History and Classical Development of Chinese Medicine

Rationale and Context of Chinese Medicine History and Philosophy

• Foundational Significance: The philosophical and historical context of Chinese Medicine (CM) forms the bedrock of its development and contemporary practice.

• Syncretism and Plurality: A hallmark of Chinese thought is that "new" ideas do not simply replace "outdated" ones. Instead, multiple frameworks are celebrated and utilized based on the needs of the time. This contrast with the linear, reductionist mode of thinking in Western science where newer paradigms typically render old ones irrelevant.

• Clinical Application: Practitioners use this historical understanding to utilize opposing diagnostic frameworks simultaneously, such as the Six-Meridian and the Four Levels. A combined diagnosis example: "external wind cold with internal heat in the stomach depleting jinye."

• Timeline of Emergence:

  • Neolithic Age: Chinese civilization emerged from the banks of the Yangzi (or Yangtze) river approximately $12,000$ years ago.

  • Xia Dynasty: China’s first dynasty developed approximately $6,000$ years ago.

Legendary Figures and Early Aetiology

• Foundational Figures:

  • Shen Nong: Credited as the founder of Chinese herbal medicine.

  • Huang Di: Credited as the founder of acupuncture.

• Pre-Han Period (Shang to Qin Dynasty): This era is the source of classical Chinese cosmology, philosophy, and political theories that were systematized during the Han Dynasty.

• Evolution of Aetiology:

  • Shang and Zhou Dynasties: Written records focus on demons, spirits, and deities as the primary causes of disease.

  • Spring and Autumn / Warring States Periods: Emergence of the "Hundred Schools of Thought," including Confucianism and Daoism.

  • Specialization: Transition away from spiritual causes led to the early development of internal medicine, external medicine, veterinary medicine, and dietary medicine.

Classical Confucianism (Ru School)

• Key Figures:

  • Confucius (Kongzi / Kongfuzi / Kong Qiu): Live between $551\times479\,BCE$. Latinized by Jesuits in the $16$th century.

  • Mencius (Mengzi): Lived between $372\times289\,BCE$.

  • Xunzi: Lived between $325\times328\,BCE$.

• Confucian Concepts:

  • Ren (仁): Benevolence, human-heartedness, or altruism. An innate human quality revealed through relationships.

  • Li (礼): Ritual propriety. Originally religious ritual, expanded to include social etiquette and manners (e.g., a handshake).

  • De (德): Virtue. A state of righteousness (zheng, 正) achieved by a ruler who leads through Ren and Li without punishment.

  • Xue (学): Constant study and observation of Li to lead to De.

• Debate on Human Nature:

  • Mencius: Argued human nature is inherently good, oriented toward good as people possess Ren.

  • Xunzi: Argued human nature is inherently evil/bad. Stressed that humans are oriented toward bad and require continual study to bring forth humanity. He viewed Heaven/Nature as a nonpurposive force that does not intervene in human affairs.

Philosophical Daoism

• Laozi and the Daode Jing:

  • Dao (道): The Way. Definitions include the origin of myriad phenomena, the origin of transformation, and the imperceptible phenomenon that does not transform.

  • Wu Wei (无为): Non-action. Describes effortless, natural, and non-purposive action rather than static immobility.

• Zhuangzi:

  • Style: Free-spirited nonconformism using metaphors, humor, and anecdotes.

  • The Butterfly Dream: Zhuang Zhou dreamed he was a butterfly and, upon waking, questioned if he was a man who dreamt of a butterfly or a butterfly dreaming he was a man. This illustrates the "Transformation of Things."

Miscellaneous Schools and Transitional Texts

• Huainanzi (Masters of Huainan): Commissioned in $139\,BCE$ by the King of Huainan. Bridges philosophy and medical theory.

  • Chapter 1.1: Poetical description of the Dao as covering Heaven and upholding Earth.

  • Chapter 1.14 (Emotions): Joy/anger are aberrations of the Dao; worry/grief are losses of Potency. Violent anger ruins Yin; extreme joy collapses Yang.

  • Chapter 4.14 (Five Elements): System of overcoming (Wood > Earth > Water > Fire > Metal > Wood). Relates element states to physical conditions (Prime, Old, Born, Paralysed/Imprisoned, Dead).

  • Chapter 7.2 (Foetal Development):

    • Month $1$: Fertilization.

    • Month $2$: Corporeal mass.

    • Month $3$: Embryo forms.

    • Month $4$: Flesh is produced.

    • Month $5$: Muscles form.

    • Month $6$: Bones develop.

    • Month $7$: Fetus forms.

    • Month $8$: Movement starts.

    • Month $9$: Pronounced movement.

    • Month $10$: Birth.

  • Microcosm/Macrocosm: Human round head = Heaven; square feet = Earth. Organs parallel nature: Gallbladder = clouds, Lung = air, Liver = wind, Kidney = rain, Spleen = thunder.

• Chunqiu Fanlu (Luxuriant Gems of the Spring and Autumn):

  • Attributed to Dong Zhongshu ($195\times104\,BCE$).

