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

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      The Inner Canon contains teachings on core subjects: the physiological make-up of the body, including the circulation of qi (roughly: energy); health and the onset and prognosis of diseases; and therapy through needling (bloodletting or acupuncture). It depicts the human body like a kingdom, with organs like the heart and liver regarded as functions, or functionaries, working in harmony through communications and transport systems – the vessels and channels of the body (analogous to China’s great rivers), through which qi would flow.

      The Canon of Problems addresses eighty-one ‘difficult issues’ which arise from the Inner Canon, relating mostly to diagnosis and needling treatment. Its significance alongside the Inner Canon was unquestioned until the Song dynasty (960–1279), but thereafter, where discrepancies were noted between the two works, it was assumed that the writer of the Canon of Problems had failed to grasp the authoritative teachings of the Inner Canon.

      The Treatise on Cold Damage Disorders, for its part, deals with the identification and treatment of diseases caused by external cold factors (shanghan bing): approximately what western medicine would designate acute infectious fevers. Diagnosis follows what is known as the Six Warps theory, and therapy is not by needling but by drugs. Formulae are given for more than a hundred prescriptions – for countering fever, diarrhoea, and so forth – and many such items from the pharmacopoeia are still in use.

      In the twelfth century Chinese physicians began to refine shanghan (cold factor) theory, developing the notion of heat-factor disorders (wenre bing), and thereby distinguishing between disorders in terms of their separate aetiologies. This tendency became more pronounced during the seventeenth century, when China was buffeted by waves of serious epidemics. Criticism of cold-damage theory then led to a succession of works on heat-factor disorders, especially the Wenre lun of Ye Tianshi (c. 1740), which elaborated the ‘triple burners’ (san jiao) system of disease classification.

      Lastly, the Divine Husbandman’s Materia Medica includes descriptions of the properties and uses of over three hundred vegetable, animal and mineral drugs, arranged into three classes: upper, middle and lower. Viewed as gentle and cumulative in action, drugs of the upper class were meant to promote health and longevity; the more potent lower class of drugs was to be employed once the patient had actually fallen sick. This longevity-oriented pharmacy was abandoned in later materia medica, giving way to systems based on curative qualities, with items being categorized according to a scheme of correspondences between yin yang and wu xing (the ‘five phases’ or ‘five processes’). Thousands of materia medica listings were written down over the centuries, the principal one being the late sixteenth-century Bencao gangmu.

      THE TRADITION

      How have these ancient texts have been able to retain such uninterrupted authority? Was it because Chinese medicine was, at bottom, hidebound or metaphysically oriented, its physicians being concerned first and foremost with dogma and only secondarily with hard evidence and the cutting-edge of experience? Some have seen it that way, and there have been critics who have dismissed Chinese medicine as nothing more than an elaborate verbal tapestry. Sinophiles, by contrast, argue that the story of Chinese medicine is one of the progressive winnowing of the grains of science from the chaff of ignorance and superstition. Along such (seemingly Whiggish) lines it has been claimed that Chinese physicians evolved theories (such as the model of the heart as a pump) which match or even surpass the evolution of western scientific medicine.

      Facing these problems of interpretation, it is crucial to remember that the Chinese medical tradition presents an example of a classical model of knowledge. The role of basic concepts such as yin yang, for instance, remains definitive, even though their meanings were capable of modification. Canonical works were regarded as the sure guides to understanding the human body (microcosm) and its relations to the macrocosm. As in the other text-based learning, there has been a scholarly predisposition in the Chinese tradition towards ironing out doctrinal conflicts by means of an attempted reconciliation in higher synthesis.

      Like Greek medicine, Chinese teachings were built upon the conviction that the body represents a microcosm of Nature and society. Corporeal processes follow rhythms comparable to those governing the workings of the universe. ‘A human body is the counterpart of a state’, observed in Inner Canon:

      ‘The spirit [the body’s governing vitalities, shen] is like the monarch; the Blood xue is like the ministers; the qi is like the people. Thus we know that one who keeps his own body in order can keep a state in order. Loving care for one’s people is what makes possible for a state to be secure; nurturing one’s qi is what makes it possible to keep the body intact.’

      Health is dependent on the maintenance of internal bodily equilibrium, and also of harmony between the body, the environment, and the larger order of things. Healing is a matter of knowing how this harmony can be restored, for which the physician must be a philosopher as well as a technician.

      Classical Chinese medical theory thus views the body as a physical entity subject to natural processes: sickness can be brought on either by some internal upset or by such external factors as cold, humidity or pestilence. Before the Han Dynasty came to power (c. 600–200 BC), ailments had often been blamed on evil spirits, or ‘wind’, which took possession of the soul: cures might be achieved by exorcism or drugs, and charms and sigils were also used to fend off demonic assaults. Because they were not yet properly anchored to their soul, the young were particularly vulnerable – one class of children’s afflictions is still termed ‘fright’.

      Belief in supernatural disorders was to be eroded, however, and from the earliest systematic formulations of cosmological principles around 200 BC, sicknesses were regarded by physicians as determined by certain natural principles, rather as in the Hippocratic teachings. Chinese natural philosophy deals less in things than in relations, processes and cycles of transformation. The key to the natural world is qi (also rendered ch’i), variously translated as ‘air’ ‘vapours’ or ‘energy’, and somewhat resembling the pneuma or spiritus of Graeco-Roman medicine. In natural philosophy, qi, which permeates the cosmos, is something which stimulates a process of transformation, or is the medium through which such processes take place. In living beings, qi can be designated as ‘vital energies’ whose circulation sustains life itself. Life arises from a build-up of qi; its dissipation is marked by death. To preserve good health, a person must nurture the qi which sustains bodily functions. Qi can also be disruptive, however – ‘pathogenic’ qi brings illness on.

      A concept fundamental for understanding the distribution of qi is the yin yang pairing, crucial from the Yellow Emperor’s Inner Canon of Medicine onwards. Yin possesses the qualities which superficially seem the diametrical opposite of yang – pairings like lower-upper, inner-outer, cold-hot, feminine-masculine, dark-light, wet-dry, etc. But these must not be read as fixed contraries; they are always relational and complementary – in any particular situation, yin and yang are symbiotic and subject to continual cyclical change.

      Yin and yang are functions of space and time. Yang is more exterior, yin more interior. Once pathogenic qi penetrates the outer yang qi, which make up the body’s defences, it reaches the interior regions of yin qi which supply the body with nourishment and growth, and thereby turns more threatening. Like every other natural process, a malady will run through active yang phases and latent yin phases: once yang sickness has reached crisis point, it moves into a yin phase, which requires a distinctive treatment. Yin yang relations, in short, are complex, and must be appreciated from various viewpoints. In health СКАЧАТЬ