Essay of Ancient China

past china In antediluvian Chinese cosmology, the universe was created non by divinities sole(prenominal) when self-generated from the interplay of natures basic duality the active agent, light, dry, warm, positive, masculine yang and the passive, dark, cold, moist, proscribe yin. both(prenominal) things, animate and inanimate, and only circumstances were a combination of these fundamentals. The ultimate principle of the universe was the tao, the way, and it resolute the comely proportions of yin and yang in eitherthing. Anything that altered the natural congress of yin to yang was considered bad, and adept living consisted of carefully observeing the tao.If unrivaled observed the tao by moderation, equanimity, and morality, as taught in the Tao-te Ching, by Lao-tzu ( 6th ampere-second B. C. ), one would be impervious to un healthiness and resistant to the ravages of aging disregard of the tao led to unhealthiness, which was non so very much a punishment for r epulsiveness as the inevitable result of playing obstinate to natural laws. However, illness overly could be ca employ by forces beyond ones control Wind is the cause of a hundred diseases, and atmospheric conditions could upset the harmonious inward balance of the yang and yin.One had to be alert to this possibility and set upon its effects as tumesce as condition intragroup imbalances of the vital forces. Longevity and health were the rewards. Chinese medicament, in league with Taoism, was foc utilize on the saloon of illness for, as the storyary Huang Ti, father of Chinese medicinal drug, observed, the superior medico helps to begin with the premature(a) on develop of disease. Although Taoist hygiene c on the wholeed for temperance and simplicity in almost things, sexual mores were governed by the yin-yang aspect of Chinese philosophy.Ejaculation in intercourse led to diminution of a mans yang, which, of course, upset the inner balance of his nature. On the opposite hand, one was strengthened by absorption of the yin released by the orgasm of ones female sidetracknerunless she was over thirty, the foretell where female essence lost its efficacy. The tao was important in Confucianism a comparable, as the path of virtuous conduct, and for centuries the precepts of Confucius (Kung Fu-tzu, 550-479 B. C. ) set the most prevalent standards of behavior. In early Chinese philosophy, on that point was a tendency to accept and combine aspects of all(prenominal) religions and to make way for new ideas.Nevertheless, the antique Chinese were profoundly conservative once an institution, custom, philosophy, mode of dress, or flat a furniture style was firm established, and it remained relatively unchanged over centuries. As Confucius express Gather in the like places where our fathers in the lead us develop ga in that locationd per fashion the same ceremonies which they before us charter performed play the same harmony which they befo re us attain played wage respect to those whom they honored love those who were dear to them. Although superannuated Chinas verbotengrowth was relatively isolated, there was early firearm away with India and Tibet.Buddhism came to China from India, and health check exam concepts and blueprints were an important part of its t for each oneings. The active and breathing exercises in Chinese aesculapian checkup examination modeology as s wellhead came from India and were close related to the principles of Yoga and to aspects of Ayurvedic medicine. There were also contacts with s fall outh-east Asia, Persia, and the Arabic world. In the second ascorbic acid B. C. , the Chinese ambassador Chang Chien spent more than a decade in Mesopotamia, Syria, and Egypt, deliverance back info on drugs, viticulture, and oppositewise out allows.Over the centuries, fellowship of humoral medicine and of numerous new medicaments filtered into China. The introduction of the wis dom of the Mediterranean world was greatly facilitated in the fifth degree Celsius by the expulsion and wide dispersion from Constantinople of the heterodox Nestorian Christians. The mother of Kublai Khan (1216-94), founder of the Mongol dynasty, was a Nestorian and asked the Pope to send European doctors to China. Early Medical Writings Classical Chinese medicine was establish primarily on plant ascri bottomland to three legendary emperors. The most old-fashioned was Fu Hsi (c. 2900 B. C. , who was practice session tongue to to possess originated the pa kua, a symbol quiet of yang lines and yin lines combined in eight (pa) enlighten trigrams (kua) which could hold still for all yin-yang conditions. This system is followed even today in the I Ching (Book of Changes), though as a biz or superstition in the West. Shen Nung, the Red emperor only ifterfly (Hung Ti), compiled the initially health check herbal, the Pen-tsao (c. 2800 B. C. ), in which he describe the effe cts of 365 drugs, all of them personally tested. One legend explains that a magic drug made his type AB skin transparent, so he could observe the do of the many plants he evaluated.A nonher story tells that he vamoose open his abdomen and stitched in a window. Shen Nung is also verbalize to have drawn up the first charts on acupuncture, a medical examination unconscious process presumably even older than the legendary emperors. The fame of Yu Hsiung (c. 2600 B. C. ), the xanthous Emperor (Huang Ti), rests on his great medical compendium, the Nei Ching (Canon of Medicine). convey orally for many centuries, this seminal work was discolorthornhap committed to writing by the third hundred B. C. Its present form dates from the eighth degree centigrade A. D. when the hold up extensive revision was done by Wang Ping. The study portion of the Nei Ching, the Sun-Wen (Simple Questions), records the discourse of the scandalmongering Emperor with chi Po, his prime minister, on vir tually all phases of health and illness, including prevention and manipulation. The section called Ling-Hsu (Spiritual Nucleus), deals totally with acupuncture. Yu Hsiung also was said to be responsible for another great compendium, The Discourses of the Yellow Emperor and the Plain Girl, which thoroughly manageed the subject of sex from the Taoist point of view.Among other celebrated stemmas for ancient medical lore, one force constitute the Shih Ching (Book of Odes), which perhaps predates Homers epics, and the Lun-yu, discourses of Confucius probably written down presently after his death, which affected patterns of behavior for many generations. During the yen Chou dynasty (c. 1050-255 B. C. ), a lengthy compilation of medical works, Institutions of Chou, was completed and became the criterion for subsequent dynasties on the duties and transcription of medical students. In the Han dynasty (206 B. C. -A. D. 20), there was a noted clinical author named Tsang Kung, who pioneered in the description of many diseases, including crabmeat of the stomach, aneurysm, and rheumatism. Chang Chung-ching, the Chinese Hippocrates, in the third snow A. D. , wrote the true treatise Typhoid and Other Fevers. Ko Hung, a far-famed alchemist and a careful observer, wrote treatises describing beriberi (a vitamin B deficiency), hepatitis, and plague, and gave one of the earlier announces on smallpox As the New yr approached there was a seasonal affection in which pustules appeared on the face and spread rapidly all over the organic structure.They looked like burns covered with white starch and reformed as soon as they were broken. The majority died if not treated. After recovery imperial black scars remained. Sun Szu-miao (A. D. 581-682) wrote Chien Chin Yao Fang (A Thousand