The Origins of Traditional Chinese Medicine
Origin of Theory
The origin of TCM theory is lost in prehistory, before writing was invented. Written language started in China during the Shang Dynasty in 1766 BC. The writings on medicine at that time project back in history over two thousand years. Ancient works are alluded to in the prehistoric period, but are now lost as "legendary".
Origin of Channels and Points
One current theory of how acupuncture points were discovered can be traced back to Stone Age. It is thought that stone knives and sharp tools were used to relieve pains and disease. Often these were used just for lancing boils and primitive surgery, however it is thought that patients may have noted sensations or changes on other parts of the body subsequent to treatment with these "needles". Later these needles were replaced by bone or bamboo.
Other interesting theories:
- Warriors in battle were hit by arrows and noticed conduction of pain to other areas of the body and spontaneous remission of pain elsewhere.
- Spots on body became tender/discolored when disease was present.
- Constipation was frequent, owing to primitive Stone Age diet. People found certain points tender when constipated and that manipulating them with pressure or pricking them brought relief.
- Relief of pain was found when heat was applied (after fire was discovered). This treatment became more specific at certain areas as results were noticed.
- Monks would notice energy moving in specific areas when they would perform meditation techniques. Over centuries these energy movements were painstakingly noted, and the channel system was gradually elaborated.
Whatever the exact origin, acupuncture is not exclusive to China. However, only in the East was it so highly developed. This occurred because of observation by ancient Chinese over hundreds and even thousands of years. It was noted that:
- An individual point could affect many different symptoms. Symptoms could be treated that were near to and distal from the actual point itself, including internal organ pathology. It was natural therefore to assume that points with common symptomatology could somehow be related. In other words the therapeutic potential extended over a considerable distance within the body. This was confirmed by the transmission of needle sensation along specific pathways.
- A therapeutic property could be achieved by a number of different points. From this evidence they inferred the existence of channels and the flow of Qi along them. As location and therapeutic characteristics of points was gradually discovered, they were named.
TCM is heavily rooted in traditional Eastern philosophy. The philosophy was not a single one and did not originate in only one era of Chinese history, but was built on, added to, and modified throughout history. This is very typical of the Chinese, who are a very pragmatic people. They have no problem accepting a wide variety of philosophies into their culture and not seeing any conflict between them. An example would be The Three Teachings: Taoism, Confucianism and Buddhism coexisted harmoniously in China: we can see them together in paintings, with Lao Tzu, Confucius and Buddha all depicted together.
Shang Dynasty (1766-1122 BC)
Beginnings of the Bronze Age. First civilization proper. They had developed writing and had religion: their deity was called Shang Ti, who lived in heaven in imperial court populated with dead ancestors.
Ancestor worship was very important (and actually is still) in China. Rituals with ancestral bronzes were performed. Shang already had high-tech bronze casting: bronzes cast with incredible atavistic animal forms. Animals were accorded great respect for their power; this shows in art.
The Shang believed illness resulted from:
- Upsetting an ancestor and being cursed
- Demon "evil" enters body; Curing involved placating ancestors by suitable rituals or asking their help to expel the demon
Shamans were mediators who talked to the ancestors, who in turn talked to Shang Ti. Questions were asked by writing them on "oracle bones", usually scapula bones or tortoise shells, which were then heated and the cracks were "divined", in other words, read by a shaman to find an answer. Questions ranged from "Will it rain?" to "Will the king die?"
One problem with history is that it relies on archeological finds and writings; however, what was written about this era was found on ritual bronzes and shells, the possessions of the rich (bronze was very expensive).
Throughout early history, therefore, we have the problem of not knowing the medicine of the simple folk, since those doing the writing were educated and wealthy.
As late as 6th century BC physicians were still linked with shamanism. Demonology and shamanism persisted through the next Dynasty (Chou: 1122-403).
Even today the "Six Evils" or six kinds of "perverse energy" persists in TCM theory, except now they are environmental energies, i.e., wind, cold, dampness, heat, summer heat and dryness.
In some areas of the East, shamanistic medicine survived almost intact, e.g. parts of Vietnam and esp. Tibet.
Chou Dynasty (1122-403 BC)
A high point of Chinese civilization, but during the Eastern Chou period (722-481), centralized control declined, local aristocracy began fighting, among themselves, and social order degenerated into the Warring States Period, a time of great instability.
However, the unstable times produced great thinkers: (Confucius was born in 551 BC). Different philosophies dating back into antiquity were investigated for possible solutions to the present problems. This was the time of the "Hundred Schools", referring to the many philosophical schools of thought that prevailed. Much was actually recorded during this period of time, incorporating different philosophical ideas.
The major medical classic, the Huang Ti Nei Ching (Yellow Emperor's Classic of Internal Medicine) was written down at this time from earlier knowledge. This is the most important of the medical classics. (Shortly thereafter, China was unified again under the harsh and repressive Chin Dynasty).
