(Scraps from a Sinological Scrapbook 漢齋閒情異誌, fragment 22)
The Influence (?) of
Confucian Philosophy on Chinese Medicine[1]
Popular Western books on Chinese medicine, and on Chinese
body-related disciplines like tai chi and qigong, often claim that traditional
Chinese medicine takes a Daoistic view of human life and health, encouraging us
to ‘follow nature’ and to abstain as far as possible from ‘unnatural’
medication or other ‘manipulative’ modes of treatment. These Western sources
often contrast this supposedly ‘natural’ or ‘wu wei’ approach with mainstream Western medicine which, they
suggest, views the human body as something to be controlled rather than
trusted.
At least two leading
Western authors, however, have challenged this idea. They assert that
traditional Chinese medicine is actually more Confucianist than Daoist in its
concept of the human being and body. Paul Unschuld (author of several acclaimed
books in both German and English, including Medicine
in China: A History of Ideas) and Giovanni Maciocia (whose 2009 The Psyche in Chinese Medicine followed
a series of earlier works)[2]
both emphasize that in the textual tradition of Chinese medicine, there is
little or no notion of the human body as a self-healing, self-organizing
entity. On the contrary, the concept of 治 (in politics ‘to govern,’ in medicine ‘to treat or cure’), in
medicine as in politics, implies active control and regulation in order to
prevent or suppress disorder which would naturally arise without it. Similarly,
the contrasting concepts of zheng 正 and xie 邪 can be used to mean either the ‘orthodox’ or ‘righteous’ as opposed
to the ‘immoral’ in a political-social sense, or the ‘proper’ or ‘healthy’
state as opposed to the ‘unhealthy’ or ‘pathological’ in a medical sense.[3]
Unschuld’s intriguing
thesis is that starting with the unification of the Chinese Empire under Qinshi
Huangdi and the subsequent Confucian-oriented Han dynasty, the political
concept of the Empire as a unified state with a central government carried out
by ‘officials’ was also applied to the human body in which the heart was the ‘emperor,’
other organs were the ‘officials’ (官), and so on. As Maciocia explains it,
the first Qin emperor...initiated a huge
program of road building and canal digging. Another important innovation of the
Qin dynasty was the fostering of trade among the various regions of China
Macicia goes on to explain the parallel with medical theory, saying
that in this model ‘...the body’s physiology is the unified economy and the
acupuncture channels are the irrigation canals.’[5]
Again, in two key passages by Unschuld:
One may well conclude that all these
structural changes that accompanied the unification of China were sufficiently
innovative to supply intellectuals of that time with the concept of an
integrated complex system, the individual parts of which can function only as
long as their relations with the remaining parts are not disturbed...The
structure of the human organism and the functions assigned to its individual
elements reflect a complex social organism founded on the wide-scale movement
of goods.[6]
During the course of the last three
centuries BC, unknown authors began to develop a system of healing whose
theoretical principles corresponded closely to the socio-political order
advocated during the same period by Confucian political ideology. As a
consequence, this system of healing was continuously dependent on the interests
and fate of Confucianism itself. With the elevation of Confucianism to orthodox
political doctrine by the Emperor Wu, the Han period theoretical foundations of
this ideology remained fixed for a long span of time.[7]
The same model which described society as a well-governed whole was
also used as a symbol of the human body. The parallel between the political and
the medical model comes out well in a quote from the authoritative Chinese
medical classic Huangdi Neijing 黃帝內經: ‘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 under way...’[8]
This notion of
quasi-bureaucratic control and governance as a basic principle of the human
organism comes out in much detail, for example, in Ted J. Kaptchuk’s The Web That Has No Weaver,[9]
which since its first publication in 1983 has been a very widely read Western
source on Chinese medicine. Discussing the internal organs in order, Kaptchuk
quotes from traditional Chinese sources, mostly the Su Wen 素問 (the more theoretical section of the Huangdi Neijing), as to their traditional rulerships.[10]
Traditionally,
according to the Su Wen, ‘The Heart
rules the Blood and Blood Vessels.’ Adding his own amplification, Kaptchuk says
the heart ‘regulates’ the flow of blood.
Again, according to the
Su Wen, ‘The Lungs rule Qi.’ Kaptchuk’s
explanation in this case says that the lungs ‘administer’ respiration and ‘regulate’
the ‘Qi of the entire body.’ The Su Wen
also says the lungs ‘move and adjust the Water Channels.’ In Kaptchuk’s simpler
amplification, the lungs ‘move water’ – shades of Unschuld’s ‘irrigation canals’!
