The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

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СКАЧАТЬ hardened. When medical colleges had been founded in Bengal and elsewhere under the British Raj, the study of Ayurveda was given a semblance of support alongside British medicine; but with changes in educational policy after 1835 and the suppression of Ayurvedic teaching in state-funded medical colleges, British support for Ayurvedic training ceased. Ayurvedic physicians continued to practise, although their training was reduced to the traditional family apprenticeship system.

      In the twentieth century, with the rise of the Indian independence movement, indigenous traditions received active encouragement from nationalists. In recent decades there have been divided loyalties: since independence in 1947, the Indian government has oscillated between commitment to western medicine in the name of progress, and acceptance of the fact that Ayurvedic medicine is widely practised, especially in the countryside, and commands sturdy loyalties. Many Indian physicians have a strong incentive to devote themselves to western medicine – it is a passport to practise throughout the world.

      In 1970, the Indian Parliament passed the Indian Medicine Central Council Act, setting up a central council for Ayurveda. Since then government-accredited colleges and universities have provided professional training and qualifications. This training, however, includes some basic education in western methods, family planning and public health. In 1983, there were approximately one hundred officially approved Ayurvedic training colleges, many attached to universities. But although the number of Ayurvedic and Yunani colleges and dispensaries has multiplied since independence, government funding has been minimal. Popular perception is said to be that the students in the indigenous medical schools failed to gain admission to modern western medical or professional universities.

      The traditions combine and are rarely exclusive. Private Ayurvedic practitioners make use of modern western treatments, often on the wishes of their patients: western-style injections are widely regarded as a powerful, almost magical cure. In a small 1970s study of fifty-nine indigenous practitioners in Punjab and Mysore, researchers found that the vast majority of drugs being used were antibiotics and similar western medicines. The idea that Ayurvedic physicians deal purely in herbs, roots, and therapeutic massage is a nostalgic myth. Today in India, the patient may take any of many available paths towards greater health. There exist side by side physicians of cosmopolitan medicine, Ayurveda, and Yunani, as well as others such as homoeopaths, naturopaths, traditional bone-setters, yoga teachers and faith-healers.

      The trend, however, is towards the greater assimilation of western medicine, especially among the wealthy and cosmopolitan. It is noteworthy that Ayurvedic medicine has not yet achieved the vogue in the West acquired by Indian philosophy and (thanks to fascination with acupuncture and the yin-yang system) by Chinese medicine.

       CHAPTER VII TRADITIONAL CHINESE MEDICINE

      Rather like the Ayurvedic medicine just discussed, traditional Chinese medicine has often been presented as an authentic incarnation of timeless wisdom. Chinese medicine, assert its champions (and occasionally its detractors) has been passed down essentially unchanged since the dawn of civilization. This characterization, along with claims that, unlike western biomedicine, it is holistic and draws only upon mild ‘natural’ substances, is to some extent a propaganda exercise. Even so, the impressive antiquity of Chinese medicine, and its distinctive attitudes towards knowledge of the human body, provide some justification for the contrast. Traditional values and canonical texts were, indeed, highly valued and, unlike the West, novelity has never been prized in the Chinese medical tradition, or for that matter in Chinese thought and culture at large.

      While distinctive, Chinese medicine is not totally unlike other medical traditions, and that is partly because it is not wholly indigenous. Over the centuries it has absorbed many outside influences, from India, Tibet, central and south-east Asia, while for the last hundred and fifty years it has been forced to adjust to western medicine. Certain of the key drugs in the Chinese pharmacopoeia were introduced from abroad – ginseng from Korea, musk from Tibet, camphor, cardamom and cloves from south-east Asia, frankincense and myrrh from the Middle East. The needling techniques behind acupuncture may have originated in central Asian shamanic healing. Indian Buddhism brought teachings concerning the soul and salvation which prescribed care for the ill and infirm. Buddhist charms were incorporated into classical Chinese therapy, while, in medieval times at least, cataract surgery was performed which probably derived from India (such operations later lapsed). Indian medical theories are not wholly compatible with Chinese models, however; and though some have held that Ayurvedic or even Greek influences are present in the use of such categories as ‘hot’ and ‘cold’ in Chinese medicine, these are better seen not as borrowings but as transcultural.

      While Chinese medicine thus assimilated beliefs and practices from elsewhere, the reverse was happening as well. As the Chinese tongue, Confucianism and Chinese Buddhism were embraced by elites through south east Asia, so too was Chinese medicine. Along with Buddhism, it had been introduced to Korea by the sixth century AD, and Buddhist priests relayed it from there to Japan. (In modern Korea, Chinese medicine is known as hanui: and in Japan as kanpo.) From the sixteenth century, Chinese medicine arrived with migrants to Taiwan, the Philippines and elsewhere – all regions where Chinese medicine flourishes today alongside the western variety.

      Alongside herbs such as ginseng and Chinese rhubarb, distinctive features of Chinese medicine, notably moxibustion and acupuncture, became reasonably familiar to Westerners from the seventeenth century onwards: from Japan, the Dutchmen Wilhem Ten Rhyne (1647–1700) and Engelbert Kaempfer (1651–1716) sent home accounts of acupuncture, including maps of the acupuncture channels. Yet this had no noticeable impact upon European medicine, even though after 1800 acupuncture enjoyed a certain vogue, especially in France.

      CHINESE HEALING

      Peasants traditionally went to folk or religious healers, for in popular thinking the supernatural was seen as a major cause of illness – sickness was believed to be created by demons or to be punishment for violating or neglecting one’s ancestors, who might then need to be propitiated with sacrifices. Learned medicine, by contrast, was wholly an elite matter, taught and practised by educated men, who treated clients from the middle and higher strata of society and from the state bureaucracy. This learned medicine was grounded on a corpus of texts: works on medical theory; on the classification, diagnosis and treatment of diseases (including collections of case histories); and on drugs and prescriptions.

      The earliest surviving texts (over ten thousand specialized medical writings have come down) date back about twenty-two centuries, and incorporate even earlier materials. Dynastic circumstances account for this timing. The Chinese Empire became politically unified in 221 BC, and the emperors of the Han dynasty (206 BC – AD 220) established a body of political, philosophical and religious teachings. This period brought about the formation of the medical canon which constitutes the theoretical basis for the ‘high classical’ medical tradition and which was to set the mould for subsequent medical doctrines and developments. An integrated empire promoted the idea of a unified body, while policy-making for a flourishing state encouraged thinking about health. Thereafter the human body was envisaged, by analogy, to the state, as a series of operations which built up, allocated and processed precious and scarce resources, through communications networks. Good medicine was like good government.

      Four core works make up the ‘high classical’ tradition, all of unknown authorship. They are the Yellow Emperor’s Inner Canon of Medicine (Huangdi Neijing), so called because it includes a dialogue between the ‘yellow emperor’ Huang-ti and his chief minister, Ch’i Po; the Divine Husbandman’s Materia Medica; the Canon of Problems; and the Treatise on Cold-Damage Disorders. The former two enjoy scriptural status, being considered as preserving the wisdom of legendary sages; every learned physician would be expected to be word-perfect with those. The latter two, for their part, were also classics which physicians would СКАЧАТЬ