get used to foodstuffs and be blessed by the God of grain. In today’s China, it is quite common for some country people to give the newborn a soup of coptidis and bovis bezoar instead of cinnabar and honey for, on the one hand, they believe in the old saying “three days of bitterness, brings honey everyday”, while on the other, such soup can help drive out heat toxins within the foetus. In Guangdong Province, ginseng soup is so commonly given to newborns that some even get intoxicated on it (it can be detoxified by using radish soup). Another tradition is to take the “first breast milk” which means to find a wet nurse to let the newborn take its first milk, three days after the birth. Girl babies should take milk from someone who has given birth to boys and boy babies from someone who has given birth to girls — in the hope that they can easily find a spouse when growing up. All these indicate that folk tradition played a very vital role in newborn care — although there were also superstitious factors involved. To keep the newborn healthy, people put stress on bathing which required a balance of hot and cold water, not too long each time and not too often. Not bathing the newborn would not do — because “no bath will cause the hair to fall out”. Pig’s bile is mixed into the water which can help the newborn “keep away from scabies all its life”. Do not use a mixture of boiled and unboiled water for a newborn. Three days after the birth, use a soup of peach roots in order to “drive away anything inauspicious and protect the baby from scabies 25

 To pigu (辟谷) was originally a Taoist way to control diet or even fast for several days to keep healthy, because Taoism believed that by simply breathing in natural air man can absorb the essential qi from nature, which is beneficial and essential for health.

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all its life.” What’s more, “for infantile convulsions and to drive away filthy qi, a soup of gold dust and tiger-skull can work: take one jin of gold and a piece of tiger skull, and stew them with three dou26 of water. Then use the soup for the new-born to bathe in. But remember the stewed soup must be used instantly after it is ready” (Qianjin Yaofang 千金要方). Such a method would be beyond the power of a poor family. And the permeation of magic cannot escape our attention here. However, bathing which helps keep the skin clean surely must have the function of disinfection and preventing disease. If the baby was “tongue-tied” Sun Simiao proposed “extracting it by separating it out with a sharp finger-nail.” Surely this would not be appropriate without disinfection, but the method behind such a procedure is correct in that it is good for the baby’s language development. Present surgeons do this with a pair of surgical scissors. It is also appropriate to use a soup stewed with herbs, to wipe off any thrush (“goose-mouth sores”), but the view that “thrush is because the woman liked to eat sticky rice in her pregnancy” is definitely wrong. There were quite strict rules for choosing a wet nurse. It was believed that: Wet nurses are those who have their blood qi converted into milk and the blood qi of the women is closely related to their good or bad moods — so the emotional character of the wet nurse is important, and we must be careful about their balance of joy and anger. Since wet nurses are of various types, either in form, in skin type, and in different situations, it is unrealistic to seek a perfect one, but one is acceptable if she does not have such problems as body-odor, goiter or fistula, cough, scabies, insanity, baldness, ulcers, oozing mouth ulcers, deafness, a stuffy nose, or fits. A master can instantly know that they have had former diseases by the sight of any moxibustion scars on her body. (Qianjin Yaofang 千金要方) Besides this, what the wet nurses ate and how they behaved should also be under strict attention. Chao Yuanfang’s General Treatise on the Causes and Symptoms of Diseases (诸病源候论) has quite a lot to say on pediatric care such as the following example: When a baby is newly born, do not cover it with warm clothing. Warm clothing makes its skin more fragile and it should meet the 26

 A unit of volume in ancient China, 1 dou = 10 litres.

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sunshine and wind quite frequently. If it lives without the sun and wind it will cause its tendons and bones to be weak, and easily harmed. Meanwhile an old cotton cloth is more favorable than a brand-new one. On sunny and windless days, the mother should take the baby out and play with it under the sun. In this way, it makes the blood thick and qi strong, and the newborn will have strong and firm muscles, and become resistant to cold and not fall ill. If the newborn is always protected behind curtains and covered with thick clothing, it will become weak and fragile, easily hurt by the cold and wind — just like trees or grasses growing in the shadows and devoid of sunshine. Newborns should wear thin clothing. This method can be practiced first in autumn — but do not shed clothing suddenly spring and summer, for it will cause wind-cold. Practice this in the autumn and gradually as the winter comes on, the baby must improve it its tolerance of the cold. In winter, two layers of cotton-padded clothes together with a coat are enough. Of course it is piteous to see a baby being cold, but simple and appropriate additions to its clothing are the best way. Sometimes to warm the baby for love just turns out to harm it. This is just like the present saying which goes “flowers in warm houses cannot fight against wind and cold.” More sunshine for the newborn can accelerate the absorption and transformation of Vitamin D in the body — which is good for the baby’s bone and mental development. This is also verified by the common saying, “if you hope for peace for your child, keep him slightly hungry and cold.” In this book, there are also such views as “guarding the infants by protecting the fengchi point”27. It is better to have a pillow filled with dried chrysanthemum leaves. When feeding the baby, a wet nurse can touch its neck to feel the fengchi point. If it has a fever, press it as well. This is used as a method of acupuncture and massage in baby care. But the book is generally opposed to using acupuncture or purging medicine immediately if the baby gets ill, but proposes the way of a “warm bath”, Heat Dissipation Powder, massage with “heating ointment” and other external therapies. Such methods are still in use today. It was quite original for traditional Chinese medicine at that time to propose the view that bian-zheng (变蒸 “transforming through steaming”) 27

 GB 20 acupoint.

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could also be used to help the newborn. This view first appeared in the General Treatise on the Causes and Symptoms of Diseases (诸病源候论) and then in the Qianjin Yaofang (千金要方), from which point on almost all books on childcare quoted such a view: Bian-zheng actually means the newborn is growing both blood and qi. The ‘transforming’ refers to the development of the qi and the ‘steaming’ is the bringing of heat to the body. It can happen to different babies in different ways. Those mild cases have just a little heat and are fretful, with cold ears and buttocks, and white bubbles like the eyes of dead fish swelling on their upper lip, and sweat seeping out. Some recover after five days and some within eight or nine days. Those more serious times are when there is a high fever in body and chaotic pulses, some sweat and some do not, a loss of appetite and they some vomiting perhaps, but this does not matter. During the process, the white part of the babies’ eyes usually turns slightly red, while the black part becomes slightly paler, also they feel no distress. All returns to normal at the end of the bian-zheng. The bian starts during the first five days and then the zheng carries on for another five days. The heat disappears in ten days. They should not be disturbed during this procedure and too much company is also not welcome. The time of the bian-zheng is not fixed, sometimes it happens early, sometimes late in the day and few babies have it at a fixed time. At the beginning of the bian, if the child suffers from a really high fever lasting several days, this is just the bian-zheng. Black Powder will help the child sweat. If the fever still lingers, Double-Purple Pills can help. But these should stop being given when the child is a little better and not given again. When the bian-zheng meets the cold it can struggle against the heat and cause severe pain in the abdomen, and much crying, so ‘hot iron’ (massage) it. It can make the bian-zheng appear similar to a ‘cold attack’ fever. If it is not coming from the bian-zheng, their body, ears and buttocks should also be hot, which means the condition is actually being caused by another disease and therefore should be treated with other remedies. If the baby is actually suffering from the bian-zheng, no other remedy should be taken. When it comes to the time when the bian-zheng starts to occur, its first appearance is usually on the 32nd day after birth (this is a bian); then on the 64th day, the bian happens once more with a zheng; both procedures occur; on the 96th day, there comes the third time when the baby will have a bulging

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anus accompanied by diarrhea; and the fourth will appear on the 128th day with both bian and zheng; the 165th day brings the fifth occurrence; on the 192nd day, the sixth; the 224th day the seventh; the 256th day the eighth; the 288th day the ninth; the 320th day the tenth until at 330 days the so-called ‘little zheng’ is finished. At the completion of which, 64 days later there occurs a ‘big zheng’ and then 128 days later another bian zheng. All the bian-zheng, either little or big, will come to the end on the 576th day. In Sun Simiao’s Qianjin Yaofang (千金要方), the same thing is expressed in slightly different words as “… for all bian-zheng, either little or big, will come to an end by the 576th day and then the baby turns out a ‘fully formed little person’.” Sun also said, Another way: newborns take their first change when they are 32 days old and bian can be detected by the bodily heat. Then they will bian again at the 64th day with both bian and zheng, the baby being able to lie down and stretch out comfortably. The third bian comes at the 96th day when the baby will have a bulging anus, accompanied by diarrhea; with the fourth bian there is both bian and zheng at the 128th day, and the babe is able to both laugh and cough. The development of the essential joints is complete when the fifth change takes place at the 160th day. At the 192nd day, both bian and zheng processes help the completion of the five zang organs — which eventually helps the baby to crawl when the seventh bian occurs on the 224th day. Both bian and zheng processes come again on the 256th day when the baby is eager to learn to speak. At the 288th day, when the ninth bian comes, they can stand properly. There have been altogether four zheng processes and nine bian which take place from the birth to the 288th day. When babies are in the process of changing (bian), one should be careful not to treat them too recklessly which will worsen the disease. In fact, it is the natural growth of the baby who, although having a high fever and restless pulse is all right, even though sweat is seeping out. Usually the sufferer will find peace within five days, at least it will end in eight or nine days. Even if the heating process causes fever, moxibustion and any other reckless treatment should be avoided. The above indicates that the so-called bian-zheng is more like a period when a periodic fever occurs, together with the newborns’ mental growth,

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step by step. They can laugh and cough when they are four and a half months old, can crawl at close to eight months, begin to speak when they are close to nine months old and stand up at ten months. After that, there are still several big zheng processes to be gone through, which come to end when they are one year and seven months old, becoming a so-called “fully formed little person”. Judging by the similarities and differences between Sun Simiao’s basis for his view and that of Chao Yuanfang’s, it can be inferred that the view of bian-zheng must have first appeared before the Sui Dynasty or during the period of the Southern and Northern Dynasties. The above view is practically the same as the law of pediatric growth in modern science, namely “head-lifting at three months, sitting at six, standing at nine and walking at one year old”, which says that babies can crawl when they are seven months old, laugh when four months old, babble out complex sounds like mother and father at eight months and begin to understand them — which is the practical beginning of learning speech. However, the typical symptoms of periodic fever are never mentioned as signs of pediatric growth. Yet, it is true that thermofluctuation is quite common in babies because their regulatory function in the nerve centre is far from powerful — and they are weak in regulating their own temperature. Meanwhile, they are more durable to heat, so much so that they can play as usual even though they have a high fever which causes no serious reaction to them. Maybe some then can have an intermittent fever (which was called “bian-zheng” by ancient physicians) which, if accompanied by no infection, can be left alone without any treatment. Such a view as this was really unique to the physicians of China. It is a pity there are no records of its close investigation. Therefore, this deserves further study by pediatric scientists. The appearance of bian-zheng and its theoretical development are more than likely connected with the popularity of alchemy, and the so-called “art of making magic pills” which had existed since the Wei and Jin dynasties. On the one hand, it shows a keen recognition of pediatric physiological growth; on the other, the common term “jie tai (结胎 knotting the fetus)” emphasizes the whole process of extracting magic pills, as it contains both heating and transforming properties.

135. The Theory of Congenital Foetal Toxin and Diagnosis Through Pediatric Finger Veins Another feature of the culture of pediatric care in Chinese medicine was the recognition of the diagnosis and causes of pediatric disease. Infants cannot

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speak and therefore can only be diagnosed through observation, traditionally conducted by looking at the markings of the finger veins. Pediatric diseases are usually believed to be connected to filthy blood and qi — because the baby has just come out of its mother’s body. So there appeared the theory of “congenital fetal-toxin” causing disease. Ever since the Song Dynasty, physicians held that the four commonest diseases for infants were ma (measles), dou (smallpox), jing (diseases such as infantile convulsions, tics or spasms) and gan (pediatric malnutrition or maldevelopment), among which dou disease was categorized by Peaceful Holy Benevolent Prescriptions (太平圣惠方) as a specific pediatric disease. All these diseases, especially acute infections such as dou and ma, spread so quickly and widely that almost no baby could avoid them. This triggered a further study by Qian Yi, a pediatric scientist, who concluded that: The fetus lies in womb ten months and can only feed on the filthy blood from the five zang organs of the mother, therefore all these toxins must be driven out after its delivery. So diseases such as sores or skin rashes are actually caused by the fluids of the five organs. For we know liver controls the tears, the lung mucus, the heart the blood and the spleen the ‘wrapping’ of the blood, so there are five names for the corresponding diseases: the liver corresponds to shuipao,28 that is a watery fluid of a bluish color and of a small size; the lung to pustules with thick turbid mucus and of a white color and large; the heart with spots because the heart controls the blood which is scarlet, and they are small, smaller than shuipao; and the spleen to rashes, like smaller maculae, for it controls the ‘wrapping’ of the blood, while its rashes are yellowish-scarlet. Also because tears and mucus are usually larger in amount, shuipao and pustules are usually more extensive; while as blood flows inside and usually in a small amount, maculae and rashes are comparatively over a smaller area. For those suffering watery blisters, the fluid is less because it is just like when the water in the blisters dries out the water is gone. (Keys to Pediatric Diseases – Diagnosis of Blisters 小儿药证直诀·疮疹候) This is the earliest mention of the theory of congenital diseases due to foetal toxin — and it compares tears, mucus and blood colour to the shapes 28

 That is, blisters, shui means “fluid” while pao is a “blister”.

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and colours of the skin damage due to infectious disease. Conversely it infers that the “fetus is being fed with filthy blood from the five zang organs” during pregnancy, and this explains why all infants have blisters or skin rashes. How audacious a view! Following on from Qian Yi, Dong Ji proposed that “pediatric macula are caused by accumulated heat within the embryo” — which actually is a variant of the view of it “being fed with filthy blood from the five zang organs”, and this view was followed by later books such as the New Book on Infants (幼幼新书), which described congenital foetal heat, congenital foetal cold, congenital foetal wind, congenital foetal convulsions, etc. It was certainly a mistake for “the theory of congenital fetal disease” to aim at tackling the cause of infection by seeking internal factors, but it is also a coincidence that in doing so it discovered an explanation for the onset and progress of what we now call “congenital” or “constitutional” disease. The only exception was Xu Lingtai who in his Lantai Guifan (兰台轨范) gave a brand new answer to this question: The baby previously was fed with the filthy blood from the five zang organs in embryo and the toxin lies in hiding at the life-gate. After its birth, if there is an epidemic of febrile illness, or the infant is hurt by the feed, or startled or frightened by touching something, the baby must be treated by remedies to drive the toxin out. At the beginning, the baby will appear with a flushed face, bloodshot eyes, continual yawning and stuffiness, coughing and sneezing, and feel cold and hot alternately, being a little cold in the limbs, have palpitations with fear, and sleep more. One should understand which zang organ is related, and what the cause behind it is. What’s more, the breast-feeding mother also should pay attention to the food she eats and avoid wind-cold… Such a view combined the idea of there being both an internal and external cause. This was approaching the correct answer. Diagnosis of pediatric finger vein markings was a creation which might first have appeared in Sun Simiao’s Qianjin Yaofang (千金要方), which gives an example: Epilepsy is a serious pediatric problem and it can cause great trouble if the doctor cannot give a timely remedy. The toxic qi springs from inside, and there will be some signs which require keen observation

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on the spirit of the baby, if you are to detect its symptoms. If the yuji vein29 turns black, it means epilepsy; if the yuji feels hot and turns black that is a sign of epilepsy; red means heat as well, but blue and enlarged means cold, while if it is dark and thin, that is all right. This is a diagnosis made from the pattern of veins on the yuji, which does not always reach up into the thumb. Later in the period between 860 and 874, during the Tang Dynasty, one who failed his imperial exams turned to seek Taoism on Tiantai Mountain — and much later achieved fame as a Taoist on Qingcheng Mountain. This was Du Guangting who wrote the Yuhan Jing (玉函经) in which one section titled Lines which Solve the Puzzle (指迷赋) goes like this, As an infant’s pulses have not developed in a fixed position, one has to observe the markings on the hukou30 that differentiate disease. Look at the side of the index finger which divides into three regions — you are searching for greeny-black or red markings. Try the right hand for a girl and the left hand for a boy. The qi shows in the bottom markings, feng (wind), in the middle, and beyond the feng-gate (‘wind-gate’) lies the ming (‘life’) in the ming-gate (‘life gate’). Observe and decide if the color is greenish-black or purple. The qi area should be looked at first, as the initial step to see if it might be slightly purple-red. If so, there must be some blockage in the spleen which appears outward as a greenish-black color… But pitifully, Du’s book was lost a long time ago and we can only find his words quoted in General and Detailed Prescriptions for Children (小儿 总微论方 completed in 1132). What Liu Fang quotes in his New Book on Infants (幼幼新, in the 1132 version) is from an anonymous entry, titled Shuijian (水鉴 the Water Mirror): When a fetus is formed and born with qi and blood, it is still not complete after three years and its physiological system has soft and weak tendons and bones, with a thin and slim stomach and intestines. So newborns are easily affected and sometimes in severe cases will die. How heart-rending! This being so, the idea of there being 29

 The yuji is the ball of the thumb on the palm.  The hukou or “tiger’s mouth” is the region between the thumb and index finger on the palm.

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‘three gates’ where the pulse is formed was put together, to solve this problem. Here, the book takes “Water Mirror” as its title which implies it must be related to Taoist principles, which suggests it had something in common with Du Guangting’s ideas. Its system of “three gates” is different from Du’s however: The view of finger-vein markings holds that there are three locations of the gates, with different forms of finger-vein markings on the second finger of the infant: they are the feng-gate (‘wind-gate’) which is near the position of the hukou; close to feng-gate, is the qi-gate; and at the end of the finger is the ming-gate (or ‘life gate’). Physicians should examine the veins’ color at the three gates for infants. To make a diagnosis, examine the fingers of the right hand. From the above, we can understand that the three gates are named the qi, feng and ming by Du Guangting, who meanwhile made a differentiation between the gender of the patient: “examine boys on the left hand and girls on the right hand.” But the view in the Shuijian is simply to look at one hand, that is, the right, and the three gates are differently ordered: the feng, qi and ming. From then on, later physicians founded differing schools in this field. Liu Fang actually adopted the view of the Shuijian (水鉴) along with its illustrations — and also made reference to Yang Daye’s Precious Baby (宝童) and some of Zhuang’s views. The following are some examples: A form shaped like a fishbone indicates curable chronic ‘fright wind’ if the finger-vein markings on the fingers reaches only feng gate; if it reaches the qi gate which relates to heart disease of the gan (malnutrition and mal-development), it is still curable; however, when it reaches the ming gate, it is incurable. Babies with fishbone fingervein markings usually get ‘fright wind’ easily and the whole body can get very hot, and they go dark-blue in their face, as well as suffering from diarrhea or convulsions. Then you should diagnose this. They can be fine after all these symptoms are cleared and the qi flows out smoothly. Babies who have a form of finger-vein markings like wiggling worms, which reach the feng gate ,means that there is some damage

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to their lungs but it can be cured; if the markings reach the qi gate, something must have piled up in the large intestine; while it is incurable if the markings have reached the ming gate. The saying goes, ‘finger-vein markings in the form of winding worms’, this indicates a serious stage of gan disease, as well as problems in the lungs and damage to the heart through the kidney. Those who suffer from these diseases, cannot be cured except by excellent physicians, who must have devoted much of their time to deep thought on these treatments. Confusing finger-vein markings: If there are vein markings at all three gates, the feng, qi and ming, they are suffering from worms. There is a popular saying, ‘confused worm-like prints appearing in the above three places, mean worms in the heart, unbearable pain and crying at night; worshipping all the gods will never help, not at all, nothing but taking medicines and further treatment.’ Flowing-pearl finger-vein markings: Also named flowing-rice fingervein markings: If the three gates are all covered by such prints, they appear as if piled up. But if the markings only appear at the ming gate, the case is incurable. If the prints come out over the whole face and body, which can be a symptom of flowing-rice markings, the patient is doomed to die, just as the popular saying goes: ‘there is no necessity to treat those who have flowing-pearl finger-vein markings, but in addition the gate they have reached must be examined; there is still a chance the prints have reached the feng gate only, and death is unavoidable if the prints have reached the ming gate.’ Zigzag finger-vein markings: The patients who bear zigzag fingervein markings usually have them twisted on the hukou out of ‘fright wind’ or cold. The symptoms include heat inside, mental disorder and a reddened face. All the above describes diagnoses made of pediatric disease from the forms and colours shown by the veins at the three gates of feng, qi and ming. If the three gates go on to allow it “through the three divisions of the limb, until it reaches the end of the finger nail” (sanguan shejia), it means the markings have broken through the feng and qi until they reach the ming, and this is really dangerous for the patient.

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There is some sense in this diagnostic method for pediatric disease. In the 1960s, Dr. Qian Chao, the president of Shanghai Jing’an Central Hospital, was inspired by this ancient method of diagnosis and by observing the microcirculation at the nail fold, and he applied atropine to save the lives of patients suffering from toxic bacillary dysentery. Here, the “nail” is referring to what is called “reaching the end of the finger-nail (shejia)” above. Later, some more recent methods, theories and medicines were developed to study this microcirculation, all of which helped Professor Xiu Lijuan get a world award for treating pediatric disease. Indeed the diagnostic method of observing the finger veins is still in use by physicians in China today.

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CHAPTER 17

Sexual Culture in Medicine A.  Ancient Sexology 136.  Sexology in Books and Paintings Ancient Chinese terms such as “fangzhong” (房中), “fangnei” (房内), “fangshi” (房室), “yin dao” (阴道 the Path of Sex) are equivalent to today’s sexology. Generally they can be divided into two aspects, skilled technology and theory, coming close to setting a standard in scientific enquiry, probably the first in the world. Chinese sexology always had a close relationship with medicine. Sexual concern began with the worship of reproduction. There might not have been a clear distinction between sexual worship and reproductive worship in primitive times. Zhao Guohua believes that “primitive people’s worship of female genitalia was not sexual worship at all but the worship of reproduction. And this was also the case with the worship of male genitalia, of the combination of female and male genitalia, of coition and of the conjunction of man and woman.”1 Accordingly, he totally rejects the idea of this as sexual worship. But I cannot agree with this unconventional opinion. The subject of food and productive culture naturally extends through reproduction to sex. The saying “food and sex are both natural in humans” (from Mencius – Gao-zi 1) is usually noted as “enjoying delicious food and sexual intercourse is in the nature of being human.” This saying reflects the psychology of enjoyment, that is, sex not only being for reproduction. The pursuit of sexual pleasure and sexual enjoyment is definitely a part of human social and cultural development. 1

 The Culture of Reproductive Worship, China Social Science Press, 1990, p. 394.

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The most remarkable feature of ancient Chinese sexology is that its research and practice were seen as neither to do with reproduction nor sexual enjoyment, but with longevity. It is hard to find this in any other world culture. The Dongxuanzi says, It was said that ‘sex shows the extremes of our disposition and is of top importance in the Dao. Therefore the Sages aimed to produce external play in order to moderate internal emotion, so that they could always be happy, peaceful, and healthy and live long. Those who are themselves careless get ill and die young.’ Believe in and trust these words! Sexual performance can be described as extreme, or as restrained, as sexually moderate, or as forbidden. Don’t indulge in sensual pleasures which will ruin the body. Have moderate sex and keep healthy! Xuannu’s Classic also says the following: Xuannu (a female celestial being) commented, “All those things between heaven and earth have to follow the changing law of Yin and Yang. Yang melts away when its finds yin; yin is unblocked when it finds yang. The movement of Yin and Yang are interdependent… if one knows the right way to do this, they will be happy and strong. Their life will be extended and their look will be rosy-like. Sexual healthcare consisted of reproductive and sexual skills, and the creation of sexual pleasure, which is also the whole essence of ancient Chinese sexology. Intemperate sex was not thought of highly. Sexual control was the most basic skill. Qi promotion, the accumulation of essence, the gathering of the nourishing qi from the women and returning it to the man, strengthening the essence and tonifying the bone marrow were the more advanced skills. The highest purpose was to live long or make an inner dan successfully (or to become an immortal) — just through these skills and processes. Sexual desire was controlled — from a theoretical point of view. Just as is said in the Suwen – On Ancient Genuine Qi, People take wine as their beverage, intemperance as common behaviour, and drunkenly make love — spending all their spirit and exhausting the genuine qi. They don’t know how to keep the qi or control the spirit, but seek only temporary pleasure. They enjoy the pleasures of life but live irregularly and so are old at the age of 50.

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These can be regarded as warning words. A paragraph in The Sexual Skills and Tonics of Qianjin Yaofang informs us of the true meaning of sex: It is said: Most people under 40 are indulgent in sex. After forty, they will feel their strength suddenly decline. Along with the decline of the body, people are attacked by a lot of diseases. If they are not given immediate treatment over a longer period of time, they will not recover from these diseases and finally die. So Pengzu (in legend said to have lived to 800 years old) said: ‘man is treated by man, truth comes from truth’. Thus at the age of forty, man should understand the skills of sexology… sex is not for indulging in nor for sexual pleasure, but for the preservation of health along with the practice of temperance in the sexual urge; it is not for debauchery or making love either, but for nourishing and treating disease. This is the whole purpose of sexology. The preface to a reprint of Sunu’s Classic says, “What’s said in Great Dai’s Rites… is to ‘correct the temperament of the people and promote the birth of children, in order to produce offspring — that is, to contribute to their fine nurture’. How can pedants of the Rites understand the essence of sexology?” They do not understand sexology at all! According to the earliest known literature on sexology, the Jade Inscription on Qi Promotion is the one of earliest documents. “Qi promotion” is the aim and backbone of sexology. Its specific skills serve this aim alone. I have deciphered the implied sexual actions of the unearthed bamboo slips from Mawangdui in terms of qi promotion. The translation goes as follows: The qi moves in love-making: going deep then store it up; awhile later extend it, down and forward; settle it and it hardens; then sprouting and growing; getting longer then shrinking back; shrinking back, this is heaven. Push it upwards towards this heaven a few times — as well as downwards towards the earth. Following this method, you will find no hitch; to go against it causes death. Among the unearthed bamboo wood slips in Mawangdui, four kinds of slips have been directly classified as to do with sexology. They may be named The Ten Questions, Combinations of Yin and Yang, The Greatest Tao and Miscellaneous Forbidden Remedies. Three silken books also have some relation to sex: Prescriptions for Keeping in Good Health, Miscellaneous

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Formulae of Treatments and The Fetus and its Delivery. According to relevant investigation, these seven books were finished between the late Warring States and the Qin and Han, not later than the twelfth year — during the reign of Emperor Wen of the Han Dynasty (168 BCE). These disarrayed slips give us full proof that ancient Chinese sexology was formed between the late Warring States Period and the turn of the Qin and Han Dynasties. This is quite near the period of the formation of the Huangdi Neijing. Eight schools of sexology have been recorded in The History of the Han Dynasty – A Bibliographic Record of Art and Literature: they include 26 volumes of Rong Cheng’s Yin Tao, 36 volumes of Wu Chengzi’s Yin Tao, 23 volumes of The Yin Tao of Yao and Shun, 25 volumes of The Yin Tao of Tian Lao and Others, 24 volumes of Tian Yi Yin Tao, 20 volumes of How the Three Kings of Huangdi Nourished the Yang, 17 volumes of Formulae – How Three Families can Have Boys, etc. These works may be regarded as all coming from the same period. Some are similar to works unearthed at Mawangdui. Several names mentioned in the books unearthed from Mawangdui (mainly Ten Questions) are the same as those in the books of these “eight sexual schools”, for example, Huangdi, Tianshi, Dacheng, Cao’ao, Rongcheng, Yao, Shun, Wangzi Qiaofu, Pengzu, Pangeng, Goulao, Yu, Shikuai, Wenzhi, King Wei of Qi, Wangqi, King Zhao of Qin, Huangshen and Zuoshen. Wang Chong, during the early Eastern Han dynasty, should have already read the newly edited Sunu’s Classic. In On Balance – The Meaning of Destiny he said, “Sunu told Huangdi that sexual promiscuity damages not only the body of the parent — but also the nature of the children.” Part of Sunu’s Classic can be read in the Doctor’s Book, which has a more detailed explanation than the sexual books from Mawangdui. Xuannu’s Book and The Cultivation of Pengzu were probably also written during this period. Later, what became recorded in the medical section of The History of the Sui Dynasty – Bibliography were the sexual books extant after the period from The History of the Han Dynasty – Bibliography Record of Arts and Literature to the Sui Dynasty: they include one volume of A Preface of the Secret Skills of Intercourse (written by a Mr. Ge), eight volumes of The Secrets in Jade Room, one volume of Xu Taishan’s Sexual Secret, one volume of Sunu’s Secret Scripture (including Xuannu’s Classic), nine volumes of New Secret Writings from the Jade Room, one volume of Sunu’s Methods, one volume of the Cultivation of Pengzu and one volume of Tanzi Talking About Yin-Yang Intercourse. This was a boom period for sexual works. Confucius’ Record made in a Closed Room and the Dongxuanzi were also probably written during this period.

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The medical part of The New History of the Tang Dynasty – A Bibliographic Record of Arts and Literature records a single volume of Mr. Ge’s Sexual Secrets, ten volumes of Secrets from the Jade Room of Chonghezi by Zhang Ding, one volume of Pengzu’s Secrets for Health, etc. There seems to have been no great development here. Among the Dunhuang remnants, The Prose of a Blissful Intercourse between Yin and Yang and Heaven with Earth is new, and was written by Bai Xingjian, the younger brother of Bai Juyi (the famous poet). Doctors’ works include some sexual books, such as A Book about Delivery, Ancient and Modern Effective Prescriptions, the Qianjin Yaofang, Waitai Miyao, Yixinfang, etc., all of which indicate that doctors adopted an absorbing attitude towards sexology. After the Song Dynasty, sexology was mainly taught in secret and kept among the Taoists. Their sexual works are included in the Taoist Canon (collected Taoist Scriptures). A large number of works on Nei Dan (inner dan) based on skills of coition were written in a cryptic script to explain the process of internal alchemy. This significant change is consistent with the change from sexual openness in the Sui and Tang Dynasties to sexual inhibition after and during the Song. But doctors still talked openly about sex. However, they paid attention to reproduction instead of sexual skills. The following books were prominent: Effective Prescriptions for Women, Prescriptions for the Treatment of the Sick, Confucians’ Duties to Their Parents, Further Discourses on the Properties of Things, A Summary of Promoting Reproduction, the Jingyue Encyclopedia – For Woman, Zhang’s General Medical Book, etc. At the beginning of the twentieth Century, a busybody called Ye Dehui compiled and published The Double Plum and Obscure Scenery Series made up from the Yixin Fang, Sunu’s Scripture, Sunu’s Formulae, Secrets from a Jade Room, A Guide to the Jade Room, the Dongxuanzi, Bai Xingjian’s Prose of Blissful Intercourse Between Yin and Yang and other medical books. He wrote a preface and postscript to each of them. There also appeared a great many pornographic paintings and statues among the folk people since the Ming and Qing dynasties. And so sexology gradually became vulgarized. From the above, it can be seen that ancient Chinese sexology mainly developed among the Taoists and within Taoist medicine. It was not lost after the Song Dynasty, but changed its form and developed into an “inner alchemy”. At the same time, a part of it separated out — to become narrower, that is, “sexual medicine”. Generally, neo-Confucianism during the Song and Ming Dynasties abruptly changed in its attitude towards sexual

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matters. On the one hand, the Taoist part of Confucianism led to there being “sexual taboos” and “sexual mystery”, and on the other hand, an obscene and vulgar sexual culture flooded out into the lower reaches of society.

137. The Growth of Knowledge of the Sexual Organs and Sexual Skills The anatomical location, naming and function of sexual organs seem to have been more complex and detailed than that of modern medicine. Taken together, it can probably be summarized thus: The Ji Guang 笄光 is also called the Jade Li, the Golden Gap, equivalent to the vaginal mouth, vaginal vestibule. Some consider it the hymen. The Feng Ji 封纪 is also called the Zhong Ji, Jade Door, Xuan Door, equivalent to labia majora and labia minora. Some consider it the vagina. The Jian Hu 封纪 is also called the Xuan Pu, Tian Ting, referring to the pubes or vaginal vestibule. Some consider it to be the vulva. The Shu Fu 鼠妇 is also called the Shu Yu, Chou Shu, equivalent to the vaginal mouth or clitoris. Some consider it the labia minora. The Gu Shi 谷实 refers to the clitoris. Some consider it to mean “five chun deep” in the vagina. The Mai Chi 麦齿 and Qin Xian 琴弦 are now considered to be the hymen. Some consider it to mean “two chun deep” in vagina. The Ying Nu 婴女 is considered to mean the posterior fornix of the vagina. Some consider it to mean “three chun deep” in the vagina. The Fan Qu 反去 is also called the right Bi Yong and left Bi Yong, referring to the left fornix and the right fornix. Some consider it be the labia majora. The He Ming 何冥 is also called the You Gu, or Dan Xue, referring to the vaginal fornix. The Red Pearl 赤数 is also called Chi Zhu, Jiao Jin, referring to the clitoris, vaginal mouth or vaginal fornix. The Quchijiu 去豉九 may be also called the Chi Zhu (or Chi Chi?) It refers to the cervical orifice or cervical fornix. The Zao Shi 慥石 is also called the Kun Stone. Some consider it to be the section “four chun deep” in the vagina or the joint between the posterior fornix and Douglas pouch.

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The Zi Gong 子宫 sometimes refers to the whole vagina. The “Two branches” 两歧 of the womb refer to the entrances of the oviduct. The Yang Feng 阳锋 refers to the male glans. The Jade Stem, Yu Ce (策), and Yu Ce (筴) both refer to the male penis. Most of these nouns are names from sexual books unearthed at Mawangdui. They are often used in the description of sexual skills and to explain different functions and feelings in sex. Abnormal sexual organs were called the “five female congenital defects” in ancient times. These women were not suitable for intercourse or reproduction. A Summary of Reproduction – Mate Selection says: The Five defects: The first is called Luo. The vulva looks like a conch and spirals inward. The second is called Wen. The vulva is as small as a chopstick. It is passable but hard to have intercourse. The woman with this kind of vulva is called a stone woman. The third is called Guhuatou. It is as tight as drum and seems to have no hole. The fourth is called Jiaohuatou, and pointed as a sharp horn. The fifth is called Mai. She has no menstruation before 14 years old or even 15 or 16. Or she suffers from irregular menstruation or amenorrhea. These five kinds of flowerless organs cannot mate with the Taiyang. So how can they give birth to babies? The above are equivalent today to vaginal stenosis, vaginismus, atresia hymenalis, half atresia hymen, uterine prolapse, labial adhesion (for instance, after vulval circumcision), primary amenorrhea, congenital absence of uterus or vagina, irregular menstruation and so on. They precluded sexual intercourse, not to mention reproduction. As for sexual partners, a woman with the above sexual disorders naturally should be excluded. Forced copulation is considered to be harmful to both partners. The books are very strict about selecting a sexual partner — because sexual intercourse is for healthcare. Besides the above-mentioned ideas, the Secrets from a Jade Room points out the following: “The Taiqing Scripture records that Huangdi asked: How to select a woman? Sunu answered: A selected woman should be gentle, her voice mellow, her hair black and fine, her flesh soft, her skeleton fine. She should be neither tall nor short, neither fat nor thin. Her vagina should be properly prominent, the hair over the vulva not be too dense, the vaginal fluid should be rich. She

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should not have given birth to a child. She should have not had a baby at the age of twenty-five to thirty. As they are making love, her vaginal fluid should be rich, her body sway uncontrollably and her sweat wet the whole body through. Every action should be pleasurable with her partner. If a man has sexual intercourse with this kind of woman, he will not get injured even if he does not follow sexual laws.” It is also said that “the most honourable men will look for the best in their sexual partner. Their shoulders have smooth skin covering them, she should have a slender body, a good nature, shiny hair, and be good-looking, a hairless vulva, mellow voice and a prominent vulva. A man will not feel tired even if he makes love with this kind of woman all day. So find this kind of woman. She can prolong a man’s life.” (the above text is taken from the Yixin Fang, the next also). It also says: “A Chinese man selects a woman mainly by her body and temperament. It is better if the woman is active and cooperative in sexual intercourse.” The Qianjin Yaofang says: “The woman does not necessarily have to be beautiful,” but she must not have “base features”. The Secrets from a Jade Room states: “A woman with base features has a dirty and rough face, disheveled hair, a big throat, a neck like a beetle, a rough voice like a man, a big mouth and nose, dull eyes… withered hair and an emaciated body, with reversed, tangled or rough pubic hair. She will do harm to a person if she makes love with him.” The Taiqing Scripture says: “As for looking for a female sexual partner, one should observe her pudenda and armpit — whether or not the hair is soft and fine. If the hair of the arms and legs is reversed, rough and withered, she will injure her sexual partner. One’s intercourse will be as harmful as one-hundred intercourses”. It also says: “A woman is most harmful if her genital organ is like a male genital organ and changes along with the wane and wax of the moon. If the woman has a penis it will harm the man greatly. If the woman is red-haired and her face, thin, sick and spiritless, it will be of no benefit to the man.” “Femininity” is the criterion of a good woman. Sexual intercourse with one opposed to the usual standard — as in the above — is considered damaging to the health of the man. Having selected a sexual partner, one should then prepare to have intercourse. The Chinese placed great importance on female sexual excitement — then the orgasm can quickly be achieved and be more timely. The Qianjin Yaofang says,

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Don’t have sex with a woman when her sexual desire is not awakened and the Yang qi still weak. Her Yin qi does not come until her spirit and qi are excited through leisurely flirting with her partner. These sexual preparations are called “sexual arousal” in modern sexology. It is commonly used in technical guidance for a woman whose sexual desire is inhibited. Ancient sexology stressed the healthy attitude of “getting the qi” rather than sexual arousal and orgasm. So Talking about the Great Tao in the book unearthed from Mawangdui stresses that: Every man has some favored things he can do with a woman, but he must not lose touch with her. For the woman it is the same — but some things only he can do it for her. Whatever you do however, do not start intercourse before her sexual desire is awakened. When starting, you should not be hesitant. Make it slow and longer-keeping, and gentle-lasting. If it seems to be ending, but in fact it does not, then the woman is greatly satisfied. She gasps out with her yin qi to replenish the yang. Her rapid panting makes the breath force the qi upward and her vulva to open naturally. She moans to ask for intercourse, more and more. Panting out means her sexual pleasure begins. Grinding the teeth and shaking the body mean a longer intercourse. And so, the male belongs to the yang, the yang refers to the surface; the female belongs to the yin, the yin refers to the inside. During intercourse, the male rubs the surface of his genitals while the female rubs the inside of her genitals, which is called the law of yin and yang and principle of the intercourse of male and female. The penis cannot stay erect if it is overstrained. Try to keep intercourse prolonged. A prolonged intercourse can make her closer to you than her brothers — and love you more than her parents. Anyone who knows this great Tao is called a Tianshi (bestowed man). Sexual arousal is a necessity for both men and women. The Song for Lovers by the great scientist Zhang Heng (78–139 CE, a great astronomer and mathematician) during the Eastern Han Dynasty describes vividly this process happening in man and woman — from falling in love to sexual intercourse: I met with you by chance and became your wife. We are newly-married and love each other, but I am careful as if touching hot water.

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Although I have not enough wisdom, I will try my best to be a dutiful, good wife. Earnestly preparing food for the family, in particular to present it at the Sacrifice. I wish to be a soft mat to cover the bed for you; I want to be a silk quilt to keep the wind and cold out for you. I will clean our bed and perfume it with flowery incense. I will close all the doors and lighten our own bedroom with beautiful lamps. I will unfasten my clothes, remove my makeup, set the pillow, Hang the net and display the paintings Which show the sex life of Sunu, Tianlao and Huangdi. Sunu is my supervisor, she teaches me in deportment, full in all its glory. Besides that, what Tianlao taught Huangdi — that has never been known by another man. Nothing is happier than such a night! It is unforgettable, forever! It seems that people had an open mind about sex during this era. The sexual books and paintings of Sunu, Tianlao and Xuan Emperor became sexual textbooks. From sexual arousal to intercourse to orgasm, it was all one continuous process, and included specific sexual skills as well. There are no less than 30 sexual postures, actions and specific skills regarding intercourse. They are described in detail in the sex manuals. The Combination of Yin and Yang in the Mawangdui says, As the essential qi arrives, penetrate deeply and upward to diffuse any heat. Then draw the penis in and out repeatedly to prevent the essential qi from discharging. Then the woman will be fully content. Then take ten actions, ten postures and ten modes. As intercourse nears its end, the essential qi has already got to the genitals. Observe her eight reactions, hear her five vocal sounds and examine her response after ten rounds of intercourse without ejaculation… “Ten actions” refer to methods of promoting qi and preserving health. “Ten postures” refer to imitating the 10 animals (such as the tiger, cicada, inchworm, fish, rabbit, etc.). “Ten modes” are rather similar to those recorded in the Jade Inscription on Qi Promotion. “Eight reactions” refer to the woman’s reactions and demands, as orgasm approaches.

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Ten modes: The first is to penetrate upward; the second to penetrate downward; the third to penetrate to the right; the fourth to penetrate to the left; the fifth to penetrate fast; the sixth is to penetrate slow; the seventh to penetrate less; the eighth to penetrate repeatedly; the ninth to penetrate shallowly; the tenth to penetrate deeply. Eight reactions: The first is hugging to start; the second is straightening out the arms; the third is straightening out the legs; the fourth is hooking from the side; the fifth is hooking upward; the sixth is locking each other’s legs; the seventh is acting as if raising up from the bed with the body flat; the eighth is shaking the body. Hugging means being close to her belly; straightening out the arms means to penetrate up and down; straightening out the legs means the stabbing is not deep enough; hooking from the side means to penetrate to the sides; hooking upward means to penetrate downward; hooking legs means the penetration is going too deep; raising up from the bed with the body flat means wanting to penetrate in a shallow manner; shaking the body means desiring a longer intercourse. The “Five vocal sounds” and “ten rounds of intercourse” are the signs of her coming to an orgasm. The Five vocal sounds: Rapid breathing means a pressing sexual impulse; heavy breathing means heightened sexual excitement; moaning (also called lei’ai, referring to female sexual moaning) means that the sexual pleasure begins as the penis penetrates the vagina; huo means that woman is extremely comfortable (huo also means female sexual moaning); biting and body shaking mean to desire a longer intercourse. The signs of Ten rounds: a fresh and cool feeling is the first round; the smell of roasted bone is the second round; a better smell the third round; vaginal secretions like ointment mean the fourth round; a rice smell the fifth round; a lubricating vagina the sixth round; a lasting intercourse the seventh round; creamy vaginal secretions the eighth round; gluey vaginal secretions the ninth round; a weakening of penile strength the tenth round. After that, the genitalia become slippery and cool again, which means that the sexual intercourse has been successful. The features of a successful intercourse are as follows: a sweaty nose, white lips, shaking hands and feet, hips lifting

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away from the mat. At this time, a man should hurry to withdraw his penis. Otherwise, it will harm him. The best is the energies filling up and the spirit entering into the viscera to generate a brightening of the spirit. The male orgasm ends with ejaculation. But the Chinese very much cherished the kidney essence. So they controlled ejaculation with mind and skill. This is to very properly stress the harmonization between man and woman and their communal happiness. The Qianjin Yaofang also points out that one should not be coarse or rude during sexual intercourse: Insert the penis into vagina as it becomes not too hard and drawn it out while it is still very hard. Draw it in and out slowly and gently. Stop the intercourse just as the semen is going to discharge. Don’t insert the penis roughly. Otherwise, it will harm the viscera, essence and veins, and cause a variety of diseases. Ancient Chinese sexology reached a considerable level of medical achievement — from a sexual point of view. Modern scientific research in the West never achieved anything like it.

138. The Initial Theory of Sexology and the Method of Storing Essence and Promoting Qi In the modern day, people are often mystified and puzzled by how sexology can be used to preserve health and for healthcare and increasing longevity. The common view is that sexual intercourse and ejaculation can give temporary pleasure, but it consumes so much essence and spirit that it makes us age easily. Some people feel dizzy the day after intercourse. Frequent intercourse will make people flat and limp. After some time, they will be “the worse for wear”. Traditional Chinese doctors describe this as “sexual overstrain” or “deficient kidney yang”. In fact, Chinese people bear great psychological pressure, but westerners are somewhat different. They very much enjoy sex and even consider that a lack of sex will make them ill. In their view, a loss of semen is only the loss of a little protein. At the same time, it is still not understood that frequent sexual intercourse can improve health and promote longevity. So there are different opinions and differing guiding principles among the Chinese and Westerners.

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Ancient Chinese sexology, which emphasizes good health, may be associated with the following three factors. First, one is guided by the theory of the correspondence between the human being and the universe. Just as the guiding principle of the Huangdi Neijing states, people cannot maintain or improve their health unless they comply with the basic law and specific rules of yin and yang, and their changes in nature. Man and woman represent yin and yang, respectively. It is natural for man and woman to have sexual intercourse. It is generally not harmful but helpful. In the Ten Questions from the books of Mawangdui, the first question illustrates this fundamental principle. It goes as follows: Huangdi asked Tianshi: What makes things move in the world? What makes grass and trees grow? What makes the sun and the moon bright? Tianshi answered: If you make a careful observation of things in the world, you will find that yin and yang are the origin and motive power of them all. With them, they will all thrive; otherwise, they will die. Eating yin to accumulate yang comes from this brilliant law. “Eating yin to accumulate yang” among the things in this world later evolved into the “taking of yin to nourish yang”. This transformation of yin and yang became the basic theory of ancient Chinese sexology — which enables people to live longer, through the intercourse of yin and yang. Second, sexology represents another form and relic of genital worship. The ancients believed that the genitals should be seen as great and marvelous. But they also decline the soonest among the organs. After that, life comes to the end. If their function can be kept from being impaired, will this not then be helpful in prolonging life? The ancients made such an inference on the basis of their intuitive understanding. The fifth question and seventh question in the Ten Questions express this. Take “the fifth question” for example: Yao asked Shun: What is the most precious thing in the world? Shun answered: Life is the most precious thing. Yao asked: And how to manage life? Shun answered: According to the rule of Yin and Yang. Yao said: The nine orifices and twelve joints of the human body are arranged in a certain manner. Why do the genitals age faster than the other organs although they are both born at the same time? Shun

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replied: Hiding themselves in the lower part of the human body, they are not used in eating or thinking. It is taboo to speak their name. But people use them in an immoderate manner — and this means they age faster. Yao asked: How to nurse them? Shun answered: We must cherish them, and learn to use them properly; nourish them with diet and have sexual intercourse moderately in order to keep the penis strong and slowly to be stirred. Don’t make love without discretion. Sex should be pleasing for both man and woman. Don’t let yourself ejaculate when feeling very happy, either. Essence will then accumulate, and qi accumulate too. Even if you live to 100, you will be healthier and stronger than ever. This was the principle of sexual intercourse followed by Shun. It is certainly unusual that genital worship should be expressed in such a manner. From this it can be deduced that the kidney, the kidney essence, the “life-gate” and “external kidney” (namely the genital organ itself) were all similarly stressed as “our congenital foundation” in traditional Chinese medicine. Third, the immortals’ methods of nourishment and daoyin are both used during intercourse. They are believed to make us healthy and enable us to live long: for example, taking medicine, “drinking dew” and “getting rid of the stale and taking in the fresh and new”. In Chinese sexology, orgasm is believed to be generating yin essence. It is the best if it is returned to tonify the brain — instead of being discharged. It is also not good if one has no sexual intercourse. A Guide to the Jade Room says, Huangdi asked Sunu: What is going to happen if somebody does not feel any want for sex for a long time? Sunu said: They should not abstain from sex. There is a law about the opening and closing of heaven and earth; the changing and transforming of yin and yang. People follow the alternate change of yin and yang and the four seasons. If you have no sex for a long time, your spirit and qi will not be able to diffuse and yin and yang will become blocked. Then how can you ‘get rid of the stale and take in the fresh’ to exercise the qi and tonify yourself? On the other hand, if the penis is not used for a long period of time it is just like being ‘dead in a small closed-off cave’. So it should fairly often have normal intercourse just as in daoyin. Who can make love actively but not ejaculate and then let the essence return to nourish his body? This is called ‘returning the

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sperm’. If you follow this practice, your way of life will very much improve. The key point is to keep the seminal fluid out of the penis during sexual intercourse. Yin essence is produced uninterruptedly during intercourse. It is then not ejaculated but returns to tonify the body. The body becomes like a manufactory of yin essence; the manufacturing skill is sexual intercourse; the aim is to tonify oneself, strengthen the body and prolong life by this essence. In the earliest theory, there was no idea of “picking and nourishing”, and no gaining of yin from the woman in order to tonify the yang of the man. But there was an idea of simultaneous feeding and daoyin (“leading and guiding the qi”), both used during the process of the sexual intercourse. There were also the “practices of the eight benefits” and “getting rid of the seven losses”. These were the secrets of success in following the theory and practice of Chinese sexology. The Great Top Dog Dao says, There are eight helpful practices and seven harmful practices concerning the qi during sexual intercourse. If one cannot use the eight helpful practices or avoid the seven harmful practices, his yin qi is halved by the age of 40, his life weakened by the age of 50, his hearing and eyesight not acute any more at 60. At the age of 70, his lower body is withered, his upper body collapsing, his essential qi unable to be used, and his nose and eyes running with snot and tears. But there is a way to recovery your strength: stop the seven harmful practices to cure disease and exercise the eight helpful practices to replenish the essential qi. In this way, the old can return and be robust and the robust not be senile. A gentleman lives a stable and happy life — with a good appetite; he then has firm skin, abundant qi and blood and an agile body. If one has sex rashly, his essential qi does not move freely, he will get sick and have the following symptoms: sweating, shortness of breath, asthma, irritation and disordered qi. If he does not get treatment in time, he will suffer from the disease of internal heat. Medicines and moxibustion can conduct the qi — but only medicines can help an external force. Strained intercourse can obstruct the essential qi and cause acne or boils, a swollen scrotum and similar problems. Qi and blood are abundant, but the nine orifices obstructed, the limbs become numb and ulcers happen as well. So a good use of the eight helpful practices and avoidance of the seven harmful practices will keep away all disease.

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During sexual intercourse, disease would be caused if the “eight benefits” are not handled properly and the “seven losses” not avoided — it is just like people practicing qigong incorrectly, which also can cause side effects. It will make them weak, and even cause collapse. The Suwen – Yinyang and Life also helpfully states, If one knows the eight helpful practices and seven harmful practices, one will harmonize his yin and yang. Otherwise, premature aging will occur, the yin qi halved by the age of 40, and one’s daily actions gradually decline. At the age of 50, one will feel heavy when moving and the ears and eyes not be sharp. At the age of 60, the sex organs wither and the qi very much declines, the nine orifices do not function well, the lower part of the body deficient while the upper is excessive; and tears and snot run out the nose and eyes. Therefore it is said that the one who knows the way to keep healthy is strong, while the one who does not know ages easily. Their bodies are the same, but the results different. The wise notice the common ground, while the unwise only notice the difference. An unwise person is short of qi, but a wise person is abundant in qi. Abundant essential qi can make the eyes and ears acute — and body agile. It also can make older people return to being strong again and robust — and the robustness increases health. The author of Neijing must have had a good understanding of sexology in putting these ideas concerning disease down in his book. But some parts were probably missed out. Later generations did not know the meaning of the “eight benefits and seven losses”. Therefore, the annotations made later by Wang Bing were wrong. The Book of Doctor Mind also deviates from the original intent of the text. The book of Great Top Dog Dao unearthed from Mawangdui restores the original meaning and appearance of these renowned “eight benefits and seven losses”: Eight Benefits: The first is making the qi strong and regulated in the penis; the second is gathering in fluid and its production; the third is time selection; the fourth is storing up the qi; the fifth is yin fluid harmonization; the sixth is holding back the qi; the seventh waiting for the qi to fill; and the eighth keeping an erect penis.

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A Practice to enhance these Eight Benefits: After getting up in the morning, meditate, straighten the back, relax the hips, contract the anus and conduct the qi down, which is called ‘qi regulation’. Swallow saliva, sit up vertically, straighten the back, contract the anus and guide the qi to the genitals, this is called ‘fluid production’. Man and woman first flirt with each other, then they have sex — as they both have a strong sexual desire. This is called ‘time selection’. During the process of intercourse, relax the back, lift up the anus and conduct the qi down, this is called ‘storing up the qi’. Don’t be rushed into intercourse. Draw the penis in and out softly. This is called ‘yin fluid harmonization’. Pull out after the semen is discharged. Stop the intercourse before the penis becomes soft. This is called ‘holding back’ or ‘qi accumulation’. At the end of the intercourse, guide the qi onto the back, hold it there and guide it down. Wait quietly. This is called ‘waiting for the qi and blood to fill’. At the end of the sexual intercourse, draw the penis out while it is still erect — which is called ‘keeping an erection’. These are the socalled eight benefits. The Seven losses: The first is closure of essence; the second is letting the essence escape; the third is essence exhaustion; the fourth is impotence; the fifth is irritation and worry; the sixth, impasse; the seventh, waste of essence. These Seven losses are as follows: if the man has pain in his penis or the woman vulval pain during intercourse, this is ‘inner closure’. If one is dripping with sweat during intercourse, this is called ‘letting the essential qi escape’. Immoderate sex exhausts the essential qi, and is called ‘exhaustion’. One desires to make love but cannot make it, which is called ‘impotence’. One is nervous and out of breath during intercourse, which is cause by ‘irritation and worry’. A man has sexual intercourse with a woman with no sexual desire, and this is called ‘impasse’. Rash or hurried intercourse benefits neither body nor activity, and this is called a ‘waste’. These are the seven losses. Therefore if one is good at using these eight benefits and avoiding the seven losses, he will have smart eyes and ears, an agile body, and strong physiological function. He will then live long and happily. Therefore, the “eight benefits” are the methods used to promote qi and store essence during intercourse; the “seven losses” are the problems or diseases

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we are prone to during intercourse. The “seven losses” are to be redressed through the “eight benefits”. The “seven losses and eight benefits” in the Book of Doctor Mind are just repeated from the Secrets from a Jade Room. But they have been altered beyond recognition. The “Eight benefits” then meant boosting essence, pacifying qi, benefitting the viscera, strengthening the backbone, regulating the vessels, accumulating blood, discharging semen and bodily posture. They were probably eight postures used during intercourse. Each could treat a disease, such as vaginal cold, irregular menstruation, white pubic hair. The aforementioned “seven losses” were similar, but also quite different. They are as follows: The first loss is ‘qi exhaustion’. Qi exhaustion refers to sex with no sexual desire but still forcing it — this leading to sweating, qi exhaustion, vexation and the eyes not seeing… The second loss is called a great discharge of seminal fluid. This is because of when one’s mind very much wants to make love — before yin and yang are in harmony — the semen is already coming out and spent. Some people have sex after drinking alcohol — which causes qi disorder and being out of breath, damages the lung, and brings up coughing, with the qi going on to lead to diabetes… The third loss is called vascular loss which refers to when one makes love and the penis does not become hard — with a forced ejaculation halfway through — so that the essential qi is exhausted; or there is also sexual intercourse after overeating — which damages the spleen and causes serious indigestion, and leads to penile atrophy and a lack of seminal fluid… The fourth loss is ‘qi leakage’. Qi leakage refers to making love when tired and sweaty, which leads to abdominal heat and dry lips… The fifth loss is visceral injury. Visceral injury refers to having sex when needing to pass urine or stool — so the forced lovemaking then causes liver damage. Or else one has rushed intercourse… After many times, he will suffer then hemiplegia and penile atrophy… The sixth loss is called ‘manifold closure’. This refers to one indulging in sex without moderation. Immoderate intercourse exhausts the essential qi. Though he tries to ejaculate, he cannot — as he is empty of seminal fluid. Then he will be attacked by manifold diseases… The seventh loss is called blood exhaustion. Blood exhaustion refers to having sex in a hurry after heavy manual labour or walking a long way, or being very tired and sweating and then having sex, or lying

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down and penetrating deep into the vagina, or being in a rush and hurrying, ejaculating again and again, until the blood and qi are totally exhausted. He will then become very feeble and suffer from penile pain and a greasy scrotum. The semen finally turns bloody. Every loss can be treated through an adjustment in the posture of intercourse. But here they are expressed differently from those in the The Great Top Dog Dao. We might regard the development of the idea of the “seven losses and eight benefits” as being influenced by the Secrets from a Jade Room. The “Eight Benefits” were for guiding and promoting qi. The “Seven Losses” can be regarded as diseases produced by excessive intercourse. In short, it can be seen that there was a fundamental change in Chinese sexology as it moved from theory to practice during the Han Dynasty — especially after the establishment of Taoism as a religion. A “picking and nourishing” or “picking and fighting” method of intercourse, along with its accompanying “internal alchemy”, was the main characteristic of Chinese sexology. Further explanation of these terms is given hereafter.

139. “Picking and Fighting” and the Inner Alchemy of Chinese Sexology At the beginning, the “picking and nourishing” and “nourishing” methods were terms referring to self-picking and self-nourishing. But from the Eastern Han Dynasty onwards, they included “picking up” the yin to “nourish the yang essence”, that is, taking from a sexual partner to benefit oneself. But there was no clear defining line between these two practices. In Ge Hong’s Just Be Simple it says, There are more than ten schools of sexology used for restoring overstrain, or treating diseases, or picking yin to nourish yang, or prolong life. But the gist is to return the essence to nourish the brain. It was originally not written down but dictated and taught between immortals. If one does not understand the gist of it, he will not live long — even he takes a famous and rare medicine. One can’t live without sex. If one does not have sexual intercourse, he will suffer from a blockage of the qi and blood. The blockage of yin and yang will make people clog up with disease. So, if people get lonely and grumble over a long period of time and have no sex, then they get ill

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and live short lives. On the contrary, immoderate intercourse will also shorten their lives. Only a regular and moderate sex life and being moderate and in harmony will not damage the body. Without this mantra, none will be free from self-harm… It seems that sexology was being mystified, even in Ge Hong’s era. It even had its own standard and pithy formula, i.e., “picking yin to nourish yang”. The standard was set in Sunu’s Scripture: Huangdi said: What’s the controlling standard for sexual intercourse between man and woman? Sunu said: There is an inherent standard in sexual intercourse. It can not only keep men from aging and women out of sickness, but also can make them happy and more energetic. If people do not understand how to control it, they will age and become injured, more and more. One should know this: The key is that the man and woman must remain calm, peaceful and harmonious in spirit. Once these three arrive, all minds come together. The bedroom must be neither too cold nor hot; people should not be full or hungry. The bodies are our fine possession. They must feel easy and comfortable in order to have sexual desire. At the beginning of intercourse, the penis should be inserted into the vagina shallowly, gently and slowly. Fewer and fewer times, let it enter in and out. Then the woman will be happy and comfortable and man’s sexual function becomes stronger and stronger. These are the standards of intercourse for man and woman. From this passage, the picking and nourishing method can be seen to be both beneficial and suitable for man and woman. Not only can the male pick qi from the female but also the female can pick qi from the male. This is different from the former-mentioned method during the Qin and Han Dynasty. The Secrets from the Jade Room says, If one knows the law of nourishing yin, the two harmonious qi can transform into a fetus to produce a male baby. Even they do not transform into a male, they will turn into essence and it run into all the vessels to nourish the yin with the yang. Thus all diseases are

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eliminated, the complexion becomes nice and colorful, the muscles strong. Your life lengthened, and you look as young again. If one masters this law and often has sex, you will not be hungry even though you do not eat for nine days. Yet the sickness of making love to a ghost will produce this. She will become thin making love to a ghost, let alone having sex with a man. Men can nourish women, women can nourish men too, borrowing yin to nourish yang and borrowing yang to nourish yin. This is the great achievement of Chinese sexology. It was also an expression of its first great transformation and development. The second great change was to advocate lovemaking as much as possible. Don’t discharge after “ten rounds in the vagina”. It even states in Intended Essence in the Jade Room, “Dozens of bouts of intercourse without seminal emission in a single day can cure all diseases and prolong life.” To this end Sun Simiao put forward a new theory of “several bouts of sexual intercourse with only one ejaculation”. He said, If one’s semen is little, he will get sick; if one’s semen is exhausted this can cause death. One must be careful. If one has intercourse several times, but ejaculates only once, his essential qi will recover quite soon and not be feeble. It cannot benefit man for him to have sex only a few times and ejaculate quickly. Discharged essence will grow back naturally. But it grows back slower than when one has intercourse without ejaculation.2 One not only “had several bouts of intercourse” with one woman but also intercourse “with many women without ejaculating once”. This was another development of the picking and fighting or nourishing theory in sexology. Sunu’s Scripture says, The key point in intercourse is to have it with many young girls without ejaculation. It will make the body agile and eliminate all diseases. 2

 From his Qianjin Yaofang.

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The Important Guide to the Jade Room also says, Peng Zu said: Huangdi became immortal by having sexual intercourse with one thousand and two-hundred women, but ordinary people die while having sexual intercourse with only one woman. This is the extreme difference between knowing the way and notknowing the way. Any man who understands this will worry about not having enough women to have sex with. In addition, a virgin was thought to be the best sexual partner. For example, A sexual partner needn’t be beautiful, but she must be young, strong and have had no children. It is greatly beneficial to have intercourse with seven or eight such women. (An Important Guide to the Jade Room) If a man wants to gain great benefit then it is good for a man to have sex with a woman who does not know any sexual truths. The woman should be a virgin or her facial color the same as a virgin’s. A young one is best. She must be at an age between fourteen and nineteen. She should not be over thirty years old. But there can be no gain or benefit having sex with a woman who is not yet thirty, but has given birth to a child. My master told me that an enlightened man can live three thousand years and even become an immortal with the help of this medicine. (Secret in Jade Room) So many sexual partners! Furthermore, they must all be young virgins! Have many times a day! This is why the “picking-nourishing method” is also called the “picking-fighting” method. No “fight”, no win! The third change was that the practice of daoyin promoting qi during intercourse was further emphasized during this period. This method of promoting qi has also been studied a great deal. First of all, you must wait for the arrival of qi. It is good if the qi arrives. Otherwise, people will get injured or even die young. Xuannu’s Book says, During intercourse, one must wait for the arrival of the four qi, which can arouse the nine qi of the woman… Even after the four qi arrive, one should also have intercourse in a moderate manner. Don’t have sexual intercourse in a rash manner. Don’t ejaculate needlessly.

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Stroke her gently to awaken her sexual desire and wait for all her nine qi to arrive before having an intercourse with such a woman. She will get injured if even a single qi does not arrive. The method of arousing the qi is also recorded in the Qianjin Yaofang: Qi gathering means inserting the penis deep into the vagina and keeping it still for some time. As the qi goes upward, the face will get hot. Mouth to mouth, breathe in the woman’s qi and swallow it. Draw the penis in and out, slowly. Draw the penis out before the orgasm comes. Close the eyes to regulate the breath. Lie on the back to ‘guide and conduct’ (daoyin) the qi. Then the body will be stronger. You can also have intercourse with another woman. The more women you change to, the greater the benefit. Man often has intercourse with only one woman which is not good for him — because the yin qi of the women will become weak. It is helpful to breathe in with the nose and out slowly with the mouth, during intercourse. People feeling hot after intercourse are a sign of obtaining qi. Apply calamus powder (three fen) and ginkgo onto the penis and vulva — this can not only strengthen the body, but also prevent wet sores. If one is going to ejaculate, one should close up the mouth, open the eyes, stop the breath, clench both hands tight, wrinkle up the nose to inhale the qi, contract the lower part of the abdomen, slightly lengthen the spine, and immediately press on the perineum acupoint with the left middle-finger and forefinger — exhale the qi slowly and knock the teeth together four times. Then the essential qi will go upward to nourish the brain and you will live long. Such specific guiding and conduction of the qi during intercourse had not been seen before. What’s more, it could be used directly to treat disease: The method of ‘regulating the five viscera’, when helps the digestion and cures many diseases: As one is going to ejaculate, one should relax the abdomen and put the mind on the qi, control the ejaculation and return its essence to all vessels. Insert the penis into the vagina shallowly nine times at a depth again between the qianxuan and the maichi; in this manner the healthy qi arrives and the evil qi

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is gone. This is a method to treat back pain: With your back against the wall, stretch out the waist neither low nor high, but just at the same level. Make the essential qi go upward instead of naturally going downward. To tonify deficiency, nourish the body and treat disease, one wants to discharge — but one really should not; simply return the essence to the body, flowing and distributing the heat of it throughout. The method of ‘brightening the eyes’: As one is going to ejaculate, he should lift the head, hold breath, shout loudly, open eyes to look around, contract abdomen and return the essence into all the veins of the body. The method ‘to make the hearing acute’: As one is going to ejaculate, he should swallow the qi, grit the teeth and hold the breath making a sound like wind in the ears, contract the abdomen again and reinforce the essential qi so it runs all over the body. Then he will not go deaf even when he is old. (all the above quotes are from Secrets in a Jade Room) Thus, the qi of the woman can also be used to tonify the man, after ejaculation. Active semen closure and passive semen closure were invented — along with the promotion of the qi through daoyin. All in all, “picking and fighting” increasingly moved towards inner alchemy during the Sui and Tang Dynasties. In the Scripture of the Immortals quoted in Sun Simiao’s Qianjin Yaofang this type of inner alchemy is acutely described: The Scripture of the Immortals says: If one wants to live long, one must have intercourse as follows: First flirt with the woman and suck up her ‘jade juice’. Jade juice refers to the saliva in her mouth. As both man and woman are moved, grip the left hand, imagine a mass of red qi, with yellow within and white without, in the dantian place. It gradually turns into the shape of the sun and moon. They dither and dally around together — and then from the dantian, enter the niyuan palace (‘mud walled’ palace, i.e., brain) — both halves united into a complete ball. Hold the breath, and insert the penis into the depth of the vagina. Don’t draw the penis in and out, but breathe in slowly. Draw the penis out as soon as it is going to ejaculate. Only a wise man can do it. The dantian is three inches below the navel; the niyuan lies in the brain — just opposite the point between the

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two eyes, and is linked with the inner thinking. Imagine a sun and moon with a diameter of about three inches. They unite into a ‘sun–moon sphere’. It is good for man if he can keep visualizing this at the same time as he draws his penis in and out. It is also said: there is a method for both man and woman to find immortality: keep imaging a red ball as large as a hen’s egg behind the navel — do not move, but remain quiet after the penis is inserted in the vagina. You can draw the penis in and out gently as if one was going to ejaculate — but do not let it happen. One will be healthy if one can manage to do this dozens of times a day and night. Then the man and woman each can meditate and uses their visualization together. This is imagination, with a strong will! Obviously, this was a very early method of inner alchemy, knitted to sexology. The Secret Book of the Five Sets of the Dragon’s Power also says, Inner alchemists store their spirit in their brain (niwan) and lift the qi up from the dantian. When there is spirit arriving, qi is following. The skill in sexology is to press the tail acupoint, to breathe in the qi and swallow the fluid — even though you just get the thread of it, you will still not ejaculate. Sexology was obviously included in the inner alchemy of Zhong and Lu’s Collected Preaching’s. But the terms of sexology had been replaced by a secret language, using such words as Kan and Li (“water” and “fire” trigrams from the Zhouyi), dragon and tiger, lead and mercury. To Understand the Truth written by Zhang Boduan, one of the Taoist leaders during the Song Dynasty, was also about inner alchemy and sexology, and its described the “seven steps”: focussing attention to calm the breathing, conducting the qi to open up the pass, keeping the essence to forge a sword, gathering in medicines to build a foundation, returning the dan to form a foetus, nourishing the body with the “fire signs” and holding and keeping in the unique yuan qi — a combination of spirit and qi. The book is written in rhyme. One of these rhymes goes as follows: Everyone has his own elixir, But it is abandoned by ignorant persons. Nectar is produced as the earth and heavens meet;

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A yellow sprout (i.e., Dan) is bred where kan and li intertwine. A frog at the bottom of well does not know the Dragon Palace; A quail in the hedge does never know the phoenix’s nest. As the dan is made, the house will become brilliant. Why search for an elixir from Mount Maoshan like others? This rhyme obviously reveals the making of an inner dan during intercourse. A variorum by a certain Zhiji Zi (“Knowing the Seed Master”), put together during the Kangxi period, was said to reveal the truth about combining inner alchemy with intercourse. One illustration is as follows: The true dan must come from her first menstruation… it is produced at the chaotic and innocent age of 14… Her lips must be as red as amber, her pupils black as lacquer. As these three conditions come together, an inner dan is made very soon. Such Taoism monographs as Life’s Dogma (性命圭旨) are all cited as classics. And inner alchemy and sexology have been united together every since. A term such as a “flower thief”, used in several novels, is also a kind of ironical criticism. However, any Taoist is not equal to a “flower thief” if he has his own strict discipline. There are many stories about fox spirits turning into beautiful women and having sexual intercourse with men to take their essence away from them, or of finally become immortals. These stories are certainly spurious. It is said in Jottings from Yuewei Cottage written by Ji Xiaolan that “‘the picking and nourishing’ method, which ‘looks attractive’ is just the same as ‘a cut-price sale’… this way of working will hurt many, and is against the law of the heaven.” These words of caution are true. Most of the stories about “picking and fighting” during inner alchemy are about “a woman picking from a man”, as opposed to a man drawing strength from a woman. Indeed, the “picking and fighting” of the female Taoist included picking yang to nourish yin — and another way of practicing inner alchemy was “cutting the red dragon”. “Cutting the red dragon” was an abstruse Taoist term, referring to breaking off menstruation. “Red dragon” refers to menstruation. It can be stopped by Taoism practice, so it is “cut off”. Then inner dan is said to be successfully made. The female practice during intercourse seems to be more complicated and subtle. It is said in the Qiaoyang Scripture for Woman that “If she makes an inner dan successfully, she will turn into ‘a jade palace covered with colorful clouds, numerous channels running through her head’; ‘her face as colorful as peach blossom and skin as beautiful as jade. The red

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dragon will not come any more. She will have a clean body, free of any dust. After accomplishing her pious deeds, she will fly to the Jade Palace in the heavens.’” One even can practice the following kongfu successfully: “One will feel hot in meditation. Suddenly a flaming pearl is shot out one zhang (three meters) high, like lightning, from the nose.” This is a Taoist fighting spell. It can be read about in many novels of the martial arts. From the medical point of view, female practice during intercourse meant to control and change one’s menstrual physiology by an act of will. It is not impossible, but it is impossible for common people to do it and actually is self-destructive and leads to deprivation of sex. Menstruation is also known as the “red lead”. The Compendium of Materia Medica says, Some alchemists fool people with their enchantments. They order people to eat a virgin’s first menstruation, which is called ‘congenital red lead’. They name it by various subterfuges and use it in many ways, such as calling it the ‘golden flower’ from the Participation Bond and the ‘very first menstrual period’ mentioned in Zhang Boduan’s To Understand the Truth. Foolish people believe them and eat such filthy things, thinking them to be a secret recipe! They take it and then often suffer from skin rashes. How hateful. This is a variation of the picking and nourishing method. Gathering part of the menstrual flow in order to make a medicine for nourishing yin and yang was very popular during the Ming dynasty. It was called making a “fairy panacea” or “red pill”. It was recorded in the Wonderful Regimen by Zhang Shiche during the Ming that this medicine “had the function of making people vigorous with a unique spiritual sense about them. Even thousands of doses of herbs are not better than one dose of this.” The famous case of the “Red Pill Event” during the time of the Ming Emperor Guangzong was a historical example of this. In fact, Chinese sexology declined after it turned into inner alchemy. People believed that “Pengzu says that man’s best accomplishment is his own bed for sleeping in — and a good man has his own bed-quilt. To sleep alone is better than taking a hundred medicines!” He was also heard to have said, “Each bout of sexual intercourse will make you live one year less.” “If one wants to be immortal, one should stop sexual intercourse before taking immortal medicines” (Qianjin Yaofang). Physicians criticised greatly the idea of longevity coming from sexology. The physician Zhu Danxi said,

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You may ask me is the ‘nourishing method’ coming from Chinese sexology and mentioned in the Qianjinfang useful, and should I use it? I reply: … Now then, sexology is helpful for tonification. It is useful for the perfect gentleman who is strong but calm as well and never over-excited when facing a woman. But it is not easy for one who is neither a sage nor an immortal. Woman is water, man is fire. Water can restrain fire. Intercourse is natural if one is willing to give — and another is willing to take. But it will kill people many times, if it is taken as one’s nourishment. I find now that since the old times, human customs are becoming worse and worse, and support for them less and less. Tonification by intercourse is absurd. It is like talking in a dream and questioning a fool! (Further Discourses on the Properties of Things) The Ming dynasty physician Wan Quan made it clearer: Too much intercourse will injure the tendons, too much ejaculation will injure the essence. The liver governs the tendons, which is yang within yin. Tendon damage will lead to yang deficiency, which will easily lead to impotence. The kidney governs the essence, which is yin within yin. Essence damage will lead to yin deficiency, which will lead to spontaneous erection. Both yin and yang deficiency will lead to spontaneous erection, impotence and frequent ejaculation. Though one wants to make love, it is impossible to do it. At this time, if he wakes up sooner and stays away from women, free from sexual desires and changes his ways to staying peaceful and clear of any areas where there are songs and dances; nourishes his body with grain and meat and supplements his deficiency with the best medicine — then his sick body will recover, just like a broken house may be repaired. If one does not see his own error, but keeps to a dissolute life, takes medicine to invigorate the yang and learns more sexual skills, he will break his life open — and it will be beyond cure. Even the Godness Nu Wa can do nothing for him — from skeleton to grave. Today people love to meddle; they consider sexual intercourse an immortal skill. They consider the ‘nine to one’ sexual skill can extract a woman’s qi and turn it into primordial qi — and so return the essence to nourish the brain. They cannot know that none can control this turbid qi — and the spent essence is like a broken bow. People cannot even control even their own sperm, so how can they manage to take anything from others? Some speak of keeping their

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spirit untouched and taking qi from another. Where is the sense in this? So then they suffer from gonorrhea. Others advocate controlling ejaculation and call it ‘the Yellow River counter-flow’, or ‘dragging back the white buffalo’. They do not know that stopping ejaculation quickly leads to carbuncles. This is not helpful and it only harms people. (from A Summary on Reproduction) These are all the brilliant opinions of medical professionals.

B.  Sexual Perversions and Disease “Sex” has always been of the greatest concern to humankind, over a long period of time. There is sexual freedom, the skills of coition medicine, sexual taboos, sexual mysteries, sexual prohibitions and so on. Therefore, sexual disease, sexual repression, sexual perversion, venereal disease, etc. are very common. All of these are interrelated in medicine.

140.  “Lovesickness” and Various Sexual Perversions Chinese call the psychological disease and need for heterosexual love “lovesickness”. Though “lovesickness” is an emotion for love and tenderness, it can also be caused by sexual starvation. It was noted as early as Cang Gong’s case record (Western Han Dynasty) in Historical Records – Biography of Cang Gong: A maid of the Jibei king, with the surname Han, had low back pain, chills and fever. Many doctors considered she suffered from chills and fever. After feeling her pulse, I then said: It is internal cold. Menstruation is blocked. I will give her herbs. After a while, the menstruation came and she became well. She was ill because she had wanted a man to have sex with. This woman suffered from amenorrhea, cold and fever because she desired a man. It was also recorded in the Experiential Formulae for Universal Reliefs written by Xu Shuwei: Chu Cheng in the Song Dynasty treated nuns and widows with a special prescription. They live alone and yin is not accompanied by yang. Their sexual desire could not be satisfied, so yin fights with yang…

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Today, the remains of Mr. Chu’s Book record that “a woman will suffer from disorder if she has no sexual intercourse with a man for more than ten years after her tiangui (menstruation) comes.” Tao Hongjing also said, “Chu Cheng used different kinds of treatment for widows and nuns, different to that used for wives and concubines.” This kind of problem often causes irregular menstruation. The Suwen – Yin and Yang Extra Theory in the Neijing says, “Sickness in the two yang channels starts in the heart and spleen — these patients often like to keep secrets which they will not speak to anyone. Such female patients suffer from amenorrhea.” In Preserving Health and Prolonging Life, Tao Hongjing cited Pengzu who said “that man cannot live without woman nor can woman live without man. If one lives alone and wants sex that could cause one’s life to shorten and there will be many illnesses. One even dreams of having sexual intercourse with a ghost. In cases like this one ejaculation and loss of spirit is equal to, and as harmful as one-hundred ejaculations.” On the contrary, Xuannu’s Book says, “People cannot live without sex. Otherwise, they will suffer from carbuncles etc. So, living alone and complaining will make them ill and their lives short; unrestrained sexual intercourse will also kill people. Only moderate behavior in intercourse is good for people and will cause no damage.” The Qianjin Yaofang says, Man cannot be without woman; woman cannot be without man. If a man has no sexual intercourse with a woman, his emotions will not be at peace. Disturbed emotions will overstrain the spirit, and shorten life… If a man represses his own desire, he will suffer from spermatorrhea and turbid urine. He even dreams of having intercourse with a ghost, which is as harmful as one-hundred intercourses to the loss of spirit. According to Freud’s theory, the subconscious reason for all mental diseases is unsatisfied sexual desire. The understanding about sex in ancient China was not only thousands of years earlier but also limited in its proper range. The most common illness was “ghostly intercourse” caused by “sexual intercourse with a ghost.” The General Treatise on the Causes and Symptoms of Disease sought out the root cause as being in the actual deficient organs themselves: Because of deficient viscera and a weak spirit, women will have sexual intercourse with a ghost and fall ill. The symptoms are as follows: They

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like to stay alone; to be obstructive; to mutter and murmur; sometimes to weep. The pulse is slow and hidden, lurking or pecking. Sometimes the pulse is tiny, continuous or cannot be found. However she appears as normal. Someone with weakness in the zang viscera tends to dream of women, or of intercourse with a ghost. The weak qi of the viscera fails to keep them in spirit, so taking advantage of this weakness then the dream of intercourse with a ghost comes in. It is reasonable to look for an internal cause in the constitution. Zhang Jingyue said, There are two patterns of women dreaming of intercourse with ghosts. One is that the sexual desire disturbs a woman’s will — so that the ghost is born within the heart instead of coming in from outside. The other is that she is born with an impure natural endowment and then attacked by a ghost from outside. Different causes, inner and outer cause different patterns. Diseases from within have few signs — except sometimes dreams of intercourse with a ghost, and vaginal discharge. Other symptoms include trance, turbid leucorrhea and vaginal discharge at night, just like any other nocturnal emission. However, most women will not admit to this. The pattern caused by an external evil is different. She speaks or laughs abnormally. Sometimes she acts as if ‘dating a ghost’. She likes to stay alone, or weep for no reason. But she looks normal and even appears as sweet as a peach flower. Her pulse is sometimes slow, sometimes rapid, or deeply hidden, or rapid and knotted, or taut and tiny, or intermittent. These are signs of the evil. If she does not receive good treatment, she will not recover soon. Then her essence and blood decline day by day, and the genuine yin is damaged day by day, until finally she suffers from tidal fever, weariness, poor appetite, loss of menstruation, emaciation, and general overstrain… (Complete Works of Jingyue – For Woman) What Jingyue is describing here is severe depression and pubescent insanity. Mental disease accompanied by many strange symptoms is easily mistaken for the action of an “evil intrusion”. However, he treats it with a “spirit-returning decoction” and moxibustion instead of dispelling the ghost. So he is not serious when he categorizes it as “evil”. The fox spirit

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stories in novels should be regarded as somewhat different. But these folk tales influenced medicine. For example, talk of a “ghost fetus” is somewhat similar. An unmarried woman suddenly lost her menstruation. Her abdomen was very large, just as if she was pregnant. Her face was suddenly red, suddenly white. Her six pulses were suddenly big, suddenly small. People considered her to be suffering from amenorrhea due to blood stasis. Who knows whether a ghost has entered her body? Or she is absent-minded and always dreaming about being married; or looks dull and undignified; or asks her relatives to look for a husband for her, but dates with someone else secretly; or else she claims to be an immortal, but secretly seeks out her own pleasures. At first, she is amazed at her adventures but refuses to tell anyone else; later she is ashamed to tell others. After some time, she will develop a large belly like a pregnant woman… (Fu Shan: Immortal Formulae for Woman) This story must be far from the truth. The “ghost fetus” may have been an abdominal mass or a neurosis. In this case it was not a ghost which had given her the idea of a foetus at all. Doctors of coition medicine have a therapeutic tool for “women without husbands”. There is a record about a penis substitute in The Secret in the Jade Room and also in Sunu’s Scripture: Peng Zu said… some will use a penis made of flour or ivory, like a male penis, and insert it into the vagina. But if they are unlucky they may easily damage themselves and die young. A woman aged 28 or 29 may appear just like a woman of 23 or 24. She will have strong yin qi and desire a man, and cannot control it. She will suffer from a poor appetite, forceful pulse and vaginal discharge befouling the clothes. The treatment is to make a flour penis of a variable size and insert it into the vagina. (Secrets from the Jade Room) This kind of penis substitute made of ivory or flour may be the origin of the phallic goods sold in sex shops in the West today. Among all sexual perversions, foot binding has had the most influence on the Chinese lady’s health and personality. Foot binding can be dated back to the phrase, “Yaoniang danced with her bound feet” during the reign

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of Emperor Li Houzhu of the Southern Tang and Five Dynasties. It is said that Yaoniang danced on a six-foot-high golden lotus-petalled basin. Her graceful dancing and charming figure attracted the audience. However, I think Yaoniang was a girl from the West. The character Yao (窅) refers to sunken eyes, which are not a feature of Chinese women. So foot binding may have been introduced from abroad. Women enjoyed more openness and freedom during the Tang dynasty. Fat women with bare breasts were common in murals. The appreciation of women’s feet was also traditionally enjoyed by men. Yaoniang dancing with her bound feet attracted not only the Li Houzhu emperor but also all the people in the country. It is said in the Han Feizi – Punishment and Award that during the Spring-Autumn Period “the king of Yue loved the brave, so his people did not take death seriously; while King Ling of Chu loved a slender waist, so many people were willing to starve themselves.” There was a social climate and psychology advocating fashion — and following the example of the nobles. The popularity of foot binding was not unusual at that time. Some scholars have started to study the history of foot binding during the Ming Dynasty. Yu Zhengxie discusses it in his Classified Compilation made in a Gui-Si Year. Qian Yong of the Qing Dynasty collected all the works about it in his Notes made in Lu Park. In 1936, Yao Lingxi published A Collection Rich with Fragrance in five volumes in order discuss this. Mr. Pan Guangdan thinks, The Chinese social climate and their system of foot-binding obviously were closely related. The tendency to ‘love the feet’, was pointed out at its earliest by Guo Moruo in his preface to The Romance of West Chamber. ‘Foot love’ here is termed ‘foot fanaticism’, by Mr. Guo.3 The most typical example of foot fanaticism is the relationship between Emperor Cheng of the Han Dynasty and Zhaoyi Zhao (that is, Zhao Hede, the sister of Zhao Feiyan). Mr. Pan Guangdan comments, The sexual relations between Emperor Cheng of the Han dynasty and Zhaoyi Zhao in Ling Xuan’s Biography of Zhao Feiyan prove sufficiently that sometimes there is a close relationship between feet and sexual excitement. ‘Emperor Cheng had been out to hunt on a snowy 3

 Sexual Psychology, the version translated and annotated by Pan Guangdan in 1943, Joint Publishing, 1987, p. 266. The next quotation is from a note in the same book.

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morning. He had got cold so he could not have a good erection. But every time he held Zhaoyi’s feet, he would have a strong sexual desire and his penis would erect itself quickly. But Zhaoyi was always turning her body away from him so the emperor could not hold her feet any longer. Fan Yi said to Zhaoyi: the great dan of the alchemists cannot make the emperor have an erection, but holding your feet can — and make him very happy! How lucky you are! Why do you decline the emperor’s penis? Zhaoyi answered: I sleep with my back to the emperor so that I can keep him there. As my elder sister said: once the emperor gets what he wants, he will be tired of you. It does still seem to work!’ So it seems only the feet of Zhao Hede had this magic, those of Feiyan did not. As a sexual perversion, foot love does certainly exist. According to Ellis’ Sexual Psychology, (Henry Havelock Ellis 1859–1939) this “sexual variation” or sexual perversion actually is a variation of normal sexual life. The patterns of human sexual life are many: foot love, fetishism, shadow love, old poplar love, love between a youthful boy and girl, paedophilia, even homosexuality, stolen love, naked love, sadomasochism, fur love, animal love, love of defects, etc. They are all fantastic and strange actions. Mild variations can also occur, such as the performances of deep obsession, i.e., sadomasochism, which includes a “sadomasochist performer” and a “sadomasochist receiver”. The former is pleased to whip and bite the sexual partner; the latter is pleased just to be whipped and bitten. Most people cannot understand it. In fact, it is a symbol of deep love, just as is said in the folk song, “I would like to be a young sheep by your side; I wish your whip gently flicked over me.” But if this goes too far, it becomes sadomasochism and sexual perversion. Foot love evolving into the prevalence of foot binding which was an idiopathic example of this in ancient China. First, sexual variation occurs in some men; then it becomes popular because of the psychology of fashion; finally it becomes a system which forces women to bind their feet due to feudal ethics. It cannot be explained by foot love or shoe fetish alone. It is a combination of the complex social and cultural background, psychological factors and sexual perversion, which cruelly changes the life of women, distorts their soul and destroys their physiological health. Foot binding is unspeakably miserable for women. It also affected the female labour force and the development of fencing, dancing and riding in China. After the popularity of foot binding at the end of the Song Dynasty, only a few women liked to and could dance well in the Han nation, and they

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appeared less often as the heroine. Instead, we have small embroidered shoes and pieces of long, smelly foot-binding cloth. Yu Zhengxie said in his Classified Compilation made in the Gui-Si Year that “the July of the third year of Chongde (1638), the government stipulated that people following the outlying regions custom of binding feet will be severely punished. So after this, girls born after the second year of Shunzhi (1645) were banned from binding their feet. But this ban was lifted in the sixth year of Kangxi (1667).” Foot binding was actually prohibited by the Qing dynasty before and after they passed the frontier. But after seizing power, they became assimilated into the Han customs. The Taiping Heavenly Kingdom also issued a prohibition on foot binding. Foot binding was completely annihilated after the Peoples’ Revolution in 1949. Homosexuality is a kind of sexual perversion. It can be found in ancient China, but it is not as common as in the West. There are some special terms for homosexuality, such as stories of the “remaining peach” for the homosexual man, the “cut-off sleeve” for a same-sex sleeping companion, and the titles “Lord Dragon Yang”, “catamite”, “my matching duke”, etc. Homosexuality and lesbianism are called “sexual perversion”, “contrary sexual feeling” or “uranism” in the West. Homosexuality is always regarded as a variation in yin and yang, man and woman in China. It is taboo because it makes for confusion between them, a man looks like a woman and a woman looks like a man. However, homosexuality is still not uncommon. The History of the Jin Dynasty-The Biography of Shi Jilong records, “Prince Zhanshi Sun Zhen asked Shizhong Cui Yue: I suffer from eye disease. How can I treat it? Yue often performed unnatural sexual acts with Zhen and teased him: ‘Pee on them.’ Zhen asked: Eyes can be peed on? Yue said: Your eyes are set so deep they are easy to pee on. Zhen hated him.” To keep a young boy as a catamite became part of the fashion. They were even castrated so they could be playthings for someone over a long period. But the record of The History of the Song Dynasty – The Record of Taizu states, “Since June, no remission for anyone daring castrate a boy for his own amusement.” He Bang’er in the Qing Dynasty also told a story about a homosexual’s psychology and its deleterious consequence in his Essays of the Night: In the period of Emperor Yongzheng, a candidate from Changshu county went to participate in the Jiangnan (South of Yangzi river) examination. He was more than forty years old. He performed very well in the first two exams and was in high spirits. He lived in the Shu room for the third examination. The night of the Mid-Autumn

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Festival, he enjoyed the glorious full moon and recited his own poems with friends which included these two phrases: ‘The moon is full tonight, but the beauty has gone.’ His friends asked him why. He sadly answered: ‘You are all scholars, so I may just as well tell you the truth. I am reminded of a trip in Wu county, teaching at a gentleman’s home. My four students were all my master’s sons or nephews. A student surnamed Liu, his wife’s nephew was very beautiful — like jade, and charming. I teased him several times, but he pretended he did not understand. One day it happened to be a festival. The students had a holiday and went to sweep the graves, leaving student Liu alone with me. I teased Liu again with a poem. ‘For whom is your embroidery quilt prepared? Our meeting is providential. Oh, beautiful jade tree, can you permit a phoenix to rest on it?’ Liu read the poem, and his face flushed. He crumpled the paper of poem and put it into his mouth. I thought he was moved. One of my friends was just serving food for us. I put a prepared aphrodisiac into the wine, which easily can make people drunk and slightly crazy. I forced him to drink a big cup of it and my lust was finally fulfilled. The next day, he found himself defiled when he woke up. He hanged himself in his bedroom. His family was unaware of the truth, but I know it. I could do nothing to let them know but found myself weeping. The master reported it to the authorities, but the case was finally dismissed after half a year. Tonight, the moon is as beautiful as the one that night, and the feeling is coming on me again. Who can release me from it? I am so sad — that is why I recite this poem.’ As he said this, his tears came down uncontrollably. The audience was terrified and thinned out. After dawn, there was a sudden hubbub. People run around spreading the news: ‘Someone is hanging in the toilet.’ In the early morning, people found out it was the scholar from Changshu.

141.  Diseases of the Sexual Organs and Functional Disorders Diseases of sexual organs include those of the gonads and the external genitalia. They are recorded as peculiar phenomena in the official as well as unofficial histories: In the Jin Dynasty, there were some people with both male and female bodies. They could have sexual intercourse with either a man or a

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woman and were very promiscuous. (The History of the Jin DynastyFive Elements) This is obviously an example of true hermaphrodism. Those recorded in The History of the Ming Dynasty – Five Elements are false hermaphrodism or a change in external secondary sexual characteristics, caused by an endocrine disorder: In the twenty-seventh year of Jiajing (1548), the daughter of Ma Lu who was a relation of the military general Ma Ji in Datong, turned into a man at the age of seventeen. In the December of the second year of Longqing (1568), Li Liangyu, a man in Jingle County turned into a woman. In May of the sixteenth year of Hongzhi (1503), the wife of Zhang Benhua in Yingshan, with the surname Cui, grew a three-cun long beard. At the same time, a merchant’s wife in Zheng Yang grew more than a hundred different strands of beards, as well. There are 13 examples of a man turning into a woman and a woman into a man in A Record of the Calamitous and Bizarre in the Draft History of the Qing Dynasty. They were regarded as disasters by the people. This was understandable — it was the attitude of the world at that time. The story about Li Liangyu turning into a woman was also recorded in Essays from an Island by Lu Ruoteng in the Qing Dynasty. Li Liangyu in Jingle County had been married to Miss Zhang for four years. Later he divorced his own wife and became a servant because of his poverty. In the first month of the first year of Longqing, he occasionally had intermittent abdominal pain but they stopped of themselves. On February 9th in the second year, the pain became serious and persistent. In April, his scrotum retreated into his abdomen and turned into a vulva. The next month, menstruation arrived. Then he started to wear female clothes. At that time, he was twenty-eight years old. A Collection of Bizarre Stories by Zhang Sizheng of the Song Dynasty records a story of a woman turning to a man.