prospering Remedies), which summarized in thirty volumes much of the known medical looking, and he headed a committee which produced a fifty-volume assembly on pathology. An extensive codification of forensic medicine, Hsi kwai Lu, was done in the Sung dynasty and became the prime source for knowledge of medical jurisprudence.Anatomy and Physiology Ideas of signifier in ancient China were reached by reasoning and. by surmise rather than dissection or forthwith observation. Since the doctrines of Confucius forbade violation of the body, it was not until the eighteenth century, coarse after Vesalius, that the Chinese began systematic, direct anatomical studies. Even as late as the nineteenth century, in the Viceroys Hospital Medical School, anatomy was taught by diagrams and artificial models rather than dissection.Physiological functions were constructed into a humoral system much like Greek concepts of the sestetth century B. C. and Galenic views of the second century A. D. , except that there were 5 instead of four essential humors. (The digit v had mystical value for the Chinese and was used for most classifications five instalments, five tastes, fi ve qualities, five kinds of drugs, five treatments, five solid organs, five seasons, five emotions, five colors, etc. ) The medical compendium Nei Ching say that each emotion had its seat in a particular organ.Happiness dwelt in the heart, thought in the spleen, affliction in the lungs, and the liver housed anger as well as the someone. Ideas in the Nei Ching concerning movement of the race (All the parenthood is under control of the heart. The blood authorized flows continuously in a circle and neer stops. ) have been thought to approach an understanding of its circulation antedating Harvey by thousands of years however, nearly body vessels were believed to convey air, and there is little evidence that commentators perceived the blood-carrying vessels as a contained system. DiagnosisThe Chinese methods of diagnosis included questioning, feeling the pulse, spy the voice and body, and in some circumstances moving the affected parts. In almost all multiplication and cultur es medical students have used a similar approach, for all therapists have sought to know as much as practicable somewhat a enduring in order to understand his or her illness and advise treatment. However, in some respects ancient mendeleviums saw each unhurried more solely as a reflection of his surroundings (indeed, the entire universe) than does the doctor of today. The Chinese doctor wanted to learn ow the patient had violated the tao, and to do this he took into composition the patients rank changes in his or her social status, household, stinting position, sense of well-being, or appetite the weather and the dreams of the patient and his or her family. Perhaps the most important diagnostic technique of the ancient Chinese was examination of the pulse. The medico felt the right wrist and then the left. He compared the beats with his own, noting precise time as well as day and season since each arcminute affected the nature of the pulsations.Each pulse had three trenc hant sections, each associated with a specific organ, and each division had a separate quality, of which there were dozens of varieties. Moreover, each division or zone of the pulse had a superficial and deep projection. Thus literally hundreds of possible characteristics were gettable. In one treatise, Muo-Ching, ten volumes were necessary to cover all the intricacies of the pulse. A patient had only to last his or her arm through drawn bed curtains for the physician to determine the symptoms, diagnosis, prognosis, and proper treatment by intensive palpation of the pulse.Whenever possible the examiner also felt the skin of the ill person. However, it was considered bad form for a man to intimately examine a woman, so special ceramic, ivory, and wooden dolls were pointed to by the handicap to indicate where discomfort was felt. Treatment According to the Nei Ching, there were five methods of treatment cure the spirit, nourish the body, give musics, treat the whole body, and use acupuncture and moxibustion. The physician had to put the patient back on the right path, the tao.Assuming that specific mental states caused changes in specific organs, the healer linked genuine objectionable behavioral and intact factors with illness and attempted to have the patient animate these. For instance, dissolute and licentious ideas led to diseases of the lungs, save acting out such thoughts brought on heart trouble. A doctor had to determine the cause of disharmony in the body and act accordingly. Exercises were developed to keep the body go and to restore well-being. Hua To, the great surgeon, worked out an ingenious system of physical therapy by advising caricature of the natural movements of animals.Massagekneading, tapping, pinching, and chafingwas also a regular method of treatment, as were the application of plasters and evacuation of the intestinal nerve tract by cathartics. In nourishing a patients body, the physician resorted to complex combinations of nutriments according to their potential amounts of yang and yin. Foods also had to fit the seasons, and each of the five tastes had benefits for a particular element of the body sour for the bones, pungent for the tendons, salty for the blood, bitterly for respiration, and sweet for muscle.Medications The Chinese pharmacopoeia was always rich, from the time of the Pen-tsao, the first medical herbal, to the afterward dynasties when twain thousand items and 16 thousand prescriptions made up the armamentarium. Drugs were considered more in all probability to be good if they tasted bad. As one would expect, they were categorize ad into five categories herbs, trees, insects, stones, and grains. The therapeutic minerals and metals included compounds of mercury (calomel was occupied for venereal diseases), arsenic, and magnetic stones.Animal-derived remedies, in admission to firedrake teeth (powdered fossilized bones), included virtually anything obtainable from living creatures whole parts, segments of organs, urine, dung. Two plant substances oddly associated with China may be singled out. One is ephedra (ma huang), the horsetail plant described by the Red Emperor, which was used for thousands of years as a stimulant, as a remedy for respiratory -diseases, to induce fevers and perspiration, and to depress coughs.Ephedra entered the Greek pharmacopoeia and eventually was disseminated throughout most of the world. It only became a factor in Western medicine in the late nineteenth century after Nipponese investigators isolated and purified the active principle, ephedrine, and established its pharmacologic action. A second medicinal herb, always highly usual among the Chinese, is ginseng (man-shaped root). To the Chinese, preparations containing ginseng were almost rattling(a) in delaying old age, restoring sexual powers, stimulating the debilitated, and sedating the overwrought.In addition it improved diabetes and stabilized blood pressure. In new year s this root has been under scrutiny by Western pharmacologists attempting to evaluate its true benefits. Multitudes in Asia, and even some Westerners, are so convinced of its speciality that high-grade wild roots have brought mythic prices (even reaching thousands of dollars apiece). Although many items in the Chinese materia medica have either faded into bscurity or been labeled fanciful, others later have been found to possess sound pharmacologic bases seaweed, which contains iodine, was used in treating enlargement of the thyroid the willow plant, containing