II.2 Concepts of Disease in East Asia

In the inscriptions that record the divinations of Shang dynasty China (eighteenth to eleventh centu­ries B.C.), we find a number of diagnostic queries like this: “Divining this tooth affliction.

Disease thus first appears in China embodied in dangerous others, as a menace from without. After the Shang dynasty, the focus of concern would broaden and shift from disgruntled ancestors to para­sites and poisons, demons and witchcraft spells. But whomever or whatever the Chinese accused of inspir­ing sickness, the defining feature of the earliest con­ceptions of disease was their independence from a conception of the body. In other words, the peculiari­ties of an individual’s somatic condition were no more relevant to understanding a fever or a tooth­ache than they were for explaining why one’s crops were destroyed in a storm. The fact that an affliction happened to attack the body was incidental. The vengeful spirits that brought sickness could just as easily have inflicted drought and famine.

This accounts in part for why a collection of cures such as the Wushier bing fang (Recipes for fifty-two ailments) of the late third century B.C. tells us so much, on the one hand, about noxious demons and the techniques for exorcizing them and teaches us so little, on the other hand, about the afflicted body itself (Harper 1982). For whether a shaman literally beat the disease out of the patient or appealed to benevolent divinities for assistance, whether de­mons were coaxed out with magical formulas or transferred sympathetically to other objects, the treatment of disease, like the diagnosis, concen­trated on agents alien to the self.

This was a remarkably influential vision of dis­ease. For instance, a dictionary of the later Han dynasty (25-220), the Shiming, glosses yi (epidemic disease) as yi (corvee), explaining that diseases were the corvee imposed on humans by demons. From the Sui (581-618) through the Yuan (1279­1368) dynasties, professors and masters of exor- cistic rituals and incantations {zhoujin) constituted a part of the official medical bureaucracy, alongside professors of such other medical specialties as acu­puncture and massage (Kano 1987). At a more popu­lar level, the folklore of medieval Japan abounds in accounts of beguiling fox spirits that seduce or pos­sess young men and women and cause them to waste away, go mad, or die (Veith 1965). And even today, a Korean shaman will acknowledge in his healing chant “ghosts of the drowned, ghosts who were shot... maiden ghosts, bachelor ghosts” (Ken­dall 1985).

In the evolution of East Asian disease conceptions, therefore, the imagination of menacing outsiders rep­resents not a transient stage of superstitions, which the rise of philosophy would supersede, but a the­matic pole to which reflection on sickness would re­peatedly return. At the same time, by the late Zhou (770-403 B.C.) and Warring States (403-221 B.C.) periods, suspicions of supernatural mischief were al­ready slipping from the intellectual mainstream. In the philosophical ferment of these periods, a new conception of disease was emerging - one that would seek the origins of sickness not in the whims of some dangerous other, but in the desires of the self.

In the late Zhou and Warring States periods, disease became a reflection of somatic condition, and so­matic condition, a reflection of the self. For the Con­fucian and Taoist philosophers of this era, the body was the dynamic product of experience, a reality continually shaped and reshaped by how one was living and had lived. Shen, “the body,” was the same shen emphasized by the ideals of xiushen, “self­cultivation,” and deshen, “self-possession”: It was the embodied self, a lifetime of decisions and indeci­sions made manifest.

The failings of the body, therefore, were insepara­ble from failures of self-mastery. Sickness in this view had little to do with ancestral ire or demonic cruelty. It arose principally from within, from im­moderation and carelessness, from gluttony and overexertion, from protracted grief and explosive an­ger, and sometimes from the mere imagination of dangers. One man falls ill after experiencing a terri­fying dream and is cured only when a clever physi­cian suggests that the dream was one reserved for future kings. Another suffers severe cramps after being compelled to drink a cup of wine in which he thinks he sees a snake. Only when he is made to realize that what he saw in the wine was merely the reflection of an archer’s bow hanging on the wall does he recover (Li 1960). The close identification of body and self went hand in hand with a subtle aware­ness of the many ways in which human beings could make themselves sick.

According to the most devoted and influential stu­dents of the body, however, the real essence of dis­ease was depletion. The experts of yangsheng, or “the cultivation of life,” envisaged the body as the container of a precious and finite vitality. If properly conserved, this vitality could sustain one for a hun­dred years, free of all affliction, and free even of the ravages of age. True health found its proof in ever­youthful longevity. If most people succumbed to dis­abilities and senescence, and died before reaching their hundredth year, if most, in short, were sick, it was because they depleted the body by squandering this vitality.

