Classical Chinese Medicine [1 ed.] 1527503976, 9781527503977

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Classical Chinese Medicine

Classical Chinese Medicine: Theory, Methodology and Therapy in Its Philosophical Framework By

Keekok Lee

Classical Chinese Medicine: Theory, Methodology and Therapy in Its Philosophical Framework By Keekok Lee This book first published 2018 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2018 by Keekok Lee All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-0397-6 ISBN (13): 978-1-5275-0397-7

CONTENTS

Acknowledgements .................................................................................... ix Chapter One ................................................................................................. 1 Introduction Background and Nature of the Book...................................................... 1 Summary of Chapters ............................................................................ 6 Conclusion ........................................................................................... 14 Chapter Two .............................................................................................. 16 The Jingluo/㓿㔌 Network Introduction.......................................................................................... 16 History: A Brief Outline ...................................................................... 18 Is the Jingluo Network Other Than Fictional? ..................................... 24 Some Methodological Comments ........................................................ 35 CCM’s Own Understanding of the Jingluo Network and the Relationship between Effect and Cause ............................. 40 Conclusion ........................................................................................... 56 Chapter Three ............................................................................................ 60 In Defence of Wuxing/ӄ㹼 Introduction.......................................................................................... 60 Internal Reasons ................................................................................... 61 External Reason: The Spirit of Positivism ........................................... 63 The Context Distinction....................................................................... 65 Context of Generating the Wuxing Hypothesis (CGH) and Context of Testing It (CTH) ........................................................................ 68 AWT: Throwing the Baby Out With The Bath Water? ....................... 74 Conclusion ........................................................................................... 77 Chapter Four .............................................................................................. 80 Chinese Classical Medicine: Ecosystem Science/Science Introduction.......................................................................................... 80 CCM, Wholism and Ecosystem Science/Science ................................. 80 Preventive Medicine (Primary Meaning) in the Context of CCM as Ecosystem Thinking................................................................. 101 Conclusion ......................................................................................... 115

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Contents

Chapter Five ............................................................................................ 117 Preventive Medicine: Shang Gong Introduction........................................................................................ 117 The Origin of Preventive Medicine in Chinese Thinking .................. 120 Preventive Medicine: Shang Gong, Zhong Gong and Xia Gong........ 136 Preventive Medicine in CCM and Preventive Medicine in Biomedicine ............................................................................. 150 Conclusion ......................................................................................... 156 Chapter Six .............................................................................................. 159 Person: As a Primitive Concept in CCM Introduction........................................................................................ 159 Cartesian Dualism and Its Aftermath for Western Philosophy and Its Medicine ........................................................................... 159 The Humean Legacy: Passion/Emotion As Beyond Reason.............. 165 CCM: Mind-Body Wholism ............................................................... 166 Biomedicine and CCM: Psychosomatic Disorders/Illnesses ............. 171 The Placebo Phenomenon: Biomedicine, Science and CCM............. 183 Conclusion ......................................................................................... 190 Chapter Seven.......................................................................................... 191 Personalised Medicine in CCM and Personalized Medicine in Biomedicine: The Irrelevance of RCT and EBM to CCM Introduction........................................................................................ 191 CCM: Personalised/Getihua Medicine .............................................. 192 Biomedicine: Precision Medicine/Personalized Medicine ................. 200 Randomized Controlled Trials and Evidence-based Medicine .......... 204 Personalized/Precision Medicine, Getihua Medicine and the Biomedical Framework ................................................... 220 Conclusion, ........................................................................................ 223 Chapter Eight ........................................................................................... 225 The Concepts of Zhèng and Fang Introduction........................................................................................ 225 Biomedicine and CCM ...................................................................... 225 Illnesses categorised in terms of Deficiency or Excess...................... 228 Concept of Zhèng ............................................................................... 230 Concept of Fang ................................................................................ 250 Qinghao, Qinghaosu, Fangzi and Biomedical Pharmacology ........... 257 Biomedicine and Getihua Medicine from the standpoint of Zhèng and Fang....................................................................................... 260