salicylic acid, was a remedy for rheumatism the Siberian wort has antispasmodics for menstrual discomfort and mulberry flowers contain rutin, a treatment for elevated blood pressure. Whether opium was used as a drug before quite late in Chinese history is still in dispute. stylostixis and Moxibustion These modalities have been an integral part of Chinese medical therapy for thousands of years.The Yellow Emperor is said t o have invented them, only when they may well have existed prospicient before his time. The aim of these treatments was to drain off excess yang or yin and hence establish a proper balance, but external energy also could be introduced into the body. In acupuncture the skin is pierced by long needles to varying prescribed depths. Needles are inserted into any of 365 points on the twelve meridians that traverse the body and transmit an active flavor force called chi. Each of these points is related to a particular organ.For instance, puncture of a certain secern on the ear lobe might be the proper way to treat an abdominal ailment. Virtually every illness, weakness, and symptom is thought to be amenable to subject area by acupuncture. Acupuncture spread to Korea and Japan by the end of the tenth century A. D. , to Europe about the seventeenth century, and recent years have seen a wider interest in this Chinese medical practice in the West. Individual paramedical healers and even some medical practitioners have been swamped with requests for acupuncture, e particularly for problems patently little benefited by conventional practices.The eventual acceptability of this practice in standard Western medicine frame to be seen. Moxibustion is as old as acupuncture, and the same meridians and points govern placement of the moxa. However, in this treatment a powdered plant substance, normally mugwort, is fashioned into a small mound on the patients skin and burned, usually raising a blister. Dentistry The treatment of tooth disorders was hold mainly to applying or ingesting drugspomegranate, aconite, ginseng, garlic, rhubarb, and arsenic, as well as animal products such as dung and urine.The Nei Ching classified nine types of toothaches, which included some obviously referable to infections and tooth decay. Like the Mesopotamians and Egyptians, the ancient Chinese believed that worms were much responsible for dental problems. Toothpicks and tooth whiteners wer e used, and loose teeth were stabilized with bamboo splints. gold was sometimes used to cover teeth, but the break up was decorative rather than protective. Surgery Although surgery was not one of the five methods of treatment listed in the Nei Ching, the natural language was known and used.Hua To, one of the few names mentioned in connection with surgery, treated an arm wound of the known general Kuan Yu by cutting his flesh and scribble the bone. Physicians knew how to deal with wounds, and at least two classics were employ entirely to their treatment. The proper attitude toward pain was to pay it without a sign of emotion, and much was made of the nimbleness of the general treated by Hua To he played chess while the surgeon operated. Nevertheless, apparently some kind of anesthesia was often used.Wine and drugs like hyoscyamus were probably mainstays, but the use of opium and Indian hemp is still in question. Eunuchs and Footbinding Another operative procedure, though har dly therapeutic, was the frequent castration of certain males seeking advancement at appeal. Though in the first place a severe punishment, the total removal of penis and testicles came to be a pledge of absolute committedness to the monarch, since it released the eunuch from conflict with Confucian admonitions of first obedience to family and the obligation of siring a son for posterity.Footbinding is also of medical interest, for it caused the development of artificially clubbed feet. Over a head of one thousand years, every young little girl of proper family willingly permitted herself to be crippled by her mother and aunts to achieve the tiny foot of warning feminine beauty. Her toes were gradually folded under the sole, and by more and more tight bandaging her heelbone and forefoot were brought closer together. Without thriving Lotuses, as the best-shaped bound feet were called, a girl was unmarriageable, nor was the life of a courtesan open to her, for tiny feet were a womans most desirable feature.For a man, a bound-foot wife had profound sexual significance, but she was also a status symbol inasmuch as her helplessness indicated that he was wealthy enough to support a woman, or women, in idleness. There was also an advantage to him in her re unyieldinged mobility, for it kept her home and made illegitimate amorous adventures difficult. Although Chinas Manchu conquerors forbade the practice in the nineteenth century, it was not until the early twentieth that footbinding was completely abandoned. Diseases Some epiphytotic diseases were understood well enough to allow the development of protective measures.In the eleventh century, inoculation against smallpox was constituted by putting scabs from smallpox pustules into the nostrils, a method which may have come from India. Wearing the clothes of someone who had the disease was another remembers of prevention. The blood of cowpox (as a protective) to smallpox may have been perceived, sinc e ingesting powdered fleas from infected cows was also recommended to equip off smallpox. But other devastating pestilences were neither understood nor held in check. During the Han dynasty an epidemic of what appears to have been typhoid fever fever killed two-thirds of the population of one region.Precise descriptions of leprosy in the Nei Ching and later works attest to the diagnostic accuracy of the early Chinese healers, but their explanation of the diseases causes and their treatment follow preconceived notions of the time. The wind and chills lodge in the blood vessels and cannot be got rid of. This is called li-feng. For the treatment prick the narcissistic parts with a sharp needle to let the foul air out. Fourteenth-century writings referred to chaulmoogra oil, a pressing from seeds of an East Indian tree, as a specific for leprosy, and this oil remained the principal antileprous drug even in the West until recent decades.An illness that may have been tuberculosis was recognized as communicable Generally the disease gives rise to high fever, sweating, asthenia, unlocalized persistence making all positions difficult and slowly bringing about consumption and death, after which the disease is convey to the relations until the whole family has been wiped out. Venereal diseases, although not well differentiated, received a variety of therapies, including the use of metal(prenominal) substances for internal medication.In the Secret Therapy for the Treatment of Venereal Disease, the seventeenth-century physician Chun Szi-sung reported using arsenic, which, until the development of penicillin, was the modern medication for venereal disease, in the form of Salvarsan and derivatives synthesized by capital of Minnesota Ehrlich. There seem always to have been places in China where the sick poor could go for medical care. With the advance of Buddhism in the Han and Tang dynasties, in-patient hospitals staffed by physician-priests became common.However, i n the ordinal century, when anti-Buddhists were in control, hospitals as well as 4,600 temples were sunk or emptied. Nevertheless, by the twelfth century hospitals had again become so numerous that virtually every district had at least one tax-supported institution. The speed classes preferred to be