There follows a brief examination of two major philosophical influences that influenced thinking (and medicine) during this crucial period.
Confucius (K'ung Fu-tzu) (551-479)
Born at end of Eastern Chou period and beginning of Warring States period. We know about him from the "Analects", a series of passages written by his disciples.
He wanted to be an advisor to a monarch. He traveled around in search of a monarch, but no one wanted his ideas; he was too moral. Everyone wanted pragmatic techniques for use in winning the wars. He therefore became a teacher. Not until 200 years after his death were his ideas taken seriously. Eventually his ideas became the imperial creed. Confucian classics: these include the Li Ching (book or rites) and the I Ching (a more ancient text which he developed and for which he wrote commentaries).
Social unrest was all due to the breakdown of respect. Respect for the hierarchy (familial and imperial). He believed one should behave as one is supposed to according to one's station in life, and not to be ambitious. He envisaged a harmonious society kept together by a tight hierarchical system of precisely defined social roles and mutual obligations.
The ruler was supposed to be a sage, who ruled by example: laws would then be unnecessary. People should be bound by respect for rituals (li) and customs.
He stressed honor, the importance of being a gentleman-scholar (Jun Zi), learning, (especially from history). He stressed also "ren", in other words, compassion and humane action.
He emphasized filial piety and the Five Relationships (a system of social mores that would establish social order). For example, ruler-subject, father-son, husband-wife, older brother-younger brother, friend-friend.
Finally, he stressed moderation. His disciples stated: "Confucius did not go to extremes."
How Confucian Ideology Affected Chinese Medicine
- Passage written by Hsun-Tzu, a famous disciple of Confucius:
"The true ruler begins to put his state in order while order still prevails; he does not wait until insurrections have already erupted."
- Passage in the Nei Ching (Chinese medical classic)
"The sages do not treat those who have already fallen ill, but rather those who are not yet ill. They do not put their state in order only when revolt is underway, but before an insurrection occurs."
- The Confucian idea of moderation shows up in the Nei Jing in several passages. In other words, health would be maintained by moderation in lifestyle.
- The Five Relationships also influenced medicine: Example: Husband-Wife imbalance (which is where the pulses at one wrist are too strong and at the other wrist too weak): Certain techniques are also called Mother-Son and Father-Son technique.
- The Zang Fu (Organs) are given names of "officials". For example , Liver is the "commander" of the armed forces. The Heart is the Supreme Ruler, the Stomach is the official in charge of public granaries. The court (body) runs well when all the officials (organs) interact harmoniously. Of paramount importance is the Supreme Ruler or Emperor (Heart). If the Emperor is disturbed, the whole court (all the other organs) will suffer. This reflects the Confucian way of thinking, the Supreme Ruler has to remain in perfect balance, and to rule by example. Even today, it is considered by many that the Heart is to be treated first if it is affected (e.g. in emotional disturbance, the Heart is always affected).
Taoism is not a religion, more a philosophy based on the concept of Tao. Sometimes said to mean "the way", or something like unknowable, unimaginable, source of all phenomena. Before Tao there was chaos, then suddenly Tao manifested as the universe (comparable to the modern "big bang" theory). Tao expresses through the duality of Yin-Yang. Tao is like the eternal primeval law of nature.
The best known ancient Taoist philosopher was Lao Tzu (Lao Tzu = "Old Master"). He wrote the Tao Te Ching: a mystical Taoist work, full of poetic allusions, riddles, etc. to expand consciousness, promote love of nature and simplicity, and rejection of worldly ambition. The Tao Te Ching is a composite text, probably dating from 3rd century BC (the same time that the major medical classic, the Nei Ching, was officially written down) but Lao Tzu has had his traditional dates fixed to make him slightly senior to Confucius (i.e., 6th century BC). It is impossible to know the exact birth date.
The best introduction to Taoism is to read some Taoist literature. The way the ancient Taoists' would teach would be via observation of the nature, in the hopes of obtaining a direct grasp of the truth. Most mystical or inner-directed spiritual paths concur with this.
In Chapter 1 of the Tao Te Ching, Lao Tzu wrote:
The tao that can be told
is not the eternal Tao
The name that can be named
is not the eternal Name.
The unnamable is the eternally real.
Naming is the origin of all particular things.
Free from desire, you realize the mystery.
Caught in desire, you see only the manifestations.
Yet mystery and manifestations
arise from the same source.
This source is called darkness.
Darkness within darkness.
The gateway to all understanding.
Taoism espouses "wu-wei" which means not doing, or non-purposive action. Being without plans, going with the flow. Not surprisingly, Taoism was a popular philosophy mainly with the aristocracy!
To seek learning one pains day by day
To seek the Tao one loses day by day
Losing and yet losing some more
Till one has reached Wu-Wei
Do nothing and yet there is nothing that is not done.
To win the world one must attend to nothing.
When one attends to this and that
He will not win the world."
