About the Origin of Chinese Medicine
This article is about the quest for the origins of Chinese medicine, a topic that sparks many discussions. Particularly when it comes to its perceived magical aspects. However, there should be nothing inherently magical about Chinese medicine. It should primarily be scientific and explainable based on Western theoretical models. Not everyone is happy with this approach, as Eric Marié (1), president of the “Conseil Académique Francais de la medicine chinoise,” confirms. He argues that it is absurd to subject Chinese medicine to a methodology designed by and for Western medicine. This not only leads to the loss of Chinese medicine’s identity but also discourages researchers from developing alternative methodologies that are compatible with the fundamental principles of Chinese medicine.
However, this dichotomy is a relatively recent development. It was only in the 19th century that the theory of microorganisms emerged (2), becoming the foundation of Western biomedicine. Since the focus was on microorganisms as the primary cause of disease, combating or eliminating these organisms became a primary objective of Western medicine. Consequently, Western medicine is mainly focused on disease eradication and surgical interventions. Islam N. (3) acknowledges Mr. Marié’s viewpoint, stating that the standardization of medical diagnosis and treatment, a core aspect of Western biomedicine, differs considerably from that of Chinese medicine. In the West, standard treatments are applied to specific groups of diseases, whereas historically, Chinese medicine does not undergo such standardization because it recognizes the uniqueness of each individual and situation. However, historically speaking, this difference is not a given. Considering that Western medicine has evolved from the Greco-Roman tradition, as evidenced by the continued use of the Hippocratic oath, we can see that East and West were not so different. Jackson (4) eloquently demonstrates how Asian, Indian, Egyptian, and Greco-Roman perspectives on disease and health share similar elements. While all traditions are familiar with surgical interventions, they all prioritize preventive guidelines concerning diet, exercise, lifestyle advice, and accounting for the influence of the environment and seasons.
Finding balance in the humoral or energetic system is characteristic of all these traditions.
In China, the concept of yin-yang balance is known, while Ayurveda recognizes the balance of the three doshas. In Greek medicine, they refer to the balance of the four humors or bodily fluids: yellow and black bile, blood, and phlegm. It is noteworthy that, similar to Chinese medicine, there is a correlation between color, seasons, organs, etc. in the Greek-Roman tradition. They also establish a connection between the four humors and the elements (fire, water, air, and earth), the primary qualities (hot, dry, cold, and wet), emotions, and seasons. Balance was indeed a core concept in explaining the capacities of the individual, society, and the cosmos, as well as understanding health and disease.(5)
However, it is not surprising to mention the concept of magic when discussing Chinese medicine and medicine in general. Both Eastern and Western cultures have historically embraced religion, magic, alchemy, and astrology alongside the use of herbs, healing rituals, or offerings to gods to alleviate illness and poverty. The involvement of “Spirits” has always played a central role, regardless of how one chooses to interpret them. In Chinese Medicine specifically, it revolves around Jing, Qi, and Shen, with Shen being linked to the emotional, mental, supernatural, and spiritual aspects of humans, as described by Michunovic. As Jackson points out, “While science can uncover the mechanisms underlying patterns of health and disease, it is the humanities that effectively reveal the meaning of experiencing pain and suffering.” The recognition of the metaphysical in the world is a fundamental concept in Chinese and Indian medicine. It is no coincidence that the Huang Di Nei Jing, considered one of the most important classics in the field, consists of two parts: the Suwen (Plain Questions) and the Lingshu (Spiritual Pivots).
That means that the spiritual aspect is an essential concept when discussing illness and health.
That is not so surprising, by the way. In Egypt (11), doctors were often educated and employed within the “Healing Temples.” This was not unique to Egypt but also present in our own Greco-Roman tradition. It was common for patients to visit the “asklepion” – dedicated to the Greek god of healing, Asklepius – in addition to receiving secular treatment. In both cultures, patients were expected to combine their treatment with making offerings to the gods. The natural and holistic Hippocratic approach was mixed with magical-religious, astrological, and folk medicine (12). This combination, as mentioned earlier, was prevalent in the way most cultures approached illness and health.