treated and cared for in their homes, thus leaving public hospitals to the poor and lower classes. The Practitioners In the Institutions of Chou, compiled hundreds of years before Christ, the hierarchy of physicians in the kingdom was delineated.The five categories were chief physician (who collected drugs, examined other physicians, and assigned them) food physicians (who prescribed six kinds of food and drink) physicians for simple diseases (such as headaches, colds, minor wounds) ulcer physicians (who may have been the surgeons) and physicians for animals (evidently veterinarians). Physicians were also rated according to their results, and as early as the Chou and Tang dynasties e ach doctor had to report both successes and failuresto control his movement up or down in the ranks.In the seventh century A. D. examinations were requisite for one to qualify as a physician, some four centuries earlier than the first licensing system in the West. Medical knowledge was thought of as a secret power that belonged to each practitioner. Whereas in other societies, both advanced and primitive, closely knit guilds might control the spread of medical lore, the Chinese physician kept his secrets to himselfpassing them on only to sons or, sometimes, specially selected qualifiers.In early times, a physician gave his services out of philanthropy, for since the original healers were rulers, sages, nobles, and, perhaps, priests, economic and social incentives were absent. Later, direct fees or salaries were instituted, and the court and certain prosperous households kept physicians on retainer. Formal schools may have existed as early as the tenth century, and in the eleventh c entury an organization for medical education was set up under imperial auspices. Under the Ming dynasty in the 14th century, the school system became fixed. It changed little over the adjoining centuries, xcept for a gradual decline, and by 1800 there was only one medical school left in Peking. Teachers were held strictly accountable for the performance of their students, and fines were imposed if the prof failed to enforce attendance or if his pupils did poorly on exams. The examination system was complex a pyramidical structure provided a process of elimination which move until those with the highest scores emerged. The top students could be heart doctors, the attached level were assistant examiners, and lower scores could mean limited assignment in teaching.Specialization may have occurred early. While physicians and apothecaries were separate for a long time, they were both regarded as healers. In the Chou dynasty there were nine specialties, and they grew to thirteen by th e Mongol period, early in the fourteenth century. The subdivisions became even more complex, with doctors for the great blood vessels, small vessels, fevers, smallpox, eyes, skin, bones, larynx, and mouth and teeth. There were also gynecologists, pediatricians, and pulsologists for internal diseases, external medicine, the nose and throat, and for childrens illnesses.Some healers specialized in moxibustion, acupuncture, or massage. Even the experts in incantation and dietetics were considered medical specialists and were often held in higher regard than other doctors surgeons were in the main of low rank. Furthermore, each of the practitioners in each form had assistants and studentsall of whom had to qualify by examination. Obstetrics was in the hands of midwives for many centuries it is not known when the first women doctors were in practice. One female physician is mentioned by name in documents from the Han dynasty (206 B.C. -A. D. 220), but women may have been doctors at an e arlier date. By the fourteenth century women were officially recognized as physicians. Throughout the Ming dynasty (1368-1644), the practicing medical theorists could be divided into six main philosophical schools. The Yin-yang group focused on insufficiencies of one of these forces. The Wen-pou doctors attributed illnesses to a preponderance of yang and frequently prescribed ginseng and aconite. The composition group used drastic medication.The Conservatives relied entirely on the authorities of the past, reedited the classic works, and made no deviations from strict authoritarianism. The Eclectic physicians, as their name implies, used a variety of principles from the other sects. The sixth school base all therapy on bringing the five elements and six vapors into harmony. Spread of Chinese Medicine to Korea, Japan, And Tibet Ancient Chinese medicine was well-developed long before the initiation of the Christian era, and its influence appears to have spread into bordering Korea by the sixth century A.D. At that time, after a severe epidemic had ravaged Japan, Korean doctors who were invited to counsel Japanese physicians introduced them to Chinese medical classics and commentaries. By the seventh century, Japanese scholars and doctors were going directly to China for their information and experience. In the eighth century, a Chinese Buddhist monk named Chien Chen came to Japan and achieved a prominent position in the imperial court at Nara, where, given the Japanese name Kanjin, he taught, practiced medicine, and translated Chinese materia medica.Late in that century, Chinese medicine was well-established in Japan, and a medical school based on its methodology was founded by the Japanese physician Wake Hiroya. Early in the next century (80610), the Emperor Heijo vainly attempted to combat inappropriate influence and restore traditional Japanese medical practice, but the methods of Chinese healing were too severely entrenched. In the tenth century, acupu ncture reached Japan, followed by moxibusti on (the word moxa is Japanese), and the full complement of Chinese medicine was accepted in Japan.With medical training closely based on Chinese systems, the Japanese exacted exceptionally intensive and prolonged study before permitting debut into the profession by governmental examination. As in ancient China, high social standing was a requirement for admission to medical school, but separate instruction by assigned teachers was apparently also arranged to accommodate the more lowly. The authority of Chinese medicine, not to mention Chinese culture and philosophy, move east as well as westbound by the seventh and eighth centuries.However, Arabic and Indian missionaries of Islam and Buddhism made influence a two-way replace as they traveled to China seeking converts. Since their missions necessitated the rendition of Sanskrit and Arabic writings into Chinese and vice versa, medical knowledge inevitably was passed back and forth. Cons equently, the crossroads areas of Southeast Asia and Tibet developed a medical system corporate trust aspects of Chinese, Indian, and Arabic practice. Arabic influence, which stemmed in part from Greek teachings, was evident in the doctrine of four humors (phlegm, blood, bile, and wind), whereas Indian deas were seen in the Yogic placement of the soul in the core of the spinal column and credit on breathing exercises. Traveling Buddhist priests, who were quite successful in spreading their faith, for a long time also practiced medicine. During this early period, the two wives (one Chinese) of a Tibetan king converted him to Buddhism, and thenceforth scholars were invited to bring Chinese writings into Tibet, which resulted in collections in Tibetan called Kanjur and Tanjur, the latter containing medical information.In the thirteenth century, the Mongol conqueror Kublai Khan wanted this body of knowledge available again in Chinese but was unable to carry through the translation. Ne vertheless, his