An example of working with the Tao is given in a traditional tale of a Prince Wen Hui and his cook. Prince Wen-Hui was visiting his kitchen one day when he happened to pause and observe his cook slicing through joints of meat. He remarked upon the deft and smooth way his cook worked, the blade hardly seeming to touch the bone as it cut. His cook explained that he simply relaxed, and non-purposefully allowed the knife to do its work. In this way, he became one with his knife, which slid through the spaces between the joints, never touching the bone. He explained that he had used the same knife for many years and it had never needed sharpening. The prince was astounded at his cook's story, and exclaimed that although he was an avowed Taoist, he had truly learned something fundamental about the philosophy from his cook.
Taoists advocated simplicity, living according to the Tao, according to the laws of nature.
The Chinese medical classics speak with reverence of sages of ancient times, who knew how to live according to the Tao, hence they lived very long lives. Whereas nowadays (3rd century BC) people had lost the ability to live in harmony with nature, did not adhere to the principles of moderation, and hence were unhealthy. One wonders what they would say about the 20th century!
Taoism eventually split into two camps: alchemical Taoism, which became a search for immortality via diet, exercise, meditation and magical herbs, and popular Taoism, which developed a church and a whole pantheon of gods, and became heavily involved with popular superstitions and demonic lore, thus losing credibility with the educated class. Earlier Taoist classics, however, continued to be read.
Taoism had a strong influence on medicine: the idea of humans being part of nature and needing to remain in harmony with nature was fundamental. "As above, so below." As an example of this, guidelines were established in the Nei Ching as to how one should conduct oneself in various seasons. In the winter time, one should go to bed early and get up late, and not waste one's energy, for winter is the time of conservation and storage (a time where Yin is strongest). In the summertime one should rise early and go to bed late and "act as if one loved everything outdoors", for Summer is the time of maximum Yang, and people's naturally have more energy to expend.
Let's return to the Warring States period, the time of great social unrest where uncertainty about personal and collective existence, increasing chaos and amorality led to the search for a lasting philosophy that might change things. The time of the "hundred schools". The medicine that developed during this period of intense philosophical activity is the central part of what traditional Chinese medicine is today. It has been referred to as the medicine of systematic correspondences.
Medicine of Systematic Correspondences
The fundamental principles of this medicine arose from divergent influences, including Taoist and Confucian ideas. The Naturalist School was responsible for systematically elaborating the concepts and theories of Yin-Yang, which had been an ancient idea that was now fully developed and recorded.
Huang Ti Nei Ching Su Wen Ling Shu
During the time of the "Hundred Schools", (3rd century BC), the famous classic of TCM, the Huang Ti Nei Ching (Yellow Emperor's Classic of Internal Medicine) was written down in its present form.
It had existed far earlier in one form or another, parts probably being handed down by word of mouth, and is thus a compilation of much earlier material, with added commentaries (commentary writing is very popular with the Chinese). The "Nei Ching" as it is called, is a mixture of ideas and philosophies, some more ancient (i.e. Taoist philosophy) and some from the time it was written (3rd century BC), such as the Yin-Yang, Five elements and theories of the Zang Fu (Organs). It is also likely that more was added to this classic by later dynasties.
The book describes the conversations between the Yellow Emperor (Huang Ti) and his physician (Chi Po), hence it is a historical (actually legendary) account.
Huang Ti is said to have lived 2697-2595 BC, i.e. before writing existed. He was portrayed as a true Renaissance man. He designed a cart based on the big dipper, designed a series of musical notes and instruments to play them on, but his great love was medicine, which is shown in the conversations he has with his physician, during which he asks about everything imaginable.
There are 2 parts to the Nei Jing:
- Su Wen (Essential Questions):
This forms the core of the book; it deals with the whole realm of medical knowledge, and involves aspects of all the philosophical concepts mentioned earlier.
- Ling Shu (Spiritual Axis):
This mainly constitutes a supplement to the Su Wen. It expounds the concept of Tao and the cosmological patterns of the universe, then portrays with vivid imagery the character of the two primordial forces, Yin and Yang, and how they interact in nature and in human beings. There is then a description of the bodily organs (as "officials" - showing Confucian influences), and their functions and pathologies. The technique of pulse reading for diagnosis and the various types of pulses are discussed at length.
The book describes how to live in harmony with nature, and the results of not doing so (imbalance and disharmony). Therapies are based on restoration of harmony and balance to the body.
Surgery is mentioned, but only as a last resort e.g. to remove tumors.
Acupuncture is mainly mentioned in the Ling Shu. Commentaries were added, both in the 3rd century BC and in later dynasties.
One commentary published in the same period was the NAN JING (Difficult Classic) appeared. This filled out the Nei Jing and answered some difficult questions. Points for acupuncture and moxibustion are discussed, as well as physiological and pathological conditions of the eight Extra Vessels. Many commentaries were added in the Tang dynasty. These are important, and render the work easier to read, the essential part was left intact.