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There was a Mr. Xiao in Guangzhou. People called him Dugang because he sailed across the ocean for trade. One of his maidservants suddenly fell pregnant. Mr. Xiao doubted that she had had an affair with a servant. He was cross and interrogated her. She replied: I have had a personal affair with your eldest daughter. Mr. Xiao has an eighteen year-old daughter, engaged to a Mr. Wang’s son. At the age of ten, she had turned into a man, but her family did not know it. After that, her story became well-known. A Record of a Rainy Autumn Night by Xuan Ding during the Qing Dynasty tells the tale of when Ye Tianshi gave a diagnosis and treatment of pseudohermaphroditism: There was a rich old man in Suzhou whose surname was Mao. He had no son but a daughter. At the age of 15, she became critically ill. The doctors were unable to treat her. Mr. Mao invited the famous doctor Ye Tianshi to treat her. Dr. Ye laughed: ‘She is not ill. If you are willing to give your daughter to me as my own and travel with me, I will give back you a healthy daughter after one hundred days. If you cannot make up your mind, she will be killed through your own actions. But it is sadly an abnormal death — not her destiny.’ The old man said in surprise: ‘If that is the case, I will give top priority to my daughter’s life — even spending thousands in gold.’ Tianshi took her home. He cleaned out a secret chamber, and selected a beautiful maidservant to sleep with her. He ordered the maidservant: ‘She is your aunt. You will rely on her all your life. Don’t disobey her. Your disobedience will worsen her illness and you will be responsible for anything that goes wrong.’ Tianshi gave her medicine and peeped in at them every day. The girl gradually grew stronger and her features appeared to soften. She and her maidservant became closer and closer, just like body and shadow together. Tianshi knew it was the way. He suddenly went into the chamber, and scolded the maidservant: ‘I have seen what you and the girl have done. You must speak it out. If you hold back anything, you will be punished. Don’t make trouble for yourself.’ The maidservant looked at the girl and wept. The girl said coyly: ‘You ordered your maidservant to stay with me. If she had disobeyed your order, she would have been punished. Why is she being punished even when she is obeying your order?’ The maidservant also

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defended herself: ‘You tricked me by pretending this boy was your foster daughter and commanding me to sleep with him. I didn’t dare disobey you. But now you still want to punish me. What shall I do?’ Tianshi laughed and said: ‘You have been obedient to your aunt? I’m happy for you. Am I blaming you?’ He told the girl to change her dress and braid her hair as soon as possible. Then he unfolded and healed her bound feet with medicine. After this, her appearance was actually that of a man! Tianshi let her father come in and said: ‘You told your boy to pretend to be ill and to deceive me by dressing up as a girl. I was misled by letting him stay with my foster daughter. Now my foster daughter has been sullied by your son. What are you going to do?’ The old man was at a loss, and did not understand. Tianshi told them all to come out and meet him. The old man was so joyful at seeing a son he was willing to take the maidservant as his own daughter-in-law. Then, in the end the two families became in-laws and had a close relationship. Ye Tianshi could identify false hermaphrodism and even “heal bound feet with medicine”. It seems that the bone deformity caused by the foot binding was possibly cured. In addition hermaphrodism could even be diagnosed by the pulse. Mr. Chu’s Book says, A man’s chi pulse on the right hand is usually weak because the pulse qi is relatively weak; a woman’s chi pulse is usually strong because her pulse reflects exuberant heart fire. If a false hermaphrodite is attractive to a woman, the pulse is that of a man. If a false hermaphrodite is attractive to a man, the pulse is that of a woman. It is difficult to reason with anyone about medicine if he cannot understand it. Zhu Danxi’s Further Discourses on the Properties of Things – Conception discusses this further: What’s the difference between an infertile man, a barren woman and hermaphrodite? I answer: A man becomes infertile because his yang qi is lost; a woman is barren because her yin qi has been blocked; a hermaphrodite occurs because yin has been attacked by evil qi. These are two different situations. Hermaphrodites are of two types: The first is meeting a man and becoming a wife or

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meeting a woman and becoming a husband; the second is becoming a wife but not a husband. Some women even have entire male organs because their evil qi is so excessive. Some people ask: but evil qi only attacks the yin, so why are the results different? I reply: The yin body is weak, so easily attacked by the evil qi. Due to the attack of the evil qi, yin and yang are mixed up together which results in there being qi between the two branches of the uterus. Neither becomes dominant. The body goes neither towards yin or yang, but between them. The evil qi makes them different, just as the hermaphrodites are different. Zhu Danxi believed that uterine bifurcation decided sex, left for a man and right for a woman. One is neither man nor woman because of being attacked by the evil qi which lodges between the bifurcations of the uterus. This uterine bifurcation came from his observation of “yin extension” (uterine prolapse). It is simple and intuitive. It is no wonder that he had this idea. This ancient understanding of hermaphrodite could only go so far. Yin ting (stiffen), also called yin tui (collapse) or “yin prolapse”, was quite a common disease of older women and caused by many deliveries, weakness and deficient middle qi. The uterus can be seen outside the vagina and appears like an eggplant when serious (third-degree uterine prolapse). It was bound to affect her sexual life. Treatment with medicine or yin-tonifying therapy is recorded in the Qianjin Yaofang and Essential Secrets from a Waitai. Li Dongyuan’s Middle-Tonifying Qi-Replenishing Decoction was also rather effective. Also there was a kind of cruel punishment or penalty — artificial induced uterine prolapse, namely youbi, or vaginal blockage called gongxing. Similar to male castration, it deprived women of their sexual function. Chu Renhuo’s Jian Hu Collection says, Jieshi Extra Talks records the occurance of female zhuoqiao (椓 zhuo, beating of the genital organs). The character zhou comes from a list Ancient Punishments, like the castration mentioned in the Shun Code. It refers to emasculation for men and vaginal blocking for women. Years ago, I met Mr. Xu, a ministry councilor of the Department of Punishment. We talked of castration. Mr. Xu told me: ‘Apart from capital punishment, four other punishments are

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used to damage the bodies of criminals, but to give them the freedom to stay with their family. Usually a woman is punished but if the crime is light the man is forgiven. For if the wife is punished with vaginal blockage, her husband gets punished too because he cannot have sex with her anymore. Orifice-beating means to beat and hammer a woman’s chest and abdomen to make the organs drop and cover the vaginal mouth. Then the woman cannot have sexual intercourse although she can still urinate. This is youbi, vaginal blockage. There is also when something is blocking the vagina and this is called yin tui. Something can even be seen outside the vagina which is called a ‘listless gourd’. Thus the woman and her husband have to sleep separately forever’. Thus this was something like what Mr. Xu spoke about. It is unimaginable that criminal law could deprive people of their sexual function and sexual intercourse. Ancient physicians also paid attention to genital diseases which affected sexual function. There were formulae for “unbearable pain during intercourse”, “bleeding during intercourse”, “marriage pain”, “vaginal pain during intercourse”, etc. in the Qianjin Yaofang — which generally refer to vaginal spasm or bleeding during violent intercourse in modern sexual medicine. These were quite common. There was also a special formula for “tightening a loose vagina”: “grind half a liang of rabbit droppings and dry lacquer, two rat bones, two female chicken livers, dried in the shade for one hundred days, make the powder into a honeyed pill as small as a bean. At a suitable time of the seventh day of the month, put one on the glans of penis and insert it into the vagina slowly. After three days, it will begin to work; on the tenth day, the vagina will become tense; on the fiftieth day, the vagina will be just like that of girl aged 15.” The mechanism for this is unknown. Perhaps it stimulates the muscle of the vaginal wall. However, the Essence of the Jade Room and Dongxuanzi use sulphur and polygala root to wash out the vulva or they are put into a silk bag and inserted into the vagina. They can make the vagina as tense as that of “an unmarried girl”. Tightening the vagina is to increase sexual pleasure. It is a symptom of a pleasure-seeking culture. Among folk customs there is also the idea of “enjoying intercourse with a virgin”. It is also related to the struggle for the “right of the first night”. It is for the same reason that Western women, especially young prostitutes, ask doctors to suture their hymen.

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Men may also suffer from a so-called “small penis”. It is treated by taking semen boitae orally, radix ampelopsis, white atractylodes rhizome, cortex cinnamomi, monkshood, etc. as mentioned in the Essence of the Jade Room, Secrets of the Jade Room and the Dongxuanzi. Again, “the penis can grow an inch if it is rubbed with a dog’s gall bladder hung on the rafter for thirty days after being filled with an equivalent amount of Sichuan pepper, asarum and herba cistanches, which have been processed and sieved.” “The penis can grow three inches if a mixture of three portions of herba cistanches powder, two portions of seaweed powder and the juice from the liver of a white dog is applied three times during the month of January. Draw water to clean it down at dawn. It is very effective.” Qianjin Yaofang records, “A formula for strengthening the yang: Apply five times every day a mixture of three liang of fructus cnidii powder and two he of the juice of the Chinese dodder herb.” “Grind the mixture of one portion monkshood and three portions cistanche, polygala root and fructus cnidii; mix them together with saliva and make a pill as big as a firmianae seed. Put the pill on the yuquan (jade spring) acupoint by the penis.” These are similar to aphrodisiacs sold in adult stores in the West today. The idea is to daub or spray the medicine onto the penis to make it thick and durable. Also, there is the world-famous oral medicine “bald chicken powder”. The Qianjin Yaofang records, Bald chicken formula: Two liang of fructus cnidii, mixed with the seeds of Chinese dodder, polygala root, radix saposhnikoviae, radix morindae officinalis, the fruit of the Chinese magnoliavine, the bark of eucommia and desert cistanche. Grind them together and sieve. Then take one fangcunbi of the medicine with wine, twice a day. Take it regularly. If you are single, do not take it. The Dongxuanzi says, Bald chicken powder treats impotence due to the five overstrains and seven injuries. Lu Jingda, the procurator of Shu County, helped his wife give birth to three boys at the age of seventy after taking this medicine. He took it for some time. His wife was tired of their constant sexual intercourse, which made her unable to sit because of the pain at the mouth of the uterus. So she threw the medicine into the yard. A rooster ate it, climbed up onto the back of a hen and pecked her on the crown for several days. The hen became bald, so people called the medicine ‘bald chicken powder’, also called a ‘bald chicken

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pill’. Pound up a mixture of three portions of herba cistanches, the fruit of Chinese magnoliavine, the seed of Chinese dodder and polygala and four portions of fructus cnidii. Sieve out the powder. Take a fangcunbi of the medicine with wine on an empty stomach, three times a day. If you are single, do not take it. After sixty days, you can have sexual intercourse with forty women. It also can be made into pills with honey. Five pills every time, twice a day. Use common sense when you take it. Compared with the formula in the Qianjin Yaofang, this does not include radix sileris, morinda officinalis or the eucommia bark. Drugs such as cistanche indeed have the function of strengthening the yang and sexual intercourse. But I suspect that the “aphrodisiac poisoning” mentioned in Jottings from the Thatched Abode was of the same ilk: Li Qingzi said that one day, he was lodging at a friend’s house. At dawn, he saw two mice begin to chase each other round suddenly. They spun around like the wind and jumped up and down, like bullets. Bottles, pots, basins, were all knocked over. The crashing sound was very scary. After a time, a mouse jumped several feet into the air, and then fell to the ground. It jumped up again and fell down again. Finally it died. Li Qingzi saw it bleed from all its orifices and was very puzzled. He hurried and told the houseboy to put everything in order to leave. He was surprised to find that more than half a dozen of philtres (of powder) on a plate had been eaten by the mouse. Then he understood that the mouse had swallowed his medicine by mistake. It was so lewd in its desires that the female mouse ran away from it. The male mouse found no outlet for its sexual urges — and was burned up and died. His friend came out his room and saw what had happened. He was surprised and amused, then said in dismay: ‘Ah! It is so. I understand now.’ Then he tipped all his pills out into the stream outside. Drastic medicine has a stronger potency and toxicity after being processed. I have witnessed many people destroyed by this medicine, just as Han Yu was by taking sulfur. Sages are no exception. My friend was possibly not destined to die, so he became enlightened by a mouse! In fact, there are many good examples of aphrodisiacs causing death. Mr. Pan Guangdan quoted earlier the story of the Han Dynasty Emperor

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Cheng (see a few pages back). Emperor Cheng suffered from impotence and looked to take medicine: … All the formulae of the Imperial Physicians did not work. The emperor sought for a panacea everywhere. Once they got some shenjiao to Zhaoyi, who presented it to the emperor. He could have sexual intercourse with Zhaoyi each time he took a pill. One night, Zhaoyi got drunk and gave the emperor seven pills. He embraced Zhaoyi in the drapery room in Jiucheng palace. They were teasing and laughing all night. At daybreak, the emperor got up to dress himself, but his semen flowed out without stopping. After a few moments, the emperor fell to the ground, sullying his underclothes. Zhaoyi saw the emperor’s semen spring out, sullying the covers as well. Soon the emperor died. A court maid told the empress dowager. She ordered Zhaoyi brought to trial. Zhaoyi explained: I looked after the emperor as a child and I am favored most by him. How can I argue for the affair of what happened in the Yetingling (an official room)? Beating herself with her arms, she cried out: Where is my emperor? Then she spat out blood and died. (Anecdote of Zhao Feiyan written by Ling Xuan) Like other aphrodisiacs, some mineral medicines are able to strengthen sexual function. But they can cause many people to die of carbuncles as well. The Qianjin yaofang points out, “Some people take mineral medicines for sexual pleasure, which is the root of many diseases.” The “Han Yu taken sulfur“ and “drastic dry medicine” mentioned by Ji Yun (the well-known intellectual of the Qing Dynasty) are similar cases. Among drastic aphrodisiacs, there is also pilose (hairy) antler. It is combined with cistanche to make antler powder. It is often recorded in the books on coition medicine. The Qianjin Yaofang says, Pengzu said: nothing is better than deer horn to keep people young and away from overstrain during intercourse. The method is to mix ten liang of deer horn powder and aconite root powder together. Then take one fangcunbi of the powder with wine, three times a day. It is very good for the body. It is also good to process it until it is yellowish and take it alone. But it works slowly in this way. It is good to make a pill with it mixed with sparrow egg too. It is very effective after taken for twenty days.

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Many prescriptions like this are recorded in the Qianjin Yaofang. They are also recorded in other books on coition medicine. The Essence in Jade Room says, This formula will strengthen a man’s sexual performance so he can have intercourse more than ten times a night. Grind an equivalent amount of fructus cnidii, polygala root, radix dipsaci and desert cistanche. Take one fancunbi of the medicine each time, three times a day. A Mr. Cao had sexual intercourse with seventy women after taking this. There is also the more commonly used medicine “Xianlingpi” or “Yanyanghuo”, i.e., “Epimedium”. It was seen more after the Song Dynasty. The Continued Natural History of Li Shi written during the Song Dynasty says, Epimedium is also called Xianlingpi. The horny ram will mate a hundred times a day because he eats this herb. Some aphrodisiacs came from foreign countries during the Tang Dynasty. The Doctor’s Book states, Jivaka’s description for impotence: Grind a mixture of one portion of lycium Chinensis, calamus and semen cuscutae. Sieve it. Take a fangcunbi of this powder each and every time. Three times a day. The penis will be as hard as iron. A secret formula from a Xin Luo (Silla, part of present Korea) monk: In the middle of August, take a nidus vespae (the nest or comb of a type of wasp or hornet), press it for one night with a flat object. Take it, then put it in a raw silk bag to dry in the shade for one hundred days, on top of some bamboo rods. This makes a good medicine. Before intercourse, take a piece of six-sided nidus vespae and boil it and put into a clean jar until the grey-black changes white. Take half of a fen of it with warm wine. Mix another half fen with saliva and apply it to the penis from the root to the end. The penis will soon dry. Then one can have sex at will. The effect will be clearer after forty days. After one-hundred days, the body will be perfectly healthy and you never sicken in your lifetime. This medicine is so beneficial — it makes people strong and healthy, cool in summer and

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warm in winter. It also keeps people away from the attack of evils. The penis will grow three inches and be as strong as an iron hammer… If one wants to be strong, he should often take it in warm wine; if one wants a long penis, one should apply to the end of the penis; if one wants it to be large, one should apply around the penis… This “secret formula from a Silla Monk” is similar to the description given in the Qianjin Yaofang of Sun Simiao. Description for impotence: Apply hive ash to the penis at night, then it will erect. If there are women around, no applying. Ancient sexology advocates frequent intercourse. There are more than thirty postures used in making love. So intercourse could easily cause distress or disease, as well as the bleeding mentioned earlier. The Secret from a Jade Room says, Cai Nu (the ‘Choice Girl’) said: What is it with men and their sexual dysfunction? Peng Zu said: If a man has sufficient qi, his penis well be warm and his semen thick and it easily congeals. There are five weaknesses of sexual function: The first is premature ejaculation because of qi damage; the second is having little or thin semen because of muscle damage; the third is bad and smelly semen because of tendon damage; the fourth is semen leakage because of bone damage; the fifth is impotence because of body damage. All these are caused by violent and ungracious intercourse. The treatment: just have intercourse but without ejaculation. Then the energy will increase a hundred fold in a hundred days. If a man raises his waist to meet his sexual partner on the abdomen, he will suffer from back pain, lower abdominal spasm, and foot spasm. The treatment: let the man be on top with gentle and smooth face-to-face sexual intercourse. Having sex after drinking is called ‘drunken intercourse’. Violent drunken intercourse will bring about yellow jaundice, black jaundice, intestinal pain… even pain in the chest and back, coughing, spitting blood and a reversed flow in the qi. The treatment: Do not have sex after drinking. Have unhurried sexual intercourse at dawn. The body will then be well.

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If one has excessive intercourse, he will sweat profusely. Furthermore, body movement and twisting brings wind under the covers. He will easily be attacked by the ‘wind evil’ because of deficient essence and exhausted qi. Then he will become weak and lame, and his hands cannot reach up to the head. The treatment: Nourish the spirit, take rehmannia root. The above sexual skills were used to treat damages due to sexual intercourse. They are wonderfully effective taken in combination with other medicines. Xuannu’s Book also records some formulae for functional sexual diseases, for use during the four seasons. The seven injuries are described as follows: Men all have yin and yang in the body. But each of them loses their life because of a woman. They have no moral integrity and are constantly in love. Always mindful with beautiful woman from suffering sexual overstrain. A man should think seriously about the seven sexual injuries. If he can regard and think about them seriously, that is the way to longevity. If one suffers from an illness one should treat it. Now here are the seven injuries and taboos. The first taboo is having sexual intercourse on the first day, last day, seventh day, eighth day, twenty-second day, twenty-third day, fifteenth day and the six ding days (every tenth day) of the lunar month. Sexual intercourse on these days brings about an injury to the essence. You face the woman but cannot have intercourse, lose your erection, have yellowish or reddish urine, and spontaneous semen discharge. It shortens life and even causes an early death. The second taboo is to have intercourse on a cloudy, rainy, windy, stormy or thundery day. The body will easily suffer from mania, deafness, blindness, dumbness, be slow-witted, forgetfulness, restless and moody. The third taboo is to have sexual intercourse just after eating and drinking. Sexual intercourse with a full stomach and unharmonious five zang-organs will lead to organ damage, reddish, yellowish or white urine, lumbar pain, a stiff neck, a swollen body, abdominal flatulence, disfigurement and a short life. It is the law of nature. The fourth taboo is to have intercourse just after peeing. At this time, the essential qi is weak, the nutrient qi instable, the defense qi undistributed across the body. Sexual intercourse then will lead to

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weakness, blockage of yin and yang qi, poor appetite, abdominal distension, melancholy, restlessness, forgetfulness, moodiness, and something like epilepsy. The fifth taboo is to have sexual intercourse after manual labour or a long walk. At this time, the nutrient qi is unstable, the defense qi undistributed. Sexual intercourse then will lead to a mutual interference of the qi with the five zang-organs, exhaustion, difficulty in breathing, a dry mouth, sweating, indigestion, abdominal flatulence, restlessness and soreness all over the body. The sixth taboo is to have intercourse after a bath or heavy manual labor. At this time, the hair and the body are still damp, and sweat streams down like rain. Sexual intercourse then will lead to head pain, abdominal pain, lumbar pain, pain of the limbs, disharmony among the five zang-organs, head discomfort and leaking urine. The seventh taboo is to have sexual intercourse in an inappropriate situation. For instance, one talks volubly to a woman, the penis becomes erects and one has sex. Rash intercourse will open the skin-pores, damage the penis, pull the muscles and hurt the internal viscera. People will suffer from difficulty in hearing, blurred vision, palpitations, like qi bumping against the diaphragm, trance-like states, forgetfulness, a cough with difficulty in breathing, internal injuries, and female flaccidity. These seven taboos have been proven by evidence. But there are wonderful medicines and treatments also for them all. These taboos prove that disease can be caused by having intercourse at an improper time, in an improper environment, under improper physical conditions, etc. Poria cocos, desert cistanche, stalactitum and semen cuscutae are introduced later on in these writings as yang-strengthening medicines. All these yang-strengthening medicines are recorded in the Qianjin Yaofang: For the Bladder by Sun Simiao. If Sun Simiao was known as the creator of tonics, then direct factors in this process were the occurrence of sexual diseases and disorders, and yang-strengthening medicine being used for intercourse. Medicine thus became influenced by the sexual culture.

142.  A Study of Venereal Disease in Ancient China Immoderate or unhealthy intercourse will inevitably lead to sexual disease. A “dripping disease” was recorded as the sixth among the seven taboos, viz. gonorrhoea. The disease “itchiness and dampness” treated with pills of

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herba cistanches in Stone Medicine in Doctor’s Book – Sexual Diseases should also properly be called gonorrhoea. Gonorrhea has had a long history in China. There is the noted record which describes stranguria in the Neijing and the Synopsis of the Golden Chamber. Some of these probably refer to gonorrhea, and this has been researched by Prof Cheng Zhifan.4 Unfortunately, there is no specified relationship mentioned between stranguria and sexual intercourse, except that in the text above. The Dongxuanzi says, “One suffers from impotence or stopping half way during sexual intercourse with a women — and dead semen comes out spontaneously. The urine drips out. There is pain in the back and loins…” Here, the relationship between impotence and the gonorrhea is clear. “Yin–Yang exchange” which is mentioned in the Treatise on Febrile Diseases may also be venereal disease. It is again recorded in the Doctor’s Mind Prescriptions – Sexual Diseases. The original text goes, If one is attacked by the Shanghan ‘Yin–Yang exchange’, he will suffer a heavy body, a weak breath, hypogastric pain, genital spasm, heat rushing to the chest, a heavy head unable to lift up, blurred vision, along with knee and tibial spasm. It is treated with trouserash. The method of burning the trousers: Burn the private part of trousers to ash. Take a fangcunbi of the ash with water, three times a day. This will make the urination smoother and lighten the swelling penis. If a woman suffers from this disease, take the trouser-ash of a man. This disease is simply explained as being triggered by sexual overstrain after “cold damage”, in the annotated version of the Treatise on Febrile Diseases. It is also recorded in the Handbook of Prescriptions for Emergencies: Burn a woman’s trousers during her menstruation to treat sexual overstrain, a swollen testicle, a testicle shrinking back into the abdomen, no stool, and convulsive abdominal pain. Take a fangcunbi. The woman will be infected with the disease from a sick man; a man will be infected from a sick woman too. The healthy person gets sick and the sick person will have a recurrence and die. 4

 Cheng Zhifan. The History of Our Dermatology Department, Journal of Traditional Chinese Medicine, No. 1, 1955.

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This description is for ‘yin transmission’. Though one has recovered from a febrile disease for many days, there is still heat toxin creating disharmony in the blood veins. If people have sexual intercourse with the patient, they will be infected with the febrile disease too, which is called ‘yin exchange’. It kills more and more people, like an epidemic. They need urgent treatment… Take the private part of a woman’s trousers and burn it to ash. Taking a fangcunbi of the ash, one will urinate smoothly and the swollen penis get well. A little girl’s pair of trousers is also good. If a woman becomes ill, she can use a man’s trousers too. This was obviously not sexual overstrain through heavy labour, but an infectious disease transmitted to a sexual partner through “yin” or “yang”. In most cases, this disease is transmitted from woman to man, sometimes it is from man to woman. Treatment with woman’s underwear (or a virgin’s trousers or man’s underwear) reflects “fighting poison with poison” or the therapy of sympathetic magic. According to the Handbook of Prescriptions for Emergencies, “the disease is not transmitted between man and man, or woman and woman. This suggests it must be transmitted during intercourse between man and woman.” This proves that it is transmitted through sexual intercourse. Besides “local swelling, there are probably ulcers too”. The Handbook of Prescriptions for Emergencies also says, Here is another treatment. When a man feels sick, twenty-one moxa cones should be put to his penis. Even if he is very ill, he will be well after one-hundred moxa cones. His eyes will be improved and even a vaginal sore can be cured. This disease features so prominently with its fever, headache, heavy body, weak breath, abdominal spasm, contracture of the knee, tibial area, etc. The local sores may be neglected. Putting together what has been said above, there must have been both systemic and local symptoms (possibly genital sores). Yet according to our current knowledge of venereal disease, no appropriate disease can be inferred from this “Yin–Yang exchange”. Professor Cheng Zhifan conducted detailed research on genital sores and syphilis. Syphilis is generally thought to have come from overseas during the sixteenth century. Genital sores and “jealous semen” sores, as mentioned in the Sui and Tang Dynasties, are types of soft chancres, which suggests a

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sexual disease — not a syphilitic one. The earliest application of mercury was in China. Treating syphilis with arsenic was also a great invention.5 But there is also a further historical note on a chancre. The New History of the Tang Dynasty – Southern Barbarian records, Some of these women are toxic. If men have sexual intercourse with them, they will suffer from sores and die. But their bodies will not decay. The text suggests that this was an infectious venereal disease caught through sexual intercourse with the southern neighbours during the Tang Dynasty. However, this single piece of evidence cannot prove whether this was a syphilitic chancre or not. There is a section about “the treatment of chancre” in Chats on Medicine by Zhang Gao of the Song Dynasty: Unmarried Tang Jing came from a rich family, and was eighteen or nineteen. A sore grew on his penis. At first, the sore was as small as the head of a pin. But he was afraid of the pain and dared not wash or touch it. After a few days, the sore attacked the skin and flesh, and one or two inches of his penis rotted away. Doctors treated it only with plasters. But the sore became more and more painful. Nobody recognized it. Taoist Zhou Shouzhen said: This is a genital chancre, also called a ‘jealous semen chancre’… If you want to treat it, stop sex for several days. Then he cut some schizonepeta, yellow lemon verbena and licorice into fine pieces to make decoction and wash the pus and crusts away. He put fructus chebulae ash mixed with musk onto the sore. He made him sleep. He was told to drink two or three mouthfuls of cold water after waking up and not to make the penis erect as it would break open the scab. Then as the scab became hard, the sore was cured. This genital chancre was obviously related to sexual intercourse. The signs are similar to those of a syphilitic chancre. It is similar to those recorded in the Qianjin Yaofang: ‘Jealous semen’ sores grow on the back of the head of penis and in the vagina. They look like a chancre. Although they are very painful during intercourse they are not chancres. 5

 See note above on Cheng Zhifan.

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The Essential Secrets of a Waitai has many entries about formulae for and symptoms of “jealous semen” sores from the Qianjin Yaofang, the Definitive Working Formula and Ancient and Modern Effective Prescriptions. This proves that the disease was not rare at that time. A quotation from the Qianjin Yaofang goes as follows: ‘Jealous semen’ sores grow on the back of the head of the male penis and in the vagina. They are more like a chancre than an ulcer. In the twelfth lunar month wrap a silver hairpin up in a piece of cotton covered with pig fat — heat the hairpin with a gentle fire to cauterize the sore. Coat it with the ash of dry sophora twigs, and apply the powder of musk, fibroferrite ore and iron vitriol after urinating. The sore will be well after two or three applications. This sore can also be cured with medicine for a chancre. Most of these accounts have prototypes in the Handbook of Prescriptions for Emergencies as follows: “this has been seen before, a swollen penis with a sore on its neck…”; “There are two kinds of genital sore. One will discharge pus from the ulcer, and is called a ‘yin erosive sore’…”; “Treat genital sores which discharge pus with alum from Gaochang”. It seems that chancres were common in the Wei and Jin Dynasties. This could perhaps have been due to signs of epidemic-type syphilis. Syphilitic chancres had already appeared. It is said that the late Qing Emperor Tongzhi (1856–1875 CE) died from smallpox. However, he probably died from both smallpox and syphilis. “The Emperor suffers from sexual sores” is recorded in “Hearsay from the Qing Palace” located in the Unofficial History of the Qing Dynasty. Here is a story about Emperor Tongzhi. The Empress Xiaozhe, daughter of Chongqi, was beautiful, dignified and virtuous. Emperor Tongzhi loved her very much. But under the domineering power of his mother, the Empress Dowager Cixi, they could not live together intimately. Cixi forced her son to live with an imperial concubine he did not love at all. The emperor did not enjoy himself in the family, so he indulged himself outside the palace. Fearing to be seen by ministers, he went to an underground whorehouse in the capital — instead of to the famous brothel outside. He had no attendants, only one or two eunuchs. At first, people did not know he was the Emperor. They knew later, but they pretended not

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to know. After a while, the poison began to come out, but the Emperor did not notice it. Then the poison appeared on his face and back. He ordered imperial physicians to treat it. They were very frightened. They knew it was a sexual toxin, but they dared not say so. They asked secretly for instructions from the Empress Dowager Cixi. She gave orders that ‘it may be smallpox.’ So the Imperial physicians treated the disease as smallpox. The treatment did not work. The emperor was very angry. He scolded them: ‘I don’t suffer from smallpox. Why treat it as smallpox?’ Physicians answered: ‘It is by order of the Empress Dowager.’ Then the emperor said nothing but became quiet and sullen. The genital fester gave off an unbearable stink before he was about to die. The hole was so deep that it reached in as far as the kidneys. Alas! Many emperors died young because of women in China, but none of them died from such sores. But Francis I, King of France died from sexual sores. So this is not really anything new.

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Medical Science, the Culture of Food and Other Things A.  The Culture of Food and Medical Science 143.  Fine Foods in Health and Nutrition The Chinese have been fastidious about delicacies and fine foods ever since ancient times. In the Huainanzi (淮南子) it says, “We can never find in this world a fox whose fur is completely white. However, we have completely white fur coats, as we can collect the white fur from many foxes; good learners should learn from the King of Qi who had to eat chicken feet then felt satisfied.” It seems that the King of Qi must be keen on chicken feet. Nowadays, there are still quite a lot of people who like chicken and duck feet in China — even if sold at a higher price for some people, there is great interest in eating them. Mencius (孟子) said, “When it comes to people’s tastes, fondness is the same all over.” By fondness he meant fondness for fine foods. So, when Cao Cao uttered “chicken ribs” as a word of command to the army, Yang Xiu immediately understood its hidden meaning — to prepare for a retreat (because chicken ribs are “tasteless yet it is a pity they have to be discarded”). During the Song Dynasty, Zhao Chongxuan once composed Chicken Ribs (鸡肋), making a list of the favourite foods of such famous men: “King Wen of Zhou loved calamus, King Wu (武) of Zhou abalone snails, King Wu Liao of Wu (吴) grilled fish, Qu Dao water chestnuts, Zeng Xi dates, Gongyi Xiu certain fish, Wang Mang abalone snails, Wang Xizhi ox heart, King Liu Yu duck with pancake, King Xiao Chengzhi paste with duck soup, King Xiao Daocheng minced meat, and King Chen Shubao donkey meat. Xiao Yingzhou of Qi could eat minced fatty meat, even as much as three Dou, while Xin Daixian of the Northern Wei (386–557) loved lamb’s livers, Lu 975

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Yu of the Tang Dynasty loved tea, and King Ming of Wei loved the sounds of the hammer and chisel.” In fact, ancient China produced lots of gourmet foods but not everyone had the same tastes. Tasty as these foods may be, they might not be right and nutritious. What makes food delicious, besides preserving the original taste and flavour, is mainly the cooking skill, which requires perfect coordination of the five flavours. Yi Yin, who once “carried cooking utensils on his back, had talked of this with King Tang of Shang, when discussing tastes and flavours.” He was really a great master of seasonings, one who could expatiate on the coordination of the five flavours. The Zhouli (周礼) recorded a chef’s duty as follows: Shiyi, medical controller of diet, is to take charge of the six grains, six drinks, six meat foods, hundreds of fine foods, hundreds of seasonings and eight precious foods for the king; and the rule is to prepare more grains in the spring, to make more soups in the summer, to make more jams and sauces in autumn and to provide more drinks in winter. In making a good coordination of flavours, make more sour food in the spring, more bitter food in the summer, more spicy food in the autumn and more salty food in the winter. Put in a good application of smooth and sweet. Be aware of the compatibility of diet, for instance, beef should be with sticky rice, mutton with glutinous millet, pork with millet, dog meat with sorghum rice, wild goose with wheat, and fish with melon. This is the law when cooking for gentlemen. Yet, it must be true that the Shiyi, the King’s dietitian, also considered that nutrition was linked to the “five flavours” which, in absorbing the essence of the four seasons and the yin and yang, can nurture the blood and qi of humans. Sun Chengze of the Qing Dynasty explained in his Records in Tianfu (天府广记) that: The Shiyi — he is someone who believes human disease to be caused by unsuitable food — because when one falls sick you can never neglect an incautious diet. So, he makes suitable diets of grains, drinks, meats and fine foods coordinated with seasoning from the different flavours and a fine compatibility of various meats — such as beef, mutton, pork, fish and wild goose — and then, in this way,

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the coordination of diet can help the king nurture his blood and qi, enjoy good health and as a result be free from disease. This is to take precautionary measures before the disease attacks. It was not only the Shiyi who stressed coordination of diet and food preparation. All those involved in the kitchen, under a kitchen chief such as a pengren, and in charge of water and fuel, had to tell whether the food was prepared well or not, was freshly cooked or not. The paoren and neiyong, officials in charge of the livestock, poultry and so on for the royal family, had to clearly differentiate foul-smelling food from that which could be eaten. If anything harmful to the health of humans came into the diet, disease would be unavoidable. Still, the pengren, paoren and neiyong were far from the only people who had this duty. There were also the xiren, the officials in charge of the vinegars, and the yanren, officials in charge of salt for all food. With vinegar and salt, the five flavours become complete, which together coordinated the qi and compensated for any weaknesses in the five organs of the body. Therefore, minor as they were, these officials cannot be overlooked and must be established as special official positions to promote the good care of all foods… These records showed that the adequacy and coordination of the five flavours were the “nutritive standard” which helped prevent diseases as well as strengthen blood and qi — and, in addition, if the standard was breached it could very likely cause disease. The pengren, paoren and the others in charge of water and fuel, foods and seasonings, respectively must tell whether the foods are well prepared or not, are freshly cooked or not, and edible or not, which is tantamount to food hygiene. Who can say that the kings and gourmets of old were ignorant of nutrition and hygiene in foods? They simply bear different standards. If what is described above is taken as the standard, all the foods cooked must be both in good condition and full of nutrition. Despite the fact that Yi Ya, during the war-mongering later-Zhou Dynasty steamed his own infant son as a favour to King Huang of Qi, Yi — a chef to the king — is still praised as number one in the catering profession. Therefore, when Han Yi in the period between the Yuan and Ming dynasties wrote a book on classical cooking, he named it Principles of Food Set Up by Yi Ya (易牙遗意). We all know Confucius’s famous words about the rule: “better to husk grains as tiny as possible and to dice

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meat as fine as possible.” But he made further statements about several prohibitions: Don’t eat putrid fish and tainted meat; don’t eat food whose color has changed; don’t eat food with a bad smell; don’t eat food not yet fully cooked; don’t have meals beyond dinner time; don’t eat food which is poorly prepared or without proper seasonings; don’t have more meat than grains; don’t become drunk even though wine is the only thing you can drink; don’t drink wine bought from the market; don’t take away dishes with ginger and don’t eat too much of it; don’t eat overnight meat which has been offered as sacrifices; don’t eat sacrificed meat three days after the ritual. These are so specific that gourmets have taken them as specific criteria. However, things were different among the common people. It is recorded in the Hanfeizi – Wudu (韩非子·五蠹) that “Man could not hope for any rice and meat when even the rice-husks became luxuries.” Zhanguoce – Hance (战国策·韩策) also records that “When there was no harvest at all in that year, people had to eat just the husks.” In Jia Yi’s Guoqinlun (过秦 论), it is also recorded that “people suffering from the cold had to wear short muffs, and those hungry rejoiced in eating husks.” Clearly, they would have done anything to have had their empty stomachs filled. “Rice” is the staple food for the Chinese. The Lunheng – Liangzhi (论衡·量知) says that “Grains when ripe, are called su which when pounded in a mortar and winnowed with a pan to get the husks off, is turned into edible rice after being steamed in a zeng; and can be eaten after being cooked over a fire.” Other grains that can be processed in the same way include su, shu, ji, liang, and shu. Cooked rice, if dried under the sun, becomes a solid food called qiu when the grains are oversized and bei when they are small. Both, accompanied by dried meat, can be served as food for travellers or army men. This has been recorded in many books, like Zhang Yu’s Dongguanhanji (东观汉记), “… in patrols, stopping under the trees they ate qiu, solid food”, and the Hanshu – Biography of Wang Mang (汉书·王莽传) describes Wang Mang as “taking patrols four times a year and crossing thousands of miles at such a senior age, when even bei or dried meat was not enough to help them endure it.” Usually such food was truly tasteless. “Eating iron rations on the march, nothing can compare with the taste of the palace meats” (according to Zhaoming wenxuan – Hail to the King, 昭明文选·圣主得贤臣颂).

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In a famine year, people had no rice to eat but made porridge, as is revealed in such books as A Record of the Three Kingdoms – Biography of Zhu Huan (三国志·朱桓传) as “In a time of pestilence when foods was rare, Huan sent virtuous and able officials to help the people, comforted them in person, and even dispatched porridge for them individually. His soldiers and the people were all sincerely grateful.” The Houhanshu – Biography of King Xian (后汉书·献 帝纪) says when in the summer of 194, there raged a plague of locusts and a drought, “at that time, grain was sold at five-hundred-thousand qian for one hu (a unit of ancient China, one hu was five dou); and beans and wheat at twohundred-thousand qian per hu. People were forced into cannibalism leaving bones piled up in the road. Then the king sent Hou Wen, his shiyushi (an official title) to bring rice and beans out of the warehouse in the Great Storage Barn to make into porridge for the hungry people. However, many people still died days later. The king, suspicious that Hou might have given short measures of rice and beans, ordered the porridge to be made before him and with his own eyes he could see nothing irregular had been done. Then he promoted Hou to head of department, replacing Liu Ai… since then, relief was always done properly.” Porridge, as the staple food for the sick and elderly, gradually becomes a symbol of consolation for the common people. The Book of Rites – Yueling (礼记·月令) records that “To support the sick and elderly, the following were specially provided: a ji, an ancient piece of furniture for supporting people when they sat, a walking stick, together with porridge.” A note in the Houhanshu (后汉书) explains “porridge”: “There’s a way which is becoming popular since the Han. The elderly, that is the over-nineties can get porridge in which rice has been stewed until quite soft and fine.” The Houhanshu – Records of Rites (后汉书·礼仪志) also states that “the autumn, a national census was carried out and as a result an order was issued by the king that each one of those over seventy years old should be granted a walking stick and supported with porridge… The walking stick, the length of nine chi, was decorated with a turtledove on its upper end — expressing the wish that the seniors would not choke when eating — as turtledoves are said never to choke, according to legend.” Yet the Record later states that in reality “either this order had not been carried out in most places — or if they did provide porridge, it was made up of half rice and half husks.” China was mainly fed by rural agriculture — animal husbandry was not common. Because of this it was impossible for the people’s staple diet to consist of much meat or dairy food. Yet such a diet, consisting only of rice and porridge, would cause insufficiency of animal-based nutrition, and porridge supporting the elderly would provide far from enough energy

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either — it was not equal to that gained from dairy products. The decoration of turtledoves on walking sticks, being something like sympathetic magic, was only to stop them being choked — it had nothing to do with nutrition. The benefits of milk drinking were unlikely to have been beyond their knowledge, but the low output of dairy products prevented such a practice. According to History of the Southern Kingdoms – Biography of Wang Ju (南史·王琚传), it was recorded that “Ju, a senior official to Jizhou, was excused after his return from the frontier by the emperor from taking formally the position of Sanji Changshi (an official close to the emperor, but without any real duties to fulfill), so as to live out his last years peacefully at home. He often drank milk which helped him have glowing ruddy cheeks — like a young person. When he died in the winter of 497, he had enjoyed a long life of ninety years.” However, this was really far from common among the ordinary people. As for animal meat, although poultry appeared quite early, it was not common for people to kill and eat meat in their daily life. The Yantielun (盐铁论) states, “In ancient times, lords would not kill cows or goats without good reason; scholars and officials would not kill dogs and pigs without good reason either. Yet today a Xianbo1 anywhere can slaughter for food and purchase wine without any good reason.” These records tell us that meat was inaccessible to either junior officials or ordinary people. Even later when meat became more frequently consumed, it was still not common, as is revealed in the Houhanshu – Biography of Zhong Changtong (后汉书·仲长统传): “Zhong entertained his guests and friends with wine on ordinary days and with roast suckling pigs during festivals or other happy occasions.” Such a tradition extends till today and people still prefer their diet to be vegetarian. Meals tend to be light with a few subsidiary foods if there are no visitors or if it is not festival time. As a result, improvements were made mainly based on the varieties of rice, flour and soy foods. Kings and other aristocratic members preferred refined rice as their major food — like the “royal special” rice, xu or liang rice, which are fine varieties of grain in China, and the like. “The Royal Special Wheat, formerly named ‘west wheat’ as it comes from the west, was so named because it was paid as tribute to the king” (from the Shiyu – Wukao 识余·物考 by HuikangYesou). “The wheat field in the north of Jiangzhou county produced rice especially for the royal families” (Records of Huayang – Ba 华阳国志·巴志). “Changsha produced excellent rice whose perfume can be carried as far as five square li away by the wind” (A Discussion on Rice with the Officials (与朝臣论秔稻书) by King Wen of 1

 Xianbo, an aristocratic title in Ancient China.

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the Wei Kingdom). People’s preference for refined rice did not alter but developed further, following the southward migration after the turmoil of the Yongjia years during the Jin Dynasty, so much so, that they were tortured by beriberi because of the lack of Vitamin B1 in their diet. More types of fancy noodles and dumplings could be made with flour. In ancient times, it was said “all that is called ‘pastry’ is made of flour. Therefore, those baked are called baked pastries and those boiled, boiled pastries and those steamed, steamed pastries; and this explains the proper name ‘basketed pastries’ for steamed buns!”(XiangsuZaji – Boiled Pastries (缃素杂记·汤饼) by Huang Chaoying in Song Dynasty). When sesame was added, baked pastries turned into sesame pastries. And boiled pastries gradually evolved into various types of noodles — as recorded by Wu Chuhou in his Qingxiang Zaji (青箱杂记): “Anything that is boiled flour product is called a ‘boiled pastry’.” They were even sometimes called “boiled officials” later in the Han Dynasty — for it might be considered a luxury food enjoyed by upper-class families. During the times of the Wei and Jin Dynasties, it was quite a popular belief that eating noodles could help fend off the cold. Shu Xi in the Jin Dynasty once wrote an Ode to Boiled Pastry (汤饼赋), which contains the lines, “In the deep winter when the cold is harsh, the nose streaming and mouth covered with frost, how to fight it? How can I recover? Boiled pastry is the best. White and soft as silk, steaming in every corner of the market, and its sweet fragrance reaching all around.” Also in the Jinchu Suishiji (荆楚岁时记), it is recorded that “When He Yan ate boiled pastry in the hot summer it forced him to wipe off the sweat with a towel. Thus people understood that his face was pale because of the flour.” What a fine thing noodles are! No wonder the first time Marco Polo made their acquaintance he fell in love with them and brought them back to Italy, where they were called “macaroni” and became popular all over the world. Pastries: There was also the mantou (a kind of pastry) which was also named long bing, or “steamed pancake” which, according to Gao Cheng of the Song Dynasty writing in his Shiwu Jiyuan (事物纪原 The Origin of Things), originally got its name from the following event: “when Zhuge Liang carried his army to the South on a punitive expedition where they had to cross the wide Lu river. Local custom decreed they had to kill people and offer them as tribute to the gods — but Zhuge ordered instead that sheep and pigs should be slaughtered, and his soldiers shaped dough around the mutton or pork to form what looked like human heads — and replace what originally should have been human. According to local tradition, human heads had to be cast into the waters, to pay sacrifice to the god — when they crossed the river.” The GujinShiwukao – Yinshi (古今事物考·饮食) also

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records, “When he raged war against Meng Huo, a tribal leader in remote southwestern China, where witchcraft was very popular, Zhuge Liang was told to pay tribute to the gods who could then send magic troops to help him. The gods would not help unless they could be fed with the heads of living human beings, according to the barbaric tradition. Zhuge did not follow this advice. He ordered his men to wrap mutton and pork with dough, and fashion them into the shape of human heads, and with these heads he paid tribute to the gods. Because of this any head-shaped dough was later called a ‘steamed head’.” Lang Ying of the Ming Dynasty in his Qixiu Leigao (七修类稿) said, “it was originally called phonetically mantou (man in Chinese means barbarian and tou head, but later was altered into mantou using different Chinese characters.” Be that as it may, the steamed buns (or steamed buns with meat) were so delicious they became widely popular. And jiaozi, or “dumplings”, and other foodstuffs originally developed out of this idea. Rice flour: It could be made into various foods like gao (i.e. “cake”), zi (i.e. “sticky rice roll”), sa (i.e. “pastry with meat”), er (i.e. “rice pastry”) and the like. “To make er, people first milled rice into flour and then soaked it in water” (from the Shuowen (说文)). “Steam the soaked wheat-flour, and we get pastry; steam the soaked rice flour, and we get er” (from the Jijiupian (急就篇) by Yan Shigu). Delicious as it was, it got other names such as “perfumed er”, “sweet er” and “charming er”. The Houhanshu – Biography of Cruel Officials (后汉书·酷吏列传) once recorded that: Fan Ye, also named Fan Zhonghua, was born in Xinye, Nanyang. When Emperor Guangwu was young, he used to be one of his playmates. At the beginning of Jianwu period (25–56 CE), he was appointed as shiyushi (an official title in ancient China) and later promoted to duwe, east of the river (roughly today’s Shanxi). Once he was summoned to the emperor in Yuntai. In earlier times Guangwu had been in a lowly post and was once arrested in Xinye. Fan Ye served as a minor official there in the market, and had given him a basket of er. Later, when he became Emperor, Guangwu never forgot this kindness, and paid him back by treating him to royal feasts and providing him with carriages and horses, clothes and other things. Er, if meat is added, becomes sa. “Mix beef, mutton and pork together and cut into small amounts; add double the same amount of rice to get er; and then steam it” (Dadaili – Neize 大戴礼·内则). However, this was

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high-level food — specially made for sacrificial ceremonies, and inaccessible to the common people. Soy Products: Soy foods, if taken as a staple, according to the ancients, cause people to become ill. Zhang Hua of the Jin Dynasty wrote in his Natural History (博物志) that “People will feel their bodies too heavy to lift their legs forward and find it difficult to walk, after eating soy beans for three years.” “A frequent diet of red beans causes rough and dry skin.” Ji Kang in his Theory of Preserving Health (养生论) also wrote, Everybody knows that soy beans cause heaviness in the body, While elm seeds make men dozy; The Albizia julibrissin tree (mimosa) helps dissolve anger And the Tawny Daylily to forget our sorrows. So soy foods have never been taken as a staple food. However, the Book of Fan Shengzhi (氾胜之书) said that “It is good to preserve soybeans for people to eat. That’s why people kept them in case there was a famine year.” The Lunheng (论衡) also said that “Soybeans, though rough and coarse, can fill the stomach when hungry; those who had eaten soybeans would mention that these foods were coarse and not sweet, but they never said that they were hungry — or had nothing to eat!” So soybeans became a delicious food for these people, on subsistence rations. In the East-Han Dynasty, “when Emperor Guangwu was in Hutuo, Mr. Gongsun recommended soybean porridge for him. Now in some counties in northwestern China, porridge is also called a ‘Hutuo meal’” (Qingyilu – the Hutuo Meal 清异录·滹沱饭 by Tao Gu in the Song Dynasty). This actually referred to a historical incident, when Emperor Guangwu was short of rice for his troops during a march. Feng Yi presented him with wheatmeal together with soybean porridge, which eventually helped the whole army cross the Hutuo River. It so turned out that eating a “Hutuo meal” was then considered an honour. Tofu: Tofu was another thing — that is, bean curd, a food product made out of soybeans. This remarkable food was looked on with new eyes. Beans are difficult to digest but soy food products on the contrary are not — they have a delicious taste and they can provide rich vegetable protein. Tofu was created by Liu An, Prince of Huainan (c.179–122 BCE), with the aid of his follower Bagong. Chu Renhuo of the Qing Dynasty in his Jianhuji (坚瓠集) praised tofu for its ten virtues with its “Virtue of Popularity as it has spread everywhere”, its “Virtue of Economy as it is sold at such a low price as one Qian”, “its Virtue of Kindness as it tastes like milk, and provides people

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with rich nutrients”, its “Virtue of Neutralization as people suffering from non-acclimatization can recover immediately upon eating it” and the like. In addition, tofu was within the common people’s reach. Su Weixi, a poet in the Ming Dynasty, once composed a poem on tofu, quite comprehensively describing it — from its production process to its smell, taste and colour: Legend says that the skill of Lord Huainan was the best: To peel the beans then to reveal the essence. Its exquisite nectar flows around the millstone Like snowflakes tumbling and diving in boiling water. The moon reflected on the surface of the jar containing Tofu Which, even cut open, is still as flawless as smooth jade. Who can fully understand this taste? No other man than a Confucian and Taoist. Tea: Of all Chinese drinks, wine was originally given first place. But later this was replaced by tea for those light drinkers for whom there were too many taboos on drinking wine — as wine not only led easily to drunkenness but also sometimes caused distress. So Tea was promoted and became the most popular drink. Liu Xianting of the Qing Dynasty wrote in his Guangyang Zaji (广阳杂记): It was believed that the drinking of tea began in the period of the Three Kingdoms, and this was recorded in a History of the Wu-Biography of Wei Yao (吴志·韦曜传): ‘Every time Sun Hao had a drink with his officials, he would set an upper limit of seven liters. Yet Yao could only drink two. So, Sun would either lower the requirement or let him drink tea instead.’ These records provide good proof for the drinking of tea. Note: there was another case in the Supplementary Biography of Zhao Feiyan (赵飞燕别传): ‘After the death of Emperor Cheng (51–7 BCE), one night, Zhao cried long in her dreams until she was stirred by the inquiries of the servants. She told them, ‘I dreamt of our late Emperor who bestowed a seat for me and offered me a drink of tea. Yet his attendants said to him: ‘This was disrespectful — to have tea served to her, with your majesty ill all the time.’’’ From these descriptions, it can be inferred that the drink of tea appeared as early as the Western Han Dynasty, but not as late as the period of Three Kingdoms.

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Recently, Zhang Menglun, by a thorough probe into both ancient and present data, pointed out that there is good evidence that the history of tea can be traced back to Sichuan during the early West Han Dynasty.2 There is a close connection between the drinking of tea and the longpreserved Chinese habit of drinking boiled water. Zhuang Chuo of the Song Dynasty wrote in his On Chicken Ribs (鸡肋编): It is commonly said that, in the northwest regions, the water is sweet but the wind harmful. People often become ill due to the strong winds but not the water, even though they drink it cold and unboiled. However, things are quite contrary in the southeast where people always drink boiled water, even if on the road. When they go to bed, they are accustomed to lie facing outwards. The walls under the heavy eaves are uncracked, as they are not made of clay, and this means there are no strong winds blowing in on them the whole year. Yet in the spring, they are usually tortured by heavy rains, and in the autumn, by drought. This is just as Su Dongpo said in his poem: ‘The spring rains pinned them down like invisible dust, the spring winds blew and threw them around’. But this never happens in Zhejiang. “Boiled water” was for sterilization — which probably begun in the Hemudu Era (the Neolithic). But after the discovery of the tea tree, people began to boil tea. Lu Yu, during the reign of Emperor Xuanzong in the Tang Dynasty, wrote in his Book of Tea (茶经): Tea comes from a wonderful tree in the south which can grow with its stem as high as one or two chi, or even tens of chi. In Bashan and Xiachuan, people would cut down tea trees which grew so thick it needed two men to stretch their arms around them… The characters used to describe tea usually have a component either ‘grass’ or ‘wood’ in them, or a combination of ‘grass’ and ‘wood’; characters mean various thing, for example one means cha (i.e. the tea leaf or tea tree), another jia (i.e. a tea tree), another she (i.e. perfumed tea), another ming (i.e. the drinking of tea), another chuan (i.e. late collected tea)… and so on. As for the quality of tea, wild-grown is better than cultivated tea; in the tea woods with heavy shade against 2

 Zhang Menglun. Research on Diets in the Han and Wei Dynasties (汉魏饮食考), Lanzhou University Press, 1988, pp. 165–170.

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huge rocks, the purple is better than the green; the tea leaf being the shape of a bamboo shoot is better than it having a saw tooth; a tea leaf with rolled up margins is better than one extended. Do not collect leaves from trees growing in valleys or on hillsides in a shaded area, for drinking tea made from them would block the flow of qi and blood and eventually cause masses in the abdomen. Tea is very cooling and suitable for drinking, especially for those disciplined ones who can use it to be cured of a thirst, annoyance, headache, dry eyes, or weakness in the limbs and uneasiness of the body — just a few sips of tea make it fairly comparable to fine cream or sweet dew. Yet if the making of tea is not accomplished with the proper timing, or is a poor product, or mingled with other plants, people will just feel ill after drinking this kind of tea. This is really the damage brought about by tea. Just like ginseng, different places produce different qualities in it. The top class grows in Shangdang, the middling in Baiji and Xinluo, while the lowest of all is grown in Gaoli. That tea from Zezhou, Yizhou, Youzhou or Tanzhou contains no medical benefits and should not be used for medicines. If someone mistakes Jini (i.e. Adenophora Hunanensis) as ginseng, it creates a disease that cannot be cured. And there are complications in drinking tea just as there are in taking ginseng. Here, Lu Yu, in comparing tea to ginseng, wanted to point out one truth — that all things are good for people, if taken properly; but if taken improperly, they will cause illness. The Chadong (茶董) also quotes the words of the poet Gu Kuang: … Before Emperor Wen of the Sui Dynasty prospered, he once had a dream in which his head was cut off by some mysterious man. After that, the emperor began to be tortured by a headache. Then a monk told him that in the mountains, there grew a grass called ming3 which should be the cure. Quan Shu, a sometime scholar, has admired it so much he has written ‘all researches into ancient classics cannot compete with a cartload of ming.’ … Liu Kun, also named Liu Yueshi, once sent a letter to his old brother Zinan saying: ‘When I feel uneasy, I usually drink tea. You can try it.’ … also, Tao Hongjing in his Zalu (杂录) wrote that ‘Perfumed tea can give you a 3

 茗 ming, Thea sinensis.

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light and energetic body. Both Lord Danshan and Lord Huangshan used to drink it.’ These records reveal that its curative function was the focus when drinking tea at that time. It became popular right up until the Tang Dynasty as an increasing number of tea trees were planted. Tea drinking became a major pastime for people to such an extent that tea houses could be found on every corner — with scholars keen on praising tea through their calligraphy. Take the famous poem by Yuan Zhen, a renowned poet of the Tang dynasty, when seeing Bai Juyi off for the eastern capital: Tea, Perfumed leaves and tender buds, Entertains poets and favours monks; Put under a white jade roller, And through a sieve of scarlet muslin. Roasted turning yellow in the pan, Dancing like flowers in the teacup. In the night, I may befriend the bright moon; Before sunrise, I greet the glowing dawn. Never feeling tired, no line between the ancient and the present; Always known to be good for you, especially after drinking wine. These words, created with such an artistry (the lines lengthen by one character progressively to the end of the poem), could never be composed by those who could not catch the beauty of tea, or who did not know about how to drink it. What a beautiful thing tea is! Books on tea drinking, just like the Sunpu (Bamboo Shoot Guide 笋谱) and the Junpu (Fungus Guide 菌谱)… are no more than the host self-boasting and trying to entertain the guest! Its function is only to reduce fat or greasy deposits and clear the head, as does Chuanxiong (ligustici) and Congbai (scallion stalk) when used for a headache. It helps discard wind and phlegm. It does not have much of an extended medical function. But the damage done by drinking tea is powerful as the internal organs are ‘scraped thin’ as well as the fatty lining of the stomach. Tea-lovers usually have pale faces and sallow, emaciated figures, for their ying and wei have been injured. The accumulated damage will just shorten their life span. Therefore,

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those who love tea are really unwise. Just look at their diet. No matter how fatty the pork, mutton or beef are, tea will degrease it completely and thus their taste is lost. If a table is greasy, wash it with tea and it is clean and clear — just like a new one. As humans are made of flesh and blood and nurtured by fat, how can we afford the loss of it? Actually the prescription of Chuanxiong Cha-tiao-san (ligusticum wallichii combined with tea) was once used to cure headaches and now is used to treat hypertension headache; tea with its function of degreasing is now applied to lower cholesterol; according to research by experts in Japan and Taiwan, Oolong tea from Fujian Province is the best. Pu’er tea from Yunnan Province is experimentally proven to have an anticancer function. Therefore, to say tea damages the body as Zhang Mu does turns out to be untrue. Actually it is the opposite, it is what people need to drink in order to prevent and treat disease as well as lower lipid levels and reduce weight. Probably Zhang made such a rebuke because it was much too popular among the Chinese people, who had always been accustomed to having a light low-fat diet, although to have had a traditional vegetarian diet, and little of it, with tea as the common drink, the corrosive effect of it would have caused malnutrition. Yet it is really due to an ignorance of the history of tea that he said there was no record of tea in Shennong’s Herbal Classic (神农本草经) right up to the falsities in A Newly Revised Materia Medica (新修本草). Also he criticized the falsehood of prescribing ginger tea for dysentery in the Compendium of Materia Medica (本草纲目), but it has been proven later by experiment that tea, with its rich tannin content, can have an astringent function on the stomach and intestine and thereby cure dysentery. Yet there is something correct in his criticisms on people swallowing tea leaves after drinking the tea and on the popularity of drinking long-kept teas, some even as long as ten or twenty years. When he found his criticisms did not draw much attention, he sighed, “If we cannot know who was the first person ever to start drinking tea, then really it is impossible to stop the whole world carrying on this practice.” Tea has long been a worldwide beverage and it will attract increasingly positive appraisals. It has truly been a great contribution towards human health out of ancient China. Food Safety: As for food safety, ancient people were careful about it. In the YinshanZhengyao – ShiwuLihai (饮膳正要·食物利害), it warns,

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Do not eat dough with a bad smell; do not eat smelly raw food stuffs; do not eat long-kept porridge or stale rice; do not eat meat which does not change color when boiled; do not eat meat which does not come from butchered animals; don’t eat smelly meat… do not eat meat from pigs or goats that died of disease; do not eat meat which still feels moist even after exposure to the sun; do not eat liver from horses or oxen… do not preserve dried sliced meat stored with rice because it will produce poison. Do not eat rotting fish; do not eat sheep’s liver with holes in; do not eat birds which died with their beaks closed. Do not eat crabs until the eighth month of the lunar year; don’t eat too many shrimps… do not eat preserved meat and the like if they either become soaked by rainwater or bitten by rats or bugs. Do not eat seafood either kept a long time or changing in color from damp or heat. Do not eat too much onion as it causes deficiency. Do not eat too much coriander as it causes amnesia. Do not eat too many bamboo shoots as they can stimulate disease; do not eat edible fungus if its color turns red. Do not eat garlic in the third month for it blurs the eyes; do not eat knotweed for it stimulates disease; do not eat frosted gourds in the ninth month; do not eat coriander in the fourth month as it causes body odor; do not eat spices in the tenth month for it injures the heart. Do not eat leeks in the fifth month for the damage the five internal organs. All these might not be perfectly correct for some are simply derived from experience and some sympathetic magic (like the connection between coriander and body odour). Yet some were also mentioned in the Synopsis of the Golden Chamber (金匮要略). In the chapter on Incompatibility of Foods (食物相反) in this book, it says, “Do not take in foods of too many types for among the variety there must be some incompatibilities, so a distinction must be made by a wise man… Do not eat lamb’s liver and pepper together as the heart will be damaged. Do not eat rabbit meat together with ginger for cholera will be the result… Do not eat pork with coriander for together they will damage the intestines. Horse milk goes against raw fish for their incompatibility causes lumps in the abdomen…” There are many incompatibilities presented, which are also mentioned in the chapter Incompatibility of Foods and a Cure (金匮要略·禽兽鱼虫禁忌并治) in the same book.

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In another chapter Food Poisoning (食物中毒), it says, “Among different varieties of foods, some are poisonous by nature and some, if eaten by careless people, though not poisonous by nature, turn poisonous after mixing with incompatible foods, or the foods fight against each other which damages the internal organs and the qi in the intestines and stomach. No matter how strong the poison is, decide what damage has been done and by which foods and you can also decide what detoxification is necessary…” For example, “for a poison caused by crabs, drink purple perilla juice, or white gourd flesh, or fresh lotus root to detoxify it. For those who imbibe wine heavily, they can drink bean-juice, or kudzu vine-flower tea, or mulberries, or a decoction made from orange peel,” and so on and so forth. Among these remedies, some actually work. During ancient feasts, although eating together was common, there were some who preferred to eat separately. It was really hygienic that food covers were used to keep flies from the food before dinner began. At the end of the Qing Dynasty, restaurants in the south even put up slogans such as “We are careful of food hygiene!” to attract more customers. After all, both a knowledge of foodstuffs and their requirements as regards hygiene and preservation were on the rise. Eating out and picnicking then were also an added pleasure. As for those unique tools, the chopsticks — which belong to the Chinese people — help cultivate subtle movements in the fingers and have had a vital impact on the development of the brain. Many people have commented on this and I shall not say any more here.

144. Medicated Foods Based on the Homology of Medicine and Food What the above involves is common dietary culture, traditions and habits, anything but not specially pursuit of keeping health or treating disease. Yet the homology of medicine and food (“medicine and food coming from the same source”) can be traced back to ancient times when Shennong already began his practice of taking the poisonous as medicine and the nonpoisonous as food. This gradually evolved into the idea that medicine can be food, and food can be medicine — and, based on each person’s physical condition and particular disease, both can help in striving for a healthy and long life or dispelling disease. Indeed this practice constituted an important part of Chinese dietary culture.

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Medicated food, or “medicated nourishment” as it is called today, probably originated from the idea of taking powders to become immortal. It is true that there are tremendous difficulties in the human becoming immortal, regardless of the difficulty in measuring how much powder is taken or the inaccessibility of refined magic pills. Only medicated nourishment, usually as a diet, easy to carry out and use, was practiced. Wang Chong in his Lunheng – Daoxu (论衡·道虚) said, Taking medicated food can really work on the lightness of the body and on nourishing the qi. However, there is no historical evidence that it can prolong peoples’ lives. Medicines can treat illness — and then you recover the qi and ultimately the lightness of the body. It is natural that men are born with light bodies and a free-flowing qi. If blocked by wind and damp, then they suffer from disease, their bodies become heavy and their qi weakened. By taking proper medicines, the bodies and qi recover. So, it is not that we are qi deficient by nature, and the medicine helps us to return to an original or even improved state. That is what originally existed in nature. Medicines can help us simply by recovering our natural state, by eliminating disease and helping us regaining the lightness of our bodies and a free-flowing qi. That is ‘returning to nature’, but how can they help to prolong life and in immortality? In a few words, Wang Chong points out on the one hand the falsity of powder-taking theory and on the other that medicine taking can help cure disease and help us recover light bodies and free-flowing qi. Medicine is acting as a particular type of foodstuff, which was an idea connected to many legends and stories — and so it was elevated and called a tonic. Take, for example, the story of Heshouwu, i.e. polygonum multiflorum, recorded in the Quantangwen (全唐文) by Li Ao during the Tang Dynasty: A monk named Wenxiang was infatuated with the art of keeping healthy. On the 18th of the third month in the seventh year of Yuanhe (812), during his pilgrimage to Maoshan Mountain, Wenxiang met an elderly man at the entrance to Huayang Cave and was told “You have the facial features of an immortal. Let me tell you a story about a secret formula: there was a man named He Shouwu, but originally known as Tian’er, and born in Nanhe

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County in Shunzhou. All his predecessors were fertile but he was naturally impotent. Once at the age of fifty eight, he was so intoxicated by wine one night he lay down in the wilderness. When he recovered consciousness, he saw two vines, three chi away, yet tangled together. He looked at them a long time, and then got up and untangled them. However the moment he had done so, the vines got tangled again. He again untangled them, and again they tangled together. After repeating this three or four times, he was so astonished that he dug out the roots and consulted others in the village. But nobody knew their name. He then placed them in the open yard and dried their roots in the sun. A village man called Lingliang teased him and said, ‘You are impotent and doomed to get old, without offspring. This vine is really a magic medicine as it can tangle up together after being separated. So you must take it!’ Tian’er then ground the dried root into powder and took it with wine. Seven nights later, he suddenly had erotic thoughts and his body felt strong and light. His sexual desire could not be quenched. He then married a widow Zeng. As a result he frequently took the vine, and every meal ate more. This continued over seven hundred days and all his recurring health problems were cured — his face even appeared younger. Furthermore, he had a son. Later he had dozens of sons all within ten years and all of them were good at medicines. This plant is called Tangled Vines (the vine of multi-flowered knotweed or Pologonum multiflorum). Anyone who takes it can live for 160 years. Yet it has not been recorded in ancient prescriptions or books of material medica. I knew it from my tutor and he found it in Nanhe. After I took it, I had a son. However, I am actually now enjoying a calm life and this medicine is harmful to it, so I refuse to take it anymore. Now it is really good for you to take it only occasionally.’ Tian’er died at the age of 160 and during his life produced altogether nineteen sons and daughters. His son Ting also took the medicine and lived for 160 years leaving behind thirty sons and daughters. His son Shouwu took the medicine and lived for one hundred and thirty years producing twenty one sons and daughters. It was written in Anqi’s Tangled Vines (交藤) that ‘Tangled Vines taste sweet and are warm without being poisonous… after taking it, cover the body with clothing until daoyin sweats it out. It is the taboo to eat pork, lamb and bloody products.’” After saying these words, the old man left with swift steps, like the wind. An official Meng, who

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knew He Shouwu and had eaten his medicine, said that this was exactly right. This vine lives in the mountains of Niutou in Bingzhou, and looks like yam rhizome, its vines tangled up and its root as big as a fist. Peel the skin off, and it can be eaten. Thus someone called it He Shouwu (‘black-haired He’). The above was written in the eighth month of Yuanhe (813). This was surely a legend, yet people believed it and medical scientists believed it as well. It was recorded by Su Song in his Bencao Tujing (Illustration of Materia Medica 本草图经) as “some formula Li Ao had recorded”. Since then, He Shouwu, i.e. polygonum multiflorum, has officially become an excellent tonic. The story of sealwort (Siberian Solomon’s Seal) is also very interesting. The Biography of Hua Tuo (华佗传) recorded that Hua Tuo once taught Fan E about the “Powder of Qiye and Qingnian”. “Qingnian, also called Dijie by some and Huangzhi by others, mainly nurtures the five internal organs and benefits the essential qi. It is said that it was first discovered by someone missing in the mountain who once happened to see it taken by some immortal — then he returned to tell Hua Tuo. Hua Tuo believed it to be a good herb and told Fang E, who then secretly took it. Yet when people were so surprised at E’s health and strength at such an old age, they asked him what he took. E, when he was drunk, made a mistake and told them the secret. Thereafter, lots of people began to take the herb and all of them benefitted” (Alternative Biography of Hua Tuo 华佗别传). This Qingnian is sealwort and was introduced by Feng Shike of the Ming Dynasty in his Yuhang Zalu (雨航杂录): Sealwort is classified as one of the upper grade medicines. According to the ancient record, taking sealwort one can achieve immorality. However, this is mostly not the case for the rich. Probably it is because sealwort, yellow in color and with a sweet taste, is truly the essence of the earth and those persevering in their practices of living in the wild and having little too eat can nourish their spleen and qi with it; and even though it might not really make them immortal, it can prolong their life. However people of wealth and power usually think and worry too much — so their five internal organs contain very much fire; needless to say their daily diet of fatty meat and fine grain actually furthers creates pathogenic qi. Sweet and warm herbs to them are like wind to a prairie fire. It will worsen the disease so

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how can they benefit from this herb? When I was in Xixue there was a famine, I told the poor to steam and dry sealwort as their food. They followed this course, and all of them survived. This is truly proof that sealwort is especially suitable for those used to coarse foodstuffs. Here, the idea is clear — taking sealwort is partially beneficial, i.e. mainly to the poor. This idea came not just out people’s experiences but also from legends. Records of Gods (稽神录) says: In Linchuan, there was a rich man who tortured one of his maids. The maid could not bear it and ran away and hid into the deep mountains. Days passed, and she was terribly hungry from lack of food. Sitting beside the edge of the water, she spotted some wild grass with attractive leaves. She picked it up, washed it in the water, and ate it together with its root, delicious! Since then, the grass became her common food. Time passed, and she gradually felt no hunger anymore and her body lighter. One night, when she was resting beneath a big tree, the sound of animals in the bushes stirred her. For fear it might be a tiger, she was thinking of climbing the tree. Yet just thinking this, she was already up the tree. When the day broke, she thought of going down to the ground and there she was immediately. Since then, whatever she thought, her body swiftly performed. Sometimes she flew from one peak to another like a bird. Years later, a man from her family went into the mountains to cut wood and discovered her. They told her master who then ordered his men to try and catch her — but in vain. One day, they found her under a cliff and tried to catch her with nets. But she ascended to the mountain top in a minute. Amazed at this, her master was determined to catch her. He was confused and said, ‘She is a humble maid — how can she become so immortal-like? She must have taken some magic medicine. Allure her with a great feast full of flavours. Make the foods tasty and delicious and place them on the roads where she passes. Secretly observe whether she eats them or not.’ She came and ate the food. Yet after her meal, she could not make her swift movement anymore and was captured. Then the secret was exposed. According to the shape of the grass she had taken, it was sealwort. When they again fed her with it, it no longer had the same power. She died years later.

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This story is exaggerated of course, but it must be true that when the poor are hungry, taking sealwort can help them survive and be healthy. This is also another proof of the homology of medicine and food. Bowuzhi (博物志) records that: Emperor Huangdi asked the Sacred Empress, ‘In all the heaven and earth, is there anything that can make people immortal?’ the Sacred Empress answered, ‘Taiyang grass can. It is named sealwort and taking it can achieve immortality. Yet there is also a Tayin grass named Gouwen, inedible which brings immediate death. Yet people know about the deadliness of Gouwen but not the life-benefits of sealwort. How strange!’ This might be related to the fact that the rich could not achieve the expected benefits of sealwort, while Gouwen is poisonous no matter whether you are rich or poor. More stories on “herbs for immortality” can be found in the Yinshan Zhengya (饮膳正要), like the story of taking Fuling. Eat Fuling (茯苓 poria). Baopuzi (抱朴子) recorded that: After Renjizi took fuling for eighteen years, a jade woman came to serve him. He could make himself invisible, live without grain and had radiant cheeks.” Sun Simiao in his Pillow Stories (枕中记) recorded that “Taking Fuling for one hundred days can drive away all disease; two hundred days of taking twice a day can control ghosts and gods; four years commands a jade women into one’s service. Things like “controlling the ghosts and gods”, “commanding a jade women into one’s service” and “making oneself invisible” are surely exaggerations. However, it is a truth that Fuling is a tonic for many people — and the Empress Dowager Cixi (1835–1908) kept taking it routinely, so that it was later popular among the folk world and “Fuling Pancake”, one of Beijing’s special foods, was often sold with reference to this story. There is another story of drinking Wujiapi Wine. It is said: Drinking Wujiapi wine: the Immortal Donghua recorded in his Zhushijing (煮石经), that Emperor Shun often climbed Cangwu Mountain saying that the ‘golden jade’ and ‘perfumed grass’, which make up much of Wujia wine, could prolong life. So there is a

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common saying: ‘Rather get a handful of Wujia than a cartload of gold and jade; rather get a jin of garden burnet than of precious pearls.’ In olden days, the mother of Lord Dinggong of Lu Kingdom achieved immortality after simply drinking Wujiapi Wine. Others like Zhang Zisheng, Yang Shijian, Wang Shucai and Yu Shiyan etc., all drank Wujiapi Wine and possessed numerous women for sex, lived for three hundred years, and produced twenty or thirty sons and daughters. Many more are those who prolonged their life by drinking Wujiapi Wine — in every generation. All the above stories relate to the herb Ciwujia (Siberian ginseng or Eleutherococcus senticosis), which grew in northeast China and, like ginseng, belongs to the panax family. The Wujiapi Wine sold in the market is different from that mentioned above. It contains the bark of the periplocasepeium plant and belongs to the asclepiadaceae family. It has another name, Perfumed Jiapi. Medicinal liquor is also quite common, like Three Snake Wine, Loose Knot Wine, Tiger-bone Wine, Guogong Jiu, pawpaw wine, etc. Wujiapi Wine sold in the market has the additional function of expelling wind damp. Also there are stories of taking Dihuang in Baopuzi (抱朴子): Chuwenzi had good night vision and powerful strength after taking Dihuang for eight years. Taking Cangshu: a man named Wen in Nanyang escaped from the wars and entered Hu Mountain. When he was hungry and fatigued, he was taught to eat Cangshu. So he was free from hunger. When he returned to his county years later, he looked very well and his strength was enhanced. The Yaojing (药经) said that in order to achieve immortality, one must absorb the essence of mountains, i.e. Cangshu. Herbs like these all have stories made up about them, and yet they are all common herbs and accessible to everyone. The most commonly used and valuable tonic is ginseng, about which it is said it has “the shape of the human body and a tremendous function as well”. It is classified as an upper-class medicine in Shennon Classic of Materia Medica and recorded as “a sweet taste and slightly cold, strongly nurturing the five internal organs, tranquilizing the spirit and soul, driving away palpitations, ridding you of pathogenic qi, improving eyesight, enlightening your

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heart and sharpening your mind. Taking ginseng for a long time can lighten the body and prolong life. It grows in valleys, and is also called Renxian or Guigai.” Fanzi (范子) recorded that “Ji Ran said, Ginseng grows in Shangdang and the more like a human its shape, the better its function.” Shangdang was originally a place in Shanxi Province producing ginseng, called Ludang. Ginseng today, which also grows in the regions beside Changbai Mountain in the eastern part of Liao River, and later Shangdang, is not as powerful as wild ginseng. Today’s ginseng is all produced either in northeast China or Korea. Later its use spread to America, where a new species was discovered, called American ginseng or Western Ocean Ginseng. The long tradition of taking ginseng as a tonic can be traced back to the Tang Dynasty — with it found in the matching lines interchanged between Pi Rixiu and Lu Guimeng, both poets of those times. It became a household tonic in the Ming Dynasty, spurred on by the warm recuperation school. However, overuse of ginseng also brings damage. For example, during the period of the Cultural Revolution (1966–1976) a young man working in a medicine shop which stored ginseng used to boil and drink it, then dry the ginseng and put it back. But he suddenly suffered from epistaxis and the bleeding would not stop. Later a herbal master told him to eat white radish to recover. Yu Ming Zhong in the Qing Dynasty recorded in his RixiaJiuwen Kao (日下旧闻考): In the 29th year of Emperor Qianlong’s reign (1764), the emperor composed a poem in six lines on a ginseng root shaped liked the human body. The Materia Medica (本草) recorded that “Ginseng, in absorbing the essence of the earth, gradually forms into the shape of the human form after several years.” This is what ginseng should be like. And people take it as something valuable and as a tonic. Yet there are still accidents happening due to its misuse. Qianlong’s poem goes as follows: With its five leaves and three branches, Precious ginseng grows in the deep mountain of Changbai! Wherefore art thou in the shape of a human after so many years? Are you the same herb today as the one once given in tribute at Taiyuan? How can the real Shangdang ginseng be found?

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Its shape is so like a human, even the facial features! And the four limb-like roots surprise people when placed in baskets. Though prolonging life as a tonic, it still often kills when poorly used. Probably it is because it brings benefit when used as a supplement, While if going too far, it is forgotten its misfortune is as painful as cutting flesh. Who can understand that in the words of Buddhist Wenshu, ‘For this plant — it can both save and kill people.’ Truly, ginseng “can both save and kill people”. Therefore, medicated foods must be chosen according to the physical conditions of the patient and the diagnosis in order to avoid misuse or overuse. This is also the principle of dietary therapy. Dietary therapy might well be as ancient as medical therapy, and it can be traced back to legendary texts, missing today, such as Foods Prohibited by Shennong and Huangdi (神农黄帝食禁), Shennong’s Food Classics (神农 食经), Foods Prohibited by Shennong (神农食忌), Food Classics of the King of Huainan (淮南王食经) and Food Classics of Hua Tuo (华佗食经). The earliest and most complete articles on dietary therapy preserved today are in the chapter “Dietary Therapy” in Sun Simiao’s QianjinYaofang (千金要方) which was later included in the Qianjin Shizhi (千金食治). As for books on dietary therapy, Meng Xian’s Dietary Materia Medica (食疗本草) (probably 713–741) is the earliest complete one, but it is said that Meng actually was a student of Sun Simiao. Later in the Yuan Dynasty, the completion of A Book on Diets (饮膳正要) in 1330 pushed it to a peak. The principles behind dietary therapy are just as stated in Qianjin Yaofang (千金要方): Zhongjing has said, ‘To attain a harmonious and healthy body, one must take care of one’s daily diet and not take medicine recklessly, for medicine with its partial benefits will disturb the inner qi and cause the body to become vulnerable to external pathogens. Those which benefit the qi cannot work without food, but results differ. Common people eat, but cannot identify the food they eat — so they are unaware just as when troubles such as ‘water or fire’ come to them. At this, I was very concerned, so I composed the chapter on dietary therapy, i.e. on the goodness and badness of the foods of the five flavours during my spare time, hoping to enlighten our children who can make reference to this and practice it accordingly. This is all I wanted!’

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Wei Xun, a medical scientist in the East Han Dynasty, once recorded that Bian Que said: The human body is the basic shape for life as a whole — so if the inner qi is disharmonious that means illness; once medicines can clear the toxins away the doctor can save the life at risk. What is essential to keep the body healthy is nothing else than food; and what can quickly drive away disease is nothing else than medicine. People who are ignorant of suitable foods cannot survive; just as people who know nothing about medical taboos cannot be cured of disease… Therefore proper diets can drive away pathogens and tranquilize the internal organs, and can freshen the spirit and nurture the blood and qi. People who cure disease simply with the proper diet can be called excellent doctors… being a doctor, one must gain a thorough knowledge of the sources of disease and only be aware of what makes the patient ill, and enable him to find the proper food to cure himself. Only after the failure of dietary therapy, should medicines be applied. Such an opinion is fairly correct because medical therapy is not in competition with dietary therapy. Chinese foods focus on the five flavours — which belong to the same family as medicines. So, the Neijing (内经) once said, Huangdi asked, ‘May I learn about the respective functions of the grains’ five flavours?’ Bogao answered, ‘Taking in wind helps one become spiritually intelligent and have a lighter body to lift oneself up; taking in qi can promote internal peace and prolong life; taking in grains enhances the intelligence as well as the mind; taking in grasses makes one ignorant and stupid but have more bodily force; and eating meat makes one bold and vigorous but often easily angered. What is taken in makes a difference. So the liver belongs to wood and blueygreen and finds sour foods suitable; the heart to fire, scarlet and bitter; the spleen to earth, yellow and sweet; the lungs to metal, white and spicy; the kidneys to water, black and salty. In a word, there are five internal organs within and five elements without — with their five corresponding colors.’ Compatibilities of food for the five internal organs: patients with liver diseases should eat more sesame, dog meat, plum and chives; patients with heart diseases eat wheat, mutton, apricot and scallion; patients with spleen diseases eat tares, beef, dates and Fructus

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Maluae; patients with lung diseases eat yellow millet, chicken, peaches and scallion; patients with kidney diseases eat soybean sprout, pork, chestnuts and leaves of pulse pants. It is highly probable that dietary therapy originated in this way, not only as the compatibility of food according to the season but also as certain medicines and foods are compatible with each other, and that this evolved into the present taboos of “dietary restraint”. The Yinshan Zhengya (饮膳正要) says: When taking medicines, the patient should avoid too much raw coriander and scallion, lettuce, stimulating foods, fat pork, dog meat, gunk, smelly fish or mutton, etc.… Do not eat the rhizome of the large-headed atractilodes together with peaches, plums, sparrow meat, coriander or scallion; do not eat black false hellebore together with orang-utan meat; do not eat fructus crotonis together with asparagus or wild pig meat; do not eat pork if you have just eaten copitidis or platycodi; do not eat rehmannia together with ulmus… And there are other incompatibilities such as Tuckahoe does not mix with vinegar, turtle shell goes against amaranth, radix asparagi goes against carp, and so on. Caution must be taken not only with foods but also with the time and the date: Taboos for those who have to take medicines for a long time: To take medicines, avoid the time of Wei4 as well as the day of Man5; avoid the day of Si in the first, fifth and ninth month of the lunar year; avoid the 4

 Wei (未), the eighth of the twelve Earthly Branches (十二地支), that is, Zi (子), Chou (丑), Yin (寅), Mao (卯), Chen (辰)，Si (巳), Wu (午), Wei (未), Shen (申), You (酉), Xu (戌) and Hai (亥). In ancient China, the twelve Earthly Branches (十二地支) identify the time. The month of Wei refers to the sixth month of the lunar year, while the time of Wei amounts to the time from 13:00 to 15:00. 5  Man (满), the day of Man (满), is a lucky day suitable for good things, but not bad things — according to the ancient Chinese calendar which held that there were twelve days called Jian (建), Chu (除), Man (满), Ping (平), Ding (定), Zhu (执), Cheng (成), Shou (收), Po (破), Wei (危), Kai (开) and Bi (闭) in a month and each day was suitable for different things.

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day of Yin in the second, sixth and tenth month of the lunar year; avoid the day of Hai in the third, seventh and eleventh month of the lunar year; avoid the day of Shen in the fourth, eighth and twelfth month of the lunar year. Probably the formation and diffusion of dietary therapy in the name of medicated foods came partly from the Yinshan Zhengyao (饮膳正要) written by Hu Sihui (c.1330). This book records such soups as Masi Daji, barley soup, soup of the soft-shelled turtle, carp soup, raw radix rehmanniae chicken soup and others. All of these are both delicious and dietary as well; also there is the porridge of the Chinese wolfberry and sheep kidneys, a thick soup of sheep bones, porridge of sheep bones, porridge of pig kidneys, porridge of Chinese yam and others — all very suitable for the elderly, to maintain health and prolong life. In Laolao Hengyan (老老恒言) during the Qing Dynasty, there was a whole roll under the catalogue of “Porridge Collection”, which recorded about one hundred recipes for porridge, a real compendium of porridge. Thus, being so close and intimate together, dietary culture and medicine were miraculously bound up together.

B.  Cases in Literature, Art, the Physical and Medical Sciences 145.  The Relationship Between Music, Poetry and Medical Science The Hanshu – Records of Ritual Music (汉书·礼乐志) states that: There is no regularity to the mental changes of sorrow, joy, pleasure and anger — although all people are born to possess blood and qi, a heart and intelligence. Sentiments 心术情绪 can only be reflected and formed when the heart is touched in response to certain outside stimuli. So weak and wan music makes people long for harmony while easy and harmonious music makes people serene and feel happy; boorish and vigorous music can express their resoluteness; honest and really true music arouses their solemnity and reverence; while peaceful music with slow tempo triggers kindness in the heart; and loose and disordered music tempts people to licentiousness. The ancient Kings grand, chanting music was composed of Ya (雅) and Song (颂) songs for the people so that they felt ashamed of the licentious type. These come from our natural disposition with a degree of

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control, guided by the rites, according to the humors of the living qi, and the ‘five constants’ in the circle; keeping the Yang qi undispersed, the Yin qi not smoldering, the firm qi without anger and the soft qi unscared. Those four flowing all inside us and showing outside us, just in their own position, without forcing. Such kinds of music can boost the kindness within and keep the heart free from pathogenic qi. So music as well as dance has a close relationship with the health of the people. The Lingshu – Chapter of the Five Notes and Five Flavours (灵枢·五音 五味篇) describes even the extent of the relationship between music and the main and collateral acupuncture channels, even though it is rather hard to understand. For example, To people of a You Zhi (右徵) and Shao Zhi (少徵)6 type both of which are of the category of the Fire Note,7 a correct treatment is to restore the function of the upper part of the small intestine meridian of the right hand Greater Yang. To people of a Zuo Shang (左商) Metal Note type or ZuoZhi (左徵) Fire Note type, a correct treatment is to restore the function of the upper part of the large intestine meridian of the left hand Yang Brightness. To people of a ShaoZhi ( 少徵) type of the Fire Note or Da Gong (大宫) of the Earth Note type, a correct treatment is to restore the upper part of the large intestine meridian of the left hand Yang Brightness. To people of a Zhong Yu (众羽) type or Shao Yu (少羽) type of the Water Note type, a correct treatment is to restore the lower part of the bladder meridian of the right foot Greater Yang. To people of a Shao Shang (少商) type or You Shang(右商) of the Metal Note type, a correct treatment is to restore the lower part of the small intestine meridian of the right hand Greater Yang…

6

 The ancient Chinese musical scale system is comprised of five notes, Gong (宫), Shang (商), Jue (角), Zhi (徵) and Yu (羽), namely the system of the pentatonic scale, roughly amounting to 1, 2, 3, 5, 6 of today’s international scale. 7  According to the ancient Chinese musical scale system, the five notes (五音) correspond to the five elements of Metal (金), Wood (木), Water (水), Fire (火) and Earth (土). Hence, the names of Metal Note (金音), Wood Note (木音), Water Note (水音), Fire Note (火音) and Earth Note (土音).

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To people of a Shang Jue (上角) type, similar to that of Da Gong (大宫) of the Earth Note type, a correct treatment is to restore the stomach meridian of the right foot Yang Brightness. To people of a ZuoJue (左角) type, similar to that of the Shang Jue ( 上角) type, a correct treatment is to recuperate the stomach meridian of the left foot Yang Brightness. To people of a Da Yu (大羽 type), similar to that of a Shao Yu (少羽) type, a correct treatment is to restore the lower part of the bladder meridian of the right foot Greater Yang. To people of a Zuo Shang (左商) type, similar to that of You Shang (右商) type, a correct treatment is to restore the upper part of the large intestine meridian of the left hand Yang Brightness… We have also quoted the discussions on the relationship of music and dance to physical health from books like Mr. Lu’s Spring and Autumn Annals (吕氏春秋) and others, but pitifully no more data can be found to prove the function of music and dance in disease treatment and recuperating therapies. And music and dance fell into disuse after feudal ethics and rites prevailed (as well as foot binding) during the Song Dynasty — so it is needless to mention their meager impact upon medical science. Hence, we make no further discussion on this. As the common saying goes — “To learn medical science for a scholar is like trying to catch a hen in a coop.” Learned people would grow into “either a capable prime minister or an excellent physician” because of their fine cultural knowledge, which made it comparatively easier for them to learn medical science. However, the fact is that many of them did not themselves become physicians — although medical phraseology often slipped into their work, and they turned out to be quite unique literary phenomena. Some of them borrowed names of Chinese medicines and used them in their poems, articles, official writings and so on, which actually first appeared early in the period of the Three Kingdoms. For example, During the Taihe warring Years of Wei (魏 227–232), Jiang Wei (姜维, an outstanding general, who paid allegiance to the State of Shu lost all news of his mother. King Wei’s troops captured his mother and ordered her to write him a letter asking him to come back, accompanied by the Chinese herb angelica which is called Dang Gui (当归) in Chinese, meaning literally ‘should return’. Jiang

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Wei replied, ‘What does one mu8 matter to me when I have hundreds of qing?9 Why would I Dang Gui (‘should I return’) when I have Yuan Zhi (i.e. polygala root, but also a homophone for yuanzhi meaning ‘great ambitions’)?’ So Jiang Wei did not return. (from Book of Song – Records of the Five Elements (宋书·五行志)) In fact, Dang Gui (Chinese angelica) is one of the most commonly borrowed terms in literary compositions for its combination of meanings. Another example is as follows: Xi Qihong, also named Wen Biao, was a learned pupil in the Wu regions. When he heard that Ge Zhenfu had been appointed an official in the far-off areas of Yunnan (tiannan, 天南) while Ge’s mother was already over eighty years old. Xi then taunted Ge with a few lines embedded with the names of Chinese herbs. These included, for instance ‘when the herb Zhimu,10 (知母 zhimu here a homophone for zhimu, literally ‘knowing one’s mother’) is old and lives in solitude, the son should return to her company (Chinese angelica has the characters ‘当归’, literally ‘should return’); why still stayed in Tiannan?’ (天南子, i.e. herb araceae but in Chinese character ‘天南’ also means ‘far away to the south’.) Touched by these lines, Ge resigned his office and returned to his hometown. He then visited Xi and thanked him with a bow, saying: ‘Master has taught me to be filial and both my mother and I gained great benefit from your poem.’ People often take this lines as a eulogy to the open-heartedness of Ge — as well as the friendship between them, Ge and Xi. (quoted in Vol. 1 of Liunan Xubi 柳南续笔) Huang Shan’gu, i.e. Huang Tingjian, a renowned litterateur in the Northern Song dynasty, also penned the following lines: “The wangbuliuxing (王不留行, i.e. the semen vaccariae plant, but is also a homophone for ‘the King did not ask to stay’), and Mr. Meng has gone; and Mr. Yin does not need to suggest him to dangui (return).”11 So this comes out, “the King 8

 mu, a unit of area (=0.0667 hectares), but mu “area” is also a homophone for mu “mother”. 9  qing, a unit of area (=6.6667 hectares), so one qing is equal to one-hundred mu. 10  Or herb Rhizoma Anemarrhenae. 11  “The king did not ask to stay” in Chinese characters 王不留行 actually is the name of a Chinese processed medicine. “Should return” in Chinese characters 当归 is the name for Chinese angelica, also a medicine.

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did not ask Mr. Meng to stay, Mr. Yin does not suggest that he depart” (Collection of Huang Shan’gu 黄山谷集). Someone else even composed a Biography of Sangjishseng (桑寄生传) which consisted of over one hundred names of medicines. Others like Lu Guimeng and Pi Rixiu, wrote poems embedded with medicine names to express feelings as well as to clarify what they meant. Zhu Xi (朱熹), the renowned master of Confucianism, once put the names of medicines into his Ci-type poem, “I Compose a Poem at the Southern Suburb (南乡子词)”: A weak figure intimidated by the winter (the herbal name is ‘天冬 Tiandong’ which is a homophone for tiandong or ‘winter’). Withered yellow flowers lie all over the ground (‘地黄 Dihuang’ a herb, but also meaning ‘yellow ground’). Do not stand too long by the mica screen (‘云母 Yunmu’, the powered medicine mica, but also meaning ‘mother to clouds/ draughts’). And avoid the draught (‘防风 Fangfeng’ which is radix sileris, but also means ‘avoid the draught’). Yet the black-headed one is now an old gentleman with white hair (‘乌头 Wutou’ which is aconite, also literally means ‘blackheaded, and白头翁 Baitouwen’ which is pulsatilla among herbs, also literally means a white-headed gentleman). A self-mocking parasitic living in poverty (‘寄生 Jisheng’ here is the name for Mistletoe but also literally means ‘parasitic life’). Deeply worried, it cannot be figured out is it a herb or grass? (‘ 木通Motong’ is Akebia Stem but here used as a joint name for all sorts of grasses, motong also literally means ‘understand the plant’). Living by springs and rocks in one’s heart, one is likely to reach old age (‘泉石膏肓甘遂老’, ‘石膏’ is gypsum fibrosum but also means ‘rocks in one’s heart’ and ‘甘遂’ is kanziol, but also can be read as ‘willingly it follows that…’). All at one’s leisure (‘从容’, ‘all at leisure’ is similar in sound to ‘苁蓉’ which is the desert cistanche). Absorb the essence of herbs — deep in the mountains (‘山药’ is the Chinese yam, but also means ‘mountain herb’). This Ci poem, gracefully composed, borrows over ten names of Chinese medicinals in a gracious and clear manner, in order to express the gloominess of the poet’s inner world. It is really an excellent poem.

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Clearly, writing such a kind of poem is really difficult work and would be an impossible mission for those not conversant with the names of medicines. The names of medicines are borrowed much more commonly in riddles along with their answers. For example, the Qing Dynasty collection of poems Jieren Yi (解人颐) contains the following: 1. “A letter (信) will never cheat (the answer is arsenic sublimate, xinshi 信 石 means ‘trustworthy stone’), please take the trouble to take it to my son (monkshood, fuzi 附子, meaning ‘take to a son’). Do not be so selfish as to live alone (radix angelicae pubescentis, 独活 or duhuo meaning ‘living alone’). You should know your mother’s hair is already grey and thin (Rhizoma anemarrhenae, 知母 zhimu meaning ‘know one’s mother’).” In summary, A letter will never cheat, Please take the trouble to take this to my son: ‘Do not be so selfish as to live alone. You should know your mother’s hair is already grey and thin’. 2. “Nothing can be found in the pharmacy (a medicine named moyao 没药 literally meaning ‘no medicine’); there are blind papers writing nothing home (blind paper is baizhi — 白纸 a homophone for baizhi 白芷, a medicine); do not hang sails when shipping on a fast river (in case the strength of the wind risks the ship sinking — the medicine fangfeng 防 风literally means ‘avoid the wind’); slippery streets could be the downfall for the elderly after rain (a medicine named huashi 滑石, literally meaning ‘slippery rocks’).” In summary, Nothing can be found in the pharmacy, These are blind papers — writing nothing home. Do not hang sails when shipping on a fast river, Slippery streets are the downfall for the elderly, after rain. 3. “Horses from the sea come early for the court (a medicine named haima 海马 actually meaning the ‘sea horse’); the failed general fled and gave up his armour (a medicine named baijiang 败酱 a homophone for baijiang 败将, ‘a defeated general’); resting in the building facing the Red Cliff (a medicine named susha 宿砂. literally meaning ‘spending the

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night on red sand’); and waking to put on my armour again at dewy daybreak (a medicine named pishuang 砒霜, homophonic to pishuang 披霜, meaning ‘covered in frost’).” In summary, Mounted horses from the sea came early to our court… The failed general fled and gave up his armour. Resting in the building facing the Red Cliff, And waking to put my armour on again at dewy daybreak. Some patriotic and learned people even used names of medicine to mock traitors, for instance, Meng Bisheng in the Qing Dynasty, who wrote The Dream of Golden Mansion (金屋梦). In this book there is a verse Shanpoyang – Zhangqiudiao (山坡羊·张秋调) that contains a medical name mocking Jiang Zhushan who surrendered to Jin Wuzhu, the general of Jin State in the north. Jiang was later captured and beheaded by General Han Shizhong of the Song dynasty. Pu Songling, the author of the LiaozhaiZhiyi (聊斋志异), composed ten scenes of Biographies of Grass and Trees (草木传) in which names of medicines were used not only in the titles of each scene — for instance, “Fights of the Cape Jasmine”, “the Litharge Plays with the Lady” (litharge is a type of lead oxide, PbO), “Dendrobe Subdues the Demons” (dendrobe is an orchid-type plant) and so on and so forth — but also in verses such as the following: How to cure night blindness? Rat droppings. How to clear heat and diuretic? Sporalygodii. How to tranquilize the mind? Cinnabar. How to sooth the stomach and prevent miscarriages? Amomum Villosum Lour. How to cure a headache? Chaste Tree fruit. How to drive out accumulations inside? Castor Beans. How to remove wind-dampness? Cocklebur fruit. What is to cure paralysis? Semen Brassicae. This composition, all precise in scan and rhyme is similar to the The ThreeCharacter Medical Verses (医学三字经), Prescriptions in Rhymes (汤头歌诀) and so on — concise and easy to remember with brief words describing the different names and functions of each medicine.