As for the Spleen,
traditional sources say it ‘rules transformation and transportation.’ Again, ‘the
Spleen governs the Blood’ – in the sense, according to Kaptchuk, ‘that it keeps
the blood flowing in its proper paths.’[11]
The Spleen also, in the Su Wen, ‘rules’
the muscles, flesh and limbs.
The Liver, in Tang
Zonghai’s 唐宗海formulation
as quoted by Kaptchuk, ‘rules flowing and spreading.’ In the Su Wen, it is compared to ‘the general
of an army.’
In the Su Wen, the Kidneys ‘rule water.’ In the
face of what might seem to be a contradiction in light of the Lungs’ ‘adjusting’
the Water Chanels, Kaptchuk explains that the Kidneys ‘are the foundation upon
which this entire process of Water movement...is built.’ In addition to this,
according to Su Wen, the Kidneys ‘rule
the bones.’
Another well-known
Western work, Between Heaven and Earth
by Harriet Beinfield and Efrem Korngold,[12]
sets out the ‘governmental’ or ‘bureaucratic’ structure of the organism even
more strikingly. In it, we read (on pp. 138-157) that the Liver is ‘like a
general working out strategy and tactics...’; the Heart is ‘like an enlightened
monarch, omniscient and ever-present, sharing his wisdom unconditionally for
the benefit of the Whole’; the Spleen is ‘like a minister of agriculture,
watching over production and distribution...’; the Lung is ‘like a minister of
state, determining the territorial boundaries’; and the Kidney is ‘like a minister
of the interior, conserving the natural resources...’
To be sure, there are aspects of Chinese medical theory that seem to
accord very well with the popular image of a Daoist lifestyle. But as Maciocia
points out, many Daoist ideas were later incorporated into Chinese medical
theory during the Song and Ming dynasties when the dominant philosophy of
neo-Confucianism imposed its own interpretations. Maciocia cautions that in
reading old Chinese medical texts like the Huangdi
Neijing, we must never assume that the word Dao is always being used in an old Daoist meaning. In Confucianism
or neo-Confucianism, it can often be equivalent to ren 仁or li 理, both words having everything to
do with the individual’s social adjustment and deportment.[13]
I would add that more generally, in neo-Confucianism the word Dao is very often used to mean ‘the
teachings,’ ‘the Tradition,’ or ‘the proper behavior’ – contrasting thoroughly
with the Dao that according to
Zhuangzi 莊子 ‘can be
passed on but not taught’ 可傳而不可授, and with Laozi’s 老子 cautions against taking social discourse seriously. In this
context, it is revealing that some of the best-known Chinese Bible translations
have used Dao for ‘the Word’, rendering ‘In the beginning was the Word’ as tai chu you Dao 太初有道.[14]
Perhaps the early translators, like the later scholar and sociologist Marcel
Granet 葛蘭言whose La Pensée chinoise [Chinese Thought,
1934] became one of the classics of twentieth-century European sinology, wished
to emphasize Dao’s quality as an ordering
element which makes things be as they are.[15]
Even aside from
neo-Confucianism, we can raise the question of whether the Dao concept really
implies that the surrounding social discourse, be it ever so restrictive, is
irrelevant or secondary. Chad Hansen, in his A Daoist Theory of Chinese Thought, even says the archetypal Daoist
writer Zhuangzi, ‘like the rest of the classical tradition, uses dao as a concept of guidance rather than
a reality concept.’[16]
In another context, he calls Dao ‘the sum of all discourse inputs.’[17]
Be this as it may, the
neo-Confucian stress on a discourse of social adjustment sometimes supplied
contemporary Chinese authors with what must have seemed convincing arguments
applying to the medical sphere. A frequently quoted example, cited also by
Maciocia, is from the writings of the Song-dynasty neo-Confucianist philosopher
Cheng Hao 程顥. It
involves a pun on ren 仁 (often translated ‘benevolence’ or
‘humanity,’ but which I prefer to translate ‘responsiveness’) and bu ren 不仁 (seemingly ‘not benevolent or humane or responsive,’ but also in a
physiological sense ‘numb’):
In medical writing the term ‘lack of
humanity’ [bu ren] is used for numbness of the hands and feet...A man of ren
regards Heaven, Earth and the myriad things as one substance, and there is
nothing that is not himself. Recognizing all things in himself, will there be
any boundary for him? If things are not parts of the self, naturally there will
be no connection between them and himself, just as in the case of numbness of
the four limbs...[18]
As Maciocia explains, ‘...a person of ren is someone who regards
others as extensions of himself, like his limbs. Such a person is naturally
sensitive to the needs and feelings of others...’[19]
Perhaps the Western ‘debate’ (if that is what it is) between the ‘Confucian’
and ‘Daoist’ views of Chinese medicine is mainly a quibble about terminology –
or about what Western writers think ‘Dao’ means. This in turn may be related to
what motivated these particular writers to study Chinese medicine in the first
place. For a long time now, many Western students of medicine have been dissatisfied
with what they perceive as Western medicine’s non-unitary, over-specialized
character. Feeling that Western medicine encourages too much isolated attention
to specific details rather than to the organism or the person as a whole, they
have been attracted to what is often called ‘holistic’ medicine. In circles
involved in these studies, the Chinese concept of Dao is often considered a
positive alternative: because it is often interpreted to imply release from
restriction, constriction, or static social definition of persons and their
situations.
