by Eric Brand

Chinese medicine has a long, fascinating history. There are nearly endless interesting topics to explore. Many readers are familiar with the foundational channel theory of the Nei Jing and the timeless dui yao herbal combinations seen in the Shang Han Lun. No doubt many of us have already read about great historical masters such as Li Dong-Yuan in the Blue Poppy reading room. Since general Chinese medical history is a huge topic, I am going to depart from the fundamentals to blog about a few fun things that may be new to many readers.

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Transition to Modern Concepts

Fertility was referenced in oracle bones, which are the earliest records of Chinese writing. Oracle bones were generally turtle shells and other bones that date back to the prehistoric Shang dynasty. These shells and bones were inscribed with writing and were put into a fire for purposes of divination- the direction of the lines after the shell cracked from the heat indicated the answer to the question posed. However, with notable exceptions such as the issue of fertility, few strong historical records of Chinese medicine are prominent until the Ma Wang Dui manuscripts in the Han dynasty. Historical evidence suggests that Chinese medicine made significant leaps forward in the Han dynasty, roughly around 2200-1800 years ago.

The Ma Wang Dui manuscripts were written on silk and have been accurately dated to 168 BCE. Notably, five phase theory and visceral manifestation are not in evidence, and the channel system had significant differences to our modern channel system. Moxa and massage were in use, but needles were not yet mentioned, and the channels were not yet integrated together. Sympathetic magic and demonology were prominent, and there was attention given to exorcism in addition to the employment of over 400 medicinal substances.

It is impossible to know if the records at Ma Wang Dui (found in a nobleman’s burial chamber) are representative of the general state of Chinese medicine at the time. However, it is clear that medicine had evolved dramatically from the Ma Wang Dui era by the time the Huang Di Nei Jing and the Shang Han Lun appeared at the end of the Han dynasty, some 200-350 years later. These sophisticated texts focused on natural explanations of disease and their fundamental theories have been the basis for Chinese medical thought all the way up to the present. While the Shang Han Lun was written by a single author, the medical historian Paul Unschuld estimates that the Huang Di Nei Jing had over 300 contributors, and likely evolved over a period of time.

Changing Concepts on the Origin and Treatment of Disease

Chinese medicine is fundamentally an empirical system of medicine. Many experts believe that ancient people observed the effects of various treatments and created theories about physiology and pathology in order to explain these observed effects. It is not uncommon to find instances where the use of a particular medicine endured despite a dramatic change in the theory underlying its use.

For example, early Běn Cǎo literature was influenced heavily by alchemy and demonic medicine. The ability to kill demonic qì was ascribed to the various parts of the peach tree, including the peach kernel. In early medicinal books, táo rén (Persicae Semen) was used to treat illnesses attributed to demonic qì, including “demonic pregnancy” (鬼胎 guǐ tāi). This disease was characterized by a lump in the abdomen that was presumed to be a phantom fetus. As the demonic explanation of this disease was replaced by the notion of blood stasis, the theory of the demon-expelling action of táo rén (Persicae Semen) was replaced with the notion that it eliminated blood stasis. Today, táo rén (Persicae Semen) remains an essential medicinal for the treatment of abdominal lumps, but the theory surrounding its use has advanced considerably.

Much later in history, a similar scenario emerged wherein a clinically effective treatment was developed based upon theory that was later deemed to be obsolete. Wang Qing-Ren, the creator of the family of formulas related to xuè fǔ zhú yū tāng (House of Blood Stasis-Expelling Decoction), developed an entire group of formulas based on erroneous anatomical knowledge. Because he only had access to the bodies of criminals that were executed by hanging, Wang observed extensive pooling of blood in the chest of the corpses. Consequently, he deduced that the large amount of blood that he saw pooled in their thoracic cavity was the cause of their illness, and developed formulas to expel stasis from this “House of Blood.” Although it is now known that his dissection methodology and theory were flawed, his remedies were effective and have now become some of the most widely-used blood stasis-transforming formulas in the clinic today. His book Yi Lin Gai Cuo is now available in English from Blue Poppy Press.

