The Physician-Shaman: Early Origins of Traditional Chinese Medicine
Mainfort, Donald, Skeptic (Altadena, CA)
THE EARLY HISTORY OF TRADITIONAL Chinese medicine (TCM) has been fraught with speculative and often conflicting claims. One common theme is that "thousands of years" of continuous oral and written tradition have yielded a venerable system of diagnosis and treatment that remains highly effective and is practiced today in respected medical institutions as a part of so-called "complementary" medicine.
But what, exactly, is this tradition? Though a few scattered clues have been gleaned from oracle bones, carved jade, and bronze inscriptions, the cornerstone for any study of Chinese medical history has been the Inner Canon of the Yellow Emperor (Huangdi Neijing), from the 1st century BCE. It is the basis not only of historical TCM, but for all later developments in TCM as well.
The literal translation of the title "Huangdi" ("Yellow Emperor") is misleading. An emperor did not write the Inner Canon. Inner Canon is a collection of conversations that, as legend has it, took place between one of China's ancient mystical patriarchs and his follower, the physician Qi Bo, some time before recorded history. According to legend, Huangdi lived in a magnificent palace in the Kunlun Mountains in the west with a heavenly doorkeeper who had the face of a man and the body of a tiger with nine tails. He is credited with founding the Chinese nation around 4,000 BCE--3,900 years before the Huangdi Neijing was formulated and composed. He supposedly lived to be 110 years of age, when a dragon descended from Heaven, "returning" him there "where he belonged." Recently, scholars have adopted improved translations, such as "Yellow Lord," "Yellow Sovereign," or "Yellow Thearch." The title and premise of the Inner Canon assert a direct connection to occult medical wisdom born at the dawn of Chinese civilization.
The Inner Canon of the Yellow Emperor regards disease as an imbalance of "Qi," or "vital air," in the blood vessels and prescribes treatments for healing the "imbalances" by means of acupuncture, herbal prescriptions, and other methods. (1) That such an elaborate system of medicine suddenly emerged out of a historical void has long troubled Chinese medical scholars. As with other received sources, the Inner Canon of today "has been subject to centuries of editing and revision. What remains is a collection of short passages that lack cohesion. Some passages are duplicated or reworded versions of others; some are contradictory and at odds with other entries.
The Mawangdui Discovery
In 1973, 30 silk and bamboo manuscripts were discovered in a lacquer box, entombed at Mawangdui (near Changsha, Hunan province) along with their owner, a member of the locally prominent Li faintly, who was estimated to be 30 years of age at the time of his death in 168 BCE. The recorded date of death indicates that all the manuscripts entombed with him must date from 168 BCE or earlier.
Discovered along with manuscripts on history, geography, military science, philosophy, astronomy, and divination, was a collection of medical texts predating the Inner Canon by at least a century. These represent the oldest immediate sources of early Chinese medicine. A research team of paleographers in Beijing established a modern Chinese transcription of the approximately 22,000 characters of medical text that was published in 1985. Since then, additional medical manuscripts from this period have been excavated at six other locations, some of them identical in content. (2) Despite the wide variety of documents, this important find presents an essentially consistent ideology, indicating that these texts are part of a larger tradition and not simply a collection of fragments.
As early as 400 BCE, physicians had begun adopting a written "way" of medicine, which led to a marked expansion of written works during the Han dynasty (206 BCE-9 CE). They combined occult family oral traditions of the Warring States period (475-221 BCE) and earlier, with a natural history of the period in which the modern categories of religion, magic, and science are not clearly differentiated. This "way" of medicine was strongly influenced by Daoist philosophy, principally the "Yin-Yang" and "Five Elements" concepts.
"Wuyi" was the title given to physicians of this period. The first part of the word, "Wu" refers to a religious shaman with magical ability and skill in subduing demons. "Yi" has to do with medical recipes, techniques and incantations. Important aspects of the "physician-shaman's" practice included the arts of cultivating the elite, developing a mystique, and gaining generous contributions from patrons and disciples. (3) Following Daoist alchemy, the shamans provided the wealthy with magical elixirs that promised longevity and immortality, health, and sexual prowess. There is no evidence of medical schools at that time. Information was transmitted under a vow of secrecy, customarily involving "blood oaths" with the threat of curses to insure that the information would be given only to "virtous" and "morally and intellectually fit" individuals. These books were coveted "objects of power," for both those who earned their livelihoods from them, and for their elite patrons. (4)
Writing styles indicate that most of the Mawangdui (MWD) texts date from 200 BCE and were certainly copied from works that had been in circulation at least 100 years earlier, making them the earliest extant texts to describe the structure of the human body. The texts are the direct antecedents of acupuncture, offering insights into the development of this later innovation. For example, the MWD manuscript texts speak of 11 blood vessels in the body that contain Qi, one less than the 12 vessels of Inner Canon theory. As in the Inner Canon, the vessels are divided into "Yin" (heavenly Qi), where illnesses are less likely to be serious) and "Yang" (earth, or "death" Qi). Both theories hold that healthy Qi travels downward through the body. But in the MWD texts, blood vessels had not yet been seen to be interconnected conduits (meridians) with an established set of Qi portals (acupuncture points) and no theoretical relations between vessels and the organs had yet been made.