grandson in the next century arranged for scholars from Tibet, Mongolia, and Central Asia to accomplish the task. Ironically, while the Mongols were in control they allied themselves with non-Chinese such as Uighars, Jews, Christians, and Moslems, and they preferred Arabic medicine to Chinese.Essay of Ancient ChinaAncient China In ancient Chinese cosmology, the universe was created not by divinities but self-generated from the interplay of natures basic duality the active, light, dry, warm, positive, masculine yang and the passive, dark, cold, moist, negative yin. All things, animate and inanimate, and all circumstances were a combination of these fundamentals. The ultimate principle of the universe was the tao, the way, and it determined the proper proportions of yin and yang in everything. Anything that altered the natural relation of yin to yang was considered bad, and right living consisted of carefully following the tao.If one observed the tao by moderation, equ animity, and morality, as taught in the Tao-te Ching, by Lao-tzu (sixth century B. C. ), one would be impervious to disease and resistant to the ravages of aging disregard of the tao led to illness, which was not so much a punishment for sin as the inevitable result of acting contrary to natural laws. However, illness also could be caused by forces beyond ones control Wind is the cause of a hundred diseases, and atmospheric conditions could upset the harmonious inner balance of the yang and yin.One had to be alert to this possibility and combat its effects as well as modify internal imbalances of the vital forces. Longevity and health were the rewards. Chinese medicine, in league with Taoism, was focused on the prevention of illness for, as the legendary Huang Ti, father of Chinese medicine, observed, the superior physician helps before the early budding of disease. Although Taoist hygiene called for temperance and simplicity in most things, sexual mores were governed by the yin-ya ng aspect of Chinese philosophy.Ejaculation in intercourse led to diminution of a mans yang, which, of course, upset the inner balance of his nature. On the other hand, one was strengthened by absorption of the yin released by the orgasm of ones female partnerunless she was over thirty, the point where female essence lost its efficacy. The tao was important in Confucianism also, as the path of virtuous conduct, and for centuries the precepts of Confucius (Kung Fu-tzu, 550-479 B. C. ) set the most prevalent standards of behavior. In early Chinese philosophy, there was a tendency to accept and combine aspects of all religions and to make way for new ideas.Nevertheless, the ancient Chinese were profoundly conservative once an institution, custom, philosophy, mode of dress, or even a furniture style was firmly established, and it remained relatively unchanged over centuries. As Confucius said Gather in the same places where our fathers before us have gathered perform the same ceremonies which they before us have performed play the same music which they before us have played pay respect to those whom they honored love those who were dear to them. Although ancient Chinas development was relatively isolated, there was early contact with India and Tibet.Buddhism came to China from India, and medical concepts and practices were an important part of its teachings. The gymnastic and breathing exercises in Chinese medical methodology also came from India and were closely related to the principles of Yoga and to aspects of Ayurvedic medicine. There were also contacts with Southeast Asia, Persia, and the Arabic world. In the second century B. C. , the Chinese ambassador Chang Chien spent more than a decade in Mesopotamia, Syria, and Egypt, bringing back information on drugs, viticulture, and other subjects.Over the centuries, knowledge of humoral medicine and of numerous new medicaments filtered into China. The introduction of the wisdom of the Mediterranean world was grea tly facilitated in the fifth century by the expulsion and wide dispersion from Constantinople of the heretical Nestorian Christians. The mother of Kublai Khan (1216-94), founder of the Mongol dynasty, was a Nestorian and asked the Pope to send European doctors to China. Early Medical Writings Classical Chinese medicine was based primarily on works ascribed to three legendary emperors. The most ancient was Fu Hsi (c. 2900 B. C. , who was said to have originated the pa kua, a symbol composed of yang lines and yin lines combined in eight (pa) separate trigrams (kua) which could represent all yin-yang conditions. This system is followed even today in the I Ching (Book of Changes), though as a game or superstition in the West. Shen Nung, the Red Emperor (Hung Ti), compiled the first medical herbal, the Pen-tsao (c. 2800 B. C. ), in which he reported the effects of 365 drugs, all of them personally tested. One legend explains that a magic drug made his abdominal skin transparent, so he co uld observe the action of the many plants he evaluated.Another story tells that he cut open his abdomen and stitched in a window. Shen Nung is also said to have drawn up the first charts on acupuncture, a medical procedure presumably even older than the legendary emperors. The fame of Yu Hsiung (c. 2600 B. C. ), the Yellow Emperor (Huang Ti), rests on his great medical compendium, the Nei Ching (Canon of Medicine). Transmitted orally for many centuries, this seminal work was possibly committed to writing by the third century B. C. Its present form dates from the eighth century A. D. when the last extensive revision was done by Wang Ping. The major portion of the Nei Ching, the Sun-Wen (Simple Questions), records the discourse of the Yellow Emperor with Chi Po, his prime minister, on virtually all phases of health and illness, including prevention and treatment. The section called Ling-Hsu (Spiritual Nucleus), deals entirely with acupuncture. Yu Hsiung also was said to be responsible for another great compendium, The Discourses of the Yellow Emperor and the Plain Girl, which thoroughly covered the subject of sex from the Taoist point of view.Among other notable sources for ancient medical lore, one might mention the Shih Ching (Book of Odes), which perhaps predates Homers epics, and the Lun-yu, discourses of Confucius probably written down shortly after his death, which affected patterns of behavior for many generations. During the long Chou dynasty (c. 1050-255 B. C. ), a lengthy compilation of medical works, Institutions of Chou, was completed and became the criterion for subsequent dynasties on the duties and organization of physicians. In the Han dynasty (206 B. C. -A. D. 20), there was a noted clinical author named Tsang Kung, who pioneered in the description of many diseases, including cancer of the stomach, aneurysm, and rheumatism. Chang Chung-ching, the Chinese Hippocrates, in the third century A. D. , wrote the classic treatise Typhoid and Other Fever s. Ko Hung, a famed alchemist and a careful observer, wrote treatises describing beriberi (a vitamin B deficiency), hepatitis, and plague, and gave one of the earliest reports on smallpox As the New Year approached there was a seasonal affection in which pustules appeared on the face and spread rapidly all over the body.They looked like burns covered with white starch and reformed as soon as they were broken. The majority died if not treated. After recovery purplish black scars remained. Sun Szu-miao (A. D. 581-682) wrote Chien Chin Yao Fang (A Thousand Golden Remedies), which summarized in thirty volumes much of the known medical learning, and he headed a committee which produced a fifty-volume