The Tong Ren

Many acupuncturists are familiar with the bronze statue known as the “Tong Ren,” or bronze man. The first such statue was created in the Song dynasty, about 1000 years ago. This statue has acupuncture channels and points inscribed upon him, and it was used as a map of acupuncture points for Chinese medical students in days gone by. Similar little plastic statues are still used by acupuncture students today. Over the years, the original bronze statue was lost, but new versions were maintained throughout the centuries.

Examples of the Tong Ren statue can be found in museums throughout China. The first time I saw a statue of the Tong Ren, it was a replica hosted at the National Palace Museum in Taipei. This museum hosts one of the most complete collections of Chinese art in the world. The replica in the Taipei museum is the same statue that most of us are familiar with, but it turns out that it is a replica of the statues used in later dynastic periods. In fact, one of the main statues in Beijing was modeled after a cast of a physical education teacher!

By the Qing dynasty (1644-1911 CE), the Tong Ren statues in use had adapted to the prevailing conservative culture of the times, and the statues were made with relatively square shoulder and hips. The net result is that the statue has a more sexually conservative look; it is far more upright and “square” than the original. By contrast, the original bronze model created in the Song dynasty was far more curvaceous; his hips and chest had a much more voluptuous and feminine look. The original statue thus had a much more sensual look than the comparatively stiff models that dominated in later dynastic periods.

Just as we saw with the recent blog on the evolution of pulse diagnosis, the Tong Ren is another obvious example where Chinese medicine adapted to the comparatively liberal or conservative sexual attitudes seen in China at different periods of time. To see an example of a replica of the original, Song dynasty-style Tong Ren, visit the Chinese medical history museum at Hong Kong Baptist University.

Li Shi-Zhen

Most American practitioners are familiar with Li Shi-Zhen. Li Shi-Zhen is best known for writing the Ben Cao Gang Mu, which was written in the 16th century during China’s Ming dynasty. Covering 1,692 medicinals, the Ben Cao Gang Mu (Compendium of Materia Medica) was the most comprehensive materia medica in the history of Chinese medicine until 1975, when the Zhong Yao Da Ci Dian (Great Encyclopedia of Chinese Medicinals) was published (it lists nearly 6,000 medicinals, and has now been surpassed by the Zhong Hua Yao Hai, which lists over 8,000).

Li Shi-Zhen is a household name in Chinese society, and all Chinese high school students have heard of him and his Ben Cao Gang Mu. Li was a pioneer because he traveled throughout China to collect local herbal knowledge, and his book became the standard reference for all doctors that followed. His book took 27 years of research and is a scholastic masterpiece with meticulous references to 952 other texts. However, the thing that makes Ben Cao Gang Mu so special is not just its focus on herbal medicine. In addition, the text is of great relevance for the natural sciences in general, such as zoology, botany, mineralogy, and metallurgy.

To briefly quote a paragraph written by the Chinese medical historian Sabine Wilms from my book Concise Chinese Materia Medica:

“Perhaps its greatest contribution is the innovative way in which Li arranged the 1,892 substances covered in the text. Correcting what he saw as inconsistencies and categorical confusions in previous works, he established ten sections in logical succession: “First are waters and fires followed by soils, since water and fire are the predecessors of all things and earth is the mother of all things. Next are metals and minerals since they come from the earth. Next are herbs, grains, vegetables, fruits, and trees, proceeding from the tiny to the huge. Next are clothes and utensils, [since they are made from] herbs and trees. Next are “worms” (虫 chong, a category including insects, spiders, snails and slugs, frogs and similar creatures), and then scaly, shelled, winged, and four-legged creatures, concluding with humans in a progression from the most base to the most noble.” The sixteen sections further comprised sixty different subcategories. In an innovative scheme, he added new sections and replaced the traditional order for listing medicinal substances with a grand new scheme of categorizing the natural world as a whole. This makes Li Shi-Zhen one of the most important figures in the history of science in China.”

I will continue to post blogs in the future about other fun tidbits and facts about Chinese medicine and its history, so bookmark our blog page and visit us frequently at Bluepoppy.com.

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