The MWD corpus does not mention the use of acupuncture needles. Instead, treatments included cauterization to force the ailing Qi downwards. Excess Qi then escaped by use of stone probes to open up boils and abscesses. There is no mention of vessels themselves being opened for bloodletting.
Some time after 165 BCE, it was discovered that areas of the body could be pierced without producing blood. Acupuncture developed from that observation into a distinct branch of Chinese medicine. While cauterization should not be viewed as an early form of acupuncture or moxibustion (the burning of medicines on an acupuncture point,) the MWD evidence supports that cauterization, not lancing, is more likely the predecessor of these later techniques.
Breath Magic, Balneotherapy, and Other Treatments
Some examples of cauterization mentioned in the MWD texts (such as burning the crown of the head) were used as counter-irritants to distract the patient from the original complaint. Four other heat therapies consist of roasting the affected area over a fire after first applying medicines to it, hot pressing of medicines onto the skin, fumigation and balneotherapy (hot medicinal baths). One roasting therapy advises that the patient "Get drunk before beginning the therapy, which is stopped when the heat is unbearable." A fumigation recipe calls for the patient to sit over a steaming jar of medicines boiled in urine where the steam is so irritating to the throat that an antidote is included to counteract it.
If a demon invades the family kitchen, "Bum pig feces inside the house, then it will stop." To treat hemorrhoids, "Boil thoroughly one male rat in urine, hot-press with the vapor." Various incantations are prescribed to thwart "demonic insect and arachnid attacks, while "Breath magic" (the religious Daoist technique of using Qi to place spells on a patient or adversary) is mentioned along with the special art of spitting Qi from the mouth. Techniques for exorcising diseases, sometimes incorporate "rooster and snake" medicines. Some incantations refer to the disease as "it," with the understanding that "it" was a foreign entity that had invaded the patient and could be commanded to depart, or better yet, "die of terror."
Some prescriptions were tailored for phases of the sun and the moon, time of day, and the direction one was facing. In addition to the previous methods, many prescriptions were administered orally, such as two concoctions made from a woman's menstrual cloth. Blister beetles, spider webs, bats, chicken feces, copper bits, cow saliva, dandruff, dog bile, mercury, fingernails, red lizard blood and rat testes are but a few of the other listed medical ingredients. While some aspects of these magical healing techniques can be seen in the Inner Canon, its later passages express a much more "modern" attitude, downplaying the role of demons and shifting more towards herbal remedies (to treat the "internal") and acupuncture (to treat the "external").
Exercise and Fitness
In addition to treatments of existing illnesses, the MWD manuscripts also provide the earliest detailed techniques on preventive health and longevity. The techniques cover four main areas: breathing exercises, diet (including aphrodisiacs), sexual methods, and physical exercise. An illustrated series of exercise postures is included with captions that explain the different movements. Consistent with the current practice of qigong, these movements were intended to cultivate increasing amounts of Qi and to enhance male sexual performance and potency.
An Evil Wind Blows
Although there had been previous uses of the written character representation of "Qi," references to the medical concept of Qi as "vital air" in early Chinese literature date to the faith to sixth centuries BCE. The MWD texts assert that Qi circulates in the vessels. This medical interpretation of Qi emphasizes the notion of Qi as "heavenly air," or ether. The texts frequently refer to the therapeutic "Jing Qi" of heaven, where Qi is explained as an influential heavenly ether, or wind. This healthful Qi was thought to be necessary for procreation, longevity, and good health. But in addition to the life-giving Jing Qi, a malevolent, opposing variety of Qi also existed. (5) Earthly wind was believed to originate from caves and tunnels, thought also to contain demons and other unknown dangers.