People have visited – and still do visit – a variety of professions in search of a solution to their problems. These professions included doctors, physical trainers, herbalists, astrologers, midwives, shamans, fortune-tellers, priests, pharmacists, quacks, and charlatans (13). Among all of these, shamans emerge as the earliest practitioners of medicine. Nearly all sources mention shamanism as the origin of medicine (14). Michunovic (15) goes even further to claim that all cultures originated from a form of shamanistic culture. He finds it undeniable that the practices of shamans form the foundation of Chinese medicine. Similar to shamans, it was a well-known phenomenon that Chinese physicians possessed a certain degree of supernatural powers. One of the key ideas in Chinese medicine is the concept of Heaven, Human, and Earth, which according to Eckman (16) is a concept derived from shamanistic thought. The role of the shaman, acting as an intermediary between heaven and earth, required possessing supernatural powers, as they negotiated with spirits from above and below about the fate of the patient (17). We won’t delve further into the presence or absence of such powers in physicians. What we can say with certainty is that in almost all cultures, a physician needed to have a broader education than just knowledge of the body or mind. According to tradition, a physician had to be a true friend, a philosopher, and a guide in both the spiritual and material aspects of a patient’s life (18). As beautifully expressed by Marié (19), “In addition to intellectual qualities, a degree of personal sensitivity must be developed to comprehend the deeper meaning.”
The Shaman might actually have been the first acupuncturist. Initially, there is the ancient character for “physician” or ‘I’, as explained by both Eckman and Schiffeler (20). The character consists of different components that tell the story of the Shaman using weapons (arrows) to destroy or expel the demons that cause illness. However, the character would later change, and the task of dancing the ‘Wu’ was replaced by the symbol for wine, emphasizing the administration of medicinal drinks. According to Eckman, this change was mainly due to the declining social status of the Shaman.
The original form of acupuncture may have been based on the expulsion of spirits or demons.
The involvement of demonology is not surprising when we consider that illness was often seen as caused by the entrance or absence of a demon or evil spirit in the body (21.) In 493 AD, an Imperial Medical College was established with departments such as Internal and External Medicine, Acupuncture and Moxibustion, Massage, and Demonology (22). In this sense, exorcism was a form of medical intervention. According to Eckman (23), this aspect was never separate from the practice of acupuncture until the early 20th century. It is no coincidence that the despiritualization of acupuncture in Communist China coincided with the banning of shamanism in Korea.
However, it would be too simplistic to conclude that Chinese medicine is based on performing exorcisms by a supernaturally gifted shaman. As Jackson (24) emphasizes, medicine has never been a monolithic system of knowledge and practices but has always been characterized by a lively variety and plurality of forms. Unraveling the history of medicine is always challenging because medical theory and practice are deeply intertwined with the social context in which they developed.
In this regard, we would like to briefly explain the developments described by Schiffeler. Not only because it vividly illustrates the above statement, but also because there is often a debate about whether Chinese medicine is Daoist or not. Schiffeler begins the history of medicine much earlier than most TCM textbooks, which attribute its origin to the Yellow Emperor. This beginning is situated in the Shang culture (Unschuld) or the Shang Yin dynasty (Schiffeler), which dates back to 1500-1027 BC. The “interpreters” or “Wu,” mentioned earlier as shamans, are considered to be the ones who interpreted the signals of nature and the communication between heaven and earth in order to ensure the well-being of the tribe and the individual. The Wu were women and represented the ultimate Yin or feminine aspect, while the Hsi were men, the wizard-physicians of that time. There were also the more well-known Fang-shih. Over time, a division emerged between wizard-physicians and priest-physicians, particularly during the Chou dynasty (1021-256 BC), which was characterized as the golden age of philosophy.
