By Eric Brand

Chinese medical theory is constantly evolving; many fundamental theories have been questioned, analyzed, and refined throughout history. A number of diseases and pathomechanisms that were recognized historically were discarded by subsequent generations, and a number of innovations and new concepts have been presented over the years. This dynamic process has resulted in a modern body of knowledge that has winnowed down obsolete theories while simultaneously advancing new explanations for conditions that were previously unknown or undeveloped in the literature. From our modern vantage point, we see many examples of pathomechanisms that failed to withstand the test of time, as well as many opportunities to advance Chinese medical theory into new and unexplored dimensions.

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Theories of physiological and pathological mechanisms that are now considered to be obsolete explanations from a bygone era abound in Chinese medicine. Some of these theories involve basic fundamental premises of physiology, while others represent disease concepts and pathomechanisms that are now considered to be clinically useless or fundamentally flawed.

Examples where physiologic theory has fallen by the wayside can be found in the analysis of modern bowel and visceral patterns. My teacher Feng Ye used to say that ancient Chinese medical philosophers attempted to form a symmetrical picture of bowel and visceral functions and pathologies so that the concept of the body would remain in harmony with theories of yīn-yáng and the five phases. Consequently, all visceral patterns were evenly distributed; patterns of kidney repletion were posited to balance patterns of kidney vacuity, lung blood vacuity held a relative place with lung qì vacuity, and liver qì vacuity stood in opposition with liver qì stagnation. All of the various combinations of pathology were developed in accordance with established yīn-yáng pairs and correspondences between the five phases.

Despite these established groupings, many of the conditions that provided theoretical yīn-yáng balance are no longer recognized in mainstream Chinese medical theory. For example, there are no patterns of kidney repletion, no patterns of lung blood vacuity, and the notion of liver qì vacuity has been almost completely undeveloped. The reason that various conditions have fallen off historically is due to Chinese medicine’s pragmatic focus on therapy. The development of pathomechanisms is dependent upon the successful application of interventions; theory alone, however balanced and beautifully composed it may be, is insufficient to sustain practitioner confidence in the absence of useful therapeutic techniques. Because treatment results were used to make sense of pathology, and pathology was in turn used to explain physiology, physiologic mechanisms that lacked treatments and pathological manifestations eventually became obsolete. In other words, the lack of medicinals to treat kidney repletion (along with the subsequent lack of resolvable symptoms that could thus be ascribed to kidney repletion) was likely the primary reason that kidney repletion patterns were phased out of orthodox medical theory long ago.

In addition, medical theory evolved to reflect changes in the perceived causes of disease. Many instances of dated concepts can be found by comparing past literature to modern works. 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 what we would know think of as an erroneous medical assumption. Wang was into dissecting cadavers at a time in history when Chinese doctors rarely cut open dead bodies, and he mostly had access to the bodies of criminals who died from hanging. These bodies happened to have large amounts of blood pooled in the chest from hanging, and he erroneously deduced that the large amount of blood that he saw pooled in their thoracic cavity was reflective of their physiology. This led to the development of formulas to expel stasis from this “House of Blood” in the chest. 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.

Although some pathomechanisms have been refined and modified to fit a changing worldview while retaining clinically useful aspects, other pathomechanisms that were proposed historically are now no longer used at all. An example of an obsolete pathomechanism can be found in the disease known as 夜夢鬼交 yè mèng guǐ jiāo, “dreaming of intercourse with ghosts.” This was a disease in women equivalent to 夢遺 mèng yí (dream emission, basically equivalent to “wet dreams”) in males. While dream emission in males is explained by normal pathomechanisms of the bowels and viscera, the corresponding condition in females was attributed to ghosts. Modern scholars such as my teacher Feng Ye believe that issues of gender inequality account for the discrepancy between the supernatural and natural causes assigned to these diseases. Though ejaculation from dreams of a sexual nature was accepted as a simple sign of hyperactive ministerial fire in males, when women awoke from sexual dreams with increased lubrication the cause was attributed to unnatural dreams of copulation with spirits. As Chinese medicine modernized, the references to dreaming of intercourse with ghosts disappeared, and this disease name is now thought to be a relic from a time when disparity between the sexes got too carried away.