Ghosts and malevolent spirits were not involved. Yet the body was still surrounded by enemies. Early historical and philosophical texts refer frequently to individuals struck down by wind or cold, rain or scorching heat. Wind and cold especially loomed large as noxious forces. To winds fell the blame for afflictions ranging from sneezing and headaches to paralysis and madness, and proverbial wisdom would soon have it that “the myriad ailments all arise from wind.” As for cold, the study of the fever­ish disorders to which it gave rise would eventually become the subject of the most influential treatise of the pharmacological tradition, Zhang Ji’s Shanghan Iun (Treatise on cold afflictions), written around the end of the second century.

But wind and cold differed from demons and spir­its in one critical respect: Their pathogenic char­acter was contingent on the condition of the body. They would invade only when the body was vulnera­ble, or more precisely, depleted. As the Lingshu of the Han dynasty later explained: “Unless there is depletion, wind, rain, cold and heat cannot, by them­selves, injure a person. A person who suddenly en­counters brisk winds or violent rains and yet does not become ill is a person without depletion” (Chen 1977). In a body brimming with vitality there was no room for noxious influences to enter.

The depletion of vitality was thus doubly noxious. It left one vulnerable to the virulence of wind, cold, and other climatic pathogens. More immediately, however, depletion was itself a form of sickness, a diminution of possibilities: It meant that even with­out the intrusion of alien influences the senses and limbs that should be strong and unimpaired until age 100 might already be weak or failing at age 50 or 60.

The leitmotif of yangsheng reflection on the body, therefore, was bao, “preservation” — “preserving the body” (6αo shen), “preserving the vital essence” (bao zhen), “preserving life” {bao sheng). To main­tain the body intact, to protect it against attacks from without by carefully conserving and contain­ing vitality within - such was the heart of the “cul­tivation of life.” But preservation was difficult. A considerable disparity separated the attentions re­quired to preserve vitality and the ease with which it slipped away, for preservation demanded concen­tration whereas the outflow of vitality often accom­panied the experience of pleasure.

This was most apparent in sexual intercourse. Al­ready in the sixth century B.C., we find a physician tracing the illness of the duke of Jin to his fre- quentation of concubines (Li 1960). Later Chinese and Japanese writings on regimen would even spec­ify the precise number of times per month or year to which intercourse should be limited (Kaibara 1974). On few points would opinion be as unanimous: Se­men was the distilled essence of life, and there could be no surer path to debility and early death than to exhaust one’s supply in frequent intercourse. Al­though moral strictures against pleasure per se were rare, philosophers and physicians constantly warned against the physical drain of sexual indulgence. It is revealing that the response in classical China to the temptations of the flesh was not mortification, but rather the art of the bedroom (fangzhong) — psycho­physical techniques centered around the prevention of ejaculation and the “recycling” of semen within the body (Van Gulik 1974).

The expenditure of vital essence in intercourse was, however, just one form of the intertwining of desire and depletion. Vitality could slip away from all the orifices: It flowed out of the eyes as one became absorbed in beautiful sights, and from ears as one lost oneself in rapturous harmonies. The ori­fices were, the Huainan zi explained, “the windows of the vital spirit,” and when the eyes and ears dwelled on pleasures of sight and sound, this vital spirit streamed outward, depleting the body and in­viting affliction (Liu 1965). This movement of the spirit toward the desired object was the very essence of desire. Literally, as well as figuratively, desire entailed a loss of self: Physical depletion and lapses in self-possession were just different views of the unique phenomenon of sickness. Conversely, somatic integrity and emotional self-mastery coalesced in the notion of health.

The secret of health thus lay in a mind devoid of desire. Such was the lesson of the “cultivation of life” in the Warring States period; and such also was the lesson of medical theory as it first crystallized in the classical treatises of the Han dynasty (206 B.C. to A.D. 220). But in the latter case the meaning of the lesson was more complex, because the meaning of disease was more complex.