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Poems containing the names of medicines were also used to express sentiment. Truly this is helpful for relieving depression as well as curing disease. Bai Juyi, a famous poet in the Tang Dynasty, was typical. He was once very depressed about his illness. Then he found that he could get a little relief and his sickness seemed not so terrible when he was composing poems. Some of his lines are as follows: “no need to worry about the diseases of old age, for my heart can heal myself” and “since I myself am my own excellent physician my mind is the curative medicine, and there is no need to call Yi He and Bian Que12 to come to the door”. Other poems are clearly sentiments about comfort, self-encouragement and restoration of confidence, while other lines composed when the jinbi (golden needle) could not work for his eye disease, like “when all medicines do not work, try taking the jinbi”,13 “neither the jinbi nor magnetite decoction can work”, “when all the medicines do not work, I have to ask the Buddhists for help” and so on, were sighs expressing the poet’s low mood. The hundred or so poems closely related to medicines, out of his total of 2803 preserved poems, can surely reveal to us something of the medical situation at those times. Many more poems related to medicines were produced by Yuan Zhen, one of Bai Juyi’s poet friends. One contains lines such as the following: Once drinking in front the flowers, Now I sickly fritter away my time still with the flowers. Leaning alone on the ragged curtain with a sad look into the distance, Just a deep sigh, a waste of the beautiful sight of spring. These lines so vividly reveal his destitute and often-troubled situation when sick. These lines were composed to express his depression as well as relieve his spirit. The same applies to other poets such as Du Fu who wrote lines such as “suffered from malaria for three years, I could still not drive it out. I searched for my body fat every day, but feel so cold that I still feel the frosts.” Poetry composition can also help expel depression — even when the depression is not caused by disease. Ouyang Xiu, a famous poet in the Song 12

 Yi He and Bian Que, both legendary excellent physicians in the Spring and Autumn period, later synonymous with any excellent physicians. 13  Jinbi, a golden needle used as an ancient tool for eye diseases; it used also to refer to treatment for eye disease.

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Dynasty, once composed his poem Annoyed by the Summer Heat (病暑) with lines like, Knowing there is no way to get away from the heat, Why not calm down and face it? Does one have to be a superior man of virtue to do this? Only a peaceful mind can tranquilize the heart… And then forget the annoyance stirred up by heat. Chao Gongshuo, also in the Song Dynasty, wrote an Ode to the Heat (暑赋) with the line “My heart is purely peaceful as still water.” Both Ouyang and Chao took the idea that “a calm heart keeps you cool” to deal with the heat. Comparatively speaking, some people even suffer hysterical heatstroke when suddenly annoyed at the news of approaching high temperatures that they faint from “heatstroke”. What a better way it is to compose poems to expel the heat! What applies to poetry also applies to painting and calligraphy, the composition of forewords to literary works, biographies, epitaphs, discussions on medicine, etc., much of which was closely related to medical science; there are so many examples that they cannot all be listed here. However, one thing must be made clear — the close relationship between Chinese culture and Chinese medical science can never be neglected.

146.  Kongfu and Medical Science It has long been held, since ancient times, that physical activity is helpful to health, the maintenance of well-being and expelling disease. Such exercises as Boyi (ancient chess playing) in the pre-Qin Dynasty, Juedi (ancient wrestling) in the Qin and Han, Maqiu (ancient polo) in the Tang, Cuju (ancient football) in the Song and others were all invented in China. Among all these physical exercises, those especially related to medical science were named daoyin or “conduction exercises” — which were not only exercises of the body but also a treatment which helped one maintain health, prevent and cure disease. Both those illustrated in the Daoyin Illustration (导引图) unearthed at Mawangdui and the Five-Animal Exercises invented by Hua Tuo later grew into some kind of magic pill purifying and qi-releasing Kongfu which even formed a unique physical exercise performed in Taoist and Buddhist temples, and was maintained in the folk world — and known as martial arts, or “Chinese kongfu” in foreigners’ eyes. These martial

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arts were characterized not only by physical movements and the exercise of the muscles, bones and tendons but also by spiritual exercises which actuated the qi, flowing through all the main and collateral channels of the body, the blood vessels and acupuncture points, to such an extent that a few people, who understood these arts, could even dianxue, i.e. hit on an acupoint and cause internal injury, or jiexue, i.e. recover from/dissolve the attacked acupoint, according to the ziwu-liuzhu or “midnight-noon ebb-flow” (子午流注) system in the main and collateral channels of the body. The Draft History of Qing – Biography of Wang Laixian (清史稿·王来 咸传) records, Wang Laixian, also named Wang Zhengnan, was born in Yin County, Zhejiang province. His ancestors had lived in Fenghua and later his grandfather settled the whole family in Yin County. When Laixian moved to Tong-Ao, a small village, he learned Neijia14 boxing from Shan Sinan. The philosophy and skills of Neijia was invented by Zhang Sanfeng, a Wudang15 Taoist of the Song Dynasty, who upheld ‘keeping composure and then subduing the actions of an opponent’. He could gain mastery by striking only after the opponent had started to strike. What Neijia upheld was different from that of Shaolin which, focusing on body fighting, belonged to Waijia. The sect of Neijia was popular during the Qin, then through the Jin and into the mid-Ming Dynasty when Wang Zongyue was perhaps the best known master of this style. It changed in the hands of Chen Zhoutong, who popularized it in Wenzhou. During the years of Jiajing (1521–1622), Zhang Songxi was the finest Neijia master and he had several apprentices — among whom Ye Jimei from Ningbo turned out to be the very best. Thus Neijia became popular in Ningbo where Ye Jimei taught each of his apprentices — including Wu Kunshan, Zhou Yunquan, Chen Zhenshi, Sun Jicha and Shan Sinan. Shan Sinan, after retiring from military service in the war against Japan, returned to his hometown to pass on the art of Neijia, but kept the most intricate and profound elements of it a secret and practiced 14

 Chinese martial arts uphold two types of Kongfu distinguished by the two ways of exercising, one called the Neijia (内家, “inner school”) focussing on qi exercises and the other Waijia (外家, “outer school”) focussing on exercises of the skins, bones and tendons. 15  Wudang (武当), one of the three biggest sects of martial arts in ancient China, the other two being Shaolin (少林) and E’mei (峨眉).

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them at home. Laixian peeped in from upstairs, through crevices in the laths of a wall and caught the general gist of it. Then he bought some fine tea in exchange for a silver cup and gave it as a gift to Sinan, who then started to teach him the secret arts of Neijia. Laixian was quite astute in his martial art practice and never showed it to others, except in a real emergency. Yet once he needs to fight, he would attack the vital acupoints, such as the points of death, of coma, or dumbness, all drawn on the rules set down on the bronze acupuncture figure. Once he attacked a young ruffian, who had humiliated him. The young man could not urinate for several days and recovered only after he had apologized to Laixian. One shepherd boy secretly learned his skill and practiced it on one of his friends, who then died. Laixian examined the boy and said, ‘It is only the coma point of you have attacked.’ Soon the boy regained consciousness. Laixian also acted chivalrously and once took revenge for others. Yet, when someone offered him money to avenge a younger brother, Laixian refused to do it and said, ‘This is treating me like a beast!’… A monk in Tiantong Temple who was named Shaoyan who had such strong arms that even four or five men could not pin him down. But no sooner was he near Laixian, than he felt such keen pain he fell down to the ground. Laixian once said, ‘Nowadays, people talk of Neijia but have nothing to show for it, so they mix Waijia into it. This art will soon wane.’ Thereafter he agreed to let Huang Zongxi16 record in detail the origin and development of the art of Neijia. In 1669, Laixian died at the age of fifty three. Huang Baijia, one of Huang Zongxi’s sons, once learned Neijia from Liaxian, and composed the Neijia Boxing (内家拳法). However, after him there was no successor. In the middle of the Qing Dynasty in Hebei province there appeared what was known as Taiji boxing (taiji quan) which was said to have originated from Wang Zongyue in Shanxi province. Yet its movements and the ideas behind it differed from those of Huang Baijia. In the late Qing Dynasty, Taiji boxing was quite popular with many practitioners. Here, the origin and philosophy of Neijia boxing are introduced briefly as well as the origin of Taiji boxing. Taken as a common art of boxing, it 16

 Huang Zongxi (黄宗羲), a renowned litterateur and great thinker in the late Ming and early Qing Dynasties.

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simply exercises the body and gets it moving, but the essence of these martial arts lies in the flowing of the blood and qi through the main and collateral channels. It is said that a mastery of the system of the “midnight-noon ebbflow” can help calculate the moments when the qi flows into some certain acupoints — including the 36 death points, 11 coma points and 103 disabling points. Attacks with fingers on some specific points can subdue any powerful opponent immediately, and all the attacked points could also be released when the reversing points are touched. This skill was quite a secret and only those who had practiced for more than ten years could be instructed by a master. Yet if ill-motivated, no one could get such instruction. Nowadays, in the folk world, there are still some who secretly pass this art on. Another story about Cao Zhuzhai also reveals the relationship between the martial arts and medical science. Similar things happened in other sects such as the Wudang, Shaolin, Taiji, etc. The Draft History of the Qing – Biography of Cao Zhuzhai (清史稿·曹竹 斋传) records, Cao Zhuzhai, his other name unknown, was born in Fujian Province. In old age, he was quite poor and made a living by telling fortunes in Yangzhou, Jiangsu province. In the regions around Yangtze River and Huai River, no healthy man could withstand one of his blows. Thus he got the nickname of Cao One-Blow. When one young man tried to pay him too much money for instruction in his arts, he refused, and as others were curious why, he answered, ‘This is really a rogue. How can I teach him my arts to help his wicked acts?’ ‘Both the arts of the fist and the stick are nothing but left-overs from the ancient dancing arts. If a virtuous man learns them, he can use them to ‘moderate his blood’ and prolong his life; such built-up power can help keep him from any bully. In other words, he only fights back when attacked. If he uses this art to bully others, he will be defeated by them. This rogue bullies others, relying on his young blood and qi, — but his qi is vain and floating in the upper body, while his legs are empty and weak. So a slight hand push along the direction he is running up can lay him down! A single man has only two fists which are no bigger than several cun. How can they combat a body of five chi’s height in all four directions! All we can do is to nurture our healthy qi and let it flow all over our body — so that when the hand or foot of an opponent comes near, we can place our fist where it is approaching and fight against his vain qi with a steady and settled

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qi. In this way, we can always be safe. Those who have mastered the essence of this art are characterized by two elements: one is a highlyfocused attention together with strong and hard muscles like packed or salted meat; the other is a healthy and strong body with a head and forehead plump and glossy like powdered rice. Both are the result of easy-flowing blood and qi — which enable the swift and efficient motions of hands naturally. In a word, only with a substantial keep inside, can peace outside be obtained, which can defeat all that offend one.’ Cao died at an age over eighty in Yangzhou in the last year of the Jiaqing emperor (1820). The martial arts, qigong and Chinese medicine are all treasures of Chinese civilization and are intimately interconnected to each other.

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A Glance at Altar Medicine A. Sacrificing to the Three Sovereigns, the Specialty of Supplication and Divination Prescriptions 147. Sacrifices to the Three Sovereigns and the Deification of Famous Doctors Sacrificing and praying to the gods has been a continuous practice in China from ancient times. Sacrifices to the Three Sovereigns and famous doctors of old have long been retained among the people. In addition, according to historical records, the government set up sacrifices of this kind, beginning in the Yuan Dynasty: Here there was a temple to the Three Sovereigns. In the twelfth year of Zhiyuan (1275) during the Yuan Dynasty, temples to Fuxi, Nuwa, Shun, Tang etc. were ordered to be set up in Zhaocheng, Hongtong County, Jiangzhou shire in the Hezhong area. At the beginning of the first year of Emperor Yuanzhen, (1295) all counties were ordered to perform sacrifices to The Three Sovereigns, just as they did to Confucius. Taihao Fuxi was matched with Goumang; the Yan Emperor Shennong with Zhurong; and the Huang Emperor Xuanyuan with Fenghou (Queen of the Winds) Limu. The Huangdi Emperor’s minister Yufu and nine other people, their names recorded in medical books, were sacrificed to in two side temples. Physicians were ordered to perform the sacrifice in spring and autumn every year. It was Wenshu Nu, the prosecutor of Lake East Road in Jiangxi who suggested in 1349 that the sacrifice to The Three Sovereigns in the spring and autumn should be hosted by imperial physicians, but the ritual had not been established. It should follow the sacrificial ritual 1015

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of the Imperial Academy, presided over by an officer of the Central Secretariat. Ritual officials in the Ritual Department of the Central Secretariat drew up what was needed; Taichang Division performed the sacrifice to The Three Sovereigns; the Labor Ministry cast sacrificial utensils; the Jiang and Huai Provinces made the necessary musical instruments. In September of the tenth year, the sacrifice was performed. Xuanhui Institute offered sacrificial food; Guangluxun offered utensils used within; the Imperial Treasury offered gold and silks; Guangyuan Storehouse offered incense and candles; Daxing Mansion offered other sacrifices; the Central Secretariat provided three libations according to official rank. The day before the sacrifice, the court sent out for the incense. Officials under the libation officials went in official dress to greet the incense — and then, with a guard of honor went to Kaitian Temple, to practice the sacrifice. An official from the Imperial Academy wrote the congratulatory message. It read: The Emperor Includes ‘xx official xx for the sacrifice’. (The History of the Yuan Dynasty – Ritual Record) Why did the Yuan Dynasty begin these sacrifices to famous doctors? Why was a sacrificial centre established in Hongdong County? This needs further research. The Ming Dynasty followed on with these rituals and made some changes: At the start the Ming Dynasty followed the system of the Yuan, sacrificing to The Three Sovereigns on March 3rd and September 9th. In the first year of Hongwu (1368), the Tailao sacrifices consisted of an ox, a sheep and a pig. In the second year of Emperor Hongwu, Goumang, Zhurong, Fenghou and Limu were sacrificed to on both sides of the temple; ten famous doctors, that is Yufu, Tongjun, Jiu Daiji, Shaoshi, Leigong, Guiyuqu, Bogao, Qibo, Shaoyu, Gaoyang were also given a supporting sacrifice. The ritual was like that from the Confucian canon — a sacrifice to a master. In the fourth year (1371), the emperor believed that it was disrespectful to sacrifice to The Three Sovereigns in all counties. Ritual officials discussed it thus: ‘Emperor Xuanzong of the Tang Dynasty had already made a temple for The Three Sovereigns and Five Emperors in the capital. But Emperor Chengzong of the Yuan had Three Sovereigns temples established in official offices, states and counties and the sacrifice performed in the spring and autumn, with it focusing on medicine. This was extremely disrespectful.’ The Emperor agreed: ‘The Three Sovereigns ascended to the throne and are the beginning of moral

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education for everyone. Can it now be proper to mix them together with medical sacrifices?’ So then these disrespectful sacrifices were forbidden in all counties. In the eleventh year of Zhengde (1516), following the report of the imperial censor Feng Shixiong, Fuxi temple was built in Qinzhou, i.e. the ancient district of Chengji. In the period of Jiajing (1522–1566), a Three Sovereigns Temple was built north of the Imperial Hospital and entitled Jinghui Temple. The Three Sovereigns and their ‘four supporters’ were sacrificed to in the middle of the complex. On the eastern side there were fourteen ‘supporters’: Jiu Daiji, Qibo, Bogao, Guiyuqu, Yufu, Shaoyu, Shaoshi, Tongjun, Leigong, Ma Shihuang, Yiyin, Bianque, Chun Yuyi and Zhang Ji — who were sacrificed to subordinately; while on the western side there were another fourteen: Huatuo, Wang Shuhe, Huangfu Mi, Ge Hong, Chao Yuanfang, Sun Simiao, Wei Cicang, Wang Bing, Qian Yi, Zhu Gong, Li Gao, Liu Wansu, Zhang Yuansu and Zhu Yanxiu. On the first jia day of February and August, sacrifice was held by the high officials of the Ritual Department and libation performed by another two high officials of the Imperial Hospital, along with the Shaolao sacrifice. A Shengji Temple was also built in the Imperial Hospital in order to provide sacrifice to the ancient doctors. It was chaired by an imperial physician. In the twentyfirst year (1542), the emperor thought the temple too small and damp, so then ordered it to be expanded. (The History of the Ming Dynasty – Ritual Record) There were two changes made in the Ming Dynasty. One was to decrease the size of the temple in the Imperial Hospital, another to mainly sacrifice to famous and ancient doctors. There were up to 28 famous doctors mentioned. The Qing Dynasty maintained this tradition: To begin with, the sacrifice to ancient doctors in Jinghui Temple (at the Imperial Hospital) merely followed the ritual of the Ming. Officials performed the sacrifice to The Three Sovereigns on the first jia day in February: to middle was Fuxi, to the left Shennong and to the right Huangdi. The four ‘supporters’ were Goumang, Fenghou, Zhurong and Limu. While Jiudaiji, Qibo, Bogao, Shaoshi, Leigong, Yiyin, Chunyu Yi, Huatuo, Huangfu Mi, Chao Yuanfang, Wei Cicang, Qian Yi, Liu Wansu and Li Gao, all fourteen of them, were sacrificed to on the eastern side; and Guiyuqu, Yufu, Shaoyu, Tongjun, Ma Shihuang, Bianque, Zhang Ji, Wang Shuhe, Ge Hong, Sun Simiao, Wang Bing, Zhu Gong, Zhang Yuansu and Zhu Yanxiu,

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another fourteen, sacrificed to on the western side. The Director of the Board of Rites presided over the sacrifice and officials from the Imperial Hospital presided over the libations in both side-temples along with the rituals of kneeling three-times, worshipping ninetimes and making libations three-times. During the reign of Yongzheng (1723–1735), all officials from the Imperial Hospital were ordered to attend and be present at the sacrifice. (The History of the Qing Dynasty – Ritual Record) So according to the above texts, sacrifices to The Three Sovereigns and Five Emperors started during the time of Emperor Xuanzong in the Tang. It had nothing to do with medicine. Famous doctors were also sacrificed to subordinately, and this begun in the Yuan Dynasty. Wu Cheng wrote in the Three-Emperors Temple in Yihuang County that “Medicine has its school; each school a temple, and each temple had made sacrifice to The Three Sovereigns since the first emperor of the Yuan Dynasty” (Yu Yue quoted this in his Collected Works made in the Spring Hall). These rituals followed the sacrifice to Confucius and were influenced by statues enshrined in Buddhist temples. At the same time, they still had something to do with Confucius. There were usually ten sages in Confucian temples, all of whom were great disciples of Confucius. The Three-Sovereigns Temple chose ten ministers of Huangdi to accompany The Three Sovereigns. By the time of the Ming and Qing dynasties, their company had increased to 28 — because of the expansion of deification and the idea of famous doctors being sages. At the very beginning, an enshrined tablet was not a statue, but merely a wooden figure. The Continued Research Document records: Their clothing and appearance take too long to get right. Don’t make any wild judgments. Follow the ancient tradition and just make wooden figures of Goumang, Zhurong and the other gods. Ten famous doctors may be arranged in order in the Confucian Temple on both sides. They should be well arranged in order of hierarchy. The officials in Jixian Academy, Imperial Academy and Taichang Etiquette Institute may discuss this together. Then it may all be done following the lead of the Ministry of Rites. This Three-Sovereigns Temple was established at the back of the Imperial Hospital, and sacrificed to mainly by imperial physicians. The common people also build folk medicine Sovereign Temples, which derived from

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the Three-Sovereigns Temples and were originally sacrificed to by the common folk. The decision of which famous doctors or gods to sacrifice to depended entirely on popularity and reputation. For example, Annals of Li County records: Shennong is the most popular, accompanied by Qibo and Medicine King Wei; while Leigong, Qin Yueren, Chang Sangjun, Chunyu Yi, Zhang Zhongjing, Huatuo, Wang Shuhe, Huangfu Shi’an, Ge Hong and Sun Simiao are all in the side-halls. The title of “Medicine King” was originally given to Wei Cicang, and it may have come from the Continued Stories of the Immortals. The Old History of the Tang Dynasty only says, “When they were young, Zhang Wenzhong… his countryman Li Qianzong and Wei Cicang in the capital, were all well known for their medical skills… Zhang lived long and was finally promoted to shangyao fengyu at the imperial hospital in his old age… Li Qianzong was made Imperial Physician Director and Wei Cicang a Guangluqing during the Jinglong period (707–709).” But Shen Fen (at the end of the tenth century) says, “The family name of ‘Medicine King’ applies to Wei, his other name being Gudao, and alternative name Cicang, and he came from Tianzhu in the Western Regions. In the twenty-fifth year of Kaiyuan, Wei Cicang came to the capital. He wore a woolen robe and scarf, and walked with a stick, dozens of gourds around his waist. He gave treatment to many over a wide area and many were cured. The emperor called him to the palace, had his portrait made and entitled him ‘Medicine King.’” This statement is inconsistent with what is said in the official Old History of the Tang Dynasty. So the title “Medicine King” probably started during the early Northern Song Dynasty. Sun Simiao (who wrote the Qianjinfang or “Thousand Remedies Worth their Weight in Gold”) was also revered as a “Medicine King” (Yaowang 药王) — probably during the Ming and Qing dynasties. Emperor Huizong of the Song Dynasty entitled him a “Miaoying Immortal”, so he was probably not known as “Medicine King” during his lifetime. However, Yaowang Temple at Yaowang Mountain in Yaozhou state is a greatly famous temple. There is no other place as special. Tian Han wrote a poem about the place when he visited Yaowang Mountain: The temple on the top of the mountain, A playground at the bottom;

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South of the mountain, north of the mountain, Cypress may be smelt everywhere. The Qianjinfang saved so many people; People drum and make music, They sacrifice to the ‘Medicine King’, Year after year after year. Talks under a Tung Tree quotes from the Immortals’ Traditions stating that the “medicine king” was Zhang Shanjun, while the “medicine king” of Qizhou, the national distributing centre of Chinese medicines, was called Pi Tong. He was popularly known as Pi Chang, a mistake for “Pichang King”. In fact, there is no rule when it comes to people sacrificing to a man of merit and making him their “medicine king”. You can find a “medicine king” anywhere. People will worship and sacrifice — as long as there are incense and candles burning during the sacrifice, people will find psychological sustenance anywhere. According to investigations made by Professor Li Tao,1 in addition to Three-Sovereigns Temple in the Imperial Hospital, there are several Yaowang Temples elsewhere in Beijing. The Outline of Capital says, “Yaowang Temple is west of Haizi by Bei’an Gate, bordering Haizi in the east. There are lots of willows on the bank. In summer, visitors drink and compose poems under them. To the east is a bridge called Western Food Bridge, where the Jade River runs into the imperial garden. The temple was built by Wei Zhongxian. The engraved headstone has fallen over.” It was said that Sun Simiao and Wei Cicang were enshrined in the middle, Qibo and Leigong at the sides. Ten famous doctors, Bianque, Yihuan, Qin Yueren, Hu Gong, Chunyu Yi, Zhang Zhongjing, Huatuo, Wang Shuhe, Huangfu Mi and Ge Hong, were all given supporting sacrifices. But this does not coincide with the headstone set up in the third year of Wanli (1575), whose upper part is for The Three Sovereigns and lower part for the names and picture hymns of ten famous doctors, Qibo, Leigong, Bianque, Taicanggong, Zhang Zhongjing, Huatuo, Wang Shuhe, Ge Hong, Sun Simiao and Wei Cicang. Eastern Yaowang Temple was built in the 44th year of Wanli (1616). In the middle of the front hall was “Reliever Sun Simiao and Wei Cicang.” In the two side halls were Tao Zhenbai, Feng Zhenren, Zhang Zhongjing, Wang Shuhe, Liu Hejian, Pang Anchang, Yihuan, Huatuo, Dong Junyi and Li Dongyuan. In the middle of the back hall were The Three Sovereigns, while at the sides the 1

 Li Tao. Yaowang Temple and Ten Famous Doctors, Chinese Medical Journal, No. 2, 1941.

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ten ministers of Huangdi and others. So there was no rule in choosing famous doctors to sacrifice to. Anyone can be sacrificed to — as long as he is famous and meritorious. In addition, there have been six Yaowang Temples in Beijing alone (nine in all). The small Yaowang Temple was built by Wujing Lord Li Chengming in North Tiantan in the fourth year of Chongzhen (1631). It was rebuilt during the reign of Kangxi. Northern Yaowang Temple in the north of Drum Tower Street was built during Jiajing (1522–1566). Hong Chengchou even wrote a monument for it during the reign of Shunzhi (1644–1661). But both of these have crumbled to dust. The Three-Sovereigns Temple itself was also burnt down in the Boxer Uprising. It belonged to a foreign embassy later and was rebuilt outside Di’an Gate. Then it changed into a girl’s High School after the establishment of the Republic of China. In 2009 summer, I tracked down these historic sites and found the remains of Yaowang Temple of Sun Simiao near Fengtai in Beijing. The names of the other temples could not be distinguished. April 28 is the birthday of the medicine king among the Yaowang Temples in Beijing. A lot of people come to the temple to burn incense since the temple opens on April 13. All drugstores cut the price for three days. The Medicine King Sun Simiao on Yaowang Mountain was born on the lunar February 2, which is also the time for the temple meetings lasting half a month. It was natural to deify famous doctors in the theocracy culture at that time, partly out of honour, partly because of the medicine’s deficiencies. Occasional effectiveness for a critical illness brings about a sensational effect due to association. So temples were established and halls built for famous doctors. “Bianque” becoming the Shenying King was such an example. It is said that the people in Lintong County of Shaanxi Province secretly buried Bianque’s body and built a tomb for him, after he had been killed by Li Xi. Later his disciples came to look for his body in secret. They agreed “to take away his head and leave the body”. His head was taken back to be buried on Pengshan Mountain in Neiqiu County in Maozhou of Hebei Province; but his body was still buried in Lintong. The tomb is still there. It was also said that Bianque even practiced medicine in Henan Province. People were so grateful for his great merit that they snatched back a pair of boots to build a cenotaph for him at Fudao Village in Tangyin County.2 During the early Jiayou (1056–1063) period, Emperor Renzong of the Song Dynasty “often was not well. He sincerely prayed to Bianque and recovered very 2

 It is said that Bianque left a pair of boots behind when he practiced medicine there. It is also said that he was killed there by the murderer of Li Xi.

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soon. So Bianque became a lord and was entitled Shenying King.” Recently, this has been found recorded clearly within a tablet inscription in Shenyinghou Temple on Pengshan Mountain, rebuilt during the second year of the Xining period (1069) of Emperor Shenzong of the Song. Bianque not only treats illness but also brings about peace and good harvest for people: The high officer Li was from this local area… It did not rain for years in this district. Li longed for rain so much he sent his subordinates to pray to Bianque for rain and made the sacrifice several times. Then it rained and snowed. Everything got nourished and people lived peacefully. As Bianque is alive, he prolongs people; as he is dead, he still works for the people. His spirit is in eternal glory; he will be remembered by us forever. The temple got rebuilt and became more famous. In the fifth year of Zhiyuan (1268) during the Yuan Dynasty, it was rebuilt again. Buhumu, the chief procurator of Yannanhebeidao, wrote a poem about it during the twentieth year of Zhiyuan (1283): … I am ill, I will come to Shenying King Temple to pray and write down this meeting. A spoonful of magical syrup refreshes me, Heaven lets me meet a wise man (Bianque), one really trustworthy! The lord of Qi is unlucky to die soon as he refused to listen to Bianque; But the crown prince of Guo is fortunate to gain his marvelous favor. The towering mountain is worshiped since ancient times; The grand temple has been esteemed by all the people in the world. It’s only the Shenying King can teach me the great skill of its operation, To change the heart of deceitful persons. There were many inscriptions and poems like this. Because praying was effective, Bianque was advocated and deified increasingly by the people. The Shenying King Temple was rebuilt in the 22nd year of Chenghua (1486) and the 21st year of Wanli (1593) during the Ming Dynasty. The milestone in Wanli was a plaque to our “Great Savior”, written by the Wanli Emperor. Furthermore, it “followed the system of the Medicine King temple in the capital by sacrificing to The Three Sovereigns, and subordinately to other

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ancient famous doctors”, and expanded greatly. Shi Yanshi of the Qing Dynasty recorded the grand sacrifice: I’ve heard so much about Shangchi pond water, Today I come to sacrifice to the Magpie (Que) King. The Great Temple has been here for thousands of years; People sacrificed to him from all around. This is a real folk-custom, And it happens to be in this particular sacrifice. There is Temple Fair every year, We should let the people enjoy themselves. In the yiwei year of Jiajing during the Ming Dynasty (1535), Yin Zhong of Yudu, the educational dean of Tangyin County, wrote an inscription on Mugwort Temple: … The emperor ordered us to sacrifice to him during the Dragon Boat Festival and honored him as Shenying King. The mugwort beside the tomb flourished as if it were blessed by the Shenying King. It is magically effective if gathered on the day of the sacrifice, to help patients. Mugwort is bitter and with slightly warm qi. It is the yang within the yin. It is very effective as an envoy herb for halting spitting blood, bleeding, uterine or vaginal bleeding, red and white dysentery — as it is used to be made into a decoction or pills. It also can warm the wombs of barren women, who want to have a baby. Or nourish and calm a pregnant woman when fetal pain appears. Also it can treat all kinds of hemorrhoids, kill the ascaris worm, eliminate evil-qi, improve eyesight, strengthen the yang, and so on. Furthermore, it can cure all diseases if it is made into a moxa cone for moxibustion. So it is said that the mugwort in Tangyin from Bianque’s tomb is immortal mugwort. Immortal mugwort is hard to get, but it is truly effective. Here is the evidence of this. Well now! If the spirit of the Shenying King exists there, it can be proven by the immortal mugwort growing in this actual place, of itself. A pill made of mugwort gathered during the Dragon Boat Festival when sacrificing at the tomb, can even save a life. Its seed can treat loss of blood, and dysentery, pacify the fetus, relieve pain and improve eyesight. It is not only taken orally, but also can be used in moxibustion for all diseases.

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People did not only deify his reputation and medical skill but also his medicines. The mugwort on Bianque’s tomb becomes an “immortal mugwort”. Bianque was deified, as was done to Zhongjing as well: A student called Feng Ying’ao in Lan Yang had alternating hot and cold fevers, and almost died during the early summer of the Wuchen year in the reign of Emperor Chongzhen (1628). One night, he dreamt of an immortal with a yellow robe and golden crown. The immortal gave touched him on the hand and he immediately felt comfortable all over his body. Ying’ao was surprised and asked: ‘Who are you? Why are you saving me?’ The immortal answered: ‘I am Zhang Zhongjing from Nanyang, the prefect of Changsha County. I would like you to do me a favor for my own trouble, can you help get rid of it? There is a temple four miles from the east of Nanyang City. Seventy-seven steps at its back is my tomb. It has been blocked up for so long that nobody knows it is there. Someone will dig a well over my tomb, unless you can uncover it.’ Ying’ao woke up and felt quite well. In that autumn, he trekked the thousand miles to Nanyang City to look for Zhongjing’s tomb and found it and the temple at the western end of Renji Bridge in eastern Nanyang. He visited Three King Temple, where ancient famous doctors were arrayed on both sides. Suddenly his eyes caught sight of a statue, with the hat and dress exactly similar to those of the immortal in his dream. He hurried to clean up the statue and found that it was indeed Zhang Zhongjing. He walked to the back to look for Zhongjing’s tomb, but found that it already became the vegetable field of the temple official. Feng Ying’ao told him everything. The official was surprised but did not believe it. He asked the old people there and was told that there really was an ancient tomb at the back of the temple… Four years later, the gardeners dug a well in the field and excavated a large tablet stone about one zhang under the ground. It read: ‘the tomb of Prefect Zhang Zhongjing.’ Its size was exactly the same as what Feng Ying’ao remembered. Under the large stone was a dark and deep stone cavern, a wind and thundering sounds were heard inside. The gardeners were terrified and covered the well… Magistrate Zhang Sanyi was also surprised at this story. He collected donations and sent his officials to supervise the building of a magnificent temple for Zhongjing. He named and wrote the inscription: ‘Han Dynasty Changsha Prefecture Medical Saint Zhang

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Zhongjing Temple and Tomb’. One venerated old man Chen Cheng remembered that ‘the mount behind the temple was said to be the old residence of Zhang Zhongjing’. Now the lane has been named ‘Zhang Lane’ after him. West of the lane was a temple to ‘True Fellow Zhang’. The plaque is still there but has been changed to ‘Immortal Zhang’. This may be misinformation — after a long time of rumor. But a temple was built in the Bingshen year during the reign of Shunzhi (1656), nearly thirty years after this Wuchen year.3 Zhang Zhongjing seems to have been less lucky than Bianque after he died. But he was finally honored as “Zhang Zhenren” very early on, and then mistakenly as “Immortal Zhang”. Finally a temple was rebuilt for him and a brilliant statue made. In fact, the Immortals tradition also states he went to Shaoshi Mountain and became an immortal: In the winter of the Yuanjia period (151–153), Emperor Huan of the Han Dynasty caught a cold and called in Ji (Zhang Zhongjing’s other name) to treat him. Ji examined him and said: ‘It is just injury by the cold.’ He gave the emperor a large dose of medicine and covered him with thick coverlet. After the emperor’s whole body began to sweat profusely — then his fever had gone by dawn. The emperor was so glad he appointed Ji as shizhong in the central court. But Zhang Zhongjing had seen the court corruption and sighed: ‘Your disease can be cured, but the nation’s disease is more difficult to cure.’ Then he took off his official hat and uniform, and went away. He later lived in seclusion on Shaoshi Mountain. People build temples for almost every famous doctor after they die, for example, Liu Hejian temple, Zhu Danxi temple, etc. I will not list them here individually.

148.  Supplication as a Specialty Zhuyou (祝由 “supplication”) occupies a special place in Chinese medicine. Zhuyou, that is, incantation or written supplication, has been a branch of Chinese medicine since Tang times. But there is no record of this subject 3

 The Annotated Synopsis of the Golden Chamber by Xu Zhongke mentions “Immortal Zhang Zhongjing” and his “Temple”. The story is told by Huang Zhuzhai.

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being set up for use in government departments. Even the famous learned doctors couldn’t truly understand it. Xu Dachun discussed “supplication as a specialty” in his Discussion on the Origins and Theories of Medicine (医学源流论): As to Zhuyou supplication, Qibo said in the Neijing – Evil Wind that: ‘Ancient witch doctors knew the bias of all diseases and their cause, so they could cure by supplication.’ Qibo again states in Moving Essence and Changing Qi that: ‘The ancient world was a carefree place, so they were not attacked deeply by evil qi — and could be cured by moving essence and incantation. But now weakening pathogens and evil factors (feng) often attack the internal five zang-organs and bone marrow, the external orifices and skin, and a minor illness will turn into a serious one and a serious illness lead to death — and this is why incantation does not work anymore.’ In a sense, supplication is only for venting emotion, guiding the qi, clearing up doubts and solving puzzles to do with the cause of a disease. Certainly, these diseases must have been minor and responsive. This approach would not have been effective for a serious illness. This is an ancient method which has been lost, and the skill of figures and incantations may now be somewhat effective for a minor illness. But for a serious illness, it does not work at all. But this was already the case in Qibo’s time, let alone our own. So we note it, but not need discuss it further. Xu Dachun believes the skill of zhuyou was a lost ancient skill. Actually the skill of using “figures and incantations” is not equivalent to the specialty of zhuyou, though they are somewhat similar. So he advocated “leaving the question open”. Yu Bian’s Continued Medicine says: The ‘Secretarial Essence of a Waitai’ (外台秘要) includes a section on zhuyou (supplication). Danxi says it means moving spirit, changing the qi and thus explaining the disease’s cause. It is good for minor illnesses. But if one is attacked by a weakening evil inside and excessive evil outside, he should be treated with the right medical method. It could be effective for heat phlegm above diaphragm. Won’t a hot stomach be cool after it gets a sip of cold water from drinking a (burnt) incantation? But it will do more damage if one

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suffers from an internal injury due to deficiency — the stomach qi will get injured as he swallows the cold ‘figured water’4 in cold winter. I have even looked this up in the Bibliographic Record. It says zhuyou belongs to a deity — and this is believed very much in the south. Some say the ‘zhu’ ‘cuts off’ the cause (you) of the disease. Both arguments exist. We do not know which is correct. So Yu Bian knew a little about zhuyou. But Zhu Danxi held an absolutely negative view towards this “figured water”. Negative attitudes among famous doctors are evidence that supplication did not spread among the population very much. There is no record about “supplication specialties” in the current version of the Secretarial Essence of Waitai, except for some written incantations and figures, such as “six incantations for malaria”. They may be the residual part of the supplication section referred to be Yu Bian. For example, Before the attack of malaria, hold a big rooster in the arms. Startle it to make it crow from time to time. Nobody is incurable. Cui’s writing incantation for malaria: Before the sun rises, hold the breath and write out the figure. First inscribe the forehead to establish the Nine Heavens, next write two lines on the palms to hold the Nine Rivers, then write on the back two lines starting at the right thigh bone and going across to the left thigh bone as follows: ‘On Nanshan Mountain there is a tree, under the tree is a pond with stagnant water, in the pond is a fish with three heads and nine tails. It does not eat grain but malarial ghosts. Hurry, hurry, this is an order.’ Finally write in arches to step on the Nine Rivers. The above method is not harmful to others but good for patients. If one does not get well, it can be written again. No error or missing characters or repetition is allowed in the writing. Don’t eat any pungent food at this time. (This written incantation comes from a Taoist in Luzhou. It is said to be indescribably wonderful. The following two methods I have also used are very effective.) An effective written incantation for malaria from Yuan Xisheng, a Shilang official at court: write two overlapping ‘golden’ characters 4

 The “figured water” was water with the calligraphic sign or symbol, either burnt or immersed in it.

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on the forehead; write two ‘fire’ characters side by side on the chest; write two ‘water’ characters side by side on the back; write a pair of wood characters of on both hands; write ‘earth’ characters on each of the feet; write four overlapping ‘mouth’ characters under the navel. Take a mouthful of water, hold the breath and write them in red. The method is effective before an attack of malaria. Again there are the “three incantations for snakebite”. For example: Cui’s Incantation for Snakebite: If somebody is bitten by a snake and you cannot go yourself, send someone else. Let them sit down and ask him which part is bitten. Look at the area and pinch first the inner curved line of thumb from left to right. Then think to oneself and murmur: ‘bite snake head, pinch snake eyes, look at snake nest, trample on snake feet’. When you have finished, you can go. As you are some distance away, he can stop pinching the area slowly. The bitten person will recover. An Ancient and Modern Record of Effective Incantations for Snakebite (from Gao Yuanhai and an army officer Canjun Li). It goes as follows: x prefecture x county, male or female, name, age, x part bitten by x color snake at x place at x hour x day x month x year. The Yin incantation reads: ‘You are Si Gongcao and I am Hai Mingfu. If you don’t take away the poison, I will nip your mouth.’ Hold your breath and think about the ‘snake’s mouth’, which is at the dorso-ventral boundary of the second joint of index finger. Pinch it with the thumb nail. Hold your breath, bend the index finger and pinch quickly. If the right hand is bitten, pinch the right; if the left is bitten, pinch the left. If somewhere in between is bitten, pinch both hands. If you forget the incantation, just pinch the swollen part to remove the blood. The patient will recover, even if you make a mistake. If these are zhuyou, then zhuyou is not a branch of medicine but an incantation with Taoist figure, or “figured water”. Thus, it cannot to be said to be a specialty within medicine — and people did not always believe it much either. Bao Dongfan said in his Notes from a Stone Room: Han Feixia once treated a patient suffering from ‘white tiger wind’ of the joints, and they believed in witchcraft not medicine. Mr. Han wrote an incantation figure with a black ink made up of concentrated xiatian cream and white mustard, and put it into water for the patient

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to take. Then the patient vomiting and had diarrhea and spat out several dou of sticky, foul sputum. He recovered soon and said Han’s ‘figured water’ was magical and could really save anyone. But today those who use zhuyou cheat by drawing false figures. People actually swallow down the burnt or immersed figure as ‘medical water’. If patients are lucky enough to be cured, it is because of the medicine not the figure. These deceived people do not believe in the medicine but the witchcraft, they love the figure but hate the medicine. They are even unaware that they have been cheated. How ridiculous! The famous doctor Yu Tuan (1438–1517) even severely criticized supplication. He once said in The Orthodox Tradition of Medicine: Some people ask: Ancient medicine includes in part the specialty of taboo and supplication. Why isn’t it in use today? The answer is that the specialty of taboo and supplication is the zhuyou coming from the Suwen. It was an established teaching among the Jushi Longshu (lay Buddhists). It is a skill used for ‘moving essence’, and effective for slight ailments. Sometimes people get frightened in the temple, or attacked by evil qi in the forest or valley. They become as if drunk or dull-witted, or possessed by ghosts. All fear and confusion can be cleared up with the help of an incantation. There was a Longshu Incantation used in ancient times. But among the present population they act as wizards, acting like children, like witches and coax the people to get their money out of them. Ay! Evil magic is used by evil people, not sensible people! “Evil magic is used by evil people” is an absolutely brilliant view. Zhuyou was likely to rise after Buddhist medicine (such as Longshu Incantations) became introduced into China. So this is why it became a specialty during the Tang Dynasty. But later it gradually declined and many famous physicians did not use it anymore. The eleventh volume of The Unofficial History of the Qing Dynasty records the use of “zhuyou in Hunan”: Zhao Ou’bei said: There is zhuyou supplication used in Hunan. It treats diseases with a figures and incantations. Chen Yuting and I both worked at the Royal Military Council. We were young and often played at Chinese boxing when off duty. Yu Ting was strong and his handclasp often hurt my hand. I was insulted by him several

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times. One day, we were in the duty room of the suburb garden. I was so angry that I wanted to retaliate against him. Taking a broken bench, I said to Yuting: ‘I will close my eyes in fighting. Don’t blame me if you are wounded by this bench.’ I thought if I closed my eyes, Yuting would not dare attack me. But Yuting in fact ventured to attack me. I did not dare attack him back with the bench. Suddenly, I was startled by a loud bang and surprised to find Yuting was dying on the ground, his face covered with blood. I had hit him on the lips. I hurried to feed him soup to revive him and called a carriage to take him to the city. As soon as I was off duty, I hurriedly rode to see Yu Ting. Suddenly my horse threw me and I lost consciousness. After a while, I woke up. The next day, I went to see Yuting and found he was fine. Later his family told my servant that I fell from the horse because Yuting performed zhuyou — to shift his hurt onto me. It cannot be that we understand the necromancy through common knowledge. Also Ge Yishan in Hunan is famous for using this method to treat diseases. People call him ‘Immortal Ge’. When I was in Yunnan Province, General Guo Yi had a tubercle on his left shoulder because of an entangled sinew from an injury, where he had once fallen when horse-riding. The wound would never heal, due to the quack medicine he took. The Yunnan governor Gongde made a point of calling Immortal Ge to treat him. He sprayed ‘figured water’ onto the wound and cut off the rotten part. But the tubercle got bigger and bigger. Ge left as his treatment had no effect. This is enough to prove that zhuyou supplications are not invariably effective. Leaving aside the failure of Immortal Ge, it would be impossible for Chen Yuting to transfer his wound to Zhao, because he would not be able to perform an incantation in a coma. Moreover, they both suffered concussions. The one fell off his horse totally because of the panic in his heart. On the contrary, as someone in the royal court, he only knew of supplication in Hunan, but did not hear of it at court. This would imply there was no supplication at court. However, there are still books of zhuyou kept among the folk population, so supplication is always among them. There are several collections in the Chinese Academy of TCM Library in Beijing: Charms from Immortal Doctors (an old anonymous manuscript) Thirteen Branches of Medical Zhuyou (by Hangu Shanren, a blockprinted edition from Qingcheng Mountain)

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Immortal Light Scripture (edited by Hong Pian in the Ming Dynasty) Ancient Perceivable Diseases (1798 Japanese edition) Ancient Criterion for Easily Divined Diseases (1819 Japanese edition) Taishang Supplication Specialty (from Zhang Zhenren, a Qing Dynasty manuscript) Essence of Immortal Supplication Specialty (anonymous manuscript) Each and every disease could or would appear to match some figure or other, or incantation among the people. So no wonder the specialty of zhuyou, which is treatment with a figure or incantation, is not seen in the foreground of mainstream medicine.

149. Holy Water, Bringing Down the Gods and Divination Prescriptions Witchcraft will always go along with and follow mainstream medicine. The authorities have the Nuo Ceremony (the exorcism) and the sacrifice to The Three Sovereigns. Among the folk world, people are even more unrestrained. It was almost institutional for people to believe in “holy water” and pray to the gods for some magical medicine for a very long time. The Records of Three Kingdoms – the History of the Wei – Emperor Ming states: Formerly, in the third year of Qinglong (235), a farmer’s wife in Shouchun County claimed she had been sent down by the gods and named herself Dengnu (‘the gathered-up one’). She said she should be residing in the Imperial Palace to expel evil spirits and pray that good luck came to the imperial family. She gave her patients holy water to drink and washed their sores. Most of them recovered. So the emperor build her a house at the back of the palace and sent out an imperial edict praising her work. She was favored very much for quite some time. But as the Emperor got ill, her water did not work. So she was killed. There is also this in the History of the Jin Dynasty – Xing Ling: Gong Zhongru’s daughter had been ill for many years, and was at death’s door. Xing Ling let her keep some water in the mouth. After a while, she could sit up with difficulty and soon recovered. Lu Yi’s mother, surname Huang, has been suffering from flaccid paralysis

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for more than ten years. As Ling gave her treatment, he sat several feet away from her, closed his eyes and said nothing. After a while, he said to Yi: ‘Help your mother to try and get up’. Yi answered: ‘My old mother has been ill so long. How could she now stand up?’ Ling said: ‘Let’s try.’ The two people helped her stand. Moments later, Ling let the mother stand on her own, and she could take a few steps by herself. She got well. People ran to tell one another about it, and many patients visited him for treatment. Mrs. Huang was afraid that her prolonged illness would return again, so Ling left her a pot of water to drink. Every time, she took away water from the pot, fresh water would fill it. After more than twenty years, the water was still as clear as before. There is no debris in it at all. People had a tendency to believe this suggestive treatment with so-called “holy water” and “figured water”. Some doctors were also caught up in it, such as Yang Xin in the History of the Southern Dynasties – Yang Xin. “He… liked reading the books of Huangdi and Laozi and often copied them out. As he fell ill, he took no medicine but ‘figured water’. He was also good at medicine and wrote ten volumes of prescriptions.” It was also at one time banned by the government. For instance, the Old History of the Tang Dynasty – Five Elements says: The second year of Baoli (826), there was a report from Bozhou saying holy water had been found which could heal all diseases. Even the people of southern Jiang and Huai travelled a long way to pray at this water. Observation officer of Western Zhejiang Li Deyu, reported this fallacy to the emperor. Prime minister Pei Du made a judgment and wrote a report: ‘This absurd thing is done by people, there is nothing in the water itself.’ He wrote to the observation officer of Bianzhou to fill in the pond of water soon. But this event brought about by Buddhist monks circulated widely among the populace and had a wide impact: The monks in Bozhou with their crafty speech are exaggerating the effect of this water, and saying it can treat all disease and calling it ‘holy water’. In the South every ten households among the common people will send someone to fetch this water. Patients are prohibited to eat meat after drinking the water. Many critically ill patients

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and old people are dying. A dou of water costs as much as thirtythousand cash. People even cheat by selling the water to others to make money by the road-side. Every day several-hundred people are arriving to fetch water. Li Deyu commanded patrolling soldiers to arrest them for putting to put end to it. Moreover he said: ‘there is holy water in Wu nation and holy fire in Song and Qi. But all these tales are absurd and forbidden. Observation officer Linghu Chu is going to fill the pool in to cut the water off at source. Please carry this out’. (New History of the Tang Dynasty – Li Deyu) However, the prohibition was only temporary. A passage from The History of the Song Dynasty – Biography of Empress Meng proves that holy water became popular again at that time: The empress’s daughter, princess Fuqing was ill. The empress had a sister who knew about medicine. She had even cured the empress’s own dangerous illness so she was allowed access to the palace. The medicine didn’t work on the princess, so the empress’s sister decided to treat her with a Taoist figure and ‘figured water’. The empress was frightened and said: ‘You don’t know this is seriously forbidden at court? It is not the same as outside.’ Then she ordered her maid to hide the Taoist figure. As the emperor came, she told him everything. The emperor said: ‘It is understandable.’ The empress burnt the talisman in front of the emperor. It spread through the palace and such actions happened again. Some people are still superstitious about holy water today. If they hear water somewhere is curative, they will run a thousand miles to burn incense and pray for a cup of water. Some mineral waters are indeed curative. But it is ridiculous for people to think they are god-given and effective for all diseases. There are many temples in China. They are not only dedicated to famous doctors but also to the gods. For example, there are 72 departments in Dongyue Temple. Medicinal departments include those for jaundice, karmic disease, plague, abortion, poison, those wrongly sentenced to death, medicine, longevity, life and death, etc. The department of karmic disease is said to treat just difficult diseases. The patients will not get well if they do not pray to the gods. Take a chronic tumour, for example: according to which

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part of you is sick, one buys a plaster to paste on it dedicated to the god who manages that particular disease and all will be well.5 In the Medicine King Temple, Luzu Temple, Guan Yu Temple, Goddess Temple, Taoist temple, Nunnery, Buddhist temple and every single temple, there is always a place for praying for a prescription or divination with eightyone slips for divination. Palmists, fortune-tellers and diviners can be seen surrounding the temples. Guanyin Temple and Wenchang Temple are the temples to pray at for a sick child. There are a bronze mule and a porcelain horse at Wenchang Temple in Beijing. The sick person will recover so long as he touches the god’s corresponding part, which matches his own sick part. Women can give birth to a child if they touch the copper mule’s genitals. As for Hades Temple, it is in charge of people’s future after death — depending on their behaviours when they are alive. So whether one is ill or not, one goes there to pray for the god’s forgiveness. They are commonly used to see off the plague gods. Make a paper boat more than ten feet long with several paper plague gods inside, then burn them at the riverside. “Paper boats and candles lighting up the sky” was a common saying during the plague. Just as is stated in Xu Shupi’s Minor Knowledge Records: Witchery is going on all over the county at the moment. People sing, dance and sacrifice to the gods, day and night… As paper plague gods and the ‘five sages from the five directions’ pass through the street, their attendants are even more than those of a general governor in the street. A very effective god at Wujiang was even set up at Chayuan Court. Now the county magistrate burns incense and worships there every day. Not only that, but there has been put up a notice to arrest people sacrificing to the god, the same as their superior is doing. The nation is now going to be destroyed, but they are only listening to the gods. How sad it is! The Ancient and Modern Books Collection quotes from a Differentiation of Puzzles saying, “Common custom attributes disease to ghosts and gods. As plague breaks out, people think it is caused by the gods of disease. Every family tries to keep it out. The actions of every evil spirit are overstated by this witchery and the one disturbs the other. If a 5

 According to Li Tao. Peking Medical Customs under Transformation, Chinese Medical Journal, No. 12, 1941.

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single family is attacked by the plague, another family will become anxious and fearful. Nobody dares to visit the family and help them out. Even their own parents, children, or siblings cannot save them. It severely corrupts public morality. Nothing is worse than this.” China was a polytheistic nation. Kind gods, those malevolent, plague gods and peaceful gods — everyone follows them. If smallpox broke out, a “smallpox goddess would be worshipped”. If a child had a fright during a fever, both the bed god and goddess would be worshipped. These gods cannot be described here individually. The attacked family often called in a Duangong wizard or Sanxiangu sorceress to help with bringing down the gods, even using sacred dance. The old custom in Jilin province was as follows: In the dead hours of the night, a witch hangs a brass bell on her waist, beats a single-sided drum, jumps around the house and sings out loud, as if she is possessed by the god. Even in severe cold, she will take off her coat, bare her chest and arm, and put an iron chain under her armpits, with several fodder choppers towards the ends. Though drenched with fresh blood, she does not care at all. It is said that this can “catch a ghost and drive away the plague”. This sacred dance is actually a branch of exorcism and Taoist magic. It has its own walk, called the “witches step”, also called “Yu’s step”. The Prescriptions for Fifty-Two Diseases records many treatments using “Yu’s step 3” and “Yu’s step 5”. Yang Xiong said in Guidelines – Chong Li that “Years ago, Mr. Si regulated the waterways and his footwork followed the witchery of Yu’s step.” It is said that “Yu walked unevenly and Tang was half-paralyzed.” Yu might have been lame, eventually creating the idea of there being a “wizard’s walk”. Taoist Scriptures – The Scriptures for Eight Gods Six Changes – Yu Steps for Calling the Gods says: Yu’s step was created by emperor Yu of the Xia Dynasty to call the gods by his way of walking. It is the root of all magic and the gist of all mystery. Long ago, Great Yu regulated the flood. The floods were too deep to predict so he calculated them designing the ‘dark carpenter’s rule’ and measuring them out successfully. But if he met a hidden spring or massive rock he could not manage, he would call in a sea spirit, river ancestor, mountain god, or earth god to decide what to do with them. As he came to the Southern Seas, he saw a bird move a large rock with an incantation. As it spoke the incantation, the bird often walked up and down using these special steps. So Great Yu copied the steps and used them in

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his skill of regulation. It was effective for everything after that. Because it was created by Great Yu, people call it Yu’s step. According to this text, Great Yu learnt the footwork from a bird incantation. But it is the same as the basic footwork for the sacred dance. Being a sorceress and using sacred dance and fuji divination (“automatic writing”) in your work mean this must have been a Sanxiangu sorceress, whose ancestor was generally believed to be the goddess Zigu.6 In fact Fuji appeared earlier, as has been mentioned before. That fuji meant the gods coming and writing a prescription for a patient is often told in the official Historical Records, and in some of the unofficial histories as well. The History of the Ming Dynasty – Wang Jin states: One day, the emperor performed fuji secretly at the palace. He was told that ganoderma mushroom could prolong life. So the emperor sent people out to gather ganoderma everywhere and store it in the imperial palace. But the court attendants stole them from the palace and took them to market secretly — and merchants bought them to present them before the emperor again, for a large reward. Courtiers were hand in glove with the merchants, and the mound of ganoderma mushroom piled up as high as a hill. People called it the Imperial Mushroom Hill. The emperor and his ministers were both corrupted by collecting illegitimate wealth. They were just fooling themselves. The Story from Heaven goes as follows: There is a Ji altar at Yuefei Temple on Wushan Mountain by Hangzhou city. In July of the xinsi year (1881), diviners called upon the gods again. Buddha descended first. After answering some questions over a long period, the old monk suddenly said: ‘I once drove out the plague from East Yue mountain area. People desecrated my temple several times and now it cannot be retrieved. So again the plague is coming. People should show repentance at once and do kind works. From the first day of the leap month to the first day of August, people should fast a month. Then they might escape the plague.’ Later Luzu (Lu Chunyang) came down and gave the same admonition. 6

 Xu Dishan. A Thorough Study of Fuji, Shanghai Literature and Art Publishing House, 1987; photocopy 1947.

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At that time, there was also a Ji altar in Yang city to pray for removing disaster and expelling the plague. But Jizu and Luzu did not attend. Jizu sent his attendant Wuqing and Luzu sent his attendant Liuxian… Wuqing judged: ‘It is pitiful you pray here. Natural disasters happen in every dynasty. You are lucky to have so many good people around you — and six-tenths of the disasters in Yang city have been removed already. Providence is fair. We should not talk too much about it. If you look eastward, you will find Yang city is just as lucky. Try your best to help each other anyway. It creates great merit. Everybody should work hard and pray to Zhenren Liu for a prescription.’ The method of divination was similar. The prescription consisted of one liang each of Bupleurum, Kudzu Root, Eucommia Bark, Cyrtomium Fortunei, half a liang of Liquorice and five stems of Calamus. Put them in a sack and put the sack in the water vat. Put as many as possible loach (mudfish) in the well. Several loaches in a water vat are good for eliminating evil qi as well. This method of divination advocates goodness and being good. The prescription is at least reasonable. The medicine was put into the water vat to disinfect the drinking water. The loach can at least show how clean the drinking water is. The fuji removing the plague was actually drawing support from sanitary methods. Jottings from the Thatched Abode by Ji Xiaolan records many such methods of divining prescriptions, including a prescription for asthenia (weakness) disease: “The immortal says: ‘No medicine can cure your disease. Inhibition of bad desires is much better than bark and roots!’ Someone prays for a child. Then the god judges: ‘There is a good prescription which will help you have a child. But any prescription is the same as no prescription; magical effect is the same as no effect…’” These twisted words mean there was nothing actually there to treat. But there are some comments made on the variety of ginseng to use, which are rather pharmacological. Ji diviners seemed to have known some medicine and could be very talkative. So Xu Dachun was also confused and had written Divination Prescriptions. As to treatment with witchcraft and bringing down the gods, Gong Dingchen during the Song Dynasty made a fine judgment on this: The Bachu area has had a custom of gossiping about witches and witchcraft, since ancient times. As for the disharmonious five qi bringing about the plague, people believe in the will of Heaven and they cannot be treated by medicine at all. So they are all busy praying to

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gods and spirits — for fear that their single chicken, pig, duck or sheep are not enough at the sacrifice. If the patient does not get well, he will blame himself for a poor sacrifice to the gods. If he is lucky enough to get well, he will put it down to his frequent prayers and rich sacrifice… I have even visited someone who thought his recovery was not due to his treatment but to the wizard being better than the physician. Alas! Wizards better than doctors? They are probably said to be better because people are easily obsessed with evil… Actually the most important thing is for the country to pay attention to the medical books. The former government compiled famous prescriptions and published them all over the country. It recorded the symptoms of plague in detail. During the Qingli period (1041–1048), Vice Premier Fan Wenzheng advised calling upon all doctors to come to the capital to study together — to improve their skill. He repealed wrong treatments and saved many lives. This was very helpful for medical progress. Secular people do not realize the kindness of the royal court, they are fooled by this absurd witchcraft and so lose their lives. I really pity them. Nowadays medical doctors are ordered to teach medical students the skills of Shennong, Zi Yi, Bian Que, Qinhe and the methods of Qibo, Yufu, etc. Bright medicine will overcome evil witchcraft. Then curable disease will not kill people again. This is definitely a good thing for the people. But I worry that the Bachu people will remain in their old customs. They do not know that medicine is better than prayer and sacrifice. So I am writing this text as a warning.7 Wise Gong Dingchen engraved these words to warn the people that it is necessary to popularize medical knowledge — and important to improve medical skills and resist witchcraft. But unfortunately witchery still became increasingly rampant and even, at times, out of control.

B. Gu Insect Witchcraft, Physiognomy and Taisu Pulse Necromancy 150.  Gu Insect Witchcraft People did not learn from the calamities caused by gu insect witchcraft during the Han Dynasty. On the contrary, insect witchcraft passed on down for 7

 The Comprehensive Medical Records quoting from Talk about Medicine.

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generations among the people. Not only that, but contagious disease made people believe in gu witchcraft increasingly, and it could not be eliminated — though the government repeatedly banned it. The History of the Northern Dynasties – The Sui Dynasty records that in the eighteenth year of the Kaihang period during Emperor Wen’s reign in the Sui Dynasty (598), “… on a xinhai day in May, people were called upon to cast out their cat ghosts, gu insects, etc. to the remote regions.” But as a result, instead gu witchcraft became popular in remote areas and an enduring problem in minority areas. People have always had a vague understanding about gu witchcraft and held an uncertain attitude towards it. For example, The History of the Northern Dynasties – The Biography of Qin King Jun records that “Jun was critically ill. He put a piece of silver in his mouth and the silver changed color. He thought he had been attacked by a poisonous gu insect.” The History of the Northern Dynasties – Biography of Mu Tipo records, “Lu Lingxuan feared that the Empress Hu could not be alienated for any real reason. So she searched for an unorthodox method — and used gu witchcraft performed on her. Dozens of days later, the Empress became insane, speaking and laughing without stopping, quite abnormally. The emperor gradually disliked her.” The Old History of the Tang Dynasty – Biography of Li Mian records, “Li Mian’s servant’s father was ill. The servant made a puppet with gu witchcraft and wrote Li Mian’s name on it, and buried it in a field ridge. It said ‘forgive me for my father’s calamity’. Then Li let her go.” All those prove that gu witchcraft was popular in those times. At the beginning, gu witchcraft used Yan-Sheng witchcraft and mostly worked through making a puppet. Later “gu attack” was more common. Sometimes it attacked through a snake or insect; some were attacked through their food. For example: A Taoist suffered from vexation and abdominal distension for two years. Zhen Quan diagnosed him saying: ‘There is a gu in your belly, which comes from eating the wrong food.’ He gave the Taoist a dose of realgar to take. After a moment, the Taoist vomited a thumb-sized eyeless snake. It was burnt and gave out a gas. The Taoist soon recovered. (New History of the Tang Dynasty – Biography of Zhen Quan) A family had a daughter suffering from a disease-like swelling. The family put up a poster searching for a skilled doctor. No doctor understood this disease. Ma Siming asked the cause of her

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problem — and was told the girl had once touched an ear of wheat and a two-foot long red thing like a snake had run into her, up her finger. She was frightened and immediately felt unwell. Her arm swelled up and became painful. In about one month, the whole upper body was involved in this hurt. The pain was unbearable. Siming gave her treatment and she was cured. (Medicine – Attacked by a Wheat Gu) Ma’s wife had been pregnant for fourteen months, but had not given birth to a baby. She was turning black and emaciated. Hanqing said: ‘She has not been pregnant but attacked by gu!’ After taking medicine, she passed something like a goldfish and recovered.8 The Qianjinyaofang states, “There are a thousand different poisonous gu. Some people who are attacked discharge blood; some like to stay in the dark; some change in mood, suddenly angry, suddenly laughing; some have heavy limbs and painful joints, and so on. Some people die after being attacked over three years, but some die only after a month or two. The gu will appear at any of the nine orifices or costal region, when one is going to die. So if you go out, you should carry with you a strong evil-dispelling medicine, such as realgar, musk or god dan. Then you will never be attacked by any poisonous gu, cat-ghost, fox or other evil spirits.” So a gu attack might have been a parasitic infection or chronic infectious disease, including schistosoma cirrhosis, tuberculosis. It is in line with the saying “flying grain can cause gu” mentioned by Yihe. The General Treatise on the Cause and Symptoms of Diseases says, “a kind of flying gu leaves no trace. It looks like some kind of spirit qi. Its attack is serious. Most guattacked people will die. A gu is extremely toxic, so it is called ‘poisonous gu’ (gudu).” These texts are all about gu. The collection of Yi Jian Stories also discusses it in detail. Yihe also mentioned that “insects in a vessel turn into gu”, which hints at not only the shape of the character for gu but also the method of keeping gu. In the beginning it seems people used to keep a gu to attack someone else. The Handbook of Prescriptions for Emergencies records: Some people keep gu insects to hurt others. The diagnosis: If one is attacked by a gu, he will have an excruciating pain in the chest and abdomen, just as if being bitten by an animal; or he will spit or 8

 History of the Ming Dynasty – Biography of Zhou Hanqing.

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discharge blood. If he is not given immediate treatment, his five zang-organs will be destroyed and he will soon die. To judge is one has been attacked by a gu or not, order him to spit water. If the spit sinks down in the water, he has been attacked by a gu; if the spit floats, after rising up to the surface, he is not attacked by a gu. A method of knowing the gu’s owner: Take a little skin from where the swelling is and burn it, then let the patient drink it in water. Then the patient will call out the owner’s name after a while. As he speaks out, it will leave. Some people take snails and crush them together to make a gu and put it in food to make people suffer an abdominal mass. It can kill them over several years. Different doctors have different medicines to treat this. Another method is to gather up some lotus leaves and place them under the patient’s mat. The patient then will also speak out the name of the gu owner. The method to keep gu is recorded in a General Treatise on the Cause and Symptoms of Diseases: “There are few gu which are all unpredictable and bewitch people in different ways. People create them intentionally. Sometimes snakes and insects are put into a vessel to eat each other, the last one alive becomes a gu. It can change shape in strange ways and get into food and wine, where it is swallowed down and harms people. It does harm to others — but brings luck to its owner. This is why these unruly elements keep gu.” The History of the Sui Dynasty — Geography Record also says, “The custom in Xin’an, Yongjia, Jian’an, Sui’an, Poyang, Jiujiang, Linchuan, Lulin, Nankang and Yichun is similar to that in Yuzhang… however, these counties often keep gu, especially in Yichun. The method is so, on the 5th day of May, a hundred different insects, from large snakes to small lice, are put in a container to eat each other. The last one alive is retained. If it is a snake, it is called a snake gu; if a louse, a louse gu. They are used to kill people as if someone eats it along with his food, his inner organs will all be consumed. After he dies, all his property will be seized by the owner of the gu. If the gu does not kill him in three years, the owner will have to concede defeat. Gu can be handed down from generation to generation. Then can also go along with girls as they get married.” This may not be untrue, as gu keepers produce their own gu. The History of the Song Dynasty – Emperor Taizu says, “The second year of Qiande (965), three hundred and twenty-six families in Yongye county were moved to remote places and not permitted to return to their hometown, for

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raising gu.” The Compendium of Materia Medica also says, “Put hundreds of insects into a jar. After a year, there must be only one insect left. It eats up all the other insects and then becomes a gu.” In the middle of the 20th century, two anthropologists, Ling Chunsheng and Rui Yifu, investigated the area of the Miao minority tribes and found that there was still a custom of keeping gu in that region.9 They commented, Poisonous gu have been a longstanding tradition since ancient times… this tradition is still kept secretly among the Miao nationality right up to today. Volume 7 of The Annals of Qianzhou states: woman in the Miao area will kill someone with gu witchcraft if they are having a feud with them. It is called fangcaogui (‘setting a grassghost on them’). If the gu is put outside the body, the snake or insects will eat the limbs and head; if the gu is sent inside the body, it will eat the viscera. The person attacked by the gu will suffer unbearable pain, or have an unsound mind and body, or creeping sensation on the skin, or much flatulence. These all will prove fatal… If the patient will not get timely treatment, they will die in a month. Both men and women can learn gu witchcraft. Secretly prepare a small jar, fill it with water and put several small shrimps in it. Bury the jar under a bed in darkness, or under a rock beside the road, in a remote mountain. If the jar is found and destroyed by someone, the owner of it will die… Before the Jiaqing period, a woman would be killed if she was found to have performed gu witchcraft among the Miao nationality. After that time, people would no longer dare to use them, but they were still sold among the people. So people still retained this witchcraft and cunning folk could profit from gu witchcraft… This survey did not get to the bottom of gu witchcraft, but proves that it has always existed. Later Ma Xueliang wrote an article: It is said widely that people perform gu witchcraft to hurt others in the Miao area of Southwestern of China. However I have lived in Miao for several years. Why have I never heard of such thing? I only hear tales that someone has become dazed and confused, or maimed, or even died because of an attack of gu. I remember that an old 9

 Ling Chunsheng, Rui Yifu. An Investigative Report on the Miao nationality of Xiangxi, The Commercial Press, 1947.

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woman of the Luo nationality once told me that she was blind in one eye after eating food poisoned by her enemy in the village. I also often saw the seller of gu-relieving medicine in the market. The person attacked by a gu would soon recover after taking medicine. Not only this, but the family performing gu witchcraft in Luo village would often be clearly marked and called a “medicine king by the villagers. They kept themselves a respectful distance away from other families. In marriage, if people knew the family possessed a ‘medicine king’, they would not intermarry with it… This old custom has been passed down to the present. It is quite credible.10 The results of this survey were inconclusive. It seems it is necessary for medical anthropologists to participate in this kind of investigation. Otherwise, it would be difficult to tease out the essential link in the transmission of gu disease. Keeping something like a snake, a turtle or frog might just be coincidence. Besides this there are also such occurrences as “secret epidemics” of chronic infectious disease, such as “guru disease” in Papua New Guinea.11 Most medicines for gu treatment recorded in the ancient books, such as the Qianjinyaofang 千金要方, were made up from other insects or animals. For instance, the following are mentioned: centipede, cantharis, hedgehog skin, musk, otter liver, or for insect-killing medicines or cathartic drugs, Realgar, Croton, Aluminite, Black False Hellebore, Spurge, etc. Nowadays, these herbal medicines are often used to treat chronic liver cirrhosis and liver cancer. Sun Simiao recorded, “Northern Procurator’s Wine for gu poison and wind, qi, cold and heat diseases” which included Aconitum, Liquorice, Rhizoma Chuanxiong, Baikal Skullcap Root, Cortex Cinnamomi, Black False Hellebore, Monkshood, Radix Ampelopsis, Platycodon Grandiflorum, Pinellia, Chinese Arborvitae Kernel, Lilyturf Root, etc. He gives the following example: There was a woman in her forties. She suffered from hemiplegia for three years. She was lying in bed all year and heard or saw nothing.

10

 Ma Xueliang. Necromancy and Gu Witchcraft among the Luo nationality in Research Essays about Etiquette and Custom in Yi Nationality of Yunnan, Sichuan Nationalities Publishing House, 1983. 11  An epidemic disease among the guru tribe in Papua New Guinea. Anthropologists and medical scientists found it to be a slowly progressing viral infection caused by the custom of women and children eating the corpse brain of their relatives. This research won the Nobel Prize in medicine.

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Her hands could not grasp. I made up a prescription for her and she recovered, becoming as well as before. She must have had a chronic infection. He cited the symptoms of gu attack as follows: If one had been ill for several years, his stool would be sometimes pitch-black, sometimes hard, and sometimes thin and sometimes a little red, which means attack by a gu. If someone suddenly discharges blood and gets worse after being treated with blood-stopping medicine, he is being attacked by a gu too. One suddenly suffers a kind of blood dysentery and his stool is red or black. No matter how much it is, he is being attacked by gu. If a stupid doctor treats him with dysentery-stopping medicine, he will be absolutely wrong. Some quacks treat gu attack as edema, which has the symptoms of swelling in the body, normal use of the limbs but a little obstructed urination. They always give patients medicine for edema and hope they will recover in fifty days. But the patient gets worse and worse, and finally dies. There is more than one case such as this. Students should study my prescriptions carefully and use them prudently, and then perfectly. Thousands of volumes of prescriptions are so different and never get to the truth. We cannot discuss them all one by one here. The above sounds rather like ascites due to cirrhosis of the liver, along with edema and its complication of gastric haemorrhage. It might be caused by chronic schistosomiasis or chronic hepatitis. Jiangnan (south of Yangzi River) lies in just such an area of endemic schistosomiasis. The book Continued Medicine records an example of treating gu with spiders. A person was attacked by a gu poison. His limbs were not swollen, only the abdomen extended. Dai Yuanli called it ‘spider disease’. A common practitioner treated him with ‘fluid-dispersing medicine’. He got worse. It was a hot summer. Someone gave him the SummerClearing Qi-Tonifying Decoction. As the young servant cooked the medicine, a spider happened to fall into the medicine. The boy was afraid of being scolded, so he quietly removed the spider and presented

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the medicine to the patient. The medicine smelt so good, he drank it all. After a while, his abdomen rumbled and he became restless. His family suspected that the medicine was wrong for him. Soon he discharged a dou of urine and the abdomen became flat. He became as well as usual. Note: Our Materia Medica says that the spider is poisonous and cold, mainly being used for dingxi disease.12 It can be cooked and eaten, but there is no mention of its therapeutic action on gu. The case was obviously ascites, with a swollen abdomen. Abdominal distension is relieved after water is discharged through the urine. The use of gu poison among the people is an eternal mystery. It will not be solved until we have a thorough investigation conducted in the areas of its use.

151.  The Taisu Pulse and Art of Physiognomy The Histories of the Song Dynasty – On the Monk Zhiyuan relates the following: A monk called Zhiyuan from Suizhou was good at medicine. At the end of Jiayou period (1063), he was called to the capital and lived at Xiangguo Temple. He was able to foreknow if one would be noble or lucky in the future, by feeling the pulse. He could know whether a son was lucky or not, through feeling his father’s pulse. His predictions were marvelously correct. Noblemen visited him one after another. Wang Gui and Wang Anshi both worked at the Imperial Academy. Gui was suspicious of his skill because it had not been heard of since ancient times. But Anshi said: ‘Ancient Yihe felt the pulse of the lord of the Jin nation — and knew that his important minister was going to die. The fate of a minister can be predicted through the pulse of his lord. Is it any wonder that the son’s future can be predicted through the pulse of the father?’ The Qingbo Magazine records what took place: I have seen my father’s friend Xu Zhikang talking about the Taisu pulse which could foretell one’s fortune. In the middle of the Zhiping 12

 A childhood disease with emaciation and abdominal distension.

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period, a monk at the capital named Zhiyuan felt the pulse of a Mr. Wang Jinggong and predicted that his son would succeed in the imperial examination. At that time, Wang Yuyu was right there with him, and did not believe the monk at all. The next year, Wang Pang really did succeed in the imperial examination. He was proud of his own skill and wrote to Mr. Wang Anshi for praise. Mr. Wang wrote back: ‘The great monk Zhiyuan knew our son would be ennobled, through feeling his father’s pulse. Academician Wang, of Chengzhi, thinks there is no such skill as this, even in ancient times. Zhiyuan in his defense states: ‘ancient Yihe felt the pulse of the lord of Jin nation and knew that his important minister was going to die.’ The minister’s fortune can be predicted from the pulse of his master. Is it any wonder that the son’s future is predicted from the pulse of the father?’ This is the general content of what has been written down about this. Mr. Xu commented: This is not written by Mr. Wang Jinggong at all. Zhiyuan’s disciples are just boasting and peddling their master’s skill! Wang Yuyu was Wang Gui, the famous academician. Pang was the son of Wang Anshi. So they had a history together. The Histories of the Song Dynasty records that Zhiyuan had said to Anshi, “But really this is of no significance”. Ji Yun comments in The Catalogue of Siku Quanshu: Nobody knows the originator of the Taisu Pulse Method, which predicts one’s fortune by feeling the pulse. Its original preface says: ‘At the end of the Tang Dynasty, a woodcutter recovered this book from a stone casket on Kongtong Mountain. The writings are in two volumes, deposited thereby an immortal.’ The absurdness of this tale is just to build up performers. Here we have only one volume. Maybe the two volumes have been united into one; maybe the other has been lost. The book was never been mentioned before, in ancient times. The Histories record the story: ‘A monk called Zhiyuan…’ and so on. This seems to be verifiable. However, if we think back to Master Zuo’s Spring and Autumn Annals, Yihe makes his prediction simply through relating together people and things. He says to the Lord of the Jin nation: ‘Your disease is incurable. It is caused by excessive sex instead of ghosts or an improper diet. Like a gu attack, this confuses people and makes them lose their will. Your minister is going to die. The gods do not look favorably on Jin nation anymore.’

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Then he says to Zhao Wu: ‘A minister enjoys the favor and salary of his lord, he also shoulders the heavy responsibility of his state. If a disaster is about to happen, and he does not handle it, he is sure to be cursed.’ Is there any word here about a pulse! Furthermore, Master Zuo’s Spring and Autumn Annals states an ‘inspection’, but not ‘feeling pulse’. So if a great doctor has the skill of the gods, he will know everything about the patient by observing his complexion. What was said by Anshi was wrong. This skill probably originated in the Northern Song, so Zhiyuan is wrong in referring it to former times. Then Luo Kuo wrote Biography of Zhang Kuo that Zhang Kuo loved medicine since he was young and travelled with Pang Anshi together. Later he heard that a Wang Pu of Shu state was good at feeling pulse, who could tell one’s fortune with Taisu pulse. Zhang Kuo followed him to learn for many years and obtained the pulse book hidden in the casket. He had a good master of the essence and said goodbye to Wang Pu. Zhang Kuo lived in Huizong period, Wang Pu and Zhiyuan were contemporaries, they both lived in Jiayou period. Let’s look at the original preface. It says the book was obtained in the late Tang Dynasty, so it does not use the ancient method. It is written in shallow seven-word rhymes. It may not be the book hidden in the casket, but gained the backing of medical workers. Ji Xiaolan had a clear attitude towards the Taisu pulse. He did not think the pulse could predict the fortune of people. The idea of a “Taisu pulse” had been totally made up. According to the book Chicken Ribs Series, the Taisu pulse originated in the Tang Dynasty and became popular in the Song: There was a soldier called Li Wenhe in Lizhou. He was a monk, committed a crime and was branded in the face. But he understood the Taisu pulse and could predict the future. Even the mystical mind can be predicted. Once he felt the pulse of a legal officer Sun Ping, and said: ‘According to your pulse, you should be a monk. But I feel it carefully and find it in name only. You should have been a monk when you were a child. Otherwise, it could be your infant name.’ I asked Sun Ping and he replied yes. Because he was always sick, he was given to a monk and named Xingzhe. I was surprised at this marvelous skill. The soldier said: ‘The pulse at the cunkou is there

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for Buddhist practitioners. The pulse at the cunkou was indistinct, sometimes felt but sometimes not. So I judged that he was a monk in name only.’ Later I got this book, matching the twelve meridians with the twelve hours, like the house system of the five elements. Different fortunes have their own methods of prediction. Every day has its own branch, matching wheel and pulse, so weal and woe can be predicted. The preface of the book says: ‘A hermit called Dong Wei in our former Tang Dynasty taught this skill to Zhang Taisu and Taisu began to practice it. So this skill is named after him.’ Many people in the capital and other places are known for their Taisu pulses. But not Li Wenhe. The book Chicken Ribs Series was written in the third year of Shaoxing (1133) and is a record of how to take the Taisu pulse. A long paragraph in vol. 3 of Zhang Gao’s Medical Stories (written in 1189, published 1224) also describes the “marvelous Taisu pulse”. It is a story about his granduncle Zhang Kuo (Zichong). It is said that after travelling much with Pang Anshi, he “heard tell of a Wang Pu in Sichuan who could not only feel out an illness, but also tell one’s fortune and predict the future. He followed Wang Pu several years and had a good mastery of this method — so he said goodbye to Wang Pu.” Briefly this is what Ji Xiaolan relates.13 Zhang Gao gives dozens of examples to explain the effectiveness of the Taisu pulse, such as a rich man in Nanling, the wife of a Nanling Zai, Qimen Zai, Prime Minister Wang Tingjun, Prime Minister Fan Yaofu, Minister Jian of the Song, Huang Junmo, Cai Jing, etc. It is written that “Zhang Kuo was famous in the Chongning and Daguan period and died in Nanchang when he was forty-nine.” He had predicted his own death. Zhang Gao is bragging about his own granduncle. The taking of the Taisu pulse was much criticized in the Ming and Qing dynasties. Wang Ji (Shi Shan, 1463–1539) in On Correcting Common Confusions in taking the Pulse wrote the following: The book is entitled Taisu, but it does not discuss the meaning of the term ‘taisu’ at all. It is full of many uninteresting, unpolished and vulgar rhymes. At first, I thought it had just been written to make money. People who are in the dark, buy it and study it one after another. None understand it for what it is… high or low, rich or poor, this has 13

 Qing author of Jottings from the Thatched Abode, see Section 149.

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nothing to do with the blood and qi in one’s body. How can it be predicted by pulse?… It is absurd to say the taisu can predict one’s fortune, one’s whole life, by a single moment of feeling the pulse. Even if it gets it right several times, it is only ‘chasing the breeze, or clutching at shadows’. There is no sense in it, no reason at all. Certainly, disease cannot be diagnosed by pulse alone. It also needs observation and listening. How can you know anything otherwise! Some doctors such as Wu Kun (1552–1620?) discuss it from a medical point of view: Though the Taisu method is ridiculous, there is something you can take from it. For instance, a round, clean and distinct pulse is called a ‘clear’ pulse; a scattered, unsmooth and indistinct pulse is called ‘turbid’ pulse. If one has a clear body and clear pulse, one will be rich, noble and happy; if one has a turbid body and a turbid pulse, one will be poor, lowly and unhappy; if one has a clear body and a turbid pulse, one contains turbidity within clarity, thus he will be rich and noble without while poor and lowly within, he will have much frustration and a little success; if one has a turbid body and a clear pulse, one has clarity within turbidity, so he will be poor and lowly without while rich and noble within, he will have much success and a little frustration. If the pulse is neither clear nor turbid, he will half succeed and half fail, have neither great gain nor serious loss. If one is rich, noble and due to live long, his pulse is clear and long; if one is poor, lowly and due to live a short time, his pulse will be turbid and rapid. If one’s pulse is clear but rapid, he will be rich, noble but short-lived; if one’s pulse is turbid but long, he will be poor, lowly but long-lived. There is a lot in what the Taisu says. However none of it goes beyond fengjiang (literally ‘wind mirror’, something like ‘looking at how they present’). So a taisu performer should learn fengjiang instead of taisu. If one has a good master of fengjiang, his skill at the taisu pulse is naturally magical. But some people go too far. They acts weirdly and seem to be all-powerful. Then they become sorcerers. Confucius said: It is time to rectify the heretical, because it is too harmful. Honest men never do these absurd things.14 14

 The Analects Ch.16.

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Zhang Jingyue is also ambiguous towards the taisu pulse. Jingyue’s Complete Works – Marvelous Pulse cites the theory of Mr. Wang, Mr. Wu and The Gist of the Taisu by Peng Yongguang. He states the following: To know whether one will be noble or low, feel the pulse to be clear or turbid; to know whether one will be poor or rich, feel the pulse smooth or unsmooth; to know whether one will be long-lived or short-lived, to feel the pulse up or down; to know whether one will be good or bad, to feel the pulse strong or weak; to know whether one will be lucky or unlucky, to feel the pulse slow or fast. This is just the same as in the Lingshu (or Neijing), following heaven, earth and man to tonify deficiency and attack excess. If the pulse at the hands is clear and fine, as if there is no pulse, it is a pure yin pulse, standing for nobleness; if the pulse at the hands is big and strong, it is a pure yang pulse, standing for nobleness. However, Xu Dachun’s view is insightful and he believes “it is absolutely unreasonable”. He states: Feeling the pulse is used for curing disease. Ups and downs in the qi and blood, wind-attack, cold-attack, summer-heat attack and dampattack, all can be felt out. It is said that the Taisu pulse can tell if one will be long-lived or short-lived, poor or rich, wise or foolish, kind or evil. The pulse is the indicator of the qi and blood. A long, hard or thick pulse is a symbol of longevity; a short, small, weak or thin pulse is a symbol of early death; a clear and vigorous pulse is a symbol of wisdom; a turbid and spiritless pulse a symbol of foolishness. This is perhaps reasonable. But if one is unable to distinguish good and evil, have poverty or riches anything to do with the pulse? If one has a long-lived pulse, but is careless and attacked by wind-cold or overstrain, he will die young. If one has a short-lived pulse, but is nursed carefully, he will live long. Some have clear qi and blood, but their mind is turbid; some have turbidity in the body, but the mind is clear. Life span and wisdom cannot be predicted. Nor can other things! These writings are absurd in deifying the Taisu pulse and saying it can predict one will be promoted to X in X years, or make X amount of money in X years, who your parents are, what your children are going to become. Probably someone performs this once and it works, but this should not deify the practice! It is absolutely impossible for the Taisu pulse to tell you everything.

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However, taking the Taisu pulse is not a special kind of medical physiognomy, although the development of Chinese physiognomy was much affected by medicine, so much so that kanyu (“geomancy”), fengshui, the five elements, six qi and four directions are all different branches of the same system. The Lingshu – Twenty-five Different Persons was the basis of much later physiognomy. It is summarized in Table 19.1.15 This physiognomy has been made much of in today’s fortune-telling books, after some superficial changes. The table can be extended to include information on wealth and rank. Take complexion as another example: “Huangdi said: What if a particular constitution loses its corresponding skin-color? Qibo answered: Constitution restricting skin-color or skin-color restricting constitution will become serious during forbidden years (nianji). If one is attacked by an evil qi at this time, one will fall ill; if one does not get proper treatment in time, one will be in danger. If one has a matching constitution and skin color, one will be rich, noble and healthy. Huangdi said: Do we know the forbidden years when constitution and skin-color restrict each other? Qibo said: Generally speaking, the most forbidden years are the seventh, sixteenth, twenty-fifth, thirty-fourth, forty-third, fifty-second and sixty-first. During these years, one must care much about one’s health because one is easily attacked by evil qi and in danger. As people live through these forbidden years, they absolutely must not confront bad things.” The “forbidden year” is the same as the kan (meaning “water”, or “pit”, one of the Yijing trigrams) in physiognomy. Besides this, there are lucky looks and unlucky looks. Here, we will not discuss them. In the Lingshu – Lifespan and Constitution it also says: Huangdi asked Bogao: I hear about easy constitutions and tense constitutions, the ups and downs of the healthy qi, being big boned and small boned, having hard muscle and fragile muscle, thin skin and thick skin. How do we understand one’s life span from these factors? Bogao replied: If one’s constitution is commensurate with one’s healthy qi, one will live long; otherwise, one will live short. If one’s skin is commensurate with one’s muscle, one will live long; otherwise, one will live short. If qi, blood and meridians are stronger than constitution, one will live long; otherwise, one will live short. Huangdi asked: What are easy constitutions and tense constitutions? Bogao replied: A strong constitution and an easy skin mean a long 15

 From Qi Hao. Medicine, Witchcraft and Qigong, Sports Press, 1990, p. 121.

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Head

Face

Shoulder

Back and Abdomen

Hand and Foot

Emotion

Life Span

Disease

favourable in spring Foot-Jueyinliver and summer, disease unfavourable in autumn and winter

wood grey constitution

small

long

big

straight back

good

worried, talented

fire red constitution

small

sharp

plump

large abdomen

small

young death, sudden suspicious, death worried, shorttempered

earth yellow big constitution

round

beautiful large abdomen

beautiful legs, small and fleshy hands and feet

favourable in autumn Foot-Taiyinkind, spleenand winter, indifferent to stomach unfavourable spring power disease and summer

metal white constitution

big

square small

small hands and feet, light boned

short-tempered, hard-headed

water black constitution

big head uneven small and cheek

small abdomen

big abdomen, shivering hands disrespectful, and feet bullying long buttocks and back

Hand-Shaoyinheart disease

Hand-Taiyinfavourable autumn lung and winter, disease unfavourable spring and summer killed

kidney disease

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life; but a strong constitution and a tense skin mean a short life. A strong constitution and forceful pulse mean one is well; a strong constitution and weak pulse mean weak qi. Weak qi puts one in danger. If a constitution is strong and the cheekbone flat, the bones are small. Small bones lead to an early death. A strong constitution with large and textured muscle means strong muscle. Strong muscle leads to longevity. A strong constitution with big and non-textured muscle means fragile muscle. Fragile muscle leads to an early death. The above are congenital. They can help us to infer that someone will be long-lived or short-lived. Medical workers must understand these points so that they can make the correct prognosis for patients — according to their qi and physical conditions. Huangdi said: I have heard about a long life and a short life. How to measure life span? Bogao replied: A person with a hollow face and bulging bones will die under thirty. If he suffers from disease, he will probably die under twenty. Huangdi asked: How to decide one’s lifetime through constitution and qi? Bogao answered: For a healthy person, if his healthy qi wins over his constitution, he will live long; for an extremely thin patient, although his healthy qi wins over his constitution, he will eventually die. If his constitution wins over his healthy qi, he will be in great danger. There are many such experiences among doctors, just like the “Hippocratic face” or “death face” in the West (the face of impending death or chronic illness). The examination of the face and constitution is able to diagnose the disease. Only when it goes too far does it becomes physiognomy. But whether we are talking about just physiognomy, complexion physiognomy, bone physiognomy or other physiognomy, none can do without anatomical knowledge. For there are always certain rules in making an examination — such as a tongue examination, an infant’s finger vein diagnosis, or the making of a prognosis of a future child’s life. It is a particular skill for a doctor to diagnose a disease by observing the qi, colour and spirit. However, storytellers and historians often make it seem miraculous, such as Bianque inspecting Lord Huan of Qi, Zhongjing diagnosing Zhongxuan, Hua Tuo predicting a future life, the “children’s lifetime prognosis” mentioned in Valuable Prescriptions for Emergencies and so on and so forth. These provide fortune-tellers with much “evidence” and work. The book On Balance talks about bone physiognomy. The section on Physiognomy in

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The History of the Han Dynasty – Bibliography Record has twenty four volumes, including one describing Bo Le selecting horses. These books were written in the Qin and Han Dynasties, at the same time as the Neijing. Liu-zhuang physiognomy, hemp physiognomy, palmistry, fortune-telling and glyphomancy all derive from these times. Much of the above altar medicine borders on witchcraft. It still lingers on among the people, sometimes it becomes popular, then it fades away again. Witchcraft in medicine will not leave or step down from the stage of history in an easygoing manner.

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CHAPTER 20

The Mentality and Behaviour of Physicians and Patients in the Tradition A.  The Cultural Psychology of Chinese Medicine 152. The Medical Expert’s Pursuit of Personality — “A Superior Physician Treats a Country” Chinese physicians historically speaking have always aimed high and had a strong sense of participation in politics. If they could not achieve their political ambition, they would choose to have a secluded life in the country and heal people around them. They would like to “become master physicians if they were unable to become good officials”. This psychology reflects the fact that Chinese physicians had a psychological and cultural complex at that time — if their self-value could not be realized, as they hoped, they would harbour a grudge. If they had a chance, they would discuss politics as a doctor — but inevitably stooped to proposing some pedantic idea, such as “first making a diagnosis of king and country”. This was also a common lapse among Chinese intellectuals of old. Therefore, being a perfect master physician was a psychological consolation, and healing the patients was an extension of healing the country. The concept “a superior physician treats a country” emerged a long time ago. The State Records – Jin State (国语·晋语) records the following: Once Duke Ping of Jin fell ill. Duke Mu of Qin sent a master physician called Yi He to give him treatment. After the diagnosis, Yi He came out and said, ‘I cannot cure you… Your loyal and talented officials will leave you and your destiny will not be blessed. If you are not dead, you will soon no longer be supported by the seigneurs under your reign as well’. Zhao Wenzi, one of Jin’s senior ministers, 1055

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heard what Yi said and refuted him, ‘It has been eight years since we helped Duke Ping become a leader among the seigneurs. There is no vicious tyranny in the country and no rebellions among seigneurs without. How can you say those words?’ Yi He answered, ‘I just predicted what would happen in the near future. I have heard that a talented official with integrity isn’t willing to assist a ruler to do unjustifiable things; a person who open-minded and straight­forward won’t get things done with one confused, just like towering trees not growing on high cliffs and pine and the cypress not living in low, damp places. You haven’t proposed any admonishments to your duke directly — or warned him to stay clear of lustful thoughts, which only has resulted in his broken-down body, whereas he is infatuated with power and won’t abdicate. Eight years of ruling have been enough, and this cannot continue!’ Wenzi asked, ‘Does a physician treat a country?’ Yi answered, ‘A superior physician is capable of treating a country in as his first duty, and then secondarily healing the patient like any other official physician.’ ‘How long can Duke Ping of Jin live?’ Wenzi asked. ‘No more than three years if the other seigneurs still support him’ answered Yi, ‘if not, he will live longer — but less than ten years. And the Jin state will confront a disaster at that time.’ The same year, Zhao Wenzi died and the seigneurs began to rebel against the Jin state — and after ten years, Duke Ping of Jin died. Yi He believed that “a superior physician is capable of treating the country in the first place, and then secondarily healing the patient”, which is a physician’s duty. At that time, medicine was mingled with other disciplines. It was assumed that governing a country was similar to healing a person, so it would be an equal choice for a master physician to decide to heal people or assist a governor in ruling the country. Obviously, this reflects the theory of the integration of the human (personal) with nature (political). Since then, governing a country has been considered the same as treating a country, and curing a single person’s illness is regarded as healing the whole population. People with noble aspirations always promote themselves as “living state physicians” or “state-policy physicians”. Huang Tingjian, a poet and calligrapher during the Song Dynasty, once wrote two poems. One states, Seeking a living state physician sincerely, You needn’t give up so soon.