"Evil winds" were thought to invade the body when some of the "poisonous air (Qi)" forced its way into a victim's airways, or acupuncture points (considered also to be small caves, or tunnels), upsetting the healthy flow of air (Qi). The fourth century BCE Lunyu confirms that Qi was considered to be even more necessary to human existence than blood. This idea that air, not blood, circulated through arteries and veins is linked to speculation about the harsh and unpredictable forces of nature and the cosmos. For example, in the work known as Guanzi (ca.350 BCE) the Earth's water systems are said to be "the blood and Qi of the Earth--like what flows through the muscles and vessels." (6)
Although the butchering of animals would certainly have provided many insights into the circulatory system, one must bear in mind the strong influence of Confucian adherence to authority, tradition and established theory. Regardless of empirical findings through trial and error, all "true" medical knowledge was thought to have emanated from the Yellow Emperor in the legendary past. This could only be comprehended in the "degenerate" present by one directly linked to the semi-divine, archaic sages. That this confusion extended into more recent times is evidenced by accounts of the Qing Dynasty anatomist Wang Qingren. In 1830 Wang published a book, Revisions of Medicine, that held to the belief that arteries carried air, not blood. To his credit, Wang fought hard for the repeal of restrictions against dissection, proclaiming that healing without knowledge of the internal organs was "like a blind man stumbling in the dark." Differing schools of thought must have held various views on just exactly how the Qi and blood act in the body. But it is clear that pulse diagnosis appeared in China around 400 B.C. and that TCM doctors believed that what they were analyzing were pulses of Qi (air), not blood.
The MWD manuscripts provide a new foundation for the early History of TCM, presenting the first clear view of a fascinating time in Chinese history when medicine rested on a competing and conjoining amalgam of magical-religious popular lore, practical experience, natural and occult philosophy. Recently excavated related materials prove that the MWD texts are not exceptional and that these ideas circulated throughout ancient China. Knowledge of demons and deities, incantations and rituals all contributed to the magical jargon of medical literature, indicating that the elite patrons of the time were much more involved in such activities than had been previously known. This set them apart from the generic beliefs of oral tradition. These books allowed the elite to glimpse some of the inner secrets of the physician-shaman's realm, enabling them to become active participants in occult culture. They reveal the theoretical development of the Inner Canon, including the advent of acupuncture.
Despite the title of the Inner Canon, such recent techniques and theory could never be linked to the "Yellow Emperor," who presumably existed some 3900 years earlier. This idea of recovering the medical wisdom of an idealized past set the process of evolution seemingly in reverse, where the ideals of high antiquity were carefully reinterpreted by shamans who deciphered the embedded codes by a process of magical induction. In this tradition, evil and heavenly winds became Qi (magic air), the principle concept on which today's TCM rests. Cauterization led to piercing with needles and then to the idea of special "caves," or acupuncture points through which the Qi could pass.
Although today's TCM doctors add electrical stimulus and the number of these points has increased, the principle of acupuncture remains essentially the same. The tradition of re-interpreting the secret meanings from by-gone eras continues today, with adherents now attempting to reconcile these beliefs with modern science. Some of the more repugnant recipes of the MWD texts have been modified to suit modern tastes, but the same theoretical concepts that guided the physician-shaman (Qi, Yin--Yang, the "Five Elements") remain as pillars of contemporary TCM. Pulse diagnosis is still used in TCM to detect problems in a patient's Qi circulation.
The growing popularity of TCM and its infusion into modern medical facilities under the guise of "complementary" medicine, demonstrates that the influences of occur tradition and practice remain deeply entrenched and defended.
(1.) Unschuld, P. 1985. Medicine in China: A History of Ideas. Berkeley: University of California Press, 71-76.
(2.) Harper, Donald. 1998. Early Chinese Medical Literature. London: Kegan Paul, 30-36, 9, 55-57, 19-21, 81, 91-94, 159-165, 477-510, 126-127, 77, 137-138, 77.
(3:) Sima Qian. 1975. Shiji. Taibei: Xinwenfang chuban gongsi, (ca. 145-ca. 86 BC). (Reproduction of 1739 Palace wood, block ed.), 28.10b.
(4.) Sivin, N. 1999. Text and Experience in Classical Chinese Medicine, 1-2.
(5.) Yuan, Z. 1991. The Ancient Chinese Exploration of Vital Energy Effect on the Formation of Qi Theory in the Huangdi Neijing, Heilongjiang: Chinese Medical University of Heilongjiang Press.
(6.) Guanzi. Fourth to first centuries B.C. Zhuzi Jicheng ed, 39, 14-23.…
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Publication information: Article title: The Physician-Shaman: Early Origins of Traditional Chinese Medicine. Contributors: Mainfort, Donald - Author. Magazine title: Skeptic (Altadena, CA). Volume: 11. Issue: 1 Publication date: Spring 2004. Page number: 36+. © 2009 Skeptics Society & Skeptic Magazine. COPYRIGHT 2004 Gale Group.
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