Classical medicine yoked together what were in fact two conflicting images of the body and its afflictions. On the one hand, the key theoretical treatises of the Han dynasty - the Huangdi neijing, consisting of the Suwen and the Lingshu, and the Nanjing- perpetuated yangsheng intuitions of the vital self warding off the dangers of the world around it. Body was clearly separated from nonbody by the protec­tive barrier of the skin, which both sealed in vitality and kept out noxious winds and cold. The two key terms of etiologic analysis, depletion and repletion, preserved in their definitions the distinction be­tween what is healthy and proper to the body (zheng) and what is pathogenic and alien to it (xie)∙. Deple­tion (xu) was a “deficiency in the body’s vitality (zhengqi),” repletion (shi), an “excess of noxious in­fluences (xieqi)."

Yet already in these definitions a new and alterna­tive conception of disease was clearly emerging for the main distinction between depletion and reple­tion was not the opposition of inner and outer, but rather the complementary nature of deficiency and excess. Subtly, but surely, the earlier rhetoric of de­fense and attack was giving way to the new logic of balance and compensation; fears of threatening out­siders were being supplemented, and to an extent supplanted, by a conception of disease as unequal distribution.

In the schemes that articulated the emerging etiol­ogy of imbalance (the dialectic of yin and yang and the five-phase cycle [wuxing] of wood, fire, earth, metal, and water), the dichotomy of body and nonbody had little significance. Cosmic events and somatic events figured on the same plane: Deep grief could cause the repletion of yin and the depletion of yang, but so too could winter cold; a state of replete wood and depleted earth might involve a hyperac­tive liver (a wood organ), but it might also stem from easterly winds (also associated with wood). More­over, both body and nonbody were subject to the same universal law of rhythmic change, the alterna­tion of hot (yang) and cold (yin), the cycle of spring (wood), summer (fire), fall (metal), and winter (wa­ter). With indefinite and infinitely permeable bound­aries, the body was seamlessly fused to a world cease­lessly transforming itself (Chiu 1986).

Disease in the Han dynasty became above all a seasonal phenomenon. Earlier observers had al­ready recognized that different afflictions tended to characterize different seasons. The Zhou H (Rituals of the Zhou dynasty) observed, for instance, that headaches were prevalent in spring, whereas sum­mer was characterized by the spread of scabieslike itching, autumn by malarial and other fevers, and winter by respiratory disorders (Lu and Needham 1967). Also widely noted was the fact that the same climatic pathogens of wind and cold had different effects in different seasons. Unseasonal weather, such as cold in summer, posed special dangers and often engendered epidemics.

The Han medical classics, however, went further and situated the seasonality of disease in the sea­sonality of the human body itself. According to the Nanjing, the most vigorous organ in spring should be the liver; in summer the heart should dominate; in autumn the lungs; and in winter the kidneys. In spring the pulse should begin to rise, gently, but growing like the first primaveral shoots; in summer it should be strong and overflowing; in autumn it should be slower and more constricted; and in winter it should lie deep as if in hibernation. To the discern­ing physician, each season exhibited its distinct physiology, and it was only with respect to this sea­sonal physiology that the standards separating health from sickness could be defined. The same signs, considered perfectly normal for one season, might certify disease in another.

Health, therefore, was a state of dynamic at- tunement in which the directions of an individual’s energies paralleled the ebb and flow of the cosmos as a whole. For every season there were appropriate foods, appropriate activities, and even appropriate feelings. For example, in spring, the Huangdi neijing advised:

The myriad things flourish, engendered by heaven and earth together. Going to sleep at nightfall one should get up early and stride leisurely in the garden. Letting down one’s hair and putting oneself at ease, one should give rise to ambitions. Engender and do not kill. Give and do not take away. Reward and do not punish. This is what is appropriate to the spirit of spring. (Chen 1977)

Failure to follow the spirit of the season, motivations and actions out of phase with cosmic transformation, resulted in deficiencies and excesses of yin and yang and the five phases, that is, in disease. The principle governing health and sickness was thus simple: Those who followed the flow (xuri) flourished; those who opposed it, fell ill or died.

As part of the cosmos, human beings were natu­rally attuned to seasonal rhythms. Yet this at- tunement, like the intact body prized by proponents of yangsheng, was an ideal frequently compromised in actuality by unruly passions. The Lushi chunqiu explained: “What fosters life is following the flow (xzzn); but what causes life to depart from the flow (bu xun) is desire” (Li 1960). Desire here referred not to the depletion of vitality, but to disruptions in the smooth and balanced circulation of influences, to rigid attachments that resisted cosmic rhythms, and to impulses that deviated from the directions of sea­sonal change. If desire in the etiology of depletion implied a partial loss of self, desire in the etiology of imbalance entailed forgetting that the self was but one part of a much larger, ever-evolving world.