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This is from Corresponding to Zizhan’s Can – Rhythm Verses (见子瞻灿字 韵诗次韵). The other goes as follows: Though Yi He is not alive at present, His words are profound and permanent; Virtuous admonishments can treat a country, How can you think about them too early? This comes from Two Poems Presented to Su Zizhan (古诗二首上苏子瞻). Shao Yong, a poet in the Northern Song Dynasty, also wrote in Song of Being Ill (有病吟) saying: A patient needs medicine when he gets ill; Bad treatment will only make him worse. A country needs treatment when malpractices occur; For treacherous officials will endanger the country. Malpractices must be corrected before things become too serious. If things have become serious, nothing can help and there is only regret. A country is like a human being. When a man gets ill, he should consult a physician for treatment, and after getting well, he needs to stop taking medicine and cultivate his body appropriately. Lu You, a great poet during the Southern Dynasty, wrote in his poem Poetizing Accidently When I am Ill (小疾偶书): How can you say it is unwise for physicians to harbor national policies? Fortunately my pocket carries good prescriptions to cure patients. Xin Qiji, a famous patriotic poet during the Southern Song Dynasty, wrote in A Pu Saman Poem – For Physician Zhang and Sending Him a Pufferfish as an Extra Gift (菩萨蛮·赠张医道服为别且令馈河豚), “Medical skill is priceless, and a superior physician can treat a country.” Zhang Xiaoxiang, a poet during the same dynasty, once wrote in Thanks Given for the Yu Gan Decoction Made in His Secret Managing Cabinet (敬谢经略秘阁余甘汤) that “Advice should be earnestly given you, wise majesty, that medicinal talents can treat a country.” Writers and artists with great ambitions always liked to style themselves “a wise physician who heals a country” and declare impassioned political views when their motherland

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was in a critical state. From the above quotations, we can see that “treating a country and healing a person” had a profound influence in history. Hong Mai, a great writer in the Southern Song Dynasty, wrote in his Rongzhai’s Informal Essays (容斋随笔): Emperor Rui Zong of Tang summoned Sima Ziwei to know about his medical skills. Sima answered that ‘Practicing the Tao one needs to reduce everything to the simplest, virtually nothing. However, it has been difficult to get rid of things that the heart perceives and the eyes see. But now your majesty even believes heterodox ideas. How could one not be concerned?’ The emperor answered, ‘This is the case when treating the body, but how about treating the country?’ Sima answered, ‘A country is just like a human being. Therefore we should be free from worries, just go where the qi flows and live in harmony with nature without any selfish motives. Then the country will be governed spontaneously.’ Sima advised the emperor to govern the country by ‘doing nothing against the nature’, but his ideas — namely ‘living in harmony with nature without selfish motives’ and ‘just going where the qi flows’ equally apply to treating the body. Medical Gatherings from Ancient Times to the Present (古今医统), written by Xu Chunfu, quotes from the Graceful Culture (郁离子) when it says, “Is ruling a country like healing a person? A physician takes the pulse of the patient to understand the pattern and then gives prescription and treatment accordingly. The pattern may be yin or yang, excess or deficiency; the pulse condition may be floating or sunken, thready or large; while the treatment could be tonifying or reducing, acupuncture or moxibustion, decoction or application. Different medicinals should be used in accordance with the specific illness. The failure of using the right medicine will worsen the illness and in turn, the illness will not be relieved. Suitable medicine can relieve the illness. So those who can only diagnose and feel the pulse but not prescribe the right formula are not physicians. Alternatively those who only know the sages’ formulae, but fail to do any diagnosis, are useless. Those who tell people ‘I can treat it’, ‘I can treat it’ but don’t know the pattern and pulse, and get the formula through hearsay, are total liars. Similarly, the problems of a country are like patterns of disease; the social order and laws are like pulse conditions; morality and penal policies are like treatment formulae and approaches; and people with talent are like medicines. The Xia Dynasty advocated loyalty, but the Shang directed itself against weakness and remedied

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corruption through integrity; the Shang advocated integrity but the Zhou Dynasty started at a disadvantage and aimed to govern the country by educating its civilians. The Qin Dynasty used cruel torture and rigorous laws to control the people, which made its civilians lives in misery. Therefore the emperor of the Han used munificent policies to comfort them and peacefully bring the people together. Diagnosis and formula, as well as medicinals were correct. For diseases in the world, seldom are any beyond the realm of treatment.” This paragraph uses the methods of treating a disease to explain the changes of dynasty in ancient China, and can be regarded as the best explanation of this idea that “a superior physician can treat a country”. Medical theory is used here to discuss the ruling of a country — although, in this case it does not imply that this was the business of a medical practitioner. Seeing both treating a country and treating a patient as duties of the physician was illustrated clearly in the Spiritual Pivot – Passing from Masters (灵枢·师传篇): Huangdi said, ‘I heard that former masters had many good tips which were not written down. I want to learn and preserve them as rules for public use. They can be used to govern the people on a large scale and cultivate life in the small scale, thus preventing people from pain and suffering. As a result, governors and people will be able to live in harmony and affection. Virtue will be passed on to offspring and descendants can benefit and be free from worries. This state can be spread generation to generation without ending. Can you tell me any of these tips?’ Qibo answered, ‘How profound your question is! No matter whether governing the people or self-cultivating one’s own health, no matter whether managing here or there, dealing with trivial things or important matters, administering the country and handling the home, they can only be achieved by ‘conforming ways’ rather than counteracting ways. ‘Conforming ways’ not only mean following the routine order of yin and yang, the meridians and qi, but also referring to what people want in the country to complying with their wishes.’ Huangdi asked, ‘How do I use conforming ways?’ Qi Bo answered, ‘Having arrived at a country, you need to be acquainted with the local customs; you should learn the taboos before you make become a guest at somebody’s home; you must understand the etiquette in the hall; just as you ought to inquire about a patient’s discomforts at the beginning of administering treatment.’ Huangdi continued, ‘How to use these appropriate ways to

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treat the patient?’ Qibo answered, ‘With a patient who suffers from a heat pattern of wasting-thirst, cold therapy should be applied; if it is a cold pattern, heat therapy is appropriate…’ Huangdi replies, ‘If the stomach desires cold while the intestines are in favor of heat, how do I treat this contradictory situation? In particular those kings and dukes who are fond of eating meat, are arrogant, indulge in sensual pleasures and look down upon everyone else, no one is able to discourage them from those adverse activities. They are certainly not pleased if counter-acting measures are adopted — but if we comply with them, the disease worsens. How to deal with this? What is the priority here?’ Qibo answered, ‘It is human nature that everybody fears death and prefers to live. If we tell them what things are good or bad for them, for their health, guide them towards the right things and admonish them by describing the pain of other patients, though it is true there are unreasonable people in this world, will they still then turn a deaf ear on such advice?’ Huangdi answered, ‘How to carry out this treatment then?’ Qibo answered, ‘During the spring and summer, physicians should treat branch symptoms first and then cure the root cause; while during the autumn and winter period, physicians should do the opposite.’ Huangdi asked, ‘How to treat patients with contradictory conditions?’ Qibo said, ‘In order to comply with such patients, in their daily life, they should live in a comfortable environment when cold, thick clothes should be put on so as to get rid of the chill; when it is hot, wear less clothing to prevent sweating. As for daily diet, food should be neither too cold on cold days nor heated on hot days. Thus, a healthy qi can be kept inside and pathogenic agents kept away — under such moderate behaviour.’ The authors of the Neijing (Inner Classics) here stand on a different footing to Yi He. Yi He points to the theory of heavenly destiny, while the Neijing harbours natural and philosophical theories — and advocates that governance of both country and people should comply with nature. After recognizing this natural principle, it is possible to do what Book of Sui Dynasty (隋书) says, “Politics can be detected as if feeling the pulse and a country’s state can be looked at as someone’s illness.” However, up until the time of Sun Simiao during the Tang Dynasty, the so-called “superior physician” was disconnected from practice, and the title had become only a rank of medical advisor or an ideal pursuit for a physician

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personally, rather than an actual occupation. Important Formulae Worth a Thousand Gold Pieces – Pattern Diagnosis (千金要方) records that “In ancient times, there were three categories of good physicians. A superior physician could treat the country; a medium physician could heal the patient; while a relatively inferior one could only cure the illness.” However, it also states that “A superior physician can diagnose from the patient’s voice, a medium one from the patient’s complexion and a relatively inferior one from the pulse”, and also “A superior physician could prevent the patient from getting the illness, a medium one can cure the disease that has yet to occur and an inferior one only treat disease when it has broken out. If great attention is not carefully paid and the physician becomes confused, the patient will hardly be cured… Quacks cannot master the method of feeling the pulse in the three positions and nine indicated areas — and fail to understand the channel condition at different times. They would either administer false formulae, or apply inappropriate acupuncture techniques. They just treat a disease following set formulae, which brings about further disorders and may cause death. How pathetic these people are! If half the patients die from unsuitable treatment this is just like explaining it by saying — ‘unfortunately there are no fine doctors’.” The roles of superior physicians here thus seemed to have been separated from politics and there were barely any superior physicians involved in politics or treating the country at that time. Xu Guozhen, a physician recorded in the History of Yuan Dynasty – Records of Xu Guozhen (元史·许国桢传), may be one in a million. The record states: He came from Quwo, Jiangzhou and was styled Jinzhi. His grandfather Ji was regional chief of Jinzhou and his father a magistrate at Rongzhou. All of them practiced medicine. Xu Guozhen was very erudite in the Classics and proficient at medicine. When the Jin army invaded, he sheltered in Yongning County, Song State. After Henan had become peaceful he went back to Taiyuan. At the state mansion before Shizu of the Yuan Dynasty ascended to the throne, Guozhen was asked to be imperial physician. The Empress Dowager Zhuangxian got sick and Guozhen cured her in a short while. The emperor thus treated him to a feast and granted him a seat at the table. The Empress Dowager was 53 years old at the time and she presented Guozhen a bar of old silver. Princess Bosa suffered from an eye illness and it was her physician’s mistake in using acupuncture which had caused her blindness. The Emperor got furious and

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wanted to kill the physician. Guozhen hurriedly went into an earnest explanation saying that ‘he certainly should be sentenced to death, but as for the reason, it is due to his greater fear of what might have happened with the treatment. If you kill him right now, there will be no physicians daring to serve you later.’ The emperor accepted his suggestion and relaxed, saying, ‘Guozhen’s honesty was enough to make him an imperial consultant’… Emperor Shizu drank horse milk to excess and this made him suffer foot disease. Guozhen boiled up medicine for him but he couldn’t bear the bitter taste and refused it. Guozhen said, ‘An old saying says that ‘good medicine tastes bitter to the mouth while the advice most needed is least heeded’.’ When the emperor got the foot disease again, he summoned Guozhen and said, ‘I am always trapped in this disease — it is because I didn’t listen to you.’ Guozhen said, ‘Your majesty has known the fact about good medicine being bitter — and you should also pay attention to the saying that good advice is harsh to the ear!’ The emperor was very pleased with him… When the Emperor went on an expedition to Yunan Province, Guozhen accompanied him night and day and participated in confidential meetings. In 1259, the emperor led his army to besiege E State and arrested hundreds of families and clans from the Song Dynasty. The generals wanted to bury them all alive, but this was stopped by Guozhen. Only the fiercer ones were killed, while the rest were set free. On the army’s return journey, thousands of civilians surrendered peacefully without resistance. As there were fatigued and starving people everywhere, along the roads, Guozhen used the army provisions of Cai State to save them from dying. When the Emperor Taizong ascended the throne, he granted Guozhen the title of ‘senior official’, put him in charge of the school of imperial physicians and awarded him a gold medal, which was later exchanged for a golden tiger-shaped tally. This was the kind of tally issued to generals for commanding all troop movements until 1266. In 1275, Guozhen was promoted to be Director of the Board of Rites. Guozhen had even sent many written statements to reduce the burden of taxes, prohibited the classification of official clothes by color, made laws clear and definite, trained the troops strictly, used righteous censors, averaged the number of guardians, founded schools and resurrected the imperial rituals and ceremonies. Most of his suggestions were adopted and implemented. All the talented people Guozhen recommended to the emperor became well-known

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and they also appreciated and valued him in turn. The emperor talked with his intimate officials about men rendering him outstanding service, and said to Guozhen, ‘before, when I went on expedition, only a few of you accompanied me through such a painful period.’ Guozhen was then promoted to chief of the Jixian Yuan (School of Talent) and called Guanglu Minister. Every time he went to see the emperor, he was called by the emperor ‘Xu Guanglu’ rather than by his name. Therefore, all the people from officials to nobilities called him by the same title. Eventually he was promoted to Grand Secretary of the School of Talent. He died at seventy-six. Xu Guozhen could talk about the country’s affairs because of his personal relationship with the emperor and made a great contribution to founding the Yuan Dynasty. His medical skill was probably adequate, but as a physician he did not contribute much to medicine. Similar physicians recorded in a History of Ming Dynasty (明史) include Wujie, Dai Sigong, etc., who were all imperial physicians and able to give suggestions on the country’s affairs. However, Sun Yat-Sen (1866–1925) was actually the best example of a physician who turned to healing a country. Lu Xun (1881–1936) was another one; he learned medicine during his early years in Japan, but eventually abandoned his occupation as physician to participate in politics and literature. Therefore, properly speaking, “superior physicians” later on often were those who considered themselves Confucian physicians — and, having the talent to manage the country, felt the only course open to them was to help heal the people. Xu Dachun (1693–1771) had some unique insights. His preface to the Treatise on the Origin and Development of Medicine (医学源流论) said that “… There is nothing more important than life and death for a human being. No matter whether you are prince, duke or minister, not even if you can reverse the course of events like a hero or sage, you cannot guard yourself from the anxiety of illness. Having once fallen ill, you have to follow the physician’s advice, and it will be your fate whether you live or die. The whole country is burdened on the emperor, while the life of the emperor depends on his physician, let alone the fates of the ordinary people…” He discussed “treating a country” from the point of view of physicians treating the diseases of important officials and imperial family members, and didn’t think physicians should have to be politicians as well. However, he was still actively involved in the people’s welfare and economic issues. Yuan Mei

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wrote in his Records of Mr Xu Lingtai (徐灵胎先生传) that “… Mr. Xu was tall with a wide forehead and long white beard. He spoke loud and looked extremely miraculous. In his youth, he learned knowledge of economy and was especially familiar with water conservancy in the east and south of the country. In 1724, the 2nd year of emperor Yongzheng, a local official intended to broaden the Tang River, which was estimated to be six chi in depth, and asked workers to shovel soil along the river bank. Mr. Xu argued, ‘This is all wrong! If you shovel the soil too deep, it will not only cause more expense, but furthermore mud easily accumulates, which will lead to mudslides on both sides.’ The local government thought he was right and reduced the breadth and depth of the river and shoveled the soil along 1.8 chi length. The expense was saved and the river preserved as well. In 1762, the 27th year of Emperor Qianlong, a furious flood attacked Jiangsu and Zhejiang Provinces, so the local governor Zhuanggong tried opening 72 harbors in Zhenze to discharge the lower reaches of Lake Taihu. Mr. Xu argued again that ‘This is a mistake! The 72 harbors of Zhenze do not affect the lower reaches of Lake Tahu — only more a dozen near the city alongside actually should be discharged. For the rest more than 50 harbors that extend more than 200 miles along the coast, with thousands of houses and tombs along the way, the cost will be heavy and people’s interests will be seriously harmed if they are discharged. What’s more, I am afraid that the soil underwater will flow back — and further block the harbor immediately. This is a river dredged by the people, not by the government.’ Zhuanggong reported this to the emperor and he agreed with Mr. Xu. The government assigned laborers to work on it and the project was done without disturbing any civilians.” Mr. Xu could be seen as a member of the Suzhou government and that’s the best a physician can do when participating in politics. However, there is always the case where a physician in a high position and having great authority could also possibly harm the country and the people. For example, Wang Jixian during the Song Dynasty, a close friend of Qingui, was a treacherous official. The History of Ting (桯史) records: I moved to Fujian Province when I was young. On my journey, I heard that there was a physician called Black Tiger King who was extremely rich. I asked others about him and knew it to be the alias of Wang Jixian, whose family had all been physicians for generations. His senior uncle had settled in the capital and was famous for a Black Tiger Elixir, so his family was called the Black Tiger King Family. Later, Jixian was appreciated by Emperor Gaozong of the

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Song dynasty and even his descendants were honored — and the whole country knew him as a ‘master physician’. Even when he was demoted, he was still respected by his title. At the start, the traitor minister Qin Hui (秦桧) grabbed all the power but didn’t let it be generally known. He bribed other high officials to consolidate his position. Wang Jixian was totally his ally. At the peak of their power, he abused the authority given to him by Qin Hui — and no other junior minister dared say anything offensive about him… Qin Hui wanted to honour Wang’s relatives, so it went without saying that he often invited them and promoted them. In turn, Jixian said good words about Hui when he had the chance. As a result, lots of Wang’s relatives became high-class figures and officials. They accepted bribes, made profits by controlling the market and forced common women to be their concubines. They committed millions of crimes beyond count, but fearful of their backer and patron, for thirty years nobody condemned them. The History of Song Dynasty – Records of Wang Jixian (宋史·王继先传) also records that Wang Jixian was “wicked and good at flattery”. He and Qin Hui both proposed a surrender to the Jin dynasty. They betrayed the country to obtain safety and honour, being the chief culprits in the destruction of the Song dynasty. Therefore, political involvement was not an actual standard for the “superior physician”. Only those who could harbour benevolence for the people, do good things for the country and save patients were considered able to be superior physicians. The title “superior physician” together with “good physician”, “wise physician” and “Confucian physician” should always be the personal pursuit and goal of every doctor — as well as the moral standard in medical ethics; it should not be the entitlement of one in any particular post or position.

153. “Medicine, It Is Mental”: The Physician’s Logic and Way of Thinking The concept of “medicine as a sense of intent” was initially proposed by Guo Yu. The Book of the Late Han Dynasty – Records of Guo Yu (后汉书·郭玉传) written by Fan Ye records that “Guo Yu was benevolent and never haughty; he would endeavor to treat people even from poor and humble families. However, he was often unable to heal the nobles. The

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emperor asked one of them to change into shabby clothes and seek treatment. Surprisingly Guo Yu cured the patient instantly with acupuncture. The emperor thus reproached him for this. He responded, ‘When you talk about medicine, it’s a mental thing. The interstitial space is extremely fine and the application of the needle following the qi flow is so very delicate that any tiny bit of difference matters a lot. The spiritual sense exists in the heart and hand — and it can only be felt. You cannot explain it. These nobles put themselves in a space far above me, so it is not surprising I treat them with horror and anxiety. There are four difficulties in treating these people: firstly they are self-centered and will not follow my advice; secondly, they don’t guard their health in their everyday life; thirdly, they don’t have a strong body which can tolerate medicine; last but not least, they love ease and hate work. The depth of the needle is hard to judge, I miss the timing and together with the fear and anxiety weighing on my heart, I am over cautious and unable to concentrate. What’s the benefit of treating the disease? That’s the reason why it can’t be cured.’ The emperor agreed.” Guo Yu’s “concentration” meant calming the mind and adjusting the breath to feel the subtle changes, and concentrate on the treatment. His idea of “medicine being a mental thing” has been repeatedly quoted throughout the following generations. The Old Book of the Tang Dynasty – Records of Xu Yinzong (旧唐书· 许胤宗传) records that “… Someone once asked Yinzong, ‘Your medical skills are magical, why don’t you write a book to benefit the following generations?’ Yinzong responded, ‘Medicine, it is mental. It relies on thinking things through carefully. People’s pulses are so subtle and profound that any physician feels it difficult to tell the difference; we can feel — but are unable to express it in words. Famous physicians in history were just as outstanding when they felt for the pulse. Once the pulse has been distinguished proficiently, the disease can be detected. If the medicine is administered appropriately, sometimes only a single herb is enough. As the medicine works and is effective, the disease is cured immediately. However, physicians nowadays cannot identify the pulse, so fail to know the source of the disease. They make their diagnosis entirely from their own subjective assumptions and more and more herbs are used. It is just like when hunting. If you don’t know the position of the hare but send out a massive troop to chase it, you will only find a group of hunters rounding up nothing — except that someone may encounter the hare accidentally. Surely such a kind of treatment is all wrong! If one herb happens to be appropriate for a disease, but then other herbs are added, then, being restricted by the other herbs in

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the hierarchy of the formula, the work of the appropriate herb will instead be hindered. That’s why not a single slip is allowed. The profound miracle of the pulse cannot be told, but if a formula is applied without recognizing the pulse, it will be ineffective. I’ve thought about this for a long time, but have been unable to write it down.’” This is what Guo Yu said about the difficulty in feeling the pulse — it can only be sensed in the mind, not told. It just depends on the physician’s ability to feel. Only those not skilled at feeling the pulse would treat the patient subjectively. The New Book of the Tang Dynasty (新唐书) puts the thoughts clearly: Having a special ‘mind’ is crucial to the physician. And it is obtained through refined thinking. The pulse is so subtle and obscure that it can be understood in my mind — but I find it hard to express in words… Physicians nowadays are not good at feeling the pulse — they just make a diagnosis subjectively. So they put too many herbs into a prescription in the hope that one will work accidentally. This action looks like hunting a hare with lots of people in the wild country. Even if one of them catches the hare, there is no skill in this. When they prescribe a formula, maybe one ingredient is appropriate for the disease, but it is restricted by the other irrelevant ones. Then the appropriate ingredient is unable to exert its full effect and that’s why the disease is difficult to cure. The delicacy of feeling needed in taking the pulse cannot be told — or written down. Though there are books about it, they eventually are of little benefit to later generations. That’s why I have no intention of writing books on this subject. According to the above, feeling the pulse ought not to solely depend on a “feeling in the fingers”, but also on refined thinking and identification based on a “mental sense”. This includes physicians’ particular experience, at the same time their comprehension and understanding of pulse theory, while wholly relying on their inner sense of self. Now any physician’s lack of experience in the pulse, use of too many herbs in the hope of accidentally curing the disease, is just the same as “using a machine gun to strafe sparrows”. Writing during the Tang Dynasty, Xu Yinzong (about 536–626 CE) had behind him much rich experience, and was good at feeling the pulse and curing “steaming bone fever” and other inner maladies. But this concept changed during the time of Sun Simiao, a great physician of the Tang Dynasty, also known as the “king of medicine”. Important

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Formulae Worth a Thousand Gold Pieces – Examination (千金要方·诊候) records the following: Zhang Zhongjing said, ‘If one wants to treat a disease, the priority must be to cleanse the internal organs and open up all the channels using medicinal decoctions, which if they follows the law of yin and yang, can scatter the pathogenic factors, moisten and brighten withered skin and benefit a patient’s qi and blood. Water can cleanse anything, so a medicinal decoction is applied. Then if there is prolonged illness in the four limbs caused by wind-cold, then use a medicinal powder as it can expel wind pathogens. Any damp impediment due to pathogenic wind wanders around and is not fixed in position, and it should be calmed with a powder. Then as for the pill, it can expel wind-cold, crush accumulations and masses, eliminate hardness, promote the appetite, and regulate nutritive and defensive levels. If a physician can combine all these skills together and apply them, he can be called a master physician.’ This is why medicine means ‘sense of mind’. It seems Sun Simiao is intending to explain Zhang Zhongjing’s theory of there being three forms of medicinal formulae, namely decoction, powder and the pill. A decoction can cleanse, a powder can disperse pathogens and the pill can expel and break up accumulations and masses. These examples use the analogy of permeation. However, he also says emphatically, “If a physician can combine these skills together and apply them, he can be called a master physician”, which means having the ability to analyse the state of the disease and being flexible. Flexibility is the key to the meaning of the saying, “medicine, it is mental”. Of course, this is not to deny the spirit of differentiation and exquisite thinking that comes from feeling the pulse. Sun Simiao also proposed making a diagnosis and analysis by combining together the four examinations (inspection, auscultation and olfaction, inquiry, palpation and taking the pulse) together with yin and yang, and the attributes of the five elements in internal organs. Basically, he outlined the thinking mode of a TCM physician in making a diagnosis: theory of the nature as the great cosmos — corresponding to the body as the small cosmos — linking with clinical manifestations — four examinations made to diagnose the condition — and appropriate therapy. From this mode, Sun put forward the requirements needed of medical practitioners. He wrote the following in the Important

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Formulae Worth a Thousand Gold Pieces – The Study for Being A Master Physician (千金要方·大医习业): If you want to be a master physician, you ought to be familiar with the following books: Plain Question (素问), A–B Classic of Acupuncture and Moxibustion (甲乙), Huangdi’s Acupuncture Classic (黄帝针经), the Ebb-Flow Acupoint Map (明堂流注), the Twelve Channels (十二经脉), Three Positions and Nine Indicators ( 三部九候), Five Zang and Six Fu Organs (五脏六腑), Exterior– Interior Points (表里孔穴), Materia Medica (本草), Medicinal Pairs (药对), and classical books written by Zhang Zhongjing, Wang Shuhe, Ruan Henan, Fan Dongyang, Zhang Miao, Jin Shao and so on. Furthermore, a master physician should also know the intricacies of and be proficient in fortune prediction, the various schools of physiognomy, divination by burning the turtle shell, and divination of the Six-and-Nines of the from the Zhouyi (The Book Changes of Zhou). If not, he will be like a blind man walking at night, easily falling into danger — even to his death. Secondly, a physician should read these books repeatedly and try to reflect on the ingenious ideas they contain, and dig into them attentively. Then, this is the right way to be a physician. What’s more, an extensive reading of other books is also required. Why? If you don’t read the Five Classics (The Book of Songs, The Book of History, The book of Changes, The book of Rites, and The Spring and Autumn Annals), you won’t know about benevolence and righteousness; if you don’t read the Five Books of History (Shih Chi, Han Shu, Dong Guan Han Ji), you won’t know past and present; if you don’t read classics of ancient philosophers, you will be unable to recognize things by yourself; if you don’t read the Inner Classic (内经), you won’t have the virtues of mercy and generosity1; if you don’t read the books of Zhuang-zi and Lao-zi, you will fail to recognize genuine cycles of movement, hence being confused at fortune prediction. In studying the terms of rest and exuberance in the five elements, astronomy is needed as well, and exploration also. If one can make a study of all this, there will be no obstacle in the way of being a good physician and everything will go well in the end. 1

 The Inner Classics referred to here may be a Buddhist text.

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There being “no obstacle in the way of being a good physician” means there being no obstacle to this “way of thinking” — as the physician will have accumulated different kinds of knowledge, natural medical science, social ecology, clinical experience, etc. It is in this fashion that medicine as a “mental intent” made during clinical diagnosis reveals itself clearly. Certainly, this is only the fundamental knowledge structure of a physician’s thought as it proceeds with treatment. Clinically, a physician is also required to have basic experience in clinical practice at the same time. Sun Simiao emphasized in Important Formulae Worth a Thousand Gold Pieces – Proficiency and Honesty for A Master Physician (千金要 方·大医精诚) that “Medicinal formulae and the various divinations are hard to master. How could we know these profound and subtle things if we are not granted some talent by the gods? They are some foolish people who would say they can cure any disease in the world after they have read books of formulae for three years. However, when they go into practice, three years later they find they are incapable of using formulae. Therefore, a physician must seek the quintessence of medicine, work hard and pursue perfection, and never try to acquire the art of healing just by hearsay, or he will surely ruin himself!” As the proverb goes “old ginger is more pungent”, or “seek help from a youth for labour and from an old physician for disease”, that is, the older TCM physicians are more experienced and have a greater knowledge thus they are nearer to scaling the heights of this “medicine, as a mental thing”. It is also the case that clinical practice and creativity in medical theory are related in the same way, as well. Medical Pioneers (医先) written by Wang Wenlu in the Ming dynasty points out the following: ‘Medicine, it is mental’. A physician has this mental sense when he evaluates a diseased state in the patient, according to differences in the moment, and prescribes a formula to treat it. It is just as when teaching proceeds differently, according to the occasion. Luo Taiwu found out that extravagance was spreading among the people. They were growing accustomed to it and fond of eating greasy food, which resulted in diseases often caused by dampness-heat and phlegm-fire. So he taught Zhu Danxi to use the method of cleaning away heat from the lung and reducing fire, thus correcting the defects of the formulae recorded in Formulae from the Imperial Pharmacy (和剂局方) as they were too warm and tonifying. However, neither was over-correction applicable. It was not right to

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use too many hot-natured formulae from the Imperial Pharmacy, but also wrong solely to apply Zhu Danxi’s cool-natured medicinals. What’s more, with the primordial qi being consumed gradually, Zhu Danxi’s therapy would harm the spleen and stomach, thus rendering phlegm production and spleen dampness. Then heat would be engendered and the spleen become deficient, a case best treated by Donghuan’s therapy of reinforcing the spleen. Therefore, the precious virtue of a physician lies in being able to perceive the movement of the qi, observe the patient’s emotion and find out the cause of the disease. “Being adaptable to changing circumstances” is the deeper meaning of the physician’s “mental sense”, regardless of whether it is applied to figuring out a theory, its application or the clinical management of the patient. But of course, “perceiving the movement of the qi, observing the patient’s emotion” and adapting to changing circumstances by using mental sense, as advocated by the medical physicians of ancient times, fall almost totally within the scope of the medical classics and all great physicians. First, one studied to achieve mastery through a comprehensive understanding of famous works — and then one could adapt oneself to the changing circumstances of the clinic. Wang Lun summarized the logic of this in his Miscellaneous Medical Works of Wise Doctors (明医杂著): Some may ask among Zhongjing, Dongyuan, Hejian and Danxi, whose book is best and which one the greatest for study? I would say, it is better to focus on the Inner Classic and then afterwards read extensively through these four masters’ books. Then there will no mistake. The Inner Classic to medicine is what the six Classical Canons are to Confucianism and Daoism. These four masters’ books can be compared to the Moderation (中庸), The Analects and Mencius’s works, which are indispensable and ‘the six steps to learning’ when studying the Six Classics. Books of these masters are neither better nor worse. They each illustrated one aspect of medicine. Zhongjing realized that though the Inner Classic demonstrated some knowledge of cold damage, it didn’t explain the transmission and the way it transformed, so he wrote his treatise and established formulae to directly discuss this in detail. However, with his ideas being followed by later generations over a long period of time, the original applications became distorted. People used his therapies

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entirely to treat diseases with varying patterns of warmth, summerheat or internal injury, causing harm to their patients. Thus Liu Hejian created method for patterns of warmth and summer-heat and Dongyuan created therapies for internal injury. Hejian’s theory actually stemmed from the ‘five circuits and six qi’ in the Inner Classic, while Dongyuan further extended its ideas on improper diet and fatigue. It was not that Zhongjing did not know about diseases caused by pathogenic warmth, summer-heat and internal injury. He just didn’t mention them in his book. In terms of ‘cold damage’, Hejian and Donghuan still deferred to Zhongjing, not daring to challenge his thought. Then Zhu Danxi came and collected up the various achievements of various experts and put forward the ideas of ‘fever due to yin deficiency’, categorized external contraction and internal injury, and pointed out that many diseases were caused by damp-heat and ministerial fire. He thus wrote many books, but all of them come within the bounds of the Inner Classic, just adding some information not recorded by previous experts. So I would like to say, learn from Zhongjing on treating diseases contracted from exogenous factors, from Dongyuan for those resulting from internal injury, from Hejian on warm diseases and from Danxi on miscellaneous diseases. In short, this makes up a complete method of studying medicine. The Complete Compendium of Ancient and Modern Medical Works (古今医统大全) written by Xu Chunfu also records this: Everyone in the world first values life. Being alive relies a lot on medicine. And the fundament fact of a physician is his medical theory. In remote times, famous physicians like Huangdi, Qibo, Bian Que, Hua Tuo had the skills to bring the dying back to life or to wake the dying soul. But generations later, people in this field didn’t study meticulously, they failed to learn the gist of it, and often harmed to patients. Why? Because they were confused about yin and yang, deficiency and excess, exterior and interior, acute and chronic states, progress and remission. They felt the patient’s pulse in a rash manner, perceived the disease pattern superficially, hurriedly listened to the voice and observed the complexion as if in a dream state. Hence, their work is all over the place, and they misuse prescriptions. Many patients are thus killed by them at a young age, being

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victims of wrong treatment and poor medical skills. Ah! Medicine was originally for saving peoples’ lives, but poor learning in medicine terminates their lives instead. Actually, this is not exactly “poor learning of medicine”, but also “unrefined thinking”. They cannot tacitly understand or reach a heightened mental sense, namely the highly skillful identification of the disease according to the logical procedures of TCM. A physician with highly skillful identification can not only adopt the clinical experience of classical medical experts but also flexibly modify their formulae — according to his own understanding. There is such a case in About Medicine – Treating Exogenous Disorders Through Mental Sense (医说·外患当以意治). It says, Diseases all derive from deficiency, excess, cold or heat; each having its own manifestations and syndromes that can be treated accordingly — by supplementation or purgation, warm or cold medicinals. However, there are also cases not caused by deficiency, excess, cold or heat, such as when bugs enter the ears, a fishbone stuck in the throat, earwigs biting the body, being full of sores cause by the Jusou worm, or dust blurring the eyes. For these cases, as they do not belonging to deficiency, excess, cold or heat, their treatment lies in having the right ‘mental sense’. This means such things as rinsing with milk or putting fried pork-fat into the ear to get rid of bugs, repeating the name of the cormorant silently or wearing a fish net to treat a stuck fishbone in the throat, using powdered ivory and fox’s bones to treat a bone stuck in the throat, drawing a picture of a worm and putting soil on the abdomen to cope with sores from being bitten, putting the bile and blood of chicken liver into water with beans to cure eyes blurred by dust, and the tooth of a ‘bamboo rat’ to treat a sliver of bamboo stuck in the flesh. All these are treating with ‘mental sense’. Fuzhai’s Dairy (复斋日记) written by Xu Hao in the Ming dynasty also records the following: HuaShou, styled Boren and also called Yingning, was good at ancient poems and essays as well as medicine… He prescribed formulae by mental sense — rather than by using a formula book. His therapy was always effective. Once on an autumn day, he was invited by some officials from Gusu city (Suzhou) to come on a trip

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to Tiger Hill. At that time, a woman from a rich family was having a difficult labor, so he was asked to return. But none of his companions wanted him to go. He just stepped forward and seeing some newly-fallen Chinese parasol tree leaves, picked them up and said, ‘You need to return immediately and boil these leaves with water quickly and get her to drink it.’ The baby was born before he returned from his trip — and people asked him where the prescription had come from. He said, ‘The physician relies on his mental sense. Why does the formula have to come from anywhere? Since this woman has been pregnant for 10 months without delivering her baby, it must have been due to qi deficiency. Those leaves dropped because of the autumn qi, which moves downward, so using them can supplement the qi which helps a delivery. How could she then not give birth to a baby!’ Such a story also appeared concerning Ye Tianshi. In A General Collection of Unofficial History in Qing Dynasty (清朝野史大观) it states, “A woman in the neighborhood had had a difficult labor over several days. Other physicians had no idea what to do, and the husband sought help from Ye Tianshi, who asked him to add a few Chinese parasol tree leaves to the formula. Then, the woman gave birth to the baby instantly. Later, some other physicians copied this idea. Tianshi laughed and said, ‘The reason that I used the parasol tree leaves was because it was the first day of Autumn. What use is it doing this at another time!’ His treatment was based on the season and so it was effective.” When this sense of mind or intent arrives in such a perfect fashion, one can really say this is the work of a “miracle-making physician”. Besides the subjective imagination, the permeation of witchcraft here also plays a significant role. This had been laughed and sneered at by Su Dongpo in his Dongpo’s Miscellaneous Records (东坡杂记). A famous chapter in this book was called Physicians using Mental Sense to Administer Medicine: Ouyang Wenzhong once spoke of a patient, who asked by the physician for the cause of his disease, replied ‘I took out a boat but was scared by the storms. So I became ill’. The physician used powder made from the wooden rudder used by the helmsman, soaked with the sweat of many years — together with cinnabar and poria — to make a decoction. The patient was cured after he drank it. In our current Materia Medica (本草), it cites the Treatise on Medicinal Properties (药性论) as saying that ‘Use the powder of the root and

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joints of ephedra and an aged bamboo fan to relieve sweating’. Wenzhong carried on, ‘Physicians applying medicine by ‘mental sense’ are just like this. It seems a trifling matter to start with, but sometimes it works. So then afterwards people do not ask questions’. I said to him, ‘Do you really think drinking water with ashes from a burnt writing brush and ink can cure foolishness and laziness? If so, then using this logic, drinking the dirty water where Boyi has washed his hands can cure greediness, eating the remains of food from his plate can treat unfaithfulness, licking the shield of General Fan Kuai can cure timidity — and smelling Xi Shi’s earrings will cure wickedness’. Wenzhong laughed out loud when he heard this. This tale I heard when I was crossing the boundary of Yin Zhou on August 17th, the 3rd year of Yuanyou (1089). I just remembered now that I had met him some twenty years earlier. So I am just writing this funny story down. Su Dongpo was really good at argument. He pushed both ends of a hidden contradiction to their extreme — and any incompatible components were exposed. He disclosed the primitive nature of using this mentality to deal with medical problems and thought it unacceptable. Li Yu, a scholar from the Qing dynasty also greatly criticized this kind of “sense”. Lu Xun, a great scholar of the modern age, has written many similar articles. For example, in his essay Life Is a Moment – Father’s Illness (朝花夕拾·父亲 的病), he talked about the formula prescribed by a physician called Chen Lianhe, in which he said a couple of crickets were needed for a medicine. Moreover, the female cricket must be the male cricket’s first wife, living in the same burrow. Lu Xu commented “it seems that the insects need to be chaste as well. They will be deprived of acting as a medicine if they get remarried.” In another essay, Graves – About Stuff like Taking Photos (坟·论照相之类), he also sarcastically stated that “consuming menses and sperm can promote longevity; hair and fingernails can enrich the blood; urine and feces will cure many diseases; flesh from the arm can benefit the parent.” What Lu was criticizing was actually the remains of the primitive “permeation of thinking” which the concept of “mental sense” had also absorbed. Therefore, whatever the positive and negative aspects of the medicine, or the “mental sense” of the physician, we can see that this line of thinking was basic in Chinese medical practitioners during ancient times. If it is appropriately used, once it is limited by natural philosophy and the physician can carefully identify the disease pattern using the four examinations, a medicinal

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prescription such as this can always be helpful and have a particular effect. But if his mental sense extends beyond the range of natural philosophy, and into areas of witchcraft, it becomes inevitably absurd and even downright dangerous. However, no matter, it could perhaps be acceptable, or even desirable — as Chinese medicine particularly stresses subjective participation and active awareness during the whole course of diagnosis and treatment.

154. “Using Medicine Is Like Deploying the Army” — The Behavioural Psychology of the Clinical Physician In terms of behaviour, there were multiple specific principles for Chinese physicians. For example, physicians wouldn’t visit a patient’s home unless they were invited. If they visited without invitation, they violated a taboo. Therefore, physicians in the past always waited at home peacefully for invitation from the patient’s family — or settled in a special unit like a hospice or Buddhist temple to provide medical service. There is an image of Zhao Taichen’s House in a very famous Chinese painting called A Riverside Scene at the Qingming Festival, and this house is equivalent to a present day clinic. Although this part of the picture only describes a medicine shop in Kaifeng’s during the Song dynasty, it was fundamental practice for thousands of years, in ancient China, for traditional physicians to sit in a shop, providing medical services. Only those considered inferior physicians, or quacks, would peddle in the street and sell fake drugs. Though there might be some master physicians among them, they were usually looked down upon. As for being invited to see patients regardless of weather and a difficult journey, this falls into the realm of ethical standards, which will not be discussed here. Traditionally, when they came into contact with illness and provided medical service, Chinese physicians formed a cautious psychological habit, especially with difficult cases, just like that of encountering an enemy’s army and battling to fight and defend themselves. It was just as “using medicine like deploying the army”. This was surely very appropriate. Sun Simiao was once quoted in the Book of the Tang Dynasty (唐书) as well as elsewhere, and his ideas had a profound influence on traditional Chinese medicine in later generations. He said:2 One should be bold as having a big gallbladder but cautious as having a small heart; be as intelligent as the round heavens but act 2

 Adapted from All Articles of the Tang Dynasty (全唐文), New Words of the Great Tang Dynasty (大唐新语), new and Old Book of the Tang Dynasty (唐书).

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benevolently as the square earth. The heart is the monarch of the five zang organs, and as monarch should always be cautious, so the heart needs to be smaller. The gallbladder is general to the five zang organs, and as general is required to be decisive, so the gallbladder should be bigger. Intelligence is always in motion — very much like the heavens — so it tends to be round. Benevolence means silent like the earth, so it tends to be square. The Book of Songs (诗经) writes ‘Act like facing an abyss or treading on thin ice’, which tells us to be cautious. Also: ‘gallant men of prowess resist foreign aggression’ — telling us to be bold. The Commentary of Zuo (左传) writes ‘A gentleman does not exchange his determination for money — nor does he feel guilty morally’, which is the principle of benevolence. The Book of Changes (易经) records, ‘he sees them, and acts without waiting a single day’3. This is complete wisdom. These words come from Sun Simiao’s answer to Lu Zhaolin, a poet during the Tang Dynasty, who had asked Sun “What are the principles of a famous physician in the course of treatment?” Sun made a general illustration of a physician’s psychology and his guiding principles, as above. Later, Li Zhongzi in the Ming Dynasty explained those words in his Required Readings from the Medical Ancestors (医宗必读), quite exquisitely. He wrote the following: One should be as intelligent as the round heaven but behave like the square earth, be bold as having a big gallbladder but cautious as having a small heart.4 Oh, everything is included here, all that a master physician needs to know. ‘Acting benevolently like the square earth’ means just that the physician should be kind-hearted and modest, behave calmly and peacefully, speak without using rash words, nor look inappropriately, nor be envious of others, or have any sexual desires; not look down upon the poor and humble, nor fear hard work, keep improving by consulting the medical classics and show mercy on those in pain and illness. ‘Being as intelligent as the round heaven’ means just the physician knowing the constant as 3

 From the Xici II.  Here, “behave like the square earth” should be “act benevolently like the square earth”. Refer to the author’s paper “A Case of Mistaken Quotation from an Old Book of the Tang Dynasty – ‘Behave like the square earth’ or ‘act benevolently like the square earth’, Literature and History, vol. 15, p. 184. 4

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well as the changeable, that he is wise and can consider each specific situations — knowing that the patient can have good or poor innate health, be young or old, fat or thin, calm or rash in temperament, from a noble or humble background, be attacked by a strong or moderate pathogenic factor, suffer hot or cold weather, the disease may be more serious or milder day or night, the facial complexion favorable or unfavorable, the voice high or low, the disease may have lasted for a long time or a short time, and the qi circuit can be either too great or too little. ‘Having a small heart’ means that the physician carries out the four detailed examinations carefully, knows the appropriate application of supplementary or reducing cold or warm formulae, considers the people’s life above everything else, and understands forever the regret of one mistreatment. So, incautiousness is not allowed. This is called having a small heart, that is, cautiousness. ‘Having a big gallbladder’ means the physician is decisive in applying the formula, namely using supplemental formula when supplementation is needed, reducing formula when reduction is needed, warm formula when it warm is needed, cold formula cold is needed, and other formulae for other specific conditions; and being able to analyze the condition explicitly and not ambiguously. The above four virtues might seem separate, but actually they are one and the same. With these virtues, no cautious physician would harm a patient; no intelligent or flexible physician would ever ruin his reputation and integrity. Therefore, if one acts benevolently like the square earth, one will surely be intelligent like the round heaven. A small heart fears loss, while a big gallbladder is based upon knowing how to work out the disease pattern, and apply medicine. Attacking the pathogen intensively or supplementing the body mildly, it might seem bold (a big gallbladder), but if you do not, the disease will not be cured. This is the big gallbladder (boldness) adapting to the small heart (cautiousness). Therefore, the small heart and big gallbladder join together — to become as intelligent as the round heaven; and the small heart, big gallbladder and round intelligence integrate together into the benevolence of the square earth. People usually misunderstand this — and think that the square will hinder the round, or the small hamper the big — but this is just to understand superficially. I have explained it all here so that everybody can understand.

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“To be bold but also cautious, intelligent but also benevolent in practice” is actually a military strategy and a principle when deploying the army. It summarizes the psychology of the best physicians, namely treating a disease as if one was involved in a battle, and applying medicine like deploying the army. The Inner Classic has some words about the relationship between medicine and the military. For example, in the Spiritual Pivot – Routine or Contrary (灵枢·逆顺), Qibo cites from Military Strategies (兵法): “When an enemy (pathogenic qi) is forceful and enthusiastic, do not battle with them. When an enemy’s army (pathogen) is powerful, do not try to attack them.” The Spiritual Pivot – Acupuncture Methods (灵枢·刺法) states, “Do not apply acupuncture when the fever is high, the sweat profuse, and the pulse disordered, for the disease state is contrary to the pulse.” The Spiritual Pivot – Jade Plate (灵枢·玉版) also draws an analogy between acupuncture and the army: “When the war begins, army flags and sword-fighting can be seen everywhere on the field, and this situation cannot be planned in a single day; for the civilians to follow orders and soldiers to march forward courageously and sacrifice their lives, this cannot be taught in a single day, either.” Both need study and training over an extended period. During frequent wars from the end of Han dynasty to the Wei, Jin, Northern and Southern dynasties, it was easy for medical experts to associate medicine with military affairs — in a proper and systematic way. Wei Fan, a disciple of Zhang Zhongjing, made the earliest metaphor: “The nature of the medicine is drastic as a defending army. The army is so fierce and devastating that no arbitrary dispatch is allowed!” It was also a citation in the Important Formulae Worth a Thousand Gold Pieces – Food Therapy (千金要方·食治). Chu Cheng once put it in Zhu’s Posthumous Papers (褚氏遗书): “Applying medicine is just like deploying armed forces, and choosing a physician like appointing a general. Those who are adept at maneuvering the military can reach the effect of the chariot by the infantry — and those who are good at administering herbs can get the curative effect of cassia twig through using ginger. The law of appointing a general is to grant him authority over the armed forces after knowing his wisdom and ability. Similarly, the way of choosing a physician is to entrust your life to him after looking at his skills and techniques. There is no disease that can’t be cured in the world — there are only physicians who are not adept at medicine. There is no medicinal that can’t be replaced, whereas there are only physicians who are not good at finding a replacement. Thus, we can certainly understand why it is that people die at the hand of some physicians.”

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Chu Cheng also elaborated on the psychology and behavioural principles of physicians in medical practice. Physicians must practice medicine like generals commanding an army, being able to distinguish the enemy’s conditions, deploy the armed forces properly and know both themselves and the enemy, thus defeating the enemy with flexibility. In addition, when there is a lack of armed force, and in a comparatively weaker situation, the general can defeat a stronger enemy by all kinds of strategies. Hence, “there is no disease that can’t be cured in the world, while there are only physicians who are not apt at medicine. There is no medicinal that can’t be replaced, there are only physicians who are not good at replacing it.” “So then physicians can carry out their treatment calmly and elegantly, achieving great curative efficacy.” Medical experts in history often tried to describe medicinal therapies in this way. For example, Li Gao wrote in Guides to a Pouch of Pearls (珍珠 囊指掌) that “The taboo when applying herbs is to push for a rapid effect, as it will inevitably result in excessive use of medicines. Harm could arise before any efficacy has been achieved. Applying medicinals without order is like employing soldiers without discipline. Though there are some that are brave, they will spoil the affair with their audacity. Applying medicinals is also like sorting out silk threads — a slow and certain method, makes it easier to get them in order while the urgent way causes more knots.” Miscellaneous Writings of Famous Physicians of the Ming Dynasty (明医杂著) written by Wang Lun records the following: Some diseases are suitable for supplementation, so try to supplement with a little purgation; some diseases are suitable for purgation, so try to purge with a little supplementation; some diseases are suitable for cold-natured herbs, so try to use some warm ones as a ‘guiding soldier’; some disease are suitable for warm-natured herbs, so try to some cold ones as a ‘guiding soldier’. Sometimes treat the lower part of the body for a disease located above; or treat the upper part of the body for a disease located lower down. Sometimes the disease is the same, but the herbs applied are different; the diseases are different, but the treatment is the same. This reasoning is subtle and students should get to the bottom of it. The essence in using herbs lies in having a clear understanding of the varying conditions. For example, wind is different at times, the earthly qi is different in different areas, climate is different in different seasons, innate endowment is different in the stout and thin, disease is different in being of long or short

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duration, and the patient is different in age and family well-being. Hence, at the time of applying herbs, the physician should never be in favor of a strange, stubborn, rash or urgent approach. Rather they should be meticulous, explicit, sophisticated and flexible. It is suggested that one ‘consider seriously and try to cure thoroughly’. Only by these means, will the herbs be applied appropriately. It is a pity that the ancient sages didn’t illustrate this clearly and even omitted to speak of it to their successors. This has caused much harm! Li Dongyuan applied medicine according to the condition and often cured it in an unorthodox manner. He used disciplines and rules to arrange the herbs but was very flexible in differing conditions. Later generations commented on this, saying ‘Zhongjing prescribed very few herbs, but Dongyuan uses up to more than twenty.’ Zhu Danxi responded saying ‘every time during treatment, I imitate Dongyuan’s way of applying herbs and Zhongjing’s formulae.’ Relatively a greater quantity of herbs exerts greater effectiveness. So why does Danxi imitate Zhongjing rather than Dongyuan? He said that no one was better than Dongyuan in detecting the properties of herbs. Truly he was a sage of medicine. Therefore, it was reasonable to follow Dongyuan and use many herbs, while for the other, he would only mess it up. Dongyuan was like the famous general Han Xin in that he could control more generals and soldiers. Danxi can only manipulate a hundred-thousand in the army, and dare not command anymore. Yu Bian’s Sequels About Medicine (续医说) also states, Physicians can only recognize a disease after the pulse has been identified. If some herbs match the illness well, ancient physicians used only one herb to treat it — because a single herb has a relatively pure nature and can achieve better efficacy. However, physicians today are not clear about the cause of the disease or pulse condition. They prescribe as many as fifteen or sixteen kinds of herbs, trying to purge and supplement simultaneously. Such a way fails to concentrate on the exclusive aim of efficacy — and thus it becomes difficult to have the disease cured. Han Tianjue said, ‘It is not necessary to prescribe too many ingredients if the formula is right. We can just learn from Zhongjing’s formulae that are very simple and convenient.’ Danxi commented, ‘Dongyuan was able to manipulate herbs like deploying

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the army, but if you don’t have such an ability, you should avoid applying the belief that the more herbs the better the result’. The attitude to the amount of herbs applied was different, but the thinking of “using medicine as if deploying the army” is the same — and so was the flexibility used in composing the formula. Zhenze’s Article Collection (震泽文集) also records: Therefore, Wang Wenke said, ‘Nowadays, physicians always imitate the formulae initiated by Li Mingzhi and Zhu Yanxiu, which are all in the realm of herbs such as ginseng and atractylodes. It seems to be the guideline for medicine and people believe in it. However, disease is variable and when herbs like ginseng and atractylodes are not applicable, they must be changed. If physicians don’t recognize the changes necessary, the treatment will surely be in vain and could lead to death; and a slight miss in understanding the change will even worsen the disease. They are both inappropriate. Therefore I say: physicians understand the basics, but not the subtle changes. They may be skillful if they can manipulate the herbs according to changes in the condition. Mingzhi and Yanxiu never neglect these changes, but physicians today only learn the common rule from them, while they do not consider the changes. It is difficult to adapt to the changes!’ Here, the difficulty of applying herbs is stressed, just the same as the difficulty in deploying an army. Xu Chunfu further pointed out in The Complete Compendium of Ancient and Modern Medical Works (古今医统大全) that “Treating a disease is like a battle between two sides. A good general is able to defend or attack appropriately and respond accordingly to the enemy; a good physician is able to choose acupuncture, moxibustion or herbs correctly, based on different conditions.” In terms of “using medicine is like deploying the army”, Xu Dachun’s Treatise on the Origin and Development of Medicine (医学源流论) talks of this explicitly and in detail: The reason why the sages can ensure people’s lives is that five cereals are used for nourishing the body, the five fruits for supplementing the body, the five livestock for benefiting the body, the five vegetables for filling the body, and toxic herbs for attacking pathogens.

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Hence, even licorice and ginseng could be toxic if not applied correctly. Ancient people were in favor of medicinal minerals and herbs, so they inevitably developed some strange diseases. It is just like belligerent people who surely suffer from the odd disaster. Therefore, establishment an army is done to suppress riots and can only be acted on as a last resort. For the same reason, herbs are used to attack an illness and you don’t take them until it is inevitable. The disease consumes essence when it is mild and damages your life when it is serious, which is similar to when occupying an enemy country. The biased nature of a herbal medicine is exploited to attack an excess in the internal organs — which means knowing the enemy as well as you know yourself and finding multiple ways to restrain the enemy then you will not worry about the life-force collapsing. Hence, for pathogens traveling in the channels, fortify the routes they travel on, thus cutting off the enemy’s thoroughfare. For drastic diseases, protect the parts that haven’t yet been affected, which means to guard the frontiers. For diseases accompanied by food stagnation, remove the food stagnation first, which is like burning an enemy’s food supply. For diseases combined with an old illness, prevent their mutual influence, depriving the enemy of any inside help. Identifying the disease’s channel transmission without using herbs blindly is to guide in the army; applying any formula which has an opposing nature to that of the illness is the art of alienation. If a disease is divided in parts and treated accordingly, a feeble force will be able to arrest any that are stronger, leaving them unable to aid each other and they weaken spontaneously. If multiple diseases are to be treated together, unify their force to conquer ‘the backbone’ of the problem, making the others’ lack of organization mean they fall apart. When the disease is progressing, don’t attack it as it is too strong. Instead, try to boost the primordial qi and wait until the evil qi becomes sluggish. When the disease is in remittance, chase it away completely by using a picked force in the army and destroy its foundation. For patients with a weak physique, do not purge excessively. The right method is to use mildly purging herbs and greatly tonifying ones. On waning days, never drain someone’s fortune. For damage caused by excess pathogens, don’t hesitate to attack using drastic herbs. Later, apply common remedies to harmonize the soil — and a rich and mighty country will rise again. However, talents must be correctly selected, weapons must be in good condition, the conquer-

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ing process must be in time, the deployed army must be correct, and one could go on and on. This is just what Sun Tzu did for the army in his treatise on the Art of War. It seems that the 13 chapters of Sun Zi’s Art of War (孙子兵法) imply all the treatment principles above. The passage above illustrates ways of applying medicine entirely using the tactics of warcraft, with great logic and clarity. Another example occurs in the works of Zhang Jingyue, who was initially a general of great prowess. In his book The Complete Works of [Zhang] Jing-yue (景岳全书), he even adopted ancient methods of military manoeuvre — such as the eight strategies, the eight tactics, a new set of eight strategies and a new set of eight tactics to illustration his medicine. Another kind of saying with regard to a physician’s behaviour is “he uses medicine like corporal punishment”. Nian Xiyao, a high official at the beginning of the Qing dynasty, wrote in Categorized Herbal Formulae (本草类方): Using medicine is like performing corporal punishment in that a mistake means losing a life. Hence the sentence of punishment should be carefully discussed first of all, by the related officials. Then the sentence can be decided and after that, announced. Since no-one can revive the dead, the method must be meticulous and thorough. It is the same when administering medicine. Nowadays, not only physicians but also patients just apply medicine according to what they have seen. When it comes to good physicians, they observe the patient, take the pulse and prescribe herbs appropriately, and effect can be achieved quickly. However, quacks use drastic decoctions in a rash manner, in a way that will soon make the patient’s condition critical. It is so easy to kill people in this way! Common people are often not good at choosing a physician as they seldom pay attention his medical skills. People should always be cautious of this! Nian Xiyao was brother to Nian Gengyao. During a period of great intrigue, Gengyao was outspoken and acted imperiously at court, and was later framed and executed. Xiyao and his father were also removed from office. Xiyao might thus have known the devastation of suffering such a penalty and that there was no way back after such a punishment. The

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careless application of medicine can also claim a person’s life. However, “using medicine like performing corporal punishment” regards the person as the object, while “using medicine like deploying an army” focuses on the disease and also takes the person into account. There is a slight difference between them. This text illustrates that the psychology of physicians in clinical practice was not only one of caution but also to be bold about treating a disease and putting the patient’s life in first place, without any lust for money, profit or fame. However, an unfavourable psychology of physicians was also not rare at that time. Li Zhongzi’s Required Reading from Our Medical Ancestors (医宗必读) states the following: As for a physician’s psychology, some seduce — by using sweet words, artificial arguments or exaggerated statements; and some flatter — by associating well with relatives and friends, establishing good relationships with servants, try by every means to be recommended to the superior, or visit someone of high rank, without invitation. Some are just frauds — as they have no knowledge at all and are illiterate, but they lie and say they are endowed by the gods or on the pretext of a secret inheritance; and some are reckless — in that they don’t care about making an accurate application of the four examinations but carelessly give out herbs. They make improper comments, saying that they are wise while others are stupid, they are experienced while others are novices. Some are just jealous — in that they elbow-out other physicians, agree with you on the outside while doing you harm on the inside, or confuse truth and falsehood; and some are greedy, insatiably avaricious and ignorant — so that they take human life lightly and rashly apply any formulae for difficult diseases, which are exacting even for good physicians, and when the condition gets worse, just blame it on others. Some are shallow and dissent from what others have said — and regard themselves too highly to be popular; others are eager enough to earn profit by treating diseases they know well, but when it comes to diseases they are not familiar with they just delay the treatment, and say there is some problems with the herbs or something. Some just wait to see what others will do, while some just delay the treatment in order to avoid arousing suspicion and so as not to do anything wrong, so then they miss the chance to give a good treatment. Then who is to be blamed?

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This famously illustrates Li Zhongzi’s idea of the “human condition of being a physician”. But it actually also describes the vulgar behaviour of all the many rascals around in the medical field. If physicians are not benevolent and skillful, they will surely fail in being cautious and well prepared to “use medicine as deploying an army”. Certainly, they are just a minority in Chinese medicine.

B. The Psychology of Behaviour During the Pursuit of Medical Help 155. “Seeking No Treatment Is Equal to Seeing an Averagely Skilled Physician” It is said, “a disease comes like a mountain collapsing and goes slowly as if drawing silk from a cocoon.” Patients and their relatives held diseases in awe and anticipated much from their physician. However, there were often more mediocre physicians than good ones. If the patient encountered a quack, a light ailment might turn worse and even unfortunately result in death. This was quite common in the Qin and Han dynasties, which is reflected in the record of Book of Han – Records of Arts and Literatures (汉书·艺文志): Medical skills concern human life and act as a guard for health. In remote times, there were Qibo and Yufu, and in the middle era, Bianque and Qinhe. They were brilliant physicians who could refer to a country’s affairs when stating an illness and infer politics from diagnosing a disease. There was Canggong during the Han dynasty. Nowadays, however, physicians’ skills are quite poor… They give improper therapies like warm cures for warm disorders and cold cures for cold cases. Hence, the essential qi is impaired internally and not detected outside, contributing to further damage. Therefore, the proverb says ‘seeking no treatment for a disease equals going to an average-skilled physician’. It is not worth criticizing such a popular psychology among patients who preferred spontaneous recovery to seeking treatment from a physician. In fact, an illness, especially a mild case of external contraction, tends to recover by itself with the help of the body’s own resistance. This may be a little inferior to being treated by a master physician, but is far better than

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going to a quack. At least, it matches that of average-level therapy. Su Che thus said in Yu Wenrong (宇文融), “foolish physicians may kill people, but those who don’t take their drugs may not perish.” Liu Fu during the Song dynasty wrote in A Last Episode of Extensive Talks about the Court (青琐高议后集): It has long been recognized that medical skill is rather more difficult than other skills. Because when one suffers a disease, even he has his children and family all around him, they can do nothing, even if they have money — while it has to be good physician to treat the disease. Hence, the merit of medical physicians is great as they are in charge of people’s lives. People always hope it is better to have more good physicians and fewer quacks. They never want their disease to be treated by quacks, who fail to differentiate clinical manifestations and pulses, thus worsening the disease. There have been such cases and I also have had such experiences. This is quite true, just as Sima Qian said in the Historical Records – Biography of Bianque (史记·扁鹊传): “People’s worries about diseases are many, while a physician’s worries about his medical methods are few.” It is better to leave the disease alone than consult a quack for treatment. Su Shi also recorded one case in Records of Gaigong Hall (盖公堂记): When I lived in my hometown some time ago, someone contracted a cold disease and had a cough. So he consulted a physician, who believed there were toxic worms in the abdomen and that he would die if left untreated. The physician thus charged the fellow a hundred coins for the treatment and asked him to take a worm-killing decoction, which as a result damaged his stomach and intestines, and caused burning pain on the body’s surface. He was also banned from delicious food. One month later, a myriad of other diseases broke out and there were manifestations of fever, fear of the cold and a constant cough, just as if he had true worms in his abdomen. So then, he consulted another physician, who thought it was a warm case, for which cold herbs were prescribed, leading to vomiting in the morning and diarrhea in the evening. The patient began to lose his appetite and was frightened. He consulted the first physician again, who then applied stalactite, monkshood root and so on, mixed together aimlessly. As a result, all kinds of complications

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presented themselves, such as severe purulent sores, itching scabies and blurred vision. The patient changed physician three times, but the illness deteriorated. An old person in the town told him, ‘It is the fault of you using poor physicians and misusing herbs. What disease do you think you have?! People depend on qi for life and food supplements it. But now you have drugs all day and their toxin disturbs the exterior and attacks the interior, which consumes your qi and inhibits your appetite, contributing to further illness. You should have a good rest at home, enjoy the food you like and decline all physicians and their herbs. Only in this way, will your qi be replenished and appetite better. Then a good therapy will be effective for your condition.’ The patient followed the old man’s advice and the disease turned better within one month. On this point, Li Yu made many “illuminating remarks”: ‘Having no medicine for a disease equals having been treated by an average-skilled physician’. These words are as good as a Golden Elixir which can save a person’s life. However, people always pedantically blame something or other when they initially suffer disease. They try all kinds of therapies including surgery, stones and herbs. And yet, their body is consumed while the illness is retained, and then they end up having to follow this golden saying. They are thereby forced into the hands of an ‘average-skilled physician’ — and without any medicine or treatment, recover quickly. Then they begin to understand the truth of this golden saying and believe in it fully. As far as I’m concerned, all the people in this world only fear death and no medicine can restore the dead to life. Medicine is for treating illness, not for treating death — and Buddhism takes over when you talk about destiny. It is so true! We have to use a proverb to get this point across. He also proclaimed publically, “It is dangerous to delay treatment and medicine, but more dangerous if you just obey others without having your own ideas. It is highly important to be more and more cautious!” His opinions were associated with his early experience of disease: In the first month of spring, my family moved from Nanjing to Hangzhou. It was a difficult time and I fell sick from overwork and

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strain, and too much worry. The medicine was useless and I was at the gate of hell several times. At the end of spring and beginning of summer, I became a little better. However, I fell down the stairs carelessly and it was so bad my bones and tendons were seriously injured and I nearly died. Two months later, I recovered a little — in the middle of the summer. Then I went with my son to Wuzhou (Jinhua) for an examination and further suffered from summer-heat, so I had to return by pushcart. I began to suffer dysentery and later malaria, and it was then complicated by coughing, panting and severe palpitations. At that time, even if there had been ten medical physicians at home and a hundred herbs to hand, none of them could cover all my medical problems. It is just like thousands of arrows shooting at me — and even heavy and thick armor was unable to save me. Furthermore, my family was in a disastrous state and quite poor at that moment, being unable to afford food and lodging — let alone pay for physicians and herbs. The only thing that I could do was to wait for the ghost of death to come and observe my own suffering getting worse and worse. Then I unexpectedly recovered. My illness at the beginning of the spring was treated by precious minerals, but it was not cured by such expensive things. My illness at the beginning of the summer was treated by herbs, but neither was it cured by such cheap things. Then my illness was given no medical treatment, neither precious nor cheap, and I recovered suddenly in no more than a month. Afterwards my appetite and physique were even better than before. Then I began to realize that disease is like a tiger that it eats people when it encounters them — but goes away if the person is not afraid of it; like the ghost that hurts those whom it encounters but leaves if the person doesn’t believe in it. Disease intimidates anyone except the poor — for the poor have great strength. Ancient people said, ‘Seeking no treatment for a disease equals seeing an average-skilled physician’. I would like to say, ‘It equals more than just an average-skilled physician, more likely a national one!’ (From The Complete Works of Li Weng’s Words) Poor people have often had such experiences. If people could not afford to pay for good physicians and herbs, and were lacking knowledge, they had to seek a spontaneous recovery by depending on themselves. Normally people have such an ability. Hence, Xu Dachun described of “not needing

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to have medicines for an illness” in his Treatise on the Origin and Development of Medicine (医学源流论): All diseases of external contraction and internal injury have presenting symptoms. They will turn better with just simple treatments. Mild cases can also turn better gradually and spontaneously without medicine. Even serious and urgent cases can turn better themselves if there is no mistreatment and a gradual recession of pathogenic factors. Therefore, recovery from illness is not only the privilege of a physician. Actually there are some diseases where it is not appropriate to have medicine… If there is no definitely effective formula, it is just trialing the body with the medicine, which is no better than going without medicine, which equals going to an average-skilled physician. Xu Dachun analysed this problem in two ways. Poor earnings and poor medical skills both contribute to the difficulty in seeking help for these patients. In such cases, if they don’t take medicine, they could just as well have been treated by an average-skilled physician. He put it more reasonably in his treatise on Mild Herbs for Curing Illness (轻药愈病论): There is an ancient proverb that ‘Seeking no treatment for a disease equals seeing an average-skilled physician’, which was in existence well before the Song dynasty. This is because many medical skills have been lost and mistreatment is common, and also because patients are unable to distinguish a physician’s skill, so it is reasonable to suggest that they do not take medicine. Though this does not help in curing the disease, it will not kill the patient. Moreover, most diseases are not deadly. When the external pathogens recede and the internal status restores itself gradually, there could be a spontaneous recovery. So, that equals seeing an average-skilled physician. But this being is too cautious. In my opinion, some cases can recover spontaneously, some are difficult to cure without treatment, and some will be fatal with neither treatment nor recovery. For diseases that can recover themselves, surely no medicine is needed; for those which are difficult to cure, medicine is certainly needed. But if we are unable to distinguish a physician’s skills and accurate use of medicines, and don’t want to take the risk of trying, it is better to prepare formulae that are moderate and supplementary, without

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purgation. Small mistakes in treatment may not be harmful and sometimes may have a special efficacy that is better than being treated by an average-skilled physician… People are destined to have occasional mild diseases — if they can choose herbs of the mildest nature and drink a decoction of them according to the symptoms, there will be no mistake in taking medicine and the result is as if they took no medicine. People aiming to cultivate their life should thus ponder deeply about the efficacy of taking no medicine. This is written out of kindness by a medical expert. He is suggesting that people should pursue rational, medical ways of seeking treatment and work on their mental state when refusing medicine. However, “seeking no treatment for a disease equals to seeing an average-skilled physician” could be seen, over a long period of time, to have created a frightfully passive mentality. Liang Zhangju, a great man in the late Qing dynasty, said in his Casual Notes made in Tui An (退庵随笔): ‘Seeking no treatment for a disease equals seeing an average-skilled physician’. This is an ancient proverb, first seen in the Book of Han – Records of Arts and Literature (汉书·艺文志). This is what people talk about nowadays — that having no medicine is like seeing an average-skilled physician. Xie Meizhuang said, ‘Good medical physicians are like high officials, while mediocre ones are like craftsmen’. If a physician cannot perceive the profound essence of the two Ancient Classics, the difference between the Four Medical Schools, the principle of the five circuits and six qi, and the differentiation between exterior and interior, then ginseng and poria will be more toxic than sodium sulphate and rhubarb, and his herbs sharper than an axe or sword. This is why people who would like to study medicine must have the utmost wisdom and patients would rather not have medicine and say it is ‘as good as seeing an average-skilled physician’.

156.  The Patient Seeking Medical Help and Selecting a Physician In practice, people often say that “seeking no treatment for a disease is equal to seeing an average-skilled physician” but this is only one aspect of a patient’s psychology. When people are inflicted by a really serious illness, they tend to do the opposite, namely to “try everything for their plight”. It is more harmful if they choose a physician recklessly.

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Chinese people always had the tenet that “if the physician doesn’t have experience of three generations, don’t try his formula.” “Experience of three generations” indicates a rich personal clinical experience. Books like The Songs of Chu (楚辞) have sayings such as “nine times breaking the arm makes him a good physician” and “three times breaking the arm makes him know medicine.” The folklore that “a long period of illness makes him a good physician” also shows the importance of medical experience. However, scholars generally consider “three generations” to mean the “books of three generations”. For example, Liang Zhangju wrote in his Wandering Writings (浪迹丛谈): I happened to hear a speaker of the family school tell Sun Cao that ‘if a physician doesn’t have the experience of three generations, don’t try his formula’. Generally according to tradition, ‘three generations’ refers to the inheritance of medical skills for three direct generations. However, it seems not the case — as I still remember much from my notes when I were young. Ancient medical experts must master the ‘books of three generations’, namely the Huangdi’s Acupuncture and Moxibustion (黄帝针灸), Shen Nong’s Classic of the Materia Medica (神农本草经) and the Plain Question’s Pulse Diagnosis (素问脉诀). Pulse Diagnosis concerns checking disease pattern, the Materia Medica is about differentiating herbs, and Acupuncture and Moxibustion for expelling illness. No one can be a medical physician without these three books. It was quite clear in these notes. If we can only take medicine prescribed by one with a medical background of three generations, there would be no one in our grandfather and father’s generations who could have had medicine given to them! Moreover, through reading about famous physicians now and in the ancient books, I have not found one with a medical background of three generations. Hence, we know this traditional explanation is not reliable. This is similar to Song Lian’s words, from the Song Dynasty: Ancient physicians must master the books of three generations. These so-called ‘books of three generations’ are Acupuncture and Moxibustion (针灸), Shen Nong’s Classic of the Materia Medica (神农本草经) and Taisu Pulse Diagnosis (太素脉诀). Pulse Diagnosis is for checking disease patterns, the Materia Medica for

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differentiating herbs, and Acupuncture and Moxibustion for expelling illness. No one can be a medical physician without these three books. This is what the Book of Rites (礼记) means when it says, ‘if a physician does not have the experience of three generations, don’t try his formula’. He gives the example of Yan Sheng from his own hometown who had a medical background of three generations, but his curative efficacy was quite poor — while Zhu Pinjun, who studied Confucianism and medicine, had great curative efficacy. By comparing them, he said, Yan Sheng had a medical background of three generations, while Pinjun had just began to learn in his generation. However, the medical skills of the latter were superior to the former. So can we judge a physician by his medical background of former generations?… Nowadays, people pursue physicians blindly and judge them by length of practice, rather than by what they have studied. When they are asked why, they would quote what is said in the Book of Rites (礼记). But do they really have a right understanding of medicine? (From a Preface to Physician Ge (赠医士葛某序)) This also illustrates how people set the standard when selecting a physician. Common people tend to select those with a medical background which extends for generations and have rich experience, while men of letters and scholars would like to choose a Confucian or educated physician. Actually, a good physician should be equipped with both theory and experience, but the patient or family member cannot distinguish the good one from the charlatan. Xu Dachun made a profound analysis of the misleading psychology of patients when selecting physicians. He wrote in his Treatise on Patients (病家论): Diseases mistreated by physicians are undoubtedly many, but many more are those mistreated by the patient themselves. We can change to another better physician if the disease is mistreated by a physician. But the harm is far greater if the right treatment is delayed by the patient themselves. Example one: some patients just delay the treatment regardless of the physician’s skills. Example two: some just find it easier to believe what others say about the physician and don’t investigate the truth themselves. Example three: some are

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familiar with physicians in their daily life, so out of convenience and fear of losing the interpersonal relationship, and together with the physician’s warm-hearted offer, they risk their life to keep this relationship and choose such a physician. Example four: some corrupt people from a distant area are in disguise as good physicians. They talk eloquently and cheat some foolish and unthinking clients. Example five: some close relatives or friends with a high rank may recommend a physician, so in response to their kindness, the patient consults such a physician reluctantly. Example six: some relatives or friends may have read some medical books and think they know the medicine very well, so when they see the physician’s formula, they recklessly discuss it and change some of the ingredients selfrighteously. If the modified formula works, they take the credit, but if it fails, they blame the physician. Example seven: some relatives or friends may respectively recommend their own physician and then say some derogatory words about the other. They argue for the physician they recommend — and even gloat over it if the patient doesn’t get well when the patient pursues treatment from another physician. Example eight: when the condition is taking a better turn, but the patient is suspicious of it, as it is taking so long — and questions about it also arise — the patient then changes the formula for another one, leading to a worsening of the illness. Example nine: some diseases do not use the routine method, for example that cassia twig is used in the morning, and skullcap and coptis are applied in the evening; or heavy-purging herbs are used for a weak body; or greatly tonifying herbs are applied for an excess condition. However, the patient is unsure and considers it the physician’s peculiar preference, so he believes what other quacks say instead. Example ten: some patients begrudge paying and are very willing to choose the physician who charges the least. But actually, famous physicians usually don’t follow another’s ideas, while others may be easier to approach, and may negotiate a lesser fee. Bianque said, ‘It is not possible to treat those who value wealth more than health’. These are the ten major reasons for patients mistreating themselves. What’s more, some patients are just happy with tonifying herbs and fear purgative formulae. So it gets blamed on destiny if they die from taking tonifying herbs, but on the physician if they died from refusing the purging formulae — but this makes the physician afraid of administering herbs according to

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symptoms. Besides these, there are other cases, such as the improper preparation of herbs and decoctions, having a decoction at the wrong time, an improper diet, irregular life-style or excessive emotion. These may not be harmful in a mild illness, but in a serious one, they are enough to damage a life. So then, what should a patient do? They should choose a famous physician with caution and trust him. It is just like a monarch choosing a minister, and trusting him totally. He carries on: “In that case, what is the best method of choosing a good physician? We must choose those who are honest and upright, knowledgeable and have learnt from other famous physicians — and can actually cure eight or nine patients out of ten. However, physicians can always have their own advantages and shortcomings. If the physician is not an expert at your case, mistreatment might be the result. Therefore, we must listen to what he is saying carefully. We can trust him if his talking is pertinent and right to the point; and the herbal formula prescribed is accurate. ‘Accurate’ here means establishing a well-designed formula for good reasons and being clear about how the formula works. In other words, the physician tells you exactly how many doses will exert efficacy. If the patient can test a physician this way, the problem of selecting a physician will almost always have been solved. If the physician is of a quite lower class — or uses odd or inexplicable words, and the curative efficacy is not in accordance with his prediction, choose some other wellknown physician immediately and don’t risk your life lightly with him. This is the way to select a physician.” (From Treatise on the Origin and Development of Medicine (医学源流论)) Dachun’s analysis is greatly detailed and he points out the misleading factors and defects in a patient’s psychology when selecting a physician. He also sets a standard for when selecting a physician and the way to test them, which is practical. He especially holds that the patient must be good at selecting a physician and then trust his chosen physician well. A harmonious relationship between patient and physician exerts a synergistic effect in curing any illness. If the patient is self-assertive and presses the physician to make a compromise, it means the patient doesn’t trust the physician — which is just as harmful to the patient himself! Again, other people discussing your treatment is just one of the psychological problems that arise for a patient. As the saying goes, “No generous person will gift you gold when you are poor, and idle people will talk about

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your medicinal formula when you are ill.” Sun Simiao warns about this early on in his Important Formulae Worth a Thousand Gold Pieces (千金要方): There are always many relatives and friends of the patient, who will visit them when they are ill. Some of them are quite naive and actually have no experience but have read about a special formula of their own. They keep talking and pretend to be wise, describing the situation as deficiency or excess, cloud or wind, gu or water or illness. It seems they know all about the formula. The patient is upset and puzzled and doesn’t know what is right. When treatment is delayed and the disease worsens, such people leave straight away. This is why it is essential to have good people around you and consult famous physicians who can discern the state of disease, who have read the formulaic books extensively, and understand the treatment well. If you do not do so, it greatly harms the patient’s progress. In addition, there are also cases of “recommending mediocre physicians because of their occasional efficacy.” Lay Buddhist Yongna in the Qing dynasty mentioned a case in Records of What I Have Heard around Here (咫闻录): The art of medicine is quite exquisite and subtle. How could someone attempt it with shallow knowledge? Physicians must have a knowledge which is profound, read extensively from the books of famous physicians, explore deeply and train hard. Only when they learn the essentials will they not constantly misconstrue their treatments. There was a person surnamed Xu in Ningbo of Zhejiang province, who knew neither farming nor Confucianism. At the beginning, he just idled away his time supported by his father and siblings. Later he got married and his wife always worried about him. In order to support the family, he started to memorize medicinal formulae and tried to earn a little by providing a medical service. Who would risk their life with his treatments if they knew his background? He was dressed in tatters in the winter and a rough hemp jacket in summer. Day after day, he wandered up and down, hunting for patients. People knew him well and looked down on him. Every time he entered a house, he would stay shamelessly until he was offered a meal. One day, a person surnamed Zhu, who lived about one mile away, died after coincidentally suffering a ‘cold damage’

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fever over eight days. Xu heard this and rushed to help. When he entered the door, the dead body had been moved out from the room to the hall. Xu pressed Zhu’s chest and said, ‘His chest is still warm, so treatment may still be effective’. However, Zhu’s family members were wanting to put the body into a coffin and bury it quickly as the weather was very hot. Moreover, they didn’t believe what Xu said because they knew he was not good at medicine. Then Xu fetched the writing brush and paper himself, and wrote down a formula called White Tiger Decoction. He asked Zhu’s younger brother’s son to buy the herbal ingredients immediately. The brother’s son replied: ‘You are not Huatuo, how can you rescue people in critical states! You are not Chunyang, so how can you bring the dead back to life! I know you are hungry, so you can just help us out and then we will feed you for three days — instead of trying your awkward skills’. Xu said, ‘Though there is no breath, the chest is still warm. Now we are fighting a losing battle. Please give me the money to buy the herbs, and I will go to buy them in town. If he resuscitates, it is the good fortune of your family. If he doesn’t, just take it that I have borrowed money from you’. The brother’s son was bothered and gave him the money. Xu bought the herbs and cooked the decoction. He poured the decoction into Zhu’s mouth and the decoction went down smoothly. After a short moment, Zhu moved his hand slightly and started breathing. Xu declared, ‘He is better’. The crying in the hall stopped totally. Hence Zhu was moved back to his old room and recovered after having further treatment over several days. As a result, they regarded Xu as a miracle-worker and realised that people can’t be judged by their looks. They rewarded him with ten liang of silver. He then became well-known by people and they came to consult him, one after another. Xu was very proud and said, ‘If the White Tiger Decoction can even resuscitate a dead person, why should it not be effective for a living person?’ So he prescribed this formula to any patient who came to see him. In less than two months, more than ten were killed by his treatments and he was beaten up by other people on several occasions. His medical skill was still very poor. This story reflects well the common people’s psychology of seeking medical help — they tend to wrongly believe those who have accidently had some effective treatment.

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Another case is when people extend their belief to those who have a great reputation in society, but not in medicine. Xu Dachun said, “We shouldn’t blindly believe in a physician’s skills… There was a person surnamed Lu in Wan village. He was very well-known in society and people not only believed in his learning, but his medical skills. If he said something was ‘right’, no one dared refute him! Though he knew only a few herbal formulae, people believed he had profound knowledge and skill, the results of his cures spread quickly and his fame was known to all. Of course, in this case his medical skills actually turned to be an endless skill at killing people!” This phenomenon was due to people’s blind adoration for the famous. It is said, “a single folk remedy drives famous physicians mad”; “unfortunate physicians treat the beginning of a disease, while fortunate physicians treat the end.” Which means treatment at the beginning is difficult, but easy at the end. A false reputation in medicine can either result from fame in other fields or from occasional effectiveness. Patients often believe in the fame and don’t investigate the actual skill. Such blind belief often extends for a short while, namely the psychology of the “blind following the blind”. When people hear about good physicians and medicines, they flock to them regardless of the distance. It is the same in the popularization of superstitions. There have been many foul therapies in history, such as “rooster blood therapy”, “water drinking therapy”, “hand shaking therapy”, “red-tea fungus therapy” and “vinegar and egg therapy”. They were very popular initially, but then faded away quickly. This has gone on since ancient times. There is a record in the Jottings from a Jade Hall (玉堂闲话): When Chang’an (Xian) was growing and prospering, there was a store selling herbal decoctions at West Market. The decoction was made up of several common ingredients and given to patients whatever the pulse condition or disease. The patient paid a hundred coins for one dose and a thousand kinds of diseases were cured soon after taking it. People could see a large pot in the spacious house where it was made, and it boiled day and night to cater for the endless stream of patients who came, from near and far. Its fame was well known in the bustling capital. Within a short while, the decoction was in short supply and people might wait 5 or even 7 days — even paying extra gold at the gate. This store earned a huge profit. At that time, Tian Lingzi fell ill and sought help from physicians all around the country, but in vain. Some in high positions even refused to treat

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him. A trusted follower happened to say, ‘Why not have a try of the decoction in West Market?’ Lingzi agreed and asked his servant to fetch it straight away. The servant got the decoction and rode back on his horse hastily. When he was near the narrow side-street, the horse stumbled and the decoction was lost. The servant was frightened of the problem of fetching the decoction again and hence filled the bottle with dyed water, from a nearby dye-house, instead. Lingzi drank it and recovered instantly. As he only knew the disease had been cured, without the knowledge of what he had drunk, he rewarded the owner of the store with a great sum of money. The fame of that store then grew even larger… This is surely a made-up sarcastic tale, but such superstitions seem to have extended into the present. Since pulse feeling is a mystery to common people, patients often had the idea of testing physicians by their taking of the pulse. Famous physicians throughout history have criticized this practice a great deal, but it has never been eradicated. Su Dongpo’s Miscellanies (东坡杂记) states: The pulse is so subtle that there have always been problems concerning it, now and in former days. An excess condition may exist when the pulse is very weak, while weak state may also be present when the pulse is greatly in excess. A slight feeling of difference will result in a different treatment outcome. Some lucky ones recover, those unlucky will die. This has worried people since ancient times. When we are ill, we have to seek help from doctors. However, very few of them can determine the pulse correctly. An extremely fine horse is not found very often, but we can still travel around; doctors such as Qinhe and Bianque are not present in every generation, but patients do not all die. Physicians can have other advantageous skills to cover up their shortcomings. Scholars and officials often seek for help without telling of their problem — so as to test the physician’s ability. This puts them in the dark when probing the disease and puzzling out the condition. When the treatment unluckily fails, they will not admit it and just conceal their mistake for the sake of their reputation. If the disease becomes incurable, they will just say, ‘it is simply untreatable.’ Occasionally, there are some patients who accept opinions from other sources and treat the disease their own way, resulting

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in the ineffectiveness of the herbal decoction. These are the common prejudices that people have and are unaware of. As for me, I usually secretly evaluate their skill while I am well — and when ill, I seek help with a clear goal in mind. I will tell them all my problems. After the physician knows them clearly, he will thus be able to differentiate the disease conditions and determine the pulse without puzzling over it. Hence, though I have been treated only by physicians with middling skills, I do usually recover. I have only come to seek help for my illness, why should I confuse the physician further! It is surely correct in this case that Su Shi assumed a cooperative but not testing attitude before his doctor, which results mostly in enhanced efficacy of the cure. Generally, however, scholar officials and even common people possess a “testing psychology”. They treat physicians like fortune-tellers, confusing the physician and confusing themselves. Wang Kentang in the Ming dynasty criticized this in his Standards for Diagnosis and Treatment (六科证治准绳): It is a pity that the common people usually keep silent and ask the physician to feel the pulse only. Is that really enough to detect the disease? The pulse denotes the flow of qi and blood in the channels. It goes faster when there is excess heat, slower when there is excess cold, is forceful when people are strong, and feeble when they are weak. But how can it clarify the exact pathogen — without any other information? It is a must for the physician to investigate the illness’s origin, and the patient to tell them the course of the disease… If the patient doesn’t inform him of this and picks up his own herbs from the pharmacy, the pharmacist also doesn’t check the disease condition when he gives the herbs and the result is that the disease stays for many years without any let up. They are so silly. Sun Simiao said, ‘Inquiry before feeling the pulse makes the diagnosis most accurate’. Su Dongpo said, ‘Our aim is to recover from the illness rather than to confuse the physician’. These two sayings are greatly beneficial to the people. The psychology and behaviour of patients when seeking help from physicians are complicated and subtle. Nowadays, patients’ psychology has not changed much. For example, people in China often initially seek help from Western medicine at the acute stage (treating the branch) and Chinese

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medicine at the chronic stage (treating the root). They try chemical drugs first and then herbal medicines, or take them simultaneously “combining Chinese and Western medicines” by their own direction. The fact is that they are just “blindly seeking medical help for an acute illness”, all relating to a blind psychology. Gong Xin in the Ming dynasty expressed his own opinions on this in an Exhortation to Patients (病家箴): Patients nowadays often begrudge the expense of treatment. They don’t seek medical help but wait for a spontaneous recovery; they don’t seek proficient physicians but go to any nearby clinics; they don’t observe carefully the condition but blindly seek any help; or just pray to the spirits and gods; and so on. If we are not cautious when there is frost, a hard icy time will be ahead. They go to seek help from a wise physician only when the illness is serious. At that time, even an elixir is unable to save their life. This is all due to their ignorance. They even consider their life as coming to an end — and it being due to misfortune. This is so foolish and pitiful! Such patients must alter their incorrect behavior. This opinion is based upon people’s common superstitions and their niggardly convenience-pursuing solutions. Li Zhongzi made a deeper analysis in his Required Readings from the Medical Ancestors (医宗必读): The so-called ‘patient’s psychology’ is a result of relative excess in the five zang-organs and bias in the seven emotions. Patients with excess yang are better being treated by cool therapies; those with excess yin by warm therapies; those who have good tolerance to toxins by drastic therapies; those with poor tolerance to toxins by mild ones. The zang-qi is different among different patients. They have different characters and food preferences. Positive patients usually deny it when you tell them the outcome looks serious; negative patients usually deny it when you tell them that the outcome looks favorable. Distrustful patients usually find it difficult to accept advice; suspicious patients resent a deep discussion. This is due to a difference in character, in what they like or hate. Rich people are often willful and don’t observe bans or prohibitions; high officials often follow their own rules and are presumptuous in violating common sense. This is due to their different social status. Poor people are

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unable to afford their daily expenses, let alone a payment for herbs. Humble people toil at work and are short of rest. This means treatment for them should be different. Some patients just want what they want to hear, instead of what they should — but fallacies will always renew. Too many ideas make for a loss of aim, and this is often due to an absence of self-opinion. Some patients prefer common recipes and never risk themselves with any special ones, which may also contribute to a bad outcome. This is like trying to put out a burning cartload of faggots with a cup of water — totally inadequate. This is due to them being too prudent. Some will only stay with a certain physician and if they can’t be treated by him, no-one else is good enough for them. This is due to the problem of fearing failure in treatment. Some impatient patients, who suffer from chronic conditions, will change physicians and receive any old therapy. Some slowcoaches, who suffer from acute disorders, will delay and allow the problem to linger on. Then it will be difficult to recover. This is due to having a different temperament. Some are fearful of tonifying herbs, such as ginseng etc. while some are not in favor of reducing medicines. This is due to personal mentality. Some are afraid to tell of their illness or hide their problems for secret purposes, or even conceal the condition in order to test the physician’s ability at feeling the pulse. They don’t know that there is not a single great physician in the history who diagnoses solely by feeling the pulse — without inspection, olfaction, auscultation and inquiry. For example, if an excess pulse is felt at the cunkou part, we can know it is a sign of food damage. However, we do not know when this started and what caused it. How can we know this only by feeling the pulse? These mistakes are all due to the psychology of patients. We must pay close attention to it. This incisive analysis comes from a talented medical expert, Li Zhongzi. It is surprising that ancient China had such a wise psychologist. He not only illustrates the patients’ psychology and behaviour in seeking medical help and observing medical instructions but also suggests that physicians analyse and figure out patients’ psychology, so as to adopt a corresponding behaviour of their own and achieve better results. Generally speaking, in the medical history of China, physicians had a good psychological sensitivity to their patients and were actively involved in diagnosis. Therefore, there were famous physicians in each generation who

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promoted the development of medicine. Among the folk population, however, as the popularization of medical knowledge was quite poor, the common people found it easy to hold false beliefs. Along with charlatans trying every trick in the book to bluff and cheat them, only a minority received a proper and decent treatment for their illness. This contrasting cultural psychology implies a “swirl of social medicine” — in which people were unable to distinguish science from superstition, and also physicians unable to produce persuasive arguments backed up by either experiment or statistics.

Conclusion of Part Three The development of Chinese medicine is closely related to natural and social ecologies. Peaceful times, times of unending hostilities and epidemics all impacted medicine in different ways, but in the course of coping with these different ecological conditions, Chinese physicians accumulated their own rich experience, developed new theories, vividly demonstrated their power and vitality, and made outstanding contributions to the continuing healthcare of the Chinese nation. Preventing and treating smallpox was the most prominent example of this — and variolation is actually the ancestor of modern immunology. Besides this, Chinese medicine was well connected to the scientific and technological developments of the time, to ideas on diet, to those of the martial arts and to the culture of sex and reproduction. On the contrary, amidst mainstream medicine, a culture of superstition still occupied the greater part of the mentality of the common people. They still tended towards a blind pragmatism when seeking medical help.

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The Cultural Process of Chinese Medicine in History and Its Crystallization When we speak about the mainstream of traditional Chinese medicine culture, we mean the non-magical, non-superstitious and scientific/pre-scientific, practically empirical medical culture. This describes the character and primary historical stance of Chinese medicine — and points us to development trends within its culture. There was always some witchery and superstitious activity in Chinese medicine. But these were just tributaries. Just as in highly modernized Britain and America, although witchcraft and superstition may still be seen, no one would say they were mainstream.

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The Essential Stream of Chinese Medicine and Its Outcomes A. The Main Developments and Characteristics of Chinese Medicine Through the Ages 157. The Beginning of the Basic Theory of Traditional Chinese Medicine in the Pre-Qin Period Witchcraft was at its peak during the Yin and Shang Dynasties and then began to decline in the Spring and Autumn and Warring States Periods. It was gradually replaced by empirical thinking, including medicine. At that time, all the major schools of philosophy sprang up, and various schools of thinkers contended. The theoretical concepts and factors of a natural philosophy became the main characteristic of the time. The “five elements”, “Yin and Yang”, “qi”, “water”, “essence”, “jingshen” (as in shen “spirit”), etc. all became fashionable topics. All these created the conditions for the germination of the traditional theory of Chinese Medicine. The first recorded medical story is of Yihe — when he diagnosed Lord Ping of Jin State in the year 541 BCE. Zuo’s Spring and Autumn Annals – The First Years of Lord Zhao states: Lord Ping of Jin State came to Qin State to ask for treatment. Lord Jing from Qin State sent Yihe in to treat him. Yihe said: ‘There is no way to cure the disease. It is caused by excessive sex and seems to be an attack by gu. He has lost his will to a woman — this is not due to ghosts or improper diet. This excellent minister is going to die. The gods do not bless Jin State anymore.’ Lord Ping of Jin State asked: ‘Can I not have close relations with a woman?’ Yihe answered: ‘Be moderate! The music of our deceased emperors was used to regulate 1107

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things, so we have the five harmonious beats — the slow, fast, fundamental and incidental, which may be altogether. As the five sounds come into harmony, the music is going to end. After that, the music will not be played again. Otherwise, it will become noisy and vexing and not loved by superior gentleman. Other things are similar to music too. Once they go beyond these bounds, we should give them up to keep healthy. Courtesy is like two instruments that play in harmony. Then gentlemen are moderating their relations with their wives, and keep themselves from vexation. Nature has six climes, which generate the five flavors, exhibit the five colors and manifest the five sounds. If they go too far, they will cause the six diseases. The six climates are the cloudy, sunny, windy, rainy, the night and day.’ They are divided into four seasons, following the sequence of the five sounds. If they go beyond the limit, they will become harmful. Excessive cloud causes cold disease; excessive sun causes heat disease; excessive wind causes limb disease; excessive rain causes abdominal disease; no abstinence at night causes a confused mind; no abstinence during the day causes heart disease. Sex belongs to the yang and happens at night, so excessive sex will cause a confused mind and internal heat. You do not behave yourself. How can you not be in a terrible situation? Yihe came out and told everything to Zhao Meng. Zhao Meng asked him, ‘which minister are you treating?’ Yihe answered: ‘He is yours. You have worked in Jin State for eight years. In that period, no disturbance has happened, no dukes have been killed. So you are good minister. I have heard that a minister enjoys the favor and salary of his lord and shoulders the heavy responsibility of his state. If disaster happens, he is unable to solve it and will be punished. Now your lord gets sick because of immoderate sex, and he cannot plan for your nation any longer. Is there anything worse than that! But you can do nothing for it, so I told him that.’ Zhao Meng said: ‘What’s gu?’ Yihe replied: ‘Gu is caused by indulgence and confusion. It is made up by the character forms for ‘insect’ and ‘vessel’. Flying insects in the rice fields are also called gu. In The Book of Changes, a woman confusing a man, a gale blowing down trees on the mountains, etc. are called gu. They are the same.’ Zhao Meng said: ‘What a good doctor.’ He gave Yihe many gifts and he returned home. This narrative is about the earliest known “six evil qi”. Besides the six qi, it treats the five pathogenic elements, immoderate sex, insects (flying insects in a rice field are also known as gu), emotional disorders, etc. The

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fundamental theory was that “excessive external qi and excessive internal emotion bring about disease.” Here, “Yin and Yang” are only used to describe climate characteristics and have no philosophical meaning. However, “excessive cloud (yin) causes cold disease; excessive sun (yang) causes heat disease” is in agreement with the later saying, “extreme yin brings about cold and extreme yang brings about heat”. It is worth pointing out that no ghosts are mentioned here, among the pathogenic factors. In contrast, Lord Ping of Jin State had earlier invited a diviner to divine any illness. The diviner had said, “Shichen and Taitai will do the trick.” But he did not know who they were. When Gongsun Qiao of Zheng State visited he explained, “Shichen is said to be the son of the ‘Shen God’ Gao-xinshi, and Taitai the son of the ‘Fen God’ Jin-tianshi.” They were in charge of the mountains, rivers, floods and droughts which happened in Jin State. If the people offend the gods, the people become sick. Obviously this was a theory about pathogenic ghosts and spirits. But Gongsun Qiao was having none of it. He said, … As for your disease, it is caused by improper work, rest, diet, joy and sorrow. How can a mountain god or star god make you sick! … make the bodily qi move freely, do not let it get blocked. The bodily qi once obstructed will weaken the body, make one unhappy and disorder everything. Now your body qi is focused on one thing, so you get sick… Now your four wives… if your wives leave, you will be well; otherwise you will be ill. It seems that Gongsun Qiao also had this different attitude towards ghosts causing disease. He points out that disease may be related to excessive sex. He explains the pathogenesis, “make the qi move freely and don’t block it.” It is also mentioned that “the wives in the palace must not have the same surnames — or their children will not prosper.” Consanguineous marriage was said to be bad for the offspring, which fits rather nicely with modern genetic theory. Let’s go back to the reign of Lord Jing of Jin (599–580 BCE in reign), four generations earlier than Lord Ping of Jin. It was the era of a seesaw struggle between witch-doctors and non-witch-doctors. The witch-doctors held a rather stable position. Zuo’s Spring and Autumn Annals – The Tenth Year of Lord Cheng (581 BCE) records, The lord of Jin (Lord Jing) dreamed of a large ghost with long hair down to the ground. Beating his breast and leaping about, the ghost said: ‘You are so evil to kill my children. I have permission from the

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gods to take my revenge.’ Then he broke down the palace door and bedroom door and closed in on him. The lord was frightened and ran into the inner room. The ghost broke down the inner door too. The lord woke up and summoned the wizard from Sangtian. The wizard said he agreed with the dream. Jin asked: ‘How so?’ The wizard answered: ‘You must not eat the new wheat.’ Jin became seriously ill, and asked for a doctor from Qin State. Lord of Huan of Qin sent Yihuan to treat him. Before Yihuan arrived, Lord Jin had the dream again. He dreamt his disease turned into two little children. One said: ‘He is a good doctor. I am afraid he will hurt us. Where to escape to?’ The other said: ‘If we stay above the huang and under the gao, he cannot do anything to us.’ Yihuan arrived. He said: ‘There is no cure for your disease. It has gone above the huang in the body and under the gao. Moxibustion cannot be used, the needle cannot reach it, and drugs will not work either.’ Lord Jin said: ‘You are indeed a good doctor’. He gave him many gifts and sent him back. On the sixth day of June, Jin wanted to eat the new wheat. The Agricultural Official presented the new wheat and the chef cooked it for him. Lord Jin summoned the wizard from Sangtian he had spoken to earlier, showed him the new wheat and then killed him. As Lord Jin was going to eat, he suddenly felt his abdomen swell up. He went to the toilet, fell into it and died. Initially Lord Jin had summoned the wizard to interpret his dream and respectfully believed in his prophesy. But when the new wheat had been harvested and presented before him, he did not believe him anymore. He killed the wizard. But he finally fell into toilet and died before he could eat the new wheat. This may have been a coincidence, but the record actually defends the wizard. In my opinion, it just reflects the intertwined struggle between medicine and witchery. Forty years on, the real doctor was still not getting the upper hand — during the reign of Lord Ping of Jin. It can be speculated from this story that Yihuan had a very brilliant diagnostic mind. This text does not mention how Yihuan located the disease between the gao and huang, so we have no way of knowing the truth. But he was wise enough to diagnose that it could not be attacked with medicated “hot ironing” or massage, and was also out of the reach of acupuncture, moxibustion and medicine. It sought out the truth from the facts and so reflected the actual level of treatment at the time. And, these treatments were not witchcraft. Something interesting is worth noting. It seems witchery was more popular in Jin State — wise men in Zheng State held a negative attitude towards ghosts causing disease — while Qin State was the most advanced.