It was the time when the concepts of yin/yang, Wu-hsing, and Tao emerged. Indeed, shortly before the Han dynasty (206 BC – 220 AD), the golden age of Chinese medicine. In terms of the development of Chinese folk medicine, there were two major streams (25): the Tao-chia, or Taoists, who were associated with the wizard-physicians primarily interested in the preservation of life and the understanding of underlying changes in life; and the Ju-Chia, or Confucianists, who focused on the ethical and moral behavior of humans. Due to the socio-political developments of the Chou dynasty, a growing rift emerged between these two streams. The Confucianist branch would further develop into what is known as “Traditional Chinese Medicine,” while the Taoist branch would remain more closely connected to folk medicine (26). The three legendary figures at the foundation of Chinese medicine, namely Fu-Hsi, Shen-nung, and Huang-Ti, are considered Confucianist physicians. Their work reflects the strong literary background of the Confucianists and their inclination to focus on the ethical and moral character of humans. However, the Taoist aspect of medicine remained closer to the common people, partly because this branch was often more affordable for ordinary individuals. The disadvantage, however, was that the Taoist branch of medicine was often viewed in a more negative light. Not only was it less literary in nature, but charlatans also found it easier to infiltrate Taoist circles than the more elitist Confucianists.
When reading about all these changing aspects in the development of Chinese medicine, it is understandable that there is a lot of confusion about what Chinese medicine is and what it is not. We can see that even at the birth of classical texts like the Huang Di Nei Jing, there was already fragmentation, branching, and differences of opinion. Besides the fact that medicine inherently consists of a variety of theories and practices, it seems to me that much of the discussion on this subject can often be unproductive. On one hand, there is a need for scientifically sound explanatory models that can fit into our understanding and way of thinking. On the other hand, there is a growing interest in Daoism and spirituality. These two seemingly contradictory aspects that play a role in the development of the modern TCM story do not make it any easier. However, gaining more insight into its history and development should at least lead to a better understanding and respect for conflicting viewpoints.
1.E. Mariél 2011—p. 11 2. Islam N. 2017 – p.40 3.Islam N. 2017—p.43 4. Jackson 2014 5. Jackson 2014—p.18 6.Jackson 2014—p.14 7. P. Eckman 1996—p.45 8.Michunovic 2018—p.3 9.Jackson 2014—p.16 10. Islam N. 2017—p.38 11. Jackson 2014 – p.13 12.Jackson 2014—p.20 13. Jackson 2014—p.14/19 14.Eckman 1996; Islam 2017; Jackson 2014; La Barre 1979; Michunovic 2018; Unschuld 1985 15. Michunovic 2018—p.2 16. Eckman 1996—p.41 17. Michunovic 2018—p.3; Vitebski 1995 18.Islam 2017—p.62 19. Marié 2011—p.9 20. Eckman 1996—p.45; Schiffeler 1976—p.26 21.Eckman 1996—p.43; Islam 2017—p.39; Jackson 2014— p.5/7/10; Michunovic 2018—p.3/6; Schiffeler p.18/24 22. Eckman 1996—p.72 23. Eckman 1996—p.45 24. Jackson 2014 – p.14 25. Schiffeler – p.28 26. Schiffeler—p.32
- Bibliografie
- Eckman P.(1996) In the Footsteps of the Yellow Emperor; Cypress Book Company Inc. San Francisco – US; ISBN 08351-2580-7
- Islam M.N. (2017) Chinese and Indian Medicine Today; Branding Asia – ISBN 978-981-10-3961-4
- Jackson M. (2014) The History of Medicine – A Beginner’s Guide; Oneworld Publications; ISBN 978-1-78074-520-6, eISBN 978-1-78074-527-5
- La Barre W. Ph.D. (1979) Shamanic Origins of Religion and Medicine. Journal of Psychedelic Drugs Vol. 11 (1-2) Jan-Jun.
- Marié E. (2011) The Transmission and Practice of Chinese Medicine. China Perspectives Centre d’étude francais sur la Chine contemporaine. http://chinaperspectives.revues.org/5613 Electronic Version ISSN: 1996-4617 p.5-13
- Michunovic I. (2018) Origin of Chinese Medicine, Acupuncture and Moxibustion ; HSOA Journal of Alternative and Complementary & Integrative Medicine Vol.4 – Issue2 :100054
- Schiffeler J.W.M.(1976) The Origin of Chinese Folk Medicine; University of California, Department of the History of the Health Sciences, San Francisco, California.
- Unschuld P.U. (1985) Medicine in China – A History of Ideas; University of California Press, London, England; ISBN 0-520-05023-1
- Vitebsky P. (1995) Shamanism; Duncan Baird Publishers Singapore; ISBN 90-5764-729-X