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The past 1000 years of Chinese medicine

1999; Elsevier BV; Volume: 354; Linguagem: Inglês

10.1016/s0140-6736(99)90352-5

1474-547X

Paul U. Unschuld,

Chinese history and philosophy

Paul U Unschuld is director of the Institute of History of Medicine at the University of Munich, Germany. His latest book is Medicine in China: Historical Artefacts and Images, published by Prestel. Chinese medicine's formative period, reminiscent of the earlier rise of Hippocratic medicine in ancient Europe and roughly coinciding with the reign of the Han dynasty, lasted from the 2nd century BC to the 2nd century AD. Henceforth, attempts to prevent and cure illness on the basis of an understanding of natural laws coexisted with older notions of health tied to beliefs in ancestors or the supernatural and a rich tradition of drug lore. The theories of systematic correspondences between phenomena, known as the yin-yang and five-phases doctrines, were applied almost exclusively to map the human body, to explicate its normal and pathological functions, to pulse diagnosis, and to guide needle treatment (acupuncture). Beginning only in the 11th century AD, eminent physician-authors systematically explored the application of drugs guided by correlative thought, thereby creating a pharmacology of systematic correspondence. These developments were part of a far-reaching neo-Confucian re-orientation of the Chinese elite, that is, of an adoption of concepts by Confucians that previously had belonged within the purview of Daoism, and of a development of new concepts that were directly opposed to comparable ideas within Buddhism. These developments also reflect reactions by some physician-intellectuals to a policy by the state to curb the influence of professional healers. Neo-Confucian moralists asked the educated to acquire sufficient medical knowledge to treat their kin themselves, rather than turn to those who practised medicine as an occupation. In the 12th century, the government sponsored the publication of prescriptions, encouraging people to identify suitable recipes for their illnesses and purchase these medications in government-operated apothecaries without having to see a physician first. Authors began to point out that each illness is a unique event that requires an individualised diagnosis. Subsequently, Chinese medicine took the form of a stream flowing into an increasing number of separate and sometimes criss-crossing river beds. The most well-known authors between the 13th and 15th centuries offered explanatory models of the basic causes of human illness. Increasingly elaborate theoretical structures were published that linked a patient's status by means of intricate diagnostic indices to combinations of specific pharmaceutical substances. For reasons unknown and concomitant with these developments, acupuncture lost much of its appeal by the middle of the second millennium, An impressive compendium of knowledge about needle piercing, the Zhenjiu dacheng, was published in 1601, 3 years after the appearance of the Bencao gang mu, a comprehensive pharmaceutical encyclopaedia. Yet, it was not uncommon for medical authors to note, as the eminent physician and writer Xu Dachun did in 1754, the demise of the acupuncture tradition. With the rise to power of the Ming dynasty in the 15th century, nationalists began to wonder what had gone wrong in Chinese intellectual history. So when the Ming dynasty was overthrown in 1648 by their northern Manchu neighbours who subsequently set up the Qing dynasty, a movement gained momentum in the 17th and 18th centuries that advocated a return to ever more distant layers of the past to uncover the sources of former Chinese independence and glory. Medicine was no exception. While some schools continued to adhere to the theoretical models of health and disease construed between the 12th and 15th centuries, an increasing number of authors sought to regain a presumed advantage of antiquity when empirical knowledge was not marred by theoretical speculation. They focused on philological reconstructions of the medical and pharmaceutical texts of antiquity or tried to grasp the spirit of old wisdom and portray it as the mould into which more recent knowledge was to be poured. Others probed new paths altogether. For a few physicians even a glimpse at folk healing or a careful and systematic inspection of human anatomy proved rewarding; both these realms had been mostly out of reach of the gentleman physician in previous centuries. A title like the Chuanya, compiled by the scholar-physician Zhao Xuemin from the notes of an itinerant healer at the close of the 18th century, offers a rare view of the most common medications and medical techniques. When western medicine was introduced to China in the 19th century, it confronted a heterogeneous array of ideas and practices that encompassed both ontic and holistic perspectives. Ontic theories traced illness to an intrusion of the body by pathogenic agents, whereas holistic ideas portrayed disease as a departure from a harmonious state guaranteed by a lifestyle that accorded with the basic laws governing the universe. The 20th century has brought the further development of Chinese medicine within the confines of its traditional theoretical foundations to a complete halt. As the ancient doctrines of yin-yang and the five phases lose their importance in everyday life, every new generation in China is increasingly alienated from the world view of systematic correspondence. Nonetheless, over the past decades an empirical and scientific basis has been built to justify the application of Chinese medicine in the future.