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Both Yihuan and Yihe were brilliant doctors, and they have been known as “He and Huan” throughout history. They did not believe in witchery but explained the causes of the disease and its treatment using the laws of natural philosophy. This was the beginning of the basic theory of traditional Chinese medicine. Developments were different in different places. No matter what actually happened, eventually real medicine came to the fore. The famous physician Bianque marked the boundary and was a key figure. He was the first outstanding doctor in Chinese medical history. He travelled throughout the land, making himself an example, showing the real power of medicine, with practical efficacy and shaking the 2,000-year-old edifice of witchcraft — which had gone on through the Xia, Shang and Western Zhou Dynasties and into the Spring and Autumn Period. The Taishigong Sima Qian praised him, saying, “All the pulses of the world start from Bianque.” A Discussion about Salt and Iron describes how “Bianque knows disease by feeling the pulse. If the yang qi is excessive, yang qi should be lowered and yin qi nourished; if the cold qi is excessive, cold qi should be lowered and yang qi nourished. So if qi and pulse are in harmony, there will be no evil qi.” This correctly sums up his academic thought and the gist of his diagnosis and treatment. His saying “no treatment for people believing in witchery instead of medicine” made a clear distinction between medicine and witchery. He was an epoch-making figure in Chinese Medicine. The relevant facts and analysis have been recorded earlier1 and I will not repeat them here. As for theory, the medical books unearthed from the Mawangdui and Zhangjiashan tombs supply the most direct evidence, although they are almost superficial in style and not systemic at all. They were copied and buried during different periods. They are crude and incomplete, and quite different to the Huangdi Neijing. Thus, we can speculate they must be dated much earlier than the Huangdi Neijing. They show just the budding theory which existed before the Neijing. Even the books read by Bianque and Chunyu Yi, and mentioned in the Historical Records – Biography of Canggong and Bianque and those mentioned by writers in the Huangdi Neijing, show only the theoretical buds of traditional Chinese medicine. They describe the state of doctoring before the Huangdi Neijing came into being. According to the available material, they can perhaps be summarized as follows: 1. Fourteen medical books unearthed from the Mawangdui tombs in Changsha City in Hunan Province with their modern names.2 1

 Chapter 5, Section 45.  Chapter 6, Section 50.

2

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2. Two books unearthed from Zhangjiashan in Jiangling County in Hubei Province: Pulse Book and Daoyin Book. 3. There are more than ten books mentioned in the Biography of Canggong Bianque: Secret Prescriptions, A Pulse Book of Huangdi and Bianque, The Transformation of Yin and Yang, The External Change of Yin and Yang, Discussing the (Pulse) Method, Diagnosis with the Five Facial Complexions, Pulse and Diagnosis, A Medicine Book, Two Classics, Magical Agreements, Conforming to the Four Seasons, The Boundary of Yin and Yang, the Stone God, etc. 4. There are more than nineteen books cited in the Huangdi Neijing (not including the seven chapters added by Wang Bing): Five Colors, Pulse and Diagnosis, Special Diseases, Scripture I, Scripture II, Yin and Yang, The Twelve Viscera, The Pulse Classic, Pulse Method, Pulse Essence, Pulse Change, Form and Divination, Behaviors, The Golden Chamber, Nine Needles, The Needling Classic, Needling Manipulations, Heat Theory, Disease Origin, etc. From these titles, some of the books seem to have already discussed theory. The Huangdi Neijing thus became a “coat of many colours”, a reconstruction of many texts. It was a masterpiece — laying the foundation for a later comprehensive theory of traditional medicine. The pre-Qin was a pioneering era, when the Chinese creative spirit came into full bloom. Medicine became one of the “hundred schools”. Although Chinese medicine did not occupy such an important place in the social and political fields as Confucianism, Taoism and Mohism, its many schools became outstanding — thanks to the Huangdi Neijing. From that time on, it passed on down through the generations, standing proudly on its own two feet, independent in the medical world and serving everybody in the world. It will continue to contribute to the health causes of the whole world.

158. The Medical Classics and Classical Prescriptions as They Formed and Fell into Disuse Among the People The ice of witchcraft having been broken, various academic schools of natural philosophy began to form a consensus concerning the laws of nature, that is, qi, yin, yang and the five elements were taken as its most basic laws. This consensus thus began guiding and integrating an understanding of medical law — thus producing the very first combining of philosophy and medicine. In this fashion the age of experience arose and then turned into

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theory. The initial medical ideas described in the previous section found a need to come together into a brand-new, huge theoretical system, which was the basic theoretical system of TCM — as represented in both the Huangdi Neijing and Nanjing. The time of writing, process of construction, basic content and possible authorship of these two Chinese Medical classics have been elaborated on previously.3 But some fundamental questions still need to be answered. Most particularly, note the “green paper” of the Select Committee on Science and Technology of the British House of Lords in November 2000, which generated a great deal of misunderstanding in its definition and discussion of traditional Chinese Medicine. In itself, it was enough to show how the outside world is still wholly ignorant of the essence of TCM theory and practice.4 “Some complementary and alternative medical therapies, especially those in the third group A (G3a), have a very special philosophy which has evolved over centuries… Sometimes these therapies are connected with the dominant religious philosophy in their original country, such as Ayurvedic Medicine (India) and Traditional Chinese Medicine. However, no evidence has been established to back them.” Open claim was made at the back of the report that those in the third group (G3a) had no right to registration, education, inheritance or financial support for research. Essentially this was to dismiss the whole of traditional Chinese Medicine. It was mere scientific chauvinism. TCM is actually rooted in the philosophical foundations and background of the Neijing. To say that it was due to a “religious philosophy” is quite ridiculous. This might be unobjectionable if we were dealing with people who had no knowledge or experience of benefiting from Chinese medicine. But the House of Lords was powerful and the Select Committee on Science and Technology authoritative, so the impact was especially large and malevolent. Fortunately Britain is democratic, and it allows the expression of opposing views and the House of Lords had a debate. Some politicians, or their relatives or their friends, having benefited from traditional Chinese medicine came out to defend it; the traditional Chinese medical community in Britain worked hard in defense and to protest, and as the governmental health department held an open attitude on the matter, 3

 See Sections 50–53 of Chapters 6–7.  House of Lords: 6th Report of Select Committee on Science and Technology: Complementary and Alternative Medicine, p. 22. The Stationery Office Limited, 21 November 2000. 4

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traditional Chinese medicine was finally ruled as being legal. The crisis was finally resolved. And yet, the problem has not been resolved completely. Theoretical clarification grows increasingly important — and urgent. Medicine is not philosophy. Medicine can treat disease, while philosophy cannot. It is wrong for people to equate Chinese medical theory with philosophy. I have published articles discussing the difference between them.5 The key points are as follows: 1. Philosophical theory is a generalization and summation of natural and social knowledge; medical theory is just a generalization and summation of medical knowledge. 2. Philosophical theory has universal value, while medical theory is just used, in principle, in the medical field. 3. Yin and Yang belong to the category of contradiction, but they are not equal to contradiction: Yin and Yang have special attributes, while contradiction only implies opposition. 4. The philosophy of Yin and Yang works as the guiding principle and the methodology of the Neijing — their principle is used usually as the logical premise for the derivation of any fresh medical theory, while Yin and Yang in medicine are specific and used as applied terms to describe physiological or pathological characteristics, symptoms, functional forms of medicinal drugs, diagnosis or treatment. When Yin and Yang are used as philosophical terms, they are abstract; when they are used as medical terms, they are specific. People see the same word, and do not notice its different use in differing conditions, so they confuse the essential difference which lies between a “philosophical” Yin and Yang and the “medical” Yin and Yang. Philosophy can only stand above the world, noble, lofty and otherworldly. In this fashion, philosophy can’t really treat disease. But philosophy can also lower itself down and infiltrate the people, producing specific knowledge. It can guide doctors and help in the formation of medical theory. This is the best combination of philosophy and medicine. A good combina5

 Ma Boying. Yin and Yang Theory and Law of the Unity of Opposites in the ‘Huangdi Neijing’, Social Science Front, no. 1 (1980), pp. 52–57; Ma Boying. A Brief Discussion on Rationality of the Attributes of Yin and Yang, Shanghai Journal of Traditional Chinese Medicine, no. 4 (1981), pp. 39–40.

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tion deserves to be praised. The greatness of the Neijing reached these heights — and became a major achievement in world medical history. It was finished before Taoism was born, and along with the other religions had its fight against witchcraft and superstition. It had no association with religious philosophy at all — and the House of Lords made an oversight here. Years ago, Mr. Ren Jiyu pointed out that Master Sun’s Art of War and a similar book on warcraft by Li Quan produced during the Tang Dynasty contain “… simple dialectic and simple materialist views. But these only involve the generalization and summary of a specific knowledge — instead of an overall generalization and summation of an objective world.”6 It is the same with the Neijing. It contains a simple materialism and a simple dialectic as well. This is quite enough. On the contrary, the Neijing also supplies the material for a philosophy. It is a successful example of a philosophy being applied to a medicine and natural science. It was able to enrich greatly the natural philosophical system of China — and fully reflect the philosophical value of yin, yang and the five elements. But if the Neijing was really pure philosophy, it would have become philosophical instead medical — and not able to construe and give advice on medical treatment. Would these English gentlemen, if they had once satisfied their natural inquisitiveness about the philosophical basis of traditional Chinese medicine, still give it “the cold shoulder” after understanding this? However, as far as Neijing is concerned, these views also expose its weaknesses and imperfections. The current version of the Huangdi Neijing includes the Lingshu and Suwen. Clinical application is basically limited to acupuncture — and it contains only thirteen prescriptions and mentions no more than twenty kinds of herbs, so its clinical value is much reduced. The principle of formulating prescriptions is correct, but exemplary prescriptions are few. Perhaps because of this, the Neijing did not spread far during the Han Dynasties. Furthermore, the Neijing might have been put together by a secret medical organization and transmitted on a small scale — so it did not get known well in society. It thus stood in opposition to popular witchcraft and “books of prophesies”, and did not receive much favour. This meant the Neijing was ignored by people for a long period. The History of the Han Dynasty – A Record of Arts and Culture just lists its title and does not describe its content or contribution. There is no word of it in the rest of the Han Dynasty volumes either, until Zhang Zhongjing mentions in his preface to A Treatise on Pathogenic Cold and Miscellaneous Diseases that he him6

 Ren Jiyu. Concise History of Chinese Philosophy, pp. 32–33.

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self had studied the Suwen and Jiujuan (alias the Lingshu). Thus, the Neijing gradually surfaced, following the production of the A–B Classic of Acupuncture and Moxibustion by Huangfu Mi written during the Jin Dynasty, the Huangdi Neijing Taisu of Yang Shangshan in the Sui and Tang and the Suwen annotated by Wang Bing. Indeed it seems the Huangdi Neijing was less influential during both the early and late Han Dynasties. A Record of Arts and Culture also lists Bai’s Internal Classic, Bai’s External Classic, Bai’s Lateral Classic, Bianque’s Internal Classic, Bianque’s External Classic, etc. There are seven medical books here, including 175 volumes in all. But except for the Huangdi Neijing with its 18 volumes and 81 chapters, all other books have been lost. No part or parcel of them can be seen today. (In fact, the seventh volume of the Suwen including nine chapters is missing; two chapters of the Lingshu have titles but no content, while the seven chapters added by Wang Bing when annotating the Suwen are in doubt.) Their disappearance might be due to the fact that they had little theoretical or clinical value, that is, less than the Huangdi Neijing itself. The Huangdi Neijing was barely saved from being broken up, and only 161 chapters are left, despite the fact that it was meant to be “stored in a golden cabinet” and preserved. There is also one record that “eleven prescription books”, including 295 volumes, were lost. But it is strange that later popular books do not quote from them at all. It might be the case that the proverb — “having no treatment is as good as having a mediocre doctor” (that is, if a patient does not go to see a doctor, it will be as good as receiving an average treatment) is true, and reflected the actual situation. Treatment may have been at a low level and fairly ineffective. Therefore, these “medical classics” and “classical prescriptions” were not seen as needing to be treasured and finally went missing. The practical value of Huangdi Neijing was not revealed until the method of its clinical application was found — this was the establishment of “treatment according to syndrome differentiation”. It was the same with the Nanjing and Sheng Nong’s Herbal Classic. They were both unknown during the Han Dynasty. Even their names go unrecorded in the History of the Han Dynasty – Record of Arts and Culture. Their content shows traces of a world of immortals and alchemists, with their prophetic books. The earliest record of the Nanjing is in the Treatise on Pathogenic Cold and Miscellaneous Diseases, while Sheng Nong’s Herbal Classic appeared in the Seven Records of Ruan Xiaoxu during the Liang Dynasty. They were hidden in the folk world for a very, very long time — until they saw the light of day quite some time later. In summary, the two Han Dynasties endured for more than 420 years. Except for its very beginning and end, this period was characterized by the

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restoration of witchcraft in all its different forms; true medical theory was forgotten and there was no great clinical progress made. We may thus hurry by its medical history, with its inclination to Taoist alchemists and immortals, signs and prophecies.

159. The Foundation of a System of Treatment According to Syndrome Differentiation in the Late Han Dynasty When I say that we can pass by medicine in the Han Dynasties in a hurried manner, I do not mean there were no achievements made at all during this time, but there was no radical change. The Nanjing and Sheng Nong’s Herbal Classic were both written during this period, a time when Wang Mang ordered the imperial physician, Shangfang, and a skillful butcher to dissect human bodies, and Fu Weng and Guo Yu were famous because of their excellent needling. The problem is that all of these could not be heard above the “wondrous stories and din” made by the alchemists and immortals over these 400 long years. Furthermore, the medical profession seemed to be basically made up of amateurs — except for Bianque and Li Xi (the imperial physician to the Qin king). Few people were interested in medicine. No wonder Zhang Zhongjing in his preface to A Treatise on Pathogenic Cold and Miscellaneous Diseases said: … It is strange that people today do not care much about medicine or study prescriptions. At best they could treat their monarch or parents, and at worst save the poor when they get into trouble — or, anyway, keep themselves living long and healthy. Instead they just scramble for glory and power, stand on tiptoe to look up at rich and powerful families and rush around looking for fame or money. They care for the minor but ignore the major; care for appearances and injure that within. If the skin is gone, where chance is there for the hair! When the country is at peace, people rush for fame and profit. Lowly doctors are looked down upon by the people. But the plague cannot distinguish between rich and poor. Any family may be destroyed and no one can be certain they will survive. Zhang Zhongjing described it as follows: As they die, their spirits disappear and turn into ghosts in hell. Their families can do nothing but cry out for them, in vain. Alas! They are all at a loss what to do and cannot realize their error. If people do

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not treasure their own lives, what can they do about glory and power? They cannot love or understand others in favorable situations, or even love and understand themselves in unfavorable situations. If disaster happens, they are in danger and act stupid. Alas! The snobbish run after vanity, forget the fundamentals and end up killing themselves. They are just as if skating on thin ice or standing at the edge of a deep cliff. They are that stupid. During that period, especially during the Eastern Han Dynasty, witchcraft and prophecy were popular. Witchcraft adapted its ways and came back, and true medicine shrank away. So generally, If they are suddenly attacked by the evil qi and suffer from some strange disease, they are shocked and frightened. They degrade themselves by asking for witches to pray for them. They ought to tell them there is no way out of their disease, and that all they can do is wait for death… Apparently witchery was still popular during this time. In the eyes of Zhongjing, there had been no famous or good doctors since Canggong in the Han Dynasty: There had been Shengnong, Huangdi, Qibo, Bogao, Leigong, Shaoyu, Shaoshi and Zhongwen during ancient times; Changsang and Bianque in the medieval period; Gongcheng Yangqing and Canggong during the Han Dynasty. But after that, no more famous doctors.7 He goes on to say, Have a look at doctors today. They do not study the medical classics to enhance their own medical knowledge, but just follow their own family’s old medical skills. In the diagnosis of disease, they just ask a few questions before making a prescription. In feeling the pulse, they just feel the cun pulse and not the chi; only the hand pulse and not the foot pulse. They finish feeling the pulse within fifty breaths — and do 7

 Most of these names are familiar to us, except for Shaoshi and Zhongwen. These may be those referred to in the Neijing. If this is true, the current Neijing must not be the one that Zhongjing had read.

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not make any reference to the pulses at the renying and fuyang. Even as the patient is going to die, they cannot feel any sign at the ‘nine regions’. The mingtang (nose) and queting (forehead and space between the eyebrows) is ignored as well. They are just looking at daylight through a tube. So it is difficult for them to judge life and death. What Zhongjing says here basically accords with the historical facts. When the plague broke out doctors could do nothing. Two-thirds of his own family died from the plague over ten years, which triggered his determination to change the impoverished medical conditions. He thus describes the mood and process of writing his Treatise: There were once more than two-hundred people in my clan. But since the first year of the Jian’an period (CE 196), two-thirds of them have died, in less than ten years, seven out of ten from the ‘cold attack’. I was so depressed and down because of my clan’s decline and premature death, that I studied hard the ancient books, collected prescriptions extensively and referred constantly to the Suwen, Jiujuan, Eighty-One Questions, Yin and Yang, Fetal Medicine and Pulse Differentiation — and then wrote the sixteen volumes of my Treatise on Pathogenic Cold and Miscellaneous Diseases. Although it cannot cure all disease, it can help people understand its system. If people can carefully study this book, they will understand the most of any ‘cold attack’. Thus, a brand-new, practical and effective system of pattern recognition in clinical treatment — based upon “syndrome differentiation” (bianzheng) — came into being. It was unprecedented. The system of “six-meridian syndrome-differentiation” and miscellaneous diseases syndrome­differentiation in the book not only brought order to dialectical thinking on disease but also demonstrated alternative models of differentiation. As far as treatment was concerned, it included 397 methods (Treatise on Febrile Diseases), 269 prescriptions (Synopsis of Golden Chamber included) and 214 kinds of medicinal drugs. These are honoured as “the fore-fathers of the many prescriptions”. The prescription principle of “monarch, minister, assistant and guide” in the Huangdi Neijing is fully implemented and manifest. As long as the syndrome differentiation is correct and the medicine given according to its indication, the effect will be speedy and effective. Zhang Zhongjing created a new era in the field of compound prescriptions, which were much more effective than single drugs.

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The efficacy of traditional Chinese medicine lies in its principle of “treatment based on syndrome differentiation” as well as in its fundamental formulae. Different symptoms reflect different constitutions; differing medical combinations can produce a large number of effective prescriptions for differing syndromes. This makes traditional Chinese medicine flexible in the clinic. Not only the disease but the patient also gets treatment. Medicine has a flexible compatibility, made according to symptom and not just limited to the 269 classical prescriptions. Later the theory of syndrome differentiation and prescription developed along with clinical practice. The prescriptions in any book, such as the General Records of Royal Benevolence, might even have been as many as 20,000. Traditional Chinese medicine opens up a limitless prospect in treating the patient. Modern scientific research cannot as yet find the essence of a “syndrome” or the secret of making different combinations of herbs to effect differing results, and can never even begin to guess what Zhongjing was talking about. Zhongjing’s prescriptions are still, to this day, honoured as “the forebears of the many prescriptions” and Zhongjing is honoured as a “medical sage” — which accurately reflects his status in Chinese medicine. Frankly, if there had been no Zhang Zhongjing, traditional Chinese medicine might not be today’s Chinese medicine. Perhaps its development would have been delayed several hundred years. He solved the methodology of combining Huangdi Neijing and medical practice — and developed its ideas in many ways. For example, syndrome differentiation using the “six meridians” originated in the Neijing, but was not seen there, as it was Zhongjing’s own unique creation. “Syndrome prescriptions” were established by him too. Some Japanese and domestic doctors set up a program of “syndrome prescription differentiation”, for instance, a “syndrome for a Guizhi decoction”, a “syndrome for a Mahuang decoction”, a “syndrome for a Xiaochaihu decoction”, a “syndrome for a Baihu decoction”, etc. But it should be pointed out that Zhongjing’s “treatment according to syndrome differentiation” was always the principle used by later generations — to grasp the outline, decide on the syndrome and then write up a specific and particular prescription.

160.  How Chinese Medicine Bloomed During the Wars Throughout Chinese history, division in society has followed prolonged unification and unification followed prolonged division. Wars broke out frequently during the Wei, Jin, Southern and Northern Dynasties. The

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united country had been divided into more than 10 small states, one following the other, throughout this long period. These unstable times lasted 369 years — a fact generally ignored by most historians. This period is also regarded as the “barren age” of medicine. War and division bring nothing but ill effects. But I have a differing opinion. Many outstanding physicians arose among common people during this time of “war, division and alien reign” — in fact four major innovations can be seen in Chinese medical history.8 Zhang Zhongjing and Hua Tuo lived towards the end of the Eastern Han Dynasty. At that time, the warlords grabbed the power, the cruel and wicked were in command, the country was at war and the common people lived in misery. But during this period there were great achievements made during their innovative careers. Hua Tuo’s lifetime has been described earlier. He was slightly older than Zhongjing and more famous than Zhongjing in history and the folk world. He was known for his surgery, anaesthesia, acupuncture and treatment of parasitic diseases and practice of preserving health through Qigong (five-animal exercises). In fact, Hua Tuo was a man of many talents. He was good at internal medicine too. Hua Tuo was one of the most important medical scientists in the cultural history of Chinese medicine. In Chinese medical history, there are only two jointly paired names — “Hehuan” (Yi He and Yi Huan) and “Huabian” (Hua Tuo and Bian Que). Obviously he was loved by the people! It is said that the Treasured Classic contains Hua Tuo’s posthumous work. But later commentators and collectors think it to be a forgery. As has been mentioned earlier, if the Treasured Classics is a forgery, and not personally written by Hua Tuo, it was possibly written by some person or persons during the Six Dynasties (222–589 CE, the Wu, Eastern Jin, Song, Qi, Liang and Chen are collectively known as the “Six Dynasties”). Nevertheless, it might have been a summary of Hua Tuo’s academic thought. He had many disciples, such as Wu Pu, Fan’E, Li Dangzhi, etc. They must have passed his thoughts down, from generation to generation. Hua Tuo was unjustly killed by Cao Cao in 207 CE and possible a draft was burnt too. But some manuscripts might have been kept and passed down. Oral thought would not die out. Deng Chuzhong says he retrieved the Treasured Classic from Hua Tuo’s tomb and claimed to be a grandson of Hua Tuo. 8

 Ma Boying. A Brief Discussion on the Influence of War and Unification on Chinese Medical Development, in The Symposium for the Establishment of Chinese Medical Documents Institute, 1982, pp. 95–102.

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Furthermore, his claim has never been denied by any in history. Thus, the book would have appeared shortly after his death. Professor Ren Yingqiu also believes the Treasured Classic to have been written by Hua Tuo.9 This statement is probably correct. He points out that the book develops diagnoses through the complexion and pulse, and through syndrome differentiation by dividing up deficiency/excess, cold and heat within the viscera. These ideas were a development of those in the Suwen and Lingshu. For example, he mentions “syndrome differentiation through the liver pulse”. First, understand its physiological attributes — it stands for the “spring-time qi”, has an exterior–interior relationship with the “gallbladder”. Second, the pulse is described as “tender, soft, void and wide”, the liver governing softness and dispersion. Third, analyse the liver possessing a “taut” pulse, including the “long taut” pulse, “softly taut” pulse, “excessively taut” pulse and “deficiently taut” pulse. These are two different situations: too great and too less. Different liver diseases have different pulses — such as the “slow, rapid, big, small, slippery and unsmooth” — which can help diagnose the main syndrome. Fourth, analyse the development and outcome of the syndrome. Finally, diagnose the disease as “cold-attacking the liver”, “heat-attacking the liver”, or a “cold liver due to deficiency” — and lastly be provided with a basis for treatment. Syndrome differentiation of the other organs through pulse was performed in a roughly similar manner, with slightly different details. Therefore, the importance of the Treasured Classics is that it forms a prelude to “syndrome differentiation using the zang and fu”. As a matter of fact, later works, such as Tao Hongjing’s Auxiliary Medication of Viscera, Sun Simiao’s Valuable Prescriptions for Emergencies, Qian Yi’s Key to the Therapeutics of Children and Zhuang Yuansu’s Medical Origins were all written using this differentiation of cold, heat, deficiency and excess within the five zang and six fu. The historical status of Treasured Classic is thus well worth affirming. In addition, the often used terms “mutual promotion”, “mutual restriction” and “mutual over-restriction” between the five elements again come from the Treasured Classic — they are not recorded in the Neijing but we begin to see them in the Huainanzi and Chunqiu Fanlu. It is clear that doctors paid close attention to social philosophy — and absorbed much from it. Medicine flourished during this period. In addition to the continuous improvement of the systems of clinical syndrome differentiation and treat9

 Ren Yingqiu. Different Schools of Chinese Medicine, Shanghai Science and Technology Press, 1982, p. 164.

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ment, medicine during this period was characterized by competition among doctors, the flowering of many differing medical schools embracing anything and everything, and governmental teaching as shown by the following examples: (a) In addition to the famous Zhang Zhongjing, Hua Tuo, Wang Shuhe, Huangfu Mi, Ge Hong and Tao Hongjing, dozens of doctors are recorded in the medical histories. Among them, some were native Taoist doctors, some Confucian, some Buddhist, but there were also foreign doctors, such as Zhifacun, Yufakai, Gaolike, and some who practiced medicine abroad, such as Dong Feng and Zhicong. Some doctors were taught by masters, but some came from large medical families, such as the Xu Zhicai family, and in addition some were civilian doctors, and some were medical officials, such as Wang Xian, Cui Yu, Yao Sengyuan, Qin Chengzu, etc. (b) The number and type of medical books were unprecedented. They describe theory, practical experience, acupuncture, medicine, medicine processing and so on. Many medical works were written: the first summative pulse works — Wang Shuhe’s Pulse Classic; the first acupuncture monograph — Huangfu Mi’s A–B Classic of Acupuncture and Moxibustion; the first simple, handy, effective and cheap clinical manual — Ge Hong’s Handy Prescriptions for Emergencies; the first research book in Sheng Nong’s Herbal Classic — Tao Hongjing’s Annotated Shen Nong’s Herbal; the first monograph on medicine processing — Lei Xiao’s Lei’s Treatise on Preparing Drugs (Liu Song), etc. All these exquisite cultural flowers came into bloom. (c) Surgical techniques were developed. Besides Hua Tuo’s original surgery and anaesthesia, there was also wartime surgery. The bone-scraping work on Guan Gong, which Hua Tuo is famous for, was not done by Hua Tuo himself, but actually by a military surgeon. There was also cleft lip repair (done by Yin Zhongkan’s military surgeon), amputation (“if a hand is poisoned, it must be cut off to save a life”), eye tumour incision (Emperor Jing of the Jin State), and last but not least the needling of eye diseases. The History of the Liang Dynasty says, “The empress suffered from an eye disease and was unable to see for a long time. The Taoist Huilong from Beidu gave her needling and she could see well.” This may have been cataractopiesis with a needle or the stripping away of the pterygium, large tumour cutting, etc. This was basically something like surgery. So we can see that treating an “external disease with internal

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therapy” was not the only distinguishing feature of Chinese medicine at this period. Treatment and prescription for sores, carbuncle and traumatic bleeding in Remedies Bequeathed by Ghosts actually combine both internal and external treatments. (d) Official medical education began in the twentieth year of the Yuanjia period during the Southern Song Dynasty (CE 443). The imperial official Qin Chengzu is reported to have established a department for medical education. So, in this way, medical education became academic, and was not confined to family mentoring or master–disciple discussion anymore. Since then, medical education began to be standardized and the status of doctors relatively improved. (e) Taking medicine for longevity became a part of lifestyle. Unconventional scholars taking medicine for longevity was a lasting and popular attraction during the Wei, Jin, Southern and Northern Dynasties. On the one hand, people lived tranquil, empty and sage-like lives; on the other, they were unconventional, uninhibited and lived for trifles. At the same time, people strove to make dan, take dan and medicine in order to live long, and so on and so forth. This was an open, free and even anarchic or laissez-faire society. The “diseases of civilization” became unprecedented and wildly rampant. Treating this disease became the task of the physician — a situation quite similar to that of the modern world. As Emperor Wen established the Sui Dynasty, the turbulent times of the Wei, Jin Southern and Northern Dynasties finally ended. What did the medicine of this period leave behind for future generations? There were a great deal of new medical experiences — yielding much for us to understand and choose from. Who did the choosing? How did they choose? What did they choose? Let’s see how our “worthy and wise predecessors” did in the Sui and Tang dynasties.

161. Great Achievements Made During the Prosperous Sui and Tang It can be said that it was in the natural course of things that medicine would become epitomized during the Sui and Tang Dynasties. A rich experience accumulated during former dynasties, along with a prosperous and peaceful atmosphere which made it convenient for scholars and to pass on information — these are the excellent factors that aid in the creation of any masterpiece.

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Agglomeration may include everything and anything, or else be selective — according to the trends and requirements of the times and the writer. During this period, the direction of the selection was mainly determined in the following way: (1) Guiding theory: Natural philosophy or witchcraft (including prophecy)? (2) System of practice: Syndrome differentiation or accumulation of experience? (3) Mode of editing: Swallow anything and everything or put a particular emphasis on something special? Of course we cannot evaluate the ancients by our present standards — or require them to think like we do today. We can only make inferences from the works and writings they left behind. Actually Ge Hong had already done just this in his grand example — his 100-volume Prescriptions in a Jade Box (also known as Prescriptions from the Golden Chamber). Handy Prescriptions for Emergencies also derived from this work, and was put together as a summary of convenient remedies for emergencies. Prescriptions in a Jade Box has been lost but we can gain some idea of what it contained from the Handy Prescriptions for Emergencies. However, our surviving edition has been supplemented and reedited so greatly by Tao Hongjing that it is difficult to know what state the original was in. The next volume which draws our attention is the Classified Prescriptions of the World in 2600 volumes, published during the Sui Dynasty. It was recorded in the History of the Sui Dynasty and History of the Tang Dynasty and quoted by the Newly-Revised Materia Medica. But this book has also been lost, so we cannot judge it either. Its background and relationship to the General Treatise on the Cause and Symptoms of Diseases have been discussed earlier.10 Actually both the General Treatise on the Cause and Symptoms of Diseases and Classified Prescriptions of the World can be regarded as one. These were the first voluminous books in Chinese medical history. But Classified Prescriptions of the World was all-embracing and disorganized. Without a theory of causality and symptomology, it was not able to deal with “treatment by syndrome differentiation”. So it did not survive, and finally went missing. However, Mr. Chao’s General Treatise on the Cause and Symptoms of Diseases provided the theoretical foundation 10

 Section 103 of Chapter 12.

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for “causality and symptomology” in traditional Chinese medicine. Although it was inaccurate in some of its conclusions, it was still unprecedented. The experiences of the previous Sui Dynasty were classified under a system of internal causes, external causes, pathological mechanisms, blood and viscera. This was a development of the system of syndrome differentiation following the ideas of Zhang Zhongjing. Unfortunately, this book has no prescriptions and skips over acupuncture, massage and daoyin, which are fairly serious shortcomings for such a comprehensive masterpiece. These shortcomings were compensated by what followed: Sun Simiao’s Valuable Prescriptions for Emergencies and Wang Tao’s Medical Secrets from the Royal Library during the Tang dynasty. The difference between them was as follows: Sun Simiao had extensive knowledge, covering all “three religions” and “nine schools of thought”. He especially began to learn medicine at 18, had “some understanding” and began to practice at 20. He already had a rich life in medicine when he travelled to the capital — and wrote his Valuable Prescriptions for Emergencies during the period between CE 627 and 640.11 He had the theoretical foundation, rich medical experience and an open mind along with experience in dealing with foreigners, so he was able to integrate fully all the medical thought up to and including the Tang Dynasty — and make it into a fine agglomeration. This included both his own personal experiences and innovative theory. Wang Tao lived nearly one hundred years later. He was a library official and had easy access to books in the Royal Library. He had a rich accumulation of knowledge, but was not a doctor, so did not have a deep understanding of medicine. Although he had sometimes treated his family, he was not a doctor at all. At most, he was only an amateur and much inferior to Simiao in his medical achievements. Therefore, Medical Secrets from the Royal Library is mainly a compilation of documents. He had read and collected together more medical texts than Sun Simiao. But it was difficult for him to comment and summarize them, as did Sun Simiao. However, Medical Secrets from the Royal Library is really a brilliant book — carrying on the tradition of the treatments contained in Mr. Chao’s General Treatise on the Cause and Symptoms of Diseases and Simiao’s Valuable Prescriptions for Emergencies. Frankly, A Supplement to Invaluable Prescriptions for Emergencies is not as valuable as Invaluable Prescriptions for Emergencies. Sun Simiao said 11

 Ma Boying. Sun Simiao’s Birth Year and Biographical Chronology, Chinese Medical Journal, vol. 11, no. 4 (1981).

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in his preface to A Supplement to Invaluable Prescriptions for Emergencies that his desire was “… to standardize profound medical theory, explore ancient and modern medical knowledge and write a prescription book called Invaluable Prescriptions for Emergencies. It can save people in need, keep them fit, and perfect them with its subtle truths. Watching from the top of Taishan Mountain, I’m still afraid that something subtle might have escaped my sight; that rumbling thunder might cover the lingering sound of the jade chimes. So I have added thirty more volumes in order to perfect this book. They are all in harmony with each other and have boundless power in combination. If they are used together, the effect will be immeasurable… If a nobleman reads this book, he will understand my ambition.” This expresses the fact that he wanted to make his Invaluable Prescriptions for Emergencies as perfect as possible. But, excepting the sections on “medical records”, “cold injuries” and some foreign prescriptions, the added content is quite miscellaneous and often repeats itself. There are two volumes especially of “Jin Scriptures”, all about Taoist magic and incantation, which are quite different from true medicine. The result is that recently some scholars have suspected that Supplement to Invaluable Prescriptions for Emergencies is a book written later and given in name to Sun Simiao.12 But I believe its author was indeed Sun Simiao. Sun Simiao said in “Exogenous Febrile Diseases — Part One” in vol. 9 of the Invaluable Prescriptions for Emergencies that “the doctors south of the Yangtze River keep the important prescriptions of Zhang Zhongjing a secret and do not impart them to others.” He supplemented a lot of prescriptions in Invaluable Prescriptions for Emergencies after he had carefully “spread out many great treatises on febrile disease and mustered up their mysteries.”13 Lin Yi, the famous Song editor, said in his epilogue to the book that the sixteen fascicles on “febrile diseases” — “including two volumes” added in the Supplement to Invaluable Prescriptions for Emergencies — were all “very ingenious and profound”. This is quite correct. He also mentions that “… there appeared the book Invaluable Essences later. I read it and believe it not to have been written by Sun Simiao but by some busybody. It was also not mentioned in Wang Tao’s Medical Secrets from the Royal Library, which records the source of every prescription. So the book seems to have been finished by the end of the Tang. Scholars should 12

 Gao Xiaoshan. The Author of the Supplement to Invaluable Prescriptions for Emergencies in Question, Chinese Medical Journal, vol. 37, no. 2 (2007), pp. 104–107. 13  Ma Boying. Treatise on Febrile Diseases Read by Sun Simiao, Journal of Traditional Chinese Medicine, no. 11 (1982).

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not mistake it as being written by Sun Simiao.” So the Song Dynasty scholars reached these conclusions. However, I judge the ancients by modern requirements and believe the Supplement to Invaluable Prescriptions for Emergencies to be less valuable than Invaluable Prescriptions for Emergencies. Here, I want to explain that these integrated books could not escape being somewhat mixed up and random. And Sun Simiao was rather a Taoist — as was Ge Hong before him. His Just be Simple was full of incantations. Was it not then natural for Sun Simiao also to collect incantations and include them in his books? The Newly Revised Materia Medica of the Tang Dynasty was the first national pharmacopoeia recorded in history, and it was put together under the charge of Su Jing. In fact, we may as well regard it as a “corpus of pharmacology” because the 850 medicines included in this book are much more than the 365 in Sheng Nong’s Herbal Classic in addition to the 736 in the Annotated Shen Nong’s Herbal. Many of them came from aboard. Those who contributed to its writing were as many as 23 persons. They spared no effort in collecting information. In such a fashion, after the time of Chao Yuanfang during the Sui dynasty, and the works of Sun Simiao in the early Tang, an official medical system of education was established with the creation of an Imperial Medical Bureau — and medicine in the Sui and Tang Dynasties progressed, according to a relatively stable plan.

162. Chinese Medicine Takes on an Organizational Structure During the Northern and Southern Song Dynasties If witchcraft was characteristic of medicine during the Shang and Zhou, “Tao medicine” was characteristic of the medicine during the Qin and Han. The general idea is that Taoist thought excluded the philosophy of witchcraft — and created its own theoretical medical system. This was in accordance with the natural laws of health and disease, and so became accepted by medical practitioners and became mainstream. However, this does not mean that it was accepted or protected by the whole of society. This identification, acceptance and protection of all people was not realized until a system of Confucian medicine, or Confucian orthodoxy, was established during the Northern and Southern Song Dynasties. In effect this was the patterning and creating of a medical, social and ecological form. People always say the general characteristics of the Chinese are “Confucian without and Taoist within”. This indeed was the basic form of medicine during and after the Song dynasty.

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Being a “Taoist within” refers to understanding Chinese medical theory, created under the guidance of Taoist natural philosophy and forming the academic backbone of Chinese medicine. “Taoist” here refers to the Taoist school (of the Warring States period 475–221 BCE) not the “Taoist religion”, even though the latter may also be classed within “Taoist medicine” in a broad sense. There were many religious factors within “Taoist medicine”. We put this question aside for the moment. The mode of thinking in “Taoist medicine” was to advocate nature, its philosophical form being “the Tao modeled on nature”, its main characteristic was a theory of ecological medicinal practice, its behaviour patterns embraced “healing through noninterference”, its living state was loose and free, its doctors free, open and tolerant, their personality independent and unconstrained. In this way Chinese medicine took the Huangdi Neijing as standard, but in addition was also inclusive, compatible and open to everything, just as “the Han and nonHan live in harmony”. The saying “medicine as a sense” (or “medicine as intent”) profoundly reflects the true essence of this Taoist medicine.14 To call this a “Confucian medicine” mainly reflects the medical system, teaching institutions, ethics, mode of practicing medicine, etc. Bluntly, it was a management system. This system was not formed at a stroke during the Song Dynasty. It was a gradual process. Emperor Wu during the Han advocated a “Confucianism-only” ideology, but the Tang Dynasty again advocated Taoism. Social thinking repeated itself, again and again. Confucianism and Taoism have always been interlocked in Chinese culture, Confucianism within Taoism, Taoism within Confucianism. The feudal system of Chinese society was thus established and strengthened by this process. The system of medicine and its regulation was also gradually formed and solidified — being especially obvious during the Song dynasty. But the psychology of the physician could not so easily be changed. The “Confucian without and Taoist within” attitude was extraordinarily tenacious in the medical domain. With a “sage-like” appearance and “drifting along with nature”, this was not often seen without, while within the thinking mode was always the same. “Behaving in a fit and proper fashion” meant being a “Confucian”, but smart thinking and taking nature as it comes were fundamental to the “Taoist”. With outer and inner in harmony, the physician did not go beyond the rules and his creative thinking was not choked either; he could maintain stable progress and hold an open, tolerant and embracing attitude towards all other forms of knowledge. But despite this, in the final 14

 See Section 153 of Chapter 20.

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analysis even the “Confucian without and Taoist within” eventually changed. Within the framework of Chinese culture, this medicine may generally be referred to now as “Confucian medicine” or “Confucian medical culture”. The Song Dynasty united the country after a 53-year period of unrest, the Five Dynasties and Ten Kingdoms, which ended the late Tang Dynasty. Many emperors during these times loved medicine and the status of medicine improved relatively. The Imperial Medical Bureau of the Tang had been renamed the Imperial Medical Service and this was maintained, consolidated and further developed during the ensuing Song dynasty. Though the “three she method” (“three generations” method) periodically rose and fell, it still delivered medicine into a Confucian system. This made it impossible for medicine to be excluded any longer. The compilation, emendation and printing of a large number of books expanded the number of doctors. “If one can’t be a good prime minister, one can try to be a good doctor” (originating with Fan Zhongyan) became a rousing call — and a large number of scholars who failed in the imperial examinations joined the medical ranks. Confucianism had already deeply rooted itself within medicine. Being “benevolent in medicine” was the basic ethical approach for a Song medical practitioner. Being “benevolent” in “medicine” meant being a “Confucian” — but it covered also being a “Taoist doctor” as well. The best doctors were Confucians. Doctors were Confucians who could not find any official position. This was the social consensus. The integration of Confucianism and Chinese medicine had a close relationship with the establishment of Zhu Xi and Zhou Dunyi’s neo-Confucianism, which had also included Taoist thought. When traditional medical theory took the Huangdi Neijing as the standard it meant it made obeisance to neo-Confucianism, namely Confucianism. Later on many physicians followed Lu Jiuyuan and Wang Yangming’s School Of Mind (xinxue 心学 “mentalism”). Within this integrated system, doctors found their own academic free space. They lived so well they found no contradiction in this. It was in the nature of Taoist thinking and behaviour to be free from secular constraints — and they became fettered to some extent. But in the medical field, the impact was not great and creative ingenuity not greatly affected. In fact, “medicine” and “transformation” (yi 医 “medicine” and yi 易 “change”) share the same source. If there are new achievements in Taoism, their doctors are certainly not going to refuse any source or method. During the Song Dynasty, in addition to the great achievements made in medical publishing, due to the development of printing and government intervention, what stood out most was the gathering together and editing of

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herbal medicine and prescriptions, the establishment and popularization of a systematic “theory of exogenous febrile disease”, the clinical division and specialization of medical theory, and a final summation of all clinical experience. Here are some examples: the Classified Materia Medica (1083) had a greater historical value than Li Shizhen’s later Compendium of Materia Medica (1578); the scale of integration within the Taiping Royal Prescriptions (992) and General Medical Collection of Royal Benevolence (1111–1117) was much larger than that achieved in the Tang; there were small, simple, effective and systemic prescription books as well, which played an active role in the popularization of prescriptions; the number of commentaries on Zhongjing’s Treatise on Febrile Diseases now passed more than 100; this “Zhongjing” book was actually not a secret anymore — and Zhongjing was now known as a medical sage with his works becoming classics; Qian Yi’s Key to the Therapeutics of Children (1,114) laid the foundation for TCM pediatrics; Chen Ziming’s Complete Effective Prescriptions for Women (1,237) also became a classic in the obstetric and gynaecological world — indeed, “praying for a child” showed especially the characteristic advantages of using Chinese medicine, which led the world at this time. Of course, there was also the development of acupuncture and so on. This has been described earlier in the book and in other medical histories, so I won’t cover the field again. But one needs to point out that all these medical publishing advances were closely linked to the establishment of a theory of TCM, used in different ways and developed along with various personal experiences. It is due to them that we owe the completion of TCM as a separate system. In summary, the main achievements during the Song Dynasty were the completion of an organizational structure within TCM — and the exploitation of any and all prospects for its stable development.

163. Chinese Medicine in Contention During the Jin and Yuan Dynasties and Its Superstable Formation During the Ming and Qing The overall situation has been settled, the framework established and Chinese medicine has matured. Next, Chinese medicine will develop, propagate and be embellished into something quite beautiful and unique. After the passing of the Southern Song dynasty, we come across the “Four Great Doctors of the Jin and Yuan”, originating in the Jin Dynasty and the subsequent period, actually five great doctors — Zhang Yuansu, Liu Wansu, Zhang Zihe, Li Dongyuan and Zhu Danxi. It may be said that the

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contention between them added many broad features to the outline of Chinese medicine. However, the study of their history and writings shows that they “expressed their own views and did not contend among themselves at all.” These great doctors lived at differing times and never attacked each other — this is despite the fact that Liu Wansu was a little resentful of Zhang Yuansu as Zhang offered to treat him when he was sick (Liu Wansu was the older by 30 years). The term “contention” is simply used to emphasize that they actively put forward some wonderful opinions and innovative theories. For example, there was Liu Wansu’s theory of “warm diseases”, Zhang Yuansu’s “mode of medicating root and branch, deficient and excessive viscera” and the “guiding action” medicine of meridianreturning and meridian-leading theory, Zhang Zihe’s “purgation method”, Li Gao’s “spleen and stomach” theory and also that “of tonifying the spleen earth with warm medicines”, Wang Haogu’s theory of “yin syndrome” and of “tonifying kidney-yang with warm medicines”, and Zhu Zhenheng’s theory of “ministerial fire”, the “yang often being excessive and yin often deficient”, and “nourishing yin to reduce fire”. These innovative theories came from three basic foundations. The first was their deep understanding and profound knowledge of classical theory and its discourses, such as the Huangdi Neijing, Nan Jing, Sheng Nong’s Herbal Classic, A Treatise on Febrile Diseases and Synopsis of Golden Chamber; the second was their own rich experience in diagnosis and treatment; the third was that they sought “the truth from the facts”, dared to reflect and innovate — by saying that “ancient formula cannot treat current disease anymore because of continuous changes in the physical, social and natural environment”. This was indeed innovative — because it meant keeping up with the times and blazing out a new trail. They provided a rubric for those physicians following “don’t go beyond classical theory develop new experiences” and thereby TCM was continuously enriched and developed. Such a pattern was also reflected in their absorption and integration of foreign medicine, for example, Hui medicine (from the Muslims) during the Yuan Dynasty.15 The point is that this framework or “basket” meant that things within the “basket” could become “dishes”. The basket or framework provided an “organizational structure” during the Song and Yuan. In other words, it actually formed a methodological system, that is, a logical system of inference. All new experiences went into the basket, through the rational 15

 Specific explanation of this is provided in another volume.

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thinking of medical scientists and thus entered into a logical system — which could provide innovative new theories. Reviewing the medical progress made during the Ming and Qing dynasties, almost all famous doctors followed this pattern in creating their own medical theory. Take the following series of treatises on febrile disease as an example: there was Wang Lu’s Review of the Medical Classic, Fang Youzhi’s Analysis of the Treatise on Febrile Diseases, Yu Jiayan’s On the Treatise of Febrile Diseases, Ke Qin’s Renewal of the Treatise on Febrile Disease, You Yi’s A Thorough Study of the Treatise on Febrile Disease and so on. Some doctors developed theories according to their own ideas, for instance, Dai Sigong, Yu Chuan and Zhang Nan; some criticized the predecessors and created their own theories, for example, Zhang Jiebin’s Jing-Yue’s Complete Works and Zhao Xianke’s Thorough Knowledge of Medicine. Annotated or reedited works were Lou Ying’s Compendium of Medicine, Wan Quan’s Wan Mizhai’s Complete Medical Book, Zhang Luyu’s Mr. Zhang’s General Medicine, Gao Wu’s Assembly of Acupuncture and Moxibustion, Xu Chunfu’s Ancient and Modern Medicine, Sun Yikui’s Pearls from Chishui Water, Yang Jizhou’s Compendium of Acupuncture and Moxibustion, Wang Kentang’s Standards of Diagnosis and Treatment, Zhang Jiebin’s Classified Canon, Wu Qian’s A Golden Mirror to the Medicine, Li Shizhen’s Compendium of Materia Medica, and other annotations by Zhang Zhicong and Lu Shantang. Skilled critics, such as Xu Dachun, also expressed their own opinions in this fashion. It is particularly worth mentioning Zhang Jingyue who summed up “eight key-links for differentiation between syndromes”16 (八纲辨证), which were applicable to all diseases and convenient for use in the clinic. These really could be described as the key link to everything. We have to admit that the result of all this activity was the ancient physicians came to be seen as less conservative — they could not be put into any kind of a stereotypical system nor could they be used to shackle any new development. Accurate evaluation of these times shows that, through these doctors own personal efforts, TCM opened up into a new superstable system — the whole became unshakable and difficult to break, and they managed to blaze a fresh trail for TCM practitioners to follow, instead of choking any innovation. As an example, we might have a look at the rise of the “febrile diseases” school. Generally speaking, the author Wu Youke (1582–1652) in his 16

 See later.

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Treatise on the Warm Pestilence at the end of the Ming dynasty (published 1642) and the authors Ye Tianshi of the Treatise on Warm Diseases, Wu Tang of a Detailed Analysis of Epidemic Warm Diseases and Wang Shixiong of Principles of Warm Diseases during the Qing became known as the “four masters of febrile disease”. Besides them, there were less famous doctors earlier on. But anyway, what was important was that they formed a totally different way of making diagnoses and carrying out treatment to that practiced in the past. It can be seen in the Treatise on Febrile Diseases that Zhang Zhongjing inherited “fever theory” from the Suwen and also the “six meridians transmission theory” concerning the “three yin and three yang”. Fever Theory informs us that “exogenous fever disease is due to cold attack. Some patients recover in ten days, but ‘some die within six or seven days’.” Six Meridians Transmission Theory extended this to the “syndrome-differentiation by the six meridians”. According to the symptoms, most would be described as flu or common cold in modern medicine. Interestingly enough, “cold” is “冷”, referring to disease caused by the cold. It means the same as “伤寒” (“a cold attack”) in Chinese medicine. Zhongjing’s “syndromedifferentiation by the six meridians” achieved great success and used just a few appropriate prescriptions, so it was a brilliant idea. But Zhongjing encountered few patients with warm disease. He just stated (in article 6 in his Treatise on Febrile Diseases) that “Taiyang disease has the symptom of fever and thirst. Taiyang disease with no aversion to cold is a warm disease.” Time went by and the situation changed. A knowledge of diseases caused by fire grew and Liu Hejian (Liu Wansu) developed the idea of “fire pathogenesis”. He treated the fire with cold and cooling medicine, but Zhang Congzheng treated it with sweating, vomiting and purgation. They were creative but limited to the idea that “heat disease was some kind of exogenous febrile disease”. They could not break from the fetters of febrile disease. In fact, some people had already put forward the idea that some fever diseases could be explained as “cold attack” and treated with descriptions for exogenous febrile diseases. Ge Hong’s Handbook of Prescriptions for Emergencies and Chen Yanzhi’s Classical Prescriptions had recorded some fever diseases which could not be named exogenous, including those due to pestilence and warm disease. “Pestilent qi” (liqi — “ghost qi” or “evil qi”) was also proposed. But they still clung to the idea of an exogenous febrile diseases, so a theory of warm disease could not be established either. Wu Youxing (Wu Youke) was the only one who made an overall observation of acute infections and febrile diseases at that time, and discovered the differences between them.

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He stated, “What physicians talk about and record is just exogenous febrile disease. But plague is common in the clinic and exogenous febrile disease actually occurs less than once or twice in a hundred cases.” So during the era of Wu Youke, cold or flu was not seen as a common epidemic disease. He said, “There is a whale of difference between epidemic febrile disease and exogenous febrile disease” and “Epidemic febrile disease is not cause by wind, or cold, or summer heat, or heat, but by a completely different kind of qi to that existing between heaven and earth.” He named this qi “miscellaneous qi”, “epidemic qi”, “evil qi” and “pestilential qi”. In general, this was called “the theory of evil qi causing disease” by later generations. Although his theory was not “the theory of microbial pathogenesis” proposed in the West 200 years later, it was not far from it. If microscopes had been available, he might have found the truth — that the epidemic was due to a bacterium. Let us leave this question open for now. In terms of traditional Chinese medicine itself, it summarized another guiding principle of syndrome differentiation, totally different from that of the Treatise on Febrile Diseases — “interior–exterior nine-pass syndrome system of differentiation”. This was a remarkable try at innovation in TCM. It was an unprecedented challenge to the ideas of the Treatise on Febrile Diseases which had lasted 600 years, since the Song Dynasty. Moreover, it challenged the ideas of the ancients. Unfortunately, Wu Youke’s “syndrome differentiation” did not go far enough. Zhang Zhibin has pointed out that it was unclear, repetitive and unhelpful. It was much discussed, but used little in the clinic.17 The statement is well reasoned. Wu Youke differentiated epidemic febrile disease (warm disease) according to etiology and semiology, but did not solve clinical diagnosis and treatment. This historic responsibility fell on his successors. First, Ye Tianshi created “defensive qi and nutrient blood” syndrome differentiation and Xue Xue created “sanjiao differentiation” in his Treatise on Damp-Heat Diseases, both writing at almost the same time; second, Wu Tang popularized sanjiao differentiation for all warm heat diseases; finally, Wang Shixiong summarized all the diagnoses and treatments of warm disease in his Principles of Warm Disease. This solved the clinical problem. People could do nothing about infectious disease in the West, but Chinese doctors successfully treated and controlled epidemic diseases with their wisdom and creativity, which is a remarkable achievement. In the 17

 Zhang Zhibin. Chinese Ancient Epidemic Chronology, Fujian Science and Technology Press, 2007, p. 135.

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West, the British Fleming discovered Penicillin in 1928 and the German Mark discovered Sulfonamides. There was no effective way to deal with bacterial infection until these medicines were used in clinic in the 1940s. Furthermore, western doctors are now not only troubled by drug resistance but also have no specific medicine for any viral infectious disease. Chinese medicine more or less has a method to deal with it. In 2003 SARS suddenly broke out in China. Chinese medicine and Western medicine were struggling to treat it, but finally SARS was controlled. After having conducted an investigation, the World Health Organization concluded that the treatment of Chinese medicine was effective for SARS.18 This meant that warm disease theory had finally found a place to display its prowess in modern medicine. The great invention of variolation against smallpox and its achievement have also been described in detail in another chapter.19 Another example of innovation in this superstable structure of traditional Chinese medicine comes from the innovative work of medical scientist Wang Qingren (1768–1831). His achievement was not a new anatomy, but the formulation of a series of prescriptions for “promoting blood” and “removing blood stasis” — with significant clinical effects on various problem diseases. According to Tang Rongchuan (or Tang Zonghai, a late 19th century physician), the system for promoting blood and removing blood stasis had been basically established by then. This remarkable innovation was the key to treating many miscellaneous diseases. Such works with this so-called “innovative spirit” also belong within this superstable structure. The integration of both the schools of Chinese medicine and Western medicine takes TCM as the mainstream — with Western medicine as forming the tributaries — in order to form “Chinese medicine as root and Western medicine as tool”. Medicine in the Ming and Qing Dynasties was like a huge hoist, bringing all kinds of medical knowledge and experience up and together, in order to form a new theory. Thus, it achieved its full and complete development. The medicine of the Qing Dynasty made great contributions. During this period, Chinese medicine indeed became superstable and made continuous innovations, as well as making progress. This is a fact that can never be denied. The points made above are just some of the characteristics and achievements of this important stage of development in Chinese medical history. 18

 ibid., p. 129.  Chapter 14.

19

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It can be contested that some branches, including witchery and superstitious activity, never completely stopped or disappeared. However, one flaw does not obscure the splendour of a jade, just as a single cloud will not cover the sun. The mainstream of Chinese medicine remains healthy and eternally pushes forward, just like the Yangtze or Yellow River.

B. Important Works and Famous Doctors from the History of Chinese Medicine 164.  Three Shi Chinese Medicine and the Four Classics “If a doctor does not learn three-Shi medicine, his medicine cannot be taken.” This is a classical statement from The Book of Rites – Specific Minor Rites II. Regardless of its original meaning, the two meanings given to this phrase by later generations have outlined precisely several characteristics in the practice and inheritance of TCM. The meaning of “three Shi” was different in differing dynasties. Some people thought the three Shi referred to the medicine of three Kings (Fuxi, Shennong and Huangdi), because ancient Chinese inventions are likely to be traced back to these three Kings. This cannot be taken as proper evidence. Some thought “the three Shi refer to Huangdi’s acupuncture, Shennong’s medicine and Sunu’s pulse-taking. If a doctor does not study their three books, his medicine cannot be taken.”20 This idea is worth looking at. Now we cannot read Sunu’s Pulse book anymore, but it had been cited in many ancient texts, for instance, the Pulse Classic. It was quoted in a few other places, such as the Suwen, the Acupuncture Classic, the Treatise on Febrile Diseases (by Zhang Zhongjing) and the Four Seasons. In most cases, these quotes are not noted but only hinted at, such as in the Neijing in the Treatise on Pathogenic Cold and Miscellaneous Diseases. We can speculate that even the founder of pulse study proper, Wang Shuhe, had not read Sunu’s Pulse. The text Pulse Changes is mentioned in the Neijing, and a Pulse Method in the Mawangdui medical books and a Pulse Book in Cangong’s medical records, but The Sunu Pulse is not mentioned in any other medical document. Personally, I think this book should be dated after the Neijing and close to the time of Shennong’s Herbal Classic. These two books coexisted. Taking The Sunu Pulse, Neijing and Shennong’s Herbal Classic as the three Shi books reflects the need for medical theory and clinical practice to 20

 Integrated Medical Records of Ancient Books and Modern Books, vol. 501.

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a certain degree. Learners can find their criteria for study in these three books and solve the manipulation of diagnosis (by the pulse) and treatment (through acupuncture and herbs). Another common interpretation of “three Shi medicine” is that it meant “medicine passed down from father to son over three generations” or “an inheritance between master and apprentice over three generations”. These different explanations exist because The Book of Rites itself is only vague in its reference. But if we look a little deeper, the classical theory of medicine did not exist at that time, so it is rather far-fetched to classify Three King’s Books as referring to “three-Shi medicine”. In the era of The Book of Rites, outstanding doctors such as Bianque were not that many, but gradually became known to the people. It is understandable that doctors were more skilled and secure if they had a teacher. The Book of Rites is usually considered to have been finished between the pre-Qin period and beginning of the Han Dynasty. It records the rituals of the Zhou. It was earlier than Huangdi’s acupuncture classic, Shengnong’s herbal classic and Sunu’s Pulse book. So “three-Shi medicine” in The Book of Rites actually might not refer to these three books. It states, “if a doctor has practiced medicine for three generations, he certainly has treated a lot of patients and is very skilled in medicine. His treatment is safe and his medicine can be taken. This is the proper course in taking medicine.” “If one has been taught for three generations, he can see something invisible. People say the old are doctors — and the young are diviners.” So “three-Shi medicine” here actually seems to suggest the importance of clinical experience and the approval of experimentation. All in all, the two explanations made by later generations summarize the inheritance and the developing method of the TCM system. This even affected modern medicine to a certain extent. We may witness the establishment of the “four Chinese medical classics” as a continuation of this idea — even though it happened quite a lot later. The so-called “four major Chinese medical classics” were discussed and determined by the Chinese government in 1956, in the process of the establishment of a Research Institute of TCM and the colleges of traditional Chinese medicine on the mainland. The situation was actually quite controversial and confusing. The Huangdi Neijing (including the Suwen and Lingshu), the Nanjing, Shennong’s Herbal Classic and the Treatise on Pathogenic Cold and Miscellaneous Diseases (including the Treatise on Febrile Diseases and Synopsis of the Golden Chamber) best describe these four classics. But some experts thought epidemic febrile disease theory should also be selected, and the Nanjing be included with the Neijing — making up the “Neinan”. However, warm disease is difficult to present in a

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book. Ye Tianshi’s Treatise on Warm Diseases is too short. In addition, the theory of epidemic febrile disease was formed slightly later than the other classics. Some people omit Shennong’s Herbal Classic, divide the Huangdi Neijing into the Suwen and Lingshu, and divide the Treatise on Cold Pathogenic and Miscellaneous Diseases into the Treatise on Febrile Diseases and Synopsis of the Golden Chamber, and with the Nanjing make it five books altogether. The Four Classics of Chinese Medicine published twelve years ago included some of these books.21 In the past, every physician could make his own choice. For instance, Sun Simiao, the famous doctor of the Tang dynasty, inculcated this in his text Concerning Great Physicians in Valuable Prescriptions for Emergencies: Anyone who wants to be a great physician, must be familiar with the Suwen, A–B Classic of Acupuncture and Moxibustion, Huangdi’s Acupuncture, the Mingtang Twelve Meridians, the Three Parts and Nine Divisions, the Viscera, Acupoints, Chinese Materia Medica, Couplet Medicines and the classical prescriptions of Zhang Zhongjing, Wang Shuhe, Ruan Henan, Fan Dongyang, Zhang Miao, Jin shao, etc. Probably these medical classics were those most read at the time; in fact, there were numerous. Books on philosophy and social sciences were also required. He goes on, “He needs to read various other books as well. Why? If one does not read the five Classics, he will not understand righteousness; if one does not read the three Histories, he will not understand the past and present; if he does not read the books of the Philosophers, he will not be sensible; if he does not read the Neijing, he will not understand the seven emotions and six sensory pleasures; if he does not read the books of Zhuangzi and Laozi, he will not live simply and naturally and everywhere be fettered in his destiny. The Five Elements and Astronomy are needed too. If one can study these all carefully, he will perfect his medical skill and go far.” The following doctors which I list below also had their own views. But they advocated that any medical practitioner needed to study other disciplines as well as medicine. This coincides with today’s trends. In modern times, we should not just list the classics in medicine — and leave it at that. There is a difference between inner and outer, primary and secondary medicine. Just as the medical scientist Lu Fu in the Ming Dynasty stated his Medicine’s Seed (also called Zhiyuan’s Medicine Seed) that medicine began in the time of 21

 Fu Jinghua et al. Four Classics of Chinese Medicine, TCM Ancient Books Press, 1996.

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Xuanyuan and Qibo, the Lingshu and Suwen are “the first books on true medicine”, the Benjing and Nanjing can be taken as “the seed of the medical classics” and the Treatise on Febrile Diseases and Synopsis of the Golden Chamber as “the seed of medical theory”, while the prescriptions in these two books were “the seed of prescription”. These books have long been regarded as standard by doctors throughout their extended practice. So it is quite unobjectionable if I myself decide on there being just four Chinese medical classics. This is simply from the perspective of making a theoretical summary and for historical guidance and inspiration. I believe it should be seen as follows: 1. 2. 3. 4.

The Huangdi Neijing (including the Suwen and Lingshu). The Nanjing. Sheng Nong’s Herbal Classic (or Benjing). A Treatise on Cold Pathogenic and Miscellaneous Diseases (including A Treatise on Febrile Diseases, Synopsis of the Golden Chamber, short for the Treatise on Febrile Diseases).

We may thus affirm the great role that TCM theory and the experience of Chinese practitioners played throughout medical history. But this does not exclude people raising questions. At the end of the Yuan Dynasty and beginning of the Ming, there was a physician surnamed Yan. Although his family had practiced medicine for three generations, he was not as good as his countryman Zhu Pinjun who became a doctor through self-study. People use this example to prove he was mistaken: “Don’t take a medicine from this physician, if his family has not practiced for three generations.” It is inappropriate to deny a generality because of one specific case, but it is also appropriate to use a special case to pose questions. The inheritance of medical experience and theory does not just happen in a medical family after many generations. There are other ways and factors involved, such as natural endowment, personal effort, clinical experience, creative thinking and the use of novel methods. I wish sincerely that physicians would not be fettered by the idea of being in a “medical family for generations” and studying the “classics”.

165.  The Works Extant in Chinese Medicine Worth Reading Chinese medicine books number more than 6,100 according to the Dictionary of Traditional Chinese Medicine.22 In addition to the above four 22

 Yu Yingao, Li Jingwei. Dictionary of Traditional Chinese Medicine, Beijing Science and Technology Press, 2000.

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“must-read” classics, each historical period had its own particularly influential classics, for instance, Sun Simiao mentioned several of these above. Doctors should read extensively — and absorb all kinds of knowledge and experience. But some books have been lost, because times change, and there are wars, difficulties in printing, etc. Some important books were left out of the Dictionary of Traditional Chinese Medicine (2000) mentioned above. From my knowledge, I have listed below 138 existing books worth reading, out of those produced before 1949. This classification emphasizes their especially academic nature. Take a Treatise on Three Categories of Pathogenic Factors as an example. Generally speaking, it is a comprehensive medical book, but it made a special contribution to the elaboration of the three pathogenic factors, so it is listed in the first class. The more important books are marked with an asterisk, so that readers may find them easier to select and reference. A. Works of Etiology and Pathology 1. 隋, 巢元方《诸病源候论》Fifty-volume General Treatise on the Cause and Symptoms of Diseases, written by Chao Yuanfang in the Sui Dynasty in 610. 2. 宋, 陈言《三因极一病证方论》 Eighteen-volume Treatise on Three Categories of Pathogenic Factors, written by Chen Yan in the Song Dynasty in 1174. 3. 清, 王清任《医林改错》Two-volume Corrections on the Errors of Medical Works with appendix, written by Wang Qingren in the Qing Dynasty, published in 1830. 4. 清, 唐宗海《血证论》   Eight-volume Blood Syndrome Theory, written by Tang Zonghai in the Qing Dynasty, published in 1884. B. Diagnostic Works  5. 晋, 王叔和《脉经》   Ten-volume Pulse Classic, written by Wang Shuhe in the Jin Dynasty in the 3rd century.  6. 宋, 施发《察病指南》   Three-volume A Guide to Diagnosis of Diseases, written by Shi Fa in the Song Dynasty in 1241.  7. 元, 杜本《敖氏伤寒金镜录》The Gold Mirror of Exogenous Febrile Diseases, written by Du Ben in the Yuan Dynasty in 1341.  8. 元, 滑寿《诊家枢要》One-volume Diagnosis Essentials, written by Hua Shou in the Yuan Dynasty in 1359.  9. 明, 李时珍《濒湖脉诀》One-volume Bin Hu Pulse Book, written by Li Shizhen in the Ming Dynasty in 1564.

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10. 清, 张登《伤寒舌鉴》One-volume Tongue Diagnosis of Exogenous Febrile Diseases, written by Zhang Deng in the Qing Dynasty in 1668. 11. 清, 林之翰  《四诊抉微》Four Diagnostic Methods, written by Lin Zhihan in the Qing Dynasty in 1723. C. Works on Acupuncture and Moxibustion 12. 晋, 皇甫谧  《针灸甲乙经》Ten-volume A–B Classic of Acupuncture and Moxibustion, written by Huangfu Mi in the Jin Dynasty in 259. 13. 宋, 王执中  《针灸资生经》Seven-volume Experience on Acupuncture and Moxibustion, written by Wang Zhizhong in the Song Dynasty, published in 1220. 14. 金, 何若愚  《子午流注针经》Three-volume Midnight-Noon and Ebb-Flow Acupuncture, written by He Ruoyu in the Jin Dynasty before 1153. 15. 元, 滑寿  《十四经发挥》Three-volume Elucidation on Fourteen Channels, written by Hua Shou in the Yuan Dynasty in 1341. 16. 明, 徐凤  《针灸大全》Six-volume Complete Works of Acupuncture and Moxibustion, written by Xu Feng in 1439. 17. 明, 高武  《针灸聚英》Four-volume An Assembly of Acupuncture and Moxibustion, written by Gao Wu in the Ming Dynasty in 1529. 18. 明, 李时珍  《奇经八脉考》One-volume Study on the Eight Extra Channels, written by Li Shizhen in the Ming Dynasty in 1578. 19. 明, 杨继洲  《针灸大成》Ten-volume Compendium of Acupuncture and Moxibustion, written by Yang Jizhou in the Ming Dynasty in 1601. D. Works on Chinese Materia Medica 20. 宋, 唐慎微  《经史证类备急本草》Classified Materia Medica from Historical Classics for Emergency in thirty-one volumes, written by Tang Shenwei in the Song Dynasty in 1082. 21. 宋, 寇宗奭  《本草衍义》Twenty-volume Amplification on Materia Medica, written by Kou Zongshi in the Song Dynasty in 1116, published in 1119. 22. 明, 李时珍  《本草纲目》Fifty-two-volume Compendium of Materia Medica, written by Li Shizhen in the Ming Dynasty, published in 1593. 23. 清, 汪昂  《本草备要》Essentials of Materia Medica, written by Wang Ang in the Qing Dynasty, published in 1694. 24. 清, 赵学敏  《本草纲目拾遗》Ten-volume A Supplement to Compendium of Materia Medica, written by Zhao Xuemin in the Qing Dynasty in 1765, published in 1864.

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E. Works on Prescriptions 25. 晋, 葛洪  《肘后备急方》Eight-volume Handbook of Prescriptions for Emergency, written by Ge Hong in the Jin Dynasty in 303. 26. 唐, 孙思邈  《千金要方》Thirty-volume Valuable Prescriptions for Emergency, written by Sun Simiao in the Tang Dynasty in about 652. 27. 唐, 王焘  《外台秘要》Forty-volume Medical Secrets from the Royal Library, written by Wang Tao in the Tang Dynasty in about 752. 28. 宋, 王怀隐等  《太平圣惠方》Taiping Royal Prescriptions in one hundred volumes, written by Wang Huaiyin et al. in the Song Dynasty in 982. 29. 宋, 曹孝忠等  《圣济总录》 General Medical Collection of Royal Benevolence in two hundred volumes, written by Cao Xiaozhong et al. in the Song Dynasty from 1111 to 1117. 30. 宋, 裴宗元、陈师文、陈承及许洪等先后校订  《太平惠民和剂局方》Tenvolume Prescriptions of Peaceful Benevolent Bureau, revised by Pei Zongyuan, Chen Shiwen, Chen Cheng, Xu Hong and others from 1107 to 1110. 31. 宋, 许叔微  《普济本事方》 Twelve-volume Effective Prescriptions for Universal Relief, written by Xu Shuwei in the Song Dynasty in the mid12th century. 32. 宋, 苏轼、沈括  《苏沈良方》 Ten-volume Good Prescriptions of Su Shi and Shen Kuo, written by an unknown person in the Song Dynasty. 33. 宋, 严用和  《济生方》 Ten-volume Prescriptions for Saving Lives, written by Yan Yonghe in the Song Dynasty in 1253. 34. 元, 危亦林  《世医得效方》 Effective Prescription for Generations in nineteen volumes, written by Wei Yilin in the Yuan Dynasty in 1337. 35. 明, 朱等  《普济方》, 《四库全书》 (   版) Prescriptions for Universal Relief edited by Zhu Su and others in the Ming Dynasty in 1390, in 426 volumes in the Complete Library of the Four Branches of Literature. 36. 明, 吴琨  《医方考》, 附  《脉语》 Six-volume Study on Prescriptions, written by Wu Kun in the Ming Dynasty, attached with two volumes of Pulse Language. 37. 明, 汪昂  《医方集解》 Collection of Prescriptions with Notes, written by Wang Ang in the Ming Dynasty, published in 1682. 38. 清, 吴仪洛  《成方切用》 Twelve-volume Correct Use of Prescriptions, written by Wu Yiluo in the Qing Dynasty in 1761. 39. 清, 鲍相璈  《验方新编》 Eight-volume New Compilation of Proved Prescriptions, written by Bao Xiang’ao in the Qing Dynasty in 1846. 40. 清, 费伯雄  《医方论》 Four-volume Theory on Medical Prescriptions, written by Fei Boxiong in the Qing Dynasty, published in 1865.

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F. Comprehensive Medical Works23 41. 元, 朱震亨  《丹溪心法》 Zhu Zhenheng’s Danxi Experience in Medicine in six different books in the Yuan Dynasty, written by his disciples in about 1360. 42. 元, 罗天益  《卫生宝鉴》 Health Mirror in 24 volumes and one supplementary volume, written by Luo Tianyi in the Yuan Dynasty in 1343. 43. 明, 汪机  《汪石山医书八种》 Wang Shishan Eight Medical Books with eight different books, written by Wang Ji in the Ming Dynasty, published from 1522 to 1534. 44. 明, 万全  《万密斋医学全书》 Wan Mizhai Medical Books with 10 different books, written by Wan Quan in the Ming Dynasty, published in 1549. 45. 明, 徐春甫  《古今医统 (大全)》 Ancient and Modern Complete Medical Book with one hundred volumes, written by Xu Chunfu in the Ming Dynasty in 1556. 46. 明, 楼英  《医学纲目》 Forty-volume Compendium of Medicine, written by Lou Ying in the Ming Dynasty, published in 1565. 47. 明, 龚廷贤  《古今医鉴》  Eight-volume Ancient and Modern Medicine Mirror, written by Gong Tingxian in the Ming Dynasty, published in 1589. 48. 明, 王肯堂  《证治准绳》 Sixteen-volume Standards of Diagnosis and Treatment, written by Wang Kentang in the Ming Dynasty in 1602. 49. 明, 张景岳  《景岳全书》 Jingyue Complete Works in 64 volumes, written by Zhang Jingyue in the Ming Dynasty, published in 1636. 50. 明, 张三锡  《医学六要》 Six Essential Branches of Medicine with six different books, written by Zhang Sanxi in the Ming Dynasty, published in 1639. 51. 清, 张璐  《张氏医通》 Mr. Zhang’s Medical Book in seven different books, written by Zhang Lu in the Qing Dynasty, published in 1699. 52. 清, 蒋廷锡等  《古今图书集成医部全录》 Integrated Medical Records of Ancient and Modern Books in 520 volumes, edited by Jiang Tingxi and others in the Qing Dynasty, published in 1706. 53. 清, 徐大椿  《徐灵胎医学全书》 Xu Lingtai Complete Medical Books in 16 different books, written by Xu Dachun in the Qing Dynasty, published from 1727. 23

 Some of the works above were also comprehensive. I will not list them again.

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54. 清, 吴谦等  《医宗金鉴》 Ninety-volume The Golden Mirror of Medicine, edited by Wu Qian and others in the Qing Dynasty, published 1742. 55. 清, 沈金鳌  《沈氏尊生书》 Mr. Shen’s Lives Books in five different books, written by Shen Jin’ao in the Qing Dynasty in 1773. 56. 清, 陆九芝  《世补斋医书》 Buzhai Medical Book, written by Lu Jiuzhi in the Qing Dynasty, a total of 64 volumes with sequels, published in 1866. 57. 清, 唐宗海  《中西汇通医书五种》 Twenty-eight-volume Five Books of Chinese – Western Medicine Combination, written by Tang Zonghai in the Qing Dynasty in about 1884. 58. 清, 周学海  《周氏医学丛书》 Mr. Zhou’s Medical Books in 32 different volumes, edited by Zhou Xuehai in the Qing Dynasty, published from 1891 to 1911. G. Works of Annotation and Research on the Neijing and Nanjing 59. 隋, 杨上善  《黄帝内经太素》 Huangdi Neijing Taisu, written by Yang Shangshan in the Sui Dynasty in an unknown year, only 23 volumes left from thirty volumes. 60. 唐, 王冰  《重广补注黄帝内经素问》 Annotated Huangdi Neijing Suwen in twenty-four volumes, annotated by Wang Bing in the Tang Dynasty in 762, published after being revised by Song Linyi and others. 61. 元, 滑寿  《难经本义》 Two-volume Original Meaning of the Nanjing, written by Hua Shou in the Yuan Dynasty in 1361. 62. 明, 王九思等  《难经集注》 Five-volume Nanjing Variorum, written by Wang Jiusi and others in the Ming Dynasty in 1505. 63. 明, 马莳  《黄帝内经素问, 灵枢注证发微》 The Elucidation of the Huangdi Neijing Suwen and Lingshu, written by Ma Shi in the Ming Dynasty, both containing nine volumes, published in 1586. 64. 明, 张景岳  《类经》 (及图翼, 附翼) The Classified Canon (with figures and supplements) in 47 volumes, written by Zhang Jingyue in the Ming Dynasty, published in 1624. 65. 明, 李中梓  《内经知要》 Two-volume Abstracts of the Neijing, written by Li Zhongzi in the Ming Dynasty, published in 1642. 66. 清, 张志聪  《黄帝内经素问, 灵枢集注》 The Variorum of the Huangdi Neijing Suwen and Lingshu, written by Zhang Zhicong in the Qing Dynasty, both containing nine volumes, published in 1670. 67. 清, 徐大椿  《难经经释》 Two-volume Annotation of the Nanjing, written by Xu Dachun in the Qing Dynasty in 1727.

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H. Annotated Works on the Treatise on Febrile Diseases and the Synopsis of the Golden Chamber 68. 宋, 庞安时  《伤寒总病论》 Six-volume General Instruction of Febrile Diseases, written by Pang Anshi in the Song Dynasty, published in 1100. 69. 宋, 朱肱  《南阳活人书》 Twenty-volume Nanyang Book for Saving Lives, written by Zhu Gong in the Song Dynasty in 1107. 70. 宋, 许叔微  《伤寒发微论》 Two-volume The Elucidation of Febrile Diseases, written by Xu Shuwei in the Song Dynasty in 1132. 71. 宋, 郭雍  《伤寒补亡论》 Twenty-volume Supplement of Febrile Diseases, written by Guo Yong in the Song Dynasty in 1181. 72. 金, 成无己  《伤寒明理论》 Four-volume Concise Exposition on Exogenous Febrile Diseases, written by Cheng Wuji in the Jing Dynasty in 1142. 73. 金, 成无己  《注解伤寒论》 Ten-volume Treatise on Exogenous Febrile Diseases with Notes, written by Cheng Wuji in the Jing Dynasty in 1144. 74. 金, 刘完素  《伤寒直格》 Three-volume Study on Febrile Diseases, written by Liu Wansu in the Jin Dynasty in an unknown year. 75. 元, 王好古  《医垒元戎》 Twelve-volume Marvel Medical Book, first written by Wang Haogu in the Yuan Dynasty in 1231 and rewritten in 1297 after being lost. 76. 元, 王好古  《此事难知》 Two-volume Those Things Hard to Know, written by Wang Haogu in the Yuan Dynasty in 1308. 77. 元, 朱震亨  《金匮钩玄》 Three-volume Exploration of Golden Chamber, written by Zhu Zhengheng in the Yuan Dynasty in 1385. 78. 明, 方有执  《伤寒论条辨》 Eight-volume Analysis of Treatise on Febrile Diseases, written by Fang Youzhi in the Ming Dynasty in 1589. 79. 明, 张遂辰  《张卿子伤寒论》 Seven-volume Zhang Qingzi’s Treatise on Febrile Diseases, written by Zhang Suichen in the Ming Dynasty, published in 1644. 80. 清, 喻嘉言  《尚论篇》 Four-volume Correction on Febrile Diseases, written by Yu Jiayan in the Qing Dynasty in 1648. 81. 清, 柯琴  《伤寒来苏集》 Renewal of Treatise on Febrile Diseases including three books, written by Ke Qin in the Qing Dynasty in 1669. 82. 清, 张志聪、高世栻  《伤寒论集注》 Six-volume Notes to Treatise on Febrile Diseases, written by Zhang Zhicong and Gao Shishi in the Qing Dynasty in 1683.

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83. 清, 尤怡  《伤寒贯珠集》 Eight-volume Collection of Febrile Diseases, written by You Yi in the Qing Dynasty in 1729. 84. 清, 徐大椿  《伤寒论类方》 Four-volume Classified Prescriptions on Febrile Diseases, written by Xu Dachun in the Qing Dynasty, published in 1759. 85. 清, 陈修园  《伤寒论浅注》 Six-volume Annotation of Treatise on Febrile Diseases, written by Chen Xiuyuan in the Qing Dynasty, published in 1820. 86. 清, 徐彬  《金匮要略论注》 Note on Synopsis Golden Chamber in 25 volumes, written by Xu Bin in the Qing Dynasty in 1671. 87. 清, 周扬俊  《金匮玉函经二注》 The Second Note on Yuhan Classic of the Golden Chamber in 22 volumes, written by Zhou Yangjun in the Qing Dynasty, published in 1687 (the first “note” in three volumes, written by Zhao Liangren in the Qing Dynasty). 88. 清, 沈目南  《金匮要略编注》 Annotation of Synopsis of the Golden Chamber in 24 volumes, written by Shen Munan in the Qing Dynasty, published in 1692. 89. 清, 尤怡  《金匮要略心典》 Thoughts on the Synopsis Golden Chamber, written by You Yi in the Qing Dynasty in 1729. 90. 清, 黄元御  《金匮悬解》 Digestion on Synopsis of the Golden Chamber in 22 volumes, written by Huang Yuanyu in the Qing Dynasty, published in 1754. 91. 清, 尤怡  《金匮翼》 Eight-volume Supplement to Synopsis of the Golden Chamber, written by You Yi in the Qing Dynasty in 1768. 92. 清, 陈修园  《金匮要略浅注》 Ten-volume Annotation on the Synopsis of the Golden Chamber, written by Chen Xiuyuan in the Qing Dynasty, published in 1830. I. Works on Epidemic Febrile Diseases 93. 明, 王履  《医经溯洄集》 Review of the Medical Classics including one volume with 21 chapters, written by Wang Lu in the Ming Dynasty, published in 1368. 94. 明, 吴又可  《温疫论》 Two-volume Treatise on Pestilence, written by Wu Youke in the Ming Dynasty in 1642. 95. 清, 叶天士  《温热论》 One-volume Treatise on Epidemic Febrile Disease, written by Ye Tianshi in the Qing Dynasty in 1764. 96. 清, 薛雪  《湿热条辨》 One-volume Differentiation of Damp-Heat Diseases, written by Xue Xue in the Qing Dynasty in an unknown year. The current version was first published in 1831.

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97. 清, 吴瑭  《温病条辨》 Six-volume Differentiation of Warm Diseases, written by Wu Tang in the Qing Dynasty in 1798, published in 1812. 98. 清, 王士雄  《温热经纬》 Five-volume Principle of Warm-Heat Diseases, written by Wang Shixiong in the Qing Dynasty, published in 1852. J. Works on a Special Subject or Special Topic  99. 齐, 龚庆宣  《刘涓子鬼遗方》 Five-volume Remedies Bequeathed by Ghosts, written by Gong Qingxuan in the Qi Dynasty, published in 499. 100. 唐, 蔺道者  《仙授理伤续断秘方》 The Secret Treatment for Trauma and Fracture, written by Taoist Lin in the Tang Dynasty from 841 to 845. 101. 宋, 钱乙  《小儿药证直诀》 Three-volume Key to Therapeutics for Children’s Disease of Qian Yi in the Song Dynasty, edited by his disciples from 1107 to 1110. 102. 宋, 刘昉等  《幼幼新书》 Forty-volume A New Book on Pediatrics, written by Liu Fang and others in the Song Dynasty in 1150. 103. 宋, 张杲   《医说》 Ten-volume Medicine Book, written by Zhang Gao in the Song Dynasty in 1224. 104. 宋, 陈自明  《妇人大全良方》 Complete Effective Prescriptions for Women in 24 volumes, written by Chen Ziming in the Song Dynasty in 1237. 105. 宋, 陈文中  《小儿病源方论》 Four-volume Treatise on Children Diseases, written by Chen Wenzhong in the Song Dynasty in 1254. 106. 宋, 宋慈  《洗冤集录》 Four-volume Record of Redressing Mishandled Cases, written by Song Ci in the Song Dynasty in 1247. 107. 金, 刘完素  《刘河间伤寒三书》, including the  《宣明论方》 (1172 年)、 《素问玄   机原病式》 (1182 年), and  《素问病机气宜保命集》 (1186 年) Liu Hejian Three Books on Febrile Diseases, written by Liu Wansu in the Jin Dynasty, including 15-volume Clear Synopsis on Recipes (1172), one-volume Suwen Original Disease Causes and three-volume Suwen Health Care (1186). 108. 金, 张子和  《儒门事亲》 Fifteen-volume Confucians’ Duties to Their Parents, written by Zhang Zihe in the Jin Dynasty in 1228. 109. 金, 李杲  《内外伤辨惑论》 Three-volume Differentiation of External and Internal Injuries, written by Li Gao in the Jin Dynasty in 1231. 110. 金, 李杲  《脾胃论》 Three-volume Treatise on Spleen and Stomach, written by Li Gao in the Jin Dynasty, published in 1249.

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111. 金, 李杲  《兰室秘藏》 Three-volume Secret Book of Orchid Chamber, written by Li Gao in the Jin Dynasty, published in about 1276. 112. 元, 王好古  《阴证略例》 One-volume Examples of Yin Syndrome, written by Wang Haogu in the Yuan Dynasty in an unknown year. 113. 元, 忽思慧、普兰奚  《饮膳正要》 Three-volume Principles of Correct Diet, written by Husihui and Pulanxi in the Yuan Dynasty in 1330. 114. 元, 齐德之  《外科精义》 Two-volume Surgical Essence, written by Qi Dezhi in the Yuan Dynasty in 1335. 115. 元, 朱震亨  《局方发挥》 One-volume Elaboration on Bureau Prescriptions, written by Zhu Zhenheng in the Yuan Dynasty, published in 1347. 116. 元, 朱震亨  《格致余论》 One-volume Further Treatises on the Properties of Things, written by Zhu Zhenheng in the Yuan Dynasty in 1347. 117. 明, 陈实功  《外科正宗》 Four-volume Orthodox Surgery, written by Chen Shigong in the Ming Dynasty in 1617. 118. 宋, 托名孙思邈  《银海精微》 Two-volume Essence of Eye Diseases in the name of Sun Simiao in the Song Dynasty, issued from 1522 to 1566. 119. 明, 倪维德  《原机启微》 Two-volume The Origin of Eye Diseases, written by Ni Weide in the Ming Dynasty, first published in 1370. 120. 明, 傅仁宇  《审视瑶函》 Seven-volume A Precious Book on Ophthalmology, written by Fu Renyu in the Ming Dynasty, published in 1644. 121. 清, 郑梅涧  《重楼玉钥》 Two-volume Jade Key to the Secluded Chamber, written by Zheng Meijian in the Qing Dynasty, published in 1838. 122. 清, 傅山  《傅青主女科》 Two-volume Fu Qingzhu Works on Obstetrics and Gynecology, written by Fu Shan in the Qing Dynasty, published in 1827. 123. 金, 陈文中  《小儿痘疹方论》 Treatise on Children’s Smallpox, written by Chen Wenzhong in the Jin Dynasty in an unknown year. 124. 明, 万全  《痘疹心法》 Twenty-three volume Experience in Smallpox, written by Wan Quan in the Ming Dynasty, published in 1549. 125. 清, 朱纯嘏  《痘疹定论》 Four-volume A Summary of Smallpox, written by Zhu Chunju in the Qing Dynasty, published in 1713. 126. 清, 张琰  《种痘新书》 Twelve-volume New Book on Smallpox Vaccination, written by Zhang Yan in the Qing Dynasty, published in 1741.

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127. 明, 江瓘  《名医类案》 Twelve-volume Classified Case Records of Famous Physicians, finished by Jiang Guan in the Ming Dynasty in 1568. 128. 清, 魏之绣  《续名医类案》 Sixty-volume A Supplement to the Classified Case Records of Famous Physicians, written by Wei Zhixiu in the Qing Dynasty, published in 1770. 129. 清, 叶天士  《临证指南医案》 Ten-volume A Guide to Clinical Medical Records, written by Ye Tianshi in the Qing Dynasty, published in 1760. 130. 清, 余震  《古今医案按》 Ten-volume Note to Ancient and Modern Medical Records, written by Yu Zhen in the Qing Dynasty, published in 1778. 131. 清, 费伯雄  《医醇賸义》 Four-volume The Medical Essence, written by Fei Boxiong in the Qing Dynasty, published in 1863. 132. 清, 张锡纯  《医学衷中参西录》 The Integration of Chinese and Western Medicine, written by Zhang Xichun in the Qing Dynasty, published in 1909. K. Popular Medical Works and Medical Songs and Rhymes 133. 明, 李梴  《医学入门》 Eight-volume Elementary Medicine, written by Li Chan in the Ming Dynasty, published in 1575. 134. 明, 李中梓  《医宗必读》 Ten-volume Required Readings for Medical Professionals, written by Li Zhongzi in the Ming Dynasty in 1637. 135. 清, 汪昂  《汤头歌诀》 Recipes in Rhymes, Written by Wang Ang in the Qing Dynasty, published in 1694. 136. 清, 陈修园  《医学实在易》 Eight-volume Easy Medicine, written by Chen Xiuyuan in the Qing Dynasty, published in 1808. 137. 清, 陈修园  《医学三字经》 Three-Character Medical Classic, written by Chen Xiuyuan in the Qing Dynasty, published in 1804. 138. 清, 陈念祖  《时方歌括》 Two-volume Medical Prescription Rhymes, written by Chen Xiuyuan in the Qing Dynasty, published in 1801.

166.  Famous Doctors in Chinese Medical History According to the Dictionary of Chinese Medical Characters, there have been over 6,200 historical figures involved in Chinese medicine.24 They all had a different influence on Chinese medicine in different ways. From my own 24

 Li Jingwei. Dictionary of Chinese Medical Characters, Shanghai Dictionary Press, 1988.

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viewpoint, I have selected the following 490 physicians. Among them, some made great contributions and had a far-reaching influence, some were experts in a certain field and saved people from the plague and the like, others were good at dealing with difficult miscellaneous diseases and again others were rural doctors enjoying a local reputation, thanks to their meritorious deeds. A. Famous Doctors in the pre-Qin Period (before 221 BCE) 1. 医缓, Yihuan was a famous physician in the Qin State during the Spring and Autumn Period. In 581 BCE, he was appointed to treat Lord Jing in Jin state. His years of birth and death are unknown. 2. 医和, Yihe was a famous physician in the Qin State during the Spring and Autumn Period. In 541 BCE, he was appointed to treat Lord Ping in Jin state. His years of birth and death are unknown. 3. 扁鹊 (秦越人), Bianque (Qin Yueren) lived from about 5th century BCE to 4th century BCE. He is known as “the father of traditional Chinese medicine”. His years of birth and death are unknown. 4. 文挚, Wenzhi was a famous doctor in the Song State during the Spring and Autumn Period in the middle of 4th century BCE to 3rd century BCE. His years of birth and death are unknown. B. Famous Doctors during the Qin (221–207 BCE), Han (206 BCE–220 CE) and Three Kingdoms (220–265 CE) Periods  5. 杨中倩 (又作杨庆, 阳庆, 公乘阳庆), Yang Zhongqian (or Yang (杨) Qing, Yang (阳) Qing or Gongcheng Yangqing), the teacher of Chunyu Yi, was a famous doctor in the late Qin and early Han Dynasties. His years of birth and death were about 256 and 176 BCE, respectively.  6. 公孙光, Gongsun Guang, the teacher of Chunyu Yi, was a famous folk doctor during the late Qin and early Han Dynasties. His years of birth and death are unknown. He might be slightly younger than Yangqing.  7. 淳于意 (仓公), Chunyu Yi (Canggong) was a famous doctor during the Western Han Dynasty. His years of birth and death are 215 and 140 BCE, respectively.  8. 李柱国, Li Zhuguo was a famous doctor during the Han Dynasty, an imperial physician of Emperor Cheng (33–29 BCE). He is the first man to collate medical books, such as the Huangdi Neijing. His years of birth and death are unknown.  9. 涪翁, Fuwen was a famous acupuncturist during the late Western Han (25 CE) and early Eastern Han Dynasties. His disciple Cheng Gao was a famous doctor too. His years of birth and death are unknown.

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10. 郭玉, Guo Yu was a famous acupuncturist during the Eastern Han Dynasty. He was the Taiyi Cheng of Emperor He (89–105) and grand disciple of Fuwen. His teacher was Cheng Gao. His years of birth and death are unknown. 11. 华佗 (名旉, 字元化), Hua Tuo (birth name Fu, adult name Yuanhua) was a famous doctor during the late Han Dynasty. His years of birth and death were about 145 and 207, respectively. 12. 张机 (字仲景), Zhang Ji (adult name Zhongjing) was a famous doctor during the late Han Dynasty. He was known as “medical sage”, “ancestor of prescription” and “clinical father of Chinese medicine”. His years of birth and death were about 160 and 218, respectively. 13. 吴普, Wu Pu, a disciple of Hua Tuo, was a famous doctor during the Han and Wei Dynasties. His years of birth and death are unknown. 14. 李当之, Li Dangzhi, a disciple of Hua Tuo, was a famous doctor during the Han and Wei Dynasties. His years of birth and death are unknown. 15. 董奉 (字君异), Dong Feng (adult name Junyi), was a famous doctor in the Wu State during the late Han Dynasty and Three Kingdoms (220– 265). He was the hero of “apricot blossoming in warm spring.” Dong Feng, Hua Tuo and Zhang Zhongjing are known as “three highly skilled doctors of the Jian’an period”. His years of birth and death are unknown. 16. 吕广 (一作吕博, 或字博望), Lu Guang (or Lu Bo, adult name Bowang) was a famous doctor in the Wu state during the Three Kingdoms. He was appointed Taiyi Ling in 239. His years of birth and death are unknown. C. Famous Medical Workers During the Jin Dynasties (265–420) and the Northern and Southern Dynasties (420–589) 17. 王熙 (字叔和), Wang Xi (adult name Shuhe) was a famous doctor in Wei and Jin Dynasties during the third century. His years of birth and death are unknown. 18. 皇甫谧 (字士安, 号玄宴先生), Huangfu Mi (adult name Shi’an, alias Mr. Xuanyan) was a famous acupuncturist during the Western Jin Dynasty and known as the “father of acupuncture”. His years of birth and death are 215 and 282, respectively. 19. 嵇康 (字叔夜), Ji Kang (adult name Shuye) was a famous scholar in the Wei and Jin Dynasties. His Health Care had great influence. His years of birth and death are 224 and 263, respectively. 20. 葛洪 (字稚川, 号抱朴子), Ge Hong (adult name Zhichuan, alias Baopuzi) was a famous doctor during the Eastern Jin Dynasty. His years of birth and death were about 283 and 363, respectively.

