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

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СКАЧАТЬ xing (Five Phases) has often been translated as ‘five elements’, but that is misleading as there is no true parallel to the Greek notion of elements; the term ‘phases’ better suggests the dynamic quality involved. The Five Phases are wood, fire, earth, metal and water, paralleling the five viscera (heart, liver, spleen, lungs and kidneys), and all the other corresponding ‘fives’ (tastes, climates, odours, emotions, sounds, etc.). Each phase represents a class of action or interaction. Physiologically speaking, wood denotes a growth phase and a branching development; fire a phase of rapid upward dispersal, and so forth. Each phase is characterized by a distinctive colour, odour, sensation, bodily secretion, etc. and definite chains of relations result. The liver, for instance, is identified with the phase of wood, and the spleen with the phase of soil. Wood, perhaps in the form of a wooden spade, could move soil; hence, a relationship between liver and spleen could be explained as resulting from the tendency of the liver to govern the functions of the spleen.

      The theory covering the patterning of these phases is known as ‘systematic correspondence’, embracing a vision of health as natural harmony within a holistic system. The Five Phases spontaneously beget each other in this sequence (the order of ‘mutual production’), while a sequence of ‘mutual restraint’ also applies – wood, earth, water, fire, metal. The body thus comprises a microcosm whose processes, healthy and pathological alike, are regarded as governed by the universal characteristics of qi, yin yang and the Five Phases.

      Within the body, qi has two aspects – these are not material but processual. The yang element, likewise called qi, represents the capacity for action and transformation; the yin component, called xue (literally ‘blood’), represents the capacity for circulation, nourishment and development. Another vital substance (jing), translated as ‘essence’, includes both the nourishment gained from food and also (via the Taoist tradition) the reproductive substances like semen necessary for procreation. The vital forces circulate through the body in regular cycles through the circulation passages. These circulation tracts linking the visceral systems include the anatomically identifiable blood vessels but also involve invisible pathways along which qi travels in its various incarnations.

      Before the systematic correspondence theory was elaborated, Chinese thinking about tracts and viscera seems to have conformed fairly closely with western anatomy. Early texts associate certain tracts with blood vessels, while others sketch in the location of the viscera. Chinese physicians were never interested in the mechanical models of the body promoted in the West after Descartes; nor, as medical theory became oriented from matter to processes, was close anatomical knowledge of the organs themselves expected.

      Classical medical theory teaches there are five yin visceral systems: the cardiac, hepatic, splenetic, pulmonary and renal. These create, transform, govern, and accumulate qi, xue and jing. There are also six yang systems: gall-bladder, stomach, large intestine, small intestine, urinary bladder and the san jiao (‘triple burner’). These process food to generate qi, xue and jing, and discharge waste. Despite apparent analogues with Western anatomical thinking about organs like the heart, lungs and liver, the emphasis is always upon functions – the Chinese body is above all a functional organism. The ‘triple burner’, which arose late in Chinese medicine, does not map onto any anatomical part of all, yet possesses a well-defined complement of functions. The connections between the visceral systems, and the sequences in which malfunctioning in one affects the others, are to be grasped in terms of the theory of systematic correspondence. Because the relationships between the viscera and the associated organs, senses, emotions and secretions are seen holistically, there can be no such thing in Chinese medical thinking as ‘Cartesian’ mind/body dualism, strict ‘localism’, or the aetiological specificity of ‘one cause, one symptom’ pathology.

      When qi is circulating in the proper manner through the body, external threats are held at bay, harmony prevails, and good health is enjoyed and maintained through temperate behaviour. There are many ways to produce healthy qi: through diet, exercise, preventative acupuncture, moxa cauterization, meditation or sexual self-control. Such methods not only reinforce health but aid longevity: some texts envisage a lifespan of over a hundred years, while others aspire, in the Taoist manner, to immortality.

      Illness (bing) by contrast results from imbalances of yin and yang, causing disturbance of qi circulation, which then impairs the normal operation of the visceral systems and the vital fluids. Obstruction, surplus or depletion of qi or xue in one of the visceral systems upset its functioning and distribution through the organism in ways determined by phase dynamics and modified in the individual case by the sufferer’s own constitution. If caught early in its yang (external) phase, the imbalance can be treated and health restored, but once the life-threatening yin phases are reached, the harm may be irreversible.

      In these theories, a disorder can be produced either by the invasion of an external threat (noxious qi) or by internally generated imbalance. ‘Excesses’ are the main danger, but deficiencies can also do harm – gynaecological disorders, for instance, are supposed common among widows deprived of sex. External pathogens include heat and cold, damp, poisons, fright (especially in the case of children), or sexual intercourse with ghosts.

      The presentation of a disorder in the particular case is shaped not only by the pathogen, but also by the sufferer’s constitution, which influences its phase dynamics. The state of disorders caused by any specific type of pathogen (cold damage disorders, for example) thus conforms to a general pattern but allows infinite variations. Though diagnostic handbooks tended to classify disorders for convenience’s sake by symptoms rather than causes, maladies could not truly be cured until their fundamental causes were fathomed.

      Classical Chinese medicine thus embraced a humoral and constitutional approach to illness – ‘biomedical’ concepts of disease are foreign to its basic thinking. In the seventeenth century, however, a wave of epidemics led physicians to propose the existence of certain types of pathogenic qi, which entered the body through the nose and mouth, and which, as in the case of tuberculosis or smallpox, could be communicated by contact. This was a new concept closer to the western one of infectious diseases, but one employed for a limited category of disorders only.

      PRACTICE

      On being called in, a physician was expected to identify the patient’s ailment and its progress before assessing treatments. On the assumption that its primary cause would be veiled by all manner of complicating symptoms, it was crucial to know the constitution and medical history of the patient, which would shape the course of the disorder and indicate likely responses to treatment. The practitioner’s task would be to break the symptoms down into a manageable set of dynamic characteristics: the fundamental cause, how the qi was affected, which visceral systems were impaired. He might relate symptoms to the Five Phases. Examining a patient with cold feet, he would attempt to determine which of the Five Phases that particular sufferer had greatest affinity for. Cold limbs would suggest Water, which might be confirmed by the presence of a foul odour, whereas a fragrant smell would point to Earth.

      Another such diagnostic system was the ‘Six Warps’, first spelt out in the Treatise on Cold Damage. This sorted out manifestations according to the degree of permeation of pathogenic qi. From the seventeenth century, this procedure was elaborated by heat-factor disorder theorists into a four-level classification based on the position of symptoms among the ‘triple burners’ (san jiao). The most popular diagnostic grid, however, was the ‘Eight Rubrics’, first outlined in the Inner Canon, which involved four sets of polar opposites of diagnostic relevance: inner-outer, cold-hot, depletion-repletion, and yin-yang.

      From the earliest medical texts, pulse-taking is commended alongside the observation of other physical and emotional evidence. The pulse was believed СКАЧАТЬ