The cosmic dimensions of Han medical thought mirrored the expansive ambitions of the first great age of universal empire. In the same way that the political vision of universal empire would survive the rise and fall of subsequent dynasties, so the vision of the body as a seasonal microcosm would continue, along with yangsheng ideals of somatic integrity, to define medical orthodoxy for nearly two millennia. Yet the views of orthodox physicians did not by any means represent the views of all. In the chaos of the disintegrating Han empire, there emerged an alternative approach to illness that had a far greater and immediate impact on the popular imagination - an approach concerned not with the cosmic systems, but with individual morality and its consequences.

Intimations of sickness as punishment can be traced as far back as Shang fears of ancestral ire, and the moral failings of more than one emperor in the early Han dynasty (206 B.C. to A.D. 8) would be blamed later for the epidemics that devastated their people. But especially in the late Han dynasty (25-220), with the rise of religious Taoism, and the Six Dynas­ties (222-589) period, with the influx of Buddhism, the equation of sickness and personal transgression came to pervade popular consciousness (Kano 1987). With the diffusion of these religions, reflection on disease assumed an introspective aspect as religious healing turned increasingly toward the scrutiny of personal memory and conscience.

Zhang Lu, leader of a Taoist rebellion in the early third century, thus required the ailing first to spend time in a “chamber of silence,” where they explored their consciences for the possible transgressions un­derlying their afflictions. Disease was the result of past sins, and recovery required the confession of these sins (Unschuld 1985). The Buddhist concept of karmic disease (yebing) also traced sickness (bing) to an individual’s past actions (Sanskrit, karma; Chi­nese, ye). Karmic analysis diverged somewhat from Taoist intuitions in that these actions might go back many reincarnations, beyond conscious recall and beyond confession — thus explaining such puzzling phenomena as congenital diseases and the afflic­tions of the virtuous. But in the popular understand­ing, Buddhist precepts of karmic consequence and Taoist teachings of sickness and sin tended to co­alesce into the same basic lessons: Good actions are rewarded, and misbehavior eventually punished; the ailments of today have their origins in the wrong­doings of yesterday.

Folk religion frequently framed these lessons in a divine bureaucracy. Unlike the often-unpredictable ancestral spirits of the Shang, the divinities of Han and Six Dynasties religion frequently resembled gov­ernment officials, keeping track of a moral ledger of good and evil deeds (Eberhard 1967). For each trans­gression, appropriate afflictions were imposed, and days were detracted from one’s allotted lifetime; meritorious acts, conversely, earned relief from sick­ness, and the restoration of longevity. The bureau­cratic regularity of this scheme even allowed the early fourth-century Taoist Ge Hong to specify the number of days subtracted from one’s life for each level of demerit.

The idea of moral accounting also formed the core of what was perhaps the most intriguing conception of disease in medieval East Asia, namely the theory of the body’s three “corpses,” or shi. Originating in China no later than the early fourth century and attaining its mature form by the Tang dynasty (618- 907), this belief posited the existence of three small creatures (shi) who inhabited various regions of the body and who recorded all the individual’s evil yearn­ings and deeds. Then, once every 60 days, on the gengshen night of the astrological cycle, these shi would leave the body while the person slept, and fly up into heaven. There they would report to the heav­enly emperor (shangdi) on the wrongdoings that they had witnessed, and the heavenly emperor would mete out punishment in the form of disease and shortened life. It was thus imperative for all who hoped to escape illness and live long lives to somehow restrain or purge these shi.

This was the origin of the custom whereby entire communities gathered together on gengshen night and stayed up until dawn to prevent the shi from escaping the body. The custom had many variants: Some villages would spend the night reciting Lao Zi’s Daode jing; others would revel in drink and merriment; and in eighth-century Japan the impor­tation of the three-s∕ιi theory gave Heian aristocrats an excuse for all-night music and poetry competi­tions. Although some philosophers, like Liu Zong- yuan, denounced the idea of the shi as superstition, gengshen practices flourished and spread through­out East Asia, surviving in rural areas well into the twentieth century (Kubo 1961).

