Medicine in China

In most of early medieval Europe, only a few classical medical treatises survived, primarily in the libraries of monastic institutions, and most medical practitioners had little education. The outcome was a split between theory and practice. In China there was no such split. Almost all of the literature, including works on doctrinal foundations, was written by practitioners.

Excavated writings on medical divination (from c. 316 B.C.E.) and on medicine (from c. 205 B.C.E.) show traces of a gradual separation of both from popular ritual healing, which had a strong occult component. The first collection of mature classical writings is the Yellow Emperor's Inner Canon (Huangdi nei jing, c. first century B.C.E.). It was one of a number of foundational works but the others of the same period have been lost. Although physicians through history considered the Inner Canon a coherent two-part treatise, David Keegan has shown that it incorporates many separate texts from different sources, some of which comment on, elaborate on, or disagree with others. The various understandings of the body, health, illness, and therapy contained in the work are inconsistent in many respects. Still, all its component text understand the body to be an ensemble of processes that, in health, remain in harmony with those of the cosmos. Reconciling the discrepancies in this most authoritative of classics in order to present a single picture was the goal of several doctrinal works over the next two centuries.

The Inner Canon defined what remained the chief characteristics of medicine: It was process-oriented and relational. Medicine treated a complex ensemble of life processes. Diagnosis was generally a matter of identifying abnormal states of the body as a whole (although, given the diversity of practitioners, the training of many allowed no more than proceeding from a list of symptoms to the name of a disorder). Even physicians who treated particular local symptoms did so from the viewpoint of the whole. Wounds were disorders in the same sense as fevers; they affected not only the lesion but all body processes. Body and mind, complementary aspects of a single organism, were bound to affect each other. Because a disease was a process, doctors had to determine its stage and anticipate its evolution. Medical thinkers defined concepts in relation to others; yang was never an absolute property, but implied a relationship to something else that, in the particular pair, was yin. A young woman might be yin in a discussion of gender relations that compares her with a male, but yang in comparison with an aged man who lacks her vitality.

The conviction that both the state and the body are microcosms that partake in the dynamic order of the universe emerged in political theory, moral philosophy, and medical thought over the last three centuries B.C.E. Intellectuals built these doctrines on the concept of qi, which was both the basic material that filled the universe and formed individual things, and the vitality that maintained body states and brought about change. The Inner Canon integrated this notion with that of yin and yang and the five phases (wuxing). It interpreted the former as paired, opposed, but complementary aspects of qi, and the latter as five aspects of it, permitting a finer analysis of interaction in cyclic change. This synthesis became ubiquitous in the history of Chinese ideas. Within medicine, additional analytic categories, especially threefold and sixfold ones, made possible a sophisticated organization of knowledge.

Authors built up a model of fivefold and sixfold systems of vital function that stored and circulated qi throughout the body. The supply of qi was partly inborn and partly metabolized from air (i.e., ambient qi) and food. These systems were named for the main viscera. Unlike in the European understanding, organs were not considered processing stations, but rather bureaucratic offices responsible for order and control of spontaneous processes.

The main principle of health was the unimpeded circulation of qi; blockages and stases led to pain and dysfunction. The normal body's relation to its environment was equally important; it had to be open to air and food, but closed to pathogens, and it had to excrete what it could not assimilate without allowing leakage of the body's own qi. Medicine from the earliest times also incorporated the value of moderation, not only in conduct but in thought. Just as sensual indulgence could open the way to invasion by pathogens, jealousy or longing could generate medical disorders.