collection on pathology. An extensive codification of forensic medicine, Hsi Yuan Lu, was done in the Sung dynasty and became the prime source for knowledge of medical jurisprudence.Anatomy and Physiology Ideas of anatomy in ancient China were reached by reasoning and. by assumption rather than dissection or direct observation. Since the doctrines of Confucius forbade violation of the body, it was not until the eighteenth century, long after Vesalius, that the Chinese began systematic, direct anatomical studies. Even as late as the nineteenth century, in the Viceroys Hospital Medical School, anatomy was taught by diagrams and artificial models rather than dissection.Physiological functions were constructed into a humoral system much like Greek concepts of the sixth century B. C. and Galenic views of the second century A. D. , except that there were five instead of four essential humors. (The number five had mystical value for the Chinese and was used for most classifications five elements, five tastes, five qualities, five kinds of drugs, five treatments, five solid organs, five seasons, five emotions, five colors, etc. ) The medical compendium Nei Ching stated that each emotion had its seat in a particular organ.Happiness dwelt in the heart, thought in the spleen, so rrow in the lungs, and the liver housed anger as well as the soul. Ideas in the Nei Ching concerning movement of the blood (All the blood is under control of the heart. The blood current flows continuously in a circle and never stops. ) have been thought to approach an understanding of its circulation antedating Harvey by thousands of years however, some body vessels were believed to convey air, and there is little evidence that commentators perceived the blood-carrying vessels as a contained system. DiagnosisThe Chinese methods of diagnosis included questioning, feeling the pulse, observing the voice and body, and in some circumstances touching the affected parts. In almost all times and cultures physicians have used a similar approach, for all healers have sought to know as much as possible about a patient in order to understand his or her illness and advise treatment. However, in some respects ancient physicians saw each patient more completely as a reflection of his surrounding s (indeed, the entire universe) than does the doctor of today. The Chinese doctor wanted to learn ow the patient had violated the tao, and to do this he took into account the patients rank changes in his or her social status, household, economic position, sense of well-being, or appetite the weather and the dreams of the patient and his or her family. Perhaps the most important diagnostic technique of the ancient Chinese was examination of the pulse. The physician felt the right wrist and then the left. He compared the beats with his own, noting precise time as well as day and season since each hour affected the nature of the pulsations.Each pulse had three distinct divisions, each associated with a specific organ, and each division had a separate quality, of which there were dozens of varieties. Moreover, each division or zone of the pulse had a superficial and deep projection. Thus literally hundreds of possible characteristics were obtainable. In one treatise, Muo-Ching, ten volu mes were necessary to cover all the intricacies of the pulse. A patient had only to extend his or her arm through drawn bed curtains for the physician to determine the symptoms, diagnosis, prognosis, and proper treatment by intensive palpation of the pulse.Whenever possible the examiner also felt the skin of the ill person. However, it was considered bad form for a man to intimately examine a woman, so special ceramic, ivory, and wooden dolls were pointed to by the invalid to indicate where discomfort was felt. Treatment According to the Nei Ching, there were five methods of treatment cure the spirit, nourish the body, give medications, treat the whole body, and use acupuncture and moxibustion. The physician had to put the patient back on the right path, the tao.Assuming that specific mental states caused changes in specific organs, the healer linked certain objectionable behavioral and constitutional factors with illness and attempted to have the patient rectify these. For instance , dissolute and licentious ideas led to diseases of the lungs, but acting out such thoughts brought on heart trouble. A doctor had to determine the cause of disharmony in the body and act accordingly. Exercises were developed to keep the body fit and to restore well-being. Hua To, the great surgeon, worked out an ingenious system of physical therapy by advising mimicry of the natural movements of animals.Massagekneading, tapping, pinching, and chafingwas also a regular method of treatment, as were the application of plasters and evacuation of the intestinal tract by cathartics. In nourishing a patients body, the physician resorted to complex combinations of foods according to their potential amounts of yang and yin. Foods also had to fit the seasons, and each of the five tastes had benefits for a particular element of the body sour for the bones, pungent for the tendons, salty for the blood, bitter for respiration, and sweet for muscle.Medications The Chinese pharmacopoeia was alway s rich, from the time of the Pen-tsao, the first medical herbal, to the later dynasties when two thousand items and sixteen thousand prescriptions made up the armamentarium. Drugs were considered more likely to be good if they tasted bad. As one would expect, they were classified into five categories herbs, trees, insects, stones, and grains. The therapeutic minerals and metals included compounds of mercury (calomel was employed for venereal diseases), arsenic, and magnetic stones.Animal-derived remedies, in addition to dragon teeth (powdered fossilized bones), included virtually anything obtainable from living creatures whole parts, segments of organs, urine, dung. Two plant substances especially associated with China may be singled out. One is ephedra (ma huang), the horsetail plant described by the Red Emperor, which was used for thousands of years as a stimulant, as a remedy for respiratory -diseases, to induce fevers and perspiration, and to depress coughs.Ephedra entered the G reek pharmacopoeia and eventually was disseminated throughout most of the world. It only became a factor in Western medicine in the late nineteenth century after Japanese investigators isolated and purified the active principle, ephedrine, and established its pharmacologic action. A second medicinal herb, always highly popular among the Chinese, is ginseng (man-shaped root). To the Chinese, preparations containing ginseng were almost miraculous in delaying old age, restoring sexual powers, stimulating the debilitated, and sedating the overwrought.In addition it improved diabetes and stabilized blood pressure. In recent years this root has been under scrutiny by Western pharmacologists attempting to evaluate its true benefits. Multitudes in Asia, and even some Westerners, are so convinced of its effectiveness that high-grade wild roots have brought fabulous prices (even reaching thousands of dollars apiece). Although many items in the Chinese materia medica have either faded into bsc urity or been labeled fanciful, others subsequently have been found to possess sound pharmacologic bases seaweed, which contains iodine, was used in treating enlargement of the thyroid the willow plant, containing salicylic acid, was a remedy for rheumatism the Siberian wort has antispasmodics for menstrual discomfort and mulberry flowers contain rutin, a treatment for elevated blood