The popularity of three-sλi etiology derived in no small part from the fact that it united many streams of East Asian reflection on disease. Though the three shi were originally conceived as small humanoids, they quickly became assimilated into traditions go­ing back to the Shang about the infestation of the body by parasites and poisonous insects, and the same drugs were used against them as were habitu­ally used to purge parasites. The notion that they would betray one only on particular nights fed, of course, into Inedicoastrological associations of health and cosmic rhythm. And in their role as keepers of the moral ledger, the three shi internalized the account­ing of merits and demerits that linked sickness to sin.

Finally, the theory of the three shi reaffirmed the conviction that sickness was somehow tied to de­sire. According to some accounts, it was the pres­ence of these shi that explained the pullulation of desires in the human heart; other accounts, con­versely, stressed how killing off desire was the only way the shi could be exterminated. But all accounts of the shi and their dangers underlined their inti­mate connection to human beings as creatures of passion. Sickness and desire, which had, with differ­ent implications, been tied together by the yang- sheng thinkers of the Warring States period and by the medical classics of the Han dynasty, were again united in medieval religion.

The physicians of the Song (960-1126) and Yuan (1279-1368) dynasties inherited a tradition of medi­cine that knew disease under two guises. On the one hand, there was the disease of theory, sickness as elucidated by the complementarity of somatic deple­tion and alien intrusion and by the system of yin and yang and the five phases. On the other hand, there was disease as it had been observed and experienced by physicians and patients over the course of a mil­lennium. As evidenced by the sprawling seventh­century nosological compendium of Chao Yuanfang, the Zhubing yuanhou Iun (On the origins and symp­toms of all diseases), this tradition was protean and unwieldy, with seemingly limitless combinations of ever-diverse symptoms (Chao 1955). A great dis­tance separated the perspicuity of theory from the dense tangle of experience. The key theme of Song and Yuan reflection on disease was the quest to reduce that distance.

The quest translated into two basic strategies. One strategy aimed at refining the classical etiology of depletion. Although recognizing that a complex variety of factors converged in the genesis of disease, many physicians from the Song and Yuan periods onward nonetheless sought to isolate a single crux of vulnerability. Li Gao, for instance, argued in the thirteenth century that “the hundred illnessess all arise from [disorders of] the spleen and stomach” (Beijing zhonqui xueyuan 1978). By contrast, his contemporary Wang Haogu sought the predisposing origins of sickness in depleted kidneys (conceived as the repository of semen), whereas Zhu Zhenheng of the fourteenth century focused on the tendency of human beings to experience “a superfluity of the yang element, and a deficiency of the yin” (Beijing zhonqui xueyuan). Later, in the Ming (1368-1662) and Qing (1662-1912) dynasties, still other physi­cians would blame the depletion of a variously de­fined organ known as the “gate of life” (mingmeri) (Beijing zhongyi xueyuan 1978).

The other strategy sought to extend the classical etiology of imbalance, to articulate exhaustively the paradigms of yin and yang and the five phases so that they might provide a more adequate language for describing the rich variability of symptoms and syndromes. This produced a highly abstract perspec­tive, which translated the concrete pathogens of wind, cold, and heat into the transparent logic of dialectical balance and seasonal rhythms; but it also produced a more unified approach to disease.

Whereas in Han medicine the marriage of the etiology of imbalance with the etiology of depletion had been at best an uneasy alliance, their strategic extensions in Song and Yuan medicine often blended smoothly together. Thus, desire, without entirely los­ing its long-standing associations with the depleting outflow of vitality, was recast as yang fire. Zhu Zhenheng^,s identification of the crux of vulnerabil­ity in excess yang and deficient yin referred, among other things, to the propensity of emotional agita­tion (yang) to predominate over rest and collected self-possession (yin). For him it was especially the inner feverishness (fire) generated by the tumult of passions that dispersed and dried up the moist vital essence (water) and gave rise to depletion. Similarly, Li Gao, who insisted on sound digestion as the pivot of sickness and health, analyzed the critical impact of emotional unrest in terms of the effect of fire (passions) on the earth-associated organs of the spleen and stomach. By translating in this way the analysis of depletion into the schemes of yin and yang and the five phases, these physicians framed the understanding of disease in a single comprehen­sive and integrated system.