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21. 鲍姑 (名潜光), Baogu (birth name Qianguang), the wife of Ge Hong, was a famous woman acupuncturist. Her years of birth and death are unknown. 22. 支法存, Zhicunfa was a famous doctor in the Eastern Jin Dynasty. After the Yongjia Southward Migration, he and the Taoist Yang became experts on beriberi. His years of birth and death are unknown. 23. 仰道人, Taoist Yang was as famous as Zhifacun in the Eastern Jin Dynasty. His years of birth and death are unknown. 24. 范汪 (字玄平, 又称范东阳), Fan Wang (adult name Xuan Ping, alias Fan Dongyang) was a famous doctor in the Eastern Jin Dynasty. His years of birth and death were about 308 and 372, respectively. 25. 于法开, Yufakai was a famous doctor during the Eastern Jin Dynasty. His teacher was Yufalan. He became known because of treating Lord Mu in the Jin State. His years of birth and death are unknown. 26. 殷仲堪, Yin Zhongkan was a famous doctor during the Eastern Jin Dynasty. His birth year is unknown and his death year was 399. 27. 张湛 (字处度), Zhang Zhan (adult name Chudu) was a famous health expert in the Eastern Jin Dynasty. His works are cited much by Sun Simiao and others. His years of birth and death are unknown. 28. 刘涓子, Liu Juanzi was a famous surgeon during the late Jin Dynasty. His years of birth and death were about 370 and 450, respectively. 29. 雷斅, Lei Xiao was a famous pharmacologist during the Liu Song Dynasty (420–479). His years of birth and death are unknown. 30. 秦承祖, Qin Chengzu was a famous doctor and medical educator in the Southern Song Dynasty (420–479). His years of birth and death are unknown. 31. 胡洽 (或作胡道洽), Hu Qia (or Hu Daoqia) was a famous doctor in the Southern Song Dynasty. His years of birth and death are unknown. 32. 深师 (僧深), Shenshi (Monk shen) was a famous doctor during the Song and Qi Dynasties (420–502). His teachers were the Taoist Yang and Zhifacun. His years of birth and death are unknown. 33. 陈延之, Chen Yanzhi was a famous doctor during the Song and Qi Dynasties. He wrote Classical Prescriptions in the late 5th century. His years of birth and death are unknown. 34. 褚澄, Zhu Cheng was a doctor in the Southern Qi Dynasty (479–502). His Chu’s Posthumous Book still can be seen. His birth year is unknown and his death year was 483. 35. 全元起, Quan Yuanqi was a famous doctor in the Qi and Liang Dynasties (479–556). His years of birth and death are unknown.

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36. 龚庆宣, Gong Qingxuan was a famous surgeon during the Qi and Liang Dynasties (479–556). His years of birth and death are unknown. 37. 陶宏景 (弘景, 字通明, 号华阳隐居、胜力菩萨, 谥贞白先生), Tao Hongjing (or Hong (弘) jing, adult name Tongming, alias Hermit Huayang, Bodhisattva Shengli, posthumous name Mr. Zhenbai) was a famous medical scientist during the Liang Dynasty. His years of birth and death are 456 and 536, respectively. 38. 释昙鸾, Shi Tanluan was a famous doctor in the Northern Wei and Liang Dynasties. He was taught by Tao Hongjing. His years of birth and death are 476 and 542, respectively. 39. 许道幼, Xu Daoyou was a famous doctor in the Liang Dynasty. His years of birth and death are unknown. 40. 王显 (字世荣), Wang Xian (adult name Shirong) was a famous doctor during the Northern Wei Dynasty. His birth year is unknown and his death year was 515. 41. 姚僧垣 (一作僧坦, 字法卫), Yao Sengyuan (alias Sengtan, adult name Fawei) was taught by his father Yao Puti to be a famous doctor in the Liang Dynasty. His second son Yao Zui (535–602) spread his medical skill in the Northern Zhou Dynasty and was known for pharmacy. His years of birth and death are 498 and 583, respectively. 42. 徐之才 (字士茂), Xu Zhicai (adult name Shimao) was a famous doctor during the Northern Qi Dynasty. Dozens of his family over eight generations were known for medicine. His years of birth and death are 492 and 572 (or 505 and 572), respectively. 43. 马嗣明, Ma Siming was a famous doctor during the Northern Qi and Sui Dynasties. He died in the Kaihuang period (581–600), but the specific years of birth and death are unknown. 44. 知聪, Zhicong lived in Wu during the reign of Emperor Wen of Chen during the Southern Dynasties. In the second year of Tianjia (561), he came to North Korea to spread medicine and to Japan to spread medicine the next year. His years of birth and death are unknown. D. Famous Doctors during the Sui (581–618), Tang (618–907) and Five Dynasties (907–960) 45. 许智藏, Xu Zhicang was a famous doctor during the Sui Dynasty (581–618). His years of birth and death were about 537 and 617, respectively. 46. 巢元方, Chao Yuanfang was an imperial physician in the Daye period during the Sui Dynasty. His years of birth and death are unknown.

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47. 吴景贤, Wu Jingxian was a famous doctor in the age of Chao Yuanang. He might be one of the authors of General Treatise on the Cause and Symptoms of Diseases. His years of birth and death are unknown. 48. 许胤宗 (引宗), Xu Yinzong (or Yin 引 zong) was a famous doctor during the Chen Dynasty and the Sui and Tang Dynasties. His years of birth and death were about 536 and 626, respectively. 49. 许智藏, Xu Zhicang, the grandson of Xu Daoyou, was a famous doctor during the Chen Dynasty and the Sui Dynasty. His years of birth and death were about 537 and 617, respectively. 50. 甄权, Zhen Quan was a famous doctor and acupuncturist during the Sui and Tang Dynasties. His years of birth and death are 541 and 643, respectively. 51. 甄立言, Zhen Liyan, the young brother of Zhen Quan, was a famous doctor during the Sui and Tang Dynasties. He was good at herbal medicine and treating parasitic diseases. His birth year was 545 and his death year is unknown. 52. 王超, Wang Chao was a famous doctor in the Zhenguan period. He was good at acupuncture and moxibustion. He was the first to describe pediatric finger vein diagnosis. His years of birth and death are unknown. 53. 孙思邈 (民间尊为 “药王”), Sun Simiao (known as the “medicine king” in the folk world) was a famous doctor and medical encyclopedist during the Tang Dynasty. His years of birth and death are 581 (or 541) and 682, respectively. 54. 杨上善, Yang Shangshan was a famous doctor in the Sui and Tang Dynasties. He wrote the Huangdi Neijing Taisu in the Daye period (605– 616). His years of birth and death are 585 (or 575) and 670, respectively. 55. 宇妥元丹贡布, Yutuoyuan Dankampot was a famous Tibetan doctor during the Tang Dynasty. His years of birth and death are unknown, probably during the seventh century. 56. 杨玄操, Yang Xuancao was a doctor in the early Tang Dynasty (618– 907). His years of birth and death are unknown. 57. 张宝藏, Zhang Baocang was a famous doctor in the Zhenguan period of the Tang Dynasty. He cured Emperor Taizong of dysentery. His years of birth and death are unknown. 58. 苏敬 (苏恭), Su Jing (Su Gong) was a pharmacologist during the Tang Dynasty. He was the chief writer of Newly Revised Materia Medica. His years of birth and death are 599 and 674, respectively. 59. 孔志约, Kong Zhiyue was a pharmacologist during the Tang Dynasty. He revised Newly Revised Materia Medica together with Su Jing and wrote the preface. His years of birth and death are unknown.

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60. 秦鸣鹤, Qin Minghe was a famous doctor during the reign of Emperor Gaozong during the Tang Dynasty. His years of birth and death are unknown. 61. 崔知悌, Cui Zhiti was a famous doctor during the reign of Emperor Gaozong in the Tang Dynasty. His years of birth and death were about 615 and 685, respectively. 62. 张文仲, Zhang Wenzhong was a famous doctor during the period of Wu Zetian (684–704) in the Tang Dynasty. His years of birth and death were about 620 and 700, respectively. 63. 孟诜, Meng Shen was a pharmacologist during the Tang Dynasty. His years of birth and death are 621 and 713, respectively. 64. 韦慈藏 (名讯, 唐玄宗赐号 “药王”), Wei Cicang (adult name Xun, Emperor Xuanzong during the Tang Dynasty entitled him “medicine king”) was a famous doctor during the reign of Wu Zetian in the Tang Dynasty. His years of birth and death were about 644 and 741, respectively. 65. 李虔纵, 与韦慈藏、张文仲, Li Qianzong was one of the “three famous doctors” during the reign of Wu Zetian, along with Wei Cicang and Zhang Wenzhong. His years of birth and death are unknown. 66. 鉴真 (本姓淳于), Jianzhen (family name Chunyu) spread Chinese medicine to Japan. His years of birth and death are 688 and 764, respectively. 67. 王焘, Wang Tao was a famous doctor and medical encyclopedist during the Tang Dynasty. His years of birth and death were about 670 and 755, respectively. 68. 陈藏器, Chen Cangqi was a famous pharmacologist during the Tang Dynasty. He was in office in the capital in the Kaiyuan period. His years of birth and death were about 685 and 757, respectively. 69. 宇陀宁玛元丹贡布 (又称老宇陀元丹贡布), gYu-thogr Nying-maYontanm Gon-po (also called elder Yutuo-yuanda-gongbu) was a famous Tibetan doctor during the Tang Dynasty, known as a “medical sage” in Tibetan medical history. His years of birth and death were about 708 and 833, respectively. 70. 王冰 (号启玄子), Wang Bing (alias Qixuanzi) was a famous doctor during the Tang Dynasty. He annotated and developed the Neijing. His years of birth and death were about 710 and 805, respectively. 71. 宋清, Song Qing was a famous folk doctor during the Tang Dynasty. He was honoured as “a virtuous and upright person”. His years of birth and death are unknown.

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72. 刘禹锡 (字梦得), Liu Yuxi (adult name Mengde) was a famous writer and poet during the Tang Dynasty. He was also good at medicine. He was ordered to compile a register of classical prescriptions and finished Credible Prescriptions. His years of birth and death are 772 and 842, respectively. 73. 蔺道者, Taoist Lin was a famous orthopedist during the Tang Dynasty. He lived among the people in the Huichang period (841–846). His years of birth and death are unknown. 74. 昝殷, Zan Yin was a famous uterologist during the Tang Dynasty. He wrote Obstetrics Treasure in the Dazhong period. His years of birth and death were about 797 and 859, respectively. 75. 李珣 (字德润), Li Xun (adult name Derun) was a famous pharmacologist in the Five Dynasties during the late Tang Dynasty. His years of birth and death were about 855 and 930, respectively. 76. 和凝 (字成绩), He Ning (adult name Chengji) was a medicologist during the Five Dynasties. He wrote Difficult Prison Records in 951. His years of birth and death are 898 and 955, respectively. 77. 韩保昇, Han Baosheng was a famous herbalist in the Housu State during the Five Dynasties. He wrote Shu Materia Medica. His years of birth and death are unknown. 78. 日华子 (名佚, 号大明?), Ri Huazi (birth name unknown, alias Daming) was a famous pharmacologist in Wuyue during the late Five Dynasties. He was still active during the Song Dynasty. His years of birth and death are unknown. E. Famous Chinese Medical Masters during the Song Dynasties (960–1127, –1279) 79. 洪蕴 (本姓蓝, 人称沙门洪蕴, 号广利大师), Hong Yun (original family name Lan, called Shamen Hongyun by people, alias Master Guangli) was a famous doctor in the Northern Song Dynasty. His years of birth and death are 936 and 1004, respectively. 80. 赵自化, Zhao Zihua was a famous doctor in the Later Zhou Dynasty and the Song Dynasty. His years of birth and death are 949 and 1005, respectively. 81. 冯文智, Feng Wenzhi was a famous doctor in the Northern Song Dynasty. His years of birth and death are 953 and 1012, respectively. 82. 刘翰, Liu Han was a famous pharmacologist in the Later Zhou Dynasty and the Song Dynasty. He was in charge of writing the Kaibao Materia Medica (973). His years of birth and death are unknown.

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83. 马志道士, Taoist Ma Zhi was a famous doctor in the Northern Song Dynasty. He wrote Kaibao Materia Medica with Liu Han in 973. His years of birth and death are unknown. 84. 贾黄中 (字娲民), Jia Huangzhong (adult name Wamin) was a famous doctor in the Northern Song Dynasty. He was in charge of writing Prescriptions from Marvelous Doctors (986) in the early Northern Song Dynasty. His years of birth and death are 941 and 996, respectively. 85. 王怀隐, Wang Huaiyin was a famous doctor in the Northern Song Dynasty. He was in charge of writing Taiping Royal Prescriptions from 977 to 992. His years of birth and death are unknown. 86. 王惟一 (一称王惟德), Wang Weiyi (alias Wang Weide) was a famous acupuncturist in the Northern Song Dynasty. He made the Tiansheng bronze figure in the Tiansheng period (1023–1032). He lived between about 987 and 1067. His years of birth and death are unknown. 87. 掌禹锡 (字唐卿), Zhang Yuxi (adult name Tangqing) was a pharmacologist in the Northern Song Dynasty. From 1057 to 1060, he presided over the writing of Jiayou Materia Medica. He was also one of agents in the Chinese Medicine Books Bureau. His years of birth and death are 992 and 1066, respectively. 88. 高若纳 (字敏之), Gao Ruona (adult name Minzhi) was a famous doctor in the Northern Song Dynasty. He proofread Treatise on Febrile Diseases and many other medical books. His years of birth and death are 997 and 1055. 89. 林亿, Lin Yi was a famous doctor in the Northern Song Dynasty and an agent in Chinese Medicine Books Bureau. His years of birth and death are unknown. 90. 苏颂, Su Song was a famous astronomer and pharmacologist in the Northern Song Dynasty. His years of birth and death are 1020 and 1101. 91. 高保衡, Gao Baoheng was a famous doctor during the reign of Emperor Renzong of the Song Dynasty. He proofread medical books. His years of birth and death are unknown. 92. 孙尚 (字用和), Sun Shang (adult name Yonghe) was a famous doctor in the reign of Emperor Renzong of the Song Dynasty. His son Sun Qi and Sun Zhao were famous doctors. They presided over the proofreading of medical books with Lin Yi. His years of birth and death are unknown. 93. 许希, Xu Xi was a famous doctor in the Northern Song Dynasty. In 1034 Emperor Renzong got treated by his “magical” acupuncture and built Bianque Temple for him. His years of birth and death are unknown.

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 94. 林士元, Lin Shiyuan was a famous doctor good at treating epidemic disease in the Northern Song Dynasty. In the eighth year of the Qingli period (1048) Emperor Renzong ordered him to compile Qingli Beneficent Prescriptions. His years of birth and death are unknown.  95. 刘元宾 (字子仪, 赐号通真子), Liu Yuanbin (adult name Ziyi, bestowed name Tongzhenzi) was a famous doctor in the Northern Song Dynasty. His years of birth and death are 1022 and 1086, respectively.  96. 陈直, Chen Zhi was a famous doctor in the Song Dynasty. He wrote Filial Care for Parents from 1078 to 1085. His years of birth and death are unknown.  97. 沈括 (字存中), Shen Kuo (adult name Cunzhong) was a famous scientist and medical scientist in the Song Dynasty. His years of birth and death are 1031 and 1095, respectively.  98. 钱乙 (字仲阳), Qian Yi (adult name Zhongyang) was a famous pediatrist in the Northern Song Dynasty and honoured as “the originator of pediatrics”. His years of birth and death were about 1032 and 1113, respectively.  99. 韩祗和, Han Zhihe was a famous doctor in the Northern Song Doctor. He wrote Essence of Exogenous Febrile Diseases in 1086. He lived between about 1030 and 1109. His years of birth and death are unknown. 100. 董汲 (字及之), Dong Ji (adult name Jizhi) was a famous pediatrician treating smallpox in the Northern Song Dynasty. In 1093 he wrote Pediatric Emergency Prescriptions for Macula and got appreciation from his hometown senior Qian Yi. His years of birth and death are unknown. 101. 杨子建 (名康侯, 号退修), Yang Zijian (birth name Kanghou, alias Tuixiu) was a famous uterologist in the Northern Song Dynasty. He wrote Ten Ways of Delivering Babies in 1098. His years of birth and death are unknown. 102. 刘温舒, Liu Wenshu was a famous doctor in the Northern Song Dynasty. He wrote Suwen – The Secret of Qi Movement in 1099. His years of birth and death are unknown. 103. 庞安时 (字安常), Pang Anshi (adult name Anchang) was a famous doctor in the Northern Song Dynasty. His years of birth and death were about 1042 and 1099, respectively. 104. 宋道方 (字毅叔), Song Daofang (adult name Yishu) was a famous doctor in the Northern Song Dynasty. His years of birth and death are 1048 and 1118, respectively.

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105. 朱肱 (字翼中, 号无求子, 人称朱奉议, 大隐翁), Zhu Gong (adult name Yizhong, alias Wuqiuzi, also called Zhu Fengyi, Great Hermit) was a famous doctor in the Northern Song Dynasty. His years of birth and death are 1050 and 1125, respectively. 106. 杨介 (字吉老), Yang Jie (adult name Jilao) was a famous doctor in the Northern Song Dynasty and the writer of Viscera Drawings. His years of birth and death are 1060 and 1130, respectively. 107. 王贶 (一作况), Wang Kuang (alias Wang Kuang (况)), the son-in-law of Song Daofang, was a famous doctor in the Northern Song Dynasty and the author of A Guiding Health Care. His years of birth and death are unknown. 108. 陈承, Chen Cheng was a famous doctor in the Northern Song Dynasty. He loved cooling medicines. As the saying goes, “there was a plate of ice in Chen Cheng’s medicine chest.” He wrote Resupplement and Figures from Shengnong’s Herbal Classic. His years of birth and death are unknown. 109. 石藏用 (名用之), Shi Cangyong (birth name Yongzhi) was a famous doctor in the late Northern Song Dynasty. He loved hot medicines. As the saying goes, “there are three dou of fire in Zangyong’s medicine chest.” His years of birth and death are unknown. 110. 唐慎微, Tang Shenwei was a famous medical expert in the Northern Song Dynasty. He practiced medicine in Chengdu from 1086 to 1094, and finished the draft of Classified Materia Medica in 1082 and finalized it from 1098 to 1108. His years of birth and death are unknown. 111. 裴宗元, Pei Zongyuan was a famous doctor in the Northern Song Dynasty. He compiled Prescriptions of the Pharmacy Bureau with Chen Shiwen and Chen Cheng between 1107 and 1110. His years of birth and death are unknown. 112. 陈师文, Chen Shiwen was a doctor in the Northern Song Dynasty, compiling Prescriptions of the Pharmacy Bureau with Pei Zongyuan and Chen Cheng. His years of birth and death are unknown. 113. 史堪 (字载之), Shi Kan (adult name Zaizhi) was a famous doctor in the Northern Song Dynasty and a Jinshi in the Zhenghe period (1111– 1117). His years of birth and death are unknown. 114. 许叔微 (字知可, 人称许学士), Xu Shuwei (adult name Zhike, also called Xu Xueshi) was a famous doctor in the Northern Song Dynasty. He was born in 1079 and died about 1154. 115. 阎孝忠 (季忠, 字资钦), Yan Xiaozhong (or Jizhong, adult name Ziqin) was a known pediatrist in the Song Dynasty. He honoured Qian Qi as

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his master and helped him write A Key to Therapeutics of Children in 1114. His years of birth and death are unknown. 116. 寇宗奭, Kou Zongshi was a famous herbalist in the Northern Song Dynasty. He finished Amplification on Materia Medica in 1116. His years of birth and death are unknown. 117. 张涣, Zhang Huan was a famous pediatrician in the Song Dynasty. He was promoted to senior medical officer from a folk doctor because he cured the prince in the reign of Emperor Huizong in the Song Dynasty. His works have been lost, but many have been recorded in A New Book of Pediatrics. His years of birth and death are unknown. 118. 郭雍 (字子和), Guo Yong (adult name Zihe) was a famous doctor in the Northern Song Dynasty. His years of birth and death were about 1106 and 1187, respectively. 119. 曹孝忠, Cao Xiaozhong proofread Zhenghe Materia Medica and more in the Zhenghe period (1111–1117) of Emperor Huizong in the Song Dynasty. His years of birth and death are unknown. 120. 卢昶 (人称”卢尚药”), Lu Chang (also called “Lu Shangyao”) was a famous doctor in the Northern Song Dynasty. He was even known to the north of the Yellow River and ordered to proofread Prescriptions of the Pharmacy Bureau in 1112. His years of birth and death are unknown. 121. 嵇清 (字仁伯, 誉称嵇接骨), Qi Qing (adult name Renbo, honoured as Ji Jiegu, bone setter) ever escorted Emperor Gaozong of the Song Dynasty in the Southward Migration. He was a famous orthopedic expert in the Song Dynasty. His years of birth and death are unknown. 122. 庄绰 (字季裕), Zhuang Chao (adult name Ji Yu) was a famous litterateur and acupuncturist in the Song Dynasty. He wrote Gaohuang Moxibustion in 1128. His years of birth and death are unknown. 123. 张锐 (字子刚), Zhang Rui (birth name Zigang) was a doctor in the Southern Song Dynasty. He wrote Jifeng Prescriptions for Emergency and more. His years of birth and death are unknown. 124. 刘昉 (字方明), Liu Fang (adult name Fangming) was a pediatric master in the Southern Song Dynasty. His A New Book of Pediatrics was published in 1150 and he died in the same year. His year of birth is unknown. 125. 史崧, Shi Song was a famous doctor in the Southern Song Dynasty. He proofread the Lingshu in 1155. His years of birth and death are unknown.

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126. 崔嘉彦 (字子虚, 希范, 号紫虚真人), Cui Jiayan (adult name Zixu, Xifan, alias Zhenren Zixu) was a famous doctor in the Southern Song Dynasty. He was especially proficient in sphygmology. His years of birth and death were about 1111 and 1190, respectively. 127. 王克明 (字彦昭), Wang Keming (adult name Yanzhao) was a famous doctor in the Southern Song Dynasty. His years of birth and death are 1112 and 1178, respectively. 128. 王继先, Wang Jixian was a famous doctor in the Southern Song Dynasty and called “Black Tiger (Dan) Doctor Wang” by people. In 1159 he joined in the revision of Shaoxing Materia Medica. His birth year is unknown and his death year was 1181. 129. 宇陀萨马元丹贡布 (又称小宇陀元丹贡布), gYu-thogrNying-maYontanmGon-po (also called young gYu-thogrYon-tanmGon-po) was a famous Tibetan doctor in the Song Dynasty. His years of birth and death are 1126 and 1202, respectively. 130. 陈言 (字无择, 号鹤溪), Chen Yan (adult name Wuze, alias Hexi) was a famous doctor in the Southern Song Dynasty and the writer of Treatise on Three Categories of Pathogenic Factors. His years of birth and death are 1131 and 1189, respectively. 131. 张杲 (字季明), Zhang Gao (adult name Jiming) was a famous doctor in the Southern Song Dynasty and the writer of Medicine Book. His years of birth and death were about 1149 and 1227, respectively. 132. 朱端章, Zhu Duanzhang was a famous uterologist and pediatrician in the Southern Song Dynasty. Furthermore, he was proficient in medicine processing. His Doctor’s Treasure Prescriptions was published in 1184. His years of birth and death are unknown. 133. 崔嘉言 (字希范, 号紫虚道人), Cui Jiayan (adult name Xifan, alias Taoist Zixu) was a famous doctor in the Southern Song Dynasty. He wrote Cui’s Pulse Book in 1189. His years of birth and death are unknown. 134. 李迅 (字嗣立), Li Xun (adult name Sili) was a famous surgeon in the Southern Song Dynasty. In 1196 he wrote Effective Prescriptions for Carbuncle. His years of birth and death are unknown. 135. 许洪 (字可大), Xu Hong (adult name Keda) was a doctor in the Southern Song Dynasty. He carefully proofread Prescriptions of the Pharmacy Bureau in 1208. His years of birth and death are unknown. 136. 桂万荣, Gui Wanrong was a medicologist in the Southern Song Dynasty. In 1213 he wrote Tangyin Prison Records. His years of birth and death are unknown.

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137. 刘信甫 (又称刘居士), Liu Xinfu (also called Hermit Liu) was a famous doctor in the Southern Song Dynasty. He wrote Prescriptions Saving Lives in 1218. His years of birth and death are unknown. 138. 齐仲甫, Qi Zhongfu was a famous uterologist in the Southern Song Dynasty. In 1220 he wrote Women’s Encyclopedia. His years of birth and death are unknown. 139. 宋慈 (字惠父), Song Ci (adult name Huifu) was a famous medicologist in the Southern Song Dynasty. His Record of Redressing Mishandled Cases was published in 1247. His years of birth and death are 1186 and 1249, respectively. 140. 魏岘, Wei Xian was a doctor in the Southern Song Dynasty. He wrote Treasure Prescriptions in Wei Family to record a drying method for a medical fistula. He was born in 1187 and his death year is unknown. 141. 陈衍 (字万卿, 号丹丘隐者, 人称冰翁), Chen Yan (adult name Wanqing, alias Hermit Danqiu, called Bingwen by people) was a famous folk doctor in the Southern Song Dynasty. His years of birth and death were about 1190 and 1257, respectively. 142. 王执中 (字叔权), Wang Zhizhong (adult name Shuquan) was a famous acupuncturist. His Experience on Acupuncture and Moxibustion Therapy was published in 1220. His years of birth and death are unknown. 143. 闻人耆年, Wenren Qinian was a famous doctor in the Southern Song Dynasty. He wrote Acupuncture and Moxibustion in Emergencies in 1226. His years of birth and death are unknown. 144. 闻人规, Wenren Gui was a famous pediatrician in the Southern Song Dynasty and his Mr. Wenren Treatise on Smallpox was published from 1228 to 1236. His years of birth and death are unknown. 145. 陈自明 (字良甫, 良父, 晚号药隐老人), Chen Ziming (adult name Liangfu 甫, laingfu 父, later alias Elderly Yaoyin) was a famous doctor in the Southern Song Dynasty. In 1237 he wrote Complete Effective Prescriptions for Women. His years of birth and death were about 1190 and 1270, respectively. 146. 施发 (字政卿), Shi Fa (adult name Zhengqing) was a famous doctor in the Southern Song Dynasty. He wrote A Guide to the Diagnosis of Diseases in 1241. His years of birth and death are unknown. 147. 严用和 (字子礼), Yan Yonghe (adult name Zili) was a famous doctor in the Southern Song Dynasty. He wrote Prescriptions for Saving Lives in 1253. His years of birth and death were about 1200 and 1267, respectively.

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148. 陈文中 (字文秀), Chen Wenzhong (adult name Wenxiu) was a pediatrist in the Southern Song Dynasty. He wrote Treatise on Children Disease in 1254 and later wrote A Treatise on Children’s Smallpox. His years of birth and death are unknown. 149. 杨士瀛 (字登父, 号仁斋), Yang Shiying (adult name Dengfu, alias Renzhai) was a famous doctor in the Southern Song Dynasty. He wrote Effective Recipes from Renzhai and more. His years of birth and death are unknown. F. Famous Doctors and Pharmacologists from the Jin (1115–1234) and Yuan (1271–1368) Dynasties 150. 何若愚 (人称南唐何公), He Ruoyu (called Nantang Hegong by people) wrote the Ebb-Flow Treatise, which was taken into the Midnight-Noon and Ebb-Flow Acupuncture Classic in 1153. His years of birth and death are unknown. 151. 成无己, Cheng Wuji was a famous doctor in the Song and the Jin Dynasties. He wrote a Treatise on Exogenous Febrile Diseases with Notes and Concise Exposition on Exogenous Febrile Diseases. His years of birth and death were about 1066 and 1156, respectively. 152. 杨用道, Yang Yongdao was a famous doctor in the Jin Dynasty. He began to write Prescription Handbook for Emergency in 1110. His years of birth and death are unknown. 153. 刘完素, Liu Wansu (adult name Shouzhen, alias Hermit Tongxuan, called Liu Hejian by people) was one of the four masters in the Jin and Yuan dynasties. His years of birth and death were about 1110 and 1200, respectively. 154. 张元素 (字洁古, 人称易水先生), Zhang Yuansu (adult name Jiegu, called Mr. Yishui by people) was a famous doctor in the Jin Dynasty. He was contemporary of Liu Wansu. His son Zhang Bi was also known for his medical skill. His years of birth and death were about 1131 and 1234, respectively. 155. 李庆嗣, Li Qingsi was a famous doctor in the Jin Dynasty. He saved many people as the plague broke out from 1149 to 1153. His years of birth and death are unknown. 156. 马宗素, Ma Zongsu was a doctor in the Jin Dynasty. He was a disciple of Liu Wansu. His years of birth and death are unknown. 157. 镏洪 (号瑞泉野叟), Liu Hong (alias Ruiquan Yesou) was a doctor in the Jin Dynasty. He was a disciple of Liu Wansu. His years of birth and death are unknown.

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158. 张从正 (字子和, 号戴人), Zhang Congzheng (adult name Zihe, alias Dairen) was one of the four masters in the Jin and Yuan Dynasties. His years of birth and death were about 1156 and 1228, respectively. 159. 李杲 (字明之, 号东垣老人), Li Gao (adult name Mingzhi, alias Elderly Dongyuan) was one of the four masters in the Jin and Yuan Dynasties. His teacher was Zhang Yuansu. His years of birth and death are 1180 and 1251, respectively. 160. 麻九畴 (字知幾, 初名文纯), Ma Jiuchou (adult name Zhiji, original name Wenchun) was a famous doctor in the Jin Dynasty. His teacher was Zhang Zihe. His years of birth and death are 1183 and 1232, respectively. 161. 元好问 (字裕之, 号遗山), Yuan Haowen (adult name Yuzhi, alias Yishan) was a doctor in the Jin Dynasty. His years of birth and death are 1190 and 1257, respectively. 162. 窦汉卿 (字子声, 名默, 早年名杰, 人称窦太师), Dou Hanqing (adult name Zisheng, birth name Mo, old name Jie, called Taishi Dou by people) was a famous acupuncturist in the Jin and Yuan Dynasties. His years of birth and death are 1196 and 1280, respectively. 163. 窦桂芳 (字静斋), Dou Guifang (adult name Jingzhai) was a famous acupuncturist in the Yuan Dynasty. He read the books of He Ruoyu, Dou Mo, etc. and became more skillful. In 1311 he compiled Four Acupuncture Books. His father was also named Dou Hanqing, who practiced medicine with moxibustion. His years of birth and death are unknown. 164. 王好古 (字进之, 号海藏), Wang Haogu (adult name Jinzhi, alias Haicang) was taught by Zhang Yuansu and Li Dongyuan and became a famous doctor in the Jin and Yuan Dynasties. His years of birth and death are 1200 and 1264, respectively. 165. 许国祯 (字进之), Xu Guozhen (adult name Jinzhi) was a famous doctor in the Yuan Dynasty. He wrote Prescriptions from Imperial Hospital and compiled Zhiyuan Revised Materia Medica. His years of birth and death are 1208 and 1283, respectively. 166. 罗天益 (字谦甫), Luo Tianyi (adult name Qianfu) was a famous doctor in the Jin and Yuan Dynasties. He became a disciple of Li Gao in his old age. His years of birth and death were about 1220 and 1290, respectively. 167. 忽公泰 (忽泰必烈, 字吉甫), Hu Gongtai (Hu Taibilie, adult name Jifu) was an acupuncturist in the Yuan Dynasty. He had frequent contact with Luo Tianyi. His years of birth and death are unknown. 168. 王开 (一名镜潭或镜泽, 字启元), Wang Kai (alias Jingtan or Jingze, adult name Qiyuan), a disciple of Dou Mo, was a famous acupuncturist

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of the Jin and Yuan Dynasties. In 1271 he became professor in Yangzhou Medical Institute. His son Wang Guorui (adult name Rui’an) was also famous for acupuncture. His years of birth and death are unknown. 169. 杜思敬 (晚号宝善老人), Du Sijing (old name Elderly Baoshan) was a famous doctor in the Yuan Dynasty. He wrote Collected Works of Medicine. His years of birth and death were about 1234 and 1320, respectively. 170. 罗知悌 (字子敬, 敬夫, 世称太无先生), Luo Zhiti (adult name Zijing, Jingfu, called Mr. Taiwu by people) was a famous doctor in the late Song Dynasty and the early Yuan Dynasty. His years of birth and death were about 1243 and 1327, respectively. 171. 曾世荣 (字德显, 号育溪), Zeng Shirong (adult name Dexian, alias Yuxi) was a famous pediatrician in the Yuan Dynasty. He was born in 1253 and probably died in 1332. 172. 王与 (字与之), Wang Yu (adult name Yuzhi) was a famous medicologist in the Yuan Dynasty. His years of birth and death are 1260 and 1346, respectively. 173. 杜本 (字伯原, 原父, 号清碧先生), Du Ben (adult name Boyuan, Yuanfu, alias Mr. Qingbi), a disciple of Luo Zhiti, was a famous doctor in the Yuan Dynasty. His years of birth and death are 1276 and 1350, respectively. 174. 危亦林 (字达斋), Wei Yilin (adult name Dazhai) was a famous doctor in the Yuan Dynasty. He made a great contribution to orthopedics. His years of birth and death are 1277 and 1347, respectively. 175. 朱震亨 (字彦修, 人称丹溪先生), Zhu Zhenheng (adult name Yanxiu, called Mr. Danxi by people) was one of the four masters in the Jin and Yuan Dynasties. His years of birth and death are 1281 and 1358, respectively. 176. 葛应雷 (字震父, 堂号恒斋), Ge Yinglei (adult name Zhenfu, house name Hengzhai) was a famous doctor in the Yuan Dynasty. He was the father of Ge Kejiu. His years of birth and death are unknown. 177. 忽思慧, Hu Sihui was medical dietitian in the Yuan Dynasty. He presented Principles of a Correct Diet in 1330. His years of birth and death are unknown. 178. 沙图穆苏 (萨里弥实, 萨德弥实, 字谦斋, 人称萨谦斋), Shatumusu (Salimishi, Sademishi, adult name Qianzhai, called Saqianzhai by people) was a famous doctor in the Yuan Dynasty. He wrote Empirical

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Prescriptions from Ruizhu Hall in 1326. His years of birth and death are unknown. 179. 李仲南 (栖碧), Li Zhongnan (Qibi) was a famous doctor in the Yuan Dynasty. He wrote Yonglei Official Prescriptions in 1331. His years of birth and death are unknown. 180. 齐德之, Qi Dezhi was a famous surgeon in the Yuan Dynasty. He wrote Surgical Essence in 1335. His years of birth and death are unknown. 181. 沈好问 (字裕生, 别号启明), Shen Haowen (adult name Yusheng, alias Qiming) was a famous pediatrician and acupuncturist in the Yuan Dynasty. People called him “Shen Tiezhen”. His years of birth and death are unknown. 182. 吴恕 (字如心, 号蒙斋), Wu Shu (adult name Ruxin, alias Mengzhai) was a famous doctor in the Yuan Dynasty. He wrote Finger Figure of Exogenous Febrile Disease in 1338. His years of birth and death are unknown. 183. 倪维德 (字仲贤), Ni Weide (adult name Zhongxian) was a famous doctor in the Yuan and Ming Dynasties. His years of birth and death are 1303 and 1377, respectively. 184. 葛乾孙 (字可久), Ge Qiansun (adult name Kejiu) was a famous doctor in the Yuan Dynasty. He carried forward the cause of his father (Ge Yinglei) and his uncle (Ge Yingze). His years of birth and death are 1305 and 1354, respectively. 185. 滑寿 (字伯仁, 晚号撄宁生), Hua Shou (adult name Boren, late name Yingningsheng) was a famous doctor in the Yuan Dynasty. His years of birth and death were about 1310 and 1380 (or 1304 and 1386), respectively. 186. 赵良仁 (一作赵良, 字以德, 又字立道, 号云居), Zhao Liangren (or Zhao Liang, adult name Yide or Lidao, alias Yunju) was a famous doctor in the Yuan Dynasty. His teacher was Zhu Danxi. His years of birth and death are 1315 and 1379 (or about 1330 and 1396), respectively. 187. 戴启宗 (字同父), Dai Qizong (adult name Tongfu) was a famous doctor in the Yuan Dynasty in the 14th century. His years of birth and death are unknown. 188. 项昕 (字彦章, 号抱一翁), Xiang Xin (adult name Yanzhang, alias Elderly Baoyi) was a famous doctor in the 14th century. His teachers are Ge Kejiu, Dai Tongfu, etc. His years of birth and death are unknown.

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189. 吴瑞 (字瑞卿), Wu Rui (adult name Ruiqing) was a medical scientist in the Yuan Dynasty. He wrote Daily Materia Medica in 1367. His years of birth and death are unknown. 190. 王国瑞 (字瑞庵), Wang Guorui (adult name Rui’an), the son of Wang Kai, was a famous acupuncturist in the late Yuan Dynasty. His years of birth and death are unknown. 191. 吕复 (字元膺, 晚号沧州翁), Lu Fu (adult name Yuanying, late name Elderly Cangzhou) was a famous doctor in the late Yuan Dynasty and the early Ming Dynasty. His years of birth and death are unknown. G. Famous Physicians of Chinese Medicine During the Ming Dynasty (1368–1644) 192. 楼英 (一名公爽, 字全善, 号全斋), Lou Ying (or Gongshuang, adult name Quanshan, alias Quanzhai) was a famous doctor in the early Ming Dynasty. He was as famous as his friend Dai Sigong. His years of birth and death are 1320 and 1389 (or 1332 and 1402), respectively. 193. 戴思恭 (字原礼, 一作元礼), Dai Sigong (adult name Yuan 原 li or Yuan 元 li), disciple of Danxi, was a famous doctor in the early Ming Dynasty. His years of birth and death are 1324 and 1405, respectively. 194. 王立 (字与权), Wang Li (adult name Yuquan) was a famous doctor in the early Ming Dynasty. Zhu Yuanzhang thought highly of him. His years of birth and death are unknown. 195. 王履 (字安道, 号畸叟, 又号抱独山人), Wang Lu (adult name Andao, alias Jisou or Hermit Baodu), a disciple of Zhu Danxi, was a famous doctor in the early Ming Dynasty. His years of birth and death are 1332 and 1391, respectively. 196. 陶华 (字尚文, 号节庵, 节庵道人), Tao Hua (adult name Shangwen, alias Jie’an or Taoist Jie’an) was a famous doctor in the Ming Dynasty. He was born in 1369 and died in about 1450. 197. 盛寅 (字启东), Sheng Yin (adult name Qidong) was a famous doctor in the Ming Dynasty. He was the grand-disciple of Dai Yuanli. His years of birth and death are 1375 and 1441, respectively. 198. 刘纯 (字宗厚), Liu Chun (adult name Zonghou), a grand-disciple of Zhu Danxi, was a famous doctor in the Ming Dynasty. He wrote Primary Medicine, Jade Meaning, Treatment of Miscellaneous Diseases, etc. from 1388 to 1408. His years of birth and death are unknown. 199. 赵道震 (字处仁), Zhao Daozhen (adult name Churen) was a famous doctor in the early Ming Dynasty. His teacher was Zhu Danxi.

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In 1405 he participated in the compilation of Yongle Encyclopedia. His years of birth and death are unknown. 200. 朱橚, Zhu Su, the fifth son of Zhu Yuanzhang, was a famous medical scientist of the Ming Dynasty. His year of birth is unknown and his year of death was 1425. 201. 匡愚 (字希贤), Kuang Yu (adult name Xixian) was a famous doctor in the Ming Dynasty. He was even a ship doctor on Zhen He’s Three Voyages. His years of birth and death are 1378 and 1459, respectively. 202. 兰茂(字廷秀, 号止庵, 自称和光道人, 洞天风月子, 玄壶子), Lan Mao (adult name Tingxiu, alias Zhi’an, personal name Taoist Heguang, Tongtian Fengyuezi, Xuanhuzi) was a famous medical scientist in Yunnan Province. He wrote Yunnan Materia Medica in 1436. His years of birth and death are 1397 and 1476, respectively. 203. 熊宗立 (名均, 又字道轩, 号勿听子), Xiong Zongli (birth name Jun, adult name Daoxuan, alias Wutingzi) was a famous doctor in the Ming Dynasty. He wrote many books since 1437. His years of birth and death were about 1415 and 1487, respectively. 204. 徐凤 (字廷瑞), Xu Feng (adult name Tingrui) was a famous acupuncturist in the Ming Dynasty. He wrote The Complete Works of Acupuncture and Moxibustion in 1439. His years of birth and death are unknown. 205. 方贤, Fang Xian was a famous doctor in the Ming Dynasty. He was the Yuanpan in the Imperial Hospital from 1436 to 1456. In 1449 he became the chief editor of Wonderful Prescriptions, which is the prescription masterpiece of the Ming Dynasty. His years of birth and death are unknown. 206. 卢和 (字廉夫), Lu He (adult name Lianfu) was a famous doctor in the Ming Dynasty. He wrote Herbal Food, Danxi’s Treasure Book, etc. in about 1484. His years of birth and death are unknown. 207. 王纶 (字汝言, 号节斋), Wang Lun (adult name Ruyan, alias Jiezhai) was a famous doctor in the Ming Dynasty. He began to write Collection of Medical Experience in the Ming Dynasty and more in 1502. His years of birth and death are unknown. 208. 刘文泰, Liu Wentai was a senior medical official in the Chenghua and Hongzhi periods (1465–1504) in the Ming Dynasty. His mistreatment caused the death of Emperor Xianzong and Emperor Xiaozong. He really did not know medicine. From 1503 to 1505 he took charge of compiling Collected Essentials of Species of Materia Medica, but Emperor Wuzong did not publish it. It was a wonder that Liu Wentai

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was sentenced to exile instead of death. His years of birth and death are unknown. 209. 虞抟 (字天民, 自号花溪恒德老人), Yu Tuan (adult name Tianmin, personal name Elderly Huaxihengde) was a famous doctor in the Ming Dynasty. He was born in 1438 and died in about 1517. 210. 韩 (字天爵, 号飞霞子；又名白自虚, 人称白飞霞), Han Mao (adult name Tianjue, alias Feixiazi or Baizixu, called Baifeixia by people) was a famous doctor in the Ming Dynasty. His year of birth was 1441 and his year of death was probably 1522. 211. 王纶 (字汝言, 号节斋), Wang Lun (adult name Ruyan, alias Jiezhai) was a famous doctor in the Ming Dynasty. His years of birth and death are 1453 and 1510, respectively. 212. 凌云 (字汉章, 号卧岩), Ling Yun (adult name Hanzhang, alias Woyan) was a famous acupuncturist in the Ming Dynasty. He came to the capital to become a royal physician from 1488 to 1505. His years of birth and death are unknown. 213. 江瓘 (字延莹, 一作民莹), Jiang Guan (adult name Yanying or Minying) was a famous acupuncturist in the Ming Dynasty. His year of birth is unknown and he probably died in 1530. 214. 汪机 (字省之, 号石山居士), Wang Ji (adult name Shengzhi, alias Hermit Shishan) was a famous doctor in the Ming Dynasty. His years of birth and death are 1463 and 1539, respectively. 215. 许绅, Xu Shen was a famous doctor in the Ming Doctor. He became known because he saved the hanged Emperor Jiajing from death in 1542. His year of birth is unknown and his year of death was 1542. 216. 刘天和 (字养和, 号松石), Liu Tianhe (adult name Yanghe, alias Songshi) was a famous doctor in the Ming Dynasty. His Effective Prescriptions from Baoshou Hall is cited repeatedly in Li Shizhen’s Compendium of Materia Medica. His year of birth is unknown and his year of death was 1545. 217. 陈嘉谟 (字廷采), Chen Jiamo (adult name Tingcai) was a pharmacologist in the Ming Dynasty. He was ever praised by Li Shizhen. His year of birth is 1486 and his year of death was probably 1545. 218. 薛己 (字新甫, 号立斋), Xue Ji (adult name Xinfu, alias Lizhai) was a famous doctor in the Ming Dynasty. His father Xue Kai (adult name Liangwu) was known for pediatrics. His years of birth and death are 1487 and 1559, respectively. 219. 万全 (又名全仁, 字事, 号密斋), Wan Quan (or Quanren, adult name Shi, alias Mizhai) was a famous pediatrician in the Ming Dynasty.

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He was especially proficient in smallpox. He serves as a link between the past and the future and was honoured as “Mr. Wan’s pediatrics”. It is said that Mr. Wan started smallpox variolation. His years of birth and death are 1495 and 1580 (or 1488 and 1579), respectively. 220. 蔡维藩 (自号安东老牧), Cai Weifan (personal name Andong Laomu) was a famous pediatrician in the Ming Dynasty. He wrote Treatise on Smallpox, Collected Works of Smallpox, etc. in 1518. His years of birth and death are unknown. 221. 魏直 (字廷豹, 桂岩), Wei Zhi (adult name Tingbao, Guiyan) was a famous pediatrician in the Ming Dynasty. He wrote Philanthropic Heart Mirror of Smallpox in 1525. His years of birth and death are unknown. 222. 高武 (字梅孤), Gao Wu (adult name Meigu) was a famous acupuncturist in the Ming Dynasty. He wrote An Assembling Together of Acupuncture and Moxibustion in 1529. His years of birth and death are unknown. 223. 沈之问 (号无为道人, 花月无为道人), Shen Zhiwen (alias Taoist Wuwei, Taoist Huayue Wuwei) was a famous doctor in the Ming Dynasty. He wrote the first leprosy monograph A Saviour for our Lepers in 1550. His years of birth and death are unknown. 224. 周之幹 (一谓子干, 号慎斋), Zhou Zhi 之 gan 幹 (or Zi 子 gan 干, alias Shenzhai) was a famous doctor in the Ming Dynasty. His years of birth and death were about 1508 and 1586, respectively. 225. 方谷, Fang Gu and his son Fang Yu are both famous doctors in the Ming Dynasty. He wrote Medicine Regulations and more. His year of birth is 1508 and his year of death is unknown. 226. 王沐 (号春泉), Wang Mu (alias Chunquan) was a famous doctor in the Ming Dynasty. He saved many people from the plague from 1522 to 1566 and was honoured as a “righteous doctor”. His years of birth and death are unknown. 227. 李梴 (字健斋), Li Chan (adult name Jianzhai) was a famous doctor in the Ming Dynasty. He wrote Elementary Medicine in about 1575. His years of birth and death are unknown. 228. 葆光道人, Taoist Baoguang was a famous oculist in the Ming Dynasty or the Northern Song Dynasty. He is listed in the Ming Dynasty because his Treatise on Ophthalmology was published in 1575. His years of birth and death are unknown. 229. 郭子章 (字相奎, 号青螺, 衣生), Guo Zizhang (adult name Xiangkui, alias Qingluo, Pinyisheng) was a famous doctor in the Ming Dynasty.

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He finished Collected Works on Smallpox Vaccination in 1577. His years of birth and death are unknown. 230. 翁仲仁 (字嘉德), Weng Zhongren (alias Jiade) was a famous pediatrician in the Ming Dynasty. He wrote The Golden Mirror of Smallpox in 1579, which has a great influence. His years of birth and death are unknown. 231. 马莳 (字仲化, 玄台, 元台), Ma Shi (adult name Zhonghua, Xuantai, Yuatai) was a famous doctor in the Ming Dynasty. He began to annotate Lingshu, Suwen, Nanjing, etc. in 1580. His years of birth and death are unknown. 232. 李言闻 (字子郁, 号月池), Li Yanwen (adult name Ziyu, alias Yuechi), the father of Li Shizhen, was a famous doctor in the Ming Dynasty. His year of birth is unknown and his year of death was probably 1572. 233. 李时珍 (字东璧, 晚号濒湖山人), Li Shizhen (adult name Dongbi, late alias Hermit Binhu) was an outstanding medical scientist in the Ming Dynasty. His years of birth and death were about 1518 and 1593, respectively. 234. 徐春甫 (字汝元, 号思鹤, 又号东皋), Xu Chunfu (adult name Ruyuan, alias Sihe, Donggao) was a famous doctor in the Ming Dynasty. His years of birth and death are 1520 and 1596, respectively. 235. 龚廷贤 (字子才, 号云林山人, 悟真子), Gong Tingxian (adult name Zicai, alias Hermit Yunlin, Wuzhenzi) was a famous doctor in the Ming Dynasty. He was awarded a tablet “Number One in Medicine”. His father Gong Xin was also known for medical skill. His years of birth and death are 1522 and 1619, respectively. 236. 孙一奎 (字文垣, 号东宿, 生生子), Sun Yikui (adult name Wenyuan, alias Dongxiu, Shengshengzi) was a famous doctor in the Ming Dynasty. His years of birth and death are 1522 and 1619, respectively. 237. 杨继洲 (字济时), Yang Jizhou (adult name Jishi) was a famous acupuncturist in the Ming Dynasty. His years of birth and death were about 1522 and 1620, respectively. 238. 方有执 (字中行, 仲行, 别号九龙山人), Fang Youzhi (adult name Zhong 中 xing, or Zhong 仲 xing, alias Hermit Jiulong) was a famous doctor in the Ming Dynasty. He was the founder of a proofreading school on the Treatise on Febrile Diseases. His years of birth and death are 1523 and 1593, respectively. 239. 吴正伦 (字子叙, 号春岩子), Wu Zhenglun (adult name Zixu, alias Chunyanzi) was a famous doctor in the Ming Dynasty. He was so famous among people that he was invited to work for the nobles.

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He was killed by jealous imperial physicians. His son Wu Xingjian (1554–?) and grandson Wu Kun are also known for medical skill. His years of birth and death were about 1529 and 1568, respectively. 240. 王肯堂 (字宇泰, 又字损仲, 损庵, 号念西居士), Wang Kentang (adult name Yutai, Sunzhong, Sun’an, alias Hermit Nianxi) was a famous doctor in the Ming Dynasty. His years of birth and death are 1549 and 1613 (or 1552 and 1638), respectively. 241. 陈司成 (字九韶), Chen Sicheng (adult name Jiushao) was a famous doctor in the Ming. He was the first person to treat syphilis. He was born in 1551 and probably died in 1633. 242. 高濂 (字深甫), Gao Lian (adult name Shenfu) was a health expert in the Ming Dynasty. He wrote Eight Discourses on Health Care in 1591. His years of birth and death are unknown. 243. 武之望 (字叔卿), Wu Zhiwang (adult name Shuqing) was a famous doctor in the Ming Dynasty. His years of birth and death are 1552 and 1629, respectively. 244. 吴崑 (字山甫, 号鹤皋山人, 参黄子), Wu Kun (adult name Shanfu, alias Hermit Hegao, Shenhuangzi) was a famous doctor in the Ming Dynasty. He was born in 1552 and probably died in 1620. 245. 陈实功 (字毓仁, 号若虚), Chen Shigong (adult name Yuren, alias Ruoxu) was a famous surgeon in the Ming Dynasty. His years of birth and death are 1555 and 1636, respectively. 246. 缪希雍 (字仲淳, 号慕台), Miao Xiyong (adult name Zhongchun, alias Mutai) was a medical scientist in the Ming Dynasty. His years of birth and death were about 1556 and 1627 (or 1546 and 1627), respectively. 247. 张介宾 (字景岳, 会卿, 号通一子), Zhang Jiebin (adult name Jingyue, Huiqing, alias Tongyizi) was a famous medical scientist in the Ming Dynasty. His years of birth and death were about 1560 and 1640, respectively. 248. 王象晋 (字康侯, 荩臣, 子进, 号康宇, 好生居士), Wang Xiangjin (adult name Kanghou, Jinchen, Zijin, alias Kangyu, Hermit Haosheng) was a famous doctor in the Ming Dynasty. His years of birth and death are 1561 and 1653, respectively. 249. 吴又可 (名有性), Wu Youke (birth name Youxing) was an outstanding expert in infectious disease and warm disease. His year of birth is 1561 and his year of death was probably 1661. 250. 王绍隆 (一作绍龙, 名继鼎), Wang Shaolong (or Shao 绍 long, birth name Jiding) was a famous doctor in the Ming Dynasty. His disciples

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had a wide influence. His years of birth and death are 1565 and 1624, respectively. 251. 胡慎柔 (法名释住想), Hu Shenrou (dharma name Shi Zhuxiang) was a famous doctor in the late Ming Dynasty. His teacher was Zhou Shenzhai. His years of birth and death are 1572 and 1636, respectively. 252. 朱惠明 (字济川), Zhu Huiming (adult name Jichuan) was a famous pediatrician in the Ming Dynasty. He published Experience Record of Smallpox. His years of birth and death are unknown. 253. 朱栋隆 (字子接, 号春海, 瓶城子), Zhu Donglong (adult name Zijie, alias Chunhai, Pingchengzi) was a famous doctor in the Ming Dynasty. He wrote Treating Smallpox by Oneself. His years of birth and death are unknown. 254. 申拱辰 (字子极, 号斗垣), Shen Gongchen (adult name Ziji, alias Douyuan) was a famous doctor in the Ming Dynasty. He was good at tongue diagnosis and wrote Tongue Diagnosis Experience of Exogenous Febrile Diseases. He was also good at surgery and wrote Thoughts on Surgery in 1604. His years of birth and death are unknown. 255. 卢复 (字不远, 晚年信佛, 释名福一, 字毕公), Lu Fu (adult name Buyuan, dharma name Fuyi because he believed in Buddhism in his later years) was a famous doctor in the Ming Dynasty. He wrote Medical Seed (or Zhiyuan Seed) in 1616. His years of birth and death are unknown. 256. 聂尚恒 (字久吾), Nie Shangheng (adult name Jiuwu) was a famous doctor in the Ming Dynasty. He was especially proficient in children smallpox that later physicians all claim that their variolation skill came from Mr. Nie. However, it is very regretful that this skill was not recorded in his Experience in Treating Children (Salvation of Smallpox) (published in 1616). His year of birth is 1572 and his year of death is unknown. 257. 赵献可 (字养葵, 号医巫闾子), Zhao Xianke (adult name Yangkui, alias Yiwulvzi) was a famous doctor in the Ming Dynasty. He wrote A Thorough Knowledge of Medicine in 1617. His years of birth and death are unknown. 258. 傅懋光, Fu Maoguang was a famous doctor in the Ming Dynasty. He became an imperial physician in the 45th year in the Wanli period (1617) and answered questions for medical officials of North Korea. His years of birth and death were about 1573 and 1644, respectively. 259. 朱一麟 (字应我, 自号摘星楼主人), Zhu Yilin (adult name Yingwo, personal name Owner of Star-Picking House) was a famous doctor in

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the Ming Dynasty. He was proficient in smallpox and wrote Complete Works of Smallpox in Zhaixionglou in 1619. His years of birth and death are unknown. 260. 倪朱谟 (字纯宇), Ni Zhumo (adult name Chunyu) was a pharmacologist in the late Ming Dynasty. In 1624 he wrote Collected Statements on Materia Medica to prove Shizhen’s Compendium of Materia Medica. People think he hit the mark. His years of birth and death are unknown. 261. 龚居中 (字应圆, 号如虚子, 寿世主人), Gong Juzhong (adult name Yingyuan, alias Ruxuzi, Shoushizhuren) was a famous doctor in the Ming Dynasty. His year of birth is unknown and his year of death was 1646. H. Famous Doctors of Chinese Medicine in the Qing Dynasty (1644–1911) 262. 喻昌 (字嘉言, 晚号西昌老人), Yu Chang (adult name Jiayan, later alias Elderly Xichang) was a famous doctor in the late Ming Dynasty and the early Qing Dynasty. He was born in 1585 and probably died in 1664. 263. 陈元赟 (名珦, 字义都, 士昇, 号既白山人, 玄香斋逸叟), Chen Yuanyun (birth name Xiang, adult name Yidu, Shisheng, alias Hermit Jibai, Elderly Xuanxiangzhai) was a famous doctor in the late Ming Dynasty and the early Qing Dynasty. He made a great contribution in spreading Chinese medical culture, Qigong and the martial arts to Japan. His years of birth and death are 1587 and 1671, respectively. 264. 李中梓 (字士材, 又字念莪, 号尽凡居士), Li Zhongzi (adult name Shicai or Nian’e, alias Hermit Jinfan) was a famous doctor in the late Ming Dynasty and the early Qing Dynasty (usually classified into the Ming Dynasty; both are right). He also taught his nephew Li Yangang (1628–1697) who became a famous doctor. His years of birth and death are 1588 and 1655, respectively. 265. 翟良 (字玉华), Zhai Liang (adult name Yuhua) was a famous doctor in the late Ming Dynasty and the early Qing Dynasty. His years of birth and death are 1588 and 1671, respectively. 266. 张卿子 (名遂辰, 号相期, 又号西农老人), Zhang Qingzi (birth name Suichen, alias Xiangqi or Elderly Xinong) was a famous doctor in the late Ming Dynasty and the early Qing Dynasty. His years of birth and death were about 1589 and 1668, respectively. 267. 潘楫 (字硕甫, 邓林, 号清凉居士), Pan Ji (adult name Shuofu, Denglin, alias Hermit Qingliang) was a famous doctor in the late Ming Dynasty

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and the early Qing Dynasty. His years of birth and death are 1591 and 1664, respectively. 268. 孙光裕 (号浮碧山人), Sun Guangyu (alias Hermit Fubi) was a famous doctor in the Ming Dynasty. He wrote Taichu Pulse Differentiation in 1635 and Complete Bloody Testimonies. His years of birth and death are unknown. 269. 袁班 (字体菴), Yuan Ban (adult name Ti’an) was a famous doctor in the late Dynasty and called the “Jiangbei famous doctor” by people. He wrote Experience in Pattern and Treatment in 1643. His years of birth and death are unknown. 270. 王尚, Wang Shnag was a famous doctor in the late Ming Dynasty. He was proficient in surgery and able to perform operations. He died in the early Qing Dynasty and the specific years of birth and death are unknown. 271. 祁坤 (字愧庵, 广生, 号生阳子), Qi Kun (adult name Kui’an, Guangsheng, alias Shengyangzi) was a famous surgeon in the late Ming Dynasty and early Qing Dynasty. He became an imperial physician in the Shunzhi period (1644–1661). He wrote Surgical Achievements in 1665. Thanks to the book, his grandson Qi Hongyuan (about 1670-?) joined in the compilation of The Golden Mirror of Medicine. His years of birth and death are unknown. 272. 汪绮石 (人称绮石先生), Wang Qishi (called Mr. Qishi by people) was a famous doctor in the early Qing Dynasty. He wrote The Mirror of Deficient Syndromes in the 17th century. His years of birth and death are unknown. 273. 戴曼公 (名笠, 僧名独立, 性易, 号天外一间人), Dai Mangong (birth name Li, dharma name Duli, Xingyi, alias Tianwaiyijianren) was a famous doctor in the late Ming Dynasty and early Qing Dynasty. His teacher was Gong Tingxian. He spread smallpox variolation to Japan. His years of birth and death are 1596 and 1672, respectively. 274. 卢之颐 (字子繇, 繇生), Lu Zhiyi (adult name Ziyao, Yaosheng), the son of Lu Fu, was a famous doctor in the late Ming Dynasty and early Qing Dynasty. His years of birth and death are 1598 and 1664, respectively. 275. 傅山 (原名鼎臣, 字青竹, 改字青主, 别字公它, 号啬庐, 石道山人, 朱衣 道人), Fu Shan (original name Dingchen, adult name Qingzhu, changed to be Qingzhu, another adult name Gongta, alias Selu, Hermit Shidao, Hermit Zhuyi) was a famous doctor in the late Ming Dynasty and early Qing Dynasty. His years of birth and death are 1607 and 1684, respectively.

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276. 方以智 (字密之, 号曼公, 又号龙眠愚者), Fang Yizhi (adult name Mizhi, alias Mangong, Foolish Longmian) was a famous doctor in the late Ming Dynasty and early Qing Dynasty. He was the first person to advocate a combination of traditional Chinese medicine and Western Medicine. His years of birth and death are 1611 and 1671, respectively. 277. 汪昂 (字讱庵), Wang’ang (adult name Ren’an) was a famous doctor in the late Ming Dynasty and early Qing Dynasty. His year of birth was 1615 and his year of death was about 1695 (or 1614 and 1701, respectively). 278. 张璐 (字路玉, 号石顽老人), Zhang Lu (adult name Luyu, alias Elderly Shiwan) was a famous doctor in the late Ming Dynasty and early Qing Dynasty. His sons Zhang Deng and Zhang Zhuo are also known in medicine. His years of birth and death are 1617 and 1699, respectively. 279. 傅仁宇 (字允科), Fu Renyu (adult name Yunke) was a famous oculist in the late Ming Dynasty. He wrote Precious Eyes (Complete Works of Ophthalmology) in 1644. His son carried forward his career. His years of birth and death are unknown. 280. 柯琴 (字韵伯, 号似峰), Ke Qin (adult name Yunbo, alias Sifeng) was a famous doctor in the Qing Dynasty. His year of birth was 1618 and his year of death is unknown. 281. 张志聪 (字隐庵, 号西陵隐庵道人), Zhang Zhicong (adult name Yin’an, alias Taoist Xilingyin’an) was taught by Zhang Qingzi and became a famous medical scientist in the early Qing Dynasty. His years of birth and death were about 1619 and 1674 (or 1610 and 1674), respectively. 282. 高鼓峰 (名斗魁, 字旦中), Gao Gufeng (birth name Doukui, adult name Danzhong) was a famous doctor in the Qing Dynasty. His years of birth and death are 1623 and 1670, respectively. 283. 程应旄 (字郊倩), Cheng Yingmao (adult name Jiaoqian) was a famous doctor in the Qing Dynasty. He began to write Second Differentiation of Treatise on Febrile Diseases and more in 1670. His years of birth and death are unknown. 284. 单南山, Shan Nanshan was a famous uterologist in the early Qing Dynasty. His A Guide to Bearing was published in 1686. His years of birth and death are unknown. 285. 高世栻 (字士宗), Gao Shishi (adult name Shizong), a disciple of Zhang Zhicong, was a famous doctor in the Qing Dynasty. His years of birth and death are unknown.

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286. 方开, Fang Kai was a famous doctor in the reign of Emperor Kangxi and Emperor Yongzheng of the Qing Dynasty. He was proficient in healthcare and Daoyin. His years of birth and death are unknown. 287. 周扬俊 (字禹载), Zhou Yangjun (adult name Yuzai) was a famous doctor in the Qing Dynasty. He wrote Complete Works of Warm Diseases in 1679. His years of birth and death are unknown. 288. 陈士铎 (字敬之, 号远公, 朱华子, 大雅堂主人), Chen Shiduo (adult name Jingzhi, alias Yuangong, Zhuhuazi, Master of Daya Hall) was a famous doctor in the Qing Dynasty. He began to write Secret Records from a Stone Chamber and more in 1687. His years of birth and death are unknown. 289. 李用粹 (字修之, 号惺庵), Li Yongcui (adult name Xiuzhi, alias Xing’an) was a famous doctor in the Qing Dynasty. He wrote a Supplement to Syndrome and Treatment in 1687. His years of birth and death are unknown. 290. 过孟起 (字绎之), Guo Mengqi (adult name Yizhi) was a famous doctor in the Qing Dynasty. After having written Herbal Classic in 1687, he wrote Wu’s Medical Records, the origin of Collected Records of Wu Doctors. His years of birth and death are unknown. 291. 冯楚瞻 (名兆张), Feng Chuzhan (birth name Zhaozhang) was a famous doctor in the early Qing Dynasty. In his later years he made his own works into Mr. Feng Secret Eight Books in 1694. His years of birth and death are unknown. 292. 王宏翰 (字惠源, 号浩然子), Wang Honghan (adult name Huiyuan, alias Haoranzi) was a famous doctor in the Qing Dynasty. He advocated a combination of Chinese medicine and Western Medicine. His year of birth is unknown and his year of death was about 1700. 293. 马运从 (名化龙), Ma Yuncong (birth name Hualong) was a famous oculist in the Qing Dynasty. His years of birth and death were about 1630 and 1705, respectively. 294. 钱潢 (字天来), Qian Huang (adult name Tianlai) was a famous doctor in the Qing Dynasty. In his later years (1707) he wrote The Origin of Exogenous Febrile Disease. His years of birth and death are unknown. 295. 马俶 (字元仪, 号卧龙老人), Ma Chu (adult name Yuanyi, alias Elderly Wolong) was a famous doctor in the Qing Dynasty. His years of birth and death are 1634 and 1714, respectively. 296. 朱纯嘏 (字玉堂), Zhu Chungu (adult name Yutang) was a famous doctor in the Qing Dynasty. He was especially good at treating smallpox

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and a famous master of variolation. His years of birth and death were about 1634 and 1718, respectively. 297. 胡璞 (字美中), 清初康雍期间名医, Hu Pu (adult name Meizhong) was a famous doctor in the reign of Emperor Kangxi and Emperor Yongzheng of the early Qing Dynasty. He was proficient in treating smallpox and practiced variolation widely in the name of “Hermit Emei”. His years of birth and death are unknown. 298. 马印麟 (字长公, 号好生主人), Ma Yinlin (adult name Changgong, alias Master Haosheng) was a famous doctor in the Qing Dynasty. He was especially good at pediatrics and treating smallpox. He wrote The Prevention of Smallpox and more. His year of birth is 1646 and his year of death was about 1735. 299. 薛雪 (字生白, 号一瓢、槐云道人、磨剑道人、牧牛老朽), Xue Xue (adult name Shengbai, alias Yipiao, Taoist Huaiyun, Taoist Mojian, Elderly Muniu) was a famous doctor in the Qing Dynasty. He was as famous as Ye Tianshi. His years of birth and death are 1661 and 1750, respectively. 300. 程国彭 (字钟龄, 号恒阳子), Cheng Guopeng (adult name Zhongling, alias Hengyangzi) was a famous doctor in the Qing Dynasty. His year of birth is 1679 and his year of death is unknown. 301. 乐梧冈 (字凤鸣), Le Wugang (adult name Fengming) was a famous pharmacologist in the Qing Dynasty. He founded Tongren Hall in 1702, which has been carried on by his offspring. His years of birth and death are 1661 and 1742, respectively. 302. 王相 (字钟岩), Wang Xiang (adult name Zhongyan) was a famous doctor in the Qing Dynasty. He was neighbour to Ye Tianshi and was able to cure the diseases which were incurable for Ye Tianshi. His years of birth and death are unknown. 303. 王贤 (字世瞻), Wang Xian (adult name Shizhan) was a famous doctor in the Qing Dynasty and an expert of sphygmology. He wrote Thorough Pulse Knowledge in 1700. His years of birth and death are unknown. 304. 孙伟 (号望林), Sun Wei (alias Wanglin) was a famous doctor in the Qing Dynasty. He was a roving doctor and finally worked in the Imperial Academy of Medicine. In 1711 he wrote My Collection of Effective Prescriptions and more. His years of birth and death are unknown. 305. 张锡驹 (字令韶), Zhang Xiju (adult name Lingshao) was a famous doctor in the Qing Dynasty. He began to write Interpretation of

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Exogenous Febrile Disease, Stomach Qi, etc. in 1712. His years of birth and death are unknown. 306. 魏荔彤 (字念庭, 一字赓虞, 号怀舫), Wei Litong (adult name Nianting or Gengyu, alias Huaifang) was a famous doctor and expert of exogenous febrile disease in the Qing Dynasty. He had written much since 1720. His years of birth and death are unknown. 307. 王三尊 (字达士, 号励斋), Wang Sanzun (adult name Dashi, alias Lizhai) was a famous doctor in the Qing Dynasty. He wrote The First Medical Rights in 1721. His years of birth and death are unknown. 308. 戴天章 (字麟郊), Dai Tianzhang (adult name Linjiao) was an expert in warm diseases in the Qing Dynasty. He wrote Complete Treatise on Warm Diseases probably in 1722. His years of birth and death are unknown. 309. 俞茂鲲 (字天池), Yu Maokun (adult name Tainchi) wrote Collected Works of Smallpox in 1727. He made great contributions to variolation. His years of birth and death are unknown. 310. 王子接 (字晋三), Wang Zijie (adult name Jinsan) was a famous doctor in the Qing Dynasty. He was friend of Wei Litong and the teacher of Ye Tianshi. In 1731 he wrote Notes of Ancient Prescriptions made in the Jiangxue Garden. His years of birth and death are unknown. 311. 蒋良臣 (字亮工), Jiang Liangchen (adult name Lianggong) was a famous doctor in the Qing Dynasty. He supplemented and published Wonderful Methods in Variolation. His years of birth and death are unknown. 312. 张朝魁, Zhang Zhaokui was a famous orthopedist and surgeon in the reign of Emperor Qianlong (1736–1795) in the Qing Dynasty. He was able to perform operations. His years of birth and death are unknown. 313. 王维德 (字洪绪, 号林屋先生, 定定子), Wang Weide (adult name Hongxu, alias Mr. Linwu, Dingdingzi) was a famous surgeon in the Qing Dynasty and wrote Complete Works of Surgery in 1740. His years of birth and death are unknown. 314. 张琰 (字逊玉), Zhang Yan (adult name Xunyu) was a famous pediatrician and expert of smallpox in the Qing Dynasty. He wrote a New Book on Smallpox Variolation in his later years and published it in 1741. His years of birth and death are unknown. 315. 吴谦 (字六吉), Wu Qian (adult name Liuji) was a famous doctor in the Qing Dynasty. In 1742 he was in charge of compiling The Golden Mirror of Medicine. His years of birth and death are unknown. 316. 李仁山, Li Renshan was a famous doctor in the Qing Dynasty. In 1744 he went to Japan and spread variolation. His years of birth and death are unknown.

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317. 叶天士 (名桂, 号香岩, 别号南阳先生、上津老人), Ye Tianshi (birth name Gui, alias Xiangyan, Mr. Nanyang, Elderly Shangjin) was a famous doctor and master of warm disease in the Qing Dynasty. His Theory of Warm Diseases was published by his disciples in 1746. His years of birth and death are 1667 and 1746, respectively. 318. 尤怡 (字在泾, 号拙吾, 晚号饲鹤山人), You Yi (adult name Zaijing, alias Zhuowu, late alias Hermit Sihe) was a famous doctor in the Qing Dynasty. His year of birth is unknown and his year of death was 1749. 319. 华岫云 (字南田), Hua Xiuyun (adult name Nantian) was a famous doctor in the Qing Dynasty. His teacher was Ye Tianshi. His year of birth is unknown and his year of death was 1753. 320. 何梦瑶 (字报之, 号西池), He Mengyao (adult name Baozhi, alias Xichi) was a famous doctor in the Qing Dynasty. His years of birth and death are 1692 and 1764, respectively. 321. 徐大椿 (又名大业, 字灵胎, 晚号洄溪道人), Xu Dachun (alias Daye, adult name Lingtai, late alias Taoist Huixi) was a famous doctor in the Qing Dynasty. His years of birth and death are 1693 and 1771, respectively. 322. 曹庭栋 (廷栋, 字楷人, 号六圃), Cao Tingdong (or Ting 廷 dong, adult name Kairen, alias Liupu) was a health expert in the Qing Dynasty. His years of birth and death are 1699 and 1785, respectively. 323. 黄元御 (又名玉路, 字坤载, 号研农, 别号玉楸子), Huang Yuanyu (or Yulu, adult name Kunzai, alias Yannong, Haoyuqiuzi) was a famous doctor in the Qing Dynasty. His years of birth and death are 1705 and 1758, respectively. 324. 杨栗山 (名睿, 字玉衡), Yang Lishan (birth name Rui, adult name Yuheng) was a famous doctor in the Qing Dynasty. He spent all his life in the diagnosis and treatment of plague. His year of birth is 1706 and his year of death is unknown. 325. 吴仪洛 (字遵程), Wu Yiluo (adult name Zuncheng) was a famous doctor in the Qing Dynasty. His year of birth is 1717 and his year of death is unknown. 326. 沈金鳌 (字芊绿, 号汲门, 晚号尊生老人), Shen Jinao (adult name Qianlv, alias Jimen, late alias Elderly Zunsheng) was a famous doctor in the Qing Dynasty. His years of birth and death are 1717 and 1776, respectively. 327. 赵学敏 (字恕轩, 号依吉), Zhao Xuemin (adult name Shuxuan, alias Yiji) was a famous pharmacologist in the Qing Dynasty. His young brother Zhao Xuekai and old son Zhao Baiyun are also famous in medicine. His years of birth and death were about 1719 and 1805, respectively.

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328. 魏之琇 (字玉璜, 号柳洲), Wei Zhixiu (adult name Yuhuang, alias Liuzhou) was a famous doctor in the Qing Dynasty. His years of birth and death are 1722 and 1772, respectively. 329. 郑望颐, Zheng Wangyi was a famous doctor and a variolation expert in the Qing Dynasty. His Theory on Smallpox Variolation was published in Hermit Yulan’s Smallpox Variolation Methods in 1750. His years of birth and death are unknown. 330. 汤御龙 (字荣光), Tang Yulong (adult name Rongguang) was a famous doctor in the Qing Dynasty. He became Wujieyuan in the 21th year of the reign of Emperor Qianlong. He even performed abdominal operation for patients. His years of birth and death are unknown. 331. 陈复正 (号飞霞), Chen Fuzheng (alias Feixia) was especially good at pediatrics. He wrote A Complete Works on Pediatrics in 1750. His years of birth and death are unknown. 332. 沈又彭 (字尧峰、尧封), Shen Youpeng (adult name Yaofeng 峰 or Yaofeng 封) was a famous doctor in the Qing Dynasty, whose house was flagged with “I Have Drunk Shangchi Water”. He began to write Gynecological Readings and more from 1764. His years of birth and death are unknown. 333. 冯学震 (字东崖, 号昨非子), Feng Xuezhen (adult name Dongya, alias Zuofeizi) was a famous doctor in the Qing Dynasty. He wrote Pulse Assembly in 1767. His years of birth and death are unknown. 334. 顾世澄 (一名澄, 字练江, 号静斋) Gu Shicheng (or Cheng, adult name Lianjiang, alias Jingzhai) was a famous surgeon in the Qing Dynasty. In 1769 he finished his Surgical Encyclopedia. His years of birth and death are unknown. 335. 田之丰 (字登五), Tian Zhifeng (adult name Dengwu) was a famous doctor in the Qing Dynasty. He wrote The Key to Smallpox in 1769. His years of birth and death are unknown. 336. 黄宫绣 (字锦芳), Huang Gongxiu (adult name Jinfang) was a medical scientist in the Qing Dynasty. In 1773 he presented Seek the Truth among the Chinese Materia Medica to Four Branches of Literature Bureau. His years of birth and death are unknown. 337. 庄一燮 (字在田), Zhuang Yixie (adult name Zaitian) was a famous pediatrician in the Qing Dynasty. His Smallpox Treatment and Medicine for Children were published 1777. His years of birth and death are unknown. 338. 俞震 (字东扶, 号惺斋) Yu Zhen (adult name Dongfu, alias Xingzhai) wrote Note to Ancient and Modern Medical Records in 1778. His years of birth and death are unknown.

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339. 史大受 (字春亭), Shi Dashou (adult name Chunting) was a famous doctor in the Qing Dynasty. He wrote Mr. Shi’s Medical Experience in 1781. His years of birth and death are unknown. 340. 余霖 (字师愚), Yu Lin (adult name Shiyu) was a famous doctor in the Qing Dynasty. He was especially good at treating plague. He wrote A View of Epidemic Febrile Diseases in 1785. His years of birth and death are unknown. 341. 刘奎 (字文甫, 号松峰), Liu Kui (adult name Wenfu, alias Songfeng) was a famous doctor in the Qing Dynasty. He wrote Songfeng Talking about Plague in 1785. His years of birth and death are unknown. 342. 郑梅涧 (名宏纲, 字纪元, 号梅涧、雪萼山人), Zheng Meijian (birth name Honggang, adult name Jiyuan, alias Meijian, Hermit Xue’E) was a famous throat doctor in the Qing Dynasty. His offspring Chenghan, Chengluo and Chengxiang carried on his work. His years of birth and death were about 1727 and 1787, respectively. 343. 俞根初 (人称俞三先生), Yu Genchu (also called Mr. Yusan by people) was a famous doctor in the Qing Dynasty. His years of birth and death are 1734 and 1799, respectively. 344. 萧晓亭, Xiao Xiaoting was a leprosy expert in the Qing Dynasty. He wrote Complete Works of Leprosy. His year of birth is unknown and his year of death was 1801. 345. 王学权 (字秉衡, 晚号水北老人), Wang Xuequan (adult name Bingheng, late name Elderly Shuibei) was a famous doctor in the Qing Dynasty. He was great grandfather of Wang Mengying. His years of birth and death are 1728 and 1810, respectively. 346. 王丙 (字朴庄, 号绳林), Wang Bing (adult name Puzhuang, alias Shenglin) was a famous doctor in the Qing Dynasty. His medical articles are collected in Collected Works of Wu Doctors. Lu Maoxiu was his great-grandson. He lived during the reign of Emperor Qianlong (1736–1795). His years of birth and death are unknown. 347. 雷允上 (名大升, 号南山), Lei Yunshang (birth name Dasheng, alias Nanshan) was a famous doctor in the Qing Dynasty. He founded “Lei Yunshang Pharmacy” during the reign of Emperor Qianlong, whose “Liushen Pills” have won fame at home and abroad. His years of birth and death are unknown. 348. 章穆 (字杏云, 晚号杏云老人), Zhang Mu (adult name Xingyun, late name Elderly Xingyun) was a famous doctor in the Qing Dynasty. His years of birth and death were about 1743 and 1813, respectively.

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349. 王九峰 (名之政, 字献廷), Wang Jiufeng (birth name Zhizheng, adult name Xianting) was a famous doctor in the Qing Dynasty. His years of birth and death are 1753 and 1815, respectively. 350. 陈修园 (名念祖, 一字良有, 号慎修), Chen Xiuyuan (birth name Nianzu, adult name Liangyou, alias Shenxiu) was a famous doctor in the Qing Dynasty. His years of birth and death are 1753 and 1823, respectively. 351. 高秉钧 (字锦庭), Gao Bingjun (adult name Jinting) was a famous surgeon in the Qing Dynasty. His years of birth and death are 1755 and 1827, respectively. 352. 吴瑭 (字鞠通, 又字配珩), Wu Tang (adult name Jutong or Peiheng) was a famous doctor of epidemic febrile disease. His years of birth and death are 1758 and 1836, respectively. 353. 曹存心 (字仁伯, 号乐山), Cao Cunxin (adult name Renbo, alias Leshan) was a famous doctor in the Qing Dynasty. His years of birth and death are 1767 and 1834, respectively. 354. 王清任 (又名全任, 字勋臣), Wang Qingren (alias Quanren, adult name Xunchen) was a famous innovative doctor in the Qing Dynasty. His years of birth and death are 1768 and 1831, respectively. 355. 江考卿 (号瑞屏), Jiang Kaoqing (adult name Ruiping) was a famous doctor of bone fracture in the Qing Dynasty. He was able perform operations for patients. His years of birth and death were about 1770 and 1845, respectively. 356. 林佩琴 (字云和, 号羲桐), Lin Peiqin (adult name Yunhe, alias Xitong) was a famous doctor in the Qing Dynasty. His years of birth and death are 1772 and 1839, respectively. 357. 何书田 (名其伟, 一名庆曾, 字韦人, 书田为其号。晚号竹簳山人), He Shutian (birth name Qiwei, or Qingzeng, adult name Weiren, alias Shutian, late alias Hermit Zhugan) was a famous doctor in the Qing Dynasty. He got the appreciation of Lin Zexu and formulated a prescription against opium. His ancestors had been famous for twenty-three generations since the Song Dynasty. His son He Hongfang (1821– 1889) and his grandson He Jun carried on his work. His years of birth and death were about 1774 and 1837, respectively. 358. 唐大烈 (字立三, 号笠山, 林嶝), Tang Dalie (adult name Lisan, alias Lishan, Lindeng) edited a magazine Collected Works of Wu Doctors from 1792 to 1801. His years of birth and death are unknown. 359. 朱弈梁, Zhu Yiliang was a famous doctor in the Qing Dynasty. He was especially good at smallpox variolation. His Experience in

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Variolation was published in 1808. His years of birth and death are unknown. 360. 邱熺 (字浩川), Qiu Xi (adult name Haochuan) studied cowpox vaccination in 1805 and wrote A Brief of Cowpox Vaccination in 1817. His years of birth and death are unknown. 361. 吴其濬 (浚, 字瀹斋、季深、吉兰, 号哲甫、雩娄农), Wu Qijun (or Jun 浚, adult name Yuezhai, Jishen, Jilan, alias Zhefu, The Farmer from Yulou) was a famous botanist and pharmacologist. His years of birth and death are 1789 and 1847, respectively. 362. 邹澍 (字润安, 晚号闰庵), Zou Shu (adult name Run’an 安, late name Run’an 庵) was a famous doctor in the Qing Dynasty. His years of birth and death are 1790 and 1844, respectively. 363. 江涵暾 (字笔花), Jiang Hantun (adult name Bihua) was a famous doctor in the Qing Dynasty. He wrote Bihua Medical Mirror. His years of birth and death are unknown. 364. 周学霆 (字荆威, 号梦觉道人), Zhou Xueting (adult name Jingwei, alias Taoist Mengjue) was a famous doctor in the Qing Dynasty. He was especially proficient in pulse feeling and finished Three-Finger Contemplation in 1827. His years of birth and death are unknown. 365. 章楠 (字虚谷), Zhang Nan (adult name Xugu) was a famous doctor in the Qing Dynasty. He wrote Medical Warnings. His years of birth and death are unknown. He probably lived in the middle and late reign of Emperor Qianlong. 366. 邹岳 (字五峰, 号东山), Zou Yue (adult name Wufeng, alias Dongshan) was a famous doctor in the Qing Dynasty. He was especially good at surgery and wrote Surgical Essence in 1838. His years of birth and death are unknown. 367. 包诚 (字兴言), Bao Cheng (adult name Xingyan) was a famous doctor in the Qing Dynasty. He wrote Ten-Agent Tablet, Save Lives and so on from 1840. His years of birth and death are unknown. 368. 马如龙 (字复元), Ma Rulong (adult name Fuyuan) was a famous doctor in the Qing Dynasty. His years of birth and death were about 1795 and 1875, respectively. 369. 王旭高, (名泰林, 晚号退思居士), Wang Xugao (birth name Tailin, late name Hermit Tuisi) was a famous doctor. His years of birth and death are 1798 and 1862, respectively. 370. 费伯雄 (字晋卿, 号砚云子), Fei Boxiong (adult name Jinqing, alias Yanyunzi) was a famous doctor in the Qing Dynasty and the founder of the Meng River School. His disciples, especially his grandson Fei

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Shengfu (1851-1914), acquired an enviable reputation in medicine over hundred years. His years of birth and death are 1800 and 1879, respectively. 371. 吴尚先 (原名樽, 又名安业, 字师机, 杖仙), Wu Shangxian (original name Zun, alias Anye, adult name Shiji, Zhangxian) was a famous doctor and an expert of external treatment in the Qing Dynasty. His years of birth and death were about 1806 and 1886, respectively. 372. 王士雄 (字孟英, 晚字梦隐, 号半痴山人、随息居士等), Wang Shixiong (adult name Mengying, late name Mengyin, alias Hermit Banchi, Hermit Suixi) was a famous expert of epidemic febrile disease in the Qing Dynasty. His years of birth and death are 1808 and 1867, respectively. 373. 陈定泰 (字弼臣), Chen Dingtai (adult name Bichen) was a famous doctor integrating traditional Chinese medicine and Western Medicine. He wrote Medical Talk in 1844. His years of birth and death are unknown. 374. 鲍相璈, Bao Xiang’ao was a famous doctor in the Qing Dynasty. He wrote New Compilation of Proved Prescriptions in 1846. His years of birth and death are unknown. 375. 于省三 (字绍曾), Yu Shengsan (adult name Shaozeng) was a famous doctor in the Qing Dynasty. During the reign of Emperor Xianfeng (1851–1861) plague broke out and he saved many lives. His years of birth and death are unknown. 376. 潘罻 (字伟如, 号桦园居士), Pan Wei (adult name Weiru, alias Hermit Huayuan) was a famous doctor in the Qing Dynasty. In 1855 he was called to the imperial palace to take pulses. He had conducted extensive research of Daoyin and Neigong and wrote Eight Exercises for Strengthening Muscles and Bones and many other books. His years of birth and death are unknown. 377. 万德华 (字醇泉), Wan Dehua (adult name Chunquan) was a famous folk doctor. He practiced medicine in Guangdong Province and did many meritorious deeds. Poor people could get free treatment from him. His years of birth and death are unknown. 378. 陆以湉 (字薪安, 定圃), Lu Yitian (adult name Xin’an, Dingpu) was a famous doctor in the Qing Dynasty. He wrote Medical Talks in a Shabby House in 1858. His years of birth and death are unknown. 379. 石芾南 (字寿棠, 湛棠), Shi Funan (adult name Shoutang, Zhantang) was a famous doctor. He wrote Disease Roots in 1858. His years of birth and death are unknown.

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380. 徐子默, Xu Zimo was a famous doctor in the Qing Dynasty. His Treatise on Diaojiaosha (Cholera) was published in 1860. His years of birth and death are unknown. 381. 莫枚士 (名文泉), Mo Meishi (birth name Wenquan) was a famous doctor in the Qing Dynasty. He found shelter in Shanghai in 1861 and wrote Study the Classics in 1871. His years of birth and death are unknown. 382. 陆懋修 (字九芝, 号江左下工, 林屋山人), Lu Maoxiu (adult name Jiuzhi, alias Worker Jiangzuo, Hermit Linwu) was a famous doctor in the Qing Dynasty. His years of birth and death are 1818 and 1886, respectively. 383. 吕熊飞 (字樵翁), Lu Xiongfei (adult name Qiaoweng) was a famous oculist in the Qing Dynasty. He was especially good at treating cataracts with needles. His year of birth is unknown and his year of death was about 1892. 384. 李俊良 (本名俊昌), Li Junliang (original name Junchang) was a famous doctor in Taiping Kingdom of Heaven. His years of birth and death were about 1820 and 1856, respectively. 385. 马文植 (字培之), Ma Wenzhi (adult name Peizhi) was a famous surgeon in the Qing Dynasty. He was the brother-in-law of Fei Boxiong and one of the founders of the Menghe School. In 1880 he was awarded a tablet “Being Perfect” because he cured Empress Dowager Cixi of her disease. His years of birth and death are 1820 and 1903, respectively. 386. 赵廷海 (字兰亭), Zhao Tinghai (adult name Lanting) was a famous doctor of bone fracture in the Qing Dynasty. His years of birth and death are 1821 and 1861, respectively. 387. 赵晴初 (名彦辉, 号存存老人、寿补老人), Zhao Qingchu (birth name Yanhui, alias Elderly Cuncun, Elderly Shoubu) was a famous doctor in the late Qing Dynasty. His years of birth and death are 1823 and 1895, respectively. 388. 过铸 (字玉书), Guo Zhu (adult name Yushu) was a famous doctor in the late Qing Dynasty and known for acupuncture. He often studied surgery with Ma Peizhi. His year of birth is 1830 and his year of death is unknown. 389. 罗汝兰 (字芝园, 广文), Luo Rulan (adult name Zhiyuan, Guangwen) was a famous doctor in the late Qing Dynasty. He saved many lives as the plague broke out in the Guangdong Province in the reign of Emperor Guangxu (1875–1908). He wrote Assembly of the Plague Ideas and more. His years of birth and death are unknown.

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390. 雷丰 (字少逸), Lei Feng (adult name Shoyi) was a famous doctor in the late Qing Dynasty. He wrote Treatise on Seasonal Diseases in 1882. His years of birth and death were about 1833 and 1888, respectively. 391. 罗定昌 (字茂庭), Luo Dingchang (adult name Maoting) was a famous doctor in the late Qing Dynasty. He advocated a combination of Chinese traditional and Western medicine and wrote The Essence of Chinese Medicine and Western Medicine in 1887. His years of birth and death are unknown. 392. 万潜斋 (自号方内散人), Wan Qianzhai (personal name Freeman Fangnei) was a famous doctor in the Qing Dynasty. He spent over twenty years in writing New Compilation of Mankind Health and published it in 1892. His years of birth and death are unknown. 393. 赵濓 (字竹泉), Zhao Lian (adult name Zhuquan) was a famous surgeon in the Qing Dynasty. He wrote Surgical Achievements in 1891. His years of birth and death are unknown. 394. 陈莲舫 (名秉钧, 号乐余老人, 别署庸叟, 十九世医陈, 戊戌徵士), Chen Lianfang (birth name Bingjun, alias Elderly Leyu, Yongsou, Yichen in the 19th century, Hermit Wuxu) was a famous doctor in the late Qing Dynasty. His years of birth and death were about 1840 and 1914, respectively. 395. 柳宝诒 (字公孙, 号冠群), Liu Baoyi (adult name Gongsun, alias Guanqun) was a famous doctor in the late Qing Dynasty. His years of birth and death are 1842 and 1901, respectively. 396. 张聿青 (名乃修, 小字莲葆), Zhang Yuqing (birth name Naixiu, infant name Lianbao) was a famous doctor in the late Qing Dynasty. His years of birth and death are 1844 and 1905. 397. 余听鸿 (名景和), Yu Tinghong (birth name Jinghe) was a famous doctor in the late Qing Dynasty. His son Jihong carried on his business. His years of birth and death are 1847 and 1907, respectively. 398. 郑肖岩 (名奋扬), Zheng Xiaoyan (birth name Fenyang) was a famous doctor in the late Qing Dynasty. His years of birth and death are 1848 and 1920, respectively. 399. 唐宗海 (字容川), Tang Zonghai (adult name Rongchuan) was a famous doctor in the late Qing Dynasty. He was a famous advocate of combining Chinese and Western medicine. His years of birth and death are 1847 and 1897 (or 1846 and 1897 or 1862 and 1908), respectively. 400. 朱沛文 (字少廉), Zhu Peiwen (adult name Shaolian) was a famous doctor in the late Qing Dynasty. He was a famous doctor combining

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Chinese and Western Medicine. He wrote Chinese and Western Viscera Study in 1892. His years of birth and death are unknown. 401. 张士骧 (字伯龙), Zhang Shixiang (adult name Bolong) was a famous doctor in the Qing Dynasty. He was taught by Tang Zonghai and advocated the combination of Chinese and Western Medicine. His years of birth and death are unknown. 402. 刘廷桢 (字铭之), Liu Tingzhen (adult name Mingzhi) was a doctor in the late Qing Dynasty. He researched the similarities and differences of anatomy in Chinese medicine and Western medicine and wrote Chinese and Western Bone Differentiation and Chinese and Western Bone Illustration in 1897. His years of birth and death are unknown. 403. 叶霖 (字子雨, 号石林旧隐), Ye Lin (adult name Ziyu, alias Old Hermit Shilin) was a famous doctor in the late Dynasty. He advocated the combination of Chinese and Western medicine and wrote Explanation of Fuqi Warm Disease from 1897. His years of birth and death are unknown. 404. 刘钟衡 (字时甫), Liu Zhongheng (adult name Shifu) was a famous doctor in the late Qing Dynasty. He wrote Chinese and Western Bronze Figure in 1899. His years of birth and death are unknown. 405. 余景和 (字听鸿), Yu Jinghe (adult name Tinghong) was a famous doctor in the late Qing Dynasty and one of founders of Menghe School. His years of birth and death are 1847 and 1907, respectively. 406. 高思敬 (字憩云), Gao Sijing (adult name Qiyun) was a famous surgeon advocating the combination of Chinese and Western medicine in the late Qing Dynasty. He wrote many books and found shelter in Shanghai in 1900. His years of birth and death are unknown. 407. 周学海 (字澄之, 瀓之, 健之), Zhou Xuehai (adult name Cheng 澄 zhi, Cheng 瀓 zhi, Jianzhi) was a famous doctor in the late Qing Dynasty. His years of birth and death are 1856 and 1906, respectively. 408. 朱玉峰, Zhu Yufeng was a famous doctor in the late Qing Dynasty. His family had engaged in orthopedics for generations and saved many soldiers in the Taiping Army. His year of birth is unknown and his year of death was 1909. 409. 蔡小香 (名钟骏, 号铁鸥), Cai Xiaoxiang (birth name Zhongjun, alias Tie’ou) was a famous uterologist in Shanghai in the late Qing Dynasty. He took the revitalization of Chinese medicine as his task. His father Yanxiang (1826–1898) and his son Xiangsun (1889–1943) were also famous in medicine. His years of birth are 1862 and 1912, respectively.

