The Final Centuries of the Imperial Age

If the Han dynasty was marked by the initial devel­opment of Chinese medicine, the Song-Chin-Yiian period was the second most dynamic formative pe­riod in the history of Chinese medicine.

The second millennium of Chinese medical his­tory was characterized by the attempts of individ­ual authors to reconcile their own observations and experiences with the ancient theoretical guidelines. One of the first to suggest a reductionist etiology was Liu Wan-su, a twelfth-century physician who proposed that most illnesses were caused by too much heat and who advocated cooling therapies. Chang Ts’ung-cheng, a few decades later, saw the main course of human illnesses as an intrusion of “evil influences,” and he founded a school emphasiz­ing “attack and purging” in therapy. His near con­temporary, Li Kao, in contrast, thought that most illnesses were a result of a failure of spleen and stomach to perform their presumed digestive func­tions, and he advocated supplementation of these two units as a basic therapy. None of these schools, or any other of the many opinions published in subsequent centuries, achieved even temporary dominance. Hence, a proliferation of individual per­spectives characterized the history of Chinese medi­cine during these final centuries rather than a suc­cession of generally acknowledged paradigms.

This does not mean, however, that this period lacked brilliance; several authors made contribu­tions to their respective fields that were never sur­passed. The Pen-ts’ao kang mu (Materia medica ar­ranged according to drug descriptions and technical aspects) of 1596 by Li Shih-chen is a most impressive encyclopedia of pharmaceutics touching on many realms of natural science. It contains more than 1,800 drug monographs and more than 11,000 pre­scriptions in 52 volumes. In 1601 Yang Chi-chou published his Chen-chiu ta-ch’eng (Complete presen­tation of needling and cauterization) in 10 volumes, offering a valuable survey of the literature and vari­ous schools of acupuncture and moxibustion, which is cauterization by the burning of a tuft of a combus­tible substance (moxa) on the skin (including a chap­ter on pediatric massage), of the preceding one and a half millennia.

Yet despite such monumental works, the dynam­ics of Chinese medical history appear to have slowed down subsequently. When in 1757 one of the most brilliant physician-intellectuals of the second millen­nium, Hsii Ta-ch’un, wrote his I-hsiieh yuan Hu Iun (On the origins and history of medicine), he recorded a deplorable “loss of tradition” in virtually every respect of theoretical and clinical health care.

The work of Hsii Ta-ch’un, who died in the same year, 1771, as Giovanni Battista Morgagni, the au­thor of De Sedibus et Causis Morborum (On the seats and causes of diseases), illustrates the fact that tradi­tional Chinese medicine, traditional European medi­cine, and even modern Western medicine have more basic theoretical foundations in common than is usu­ally believed. Hsu Ta-ch’un, a conservative who was not influenced by Western thought and was a sharp critic of the influences of Song-Chin-Yiian thought on medicine, nonetheless wrote treatises on “intra­abdominal ulcers” and, following a long tradition of military metaphors, compared the use of drugs to the use of soldiers. One may assume that he would have had few difficulties in communicating with his contemporary Morgagni or in understanding Western medicine as it later developed.

Given the internal fragmentation of traditional Chinese medicine and the fact that it contained many of the theoretical foundations of modern Euro­pean and U.S. medicine, it should be no surprise that the latter was quickly accepted in China early in the twentieth century, a process stimulated by a feeling shared by many Chinese that a decent existence could be achieved only by employing Western sci­ence and technology. Only during the past four de­cades has there been a reassessment of the value of traditional medicine in China.

For decades, traditional Chinese medicine was held in contempt by virtually all prominent Chinese Marxist thinkers. In the 1950s and 1960s, however, it became apparent that Western medicine, with its emphasis on expertise and its many tenets that con­tradicted those of dialectical materialism, could not be fully integrated into a socialist society, and Chi­nese medicine was suddenly perceived to be a politi­cal tool. Chinese Marxist dogmatists began to point out the antagonism between Western medicine, so- called bourgeois metaphysics, and individualism, on one side, and dialectical materialism and traditional Chinese medicine, on the other. Whereas the com­plex formulas of traditional Chinese pharmaceutics could not be explained by modern pharmacology, the second law of dialectics as formulated by Friedrich Engels offered a satisfactory theoretical foundation.

Similarly, acupuncture anesthesia resisted modern scientific explanation, but could be understood on the basis of the dialectics of internal contradiction. Since the demise of the Cultural Revolution, such theoretical reinterpretations of traditional Chinese medicine have coexisted in China with Western medicine, with the latter dominant on virtually all levels of health care.

Efforts to preserve Chinese medicine include at­tempts to select those facets of that heterogeneous tradition that appear to form a coherent system, that are thought to supplement Western medicine, and that are not considered superstitious. Research on the scientific basis of traditional Chinese medicine is being pursued on many levels. Veteran doctors, how­ever, prefer a continuation of traditional Chinese medicine in its own right. Although the dialogue between Western medicine and Chinese medicine goes on, not without tension, the Chinese population turns to both, selecting whatever it considers best for a specific problem.

Paul U. Unschuld