Kaptchuk, for example,
at the end of his first chapter stresses
...the very important evolution in the last
few decades [in the West] toward interdisciplinary and integrative medicine,
and the even more recent development of “holistic” medicine. A modern hospital’s
medical team employs a wide variety of approaches that go far beyond the late
nineteenth century biochemical models. For example, a pain unit may include
rehabilitation, occupational, and physical therapists, a nurse, a psychiatrist,
a social worker, art, movement, or music therapists, a relaxation counselor,
and a nutritionist...The newer concepts of holistic health are an extension of
the current Western concern to go beyond a reductionist model. Indeed, this
book itself can be viewed as part of the growing holistic interest.[20]
But Kaptchuk takes a nuanced view of all this. Though he stresses
and discusses Daoism in his book, in an interview in the magazine MD he cautioned against the ‘tendency...to
overvalue Chinese medicine because it is holistic and spiritual,’ saying this
attitude was a ‘barrier to a genuine understanding.’[21]
He does not present Chinese thought as believing in an always-liberating,
ever-free flow. On the contrary, he astutely states that
The Chinese world-view is circular and
self-contained...The Chinese physician begins with a knowledge of the whole,
made up of the countless details codified in traditional medical texts. The
movement between...the macrocosm of all bodily phenomena to the microcosm of
one unique human being, is mediated by the conceptual framework of the patterns
of disharmony.[22]
What is noteworthy here is that the ‘knowledge of the whole’ is not
a new knowledge which the current person has somehow attained thanks to his or
her unique new place in the flux. The knowledge itself is made up of elements
which have long since been ‘codified’ in ‘traditional texts.’ To me, that
sounds like a very Confucian idea. True, there is said to be a movement between
‘macrocosm’ and ‘microcosm,’ but again: the movement is not unstructured: it is
‘mediated’ by a ‘conceptual framework of patterns’ – in other words, as I would
phrase it, of socially recognized possibilities.
Between
Heaven and Earth contains much autobiographical material
on its authors’ personal history of attraction to Chinese medicine – too much
to be easily summarized here. Again the concept of the Dao plays a prominent
role. But it seems to me that the authors are eager to see it as a totality
concept, in this sense downplaying its character as a specifically ordering agency. More than once, we read
that the Dao is ‘undifferentiated’ or ‘unbroken.’[23]
It ‘transcends the illusion of separation’[24]
– yet the authors add that it does so ‘within a pattern of indissoluble connections
in a circular network.’[25]
Here once again, we
encounter the notion of a ‘net-’ or ‘web-’ like closure lying at the heart of
the Chinese health concept. I doubt whether all Western readers would agree as
to whether this is a ‘benign’ or somehow an ‘ominous’ notion. Perhaps their
choice as to whether it is ‘Daoist’ (i.e., in this context, benign) or ‘Confucianist’
(suggesting social pre-patterning, hence also control) depends on their
personal concept of whether ultimate ‘circularity’ is a supportive or a
limiting thing.
Kaptchuk traces the
term ‘the web that has no weaver,’ as in the title of his book, to Joseph
Needham, and quotes Needham as saying ‘the key-word in Chinese thought is Order and above all, Pattern....’[26]
Also from Needham is the explication ‘...The conception...[is] of a vast
pattern. There is a web of relationships throughout the universe...Nobody wove
it, but if you interfere with its texture, you do so at your peril...’[27]
Coming to this point, I am reminded of a remarkable poem, titled ‘Life’
生活, by the
eminent modern Chinese poet Bei Dao 北島.[28] The
poem consists of a single word:
網
which I think could equally well be translated as ‘net’ or ‘web.’
Is a ‘net’ a benign
thing, as in a ‘social network’ or ‘support network’...or does it trap, capture
as a ‘fishnet’ does?
Is a ‘web’ usefully
benign, as for many of us nowadays ‘the web’ is...or is it more in the nature
of a ‘spider web’?