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I. Famous Doctors in the First Half of the 20th Century (the Late Qing Dynasty and Early Republican China) 410. 杨熙龄 (字铸园, 著园), Yang Xiling (adult name Zhu 铸 yuan, Zhu 著 yuan) was a famous doctor in the late Qing Dynasty and the early Republican China. He advocated that it was very right to “ban Western medicine”. His son Yang Shucheng (birth name Yuzeng, about 1896–?) was also a famous doctor. His year of birth is unknown and his year of death was 1919. 411. 石晓山 (名荣宗), Shi Xiaoshan (birth name Rongzong) was a famous doctor in the late Qing Dynasty and the early Republican China. He, his father Shi Lantian and his son Shi Xiaoshan were all proficient in orthopedics and traumatology. His years of birth and death are 1859 and 1928, respectively. 412. 张锡纯 (字寿甫), Zhang Xichun (adult name Shoufu) was a famous doctor in the late Qing Dynasty and the early Republican China. He worked hard to combine Chinese and Western medicine. His years of birth and death are 1860 and 1933, respectively. 413. 黄灿 (字石屏), Huang Can (adult name Shiping) was a famous doctor in the late Qing Dynasty and the early Republican China. He was known as the “Magic Acupuncturist”. His years of birth and death were about 1860 and 1920, respectively. 414. 杨如侯 (名百城), Yang Ruhou (birth name Baicheng) was a famous doctor in the late Qing Dynasty and the early Republican China. He opposed the abolition of traditional Chinese Medicine, took charge of editing the national Chinese medical notes and brought them to completion. His years of birth and death are 1861 and 1928, respectively. 415. 张生甫 (名国华), Zhang Shengfu (birth name Guohua) was a famous doctor in the late Qing Dynasty and the early Republican China. He, Zhang Xichun and Zhang Shanlei are called “domestic three Zhang’s”. His year of birth is 1864 and his year of death is unknown. 416. 余奉仙 (字涤凡), Yu Fengxian (adult name Difan) was one of the three famous doctors in Northern Jiangsu in the late Qing Dynasty. His son Wuyan and his grandson Ying’ao were famous in medicine too. His years of birth and death are 1860 and 1939, respectively. 417. 周雪樵 (字维翰), Zhou Xueqiao (adult name Weihan) was a famous doctor advocating the combination of Chinese and Western medicine in the late Qing Dynasty. His year of birth is unknown and his year of death was 1910.

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418. 何廉臣 (名炳元, 号印岩), He Lianchen (birth name Bingyuan, alias Yinyan) was a famous doctor in Zhejiang Province and Shanghai in the late Qing Dynasty and the early Republican China. His years of birth and death are 1861 and 1929, respectively. 419. 刘耀先 (字延年, 号景云), Liu Yaoxian (adult name Yannian, alias Jingyun) was a famous oculist in the late Qing Dynasty. He was especially good at treating cataracts with needles. His year of birth is 1864 and his year of death is unknown. 420. 丁甘仁 (名泽周), Ding Ganren (birth name Zezhou) was a famous doctor in the late Qing Dynasty and the early Republican China. He carried forward Menghe School. His years of birth and death are 1865 and 1926, respectively. 421. 李培卿 (字怀德), Li Peiqing (adult name Huaide) was a famous acupuncturist in Shanghai. His years of birth and death are 1865 and 1947, respectively. His son Lu Shouyan (original Li Chang 1909– 1969) was also known for acupuncture. 422. 沈绍九 (名湘), Shen Shaojiu (birth name Xiang) was a famous doctor in Chengdu. His years of birth and death are 1866 and 1936, respectively. 423. 曹颖甫 (名家达, 字尹孚, 号鹏南、拙巢老人), Cao Yingfu (birth name Jiada, adult name Yinfu, alias Pengnan, Elderly Zhuochao) was a famous doctor in Shanghai. His years of birth and death are 1866 and 1937, respectively. 424. 余伯陶 (字德壎), Yu Botao (adult name Dexun) was a famous doctor in the late Qing Dynasty and the early Republican China. He took the revitalization of traditional Chinese medicine as his task and became the leader of the “Medical Salvation Delegation” in 1914. His year of birth was 1868 and his year of death probably 1922. 425. 吴佩衡 (名钟权), Wu Peiheng (birth name Zhongqan) was a famous doctor in Yunnan and Shanghai. He opposed the abolition of traditional Chinese medicine. His years of birth and death are 1868 and 1971, respectively. 426. 金子久 (名有恒), Jin Zijiu (birth name Youheng) was a famous doctor in Zhejiang Province and Shanghai. His years of birth and death are 1870 and 1921, respectively. 427. 范文虎 (名赓治, 字文甫, 晚年易字文虎, 别号古狂生), Fan Wenhu (birth name Gengzhi, adult name Wenfu, late adult name Wenhu, alias Gukuangsheng) was a famous doctor in the late Qing Dynasty and the early Republican China. His years of birth and death are 1870 and 1936, respectively.

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428. 陈任枚, Chen Renmei was a famous doctor in Guangdong Province. He was especially proficient in warm disease and medical education. His years of birth and death are 1870 and 1945, respectively. 429. 萧龙友 (名方骏, 号息翁、不息翁), Xiao Longyou (birth name Fangjun, alias Elderly Xi, Elderly Buxi) was one of the four famous doctors in Beijing. His years of birth and death are 1870 and 1960, respectively. 430. 夏应堂, Xia Yingtang was as famous as Ding Ganren in Shanghai. His son Libin carried on his business. His years of birth and death are 1871 and 1936, respectively. 431. 吴瑞甫 (字锡璜, 号黼堂), Wu Ruifu (adult name Xihuang, alias Futang) was a famous doctor in Fujian Province and Singapore. He advocated the combination of Chinese and Western medicine. His years of birth and death are 1871 and 1951, respectively. 432. 朱南山 (名松庆, 又名永康), Zhu Nanshan (birth name Songqing or Yongkang) was a famous uterologist in the late Qing Dynasty and the early Republican China. His years of birth and death are 1872 and 1938, respectively. 433. 杜亚泉 (原名炜孙, 字秋帆), Du Yaquan (original name Weisun, adult name Qiufan) was a famous doctor in the late Qing Dynasty and early Republican China. He refuted the abolition of the Chinese medicine and advocated the combination of Chinese and Western medicine. His year of birth was 1873 and his year of death is unknown. 434. 张寿颐 (字山雷), Zhang Shouyi (adult name Shanlei) was a famous doctor advocating the combination of Chinese and Western medicine in the late Qing Dynasty and early Republican China. His years of birth and death are 1873 and 1934, respectively. 435. 裘吉生 (名庆元, 又字激声), Qiu Jisheng (birth name Qingyuan, adult name Jisheng) was a famous doctor in Hangzhou and Zhejiang. He opposed the abolition of traditional Chinese medicine and advocated the combination of Chinese and Western medicine. His years of birth and death are 1873 and 1947, respectively. 436. 蒋维乔 (字竹庄, 号因是子), Jiang Weiqiao (adult name Zhuzhuang, alias Yinshizi) made a special contribution to healthcare with Qigong in Republican China. His years of birth and death are 1873 and 1958, respectively. 437. 包识生 (名一虚, 字德逮), Bao Shisheng (birth name Yixu, adult name Dedai) was a famous doctor in the late Qing Dynasty and Republican China and a modern educationist in Chinese traditional medicine. His year of birth is 1874 and his year of death was about 1936.

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438. 丁福保 (字仲怙, 号畴隐居士, 又号济阳破衲), Ding Fubao (adult name Zhonghu, alias Hermit Chouyin, Jiyangpona) was proficient in Chinese and Western medicine and advocated the combination of both. His years of birth and death are 1874 and 1952, respectively. 439. 吴汉仙 (字捷三, 号拌湖医叟), Wu Hanxian (adult name Jiesan, alias Old Doctor Banhu) was a famous doctor in Republican China. He refuted the abolition of Chinese medicine and advocated the combination of both Chinese and Western medicine. His years of birth and death are 1876 and 1948, respectively. 440. 赵熙 (字辑庵, 号遁仙), Zhao Xi (adult name Ji’an, alias Dunxian) was called the “famous doctor of Jin” in Republican China. He was especially good at acupuncture. His years of birth and death are 1877 and 1938, respectively. 441. 曹炳章 (字赤电), Cao Bingzhang (adult name Chidian) was a famous doctor in Shanghai and Zhejiang Province. His years of birth and death are 1877 and 1956, respectively. 442. 冉雪峰 (又名敬兴), Ran Xuefeng (birth name Jingxing) was famous in Sichuan and Hubei. He was especially good at treating epidemic disease. His years of birth and death are 1877 and 1962, respectively. 443. 郓铁樵 (名树珏, 别名冷风、焦木), Yun Tieqiao (birth name Shujue, alias Lengfeng, Jiaomu) was a famous doctor in the Republican China. He was a key person refuting the abolition of Chinese medicine. His years of birth and death are 1878 and 1935, respectively. 444. 曲焕章, Qu Huanzhang was a famous doctor in Yunnan Province. He was the founder of Yunnan Baiyao. His years of birth and death are 1878 and 1938, respectively. 445. 陆士谔 (名守先), Lu Shi’e (birth name Shouxian) was a famous doctor in Shanghai. His years of birth and death are 1878 and 1944, respectively. 446. 王珏 (字云门), Wang Jue (adult name Yunmen) was a famous doctor in Republican China. His treatment for diphtheria in Jiangdu of Jiangsu Province was rather effective from 1926 to 1927. He wrote Differentiation of Epidemic Throat Disease in the next year. His years of birth and death are unknown. 447. 薛文元 (名蕃), Xue Wenyuan (birth name Fan) was a famous doctor in Shanghai. Ding Ganren and Xia Yingtang both thought highly of him. He opposed the abolition of traditional Chinese medicine. His year of birth is 1800 and his year of death is unknown. 448. 谢观 (字利恒, 号澄斋老人), Xie Guan (adult name Liheng, alias Elderly Chengzhai) was a famous doctor in Shanghai. He opposed the

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abolition of traditional Chinese medicine. His years of birth and death are 1880 and 1950, respectively. 449. 张伯熙 (字祖泳, 明达), Zhang Boxi (adult name Zuyong, Mingda) was a famous doctor in Shanghai. He opposed the abolition of traditional Chinese medicine. His years of birth and death are 1880 and 1949, respectively. 450. 焦易堂 (名希孟), Jiao Yitang (birth name Ximeng) served as the director of the Central State Hospital since 1931. He opposed the abolition of traditional Chinese medicine. His years of birth and death are 1880 and 1950, respectively. 451. 王秉钧 (字和安), Wang Bingjun (adult name He’an) was a famous doctor in Republican China. He advocated the combination of Chinese medicine and Western medicine and annotated newly Treatise on Exogenous Febrile Disease and Synopsis Golden Chamber in 1929. His years of birth and death are unknown. 452. 王仲奇 (名金杰, 晚号懒翁), Wang Zhongqi (birth name Jinjie, late name the “Lazy Old Man”) was a famous doctor in Xin’an in Republican Chian. His years of birth and death were 1881 and 1945, respectively. 453. 李鼎铭 (原名丰功), Li Dingming (original name Fenggong) was a famous doctor in Yan’an and cured Mao Zedong of chronic disease during the Long March. His years of birth and death are 1881 and 1947, respectively. 454. 张骥 (字先识), Zhang Ji (adult name Xianshi) was a famous doctor in Sichuan. His year of birth is unknown and his year of death was 1951. 455. 施今墨 (原名毓黔, 字奖生), Shi Jinmo (original name Yuqian, adult name Jiangsheng) was one of the four famous doctors in Beijing in Republican Chian. He worked hard to oppose the abolition of Chinese medicine. His years of birth and death are 1881 and 1969, respectively. 456. 汪逢春 (一名朝甲, 号风椿), Wang Fengchun (birth name Chaojia, alias Fengchun) was one of the four famous doctors in Beijing in Republican Chian. His years of birth and death are 1882 and 1948, respectively. 457. 陆仲安, Lu Zhongan was a famous doctor in Beijing and Shanghai in Republican China. He was invited to treat Sun Zhongshan (Sun Yat-sen) during a critical illness. His years of birth and death are 1882 and 1949, respectively. 458. 张菊人, Zhang Juren (original name Tingluan, used name Hanqing) was famous in Beijing and Jiangsu in Republican China. His years of birth and death are 1882 and 1960, respectively.

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459. 陈无咎 (名淳白、茂弘, 号无咎居士、壶叟), Chen Wujiu (birth name Chunbai, Maohong, adult name Hermit Wujiu, elderly Hu) was a famous doctor in Shanghai. His years of birth and death are 1883 and 1948, respectively. 460. 胡文虎, Hu Wenhu (Aw Boon-Haw) did pharmaceutical business with his father Hu Ziqin (Aw Chu-Kin) in Southeast Asia and created Tiger Balm, Eight Diagrams Dan, etc. His years of birth and death are 1883 and 1954, respectively. 461. 马英麟 (字裕出, 号二琴), Ma Yinglin (adult name Yuchu, alias E’qin) was a famous doctor in Tianjin. He often discussed medical skill with Zhang Xichun. His years of birth and death are 1883 and 1968, respectively. 462. 祝味菊 (号傲霜轩主), Zhu Weiju (alias Proud Xuanzhu) was a famous doctor in Shanghai. He advocated cooperation between Chinese and Western medicine. His years of birth and death are 1884 and 1951, respectively. 463. 孔伯华 (字繁栖, 人称 “石膏孔”), Kong Bohua (adult name Fanxi, called “Kong Plaster” by people) was one of the four famous doctors in Beijing in Republican China. He opposed the abolition of traditional Chinese medicine. His years of birth and death are 1885 and 1955, respectively. 464. 黄竹斋 (原名谦、只吉, 号中南山人、诚中子), Huang Zhuzhai (original name Qian, Zhiji, alias Hermit Zhongnnan, Chengzhongzi) was a famous doctor in Xi’an. His years of birth and death are 1886 and 1960, respectively. 465. 徐小圃 (名放), Xu Xiaopu (birth name Fang) was a famous pediatrician in Shanghai. His years of birth and death are 1887 and 1961, respectively. 466. 丁仲英 (名元彦), Ding Zhongying (birth name Yuanyan), the second son of Ding Ganren, was a famous doctor in Shanghai. Later he lived in America. His year of birth was 1888 and his year of death is unknown. 467. 蒲辅周, Pu Fuzhou was a famous doctor in Chengdu. His years of birth and death are 1888 and 1975, respectively. 468. 方慎盦, Fang Shen’an was a famous doctor in Shanghai. He was especially good at acupuncture and opposed national nihilism and the abolition of Chinese medicine. His years of birth and death are 1892 and 1962, respectively.

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469. 史沛棠 (名维清), Shi Peitang (birth name Weiqing) was a famous doctor in Hanzhou and Zhejiang. His years of birth and death are 1892 and 1965, respectively. 470. 杨则民 (一名寄玄, 字潜盦), Yang Zemin (alias Jixuan, adult name Qian’an) was a famous doctor in Zhejiang in Republican China. He was a mainstay in the stand against the abolition of Chinese medicine. His years of birth and death are 1893 and 1948, respectively. 471. 孔宪仁 (字静山), Kong Xianren (adult name Jingshan) was a famous doctor in Shanxi. He was especially proficient in ophthalmology. His family had practiced medicine for four generations. His years of birth and death are 1893 and 1960, respectively. 472. 陆彭年 (字渊雷), Lu Pengnian (adult name Yuanlei) was a famous doctor in Shanghai in Republican China. His teacher was Yun Tieqiao. His years of birth and death are 1894 and 1955, respectively. 473. 王文鼎, Wang Wending was a famous doctor in Sichuan and Beijing. His years of birth and death are 1894 and 1979, respectively. 474. 时逸人, Shi Yiren was known in Shanghai and Shanxi in Republican China. His years of birth and death are 1897 and 1965, respectively. 475. 陈耀堂 (字炯、龙山, 号衮公), Chen Yaotang (adult name Jiong, Longshan, alias Mr. Gun) was a famous doctor in Shanghai. His teacher was Ding Ganren. His years of birth and death are 1897 and 1980, respectively. 476. 许半龙 (又名观曾, 字盥孚), Xu Banlong (alias Guanzeng, adult name Guanfu) was a famous doctor in Shanghai. His years of birth and death are 1898 and 1939, respectively. 477. 严云 (字苍山), Yan Yun (adult name Cangshan) was a famous doctor in Shanghai in Republican China. He was good at treating acute heat disease. His years of birth and death are 1898 and 1968, respectively. 478. 王一仁 (一名依仁, 原名晋第), Wang Yiren (or Yi 依 ren, original Jindi) was a famous doctor in Shanghai. His teacher was Ding Ganren. His years of birth and death are 1898 and 1971, respectively. 479. 承澹盦, Cheng Dan’an was a famous acupuncturist. His years of birth and death are 1899 and 1957, respectively. 480. 高凌云, Gao Lingyun was a famous doctor in Jiangxi. His teacher was Ding Ganren. His years of birth and death are 1899 and 1966, respectively. 481. 章巨膺 (又名寿栋), Zhang Juying (alias Shoudong) was a famous doctor in Shanghai. His teacher was Yun Tieqiao. His years of birth and death are 1899 and 1972, respectively.

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482. 岳美中 (原名钟秀, 号锄云), Yue Meizhong (original name Zhongxiu, alias Chuyun) was a famous doctor in North China. His years of birth and death are 1900 and 1982, respectively. 483. 秦伯未 (名之济, 号谦斋), Qin Bowei (birth name Zhiji, alias Qianzhai) was a famous doctor in Shanghai. His teacher was Ding Ganren. His years of birth and death are 1901 and 1970, respectively. 484. 程门雪 (名振辉, 号九如、壶公), Cheng Menxue (birth name Zhenhui, alias Jiuru, Hugong) was a famous doctor in Shanghai. His teachers were Wang Lianshi and Ding Ganren. His years of birth and death are 1902 and 1972, respectively. 485. 黄文东 (字蔚春), Huang Wendong (adult name Weichun) was a famous doctor in Shanghai. He teacher was Ding Ganren. His years of birth and death are 1902 and 1981, respectively. 486. 章次公 (名成之, 号之庵), Zhang Cigong (birth name Chengzhi, alias Zhi’an) was a famous doctor in Shanghai. His years of birth and death are 1903 and 1959, respectively. 487. 丁济万 (名秉臣), Ding Jiwan (birth name Bingchen), the eldest grandson of Ding Ganren, was a famous doctor in Shanghai. His years of birth and death are 1903 and 1963, respectively.

C. Eight Major Contributions and Mysteries Concerning Traditional Chinese Medicine 167. The Five Elements, Yin–Yang & Qi and Blood — A Basis for Theory The initial theories of the traditional Chinese medicine were, in short, centred on such key ideas as qi and blood, yin–yang, the five elements and five internal organs. The Suwen – Tianyuanji Dalun (素问·天元纪大论) states the following: The five elements in the nature control respectively the five directions25 which produce coldness, heat, dryness, dampness and wind; and the five internal organs of human bodies can engender five types of qi which boost joy, anger, anxiety, thought and fear. With 25

 The five directions, according to the ancient Chinese philosophy, are east, west, south, north and the centre.

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mastery over the inter-attacking of these five circuits, all diseases can be cured. And this runs in a cycle without an end. The system of the five circuits and yin–yang pervades the whole of nature, setting the orders and laws, engendering all changes, controlling death and life and working by the Way of the Immortals. How can it be neglected? Hence, the growth of things is called generation, at their extreme point they change and those with the undetectability of either yin or yang are called immortal; while those who can apply flexibly the natural laws without rigid adherence to certain ways are considered as sages. The changes of Yin and Yang work in the universe in a profound manner; the changes in man as mastery of the natural laws of the whole world; and the changes on the earth work as the generation and transformation of everything else. Furthermore, this generation and transformation produces the five flavors; man’s wisdom is boosted by the mastery of the natural laws; while those that are immortal are related to the profundity of the universe. Of all that is produced by these things immortal, what blows in the air is called wind; what grows on earth is wood; in the air becomes heat, on the earth becomes fire; in the air becomes dampness, on the earth becomes dirt; in the air becomes dryness, on the earth becomes metal; and in the air becomes cold, while on the earth becomes water. Thus, all that is qi without any form in heaven turns out to be an object with form on the earth and the inter-action between them engenders transformation and produces everything. With heaven above and earth below, heaven and earth hold everything within; with the uprising of yang to the left and the decline of yin to the right, left and right symbolize the roads of Yin and Yang; with water symbolizing yin and heat yang, water and heat become the symbols of Yin and Yang; with things growing in spring symbolizing wood and things fruiting in autumn symbolizing metal, metal and wood indicate respectively the end and beginning of everything. Yet the qi of yin–yang is not invariable and it sometimes waxes and sometimes wanes. So do the formal objects — which sometimes prosper and sometimes decline during their development. It is owing to the inter-actions between the qi above and the objects below that traces of excess and deficiency are recovered. These statements describe the general law behind yin–yang, the five elements and the transformation of the qi, and explain the rules of generation

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and transformation among things in nature. The chapter Shengqi Tongtianlun (生气通天论) even points out the relationship between yin–yang, qi and blood and the human body: Since ancient times, people have believed that the key of life lies in whether they can get the qi from heaven; and this key relates to nothing more that the yin–yang in heaven. Between heaven and earth, all that is as big as the whole country, or as small as a human being’s nine openings, five internal organs or twelve joints of the four limbs, all of this connects with the qi of heaven. Yin hides inside and supports yang; while yang protects the exterior to make the body strong. Excessive yang with deficient yin will cause a fast and pressing flow of the blood in the vessels, and if attacked by pathogenic heat, it becomes worse and turns to mania. On the contrary, excessive yin with deficient yang will cause blockages of the qi in the five internal organs which blinds the nine orifices. So the sages try to make a perfect balance between Yin and Yang — so as to obtain harmonious muscles and tendons, strong bones and marrow and a smooth and easy-flowing qi and blood. In this way, through internal and external harmony we can guard against pathogenic qi and keep the normal function of hearing and eyesight, and ultimately guarantee the normal workings of the qi and body. The key factor in Yin and Yang is that only when yang is compact can it strengthen the yin essence. A disharmony between Yin and Yang is like a year with only spring and no autumn, or a year with only winter and no summer. So the coordination and interaction of Yin and Yang is the highest standard in keeping our normal physical condition. Excessive yang cannot compact and causes the yin to be weak and gradually die out. Only with a peaceful yin and compact yang, can the spirit be normal; for if Yin and Yang separate, man’s spirit dies out therein. From the point of view of medical science, the key words are “qi and form” and “deficiency and excess”. The word “qi” is a bridge linking the yin–yang of heaven and earth, and man’s physiological and pathological conditions. Although simply a term, in linguistic form, “qi” actually symbolizes all intermediary factors related to any transformation. Theologically, it pervades everything. Although without form, it has an image — which can be sensed but not seen. All changes and transformations of yin–yang and the

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five elements cannot do without it — it represents the origin, initiative power, process and result, and explains the dialectical relationship between the unity of the opposites of “form”, characterized by visual image, shape and structure. “Form” is both sensible and visible, but function, power and transformation are all powered by the help of “qi”. For example, such climates as wind, heat, dampness, dryness and cold are decided by the qi of heaven, while such elements as wood, fire, earth, metal and water by the forms of the earth. Increase and decrease actually relate to an increase and decrease in “qi” — in that a decrease in “qi” brings about a decrease in “form”, while an increase in “qi” causes a strengthening of “form”. From the point of view of medical science, “qi” describes the power, the energy and all functional activities of life, including the psychological activity of the spirits, senses, thoughts and so on. On the contrary, “form” relates to the body, the five-zang and six-fu organs, as well as all structures and tissues including the flowing blood and body fluids. The relationship between “qi” and “form” has an excellent description in the Lingshu – Benzang (灵枢·本藏): Man’s blood, qi and spirit constitute life. Meridians provide the place for the blood and qi to flow smoothly and nurture Yin and Yang, moisten bones and muscles, as well as benefit the joints. A powerful defensive qi can protect the muscles and skin and keep it in perfect condition; and a compact ability of psychological movement can guard the spirits, control the souls, and help us accord with climatic and emotional changes. Therefore, a peaceful blood-flow helps the normal activities of the meridians, nurtures Yin and Yang, strengthens muscles and bones, and clears the joints. A peaceful defensive qi benefits strong muscles and smooth skin. While a good control of psychological activities brings high spirits, compact souls, no anger and pity, as well as no damage from pathogenic qi to the five internal organs. The harmony between cold and warmth helps a good digestion in the six fu organs, freedom from joint-pain due to damp or wind, a smooth flowing of qi along the meridians and excellent condition in the limbs and joints. This is common for all people. The five zang organs hide the spirits, blood, qi and souls, while the six fu organs digest foodstuffs and help fluids flow. Both “qi” representing yang and “blood” representing yin circulate within the body. To be precise, “qi” communicates with both the exterior

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and interior of the body and together with the blood circulating within the human body. The Huangdi Neijing (内经) holds the view that “qi” comes from air and foodstuffs in the natural world. In such cases, for instance: Heaven provides people with five qi and earth with five flavors. The five qi come into man’s body through the nose and hide in the heart and lungs so that man distinguishes the five colors, and different sounds. While the five flavors, once getting into man’s body, hide in the intestines and stomach with their hidden flavors able to nurture the five qi. When the qi attains peace within, the generation of fluids takes place and when the essence of the fluids evaporates, immortality is produced. (The Suwen – Liujiecangxianglun (素问·六节藏象论)) The true qi is thus bequeathed from heaven and nurtures the human body when combined with the qi from grain. (Lingshu – Cijiezhenxie (灵枢·刺节真邪)) Once bequeathed the grain which get into the stomach, the qi can go through the lungs, the five-zang and six-fu internal organs — all of which will be nurtured henceforth. The clear resultant is called ying, i.e. nutrient qi, while the opposite is called wei, i.e. defense qi, with the ying flowing inside the vessels and the wei outside — both of which circulate around endlessly in the vessels for fifty rounds each — and then meet each other again. Thus ying and wei, like Yin and Yang, connect with each other like a ring. (Lingshu – Connection of Nutrient and Defense Qi (灵枢·营卫生会)) What is called “rong” is the essence of the grains which balances the five-zang and nurtures the six-fu internal organs. Therefore, it can go into the pulses. In other words, following the pulses one can connect with the five-zang and six-fu organs (The Suwen – Bilunpian (素问·痹论篇)). Here, both “ying” and “rong” refer to things such as “xue”, i.e. blood. So blood is also a transformation of qi, a point put more specifically in the Lingshu – Connection of Nutrient and Defense Qi (灵枢·营卫生会) when it says, “ying and wei both are essential qi; while xue (blood), is magical qi. So blood and qi belong to the same category but have different names.” Taking the theory of yin–yang and five elements as the philosophy of ancient times, the idea of qi and blood functioned as an intermediary and aided the introduction of philosophy into medical science and the construction of medical theory. With an idea like this, philosophy was introduced into medical science and enlivened everything. Such a philosophy and medicine

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could never meet without there being a bridge between them — this bridge was formed by the idea of qi and blood. If the zang and fu organs together with the four limbs can be imagined as a kind of machine, it is the qi and blood that bring it to life. In other words, this life moves forward according to the rules and laws of the theory of Yin and Yang, and the five elements in nature. Therefore, such things in Chinese medicine as a concept of body structure, its view of physiological pathology, its concept of diagnosis, therapy and treatment by acupuncture and other medicines, the concepts and methods of healthcare and disease prevention, like qigong and the rest, all derive their system and explanation by being based upon a philosophy of Yin and Yang, qi and blood. Kou Zongshi once said that “Man cannot live without blood and qi.” Zhu Danxi also said that “man can live on nothing but qi and blood.” As a result, it can be presumed that the idea of qi and blood is central to both the structure and theory of Chinese medical science — and to the whole of human life. Simultaneously then, problems arise: “from the modern point of view, what on earth are qi and blood?” It might be easier to define blood, but what exactly is “qi”? Is it “air” or “energy”? The answer could be “both” but also “neither” because there are so many things “qi” can represent — it occupies such a large scale. For example, pathological qi is called “pathogenic qi” which, as a pathological factor, is opposite to the qi of life and health. As for such ideas as pathogenic qi consisting of exterior and interior pathogens, it cannot help to test “qi” in the laboratory to see if it is something like a “molecule” (in molecular biology) or some “molecule-structured matter” which might be referred to as a “medium” (although this theoretically does make some sense). In other words, simply placing “qi” on a plate and showing it to others is out of the question. In short, “qi” as a general concept cannot be demonstrated. Furthermore, as for “xue (blood)”, although visible and testable, it is defined in Chinese medical science as distinct from “blood” as understood by western medical science. In traditional Chinese medical theories, “xue (blood)” might be said to exist as being different, as it is a medium opposed to “qi” — for “qi belongs to yang and xue (blood) to yin”. So following up this idea, “xue (blood)” is also untestable and its function cannot be explained as something material in modern science like a cell, a molecule and suchlike. Similarly, the zang and fu organs can only be taken to be some compound mixing together of some particular functions and concepts, resulting in the naming of the twelve zang and fu as the twelve basic functional units of the human body — but being completely different from the actual chemical, organ concepts of modern anatomy.

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Yet again, undoubtedly, Chinese medical science is composed of a system of diagnosis, treatment and disease prevention based upon these theories — the theory of yin–yang and five elements, the theory of the zangfu organs and channels and collaterals, of the spirit, and of the qi and xue (blood). Thousands upon thousands of hours of clinical experience have proven its effectiveness, which does not exist within or is unmatched in any other medical system. So therefore nobody can hold any mistrust against the theories of traditional Chinese medicine; they outshine all others and have made an enormous contribution to the world of medical science. Meanwhile, one thing which should not escape our attention is that in today’s era when scientism prevails, if a theory lacks some parenchymal molecular items which may be discoverable in the laboratory, it is doomed to be seen as a logical paradox to modern science. As a result, a treasure hailed by Chinese medical practitioners is accused of being absurd by western medical experimenters. Such disputes have lingered from ancient times to the present. This is also the most active section in the front-line war between empirical and evidence-based medical systems. However, no scientists with truly keen sensitivity would deny the facts or defy the centuries of value behind Chinese medical theory — they would rather leave the question open and hold it as a myth which future generations may find time to investigate. Truly, it is much more scientific to cooperate rather than resist.

168. The Four Examinations and Eight Principles — Keys to Pattern Identification The Four Examinations and Eight Principles are the basis for the diagnosis of disease in traditional Chinese medical science. The Nanjing: the Classic on 81 Medical Problems (难经) said that “The 81 Medical Problems points out that according to the Classic, those who can make diagnosis simply by inspecting are immortals; by listening and smelling, are sages; by inquiry, are artisan physicians; and by pulse taking, those who know some true skill. Why is this so? Because those who can make diagnosis simply by inspection make it through inspecting the five colors; those by listening and smelling make differentiation between diseases through listening to the five sounds; those by inquiry are asking about the five flavors the patient desires — so they know from what and where they get their disease; and those using pulse taking are touching on the cunkou pulse, observing the empty and full, and so making out which zang and fu organ the disease has come from. The Classic has told us that diagnosis by examining the external symptoms is done by the sages; while by sensing the internal symptoms, the

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immortals. These are the answers to the question.” This really does make sense. As for those who are skilled at so-called “inspecting, listening, inquiring and pulse-taking”, these are called respectively those “immortals, sages, artisan physicians and those who know some true skill”. Yet in ancient times, two thousand years ago, could a Chinese medical physician really make such magical diagnoses? This is doubtful. In fact, any operational approach itself requires a process, moving gradually from imperfection to perfection. Take the medical classics, for example: the Neijing emphasizes inspection of the complexion but says little on inspection of the tongue, as well as on listening and inquiring. The Suwen states, “whether the pulses are slippery or unsmooth, floating or deep, can be differentiated through the pulse; the visceral manifestation of the five zang organs can be done likewise; the balance of the five tones in the five zang organs can be felt mentally; the subtle difference between the five colors can be distinguished by inspection; and with the combination of pulse taking and inspection, no disease cannot be diagnosed” (A Chapter on the Generation of the Five Zang Organs (五脏生成篇)). “This combination of pulse taking and inspection of the complexion is what was stressed by the gods and immortals who then taught my late mentors… After a thorough inspection of the complexion and pulse, a physician may know the mental and physical condition of the patient — as any change in them can be traced for it will never disobey the congruence of the four seasons, or eight winds and six directions corresponding to the five elements: metal, wood, water, fire, and earth. Therefore, to know the essence, get the subtleties. And where to get the subtleties? In inspecting the complexion and taking the pulses” (A Chapter on the Yijing and Bianqi (移精变气论篇)). So those who were skilled in diagnosis firstly inspected the complexion and took the pulse, making out the Yin and Yang; they got to know which part was diseased by differentiating lucidity and turbidity and then determined what the patient was suffering from by inspecting how he breathed and made out the major elements of the disease by making a comprehensive judgment of the whole. Finally, they knew where the disease was born by a differentiation of the floating, deep, slippery or unsmooth pulses at the cunkou. What was called the “se” (complexion) here mainly refers to the facial complexion and condition of the spirit. The Neijing (内经) only once mentions some syndromes of the tongue, such as a protracted tongue, a stiff tongue, tongue atrophy, a curled tongue and so on. A yellow tongue as well as a dry tongue and lip were mentioned but without any systemic discussion, or concern about the tongue coating. Books specializing in tongue diagnosis

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did not appear until the Yuan Dynasty (13th century) — books such as Mr. Ao’s Book of Diagnosis (敖氏金鉴录) and others — and it was not until the Ming that tongue diagnosis became a mature and essential part of traditional Chinese medical science, following on Zhang Deng’s composition of Diagnosis of the Tongue (伤寒舌鉴). Today, Chinese physicians in the clinic take the tongue, which they believe to be the only visible internal organ of the human body, to be a mirror revealing the changes in qi and blood of the internal organs of body. The fact is that this practice works well every time they operate it. Now it has become a unique diagnostic method within traditional Chinese medical science, but why and how it works still remains a puzzle. Another puzzle relates to pulse diagnosis. The Neijing divides the whole of the major arteries into three positions and nine places to take the pulse and, just like the above, held that physicians could “know where the disease was born by a differentiation of the floating, deep, slippery or unsmooth pulses.” Later the Nanjing reduced this to “only taking the pulse at the cunkou.” Wang Shuhe was even able to determine the three positions and places to take the pulse, by only taking the pulse on the wrist’s radial artery, and furthermore categorized a possible 24 pulse manifestations on the basis of what had been said in the Neijing and Nanjing. During the Ming Dynasty, Li Shizhen and others moved this on to 28. This was totally different from observations in the West, where the speed of the pulse alone was recorded. In China, it is quite common for a patient to stretch out his arm for the physician to take his pulse — and get a general diagnosis of the disease. Some experienced physicians will then tell the patient roughly what is going on in his body, though at the same time, reminding him of the inability of making a thorough diagnosis simply through the pulse. With these words, the patient will then believe the physician. It seems like a test on the physician, made by the patient. But in fact, the physician makes the diagnosis not simply by pulse taking, but also through inspecting the complexion. With the traditional method of syndrome differentiation, (not the same as “disease differentiation” in western medicine), a physician can describe nearly 80% or 90% of the factual syndrome. What magic there is in pulse diagnosis! It is by no means a single two-dimensional manifestation, but a 3-dimensional picture. Modern science is still unable to create a pulse instrument accurate enough to record the pulse — and therefore objective research on this is out of the question. To learn pulse diagnosis, one needs to practice again and again in the clinic, make a careful study after mentorship, think a lot and practice a lot. Otherwise, when there is a physician “seemingly clear

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in mind, but unable to practice it with the hand”, it will bring about much uncertainty. For this reason, tongue diagnosis is much more objective than pulse diagnosis. Diagnosis through listening was used to determine the disease by hearing such sounds as the patient’s voice, breathing, coughing and so on. By hearing the “five tones from the five zang organs”, a physician could distinguish between Yin and Yang, insufficiency and sufficiency, and cold and hot, which drew much attention in the Neijing (内经) and Treatise on Febrile Diseases (伤寒论). However, this method developed but slowly during the later centuries. In modern times, physicians have been making diagnoses not only by listening to sounds but also by smelling bodies, the breath, urine, faeces and sputum, which might also have been influenced by the methods of western diagnosis. Diagnosis by inquiry was mentioned systematically by Zhang Jingyue during the Ming Dynasty in his Book of Jingyue (景岳全书) and Ten Inquiries (十问篇), where he included his influential Song of the Ten Inquires: “To inquire — number one of hot or cold; two of sweating; three of head and body; four of urine and excrement; five of diet; six of the breath; seven of listening and looking; eight of thirst; nine of Yin and Yang, through pulse taking and inspecting the complexion; and ultimately ten making an accurate diagnoses through smelling. It is easy to make these inquires — but remember to make it clear to the patient what you are doing to avoid any bad feeling.” Technically, these are actually only eight inquiries. Therefore, Chen Xiuyuan in his Easy to Do Medicals (医学实在易) revised and extended this list into the following (13 aspects in all): “To inquire — one of hot or cold; two of sweating; three of head and body; four of urine and excrement; five of diet; six of the breath; seven of listening and looking; eight of thirst; nine of the medical history; ten of possible causes; once more of past medicines taken; and one particular inquiry on menstruation for women when whether slow or rapid, stopped or falling out tells all; and the last few words of the examination concern smallpox and measles in children.” In the words of Zhang Jingyue, “The ten inquiries form the essence of diagnosis and are a must for clinical treatment. With a full knowledge of these ten possible enquires, doctors can grasp the ‘six changes’ and get all symptoms of the disease in their mind. The difficult-to-use medicinal compounds may effect an inappropriate treatment, if you do not get the very nature of the disease… Anyone who wants to do these medicinals must firstly make these inquires so as to make the appropriate judgment, which

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will bridge them over to the ultimate treatment. Together then with wide reading and profound understanding, there is no way they will not make a treatment appropriate! And if quite skilled in mind and practiced in hand, one can be sure of giving much help both to the patient and oneself. So be cautious! Lay emphasis on making these enquires.” What one could achieve through these inquires, focussing on the main part of the patients’ complaint, was of vital importance both in western and Chinese medical science — except that they differed in content and the steps taken. On the contrary, an appropriate diagnosis could only be made by coordinating these inquires either through a “comprehensive analysis of pulse and symptoms”, a “preference for symptoms over pulse” or a “preference for pulse over symptoms”. This is because that which is collected through the guidance of Chinese medical theory and the making of the “four diagnoses” is something quite unique and special. After a comprehensive analysis, symptoms which manifest the patient’s condition might be revealed — and thereafter a Chinese diagnosis could be performed. That which is called “bianzheng” (pattern identification) is quite different from the “bianbing” (disease identification) of western medical science. “Zheng” stands for a unique pattern formed by a physician based on his clinical knowledge of pathological changes in the patient’s blood and qi, while “bing” (“disease” in western medical science) is a pattern of the morphological changes which are happening due to the patient’s pathology. Therefore, “zheng” is “alive”, while “bing” is “dead”. When different symptoms appear in different phases of the same disease, it is called “one disease with differing symptoms”; when the same symptoms appear in different diseases, it is “different diseases with the same symptoms”. For “zheng”, it is sometimes hard to find pathomorphological or molecular biological changes to help make a diagnosis. Chinese medical physicians distinguish “zheng” using the visual sense — by observing patients and inspecting symptoms — and yet the symptoms they rely on are totally different from those derived from in vitro tissues or dead bodies. So “zheng” is “alive”, because of its changeability during the disease process. Moreover, it is contrary to “bing” — which is determined by objective and reliable evidence found perhaps even after the death of a patient through pathological changes in in vitro tissues or medical tests such as microbiological sampling, biopsies, X rays, B mode ultrasound, CT, MRI and so on. Just as it is said that “no final verdict can be announced on a man before his death”, a final judgment in western medicine can only be made with the pathological testing of a dead body. That is why I say “bing” is “dead”, for

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it is based on “dead evidence” and will never change. Actually the term “syndrome” in western science is different from “zheng” in Chinese medical science, as their idea of a syndrome will not necessarily change along with the progression of the disease. Based on the correct tests made on the “bing”, western medical science copes with the disease, while Chinese medical physicians treat patients according to their appropriate judgment of the “zheng” — dynamically adjusted as the disease progresses. Here lies the big difference. In this respect, Chinese medical physicians can judge the patterns which patients present and accordingly create prescriptions fast and efficiently, without the aids of modern instruments and various scientific methods — they can even do this with diseases which still remain unknown to western medical science, such as SARS. This is a great contribution. Yet, what exactly is the nature of the “zheng”? It has become quite a mystery. Up to now, we can only say that “zheng” signifies the rivaling conditions of the yin–yang, qi and blood of the zang and fu organs, healthy and pathogenic qi, and so on within the human body. On the face of it, “bing” is probably based on “zheng” and serves it well, in a quite different manner to the way “bing” operates in western medical science. In short, Chinese medicine made a great discovery. Chinese physicians discovered the use of “zheng” and can make a judgment based on it so as to treat diseases throughout the world — where no scientific instrument is needed to help observe, analyse or test a condition. And this owes much to the Chinese invention of the four diagnoses — inspecting, smelling, inquiring and pulse taking — which help to distinguish diseases through “inspecting the outside, judging the inside”. The Lingshu (灵枢) says as follows: Qibo commented, ‘there are intimate connections between things, the sun and moon, the water and the mirror, the drum and sound, etc. When the sun and moon shine, shadows are produced; while both water and a mirror can reflect things clearly; sounds come out when the drum is beaten. All these tell us that changes in one thing will lead to certain changes in another, just like the productions of shadow, reflection, and sound. Once you understand this, you will get the art of acupuncture.’ Huangdi said, ‘How profound! Yet, what an obvious theory: it contains just the shining light of the sun and moon, so clear indeed — it cannot be misunderstood. Why do I say so? Because this theory still clings to the common natural law of Yin and Yang. It makes a comprehensive observation based upon

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clinical findings, catches the change in the pulse through pulse taking, gets the external symptom through an inspection of the face, and then after analyzing and generalizing all the data based on yin–yang theory, reaches a conclusion, as realistic as the reflection in water or a mirror. For example, when a man utters something with a dumb and low voice along with a dim complexion, he must have some pathological changes within. The outer reflection of the internal lesions is a result of the mutual reaction of yin–yang both inside and out. This goes along with the same resemblance of human beings to their shadows. Externally, getting the external changes one can detect the internal disease; and internally, knowing the disease of the internal organs can help speculate about the external symptoms. This is the essence of yin–yang theory, as well as the common law of nature. Please let me store these writings up in the elegant chambers of Ling and Lan,26 never to let them be taken out.’ Actually such an idea of “through the external changes one can detect the internal disease” resembles modern black-box theory, which proposes that all inside information will leak out in various ways. Stimulated from the outside, things will respond just like a drum beaten by sticks will make a sound. The information sent out, either active or passive, could be in plain or secret code — which requires a receptor to decipher it. The process of deciphering it is operated by some “decoding machine”. In effect, connections with the pulse and tongue, and others observations, along with the diagnosis of “zheng” at work in the physician’s mind, create a kind of “decoding machine”. This is the “law of pattern identification” at work in Chinese medicine. Sophisticated physicians who are well acquainted with this kind of “decoding machine” can easily get the information they need — through making the four examinations and then deciphering them to make a diagnosis of the “zheng”. This kind of “decoding machine” can also be seen at work in the “law of pattern identification” which Zhang Zhongjing was the earliest to propose — his “six-meridian pattern identification” system, from his Treatise on Febrile Diseases (伤寒论). This was used to differentiate patterns of febrile disease according to the six basic phases responding to the six meridians, the “Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin”; 26

 The Chambers of Ling and Lan, refer to Lingtai and Lanshi, the rooms for Huangdi to store his books.

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for each disease caused by each of the six meridians, there were various patterns with some fixed prescriptions of formulae. Hence, the laws of pattern identification can also be named by their corresponding formula, that is, what is called “formula pattern-identification”. Beginning with the Synopsis of the Golden Chamber (金匮要略), and systematized by Qian Yi and the four masters of Jin and Yuan periods, “visceral pattern-identification” and “miscellaneous diseases pattern-identification” were created. The flourishing of “three causes theory” boosted “disease causes pattern-identification”; theories of “pattern-identification based on qi, blood, and fluid” and “pattern-identification based on disease mechanism” were formed during the prevailing time of disease mechanism theories. Then coming out of the idea of febrile diseases, warm disease theory triggered Ye Tianshi’s “defense-qinutrient-blood pattern-identification” system and Wu Tang’s “triple energizer pattern-identification” system. Yet among all these laws of pattern identification, the most essential was the “eight-principle pattern-identification” system which upheld the four symmetrical phrases of Yin and Yang, hot and cold, exterior and interior, and deficiency and excess in order to guide an analysis of the internal conditions of the body. Thus, it became known as the “eight-principle” method. It had been applied already throughout the Treatise on Febrile Diseases (伤寒论) and Synopsis of Golden Chamber (金匮要略), but not systematically. It was not centred on these “eight words” until researchers in the school of febrile disease — like Zhu Gong, Xu Shuwei, Cheng Wuji and others — made the “Song of Exterior Pattern-Identification”, the “Song of Interior Pattern-Identification”, the “Song of Exterior–Interior and Hot–Cold Pattern-Identification”, the “Song of Exterior–Interior and Deficiency-Excess Pattern-Identification”, the “Song of Yang like Yin Identification” and so on in their A Hundred Songs to Identify Febrile Diseases (伤寒百证歌). However, it was still not made an explicit rule. Then came the Ming dynasty, and Wang Zhizhong, in his Mr. Dongyuan’s Book on Identification of Febrile Disease Pulses (东垣先生伤寒正脉) (1477), proposed clearly that “to treat diseases is nothing more than what is contained in these eight words — deficiency, excess, yin, yang, exterior, interior, hot and cold. Ignorance of these eight words will kill people!” The eight words finally got spoken about and were formed into eight principles. Fang Yu, in his Yilin Shengmo (医林绳墨) (1584), also pointed out that Zhang Zhongjing in his Treatise on Febrile Diseases (伤寒论) “had by essence done nothing but deal with the eight aspects of exterior, interior, deficiency, excess, yin, yang, hot and cold.” Similar ideas appeared in Zhang Sanxi’s Six Essences

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of Medical Science (医学六要) (1609). The most influential and thorough analysis was made by Zhang Jingyue who, in Chapter One “Chuanzhong Records” of the Book of Jingyue (景岳全书) (1624), proposed a highly systematic theory — a “theory of two outlines and six changes” — proclaiming that Yin and Yang work as the basic law for all medical treatments. “No mistake in Yin and Yang, no treatment poorly done!” These “six changes refer to exterior, interior, hot, cold, deficiency and excess, these six of which are truly the key for medical treatment. With a thorough knowledge of these six, all diseases can be cured as easily as saying one, two, three!” Furthermore, Zhang also exemplified syndromes of exterior, interior, hot, cold, deficiency, excess, false cold and false hot, together with ways to identify them. It was then that the renowned “eight principles”, the most basic generalization of disease patterning, finally came into being. Later in the Qing Dynasty, an “eight-principle pattern-identification” method, disseminated by such popular works as Cheng Guopeng’s Thoughts on Medical Treatment (医学心悟) (1732), became the go-to tool for all clinical work. All in all, the laws of pattern identification in Chinese medicine make up ten: the identification of eight principles, of six changes, of disease causes, of zang and fu organs, of the disease mechanism, of qi, blood and fluid, of miscellaneous diseases, of defense qi and nutrient blood, of the triple energizer, and of formula and decoction. Among these, the “eight principles” is the most general with the others being optional and suitable for different patterns with different patients and different diseases. I myself have done clinical treatment for years in Britain and found that some patients who had poor results with western medicine (although they had a clear diagnosis) finally turned to Chinese medicine. It is true that the latter in its four examinations lacks evidence for pattern identification. Hence, I propose that there could be a way for Chinese physicians to take western diagnoses sometimes as a basis to help them speculate about disease patterns. For example, a patient is diagnosed as suffering from splenomegaly with hypersplenia, but his tongue veins are normal with no abnormal complaints. In Chinese medical science, an abdominal mass is called an “abdominal lump” which is known as “blood stasis” or “phlegm stasis” — by the theory of “miscellaneous disease pattern identification”. So if you follow this pattern identification, the prescription must work every time. Clinical treatment in this way turns out to be effective. This is in accord with what Zhu Danxi said, “some strange diseases might be caused by phlegm”, and also the reason Wang Qingren liked to use infradiaphragmatic Stasis-Expelling Decoction to cure conditions such as these. Herein lies the charm of pattern identification in Chinese medical science.

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169. The Toxicity-Relieving and Property-Enhancing Qualities of TCM Traditional Chinese medicine concerns those medicines prescribed under the guidance of the theories of TCM, including medicinal herbs, animal medicines and mineral medicines. Without the guidance of TCM theory, these herbs along with their products, either singly or in combination, prescribed through one’s own experience, cannot properly be called Chinese medicine. Therefore, TCM theory is the crucial factor — as it differentiates both properties and mechanisms. Other countries, nations and regions have their own herbal medicines, either traditional or non-traditional, yet often with quiet separate uses and treatments from traditional Chinese medicine. Even in China, there are many herbal medicines of this kind, which do not belong within TCM. On the contrary, TCM sprouted and grew from folk or herbal medicine. The medicines appearing in the Shanhaijing (山海经) and Prescriptions for Fifty-Two Diseases (五十二病方), strictly speaking, cannot yet be called traditional Chinese medicines. However, the medicines prescribed under the guidance of TCM theory in both the Neijing (内经) and Shen Nong’s Herbal Classic (神农本草经) can truly be considered as such, and the latter especially as it became the earliest classic in TCM, in which 365 kinds of Chinese medicine were listed and divided into three grades — upper, middle and lower — for their use in prescription. Furthermore, with the continuous revision and supplementation of such books as Notes on Herbal Classics (本草经集注), A Newly-Revised Herbal Classic (新修本草), as Encyclopedia of Herbal Medicine (证类本草), Compendium of Materia Medica (本草纲目) and others, a profound system of TCM came into being — and it’s believed that there are over 5,000 kinds of traditional medicines being used at present, among which more than 500 are commonly used.27 As well as the guidance given by TCM theory, there are other factors listed below which can well explain why the consideration of TCM results in better treatment, with less side effects, than the use of herbal medicine on its own. First of all, the theory of “four properties and five flavors” is used to discriminate the different properties of TCM medicinals. “Four properties” (siqi) does not refer to the odour or smell commonly sensed by the noses, 27

 Yan Zhenghua, Science of Traditional Chinese Medicine (中药学), People’s Medical Publishing House, 1991, p. 14.

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but the “four qi of cold, hot, warming, and cooling” as in the medicines mentioned in Shen Nong’s Herbal Classic (神农本草经). These were not the smell or taste but only differentiating properties of the medicine. Kou Zongshi in his Explanations on Herbal Classics (本草衍义) (1116) explained it so: “the word ‘qi’ 气 here, I’m afraid, was miswritten by people and it should have been ‘xing’ (性 meaning ‘property’) which makes total sense for all prescriptions.” Li Shizhen in his Compendium of Materia Medica (本草 纲目) said, “ever since the Suwen (素问), ‘qi’ has been used as the only word for it but habits die hard, so be it.” Actually, the four qi of “cold, hot, warming and cooling” determine the effect of the medicine. The General Conclusions on Zhizhenyao (至真要大论) in the Suwen (素问) also states that “Heat is used to treat cold, while cold used to treat heat.” Shen Nong’s Herbal Classic (神农本草经) also concluded that the general law is to use hot medicines to treat cold diseases and cold medicines to treat hot ones.” In syndrome differentiation, there are cold syndromes and hot syndromes — which call for different medicines. Yet the properties of medicines are to be determined during the process of curing the “syndrome”. Generally speaking, medicines which can relieve or cure heat syndromes hold cold or cooling properties and vice versa. Therefore, warming and hot medicines possess the effects of warming the interior and dissipating cold, tonifying fire and assisting yang, as well as helping move blood, while cooling and cold ones can clear heat and purge fire, cool the blood and remove toxin. Within this differentiation, different virtues make some super-hot, super-cold, slightly warm, slightly cold or neutral due to the needs of the different symptoms. This use of different medicines to treat and cure different symptoms is unique to traditional Chinese medicine. The “five flavors”, according to Shen Nong’s Herbal Classic (神农 本草经), are the “sour, salty, sweet, bitter and pungent flavors of medicines” which correspond to the five elements and five qi. The Huainanzi (淮南子) records, “Shen Nong himself tried the hundred herbs as well as the waters and springs around him, in order to help the people avoid poisons. Sometimes, he himself was poisoned by seventy in a single day.” This is truly the earliest human trial — being used to determine the properties and usages of medicines by taste. The Neijing (内经) generalized this, saying, “Pungent medicines have a dispersing effect; sour contracting, sweet slackening, bitter hardening and salty softening.” This, together with the “bland-tasting which have damp-excreting and diuretic effects”, outlines the different treatments given by different medicines with different flavours. Wang Ang in his Essential of the Herbal Classic (本草备要) further explained thus: “All

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medicines, of a sour property can help astringe and contract; of a bitter property, purge, diffuse and harden; of a sweet property, tonify, harmonize and slacken; of a pungent property, disperse, moisten and restrict; of a salty property, sink and soften; of bland properties, promote the orifices and excrete damp. These are the effects of the five flavors.” Apparently, these ideas were taken from his own practical experience. Therefore, in the age of ancient China — when research was not accessible — people tried to differentiate the medical effect, through the theories of the five flavours. This was one of the most important creative leaps made by ancient traditional Chinese medicine. Moreover, there is also the theory of “ascending, descending, floating and sinking” in TCM. It originally sprung out of the words in the Neijing (内经): “the lucid yang goes out the upper orifices, the turbid yin out of the lower ones. The lucid yang goes through the striae and interstices, while the turbid yin through the five-zang organs; the lucid yang floats in the four limbs while the turbid yin in the six-fu organs.” Just as Yin and Yang move upward and downward, go out and in, diseases make a similar motion. For example, diseases such as coughing, vomiting and dizziness will show syndromes relating to the upper orifices, while diarrhoea, metrorrhagia and metrostaxis and a prolapse of the rectum relate to the lower. Spontaneous sweating and night sweating push it out, while retention and constipation keep it in, and so on and so forth. Physicians need to prescribe different medicines to gain the proper treatment. Such a theory was first proposed by Zhang Yuansu, Li Dongyuan and Wang Haogu during the Jin and Yuan Periods, in which Zhang, in his Medicine Origin (医学启源) drew out the outline, “qi-flavors, thick–thin, cold–hot, yin–yang ascending-descending”, while Li in his Yongyao Faxiang (用药法象) listed the relationships between medicines and flavours in the following: “medicines with a bland flavor help ascend — these are medicines of a sweetly-neutral flavor, a pungentlyneutral flavor, or slightly warm flavor or slightly bitter-neutral; medicines with a thin qi help descend — these are medicines of a sweetly-cold flavor, a sweetly-cooling flavor, or a sweetly-bland-cold or cooling flavor, with a sour-warm flavor, or sour-neutral flavor, or with a salty-neutral flavor; medicines with a thick qi tend to floating — such medicines as those with a sweet–hot or with pungent-hot flavors; medicines with thick flavors tend to sinking — such medicines as those with a bitterly-cold flavor or a salty-cold flavor; medicines with a neutral flavor may be combined with the four qi and four flavors — such medicines as those with a sweetly-neutral flavor, a sweetly-warm flavor, a sweetly-cooling flavor, a sweetly-pungent or neutral

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flavor, or sweet and slightly bitter or neutral flavor.” Wang Ang in his Essential of Herbal Classic (本草备要) pointed out, “Medicines together with a thick qi and bland flavor cause floating and ascending; medicines together with a thick flavor and thin qi cause sinking and descending; medicines with both thick qi and thick flavors cause floating and sinking; while medicines with both thin qi and thin flavors cause ascending and floating.” In his Compendium of Materia Medica (本草纲目), Li Shizhen cited from these sources and pointed out especially that qualified physicians must be good at combining and differentiating between medicines and make a proper use of them, under the guidance of the principle that “medicines with sour and salty flavors do not help ascend; medicines with sweet and pungent flavors do not help descend; medicines with cold flavors do not help float; and medicines with hot flavors do not help sink.” Therefore, to treat a disease with ascending symptoms, medicines with salty and cold flavours can be used to make it sink to the lowest regions; in diseases with sinking syndromes, liquors can be used to help it float to the highest openings. Yet only those who understand the true meaning of the universe and acquire the power of life can do this well — for one herb may possess ascending powers in its root and descending powers in its branches and tips, a floating effect when raw while a sinking effect when stewed. It truly depends on the herb itself — as well as on the individual. It needs good knowledge of the properties of medicines by direct instruction in a clinical setting, and in various treatment conditions — such as correcting the body’s functional disorders, eliminating pathogens, etc. all under the guidance of theory. Compared with western pharmaceutics based on animal experimentation, Chinese medicines may easily cope with disease according to the theory of the “four qi five flavors”, the “ascending, descending, floating and sinking”. How miraculous this is! There was also the theory of “meridian tropism”, a new research angle on pharmacological mechanisms, which gave rise to such terms as “into the meridians (rujing)” and “along the meridians (zoujing)” which came originally from the Neijing (内经) and the Treatise on Febrile Diseases (伤寒论). During the Jin and Yuan Periods it got its present name, thanks to Zhang Yuansu who, in his Specimens of Internal Medicine (脏腑标本药式), made explicit the theory “meridian tropism” as well as the idea of having a “guiding action”. Later on its completion and perfection owed much to Li Dongyuan, Wang Haogu, Liu Wentai, Li Shicai and Shen Jin’ao. This theory, making clear the target of the medicine, helped physicians use medicines under clear guidance — and thus remarkable effects were achieved. Since the

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zang-fu organ or a part of the body usually functioned as the major target, a meridian could become a channel for the medicine to enter, and so the whole range of meridians become a target area for the treatment. Moreover, some medicines, when going through certain channels, could guide other medicines together — to move forward towards their target. This was what was meant by “guiding action”. So the theory of “meridian tropism”, in positioning medicinal targets, together with the theory of “four qi and five flavors” which told of the properties of medicines and the theory of “ascending, descending, floating and sinking” which showed the direction the medicine would work in together became the basis for the pharmacological explanation and clinical practice of TCM. It has been proven recently that a close relationship lies between medicinal meridian tropism and the selective effect of its active constituents, similar to “receptor theory” in modern pharmacology.28 In addition, the side effects of medicines have always been of concern to both doctors and patients. Yet a “toxin” in TCM is semantically different from what’s commonly taken to be a “poison”. It has previously been cited that the Book of History (尚书) said, “No side-effects, no cure.” A common saying is also, “no medicine can avoid toxins.” So a medicine can be both a cure and a toxin at the same time. In the Rites of Zhou (周礼), Tianguan states, “Physicians, in command of medical affairs, gather toxins to make their medical treatments.” Hence, to some extent there is this synonymous use of the term “toxin” here for “medicine”. Yet, “toxin” in this respect had nothing to do with “poison”, which kills people, or “drugs” which only have cumulative effects and no healing value. Actually, the distinction between medicine and food can help us understand the meaning of the saying, “all medicines contain toxins.” It is true what people say that medicine and food come from the same source, but there is still a difference between them; for medicines can become toxic, and foods usually not. Even so, medicinal toxins can also be acceptable to someone healthy, because when we say “toxins” in medicines lie in their properties, this also provides us with a basis for us, as physicians, to make up a suitable prescription to treat it. Zhang Zhongjing in his Book of Jingyue (景岳全书) is quoted as saying, “I truly disagree with the conclusions of ‘which herb is toxic, and which is not’ made by the Herbal Classic (本草), for no medicine can avoid being toxic, just as medicines with hot 28

 Yan Zhenghua, Science of Traditional Chinese Medicine (中药学), People’s Medical Publishing House, 1991, pp. 39–40.

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properties contain heat toxins, those with cold properties contain cold toxins, and so on and so forth. Any misuse of them will make people ill and it is the toxin itself within the medicine that causes the illness.” This is notwithstanding the fact, of course, that some medicines also have properties not favoured during the treatment, which can truly turn toxic and give rise to side effects. Either excessive doses or medicines taken over too long a period during treatment will cause toxic side effects as well. Negligence of the too strong properties of some medicines will poison patients. Therefore, what matters during treatment is the avoidance of or relief from side effects. This became the impetus for the making of a truly creative masterpiece within Chinese medicine, as we shall see below. In a nutshell, the side effects of traditional Chinese medicines are closely connected with the toxin constituents of the medicine itself. A medicine may hold some toxic constituent if broken down, but if mixed with other constituents, this toxicity may be restricted or softened. In other words, the best curative effect and least side effects can be achieved by a correct discrimination of herbs and a proper selection of genuine, regional materia medica, gathered at the right time, preserved in the right place, processed properly into different formulations under the law of compatibilities, along with the direction and cooperation of dose and duration. In short, Chinese medicine can play a far greater role when it is used under the guidance of TCM theory. This is truly a great mystery — as well as a great learning resource, awaiting our study.

170.  The Magic of Compound Prescriptions Compound prescriptions form the quintessence of traditional Chinese medicinals. In the last fifty years many scientists and medical experts studied TCM, for Western medical companies wanted to discover new drugs and figure out a way of patenting their products, and creating wealth, but nearly all have failed. Hardly any achievements have been made — except that some single Chinese medicines such as ephedrine, Berberine, artemisinin and a few others have confirmed their unique healing power, with their clarified chemical structure becoming the standard in western medicine. But clinically, it is acknowledged by TCM physicians that compound prescriptions have better effects than single medicines. It is also experimentally proven that the recomposition of any constituent from the original prescription cannot beat an original medicine. After his research on the formula Shen Mai San, composed of ginseng, radix ophiopogonis and the

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fruit of Chinese magnolia vine, and used to benefit qi and blood as well as improve heart function, Prof. Shi Zaixiang pointed out that any one or two herbs combined together will not get the same effect as the original three herbs, put together in the original prescription.29 The better effects of compound prescription lie also in their toxinrelieving function. Take Longdanxiegan Pills, for example. The pill contains two kinds of Caulis Akebiae (Mutong), among which Caulis Aristolochiae Manshuriensis (Guanmutong) contains aristolochic acid which is considered to be nephrotoxic. It has been experimentally discovered by Quan Shijian and Wang Hongdan that the different compatibilities of the Chinese herbs will influence the amount of aristolochic acid A — which is lowest in Longdanxiegan Pills.30 Quan and Wang also quoted in their thesis Zhang Yan’s findings that Liuweidihuang Pills can reduce greatly the amount of aristolochic acid A in Caulis Aristolochiae Manshuriensis fluid.31 Among the laws for making compound prescriptions, the most essential is the law of “sovereign, minister, assistant and guide”, explained in the Suwen – Zhizhen yao Dalun (素问·至真要大论): “The herb aiming to deal with the major syndrome functions is the sovereign; the one aiding the sovereign herb is called the minister; the one suppressing the side effects is the assistant; and the one directing the herbs to the target area is the guide.” One volume of sovereign herb together with two ministers makes a small dose; one volume of sovereign herb with three ministers and five assistants makes a medium dose; one volume of sovereign herb together with three ministers plus nine assistants makes a large dose. A prescription of one volume of sovereign herb together with two ministers belongs to an odd type; that of two sovereigns with four ministers belongs to an even type. The law of “sovereign, minister, assistant and guide” has become the standard for physicians drawing up prescriptions. Seemingly similar to western prescriptions of medicines, it is in reality different — for western physicians only make up a party of different herbs in no set order, and without any rules of assistance or guidance. That is to say, western medicines cope with syndromes on a one-to-one basis — one herb 29

 Shi Zaixiang. Study of Left Ventricular Function in Patients with Heart Qi Deficiency, Journal of Traditional Chinese Medicine, vol. 23, no. 12 (1982), p. 938. 30  Quan Shijian & Wang Hongdan. Empact of Different Compatibility of Herbs on the Amount of Aristolochic Acid A in Caulis Aristolochiae Manshuriensis, Journal of Guangzhou University of Traditional Chinese Medicine, vol. 24, no. 6 (2007). 31  Zhang Yan, Liu Yangqing & Zhao Huihui. Empact of Compatibility of Chinese Herbs on the Amount of Aristolochic Acid A in Caulis Aristolochiae Manshuriensis, Tianjin Pharmacy, vol. 17, no. 4 (2005), p. 360.

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for one syndrome. But Chinese prescriptions take a clear route and a strict order for each herb, each of which takes on a different function to aid the sovereign in tackling the major syndrome of a disease — just like soldiers working together in an army. The value of this law became especially prominent after the Jin and Yuan Periods when medicines which had a “guiding action” were said indeed to “steer any sovereign herb” to a certain target. The efficacy and toxicity of the compound prescription depend largely on the compatibility of each herb within it. Among examples from the Science of TCM Formulae (中医方剂学),32 there is an illustration of making up the same decoction, Chengqi Decoction, along with different compatibilities depending on the medicinals used. It states, “For interior diseases with exterior symptoms, a purgative method is suitable and rhubarb is always taken as the major herb. If the heat is excessive but not at the accumulative stage yet with vexation and abdominal distention, rhubarb should be compatible with the salty-cold properties of mirabilite, being used to discharge the heat, hence this points to Tiaowei Chengqi Decoction; if there is an accumulation of heat but it is not excessive with fullness of the abdomen and constipation, rhubarb should be compatible with the bitter properties of Magnolia officinalis and Fructus Aurantii Immaturus being used to purge the heat, as in Xiao Chengqi Decoction; if excessive heat has already accumulated, and the exterior symptoms are clear, or there is heat retention with watery discharge or diarrhea with watery discharge, all four herbs: rhubarb, mirabilite, Magnolia officinalis and Fructus Aurantii Immaturus must be used as a drastic purgation to preserve yin fluid, and this points to Da Chengqi Decoction.” These three varying prescriptions of Chengqi Decoction, all used to treat diseases with heat and constipation, differ in their compatibility with different syndromes and thus attain a different effect. Yet from the angle of western medical science, this heat with a slight difference in the syndrome may be one and the same disease. With traditional Chinese medicines, any slight alteration in the compatibility of the herbs can make a tremendous difference to the effect. This is easy to understand with the help of the theory of TCM, but difficult for a modern western researcher trying to probe into any particular healing mechanism. A common saying is, “the dose problem is the key issue in traditional Chinese medicine.” It may not actually be correct, but certainly it is indeed often the case. Another example from the Science of TCM Formulae (中医方 剂学) describes different prescriptions which use the same herbs but which 32

 Jiangsu New Medical College, Science of TCM Formulae (中医方剂学), Shanghai People’s Publishing House, 1972, p. 9.

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take on a different effect, because of the different volumes used of each herb. Xiao Chengqi Decoction, Magnolia Officinalis Three Agents Decoction, and Magnolia Officinalis and Rhubarb Decoction all use the three herbs rhubarb, Magnolia officinalis and Fructus Aurantii Immaturus. In Xiao Chengqi Decoction, four liang of rhubarb act as sovereign, three fruits of Fructus Aurantii Immaturus as minister and two liang of Magnolia officinalis as assistant. It is widely used to treat diseases with syndromes of yang brightness and fu-organ excess, constipation, tidal fever and delirious speech. But Magnolia Officinalis Three Agents Decoction, with eight liang of Magnolia officinalis acting as sovereign, five fruits of Fructus Aurantii Immaturus as minister and four liang of rhubarb as assistant, is used to treat syndromes of fullness of abdomen and constipation. Magnolia Officinalis and Rhubarb Decoction takes one chi of Magnolia officinalis and six liang of rhubarb both acting as sovereign, and four fruits of Fructus Aurantii Immaturus as minister, and is widely used to treat thoracic fluid retention and fullness in the chest. To cure syndromes of yang brightness and fu-organ excess, Xiao Chengqi Decoction aims for purgation so it takes rhubarb as the sovereign herb. To cure major syndromes of qi obstruction, Magnolia Officinalis Three Agents Decoction takes Magnolia officinalis as sovereign, for its purpose is to eliminate fullness. The alteration of the places of sovereign, minister, assistant and guide brings about the differing names of the prescriptions and also makes clear their different effects. Therefore, doses determine effect — and this asks for different compatibilities between the herbs.

171.  The Undetectable Nature of the Acupuncture Meridians In 1961, I went to Shanghai Second Military Medical University to study western medicine. In the anatomy class, I asked the lecturer Mao Zengrong why the Chinese medical circle remained so indifferent when North Korea was thrilled at Prof. Kim Bong-han’s discovery of the nature of meridians and acupoints. Kim had been praised as a hero and awarded a Kim II-Sung medal, and it had been reported in all the newspapers. Mao sat up and told me that according to TCM, meridians and acupoints only existed in living bodies, not in corpses. So what Kim discovered as “Bong-han’s bodies” or “Bong-han’s Channels” under the microscope and claimed as the true nature of acupuncture meridians and acupoints could only be nonsense. Startled and impressed by his words, I was later informed that Prof. Xu Fengyan, the famous physiologist at Shanghai No. 1 Medical College (later renamed Shanghai Medical University), was sent by the Chinese Health Ministry to North Korea to inspect this issue. Upon his return to China, Xu reported to the Ministry that

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under the same microscope, using the same procedure, he could not find the bodies and channels Kim Bong-han had said he had discovered. The results of these experiments, if they could not be duplicated, must remain inconclusive. Most probably, the Health Ministry transferred this conclusion back to Korea and they then cancelled the honourable title for Kim Bong-han. Acupuncture is one of the most effective treatments acknowledged by world organizations, including the WHO. Yet only acupuncture analgesia is approved by ordinary western doctors — who try to explain it based on neurological theories. Some people, like Professor Ernst from Britain, have even separated “western acupuncture” or “medical acupuncture”, dreaming that they can compete with traditional Chinese acupuncture and further debase it as “non-scientific”. These people are ironically ignorant of the fact that what they call “neurological mechanisms” are in fact nothing but one of the many mechanisms through which acupuncture works and endorphin, which they talk about so often, is simply one typical neurotransmitter which occurs during acupuncture anaesthesia. In fact, acupuncture can not only relieve pain but can also cure a variety of diseases which actually cause no pain, like high blood pressure, menopausal syndrome, depression and so on. The true nature of acupuncture is far from clear right now. In China, various theories, like the “theory of main body fluids”, the “theory of lymphatic vessels”, “endocrine theory”, “electrobiology”, “holography biology”, etc., all have their say — each capable of partly explaining the phenomenon, but incapable of totally figuring things out. The Lingshu – Jingshui (灵枢·经水) said, “For a common adult male, exterior examination and measurement when he is alive, or autopsy when he is dead, can help make clear how hard his zang organs are, how big his fu organs are, how much essence from grain is still there, how long his vessels are, how clear his blood is, and what amount of qi he has. Whether he has sufficient blood and insufficient qi in his twelve channels, or insufficient blood and sufficient qi, or both insufficient blood and qi, can be figured out by these findings.” It is true that these words have been seen as proof that anatomy has long existed in traditional Chinese medicine. Yet, can it really be decided from an autopsy “whether he has sufficient blood and insufficient qi in his twelve channels, or insufficient blood and sufficient qi, or both insufficient blood and qi”? In the previous chapters, I have pointed out that one big difference between anatomy in TCM and that in the West is that the latter is taken from autopsy and animal anatomy while the former, besides autopsy, pays more attention to the living perception of the human body. This must be the case in the above remarks on the sufficiency of qi and blood in the twelve channels, taken from the Neijing (内经).

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Wang Xuequan (1728?–1810), the great-grandfather of Wang Shixiong, the renowned scientist who studied epidemic febrile diseases, pointed out in his Notes Made in Chongqing Hall (重庆堂随笔) that “qi is what human and animals depend on to get form.” The Neijing (内经) says, “no qi, no soul, no body” (churufei ze shenji huamie 出入废则神机化灭).33 Just like a leather sac containing water, the sweat pores in the skin are insensitive when not alive. This is also the reason why Lecturer Mao told me there are no meridians in dead bodies — either through analogy or tissue examination. I kept this in mind until 1978 when I was enrolled as one of the first postgraduate students in the Academy of Traditional Chinese Medicine. One day in the library of Beijing University of Traditional Chinese Medicine, in a journal on the latest developments in molecular biological chemistry, an article caught my eye. It was written by a German, dealing with the differences of configuration and conformation between the molecular structure of living and dead protein. The author said that these configurations and conformations were invisible and would disappear after death. This gave some modern experimental proof for TCM’s concept that meridians only exist in living bodies — and would be invisible and disappear from dead bodies. This article also pointed out that the configuration and conformation of living protein may change due to some certain physicochemical irritation, and then transfer these changes to its neighbouring proteins at quite a slow speed, fairly different from that of neurotransmission. Interestingly, the meridian-sensing system seems to work in a similar slow manner. It should be noted that my hypothesis is by no means the only one possible. However, it must be correct that the riddle of the acupuncture meridian must lie not in the dead body or in vitro tissue, but in the functional structure of living life.

172. The Endotherapy of Exogenous Disease Without an Operation A common saying goes, “Go to a western doctor for surgical diseases, and find a TCM practitioner for internal diseases.” Western medical science is good at surgical operations, while traditional Chinese medicine excels with internal disease. Although in history TCM once had a sparkling record of surgical operations, such as Hua Tuo making a splenectomy and inventing mafeisan, the first anaesthesia used in the 33

 From the 六微旨大论 Section 13.

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world, pitifully, his manuscripts are now lost and nothing remains. Since then, TCM surgery has been reduced simply to dermatology. Only a few records of surgical operations have been kept throughout history. Nevertheless, surgical diseases can be cured by taking Chinese medicinal decoctions or by acupuncture, which is one of the main features of TCM. I still remember in 1970 when I was a local doctor in the mountainous regions of Zhejiang Province, an acute appendicitis case was sent to me. At that time, no car, no light, no scalpel and no nurse left me, a western medicinal doctor, with no other choice but to try acupuncture with him — a patient who should have been given immediate surgery under the principles of western medicine. I had planned to send him to hospital early the next morning, but it turned out that after I gave the acupuncture treatment to the “appendix point”, the patient’s symptoms were relieved and no stomachache was felt at daybreak. This gave me a big shock and shifted my strong belief in western medicine back into a tremendous interest in traditional Chinese medicine. After that, I worked harder to study TCM and succeeded in curing several appendicitis patients by acupuncture in the USA and Britain. Surely this is not because I am so talented, but because the time-honoured tradition of the Chinese can find an internal way to treat surgical diseases. In reality, this has been sanctioned by the WHO: traditional Chinese medicine can treat acute abdominal diseases and some modern surgical diseases can also be cured by TCM methods, just like using “a small splint to treat a fracture”. Of course it is wrong to refuse surgery when the surgical indications and operational conditions are good. What makes sense is that traditional Chinese medicine can really “strut its stuff” and take the patients out of pain when surgery is denied them. This is why the focus of our research must be on making out how TCM can find an internal way to treat surgical diseases.

173.  Variolation — A Way of Keeping Well Disease prevention has always been a priority in TCM. To put the stress on prevention, rather than the treatment of disease, is one of the characteristics as well as advantages of Chinese medicine. Bian Que once said that among his three brothers, who were all doctors, his eldest was the best doctor and even his second brother was better than him because “my eldest would get rid of the disease before it could cause sickness… whilst when my second brother treated disease, I was nothing compared to him.” His eldest brother could make things happen before the disease took place or caused pain and injury to the patient. He was better than Bian Que, but the Bian Que himself

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enjoyed larger popularity. It is commonplace that big things like saving lives always draw more attention than the preventive treatment of disease. In fact such a remark as “it is the most skillful doctor who treats before the disease occurs” was recorded long ago in the Neijing (内经). The eldest and second brothers of Bian Que were among those “skilled doctors” mentioned in the Suwen – Siqitiaoshendalun (素问·四气调神大论篇): “Sages do not treat disease, but prevent disease. They do not cure disorder, but prevent disorder. This is truly the case! To treat disease with medicine, or to cure disorder when disorder appears, both are like digging a well after you feel thirsty or manufacturing weapons when the battle is under your nose. Isn’t this too late?” Prevention is proactive, while treatment is passive; prevention aims to deal with issues before they happen, while treatment rushes to fight the problem. Clearly the former is better. There are many categories of preventive medicine, and they have been listed previously.34 Variolation against smallpox is one of the best. How the Chinese discovered variolation and prevented people from catching smallpox has been explained in detail before35 and I won’t add to it here. It is increasingly acknowledged to have made a great contribution to the healthcare of mankind. Originally, how variolation could prevent smallpox was puzzling, and not well understood. But both variolation and the Jenner vaccine in the West helped wipe out smallpox throughout the world — and with the development of medical science, the immunological principle behind them has been brought to light, so much so that Dr. Joseph Needham considered the discover of variolation by the Chinese to have been “the origin of immunology”.36 The deciphering of variolation was the first case of modern science tackling the numerous myths in TCM. However, it still remains a riddle why TCM was so effective in treating smallpox throughout history. Traditional Chinese healthcare which takes a healthy and long life as its ultimate goal was also a first in medical science. The Suwen – shanggu tianzhen lunpian Chapter 1 (素问·上古天真论篇第一) says at the very beginning: The ancient peoples, who knew the rules, nourished from Yin and Yang, balancing between exercise and thinking, and had a regular diet 34

 Chapter 5.  Chapter 14, also see Alicia Grant, Globalisation of Variolation: The Overlooked Origins of Immunity for Smallpox in the 18th Century, World Scientific, 2019. 36  ibid., Joseph Needham, China and the Origin of Immunology (中国与免疫学的起源). 35

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and lifestyle, without overstrain, so they could keep their bodies and souls intact until they ultimately passed away after a long life of over one-hundred years.” One hundred years was one’s natural life span, similar to that in the present day. In addition, the division into four kinds of people, “immortals”, “realized ones”, “saints” and “sages”, reflects the idea of Taoist medicines where the key concept of health is as follows: “In far ancient times, there were immortals who created and controlled heaven and earth, balancing Yin and Yang, taking in the essence of qi, keeping their souls intact in themselves, as well as in their flesh, so that they could live a long life, together with heaven and earth. Their immortality was the result of practical Taoism. In ancient times, the ‘realized ones’ virtually epitomized Taoism, melting into Yin and Yang, regulated by the four seasons, avoiding earthly life, concentrating their spirits, traveling between heaven and earth, with their senses reaching far beyond all directions, and all these activities help lengthen their life span and make them strong. In this way, the ‘realized ones’ could be upgraded into immortals. Then there were saints who lived harmoniously between heaven and earth, observed the universal laws, fit their desires into an earthly life, without resentment and hatred, taking their actions to comply with tradition and custom, wearing clothes with ordinary decoration, and not showing off at all. They would not overstrain their bodies for external issues, nor put much burden on their minds, but would live leisurely and complacently in a quiet and happy way. Thus, they rarely got tired either in their bodies or their souls, and could live up to one hundred years. As for the sages, they understood the laws of nature’s changes, the rising and setting of the sun and moon, the positioning of the stars, they followed the rules of Yin and Yang, and catered to the turning of the four seasons in order to learn from the ancient immortals their way of keeping well. These people could also live a longer life but still they came to the end of their time. The key to a healthy and long life can be seen to lie in living harmoniously with the surrounding nature, physically and psychologically, and in finding a harmony between the inward world and outer society — with no overwork, no worries and a true integration of man and nature. This is the way of keeping healthy, and the essence of eco-medical science — the perfect balance between nature, society and the psychological environment.

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The Neijing (内经) talks a great deal about keeping well, and TCM, in later ages, greatly developed its methods; they can be divided into two systems: the first, exterior exercises; the second, interior exercises. Exterior exercises can be traced back to dancing during the pre-Qin period, Chuju (the earliest football) during the Han Dynasty, as shown in the Daoyin Pictures (导引图) unearthed in the Mawangdui Tombs, the Five-animal Exercises created by Hua Tuo, and Chinese Polo during the Tang Dynasty, all of which link with the world of modern martial arts and qigong. These sports and exercises aimed to make the body stronger. Interior exercises originated from the idea of “tonifying insufficiency and discharging excess” — which is transferred into a health-keeping exercise for both the weak and those who pursued a longer life. This included a whole range of theories, rules and techniques, from practicing breathing, pill taking, the arts of sexual health, and the “inner pill” or “temperament cultivation” of Taoism to dietary therapy and the tonifying medicines of physicians. The concept of “food therapy being better than tonifying medicines” stressed the non-damaging and tonifying effect of food on a healthy body. Doctors’ prescriptions are necessary for tonifying medicines which can tonify the qi, blood or a deficiency in the five-zang organs, and promote the physical power of the sick. But besides this, they can balance the qi and blood in everyday conditions, and correct early functional disorders of people living in sub-healthy environments. Herbs, such as ginseng, ganoderma, sealwort, rehmanniae vaporata, royal jelly and others, plus prescriptions, such as Buzhongyiqi Decoction, Six-Ingredient Rehmannia Pill and so on, all have strong effects on strengthening the body. These tonifying methods and medicines have never been used in Western medicine, and along with the above-mentioned “interior exercises” were all a great creation within TCM. Healthcare, a crucial element within preventive medical science, is synonymous with the popular idea of “well-being”, and coincides with what the WHO calls “health for everyone”. These theories and practices of TCM are a treasure house of preventive healthcare for all mankind.

174.  Turning to TCM When Western Medicine Fails During my many years of medical practice in Britain, I have found that patients can basically be categorized into two kinds: patients who refuse to take western medicines for fear of side effects or favour natural therapies and patients who had been failed by western medical treatment or who have lost faith in western medicine. The latter make up the larger proportion.

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At the end of the 1980s, a mother took her child to a famous dermatologist who had tried to treat his eczema but failed. She said, “You told me you had tried every possible way and it couldn’t be cured. Here, you see, a TCM doctor has cured him.” The dermatologist was shocked to find that the boy’s eczema which he had once failed to cure had disappeared. This dermatologist was Dr. David Atherton. With doubts in his mind, he visited a TCM clinic and then began to conduct various clinical experiments using double-blind, randomised controlled trials, with the result that TCM was found to be effective in curing eczema. About 70% of eczema cases in children, who had been treated but failed in Great Ormond Street Hospital, improved after treatments by TCM. With the publishing of his paper, patients with skin diseases flocked to any TCM clinic, and most of them got better results. In my view, the patients who came to me were basically either those with difficult miscellaneous diseases announced to be incurable or those who had made no progress at all. At least 80%, I would not boast 100%, of the patients progressed or became cured after treatment. One case was chronic fatigue syndrome of unknown origin, quite rare in China, and in Britain usually named Myalgic Encephalomyelitis. While western doctors could do nothing but tell the patient to rest occasionally, I was 100% confident I could cure it 100% of the time. Several patients suffered from acute pain in the chest and abdomen and came to me after many hospital admissions. Their stays in hospital were temporarily for pain relief and the repeated breakouts of the severe pain drove them almost insane. I treated them, some for a single week, some for longer, and all were cured of their pain. There was another patient who fell into a deep coma after a stroke caused by an operation on a coronary artery while in hospital — and his family was even informed to make preparations for his death. When I was called, I knew it was indeed a deep coma as confirmed by western medical examinations. That moment, I made several prescriptions, mixed with grated Angongniuhuang Pills and juice, and injected them into his body through the nasal feeding tube. Two days later, the patient began to come around. Then after acupuncture and other TCM treatments, he recovered day after day until he could get out of his bed and even did some housework. In January 2010, I cured a 22-year-old girl who had been in a deep coma for ten days after concurrent encephalitis evoked by cold and fever. In summary, in similar chronic cases, or terminal cancers, TCM treatments can work really well to alleviate the symptoms and give a better quality of life, although they may not get results quickly or cure the disease.

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Infertility nowadays is a rapidly growing problem. Behind it, there are often various causes. Some who have refused to have a child when young, have advanced to an age when they want one. Some cannot become pregnant even after stopping taking contraceptive pills. Although development in science and technology has brought success — IVF, test-tube babies, surrogacy and the like — the overall success rate is low, under 30%. Now British women who are infertile have found that acupuncture and Chinese medicine can help. With a combination of western medicine and TCM treatment, some of them naturally conceived, and sometimes it increases the success rate of their IVF. The cure of infertility has become a hot issue in the British TCM circle. From my personal experience, I have helped tens of women get pregnant and give birth to healthy babies after combining treatments of acupuncture and Chinese medicine. One of them had tried IVF six times in hospital, but all failed. Then with my treatment, success came in a single attempt. Another whose second husband had previously had a vasectomy but the reconnecting failed and the IVF was unsuccessful. She was recommended to me. After TCM treatment, she tried IVF again and this time it succeeded. In May, 2008, she delivered a boy, quite healthily. In 2010, I managed another two cases of natural conceptions and healthy deliveries after Chinese medical treatment. Western medicine will not treat anything without experimental data. This is called “evidence-based medicine”. However, not all patients can afford the wait for the data to get their medical treatment. Time is precious and sometimes costs lives. Take the example of SARS. Traditional Chinese medicine, with a head start, achieved better treatment than that of western medicine. When western medicine fails, people can at least turn to TCM — and it can provide another choice with results that may be unexpected. This is the charm of traditional Chinese medicine. In my attempt to summarize these eight contributions which TCM has made, I find that they are in effect eight mysteries. None of them, except one — variolation — has been deciphered. All of them together inform us of just one thing — that TCM is effective. What troubles people about these mysteries or rather myths is that people know they are effective, but do not know why or how. In my opinion, anyone who could help decipher any one of these puzzles would truly qualify for a Nobel Prize.

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CHAPTER 22

The Root of Life and the Future of Chinese Medicine A. The Essence of Chinese Medicine: A High-Quality Ecological Medicine History implies a course of time; culture implies a body of history and theory the backbone of a culture. The culture of Chinese medicine is an important part of the culture of the Chinese nation, and the theory of Chinese medicine the sediment of Chinese culture. Chinese medical theory is unique, and different from the Western or any other medical system. The theory of Chinese medicine is powerfully viable — surviving some thousands of years without declining, and has been effective in guiding clinical practice constantly through medical practice. During my study of the history of Chinese medicine, I found that the essential character of Chinese medicine was its theory of there being high-quality ecological medicine.

175.  Chinese Medicine, Is It Scientific or Not? In today’s world with a prevailing climate where one is “bullied” by “scientism”, it is inevitable that we discuss Chinese medicine in line with it being a science. This discussion — controversy even — has lasted more than 150 years. These days, the number of those who oppose Chinese medicine is small, but they are domineering, and openly champion the abolition of it as a traditional medicine. I have also participated in this debate.1 In 2006, Jia Qinglin, the Chairman of the Chinese People’s Political Consultative 1

 Boying Ma. Scientific Connotations of Chinese Medicine: About Science, Non-Science and Pseudo-Science, Science & Culture Review, vol. 4, no. 2 (2007), pp. 77–91. 1229

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Conference, visited the UK and I presented a paper to him. Later, I saw Wu Yi, Vice-Premier of China, speak at a National Conference of TCM and state clearly that she supported Chinese medicine and its many creations and original innovations, which are worthy of research and promotion. This pacified those boycotting Chinese medicine at the time, but potential opponents still remain. In this dispute, I agree with Prof. Liu Bing’s opinion that anyone who regards Chinese medicine as a “superstition” or “pseudo-science” is strongly in favour of adopting it as a “science” (in the sense of a “Western science”, being associated with a wider range of ideologies), and attempting to fit it into the theories of Western medicine. This is actually assuming a stand of scientism in the sense of setting it within the Western mainstream.2 Using this approach, Chinese medicine will never be treated fairly — nor ever have an ideal future. Hence, the most urgent thing is to change this stance. There are two problems: an “unclear stance” and an “unclear concept”. In 2005, Prof. Wang Yongzhou, a friend of mine and practicing acupuncturist in France, seriously raised this question at the 2nd International Conference of Traditional Medicines in Paris: “Does Chinese medicine require approval from science?” He answered his own question: “Whether Chinese medicine is scientific or not is just a judgment and assessment made by modern people. The existence of Chinese medicine for 2,000 years is a fact that no one can deny. Its existence results from the requirements of human development and survival. Rooted in the mighty and long-lasting culture of the Chinese, it was once the only kind of medicine available for China and its surrounding countries. Nowadays, independent of the will of the people, it resides in every part of the world, regardless of country or state, whether developed or undeveloped, civilized or barbaric. As a method and also a choice for people when preserving their health, its practical value is acknowledged widely and accepted. Its efficacy has earned it a warrant by which it may enter anywhere in the world. Whether Chinese medicine is scientific or not has still not been established — but this question is perhaps not so important, because first and foremost TCM presents a culture, a culture to be recognized, accepted and even esteemed. Science is still helpless and blind in many as yet unknown areas of research into the extremely complicated human body… The biggest mistake being made in Chinese medical research today is to confuse the complicated and multi-aspected individual with the special nature, structure and morphology of the natural sciences; to try and 2

 Liu Bing. Facing a Possible World-view: A Multi-cultural Science, Science Press, 2007, p. 24.

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simplify the complexities of life into physical and chemical phenomena — and regard them as absolutes of belief and the sole standards for life-science and medicine. Obviously, such research which holds a narrow, material view and labels everything in physical and chemical terms, means sharp deviation from the traditional approach of Chinese medicine. It is not that Chinese medicine has no scientific connotations, but a narrow scientific view is insufficient when investigating the whole picture. We must be clear that Chinese medicine has its own stance — and reject judging Chinese medicine by immature Western scientific standards, that are futile, chemically and basically laboratory-based. The task for modern researchers in Chinese medicine is to make a search for the intrinsic ‘person-centered’3 rule in Chinese medicine, thus guiding the way for its future.”4 I agree with this viewpoint. Advocates with a narrow scientific view find it hard to accept the above view, but this is self-contradictory. First, they forget and have forgotten their own (self-claimed) identity within science. Surely, they would never deny their own scientific identity and would place themselves firstly always as scientists or sociologists? Yet again, is being “person-centered” against science? Do the social sciences, such as philosophy, sociology, cultural studies, history studies, politics, economics and marketing, belong to the sciences? If they are scientific, why is not a person-centred approach? Second, what is the definition of a science? What about its connotations and extensions? To put it in other words, what implications are there behind “being a science”? In the Oxford Dictionary (1990 edition), “science” has the following five meanings: (1) A branch of knowledge dealing with a body of facts or truths gained through systemic observation and experimentation, especially those on the structure and behaviour of the physical and natural world (natural science is, namely a branch of science which deals with the physical world, e.g. physics, chemistry, geometry, geology, biology and botany). (2) a. A department of systematized and intrinsic knowledge, especially a branch of knowledge gained through detailed illustration, such as political science. b.  The application and theory of such knowledge.

3

 Renxue人学 “homonology” or “person-centered study”.  See Wang Yongzhou, Feng Lanjing. Back to Chinese Medicine, WFC Medical School: Human Health and Chinese Medicine, Paris, 2005, pp. 164–167. 4

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(3) A systemically organized body of knowledge on a particular subject, such as linguistics. (4) Proficient skill, but not the force itself or the natural force. (5) Archaic knowledge of any kind. According to the above definitions, the most basic character of a science is having a knowledge system that is systematized, reflects objective rules and progresses or innovates constantly. It involves different levels of nature, society and mankind — from the historical to the modern day. To state it further, science is the essential part of a culture; science opposes witchcraft and superstition; science is rooted in experience and facts, and allows imagination; the conclusions of science can be proven by evidence, are repeatable and can also be overturned; lastly, the scientific system is open ended, it develops and completes itself constantly, and never stands still or terminates.5 In this sense, taking into consideration the Oxford Dictionary definitions, Chinese medicine as being “person-centered” is totally in line with it being a science (excepting the first definition). Chinese medicine and science embrace each other and are unified — as they have the same stance. However, in the eye of those with a narrow scientific view, the concept of “science” merely refers to laboratory-based science. They appear somewhat stubborn about the definition and scope of what constitutes a science. They push science to an extreme and shut it within a self-confined frame, repelling any other approach. They are blind to any objective facts which lay outside their frame, oblivious and trying to crush down this new sprout of an emergent science. If all of us followed this approach, science would partly lose its creativity and invention. We can also talk about the common definition, scope and connotation of what makes a science. Whether one theory is scientific or not, we can generally judge by the following four criteria. (1) Abstraction: This implies having a logical aspect and internal organization — a system differentiated from the actual content. In other words, the question is this: have the logical connections contained among the propositions made in the system been clearly illustrated? A larger part of general propositions consists of theories, or rules that can be applied 5

 See Boying Ma. Scientific Connotation of Chinese Medicine: About Science, Non-Science and Pseudo-Science, Science & Culture Review, vol. 4, no. 2 (2007), p. 82.

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hypothetically, and are only applicable to one specific fact. Science denotes universality or general applicability of a proposition within a certain logic. This indicates the abstraction of any theory. Any so-called theory failing to meet this standard may be called a “hollow theory” or pseudoscience. (2) Testability: This means that the theory is naturally able to endure a test of facts within the realm of its propositions. When arguments are deduced from such propositions, they can be proven or at least provide a basis for further observation or testing. A scientific theory is always assessed by its accuracy in prediction. If predictions are unable to be repeatedly proven, the scientific theory just doesn’t exist anymore. (3) Falsifiability: We can’t say that a scientific theory is able to predict or be proved hundred percent of the time. Partial non-conformity always exists, but this doesn’t defy testability. To put it another way, another discipline within scientific theory means that any theory will contain errors. No one theory is applicable to everything — or all phenomena in the world. As regards flaws within any particular theory, people will identify them, and thus the theory will develop. This means any scientific theory is just not once and for all but, itself, signifies change in the future. The development of theory lies in its falsifiability — for truth can be discovered in time by disclosing errors. (4) Simple expression: Hegel told us that the essence of everything is simple. Generally, theories at present can be expressed through rules, axioms and mathematic equations. If the theoretic logic of Chinese medicine is put under the microscope of biomedicine, we can quickly conclude that “Chinese medicine is not scientific”. Actually, there are two kinds of medicine — and they enjoy different scopes and systems, and one cannot be evaluated by the other accurately. We are often not clear about such differences and many criticisms result from this. If we evaluate Chinese medicine according to natural systems, the social ecosystem and psychology, its theories are basically scientific, though there still remain some problems. As an abstraction from reality, we can even say there has never been such a medicine, a medicine that made such a regular abstraction of ecological and psychological factors. It is indeed fundamentally testable, but historically, Chinese medicine has always taken the individual human being as its test bed — it has a strongly empirical nature and does not yield easily to experimental testing which needs controlled

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conditions and statistical methods inappropriate for the pattern differentiation of Chinese medicine (unlike the disease differentiation within biomedicine). Therefore, testability is generally rough and ready — and contains considerable subjectivity. Some irrational proponents of Chinese medicine boast there can be “no falsification” of it and believe it has been made perfect. They don’t understand that such a kind of advocacy will only do it a disservice. There are many defective theories within Chinese medicine. Take the theory of the Five Circuits and Six Qi, for example. Regardless of those who don’t truly understand it, among those who understand it well, we may ask, “do the regular qi circuits illustrated by this theory always correspond to objective fact?” The ancients actually proposed that “qi circuits are not the same any more, as ancient and modern are different.” What’s more, the natural ecology is disturbed greatly at present and the greenhouse effect has changed the global climate. Take the five directions theory of the five phases as another example. The central plains of China are commonly used to illustrate the features of the other four directions. If you live in China, the eastern direction is associated with easterly winds, spring and warmth. However, this is not applicable in the United Kingdom. When the eastern wind blows in the UK, it is cold and implies the coming of cold autumn and winter. The situation in the southern hemisphere is similar. We can see that many things in Chinese medicine can be falsified and it is more a case of it representing simple mathematical forms and expressions. The dispute over whether Chinese medicine is scientific or not has lasted a long time. Some propose it to be a kind of metaphysics; some explain it as a pre-science (or quasi-science); some believe it to be a super-modernized science — although they can still not understand many things within it. These opinions vary, but the opinion put forward by Mr. Chen Lifu is correct. He has said, “Science cannot part from the facts; and if we label facts as ‘not scientific’ without further enquiry, it is just a kind of hindering of the advancement of science — and we will be the culprits of science.”6 Chinese medicine lives in the world because of its clinical effectiveness and cannot be eliminated. This is fact — and it also makes for it having a scientific foundation. Some researchers just consider biomedicine to be scientific and any other medical systems incompatible with it as not scientific. Then, although they consider them to be “a bit scientific”, they just extract one of two 6

 Chen Lifu. Anticipation in Chinese Medicine, Published by Private College of Chinese Medicine in 1970 on the preface of 1st edition.