pressure. Whether opium was used as a drug before quite late in Chinese history is still in dispute. Acupuncture and Moxibustion These modalities have been an integral part of Chinese medical therapy for thousands of years.The Yellow Emperor is said to have invented them, but they may well have existed long before his time. The aim of these treatments was to drain off excess yang or yin and thus establish a proper balance, but external energy also could be introduced into the body. In acupuncture the skin is pierced by long needles to varying prescribed depths. Needles are inserted into any of 365 point s along the twelve meridians that traverse the body and transmit an active life force called chi. Each of these points is related to a particular organ.For instance, puncture of a certain spot on the ear lobe might be the proper way to treat an abdominal ailment. Virtually every illness, weakness, and symptom is thought to be amenable to correction by acupuncture. Acupuncture spread to Korea and Japan by the end of the tenth century A. D. , to Europe about the seventeenth century, and recent years have seen a wider interest in this Chinese medical practice in the West. Individual paramedical healers and even some medical practitioners have been swamped with requests for acupuncture, especially for problems apparently little benefited by conventional practices.The eventual acceptability of this practice in standard Western medicine remains to be seen. Moxibustion is as old as acupuncture, and the same meridians and points govern placement of the moxa. However, in this treatment a pow dered plant substance, usually mugwort, is fashioned into a small mound on the patients skin and burned, usually raising a blister. Dentistry The treatment of tooth disorders was confined mainly to applying or ingesting drugspomegranate, aconite, ginseng, garlic, rhubarb, and arsenic, as well as animal products such as dung and urine.The Nei Ching classified nine types of toothaches, which included some obviously due to infections and tooth decay. Like the Mesopotamians and Egyptians, the ancient Chinese believed that worms were often responsible for dental problems. Toothpicks and tooth whiteners were used, and loose teeth were stabilized with bamboo splints. Gold was sometimes used to cover teeth, but the purpose was decorative rather than protective. Surgery Although surgery was not one of the five methods of treatment listed in the Nei Ching, the knife was known and used.Hua To, one of the few names mentioned in connection with surgery, treated an arm wound of the famous general Kuan Yu by cutting his flesh and scraping the bone. Physicians knew how to deal with wounds, and at least two classics were devoted entirely to their treatment. The proper attitude toward pain was to bear it without a sign of emotion, and much was made of the insouciance of the general treated by Hua To he played chess while the surgeon operated. Nevertheless, apparently some kind of anesthesia was often used.Wine and drugs like hyoscyamus were probably mainstays, but the use of opium and Indian hemp is still in question. Eunuchs and Footbinding Another surgical procedure, though hardly therapeutic, was the frequent castration of certain males seeking advancement at court. Though originally a severe punishment, the total removal of penis and testicles came to be a pledge of absolute allegiance to the monarch, since it released the eunuch from conflict with Confucian admonitions of first loyalty to family and the obligation of siring a son for posterity.Footbinding is also of medica l interest, for it caused the development of artificially clubbed feet. Over a period of one thousand years, every young girl of proper family willingly permitted herself to be crippled by her mother and aunts to achieve the tiny foot of ideal feminine beauty. Her toes were gradually folded under the sole, and by increasingly tight bandaging her heelbone and forefoot were brought closer together. Without Golden Lotuses, as the best-shaped bound feet were called, a girl was unmarriageable, nor was the life of a courtesan open to her, for tiny feet were a womans most desirable feature.For a man, a bound-foot wife had profound sexual significance, but she was also a status symbol inasmuch as her helplessness indicated that he was wealthy enough to support a woman, or women, in idleness. There was also an advantage to him in her restricted mobility, for it kept her home and made illicit amorous adventures difficult. Although Chinas Manchu conquerors forbade the practice in the nineteent h century, it was not until the early twentieth that footbinding was completely abandoned. Diseases Some epidemic diseases were understood well enough to allow the development of protective measures.In the eleventh century, inoculation against smallpox was effected by putting scabs from smallpox pustules into the nostrils, a method which may have come from India. Wearing the clothing of someone who had the disease was another means of prevention. The relationship of cowpox (as a protective) to smallpox may have been perceived, since ingesting powdered fleas from infected cows was also recommended to stave off smallpox. But other devastating pestilences were neither understood nor held in check. During the Han dynasty an epidemic of what appears to have been typhoid fever killed two-thirds of the population of one region.Precise descriptions of leprosy in the Nei Ching and later works attest to the diagnostic accuracy of the early Chinese healers, but their explanation of the disease s causes and their treatment follow preconceived notions of the time. The wind and chills lodge in the blood vessels and cannot be got rid of. This is called li-feng. For the treatment prick the swollen parts with a sharp needle to let the foul air out. Fourteenth-century writings referred to chaulmoogra oil, a pressing from seeds of an East Indian tree, as a specific for leprosy, and this oil remained the principal antileprous drug even in the West until recent decades.An illness that may have been tuberculosis was recognized as contagious Generally the disease gives rise to high fever, sweating, asthenia, unlocalized pains making all positions difficult and slowly bringing about consumption and death, after which the disease is transmitted to the relations until the whole family has been wiped out. Venereal diseases, although not well differentiated, received a variety of therapies, including the use of metallic substances for internal medication.In the Secret Therapy for the Tr eatment of Venereal Disease, the seventeenth-century physician Chun Szi-sung reported using arsenic, which, until the development of penicillin, was the modern medication for venereal disease, in the form of Salvarsan and derivatives synthesized by Paul Ehrlich. There seem always to have been places in China where the sick poor could go for medical care. With the advance of Buddhism in the Han and Tang dynasties, in-patient hospitals staffed by physician-priests became common.However, in the ninth century, when anti-Buddhists were in control, hospitals as well as 4,600 temples were destroyed or emptied. Nevertheless, by the twelfth century hospitals had again become so numerous that virtually every district had at least one tax-supported institution. The upper classes preferred to be treated and cared for in their homes, thus leaving public hospitals to the poor and lower classes. The Practitioners In the Institutions of Chou, compiled hundreds of years before Christ, the hierarchy of physicians in the kingdom was delineated.The five categories were chief physician (who collected drugs, examined other physicians, and assigned them) food physicians (who prescribed six kinds of food and drink) physicians for simple diseases (such as headaches, colds, minor wounds) ulcer physicians (who may have been the surgeons) and physicians for animals (evidently veterinarians). Physicians were also rated according to their results, and as early as the Chou and Tang dynasties each doctor had to report both successes and failuresto control his movement up or down in the ranks.In the seventh century A. D. examinations were required for one to qualify as a physician, some four centuries earlier than the first licensing system in the West. Medical knowledge was thought of as a secret power that belonged to each practitioner. Whereas in other societies, both advanced and primitive, closely knit guilds might control the spread of medical lore, the Chinese physician kept his secret s to himselfpassing them on only to sons or, sometimes, specially selected qualifiers.In early times, a physician gave his services out of philanthropy, for since the original healers were rulers, sages, nobles, and, perhaps, priests, economic and social incentives were absent. Later, direct fees or salaries were instituted, and the court and certain prosperous households kept physicians on retainer. Formal schools may have existed as early as the tenth century, and in the eleventh century an organization for medical education was set up under imperial auspices. Under the Ming dynasty in the fourteenth century, the school system became fixed. It changed little over the next centuries, xcept for a gradual decline, and by 1800 there was only one medical school left in Peking. Teachers were held strictly accountable for the performance of their students, and fines were imposed if the professor failed to enforce attendance or if his pupils did poorly on exams. The examination system was complex a pyramidal structure provided a process of elimination which continued until those with the highest scores emerged. The top students could be heart doctors, the next level were assistant examiners, and lower scores could mean limited assignment in teaching.Specialization may have occurred early. While physicians and apothecaries were separate for a long time, they were both regarded as healers. In the Chou dynasty there were nine specialties, and they grew to thirteen by the Mongol period, early in the fourteenth century. The subdivisions became even more complex, with doctors for the great blood vessels, small vessels, fevers, smallpox, eyes, skin, bones, larynx, and mouth and teeth. There were also gynecologists, pediatricians, and pulsologists for internal diseases, external medicine, the nose and throat, and for childrens illnesses.Some healers specialized in moxibustion, acupuncture, or massage. Even the experts in incantation and dietetics were considered medical spe cialists and were often held in higher regard than other doctors surgeons were generally of low rank. Furthermore, each of the practitioners in each category had assistants and studentsall of whom had to qualify by examination. Obstetrics was in the hands of midwives for many centuries it is not known when the first women doctors were in practice. One female physician is mentioned by name in documents from the Han dynasty (206 B.C. -A. D. 220), but women may have been doctors at an earlier date. By the fourteenth century women were officially recognized as physicians. Throughout the Ming dynasty (1368-1644), the practicing medical theorists could be divided into six main philosophic schools. The Yin-yang group focused on insufficiencies of one of these forces. The Wen-pou doctors attributed illnesses to a preponderance of yang and frequently prescribed ginseng and aconite. The Radical group used drastic medication.The Conservatives relied entirely on the authorities of the past, ree dited the classic works, and made no deviations from strict authoritarianism. The Eclectic physicians, as their name implies, used a variety of principles from the other sects. The sixth school based all therapy on bringing the five elements and six vapors into harmony. Spread of Chinese Medicine to Korea, Japan, And Tibet Ancient Chinese medicine was well-developed long before the beginning of the Christian era, and its influence appears to have spread into adjacent Korea by the sixth century A.D. At that time, after a severe epidemic had ravaged Japan, Korean doctors who were invited to counsel Japanese physicians introduced them to Chinese medical classics and commentaries. By the seventh century, Japanese scholars and doctors were going directly to China for their information and experience. In the eighth century, a Chinese Buddhist monk named Chien Chen came to Japan and achieved a prominent position in the imperial court at Nara, where, given the Japanese name Kanjin, he taugh t, practiced medicine, and translated Chinese materia medica.Late in that century, Chinese medicine was well-established in Japan, and a medical school based on its methodology was founded by the Japanese physician Wake Hiroya. Early in the next century (80610), the Emperor Heijo vainly attempted to combat foreign influence and restore traditional Japanese medical practice, but the methods of Chinese healing were too firmly entrenched. In the tenth century, acupuncture reached Japan, followed by moxibusti on (the word moxa is Japanese), and the full complement of Chinese medicine was accepted in Japan.With medical training closely based on Chinese systems, the Japanese exacted exceptionally intensive and prolonged study before permitting entrance into the profession by governmental examination. As in ancient China, high social standing was a requirement for admission to medical school, but separate instruction by assigned teachers was apparently also arranged to accommodate the more lowly. The authority of Chinese medicine, not to mention Chinese culture and philosophy, moved east as well as west by the seventh and eighth centuries.However, Arabic and Indian missionaries of Islam and Buddhism made influence a two-way exchange as they traveled to China seeking converts. Since their missions necessitated the translation of Sanskrit and Arabic writings into Chinese and vice versa, medical knowledge inevitably was passed back and forth. Consequently, the crossroads areas of Southeast Asia and Tibet developed a medical system combining aspects of Chinese, Indian, and Arabic practice. Arabic influence, which stemmed in part from Greek teachings, was evident in the doctrine of four humors (phlegm, blood, bile, and wind), whereas Indian deas were seen in the Yogic placement of the soul in the core of the spinal column and reliance on breathing exercises. Traveling Buddhist priests, who were quite successful in spreading their faith, for a long time also practiced medi cine. During this early period, the two wives (one Chinese) of a Tibetan king converted him to Buddhism, and thereafter scholars were invited to bring Chinese writings into Tibet, which resulted in collections in Tibetan called Kanjur and Tanjur, the latter containing medical information.In the thirteenth century, the Mongol conqueror Kublai Khan wanted this body of knowledge available again in Chinese but was unable to carry through the translation. Nevertheless, his grandson in the next century arranged for scholars from Tibet, Mongolia, and Central Asia to accomplish the task. Ironically, while the Mongols were in control they allied themselves with non-Chinese such as Uighars, Jews, Christians, and Moslems, and they preferred Arabic medicine to Chinese.