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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.
Philosophical
Roots
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.
Shamanistic Medicine
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.
Brief
biography
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).
Confucius
ideas
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
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.
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