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points from these systems to supplement their own biomedicine viewpoint. This kind of view is extremely erroneous. The difference between Chinese medicine and biomedicine is not a matter of being scientific or non-scientific, but a matter of research objects, methods and stratagems. In 1978, I once asked Professor. Ren Yingqiu at Beijing University of TCM for his opinion. He said, “It is like in modern times, we have planes, ships, trains and cars for the convenience of travelling, and there are still donkeys walking in the hills. Even if biomedicine has been made more scientific and modern, it can still not replace the donkey of Chinese medicine.” But this is only one aspect of the problem of effectiveness and utility. We need to seek out a scientific theory. Automatic machines use the mechanics of machinery, while the donkey uses biological mechanisms to climb a hill. To investigate what it is truly happening here is the key to understanding the essential distinction being made between them. Biomedicine targets specific fine substances, such as bacteria and viruses, body cells, biological molecules and trace elements. It adopts atomism or reductionism, which takes apart and analyses any targeted research under ideal, controlled conditions in order to find out causative factors, pathogenesis, pharmacological mechanisms, and also apply accordingly measures to prevent and treat disease. This is an extremely objective and effective way of working, which has yielded many medical advancements in the last 200 years, especially the last few decades. On the other hand, Chinese medicine mainly explores the larger ecological picture, regarding the human being as a force within nature and society, and restricted by its surrounding environment. The individual also has his/her own complicated psychological motives and activities. All the above factors interact with each other to create a cultural ecology — together with the influence of history and tradition. The causes of human disease are just as they are recorded in the Inner Classic, “All kinds of diseases inevitably result from the dry, damp, cold, summer-heat, wind and rain, sexual intercourse, emotional problems, diet and living conditions.” No causes of disease lie beyond either endogenous factors, exogenous factors or factors either endogenous or exogenous. They are all determined by the natural ecology, social ecology and/or psychology of the individual. Though biomedicine also recognizes these, it usually searches for a cause–effect relationship by taking a specific and separate way through the data, while Chinese medicine seeks to build up an abstracted and macroscopic picture. In other words, the difference is whether to admit or not the abstracted rules of the ecosystem and psychology (which are the rules of human disease and

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health, as well). Chinese medicine admits to their existence clearly: the rules of qi, yin–yang and five phases — more specifically, the theories of the five circuits and six qi, zang-fu organs, channels and application of the four examinations, eight principles and pattern diagnosis identification with the corresponding treatment. Arguing by analogy, if we perceive the macroscopic research made by astronomers into the universe as scientific, we should admit that the search made by Chinese medicine into ecological factors affecting the individual is also scientific. In the past, we might have used the ideas of a “medicine of natural philosophy” or a “methodology of simple systems-theory” to describe the methodology of Chinese medicine. However, it is difficult to clarify well the many issues in Chinese medicine — and this makes it easy to regard as “metaphysical” — further reducing it to a “non-scientific” level. Instead, we should change the angle and approach of Chinese medicine and put it on a higher level, which will make the data it yields clearer. The main features of Chinese medicine lie in the large systems which embrace its research object — and the systematic theory and form of its research methods. The theories of Chinese medicine are based on the practice of the rules of yin–yang and the five phases, and on the natural, social and ecological, and psychological changes within the individual human body. The most important characteristic of a science is that it never ends. If science regarded itself as possessing all the truth, it is not a science anymore. Nevertheless, people tend to consider the present body of science as being at its summit and stubbornly abide to it as the “gold standard” — and use this to repress other views. Using the standard of biomedicine to evaluate Chinese medicine is just such a mistake. Such individuals go against a dynamic, developing and changing dialectic and would rather adhere to a narrow sense of scientism and succumb to viewing things rigidly. This is rather a pity for us all.

176. Comments on the Transforming Modes of Biomedicine and Evidence-Based Medicine Fundamentally speaking, biomedicine never actually set itself in a certain mold. I would say that biomedicine started with Hippocrates, during an era of philosophical and empirical inquiry into medicine, with the biomedicine of the Middle Ages, during an era of religion-controlled medicine, and with the biomedicine after the Renaissance, which represented an era of experimental medicine. Generally speaking, this later era of experimental medicine

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was the so-called era of “biomedicine” predominantly, as it ruled over all other kinds of medicine. Biomedicine explains any disease through biological theories; disease is caused by physical, chemical, biological or microbial factors damaging or infecting the human body, and pathology by the destruction or alternation of body organs, tissues, cells, body fluids, molecular structures and so on. Moreover, decades after the discovery of antibiotics, communicative and infectious diseases have been greatly taken under control and their incidence reduced greatly. The disease spectrum has altered and diseases resulting from society, the ecological environment, psychological and mental factors take up more than 80% of all kinds of disorders. The mode of biomedicine has fallen short of explaining the etiology and pathology of these illnesses and of offering effective therapies. In 1977, Dr. George L Engel (1913– 1999), an American psychiatrist, proposed a “bio-psycho-social medical model”, which covers the new features of medicine. It advocates that besides considering biological factors in the course of disease diagnosis and treatment, doctors should take any social or psychological factors fully into account. His proposal has been widely approved and adopted. In such cases, if the doctor always keeps this new medical model in mind, s/he will also consider social and psychological factors in making a diagnosis, which certainly is more considerate than simply considering biological factors. Nevertheless, social and psychological factors are still regarded as separate factors, which one by one may be seen to connect with health and disease. If their influence is seen, great attention may still be paid to them and accordingly therapies applied to eliminate them. But if their influence is not seen, doctors still ignore them. This has to be regretted within the normalcy of present medicine. Meanwhile, the call for protecting the environment has been increasingly intensified. Research into the relationship between environment and organism, especially the environment and human beings, has promoted the birth of a new biology. One of its branches within the medical field is ecological medicine, which studies the relation between various environmental factors and human health and disease, how to maintain health and obtain the greatest benefit from the favourable ecological environment, how to prevent harmful factors in the environment from harming our health and causing disease and how to improve the environment, to benefit health and recover from illness. All environmental factors are in the scope of this research, such as climate, earth, water, air, biotic community, natural disasters, human pollution and so on. This research, however, is still actually being conducted by

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measuring the extended physical, chemical and biological pathogenic factors within the biological, medical model. Their connection with the human body is basically still one-to-one — we are still not able to see the human body as an integral part of the nature. Therefore, this new medical mode of ecological medicine doesn’t evoke revolutionary or dynamic changes within the dominant biomedical model at present. There are quantitative changes being made, but not qualitative ones. At the start of 1990, the medical world began to welcome EvidenceBased Medicine (EBM). Chinese scholars followed this trend closely and popularized it fully. In March 1999, the Chinese Cochrane Center was established in the West China Hospital, Sichuan University — only 13 countries in the world had such a centre until 2001. In June 1999, a seminar on “EBM and Research of Chinese Medicine” was held in Guangzhou, Guangdong province.7 In only ten years, EBM has been given supreme status and seen the “medical gold standard”, as “double-blind, randomized and controlled” experimental and clinical research, evaluated by statistical analysis. All therapies that don’t meet this standard are regarded as “non-scientific”, “unreliable” or “not to be trusted”. In 2000, the British House of Lords released the blue book of the Science and Technology Committee, in which it described Chinese medicine as a therapeutic system associated with some philosophies and religions without scientific evidence — and categorized it as falling into Group 3a, a group that can’t be given grants for teaching, research or funding support.8 Mr. Edzard Ernst, a so-called “sole medical professor of complementary and alternative medicine in the UK”, took advantage of this to harshly criticize and put down Chinese medicine, which reached a low ebb within the UK. Actually, regarding the “gold standard” as the only standard of EBM may be possibly against the original intent of some of its founders, such as Archibald Leman Cochrane (1909–1988) and David Sackett, the director of Cochrane Center of the Oxford University. Archibald Leman Cochrane was born in Scotland and practiced medicine for many years in America. The concept of “EBM” was initially put forward in his book Effectiveness and Efficiency: Random Reflections on Health Services. However, it was in 1992, several years after his death, that 7

 House of Lords, Select Committee on Science and Technology: 6th Report of Session, 1999–2000，Complementary and Alternative Medicine, p. 723, London the Stationery Office, 21 November 2000. 8  ibid.

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EBM was first used as a term in the JAMA, the famous American medical journal. They stated that treating illness requires evidence and they regarded this thought as being reflected in the earliest ancient Greek and Chinese medicines. Avicenna in the 11th Century inherited this thinking. EBM enjoys slightly different grading standards, under different systems. The U.S. Preventive Services Task Force provided a grading system with three grades and five levels: · Level I: Evidence obtained from at least one properly designed randomized controlled trial. · Level II-1: Evidence obtained from well-designed controlled trials without randomization. · Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one centre or research group. · Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. · Level III: Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.9 The NHS in the UK graded EBM into four levels: · Level A: Consistent Randomized Controlled Clinical Trial, cohort study, all or none, clinical decision rule validated in different populations. · Level B: Consistent Retrospective Cohort, Exploratory Cohort, Ecological Study, Outcomes Research, case-control study; or extrapolations from level A studies. · Level C: Case series study or extrapolations from level B studies. · Level D: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles.10 But Dr. Qu Jie-cheng from Hong Kong summarized it a little differently. He suggested five levels of EBM based on the quality and reliability of clinical research evidence. The first level is the most reliable and it decreases in order with the lowest reliability at the fifth level.11 9

 See https://en.wikipedia.org/wiki/Evidence-based_medicine.  See http://evidencebasedmedicine.com.au/?page_id=30. 11  Qu Jie-cheng. When Chinese Medicine Encounters Western Medicine: History and Reflection, Hongkong: Joint Publishing, 2005, pp. 173–174. 10

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· Level 1: All the systematic review (SR) or meta-analysis of randomized controlled trials (RCTs). · Level 2: An RCT with sufficient samples. · Level 3: Controlled trials without randomized grouping. · Level 4: Non-controlled case observation. · Level 5: Expert opinion. He pointed out that under such a five-level grading, a majority of the daily clinical treatments being carried out within biomedicine fail to meet the standard of level 1 or level 2. A simple case is of using digitalis for heart failure, which has been done in Western medicine for several hundred years. However, it is not easy to find evidence at level 1 or level 2 for it. If it is so difficult to evaluate Western medicine under the mode of biomedicine by high-level evidence, how can it be applicable to the evaluation of a new “bio-psycho-social medical model”? If the new medical model follows the gold standard of EBM, it will be hard to move forward. The gold standard may have some positive significance within the development of pure biomedicine, but it also possibly would rule out therapies unable to meet its standard, and many useful procedures will be terminated by mistake. This would do irreparable damage to creative medical factors and certainly repress any new medical mode of working. The reality of our biomedical society in the West is that these so-called “professors against Chinese medicine” are wielding the new rod of a “medical gold standard” to attack and suppress Chinese medicine. The original intent behind EBM was to be able to provide evidence to support the clinical practice of Chinese medicine — using a grading standard. Disappointingly, some people split the grading levels of EBM by ignoring all the other grading levels except the “gold standard”. This act has been a hindrance to the development and further research of new medical models. Hence, I proposed a Chinese medical and clinical assessment system based on EBM.12 This system includes five levels of grading: · Level 1: The gold standard of medicine, namely the rigidly designed RCT with its data processed by statistics. 12

 Ma Boying. EBM Grading Standard and the Establishment of Chinese medical Clinical Research Assessment System. Modernization of Traditional Chinese Medicine and MateriaMedica, World Science and Technology, no. 2 (2010), p. 13.

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· Level 2: The silver standard of clinical research, namely the partly randomized controlled trial that excludes subjective selection and enjoys a certain degree of randomized controlled research. For example: a controlled trial with a large sample; a rigidly designed, large-scale, survey-based statistical research project without subjective selection for grouping; survey-based and statistical research established under the supervision of a blinded third party and/or controlled groups among the patients themselves — all of which can be regarded as meeting the silver standard. · Level 3: Authoritative opinion from an expert group, such as the observed results of clinical effectiveness approved by a third-party expert group or echoed by experts recorded in medical literature in history; a retrospective literature review of modern clinical reports (including the collection of case reports of the same category) being approved by an expert group. · Level 4: Research reports of controlled but not randomized trials. · Level 5: Special case report that is contrary to the first three grading levels. Clinical research results that can meet the standards of the first three levels can be deemed as reliable, universal or authoritative conclusions, being able to guide clinical diagnosis and treatment. Clinical research results of the fourth and fifth levels can be taken as important for dealing with difficult and rare diseases or as the start of further research — in order to avoid some potential factors being neglected or discarded. The reason for listing “the controlled groups among patients themselves” is that most patients from Western countries coming to consult TCM doctors are those who have received biomedicine treatment without efficacy. Hence, it is significant that the patients themselves had no efficacy with biomedicine, but had efficacy with Chinese medicine. The diagnosis is made by biomedical doctors and laboratory data, and this is seen as sufficient, while the TCM treatment is carried out by TCM doctors solely using acupuncture or herbs. The clinical effectiveness is assessed by doctors of biomedicine with laboratory data being used for comparison. In terms of subjectivity, a double-blinded third party can be appointed to supervise the whole course. This is very necessary in group research. It is reasonable to believe that adopting such a Chinese clinical assessment system will greatly accelerate the deepening of Chinese medical research and enhance clinical research into Chinese medicine.

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177.  The Ecological Medical Theory of Chinese Medicine Let’s first read three very interesting and oft-quoted passages: (1)  The Old Book of Tang Dynasty – Biography of Sun Simiao (旧唐书·孙 思邈传): Simiao had profound knowledge and skills, both ancient and modern, and thoroughly mastered all arts and calculations. He was an expert in the differing schools of Taoism and Buddhism. One time, when Lu Zhaoling, a famous poet, was badly ill and no practitioner could cure him, he asked Simiao, ‘What’s the way famous practitioners treat disease?’ Simiao answered, ‘I heard those good at interpreting Heaven always take people into account; those good at interpreting people also root it in Heaven. Heaven has four seasons and five phases. The succession of seasons shows the motion of the heavens. It gathers as the rain, angers as the wind, congeals as the frost and snow, displays as the rainbow, all of which are the regular elements of heaven. A person has four limbs and five zang organs, sleeps and awakes, and breaths, inhaling and exhaling, moving the essence and qi to and fro — it becomes nutritive and defensive when in flow, the complexion when in expression, and the sound and voice during exertion. These are the regular elements of the human being. Yang elements rely on shape, while yin elements consume essence. This is the same in mankind and Heaven. When these elements are in disharmony, heat is produced by simmering, cold is generated the other way round, masses are caused by aggregation, sores and ulcers are a result of collapse, panting is made by running long, and withering comes from the draught. These changes will reflect on the surface and show during physical activity. When it comes to heaven and earth, they change similarly. In accordance with this, abnormal motions of the stars, sun and moon, and comets are critical signs within heaven and earth; the disordered coming of winter and summer is the result of an evaporation disorder within heaven and earth; stone and earth eruptions are the tumors of heaven and earth; the collapse of mountains and hills is the sores and ulcers of heaven and earth; the speedy wind and rainstorm are the panting of the heaven and earth; the dryness of the rivers is the scorching and withering of heaven and earth. Good practitioners treat with herbs and acupuncture; sages harmonize using morality and supplement their treatment through influencing human affairs.

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Therefore, people who have disease can be treated, and heaven and earth when they have disasters they can also be eliminated.’ (2)  Collections in Jiuling Mountain House (九灵山房集) written by Dai Liang records Zhu Danxi treating an illness: One woman was ill and had no appetite. She was reluctant to speak and had rested in bed facing the wall for half a year. Other practitioners said it was beyond their capability to treat her. So Danxi came to treat her and found the pulse at the liver section had extended out of the cunkou. He said, ‘This is because of missing her man — which means the qi stagnates in her spleen.’ By interrogation, it was understood that she had been married but her husband had been away in Guangzhou for five years. Danxi said to her father ‘this disease can only be settled by anger, as angry qi belongs to the liver-wood and can entangle the fettered spleen-earth. It is appropriate to make her angry at present.’ Her father didn’t agree with him. Therefore, Danxi went in and slapped her face three times and scolded her for missing men other than her husband. The woman cried loudly and ran into a rage, which made her have an appetite again. Danxi then told her father quietly that ‘though the fettered qi of missing others has been temporarily solved, it will only not relapse if she can be happy.’ So they pretended they had received a letter from her husband and that he would soon come back. Three months later, her husband returned and her illness never relapsed. (3) In Treatise on the Origin and Development of Medicine (医学源流论) written by Xu Dachun, there is a chapter named “A Treatise on Diseases Following Country’s Fate”: The qi circuit of heaven and earth changes one time every several hundred years, and the fate of the country responds to it also. We don’t need to talk about remote times, but just recent dynasties. At the end of the Song Dynasty, the central part of China was occupied by the enemy and the emperor was incompetent, and officials incapable. Accordingly, herbal formulae established by Zhang Jiegu, Li Dongyuan and others were all focused on supplementing the ‘middle palace’ of the body and boosting the stomach, chiefly using fairly dry and yang-enhancing herbs. It was the same with formulae from the Imperial Pharmacy. During the Ming Dynasty, the emperor was fatuous and officials corrupt — which meant that people received no

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benefit from the government. Therefore, Zhu Danxi and practitioners like him all chiefly applied yin-nourishing and lower-part boosting therapies. During our present time, the country’s fate is glorious and emperors succeed each other smoothly — having absolute power. The official management is well arranged and government benefits distributed to the common people. This is a significant sign of yang preponderance above. Moreover, it is common that people wear colored belts and red clothes, and smoke tobacco, indicating that the fire of the five phases is solely predominant. Therefore, all diseases have a sign of predominant yang above. Decades ago, Yunjian senior practitioners sensed this and often used cold-natured herbs to save patients who had been treated by warm and tonifying herbs, by mistake, achieving miracle effects. This is actually in accordance with qi circuitry, but people nowadays don’t know anything about it. In addition to being unable to treat illness based on symptoms, they stubbornly abide by the saying that over-using warm and hot herbs is better than applying excessively cold ones. They use herbs which are relatively warm and hot, and have exceeded proper limits. Take summer-stroke for example, the case of latent yin in the interior needs to be treated by Da Shun San (Greatly Smooth Powder) or Li Zhong Tang (Center Regulating Decoction), but this is very rare. But practitioners nowadays all use such decoctions as Li Zhong Tang for any kind of summer-stroke. I have seen numerous patients dying by experiencing cracking sensations in the seven orifices. It has been the case that all practitioners only believe in the ancient sayings of Dongyuan and apply dry-natured herbs like atractylodes rhizome. Such bad habits are all due to being oblivious of the ‘heavenly motion’ and country’s fate — and adopting previous theories to harm present patients. Hence, ancient people said, ‘anyone who doesn’t know heaven, earth and mankind, cannot make a practitioner.’ The above three passages basically represent the essence of Chinese medical theory, and cover all aspects of natural ecology, psychology and social ecology. It can be regarded as “tri-ecology medicine”. The Chinese medical theory is an adaptation of ecological medicine. In all the above discourses, we may state the following definition: Chinese medicine studies the rules of the impact of natural and social ecologies and individual psychology on human health and disease, and uses them scientifically to guide clinical diagnosis, treatment and prevention.

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Furthermore, the way “famous practitioner’s cured illness” as proposed by Sun Simiao fully illustrates the essence of Chinese medicine. It is simply a natural ecology. Zhu Danxi and many famous practitioners in the history applied the generation and restriction theory of the five phases in the emotions to treat various psychological diseases, which shows that such rules are not only in the realm of natural ecology but also in social ecology and psychology. Xu Dachun’s writing can be a little far-fetched and not necessarily accurate, but it represents a new exploration within the rules of social ecology, which fits with the development route of Chinese medicine and the general orientation of its research methodology. “Tri-ecology medicine” and its rules comprise actually what Chinese medicine has discussed and practiced for more than two thousand years. And all these are truly an extended connotation of the culture of the Chinese nation. Therefore, more than being the essence of Chinese medical theory, they represent the essential culture of all Chinese medicine. As regards the ecological theory of Chinese medicine, we may investigate it in the following ways. The first is the unity of macrocosmos and microcosmos. Macrocosmos refers to the nature of heaven and earth and microcosmos to the individual body. Human beings live between heaven and earth and are surrounded by a natural environment, so practitioners are required to know the relationship between them. In Plain Questions – A Comprehensive Discourse on Changes resulting from Qi Interaction (素问·气交变大论), it records To know the Way is to know the line patterns of heaven above, to know the structures of the earth below, and to know the affairs of man in the center. Someone with this knowledge can exist for long… What is positioned in heaven, these are the line patterns of heaven. What is positioned on the earth, these are the structures of the earth. What is penetrated by the changes and transformations of the human qi, these are the affairs of man. The fact is that that which is in great excess, it precedes heaven; while that which is inadequate, it is behind heaven. That is what is called ‘government and transformation — to which the human corresponds.’ Plain Questions – A Discourse on the Six Terms and on their Visceral Manifestations (素问·六节藏象论) records,

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Since antiquity, those that communicate with heaven, the basis of life, have based it in yin and yang. All the yin and yang qi within the nine regions and nine orifices, communicates with the qi of heaven. Hence, its generations are five; its qi are three. Being three they form heaven; being three they form the earth; being three they form man. Three times three, together this makes nine. Nine serves to divide the earth into nine fields; the nine fields are the nine internal organs. The fact is, the spirit organs are five, and the physical organs are four. Together this makes the nine internal organs. It also records, A duration of five days is named a hou; a duration of three hou is named a qi; a duration of six qi is named a season; a duration of four seasons is named a year. Each of them follows what is responsible for governing it. The five periods succeed each other; each of them governs one of these sections of the year. When the days of an annual cycle are complete, this constitutes one cycle, after which it commences anew. When a time period begins, the respective qi spreads. Like a ring, this process has no end. The hou follow the same law, too. The Plain Questions – A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (素问·阴阳应象大论) records, As for yin and yang, they are the Way of heaven and earth, the fundamental principles governing the myriad beings, father and mother to all changes and transformations, the basis and beginning of generating life and killing, the palace of spiritual brilliance. To treat disease, one must search for the basis. Hence, the accumulation of yang, that is heaven; the accumulation of yin, that is the earth. Yin is tranquility, yang is agitation. Yang gives life, yin stimulates growth. Yang kills, yin stores. Yang transforms qi, yin completes physical appearance. Cold at its maximum generates heat; heat at its maximum generates cold. Cold qi generates turbidity; heat qi generates clarity. When clear qi is in the lower regions of the body, then this generates outflow of undigested food. When turbid qi is in the upper regions, then this generates bloating. These are examples of activities of yin and yang qi contrary to their normal patters, and of diseases opposing the pattern of compliance.

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The Plain Questions – A Comprehensive Discourse on Regulating the Spirit in Accordance with the Qi of the Four Seasons (素问·四气调神大论) also records, Hence, yin qi, yang qi, and the four seasons, they constitute the end and beginning of the myriad beings, they are the basis of death and life. Opposing them results in catastrophe and harms life. If one follows them, severe disease will not emerge. This is called ‘to achieve the Way’. For the Way, the sages follow it, while stupid men go the opposite way. If one follows yin and yang, then life results; if one opposes them, death results. If a violation is taken as obedience, a disease known as neige (inner conflict) will be caused. From above quotations, we know the following: (1) The macrocosmos contains the microcosmos, and the latter is subordinate to the former. (2) The unity of the macrocosmos and the microcosmos is realized by the rules of yin–yang, five phases and qi. Just as has been illustrated before, the rules of the yin–yang, five phases and qi are originally the laws of nature, but are applicable to human life as well. (3) To introduce the rules of nature into human life implies a similarity and unity of ecological law between the living state of human beings and the ecological environment. Human affairs need to comply with and adapt to the rules of nature and doctors should follow this line to understand and treat disease. The macrocosmos is a mobile object, which is expressed as “the cosmos as the upper, lower, left and right around, as well as the passing of the ancient and coming of the present”. Qi permeates the universe and the yin–yang and five phases are the drive of this mobile cosmos. Human beings as a part of this mobile object exist within it and change with it. The diseases of mankind also occur following such a course. The second is the similarity of things in the world, which refers to some having a similar nature — among those objects that can mutually coordinate with and supplement each other. This is very important in treating disease. The Plain Questions – A Discourse on the Six Terms and on their Visceral Manifestations (素问·六节藏象论) records, Herbs and grasses generate five colors; the changes undergone by the five colors are more than one can see. Herbs and grasses generate five flavors; the delicacies of these five flavors exceed one’s perception. Cravings and desires differ; each has something it communicates with. Heaven feeds man with the five qi; the earth feeds man with the five

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flavors. The five qi enter through the nose and are stored in the heart and lung. They cause the five complexions to be clear above, and the tones and voices manifest themselves. The five flavors enter through the mouth and are stored in the intestines and stomach. When the flavors have a place where they are stored, this serves to nourish the five qi. When the qi are generated in harmony and when the body liquids complete each other, then the spirit will be alive of itself. The Plain Questions – A Comprehensive Discourse on Phenomena Corresponding to Yin and Yang (素问·阴阳应象大论) also records, Water is yin; fire is yang. Yang is qi; yin is flavor. Flavor turns to physical appearance. Physical appearance turns to qi. Qi turns to essence. Essence turns to transformation. Essence is nourished by qi. Qi generates physical appearance. Transformation generates essence. Physical appearance is nourished by flavor. Flavor harms physical appearance. Qi harms essence. Essence transforms into qi. Qi is harmed by flavor. Flavor is yin and exits through the lower orifices. Qi is yang and exits through the upper orifices. That which is of a strong flavor is yin; that with a thinner flavor is the yang of the yin. That which is of strong qi is yang; that of a thinner qi is yin of yang. When the flavor is strong, then outflow results; when it is thinner, then penetration results. When the qi is weak, then it brings forth outflow; when it is strong, it brings forth heat. The qi of a strong fire weakens. The qi of a small fire gains in strength. Strong fire feeds on qi. Qi feeds on a small fire. A strong fire disperses qi. A small fire generates. An acrid flavor and sweet flavor are effused and disperse, and are yang. A sour flavor and bitter flavor cause gushing up and outflow, and are yin. When yin dominates, the yang is ill; when yang dominates, the yin is ill. When yang dominates, there is heat; when yin dominates, there is cold. Doubled-up cold results in heat; doubled-up heat results in cold. Cold harms the physical appearance; heat harms the qi. Harmed qi causes pain; a harmed physical appearance causes swelling. Hence, when there is pain first and swelling afterwards, qi has harmed the physical appearance. When there is swelling first and pain comes afterwards, the physical appearance has harmed the qi. When wind dominates, there is movement; when heat dominates, there is swelling. When wind dominates, there is movement; when heat dominates, there is swelling. When dryness

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dominates, there is aridity; when cold dominates, there is surface swelling. When dampness dominates, there is soggy outflow. Heaven has the four seasons and five agents. It is through the former that heaven causes generation, growth, gathering, and storage. It is through the latter that it generates cold, summer-heat, dryness, dampness, and wind. Man has the five depots; they transform the five qi, thereby generating joy, anger, pensiveness, anxiety, and fear. The fact is, that joy and anger harm the qi; cold and summer-heat harm the physical appearance. Violent anger harms the yin; violent joy harms the yang. Receding qi moves upwards; it fills the vessels and leaves the physical appearance. If joy and anger are unrestrained, if cold and summer-heat exceed the norm, life no longer exists on a solid foundation. Hence, doubled-up yin must become yang; doubled-up yang must become yin. Hence it is said: If a person is harmed in winter by cold, he will suffer from warm-disease in the spring. If he is harmed in the spring by wind, he will develop an outflow of undigested food in the summer. If he is harmed in summer by summer-heat, he will suffer from malaria in the autumn. If he is harmed in autumn by dampness, he will develop a cough in the winter. The above quotations may seem a little difficult to understand, but generally, they describe the basis of similarity and mutual transformation among all things in the world. Whatever the climate, the emotion, food, odour of herbs and so on, it exerts a function with its yin–yang features, sequence of five phases and qi as medium. The human body relies on things in the ecological environment for nourishment, while harm will be caused in cases of insufficiency and excess, creating the etiology and pathology of disease. However, this harm can be rectified by external factors — based on yin–yang and other theories. This is just the basis of applying food, air, living conditions and herbs to treat disease. Hence, a theoretical guideline is formed: diseases are caused by natural factors and can be treated by natural therapies. To use nature to treat nature is the fundamental reason that the ecological theory of Chinese medicine enjoys practical value. That’s what the Plain Questions – A Discourse on How the Qi in the Depots Follow the Pattern of the Seasons (素问·藏气法时论) records: Toxic drugs attack the evil. The five grains provide nourishment. The five fruits provide support. The five domestic animals provide enrichment. The five vegetables provide filling. When they are consumed in

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appropriate combinations of qi and flavors, they serve to supplement the essence and enrich the qi. These five grains, fruit, domestic animals, and vegetables have acrid, sour, sweet, bitter, and salty flavors. Each exerts a specific benefit. Some disperse, some contract; some relax, some tighten; some harden, some soften. As for the diseases of the four seasons and five depot organs, they are treated in accordance with the capabilities of the five flavors. In short, substances outside the body and organs inside the body have similarity of structure. Deficiency in the body can be supplemented by the external environment, and blockage in the internal substantial movement can be unblocked by external methods. That is to say, human diseases can be cured by the help of external substances or forces. This is the basis of using Chinese medicine to treat disease. The third is the introduction of social and psychological factors. Sun Simiao’s Important Formulae Worth a Thousand Gold Pieces – Diagnosis and Syndromes Part 4 (千金要方·诊候第四) states, “In ancient times, those good practitioners who treat the country are the superior ones, those who treat a person are the middling ones, and those who treat the disease are the inferior ones.” This record is probably derived from the Spiritual Pivot – About Masters (灵枢·师传), which records, Huangdi asked, ‘I heard that previous masters kept their insights in the heart rather than in bamboo slips or writings. I want to know such insights and record them, as principles for practice, thus using them to govern the people in a superior sense and treat people’s illness in an inferior sense. Hence, all people will be free of illness. The upper and lower people will be in harmony, merits will be distributed to the people, and their offspring free from worry. This will pass on to later generations without an end. Could I know about these insights?’ Qibo answered, ‘You have asked a far-reaching question! For governing the people and yourself, governing this and that, governing the small and big, governing the country and family, the only thing is to comply with them rather than oppose them. This compliance is not only to do the yin–yang and qi of the body, but also the will of people.’ It is similarly recorded in Ban Gu’s Han Book – A Preface to Arts and Literature (汉书·艺文志序): “Therapies and techniques in medicine are just

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tools for preserving life and guarding the emperor and his officials. In remote ancient times, there were Qibo and Yufu; in the middle period, there were Bianque and Qinhe. They talked about disease in association with the country and about diagnosis linking up with politics.” They unified the governance of the country and treatment of disease in one single framework — in order to understand them, for their management strategies and ideas are all one and the same. Those who can govern a country well are like a wise and proficient practitioner. In turn, those practitioners who can only treat several diseases are just mediocre. If a practitioner can act as when governing a country and fully consider the social and psychological factors in the patient, then s/he must be wise and proficient. “To treat a country” refers to the social factors in medical treatment, “to treat a person” refers to the psychological factors and “to treat the disease” just focuses on the disease itself. Only those practitioners who are able to treat disease by taking the social and psychological factors into account can be regarded as “superior practitioners”. The social and psychological factors of an illness are universally in existence. The Plain Questions – A Discourse on Expounding the Five Faults (素问·疏五过论) states, Whenever one wishes to diagnose a disease, it is essential to inquire about the patient’s drinking and eating habits and his place of living. Whether he has experienced violent joy or violent suffering, or whether he has experienced an initial joy that was followed by suffering. All this harms the essential qi. When the essential qi is exhausted and when its flow is interrupted, the physical body will be destroyed. Violent anger harms the yin; violent joy harms the yang. Receding qi moves upwards; it fills the vessels and leaves the physical appearance. In diagnosis there are three rules to be observed. The patient must be asked whether he is of noble or low rank; whether he was a feudal lord who has been demoted or harmed; and whether he aspires to be prince or king. The fact is, when a man of noble rank is stripped of his power, even though he was not struck by an evil qi from outside, his essence and spirit have been harmed inside and hence his body must face destruction and death. If someone was wealthy first and became poor later, even though he was not harmed by an evil qi from outside, his skin will be scorched and his sinews force the body to bend. He suffers from limpness and an inability to walk; his limbs have are cramped. When a practitioner is unable to

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severely reprove a patient and, hence, unable to move the patient’s spirit and when his outer appearance is soft and weak, so that the patient behaves disorderly to a degree where he fails to observe the regular pattern, and his disease cannot be removed, then no therapeutic activities can be performed… Whenever one diagnoses a disease, it is essential to know its end and beginning, and one must also know the remaining clues. Take the pulse, inquire about the name of the diseases, and match your findings with the male or female gender of the patient. Separation and interruption, dense compactness and knotting, anxiety, fear, joy, and anger, whether they let the five depot organs be empty or depleted and whether they let the blood and qi lose their guardian function, if the practitioner fails to know this, what art is there to speak of? Hence, it is said: ‘When the sages treated a disease, they certainly knew the yin and yang qi of heaven and earth and the normal arrangements of the four seasons; the five zang organs and six fu organs, female and male, exterior and interior, as well as piercing, cauterization, pointed stones, and toxic drugs — in all the diseases they mastered. Their approach to human affairs was natural, thereby they understood the Way laid down in the classics. The noble and the commoner, the poor and the wealthy, they all represent a structure of different ranks; and the sages inquired from the patients whether they were young or old, and whether they had a character which was courageous or timid. As for the eight cardinal ‘turning points of the season’ (zheng) and the nine ‘regions’ (hou), in their examination these were of definite help too. They investigated all the divisions and sections of the human body and knew the root and beginning of the disease to be treated. The Spiritual Pivot – An Inquiry (灵枢·口问) states, The original causes of human diseases are all the wind, rain, cold, or summer-heat, the sexual union of yin and yang, or through emotions such as joy or anger, beverages or food, and the place of living. Drastic fright or fear separates the blood and qi, frustrates yin and yang, depletes the channels and collaterals, blocks vessels, reverses yin and yang, retains the defensive qi, empties the channel’s vessels, disorders the qi and blood, eventually leading to morbidity.

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The above records obviously took social factors (changes between noble and humble, the bitter and happy, rich and poor) and psychological factors (like worry, fear, joy and anger, and separation, resentment, depression and timidity between men and women) into consideration in the pathology. And this consideration is on the basis of the yin–yang, qi and blood, five phases, and deficiency and excess as they change within the five-zang organs during diagnosis and treatment. Whether this disease is social or psychological, or due to biological factors, it can be placed under the same morbidity mode of yin–yang, qi and blood and be rectified by acupuncture or herbal prescriptions. For example, for depression or psychological problems of the liver qi, we can treat them by needling acupoints such as PC 6 (nèiguān) and HT 7 (shénmén) and herbal formulae like Free Wanderer Powder (Xiāo Yáo Săn) and Bupleurum Liver-Soothing Powder (Chái Hú Shū Gān Săn) guided by Chinese medical theory. The synergic effect of these herbs in these formulae doesn’t target the nervous system directly and is totally different from antidepressant or psychological therapy in biomedicine. But their effectiveness in a clinical setting is well recognized. The above selections have shown that the ecological theory of Chinese medicine includes both social and psychological factors, which is sharply in contrast to modern medicine’s emphasis on natural ecology. The ecological theory of Chinese medicine integrates natural ecology, social ecology and psychological ecology, and has a more profound connotation and wider extension. It also is more abstract in its generalization of theoretical principles. In addition, a distinct clinical effectiveness further proves its accuracy. That’s why I would like to say, the ecological theory of Chinese medicine is a high-class ecological theory. Let’s take a look at the epistemology of the ecological theory of Chinese medicine: that is, the unity of heaven and mankind. When talking about the “unity of heaven and mankind”, scholars often criticize it as idealism because in sociological terms, a popular concept in ancient China was that a conscious and willful “heaven” controls everything. For instance, phrases such as the “heavenly order”, “heaven’s will”, “heaven’s son” and “heaven condemns” denote as such. However, this meaning doesn’t exist in the Inner Classic. What is discussed in the Inner Classic is the law of nature, which dominates the human society, health and disease. The heaven in the Inner Classic stands for specified things in nature, such as the weather, climate, cloud, rain, sun and moon in the sky, wind, cold, summer heat, dampness, dryness and fire. It corresponds to the “earth”, both of which are used to explain changes in nature. Therefore, the

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concept of “heaven” in Chinese medicine is totally different from the popular idea of “heaven” in ancient society and politics. The “unity of the heaven and mankind” from the Inner Classic is not an ideal of divine creationism. Nowadays, many people, including some sociologists, consider the basic character of Chinese culture to be the “unity of the heaven and mankind”. This is probably right, but I think we should still approach it in two other respects. Sociologically, the “unity of the heaven and mankind” tends to be an idealism of divine creationism, which serves the ruling class and doesn’t deserve approval. However, in the aspect of natural science, the “unity of the heaven and mankind” in medicine is almost accurate, and its essence is the “correspondence between heaven and mankind”, a process that observes nature and so discovers rules to be applied in medical practice. Plain Questions – A Comprehensive Discourse on Changes Resulting from Qi Interaction (素问·气交变大论) states, “Those who know how to speak about heaven, they must have a corresponding knowledge about man. Those who know how to speak about the past, they must have experienced the present. Those who know how to speak about qi, they must have a clear knowledge of concrete things. Those who know how to speak about correspondences, they are one with the transformations of heaven and earth. Those who know how to speak about transformation and change, they penetrate the structures of spiritual brilliance.” This heaven has no relation to human will, but only bears the weight of there being objective rules in nature. The “speak about” refers to the illustration of natural rules; the “correspondence” means embodiment and adaptation; the “have experienced” means to test and realize. A person who is able to “speak”, “correspond”, “have a clear knowledge”, “transform” and “change” is a man good at thinking, practicing, abstracting, proposing new theories and “penetrating the structures of spiritual brilliance”. This methodology of “recognizing things as they are” was initially based on a plain method of analogy, on the similar appearance of one thing to another (the human body). For example, Spiritual Pivot – Pathogenic Invasion (灵枢· 邪客) states: Huangdi asked Bogao, ‘I want to know how the body parts correspond to heaven and earth.’ Bogao answered, ‘heaven is round and the earth is square, which corresponds to the round head and square foot of the human body. Heaven has the sun and moon, and a person has two eyes. The earth has its nine continents, and a person has nine orifices. Heaven has wind and rain, and a person has joy and

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anger. Heaven has thunder and lightning, and a person voice and sound. Heaven has four seasons, and a person four limbs. Heaven has five sounds, and a person five zang organs. Heaven has six melodies, and a person six fu organs. Heaven has winter and summer, and a person feels cold and warmth… Heaven has yin and yang, and a person male and female. There are 365 days in a year, and a person has 365 joints. The earth has high mountains, and a person has the shoulders and knees. The earth has its deep valleys, and a person has armpits and a popliteal fossa. The earth has its 12 rivers, and a person has 12 channels. The earth has its spring vessels, and a person has defensive qi. The earth has grasses, and a person has fine hairs. Heaven has day and night, and a person has rest and work. Heaven has the star distribution, and a person has the teeth. The earth has small hills, and a person has small joints. The earth has hill stones, and a person has prominent bones. The earth has its woods and forests, and a person has the tendons and sinews. The earth has its populated towns, and a person has flesh. The year has 12 months, and a person has 12 large joints in the limbs. The earth has places where no grass can grow, and a person can be infertile. This is the correspondence between heaven & earth and the person.’ This analogy seems unconvincing and not very logical, and some people may even criticize it as not even a matter of fact. This way of thinking obviously retains some trace of wizardry in its thought of similarities, but here there is no god’s or ghost’s willing, no dominance of supernatural divine forces and this sets a clear boundary between theology, witchcraft and agnosticism. If we do not regard the unrealistic surface of this method, but consider its dealings with similarity in nature (rules), this methodology of finding correspondences between heaven and humankind is very meaningful. This method is widely applied in the Inner Classic for explaining the body, disease and treatment. For instance, in responding to Huangdi’s inquiry about how to recognize reasons for the diversity of pain, Qibo speaks some convincing sentences. Plain Questions – A Discourse on Pain (素问·举痛论) records, Huangdi asked: ‘I have heard: those who know how to speak about heaven, they must have experienced man. Those who know how to speak about the past, they must have become one with the present. Those who know how to speak about other people they must have dealt with themselves sufficiently. Thereby their understanding of

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the Way is free from confusion and the essential can be known to its fullest extent. This is so-called ‘understanding’. Now I ask you, Sir: to bring about a situation where from words one can obtain knowledge, from inspection one can obtain insights and from feeling one can obtain a hold — that is, to bring about a situation where one has experienced oneself with release from ignorance and all delusions gone. May I hear about this?’ Qibo paid reverence, twice knocking his head on the ground and responded: ‘Which Way is this question about?’ Huangdi asked, ‘I should like to hear the following: when man’s five zang organs experience sudden pain, which qi causes this?’ Qibo answered ‘The flow in the channels and vessels does not stop. It circulates without break. When cold qi enters the channels, stoppage and retardation result. The contents of the channels and vessels are impeded to the degree that they fail to flow. When the cold qi settles outside the vessels, the blood is diminished; when it settles inside the vessels, the qi cannot pass through. Hence, there is sudden pain.’ Here, Qibo is not simply just using an analogy — he is naturally applying the theory of qi, yin–yang and the five phases to explain the pain caused by impeded qi and blood circulation: blockage leads to pain. It is a marvelous creation to develop and transform the rules of qi, yin–yang and five phases into forming a specific medical theory. This is an example of the major mode followed by Chinese medicine in analysing the pathology, the disease mechanism, and in finding the right treatment or right herb, attaining great things. In summary, the methodology of correspondence between heaven and man is not only the tie that connects together ecological medicine as an integrated whole but also the key to opening the door of ecological Chinese medicine. Since ecological Chinese medicine is a synthesis of natural ecology, social ecology and psychological ecology, as well as physiology, pathology, therapeutics and techniques, it is a system of its own and practical with theoretical guidelines. Hence, Chinese medicine is greatly superior to and more advanced than the ecological medicine of the modern day — that is still in its infancy. What needs to be altered in the ecological theory of Chinese medicine is its language; it needs to be much more easily understood and applicable for Western doctors and even the common people.

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B.  The Vital Source of Chinese Medicine 178.  The Cultural Soil of Chinese Medicine Chinese medicine grows and develops in China, a land with a culturally rich soil. On the one hand, China covers a vast territory with an enormous population. On the other hand, Chinese medicine has a long history, unanimous theoretical principles and richly accumulated experiences, and in addition has made great contributions to the healthcare and survival of the Chinese people for thousands of years, gaining great trust among the Chinese nation. In a general sense, the Chinese medical tree has roots that lie deep and it stands up sturdily with its overarching branches and leaves. This great tree didn’t fall in the past and will not fall in the future. The cultural land of China will continuously supply nutrients to this great plant and ensure a robust growth. One of the cultural features of Chinese medicine is its opposition to witchcraft and superstition. This was one of its mainstays. Witchcraft and superstition can cheat people for a while, but it cannot be maintained for long. The mainstream development of Chinese medicine has always proceeded along the right path. Though there could be some mud of witchcraft and superstition retained, much has been washed away in the course of historical Chinese medicine. The materialism of natural philosophy has the ability to self-cleanse. Chinese culture has some features of external Confucianism and internal Taoism, which are also typical of Chinese medicine. Some people call Chinese medicine a “balanced medicine” in that it stresses the balance of yin and yang, the orderly motion of the five phases, the harmony of qi and blood circulation, the cooperation of internal organs, the body’s adaptation to the external environment and even the “benevolence” of medical ethics — all of which reflect the integration of Confucianism and Taoism in medicine and among medical practitioners. It doesn’t apply extreme treatments, drastic methods and uses surgery as little as possible. It takes needles to guide qi, moxa to warm qi, herbs to rectify the disorder in routine or contrary treatments, all of which target balance, in all, very similar to the doctrine of mean. These make Chinese medicine and their practitioners full of human touch. It is a feature of social medicine that it closely connects with society — while being prevented from being isolated from society. Chinese medicine has never stood high above the masses and reality, but lies down on the ground — with its roots spread deep and wide among the

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common people. For a long time, Chinese medicine had no independent identity, or social status, but it was ubiquitous. Not many famous practitioners in the history were full time. Most full-time medical practitioners were imperial ones, but very few of them made outstanding contributions. Bianque was a folk medical practitioner, and Chun Yuyi was part time, while his major post was director of food storage. Zhang Zhongjing was an official in charge of Changsha city and practiced medicine in his spare time. Hua Tuo would rather treat the diseases of common people than always serve Cao Chao, and was finally killed by Cao Chao. Huangfu Mi’s main job was writing books, while Ge Hong aimed to be immortal by advocating Taoism and fashioning longevity pills. Sun Simiao didn’t follow the Tang emperors’ call to serve them and Wang Tao was a library director. The Poet Wang Bo said, “Anyone who is a son must know some medicine.” This echoed well with Zhang Zhongjing’s earlier preface in the Treatise on Cold Damage and Miscellaneous Diseases (伤寒杂病论), which criticized the fashion at that time: “It is the fault of people today that they don’t care about medicine, or study medical formulae and skills, treat diseases of the emperor or their parents, or preserve their own health thus ensuring long life.” In the Song dynasty, Fan Zhongyan proposed, “if not a good minister, then be a good medical practitioner,” and people flocked to become medical practitioners. Certainly, many people changed profession and became physicians as they failed the examination for officials. Even among officials, most knew a little medicine. Together with the hermits in the hills, common people and villagers collecting herbs, people who knew medicine were very common. Among the ancients, there were very few medical schools except those cultivating the Imperial medical practitioners; there were almost none for the common people. It was not until about a hundred years ago that quite a few schools of Chinese medicine were established. Medical practice in the folk world was usually inherited from the family, or occurred among apprentices following their master. This was also the reason that Chinese medicine was “down to earth” with its roots spreading wide among the common people. This made the roots of Chinese medicine spread deep and far among the folk. The reason that Chinese medicine was popular and resided among the folk lay in its simple, convenient, effective and cheap character. The mass culture of China is non-romantic, practical and had no regard for the “gorgeous surface” of fashion — although some people always would do the opposite. People were usually plain in manner, simple, practical and believed in time and money saving. While pursuing its medical goals, Chinese medicine catered to their actual and psychological needs.

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From the middle of the 1970s onwards, Chinese medicine developed quickly outside China. For more than thirty years, Chinese medicine has not only been popular in China and Southeast Asia but has also spread to the European, American, Australian and African continents and become gradually settled — gaining increasing popularity among the local people. A great many local practitioners have been trained in China or their own country. The broad earth of Chinese medicine has expanded to cover the globe. Being part of a foreign medical culture, people changed from curiosity about it to a hearty love. The ideas of being natural, neutral, harmonious and holistic stand high in people’s hearts. Its effectiveness, less toxic nature and fewer side effects have won their trust. Those who are disappointed at the shortcomings of biomedicine show more of an enthusiasm for Chinese medicine. In a foreign culture, Chinese medicine is absorbing nutrients of each foreign culture to boost itself. It can be asserted that Chinese medicine will forever be retained in these countries — regardless of the support of the government or opposition from scholars of biomedicine.

179. Die-Hard Chinese Medical Practitioners Providing Effective Treatment, with Less Toxicity and Fewer Side Effects In any soil, there must be seeds, and so Chinese medicine must have its seeds. Famous Chinese medical practitioners appeared one after another in history and they are the elites of Chinese medicine. In modern society, by confronting the dominance of biomedicine, Chinese medicine had once been forced into a corner and lost its strength. However, just as Lu Xun, a famous Chinese writer, said, “China is not lacking in people who bear responsibility and take blame, and never give in. They are the backbone of China.” Chinese medicine also has such a backbone, namely those die-hard Chinese medical practitioners. In a narrow sense, they have the following characteristics: (a) They are “pure Chinese medical practitioners”, most of who learnt Chinese medicine from their masters, or studied in a private medical school. Some even learn by themselves to become medical talents. (b) They are fully confident in the Chinese medical model of practice — because they have rich clinical experience and have successfully cured many patients. (c) They are proficient at or familiar with the Chinese medical classics and various ancient Chinese medical works. Some of them can even recite the contents of these works. Therefore, they can apply Chinese medical

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practice at a high level. They often have a deep understanding of Chinese medical history. (d) They have a deep understanding of traditional Chinese culture. With special favour, they can often write poems and act gracefully. When Chinese medicine is attacked, they will step forward bravely and find sufficient grounds to defend it. There had been many die-hard Chinese medical practitioners in the past. Mr. Mao Jialing listed 169 of them in his book.13 At present, the most representative are Qiu Peiran, Deng Tie Dao and Peng Jian. In recent years, Peng Jian published I’m a Die-Hard Chinese Medical Practitioner, which has had a very positive reception.14 It records many cases of his clinical experience, all of which were cured purely by Chinese medicine. In particular, he spoke out concerning the inner voice of the die-hard Chinese medical practitioner. He pointed out, Clinical effectiveness is the life of Chinese medicine. If we are unable to cure disease, we will not win confidence from the people. Without many die-hard Chinese medical practitioners, Chinese medicine will not be able to have a foothold in society. Regardless of any theories and sayings, the top priority of Chinese medicine is to cure illness. However, the reality is that among a large number of medical practitioners in the vast land of China, it has been hard to find really good people who are able to cure an illness with genuine Chinese medicine. This is not being alarmist. It is a fact, to the great bitterness of senior Chinese medical practitioners and dissatisfaction and disappointment of the common people. In present day China, people will not listen to the words of those who occupy a humble state, and few support those with unique ideas; it is difficult to settle down to academic work and more difficult to speak out the truth. Besides, the issue of Chinese medicine has many embarrassing secrets hidden in its depths. Therefore, it is actually wiser for individuals to keep silent — but if all the people keep silent at a critical moment in Chinese medical thinking, it creates a 13

 Mao Jialing. A Look at China with the 3rd Eye, Beijing: Beijing Science & Technology Press, 2007, p. 143. 14  PengJian. I’m a Die-Hard Chinese Medical Practitioner – PengJian’s Academic Ideas and Collection of Thoughts in Clinical Practice. Beijing: People’s Medical Publishing House, 2007.

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void, and an absence of conscience, independent personality and social responsibility. The reason that die-hard Chinese medical practitioners can stand steadily essentially resides in the favourable effectiveness of purely Chinese medical treatment. Clinical effectiveness is the foundation of the life of Chinese medicine. In a world dominated by biomedicine, Chinese medicine has advantages particularly in the following fields (according to my observations through years of practice in countries outside China)15: (1) Weakness: Weakness is not one disease, nor even a syndrome, but a common chief complaint of the patient. It can either be a symptom of the disease, or a symptom during the recovery phase, or more commonly part of the status of “sub-health”. It is very common among people. To biomedicine, it cannot be a realm of treatment because it has no definite primary causes, such as infection, malnutrition or poisoning. Biomedicine has no therapies for supplementation — or rather the concept of supplementation is different, as it regards nutritive therapy as supplementation. Chinese medicine has a very important principle of treatment, that is, “to supplement the deficiency and purge the excess”. This deficiency includes undernutrition, more importantly insufficient strength or mentality. It is the weak patient who, in Chinese terms, is deficient in yin and yang. Acupuncture, moxibustion and herbs can all be applied for supplementation. Supplementary herbs and herbal formulae include ginseng, astragalus root, rehmannia root, reishi mushroom, lycium fruit, royal jelly, acanthopanax root bark, Centre-Supplementing and Qi-Boosting Decoction, Six-Ingredient Rehmannia Pills, Golden Cabinet’s Kidney Qi Pills and so on. These can be very effective when they are applied in accordance with the patient’s individual physique. This is a unique and effective Chinese therapy that has been very familiar among the Chinese people — and gradually more and more recognized and adopted outside of China. (2) Viral infections: Up to now, there has still been no specific wonder drug for viral infections. Chinese single herbal formulae or combined formulae are significantly effective for viral flu, chicken pox, mumps, herpes zoster, hepatitis and so on. My British patients are accustomed to drink15

 Ma Boying. Which Difficult Diseases in the Europe Respond Well to the Treatment of Chinese medicine. Essays of the 1st UK International Chinese Medical Conference. London, 2003, pp. 73–87.

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ing infused isatis root granules ((板蓝根)) for a common cold or flu at its onset. They have experienced the favourable effects of isatis root and even introduced it to their relatives. Herbal formulae, such as Lonicera and Forsythia Powder, Common Cold Granules and Pharyngitis Tablets, are all commonly used. (3) Difficult diseases which are ineffectively treated by biomedicine: These include ME, MS, pain of unknown origin, diarrhoea of unknown origin and many chronic diseases ineffectively treated by biomedicine. Most can be improved or cured by Chinese medical therapies. Even among cancers and AIDS, although the cure rate is not high, some cases can be cured, and the patient’s delight is beyond question. Chinese medicine is more adept at enhancing life quality, reducing the side effects of chemical and electrical therapies, and remitting pain. Patients feel its definite benefits. (4) Chemical drugs and side effects: There are many patients refusing chemical drugs, experiencing side effects from biomedicine, being unable to continue the treatment of biomedicine due to drug intolerance or resistance, or advocating natural therapies. In these cases Chinese medicine is often their optimum choice, because Chinese medical treatment is proven in effectiveness. At present, the most urgent problem in Chinese medicine is the requirement for genuine medical practitioners, with solid skill, who are able to cure diseases that fail to respond to biomedicine. This summary of new clinical advantages and experiences well represents the true vitality of Chinese medicine — and it will hopefully prepare the conditions for a theoretical breakthrough. There has been a noteworthy problem in recent years. On the one hand, we know that Chinese medicine and herbs undoubtedly have fewer toxic or side effects. On the other hand, the toxicity and side effects of Chinese herbal products have been widely quoted recently and their safety questioned greatly. To secure the safety of Chinese herbs is a common goal. Without safety, patients will not trust Chinese practitioners and Chinese medicine will not survive. It is common sense that Chinese medicine is safer than biomedicine. In the 1990s, the West began to have more contact with Chinese medicine and at that time, Western media exaggerated Chinese medicine as a myth without any toxic or side effects. This kind of propaganda was inappropriate in many ways and the result was a strong contrast in feeling: once a minor problem arose, even though what appeared was

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sometimes not really there, there would be a public outcry. The most significant case was the event of Longdan Xiegan Wan (a Chinese herbal formula). Since 2000, starting in the UK, and then in many other countries, all herbs or Chinese patent medical products containing Longdan Xiegan Wan or aristolochic acid were prohibited. Meanwhile, a new phrase “Chinese herbal nephropathy” (CHN) was coined. Later, articles attacking Chinese medicine appeared repeatedly, and consisted of a serious attack to Chinese medicine outside China. I myself with some of my peers rose up vigorously to refute this and wrote letters to related journals for debate. Eventually, the term CHN was abandoned. In 2003, I helped win a lawsuit, which was specially reported as “The case of the Brighton TCM Clinic being sued for being the culprit in nephritis”.16 This partly reversed public opinion. In this lawsuit, I testified as an expert and the testimony was mainly based on an Oxford University textbook, in which 94 kinds of chemical drugs were listed as being able to cause nephropathy, whereas the suitor had taken three of them (aspirin, paracetamol and a kind of antibiotic). If the possibility of these chemical drugs causing nephropathy had not been excluded, it could not be concluded that the nephropathy was caused by the Longdan Xiegan Wan, according to the diagnostic principles of biomedicine. Though we won the lawsuit, I am still unable to dissipate people’s doubts on the nephropathy being caused by the aristolochic acid in the Longdan Xiegan Wan, because almost no one at that time had done any toxicological research on aristolochic acid. Longdan Xiegan Wan and aristolochic acid cast a lingering shadow over all Chinese herbs — any could be suspect. Once a few people became uncomfortable and happened to have taken Chinese herbs, biomedical doctors or media would blame it on the Chinese herbs. There are two reasons for this. One is that in the West, especially the biomedical world, people are always skeptical about Chinese medicine and herbs. Another is that there has not been enough research into the toxicity or side effects of Chinese herbs, and people are unclear about their dosage, degree of toxicity, median lethal dose and so on. Biomedicine has very detailed research in these aspects, so when side effects or even lethal accidents happen, there can be no blame since the dose is always in the “specified range”. In the future, research into these aspects should be reinforced — with a specific range of toxic and side effects outlined, backed up by experimental data. Henceforth, unnecessary trouble will be avoided and 16

 China Business Daily (UK): London, January, 10th, 2004.

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the population feel reassured about taking Chinese herbs, positively promoting the survival and development of Chinese medicine. Chinese herbal science needs to be “sturdy”. Likewise, the quality of Chinese herbs from the Chinese market must be strengthened. In the past, when the natural environment was better, it was free of the problems of heavy metals and pesticide use, and contamination by other toxic substances, and now there are GMP and GDP standards of plantation and processing. However, the environment has been made much poorer and the international standards could be higher. If these problems are not confronted, the high-quality land becomes of poorer quality and the survival and development of Chinese medicine are severely degraded. The soil needs to be well preserved and cultured.

180. Theoretical Advancement and Foresight: “Creativity” as the Motive Force Within TCM Chinese Medical Theories have now reached a phase where all-around reform is a necessity; they require deciphering and reconstruction. According to the paradigm illustrated in Kuhn’s The Structure of Scientific Revolutions, after an old paradigm has encountered many abnormalities, it will be broken down to some extent. It is not workable to see abnormalities and do nothing. Neither is it right to blindly defend the old paradigm and decline to notice any abnormalities — this is not at all beneficial to the development of Chinese medicine. What we need to do is summarize new rules and abstract new theories. The theories of yin–yang and five phases have stood for twothousand years, but they can’t remain static another two-thousand years. We should promote change. There had been many cases in history. If there can be more medical experts such as Wang Qingren, Xu Dachun and Wu Youke, a revolutionary leap in Chinese medicine will come about. Do not linger over the boring hypotheses “if Wu Youke could have seen bacteria” or “if Wang Qingren’s anatomy could have been more developed”. Now that we have seen the bacteria and anatomy has greatly developed, have these promoted a development in Chinese medicine? Have these enabled Chinese medicine to leap forward? Not yet. In fact the opposite often happens: the fruits of biomedicine undermine Chinese medicine. To put it extremely, if Wu Youke’s “theory of miscellaneous qi” had developed into bacteriology and were Wang Qingren’s anatomy able to reach a new precision, we could have said that these recent developments of modern medicine

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initially came from China. The achievements of these ancient medical experts need to be cherished, but it is nonsense for us to imagine we can extend their ideas purely subjectively. Wu Youke was only able to reach his “theory of miscellaneous qi” by exploring the new field of differentiation of warm diseases, and Wang Qingren only able to establish a new theory of activating blood and resolving stasis on the basis of his anatomy. They propelled Chinese medicine to a new level in accordance with the history of Chinese medical development. Xu Dachun, an outstanding medical theorist, with a wide range of knowledge commented on Chinese medicine, and revealed great insights. Though these comments were both right and wrong, they were at least able to “season” the medical world — and inspire other medical practitioners to think more and explore. There should be more of such people in the medical world — not fewer. I often think of Liang Shuming’s viewpoint in his Eastern and Western Cultures and Their Philosophies (published 1921) that the Chinese culture is a kind of premature culture. He stated in another book that “I often say Chinese culture is premature as a culture of mankind. It didn’t experience many phases, but reached its climax in a single stride.”17 “Premature“ can thus be understood as “surpassing an era” or “being prospective”. It is completely different from the contemporary Western culture and among modern Westerners has been criticized extensively and thought unreasonable. However, many Westerners have gradually found ancient Chinese culture to be full of wisdom and call it “Chinese wisdom” or “Eastern wisdom”. Some developments in the Western society have even followed paths common to the Chinese people. For example, Laozi’s “way of all nature” and Confucian Theory have become increasingly favoured by the Western world, and many of their theories and principles adopted. In such a way, it is easy to understand the premature nature of Chinese medical theory. In short, ecological medical theory in the West only spoke of “germs” — but there was a complete ecological and medical system in China, albeit one which could not be integrated into modern medicine. This was the fundamental reason that Westerners were unable to comprehend it, and why it declined temporarily. The Chinese theoretical system has points totally incompatible to the West’s system of use. In this respect Chinese medical theory was surely precocious, and too premature for people to understand and accept. 17

 Liang Shuming. Morning Words – Apprehension of the Human Life. Tianjin: Baihua Literature and Art Publishing House. 2005:128.

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Nevertheless, premature doesn’t necessarily mean immature or naive. We have evidenced that achievements in Chinese medical theory and clinical practice have developed and been completed over the course of thousands of years. The fact that it has safeguarded the prosperity of the Chinese nation and the people’s health indicates that as a medicine it is actually “mature”. Being immature is only an illusion, which doesn’t mesh with the Chinese medical theories themselves — seeing it as “immature” only outlines the failure to understand it in depth. The phrases and rules of “qi, yin–yang and the five phases“ can still not be adequately expressed in modern language. Therefore, “premature” is not an accurate description of the Chinese medical theory. “Advanced” is a better description. Being advanced shows potential — instead of its faults. Being advanced, Chinese medical theories, through their perspective, imply a prospective development of medicine. Being advanced thus means great creativity. This creativity is primarily due to the spacious opportunities opened up in the research field by the Chinese medical advances. Chinese medical theories have been proven to be right in clinical practice, but this is not enough. Chinese medical theories are proven correct, but lack detail and a modern interpretation of their mechanism. In previous times, it was prosperous and thriving. This creativity is its vital force, the force that drives the life of Chinese medicine.

C.  Puzzles and the Future 181.  Puzzles: Turmoil and Swirls Chinese medicine was originally a river that ran smoothly and slowly forward. However, following the entering of modern biomedicine into China, drastic turmoil occurred and swirls disturbed and stirred up mud and sand at the river bottom, making the flow quite turbid. The river hence lost its former tranquility, oblivious to what lay ahead. These turmoil and swirls are mainly reflected in the following six aspects: (1) There is a debate between Chinese medicine and biomedicine. The power of abolishing Chinese medicine once again was predominant. Many people pretended to be experts in Chinese medicine and criticize Chinese medicine unreasonably. (2) A great number of Chinese medical practitioners lost self-confidence. Some learnt Chinese medicine, but didn’t take up a career; some blindly worshipped biomedicine and followed everything it said. They used biomedicine as it was more convenient in clinical practice, while making light of Chinese medical theories, a situation more significant in medical hospitals

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in the cities or among young Chinese medical professionals. They envied the infinite benefits of biomedicine and its modern equipment, advanced science and technology. Biomedicine is obviously effective and greatly in fashion. On the contrary, Chinese medicine is traditional, almost bound to the past and still moves stubbornly forward. An acupuncture needle and a handful of herbs cannot to be regarded as refined in any way. In their eyes, Chinese medicine exerts its effectiveness slowly, enjoys few experimental results, is old-fashioned, and thus should be retained but given a lower status. It seems the viewpoints of the cities are dominant. However, in poor villages and remote areas, herbs and acupuncture still exert great effect — beyond the vision of the city people. Doctors from villages are humble and have a low status, so their words are always treated lightly. This makes a great difference in status between Chinese medicine and biomedicine. Moreover, some Chinese medical doctors, who are not confident, are humbled and go on their knees to cater to biomedicine in the academic field. They are grounded in biomedicine and so pick up faults in Chinese medicine. They do not help to improve Chinese medicine, but just criticize it and even gladly try to eliminate it. “Let Chinese medicine perish as soon as possible” they say, and it seems to give them some relief. They are vassals and “internal opponents” promoting the abolishment of Chinese medicine. Their initial intent may have been kind as they thought this would promote the modernization of Chinese medicine, but they don’t know the history — and their behaviour severely damages the traditions. (3) The education system of Chinese medicine became a complete copy of biomedicine since its establishment in the 1950s. Half the courses belong to the scope of biomedicine and the branches of Chinese medicine are also divided in accordance with biomedicine. In recent years, acupuncture has been separated from Chinese medicine as well. The holistic approach of Chinese medicine has thus been damaged. This influence reached overseas so that acupuncture and Chinese medicine became rivals. Not only were they registered separately but also in many aspects the acupuncture side overwhelms the Chinese medical side and the status of the latter is inferior to the former, putting the cart before the horse. For the internship of Chinese medical students, the hospital is not a purely Chinese medical hospital and the primary choice of diagnosis and treatment is often biomedical. Students have to make up their clinical practice of biomedicine as soon as possible, or are unable to continue in the internship. Therefore, graduates of Chinese medicine have a knowledge of both Chinese medicine and biomedicine, but are unable to master either. Their self-confidence is further frustrated. When these Chinese medical graduates come to work, they are not welcome in

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either market. If the establishment of a Chinese postgraduate system had not happened, after the “Culture Revolution”, the Chinese medical elites would have been placed under the present educational system. There has been a rise of Chinese medical training in recent years, of apprentices following a master, which is actually a good phenomenon. However, some of them return to the ideology of the small-scale peasant economy — in that they recognize only their own master and repel others, and become narrow-minded, shortsighted and lack the generosity of their masters. Such Chinese medical doctors find it hard to take on the burden of the responsibility of developing and promoting Chinese medicine. How can we improve the educational system in Chinese medicine? How can we recognize the traditional system of apprentices following a Chinese medical master and integrate this into a modern educational system? These have been the problems in dispute, and are worthy of deep consideration. (4) Funding for Chinese herbs and acupuncture is increasing in China, but achievements are few. Very few people are able to think calmly and go deep into their research. One problem is that some theoretical issues are short of research; another problem is derived from the reality that research is not able to be carried forward step by step and there is nobody willing to sort out the heritage of Chinese medicine — because the allowed research period is usually very short and if the research papers are not of a high level, scholars will fail to be promoted through the university rank or personally benefit. Research work must proceed gradually and if we are not clear about the heritage of Chinese medicine, how can we discover the salient points and find the moments of breakthrough which Chinese medicine demands? Also the research methodologies appropriate for Chinese medicine and acupuncture have still not been discovered, and there are few researchers in this field.18 In the history of science, any scientific advancement or major breakthrough is associated with an improvement or innovation in methodology, method or equipment. If Chinese medical research is always limited in its scope and can’t escape, it will surely stagnate and be unable to move forward. (5) In China, regardless of medical practitioner, patient, medical text or belief, the aspects of the whole of Chinese medicine are too deeply entangled with the general culture of the country, which has created a giant swirl. This swirl makes the cultural consciousness and psychology surpass the original scientific features of the medicine — and eclipses its independence. Witchcraft, superstition and popular psychological belief are mixed up with 18

 Ma Bo-ying. About the Selection of Chinese medical Research Programs for International Cooperation. World TCM. 2008, 3(2): 69–71.

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medicine, and are sometimes difficult to separate. The uncertainty within, connotation and flexibility innate in Chinese medicine just cover too great a range. Concepts of Chinese medicine are not confined in scope, diagnosis can be variable and explanation often hyped up. The internal science of Chinese medicine sinks into the popular culture, especially the tight encirclement of backward-moving and habitual forces. If Chinese medicine is unable to break this encirclement, it doesn’t have hope; if Chinese medicine can’t release itself from this swirl, it will drown. Many excellent things in Chinese medicine and its culture need to be refined and elevated, and require boundaries to be set between it and popular culture. (6) In recent years, the market economy in China makes people go out all for profit and making money. Various Chinese healthcare products are on the market in different forms. People put profit ahead of curative efficacy. Even if the products are not effective, they will change and be sold in another form after several years’ survival in the market. Fake and inferior herbs are also abundant, seriously sabotaging the renown of Chinese herbal medicine. In addition, the management of scale, which is the essence of a market economy, is still not able to function in Chinese medicine and propel the Chinese medical industry into a new stage.

182.  Research Methodologies and Research into Methodologies The exploration of Chinese medicine has never been stopped in its course. The Chinese government has a firm strategy on protecting Chinese medicine. The enthusiasm for modernization among medical experts and scientists outside of medicine is always on the rise. At present, the main method is still to combine both Chinese medicine and biomedicine, and use biomedicine or modern science and technology to research Chinese medicine. There are no independent research methods aside from the above. Mr. Liang Shu-ming (1893–1988) pointed out the following:19 The Taoist school has made great contributions to our understanding, the operation and manipulation of aspects such as respiration, digestion and circulation, and their contribution to medicine is marvelous. No matter how western biomedicine dissects it, what it sees are traces left by life activities rather than life itself. It is unable to deduce changes. In anatomy, no matter whatever the exquisite 19

 Liang Shuming. Morning Words – Daily Meditations on Human Life. Tianjin: Baihua Literature and Art Publishing House. 2003:123–128.

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microscope applied, the findings are still rough and shallow in import; whatever the techniques used, the concepts produced are still just images and not integrated life. The Taoist school always takes part in life’s activities, so its findings are of the living life of the body. In conclusion, biomedicine and Chinese medicine follow two different paths: one the way of being static, scientific, mathematical and divisible, while the other the way of dynamism, metaphysics and being indivisible in its movement. Comparing these two paths, Chinese medicine in the last resort could be said to be a little superior, but there is no way at present to prove it. This is not to concern ourselves with certain Chinese medical doctors with their present “magic skills” — for, even if there were present, they would be unable to prove themselves in the front of modern science. The result would only be that people would just be surprised at the magic. They would be hard to convince — as Chinese medicine can’t describe itself in modern terms. Hence, Chinese medicine has academic value and status, but it is unable to explain itself to people. Communication between Chinese medicine and biomedicine is still impossible. It can only be realized in the far future and this possibility lies in biomedicine, through gradual research, progress and transformation — thus embracing in a similar way Chinese medicine. Chinese medicine can only stand by passively and wait for others to recognize it. From this point of view, the way of biomedicine is the orthodox one — and Chinese medicine must follow. Only in such a way can achievements be made which are different from those of the present and be found reliable. The words of Mr. Liang are correct. Chinese medicine in history hasn’t actually formed independent, objective, reliable, testable and falsifiable methods or mature methodologies, while biomedicine hasn’t established a methodology able to research life in movement and change. This has a similar sense to the fact that “channel and collaterals exist only in a living body rather than a dead one” as we commented before. However, biomedicine has its own series of research methodologies and with the progress of these methodologies, it is possible that it will gradually find a way to Chinese medicine, thus embracing it. Mr. Liang also said, It seems a failure for biomedicine if it needs to transform to approach the Chinese medicine, but actually, the result is that Chinese medicine complies with it. This is because Chinese medicine can’t explain

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or be recognized on its own. When explained by biomedicine, the methodology surely belongs to the latter. Chinese medicine can only be contained in biomedicine when the biomedical system has extended to a certain degree. This must be the future — but how far is this future? In my opinion, it will not be realized until biomedicine can have some comprehension of life and take the life as its research object. I think the major handicap in biomedicine is its insufficient recognition of life — for it considers the human body to be a combination of different parts and it treats disease as ‘repairing the machine’. On the other hand, Chinese medicine can be regarded as an ‘academic’, holding thoroughly on to all concepts of life. We can only wait for the transformation of the fundamental methods of biomedicine and let it approach, illustrate and recognize Chinese medicine. Otherwise, Chinese medicine will neither be knocked down nor become orthodox. Mr. Liang’s words are clear and penetrating. How to evaluate the past integration of Chinese medicine and biomedicine? The criticism for the most part concerns using biomedical methods to research Chinese medicine which means that as a result Chinese medicine becomes dismembered. The crucial reason is that the methods of biomedicine haven’t changed. To apply biomedical methods to Chinese medical research is correct, but if “its fundamental method hasn’t been transformed”, it is impossible to truly touch the core of the Chinese approach. Concerning this, Mr. Liang once made a pointed remark: It can’t be regarded as integration when we find some sentences from Chinese medicine compliant with the science, or some herbs are found to be useful after having laboratory tests, or some Chinese medical formulae are recognized as effective. This is because they employ two totally different sets of research methods. If we solely take the stand of biomedicine, to acknowledge one article of Chinese medicine as being right this can be deemed as being to the advantage of Chinese medicine. If we only use present attitudes and methods to research odds and ends within Chinese medicine, it becomes just a way of sorting it through to provide some credible evidence — but this is not to include Chinese medicine in its totality. However, it is just not workable to contain Chinese medicine totally within biomedicine, because biomedicine must then discard its fundamental methods and not be biomedicine anymore.

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Mr. Liang’s opinions are especially profound and to the point. It is a pity that his books have only been republished recently and we can only now have a chance to read them. His viewpoints are basically unanimous with mine.20 Chinese medicine and biomedicine enjoy two totally different systems. The fundamental difference lies in their methodology and epistemology, and Chinese medicine will only prosper when revolutionary changes in methodology have occurred. However, these revolutionary changes in methodology have to occur initially in modern science and biomedicine. At that time, biomedicine would contain the medicine and, essentially, the ecological theory of Chinese medicine would gain modern support and transformation, encompassing the whole system of biomedicine. This would usher in a fresh new era in human medicine. Considering the above views, I find that my difference with Mr. Liang is that I propose a theory of ecology, an adaptive medical theory of naturesociety-psychology, and ecological medicine, which contains modern biomedicine — mainly as it lies within the scope of natural ecology. When Mr. Liang was writing, ecological medicine hadn’t emerged but if it had, he would also have put this view forward. The methodology of biomedicine would be totally new and different from the pure research methodology of biology, and would include the present research methods of biomedicine. I also am not totally in agreement with Mr. Liang when he calls the methodology of Chinese medicine “metaphysical”, for I hold that the Chinese classical medical methodology and epistemology are more a “simple system theory”. We can say a lot on this issue. During the formation of Chinese medicine, the Taoist’s “return and view the inner view” indeed played an important role. Mr. Liang’s opinion is a little excessive, but still worth noting. For example, he said: Generally, all Chinese academies, especially those medical and to do with Kongfu, ultimately are rooted in Taoism with regard to their fundamental methodology. All the famous ancient medical practitioners were Taoists, such as Ge Hong, Tao Hongjing and Hua Tao. They didn’t just apply some fragmentary skill, but had a certain way with things, just as Zhuangzi’s says: ‘techniques approach to the Way’. The root of their skills lay in their communication with the Way. What is the Way? The 20

 Ma Boying. A discussion on the features of epistemologies and methodologies of Chinese medicine at its formation period. Chinese Journal of Medical History. 1982,12(4): 196–199.

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Way is the macro life of the universe. To communicate with the Way indicates communication with the macro life of the universe. The difference between Chinese medicine and biomedicine is actually representative of the difference between all academies in China and the West: biomedicine follows the way of science and Chinese medicine the way of metaphysics. Science stands at a static point to observe things objectively. It doesn’t have the universe in its entirety and can only observe phenomena from the outside and transform everything into a something static and frozen. All phenomena are ultimately transformed into mathematics. Science is “mathematization”. When all things can be expressed by mathematics, they are then included in science. This is a way to make static and digitalize, a way human beings must grasp in order to control nature. However, this is only one way of doing things, and not real to life. Reality is dynamic and indivisible. In science, however, there are no such things as “dynamic” and “inseparable”. These so-called “dynamic”, “inseparable whole” and “all lives being in one” suggest all that beyond mere looking, touching, listening and even thinking without. Instead, it means one must look inside and listen within, and make efforts to learn about life “on the inside”. Life is basically blind and the wisdom of common people always consumed by the blindness of life, so their wisdom becomes blind as well — which is revealed in a “great mechanicalness”. In China and India, wisdom is not used outside, but serves life and turns life into wisdom — rather than wisdom being enslaved by life. And indeed, Chinese Confucianism and Taoism are the same. The sages of Confucianism are those who can best know themselves and turn life into wisdom. The difference between the common people and the sage lies in that they don’t understand themselves and have nothing to do with themselves; they live blindly and move mechanically on the road of life. So then to “do what you wish without breaking the rules and rites” in Confucianism indicates that life has successfully become wisdom, and it is as if the whole body were to become transparent. Confucianism and Taoism both require one to know oneself, but the difference is in that the former tries its best to learn about one’s own mind, using methods such as “reflecting on oneself”,21 while 21

 I will not go into this in detail. But to illustrate it further, we must compare it to modern psychology, which mostly opposes introspection. But then reflection on oneself is different from introspection.

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the latter requires understanding one’s physiology, and one major technique is to sit silently looking inside and listening instead of outside. “Looking inside and listening” is a metaphor; it actually refers to knowing and recognition. The beginning of recognition concerns aspects of respiration, blood circulation and digestion. To pay attention to the respiration is to discern every part of it within the body. The respiration, blood circulation and digestion are not activities of the voluntary muscles. People usually pay no attention to them, but the Taoist follows them by heart. For example, the whole body (skin) has a respiration and the Taoist is required to know and recognize it, and then gradually control it. It is the same with the blood circulation and digestion. There is a subtle and clear discernment concerning things and places that common people take for granted. This is also “to return wisdom to the body”, and a marvelous medicine it is when present. Chinese medicine has its roots in just this. Guo Moruo once said, “Science needs imagination”, and Mr. Liang emphasizes “introspection” and “looking inside and listening”. They have many points in common. It is not irrational to regard this as a “metaphysical” method. However, though “metaphysical” thinking can generate creative thinking and form theoretical hypotheses, this is not the positive method of the natural sciences. Medicine belongs to natural science, so it requires evidence. The theories of Chinese medicine to a great extent have attributes of science about them — and our task is to prove the rational and disprove the irrational. The formation of Chinese medical theories came about as a result of the macro observation of natural phenomena, the phenomena of life and illness. “Introspection” and “looking inside and listening” play a very small part in Chinese medical practice, and are not the focus of research nowadays. They may play a greater part in Kongfu and qigong, but we don’t need to mix them up with Chinese medical research at the moment. For research into living things, it is not that we are unable to use advanced instruments and special technologies, but the point is we are still lacking such instruments and methods. We cannot really be confident about the evidence for metaphysics. But I am confident in the research performed in the study of living life and in the ecological medical theory of traditional Chinese medicine. Laozi once said, “The Way that can be trodden is not the common Way. The name that can be named is not the usual name.” One view of this sentence is that in the eyes of Laozi, the Way is unable to be clarified — otherwise, it

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would not be the Way; the name is unable to be named accurately — otherwise, there would be a gap between it and the actual subject. To a large degree, the great Ways in the world are hard to clarify and those that can be clarified are the “common Ways”. “Name” means concept or definition, and it is very hard to define accurately and exactly. This seems a little difficult to understand, but in turn, it is common for “common Ways” and “common names” to be clarified and named. Medicine serves as subordinate to the great Way of the world, but lies within the scope of the “common Ways” and “common names” — and these can be illustrated and named. Then we do not need any more “metaphysical” Ways. In fact, it obviously still needs a considerably long time for the establishment and practical application of a new system and methodology. We need time, accumulation and patience — in order to reach a new phase of scientific Chinese medicine. In the process of medical research, we should allow and encourage the coexistence of differing opinions and research methods. We must focus on the methodology of research and it is highly urgent that we conduct research into different methodologies. Only in such a way will we find the right direction and method. Together with our everyday, downto-earth activity, the anticipated scientific results of Chinese medical research will then be founded upon a firm footing.

183.  An Evergreen Life Although there are numerous problems in Chinese medicine, the river still pushes forward with great strength and vigour, and the great tree becomes even more flourishing. Don’t you see? “The eastward-flowing rivers wash away everything, leaving only the famous and popular”. “Thousands of ships go by a sunken one, and millions of trees turn green in front of the one that is decrepit.” The theory may be grey, but life is evergreen. Yet again, the primary task is to secure and promote the clinical practice of Chinese medicine: this is the source of its preservation, its nourishment and development. In particular, die-hard Chinese practitioners, pure in practice, are sorely needed. Their clinical accumulation of experience and data is a most precious fortune, a potential for innovation and support for the scientific community. They should be more proficient in the history of Chinese medicine and its ancient literature, and draw nourishment from them. Don’t use the present incomplete statistics to oppress the clinical practice of Chinese medical practitioners. There is no significance in the statistical percent of the “total curative efficacy” of cancer treated by Chinese medicine,

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but for the saved patients and their family, there is one hundred percent happiness. This is a noteworthy sign for researchers. To integrate Chinese medicine and biomedicine should be the way forward. Just as I have stated earlier, at present only the methods of biomedicine can be applied when researching Chinese medicine, but such research must respect its integrity and never use one regional negative result to deny the whole system. Negative results cannot prove the inaccuracy of Chinese medical theory, when the problem is that probably the research methods and devices used are not fit for the purpose. When people had only the ruler, we were unable to measure the height of the sky and the thickness of the earth, but we could do so when we had the telescope. With the microscope, we can see bacteria, and with an electron microscope, we can see viruses. Newton’s law solved the classical problems of physics, and Einstein’s relativity solved the laws of the universe. If research methods, technologies and devices can’t reach a new level, we are unable to see the hidden world and its laws, but that doesn’t mean that world and its laws don’t exist. In all cases, at the contemporary level of biomedical research, we welcome positive outcomes, but as for negative results, we cannot use them to deny the legitimacy of Chinese medicine. Applying modern scientific methods to research Chinese medicine is essentially akin to using biomedical means to research Chinese medicine, though the former possibly operates at a higher level and has a wider scope. We welcome the involvement of modern scientific methods — the salient points to note are the same as those when using biomedical models to research Chinese medicine. In countries outside China, since practitioners of Chinese medicine are not allowed to apply biomedicine, it is relatively better to conserve the features of a purely Chinese medicine. When Chinese medical practitioners are in a foreign culture, it is more common and much easier to change or inspire thinking. As they cure diseases that have never been encountered in China, the unique features of Chinese medicine will be revealed — which will not only enhance confidence in Chinese medicine but also provide great benefits for new thinking and innovative methodology. The effectiveness of Chinese medicine will attract scholars in the West and have them involved in research in Chinese medicine, the benefits of which surely outweigh any shortcomings. By means of conflict and communication with a foreign culture, the Chinese medical culture itself will be promoted. To remedy one’s own problems by using another’s good suggestion may after all create a shortcut — a shortcut to a new force to be reckoned with.

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To summarize, with a developmental phase lasting some thousands of years, Chinese medicine has reached a new era and a new time, enjoying both challenges and opportunities. It will surely find its own way forward. Only as long as we adhere to and maintain the advantages of clinical practice, and as well find the key which can open up scientific research into its unique approach, will the development of Chinese medicine be quickened enormously. Some people said the 21st century of “global medicine” is the era of Chinese medicine. We hope so. But whether this happens or not, a new generation of Chinese medical practitioners have stood up on the stage and are ready to perform. Archimedes said, “Give me a lever long enough and a fulcrum on which to place it, and I shall move the world!” Let us hope the younger generation can find such a fulcrum!

Conclusion of Part Four The cultural background of traditional Chinese medicine is multilayered and complicated, but Chinese medicine, as it grows up from the earth, is for the most part beneficial. There are some ups and downs, but nothing drastic and the tendency is positive. There are some redundant and harmful branches, but minor flaws cannot obscure a jade’s essential beauty. It has encountered drastic opposition, but its roots remain firm and steady. A vast number of famous Chinese medical practitioners have left deep footprints over the course of Chinese history. These are those that are seen as models and a source of wisdom for their successors. The essence of Chinese medical theory is a high-quality ecological medicine (nature, society and psychology) — and no other theoretical ecological model is able to surpass this. Chinese medicine historically has achieved great results, while also leaving for the modern world many unsolved enigmas — which await a new generation of die-hard Chinese medical practitioners. These are the ones who can make innovations and breakthroughs in clinical practice, enhance the methodologies of scientific research and develop new technologies. Whatever happens concerning Chinese medicine, the pace of its development will continue as it persistently follows its own way forward.

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General Conclusions I studied the whole developmental process of Chinese medical and cultural history, and compared it to Western medicine. First of all, the most important conclusion I have drawn from this is that the essence of Chinese medical theory and its clinical application lies in the adaptability principle and the law of ecological medicine as well as their applicability in the clinic. This kind of ecology includes natural ecology, social ecology and the psychological environment; it is not confined just to the world around us and the biomedical realm, but also the correspondence between heaven, earth and the human, essence, qi and spirit; its operating laws are the classical philosophical terms of Yin and Yang, the five elements and qi. The theory of Traditional Chinese Medicine was created by the Chinese people — and formed by combining the natural view theory of Chinese classical philosophy and clinical medicine. The significance of this firstly lies in the fact that this special combination broke through and developed into a classical philosophy in ancient China and contributed to its development; and secondly, that this transformation which took place in the philosophy of medicine could be directly applied to clinical practice, and verified by clinical efficacy. This made it assume a hugely different form from that which it had in popular philosophical circles. This theory of ecological medical laws is, of course, not expressed in modern language, but in Chinese terms — and at present there is no appropriate form of modern medical language to replace it. But furthermore, the core of this ecological theory is also obviously scientific. It began more than two thousand years ago, and yet is in line with modern thinking in medicine, and clearly ahead of its time. However, due to its lack of strict expression and demonstration in terms of modern science, it looks simple and prescientific. Therefore the classical theory of ecological medicine which lies

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behind TCM is still difficult for most modern people to understand — it presents huge opportunities for the development of expression. Secondly, the main methodological characteristics behind the historical development of TCM have been to use the method of hermeneutics to create new theories — that is, based upon their clinical efficacy. This is the principle of “advocating a reason and proposing a theory” pursued in Chinese culture. The “reason” refers to the curative effect in the clinic; while the “theory” implies finding a basis within the TCM text to explain it (hermeneutically). The advantage of this is that it keeps the TCM “tree of life” evergreen and maintains creativity in practice, thus forming a survival system within the unchanged theoretical TCM framework — along with its more variable forms of practice. This hermeneutic method is incompatible with an experimental methodology, and its conclusions may not be as rigorously drawn as those discovered by experiment. For any experimental methodology may be too dogmatic, as it cannot be perfected in isolation. It is too easy to “throw out the baby with the bath-water” (that is, to discard the useful with the useless). Experimental methods and instruments need always to be further improved, and statistics perpetually need revising. The current reality is that there is little time or space for the development of experimental medicine in TCM, and TCM is permanently criticized by modern medicine on this basis. In the long run, a combination of explanatory (hermeneutic) and experimental methodology acting together, will define the future direction of medical development. Thirdly, like other medical systems in the world, TCM has gone through an initial state and a time of superstition and witchcraft. It was the naturalism of ancient Chinese philosophy that ended the witchcraft, and also brought about a medical phase by following natural philosophy. Since then, TCM has embarked upon a grand path of healthy development. This embodies the mainstream of TCM. However, witchcraft and superstition still infect and erode it and, especially in folk medicine, witchcraft and superstition are common. In this regard, modern researchers should not be diverted from their task. It can be said that TCM is a unique product of the long process of Chinese cultural history. It may be seen to be a large tree growing in the soil of Chinese culture, just as crystalline structures are found in a pile of sand. But as a whole it has to be differentiated from the cultural soil that surrounds the core of TCM within the whole historical process. All these cultural factors related to the development of TCM, scientific or unscientific,

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positive or negative, either welcomed or declined today, including the theory and practice of TCM and even the superstitions themselves, they all can and should be grouped within the category of “TCM culture”. But these cultural factors should not be confused with or made equal to TCM itself. TCM culture is a very broad term, but TCM is limited to theory, method, and practice, and just the part that is truly able to solve the problems of medical treatment, illness prevention, healthcare, and the promotion of longevity. “Practice is the criterion for testing truth.” TCM is the part that is tested by clinical practice and its approach towards the truth. TCM culture, however, is not, as it includes contents weeded out throughout history — these being the rough and anti-scientific. A distinction must be clearly made between TCM culture and TCM. Fourthly, the contributions made to world medicine by TCM are enormous. For one thing, historically speaking TCM has made outstanding contributions to the health, prevention of disease and medical treatment of the Chinese themselves — and achieved many good results, such as human variolation against smallpox, preceded by cow-pox vaccination, which made a start on defeating smallpox in the world. For another thing, TCM nowadays provides both a macroscopic theory and a methodological system of ecological medicine that is totally different to that of modern medicine. This can now bring new hope for future medicine. In addition, TCM has accumulated a great deal of clinical experience, being effective in both treatment and prevention, and become a source of empirical knowledge that can inspire modern physicians both within research and clinical practice. For problems and diseases as yet unsolved by Western medicine, it is meaningful to try TCM. Curing a medical case is something like bringing the gospel to a patient. TCM is a medical system that can bring about real benefits to the health of mankind. Fifthly, TCM is an open system, not conservative and closed as some have thought in the past. It possesses a theoretical system of eco-medicine which has its own connotations — and they are enormous. The world, nature, social ecology and the psychological environment relating to human life, health and disease can all be accommodated into this theoretical system. Historically, TCM did not reject foreign medicines, but tried its best to absorb and transform it into an integrated system. TCM never rejects other medicines but lets them alone — even if they cannot be integrated. A good case in point is the way modern Western medicine entered into China and developed within this huge system. In contrast, the Western medical approach is less tolerant and willing to accept Chinese medicine. This is

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especially true when it develops in a flourishing and powerful manner. Of course, any type of medical cross-cultural transmission will go through a process of rejection and controversy, transformation and variation, acceptance and integration, to a varying degree. The influence of some social factors on this process is important, both positive and negative, e.g., the emperor’s personal hobbies or experiences, the special appeal of political innovators, the antagonistic attitude of the common people and the mainstream medical profession, and so on and so forth. The process and result of intercultural communication is complex and cannot be generalized. It is also interesting to note that variations in transmission are not determined by the amount of information or attitude of the recipient — but by unexpected events, such as “key activations” and “amplification effects”. After the introduction of human variolation to the West, variations in vaccination methods, sources and so on were derived from bovine vaccination. This is the best example. And the Four Great Inventions which came from China (the compass, gunpowder, paper-making, and block printing), were actually only “four small inventions”, but later were amplified as they became introduced to the West. The stirrup was a trivial invention in China, but after it spread to Europe, the era of the Knight began. Simply due to unexpected effects and outcomes, great and significant changes occurred in the development of science, medicine and society. Therefore, cross-cultural communication is worth encouraging, and the coexistence of multiculturalism is certainly worth promoting. Sixthly, the study of history, especially the study of cultural history, should and must use the research methods and achievements of anthropology. Initially, I put this view forward in a paper at the International Symposium on the History of Chinese Science, Technology and Medicine held in San Diego, USA in 1988. Later, it was fully implemented when I studied and wrote the History of Medicine in Chinese Culture. Working in the UK and treating patients became my “field work” (the basic method of anthropological research), and I wanted to understand how TCM was transmitted across cultures to the West — how Westerners knew and accepted it. However, in the study of medical cultural history, I used more the achievements of anthropology and applied them to the study of medical history. Archaeology, physical anthropology and other materials of anthropology are easy utilized, but I paid more attention to the achievements of primitive thinking, ethnography and linguistic research. This is because the results from research such as this can lead us to return to the original scene of historical events, not merely watch from the perspective of modern times. We

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may then watch, taking the perspective of the ancients, getting involved in understanding the event itself, in an analysis of “collective image” and “original logical thinking”, thus working towards excavating the hidden truth behind the event. By using this approach, we can re-examine the events, myths and legends which have been recorded in ancient documents, and find out what actually happened, in which era and which setting, what the facts behind these events were, and the causes of their development and transformation. So, I propose there are really only three divisions to historical research: What is it that is there? What are its characteristics? and Why is it there? I sincerely hope that bearing these three questions in mind will deepen and promote what we know and understand about this history, its historical facts and historical truths.

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About the Author Boying Ma is an internationally celebrated medical historian with expertise in medical cultural anthropology. He has published 10 books and more than 300 articles in Chinese and English. In particular he was a co-worker with Dr. Joseph Needham and Dr. Gwei-djen Lu in Cambridge, UK, during 1985–88 and 1993, contributing to Volume VI of Science and Civilisation in China. Dr. Ma graduated from Shanghai Medical University in 1967 and received a master’s degree from the China Academy of Traditional Chinese Medicine (Beijing) in 1981. He was a full Professor of Shanghai Medical University and a Committee Member of the Academic Experts Board of the Shanghai University of Traditional Chinese Medicine. Since 1995, he has practised medicine and trained Chinese medicine doctors in the UK. He was elected Life Fellow of Royal Society of Medicine in 2005. He was appointed Honorary Professor at the University of Paris Bobigny Medical School and received an honorary doctorate from The University of Cape Town, South Africa. He has founded the Xinglin Graduate School of Traditional Chinese Medicine in the UK. Dr. Ma was a visiting professor at the University of Kingston, UK, a consultant to the Confucius Institute of Chinese Medicine at London South Bank University and a visiting professor at the following Chinese universities: Heilongjiang University of Chinese Medicine, Yunnan University of Traditional Chinese Medicine, Hunan University of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine. He was also an honorary visiting professor at the Chinese University of Hong Kong. Prof. Ma is the chairman of the Federation of Traditional Chinese Medicine Practitioners, UK, and is currently the executive chairman of the Pan-European Federation of Consultants in Traditional Chinese Medicine and executive director of the World Federation of Chinese Medicine Societies. 1285

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