But perhaps it would be
too non-Daoistic, certainly too non-holistic, to expect a yes-or-no answer to
these questions.
--Lloyd Haft
[1] Based on a paper presented on October 25, 2012 at the International
Scholarly Conference on Chinese Classics and Culture, Department of Chinese
Literature, Central University ,
Taiwan
[2] Paul Unschuld, Medicine in China : A History of Ideas, Berkeley :
University of California
[3] On this opposition, see Unschuld, Das
Heil der Mitte –, Theorie und Praxis, Ursprung und Gegenwart der Medizin in
China, München/Linz: Cygnus Verlag, 2005, p. 70. Maciocia, in his
Pinyin-English glossary, refers to xieqi
邪氣 as ‘pathogenic factor’; the ABC Chinese-English Dictionary (1996) gives as one of its
definitions ‘shocking behavior.’
[4] Maciocia, The Psyche in
Chinese Medicine, p. 314.
[5] [ibid.]
[6] From Unschuld, Medicine in
China: A History of Ideas, quoted in Maciocia, The Psyche in Chinese Medicine, p. 314.
[7] From Unschuld, Medicine in
China: A History of Ideas, quoted in Maciocia, The Psyche in Chinese Medicine, pp. 321-322.
[8] Translation in Unschuld,
Medicine in China: A History of Ideas, quoted in Maciocia, The Psyche in Chinese Medicine, p. 322.
The Huangdi Neijing is far and away
the best-known (and still best-read) classical source on medicine. Scholarly
opinions differ as to its dating and origins. Many place it, or parts of it, in
the first few centuries before the Christian era.
[9] The Web That Has No Weaver:Understanding Chinese Medicine. Chicago
[10] For the full discussion and source references, see Kaptchuk, pp.
54-65. The quotes from old Chinese sources are in Kaptchuk’s translation.
[11] For the particular verb ‘govern’ in this instance, see Kaptchuk,
pp. 71-72, note 27.
[12] Original New York
[13] Maciocia, p. 324. On li
in this sense, compare the Internet Encyclopedia of Philosophy’s article on
Cheng Yi 程頤 [by Wai-ying Wong, consulted 8 september 2012]: ‘The concept of li is central to Cheng Yi’s ontology.
Although not created by the Cheng brothers, it attained a core status in
Neo-Confucianism through their advocacy. Thus, Neo-Confucianism is also called
the study of li (li xue). The many facets of li are translatable in English as
“principle,” “pattern,” “reason,” or “law.” Sometimes it was used by the Chengs
as synonymous with dao, which means the path. When so used, it referred to the
path one should follow from the moral point of view. Understood as such, li
plays an action-guiding role similar to that of moral laws.’ For an
excellent study of some of these concepts and their interrelations in
neo-Confucianism, see Olaf Graf, Tao und
Jen: Sein und Sollen im sungchinesischen Monismus, Wiesbaden: Harrassowitz,
1970. See also various works written or translated by Wing-tsit Chan 陳榮傑, including Neo-Confucian Terms Explained and Reflections on Things at Hand.
[14] On this, see also Lloyd Haft, ‘Perspectives on John C. H. Wu’s
Translation of the New Testament,’ in Chloe Starr (ed.), Reading Christian Scripture in China, London
[15] See Granet’s book as a whole, and especially the chapter on ‘The
Dao.’ To my knowledge, this very important book has never been published in an
English translation.
[16] Chad Hansen, A Daoist Theory
of Chinese Thought: A Philosophical Interpretation, Oxford University Press
2000 [originally published 1992], p. 268.
[17] Chad Hansen, ‘Language in the Heart-mind,’ in Robert E. Allinson
(ed.), Understanding the Chinese Mind:
The Philosophical Roots, Oxford University Press, 1989, p. 96.
[18] Maciocia, The Psyche in
Chinese Medicine, p. 319, quoted from Huang Siu-chi, Essentials of neo-Confucianism. Westport ,
Conn. : Greenwood
[19] Maciocia, p. 319.
[20] Kaptchuk 1983, p. 26.
[21] Quoted in the front matter to his book.
[22] Kaptchuk 1983, pp. 256-257.
[23] In the German edition quoted above, pp. 23, 74.
[24] P. 23.
[25] P. 23.
[26] Original from the second volume of Needham
[27] Original from Needham
[28] Pseudonym of Zhao Zhenkai 趙振開 (1949- ). The poem, widely accessible on the internet, I believe
appeared in Bei Dao’s collection 太陽城札記 (Notes from the City of the Sun – this is also the title of a
bilingual edition with translations by Bonnie S. McDougall, Ithaca :
Cornell University
East Asia Papers: China-Japan Program, No. 34,
1983).