  • Chapter 50: Describes Yin and Yang movements through seasons (e.g., Spring: Yang emerges, Yin withdraws).

  • Chapter 78: Concepts of Yangsheng (nourishing life) by living in harmony with seasons.

Han Dynasty Medical Classics

• Huangdi Neijing (Inner Classic): Divided into Suwen (Basic Questions) and Lingshu (Spiritual Pivot). Shifted medicine toward systematic correspondence based on nature.

• Nanjing (Classic of Difficulties): Written circa $1$st or $2$nd century CE. Uses a Q&A format to clarify clinical difficulties in pulse, channels, and points.

• Shanghan Zabing Lun: Authored by Zhang Zhongjing (Zhang Ji) in the $3$rd century CE. Divided into Shanghan Lun (Cold Damage) and Jingui Yaolue (Essential Prescriptions of the Golden Cabinet).

  • Broad vs. Narrow View: Shanghan can mean exclusively cold evil or encompass all pathological factors (the view of Japanese scholar Koretada Nakanishi).

Post-Han to Tang Dynasty Developments

• Post-Han ($221\times618\,CE$):

  • Huangfu Mi ($215\times282\,CE$): Compiled Zhenjiu Jiayi Jing (Systematic Classic of Acupuncture). Expanded point count from Neijing's $160$ to $349$.

  • Wang Shuhe ($263\times317\,CE$): Authored Maijing (Pulse Classic), defining $24$ pulse images. Established pulse positions:

    • Left: Cun (Heart/SI), Guan (Liver/GB), Chi (Kidney/BL).

    • Right: Cun (Lung/LI), Guan (Spleen/ST), Chi (Kidney/BL).

• Tang Dynasty ($618\times907\,CE$):

  • Chao Yuanfang ($550\times630\,CE$): Wrote Zhubing Yuanhou Lun (Treatise on Pathogenesis and Manifestations), documenting $1,739$ symptoms.

  • Sun Simiao ($581\times682\,CE$): "King of Medicine." Wrote Beiji Qianjin Yaofang ($5,300$ remedies). Emphasized ethics and dietetics.

Song and Jin-Yuan Dynasties

• Song Dynasty ($960\times1279\,CE$): Return to Han classics.

  • Qian Yi ($1032\times1113\,CE$): Expert in paediatrics; wrote Knack of Paediatric Patterns ($1119$).

  • Cheng Wuji ($1050\times1140\,CE$): Integrated Neijing theory with herbalism in his Shanghan Lun commentaries.

• Jin-Yuan Four Great Schools ($1115\times1368\,CE$):

  • Liu Wansu: Cold and Cooling School. Focused on heat-related diseases.

  • Zhang Congzheng: Attacking and Draining School. Used diaphoresis, emesis, and purgation to eliminate pathogens.

  • Li Dongyuan: Earth Reinforcing School. Spleen/Stomach harmony; authored the "Yin Fire" theory.

  • Zhu Danxi: Nourishing Yin School. Postulated "Yang is often excessive, Yin is often insufficient."

Ming and Qing Dynasties

• Ming Dynasty ($1368\times1644\,CE$):

  • Yang Jizhou: Wrote Great Compendium of Acupuncture and Moxibustion ($1601$).

  • Li Shizhen ($1518\times1593\,CE$): Compendium of Materia Medica ($1,898$ substances, $11,000$ formulas).

  • Gao Wu: Defined the four "Command Points" (LU7, LI4, ST36, BL40).

• Qing Dynasty ($1644\times1911\,CE$):

  • Warm Disease (Wenbing) School: Developed to treat febrile epidemics.

  • Wu Youke: Wenyi Lun; argued pathogens enter via nose/mouth.

  • Ye Tianshi: Created the Four Levels (Wei-Qi-Ying-Xue) framework.

  • Wu Jutong: Wenbing Tiaobian ($1798$); allocated diseases to the three burners.

  • Wang Qingren: Rectified anatomical errors by inspecting cadavers; argued the brain (not heart) governs the mind.

Modern Development and Global Integration

• School of Integration ($1933$): Zhang Xichun pioneered integrating CM with Western Medicine (WM). Motto: "Esteem Chinese and respect Western."

• Inception of TCM ($1950$s): Creation of "Bianzheng Lunzhi" (Pattern Differentiation and Treatment Determination) to systematize CM education.

  • TCM Diagnosis: Distinguishes signs/symptoms, patterns, and diseases.

  • Fang Yaozhong ($1921\times1995$): Developed a $7$-step approach to Bianzheng Lunzhi.

• Medical Acupuncture: Uses biomedical data; focuses on Myofascial Trigger Points (MTrPs) and functional MRI evidence of neuronal plasticity and increased cerebral blood flow.

• WHO Traditional Medicine Strategy ($2014\times2023$):

  • Primary Goals: Harnessing TM's contribution to health and promoting safe/regulated use.

  • Four Objectives: Policy integration, Safety/Efficacy/Quality, Access (affordability), and Rational Use.", "title": "History and Classical Development of Chinese Medicine"}