The new technology of printing ensured the broad dissemination of Song and Yuan medical treatises, and these were assiduously studied not only by Chi­nese physicians in the Ming and Qing dynasties, but also by their counterparts in Yi dynasty Korea (1392-1910) and Tokugawa Japan (1600-1868) (Fujikawa 1980). No small part of the persisting myth of Chinese medicine as based on a timeless, monolithic theory is due to the resultant identifica­tion, throughout East Asia, of medicine with the systematizing tradition established by Song and Yuan physicians.

In reality, of course, Song and Yuan medicine it­self comprised many diverging viewpoints, and sub­sequent periods witnessed a widening spectrum of ideas. Zhang Congzheng at the turn of the thir­teenth century, for instance, rejected the prevailing focus on inner depletion and attunement and urged that intrusive attack was the primary fact of dis­ease. His nosology, accordingly, recognized six basic kinds of disease, corresponding to the six climatic pathogens of wind, cold, fire, humidity, dryness, and heat. Later, in extensive investigations into epidem­ics in the Qing dynasty, Wu Youxing, boro just be­fore the middle of the seventh century, and Wu Tang, boro a century later, probed even deeper into extrin­sic causation. They distinguished between common­place infiltrations of cold and other climatic agents, which occurred through the pores, and epidemic fi­ery afflictions (wenbing), which entered through the mouth and nose (Beijing zhongyi xueyan 1978).

Beyond China’s borders, there were outright crit­ics as well as devoted followers of this Systemizing tradition. In the late seventeenth and eighteenth centuries, the Ancient Practice school (kohoha) of Japanese medicine rallied specifically around the overthrow of the Song-Yuan spirit of system. It in­spired some radical conceptions of disease, such as Yoshimasu Todo’s eighteenth-century theory that all disease arises from one poison and Goto Konzan^,s earlier notion that all disease results from stagna­tion in the flow of vital energy (Fujikawa 1980). Although these theories themselves did not have a lasting impact, the critical ferment they represented inspired physicians and scholars in late-eighteenth- century Japan to undertake the first serious studies of Western medicine in East Asia.

Students of medicine and health care in contempo­rary East Asia have stressed the persisting plurality of disease conceptions (Kleinman et at. 1975; Leslie 1976). As in the past, the advent of new approaches to disease, and in particular the introduction of ideas from the West, has led not to the abandonment of traditional assumptions, but simply to a more com­plex skein of beliefs and practices.

Some aspects of medical pluralism are obvious. A Korean healer who specializes in exorcizing noxious spirits may also refer patients to acupuncturists and hospitals (Kendall 1985). Acupuncture texts pub­lished in Taiwan today habitually refer to both the nosology of cosmopolitan medicine and the language of yin and yang.

There are also subtler forms of syncretism. The ostracism of tuberculosis patients and their families in early-twentieth-century Japan, for example, com­bined a vague understanding of modern theories of infection and heredity with traditional notions of contagious pollution and sickness as sin (Namihira 1984; Johnston 1987). But perhaps the most intrigu­ing manifestations of the ever-present past have to do with the actual experience of illness.

Medical anthropologists have observed that pa­tients in East Asia tend to experience all illness as illnesses of the body. That is, whereas a North Ameri­can patient might complain principally of anxiety or depression, a Chinese patient will complain rather of palpitations, digestive disorders, or suffocating sensations in the chest (men), focusing on physical rather than emotional symptoms. Moreover, rather than seeking psychological explanations such as stress or frustration, Chinese and Japanese patients manifest a distinct preference for understanding dis­eases in terms of climatic and somatic etiologies - chilling wind, change of seasons, sagging stomach, acidic blood, imbalance in the autonomic nervous system, or simply weak nerves (Kleinman 1980; Ohnuki-Tierney 1984).

Such concepts as the autonomic nervous system and blood pH derive, of course, from modem science, but the general attachment to somatic symptoms and analyses surely goes back thousands of years. Desires and emotions figured centrally in tradi­tional East Asian conceptions of disease, but they were never based in some disembodied psyche. They were invariably intertwined with somatic experi­ence. Thus anger, for Han physicians, entailed the rise of the vital spirit, fear the sinking of the spirit, joy its relaxation, and grief its dissipation. The yangsheng thinkers before them saw self-possessed freedom from desire and the physical containment of vitality as one and the same reality. If, as anthropolo­gists report, patients in East Asia manifest an un­usual sensitivity to and interest in the body, this sensitivity and interest are perhaps related to a long cultural tradition that conceived of the body as the dynamic product of lived life, that is, as the embod­ied self.

Shigehisa Kuriyama

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