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Fang and Food: Food as Medicinal ................................................... 268 Assessing the Cause-Effect Relationship: Treating Chronic and Acute illnesses in CCM ......................................................... 275 Conclusion ......................................................................................... 282 Chapter Nine............................................................................................ 285 CCM and Its Unifying Principles of Physiology, Illness and Therapy (PIT-ism) Introduction........................................................................................ 285 Absurdity 1 ........................................................................................ 286 Absurdity 2 ........................................................................................ 293 Absurdity 3 ........................................................................................ 295 Absurdity 4 ........................................................................................ 301 Conclusion ......................................................................................... 315 Chapter Ten ............................................................................................. 318 CCM as Yidaoyi: Macro-Micro-cosmic Wholism Introduction........................................................................................ 318 Tianren-xiangying, the Cyclic Ascending-Descending Law of Nature, Macro-Micro-cosmic Wholism and Yidaoyi ................................. 318 Axiomatic Construction of CCM in terms of Its Laws of Nature ...... 329 The Person-body, the Laws of Nature, Wuxing and the Jingluo Network ........................................................................................ 330 Contextual-dyadic Mode of Thinking ................................................ 334 Conclusion ......................................................................................... 338 Chapter Eleven ........................................................................................ 341 Integrating Zhongyi with Biomedicine? Introduction........................................................................................ 341 Integration as Assimilation ................................................................ 343 The Chinese Project of Integrative Medicine..................................... 345 The TCM Project at the Level of Drug Use, ...................................... 352 Exploring the Incoherence of Lake’s Account of IM ........................ 356 A Respectful Partnership: coexistence, not integration for CCM-zhongyi ......................................................................... 362 Conclusion ......................................................................................... 368 Chapter Twelve ....................................................................................... 371 Conclusion Summary in Ten Points...................................................................... 371

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Appendix 1 .............................................................................................. 376 The Neijing: Date and Authorship Introduction........................................................................................ 376 The Textual Approach ....................................................................... 377 The Non-textual Approach ................................................................ 378 Conclusion ......................................................................................... 390 Appendix 2 .............................................................................................. 393 De-mystifying Zhang Zhongjing Life The Fate of His Work Following His Death ...................................... 396 Conclusion ......................................................................................... 407 Appendix 3 .............................................................................................. 410 The Fallacy of Misplaced Analysis What is this Fallacy? .......................................................................... 410 CCM as (Han) Body Politics Writ Large ........................................... 411 Conclusion ......................................................................................... 428 Appendix 4 .............................................................................................. 430 De-mystifying the Legend of Bian Que Why Bian Que Is Controversial ......................................................... 430 Some Biographical Details,................................................................ 431 Bian Que and Sima Qian.................................................................... 436 Bain Que, the Hanfeizi and the Fallacy of Misplaced Reasoning, ..... 437 Conclusion ......................................................................................... 442 References and Select Bibliography ........................................................ 445 Chinese Historical Periods and Dynasties ............................................... 476 Glossary of Some Chinese Terms in Pinyin ............................................ 477 Index ........................................................................................................ 482

ACKNOWLEDGEMENTS

I owe many debts to many people each of whom I am unable to thank individually. Minimally, however, I must mention two types of help I have received. On the technical side, I would like to express gratitude to those members of the University of Manchester IT and Library Staff (working in the Alan Gilbert Living Commons) as well as the Library team at the Documents Supply Unit who over the months and years had so cheerfully gone out of their way of duty to help and support me. Another person, a friend, must be thanked for having unstintingly helped me to configure and prepare electronically the many figures in the text. I must also thank another friend who expended an unconscionable amount of time and effort to ensure that the text reads clearly and fluently. On the more narrowly academic side, I would like to thank Andriy Vasylchenko (Skovoroda Institute of Philosophy, National Academy of Sciences, Ukraine) who had patiently read through sometimes several drafts of some chapters with many suggestions for clarity and improvement. Most of all, I must thank Zhang Yu and Jiao Bin (Beijing Sanlitun Hospital) for their encouragement, sending on “must read” books on the subject, going through every chapter to make sure that I would not have committed serious flaws in my understanding of CCM. (For any which remain, I alone am responsible.) Last but not least, I must also thank Cambridge Scholars not only for their efficiency but also the courtesy with which they have responded to my numerous queries. Without the unflagging help and support of all the above and many more besides, this book would and could not have been written or published – thank you every one. Keekok Lee University of Manchester July 2017

CHAPTER ONE INTRODUCTION

Background and nature of the book This volume is the sequel to The Philosophical Foundations of Classical Chinese Medicine: Philosophy, Methodology, Science (Lee 2017a) as well as forming the final component of a trilogy, beginning with the publication of the volume, The Philosophical Foundations of Modern Medicine (Lee 2012b). The trilogy is united in terms of both the subject matter of their investigation and the methodological approach adopted to explore their respective content. All three look at different systems of medicine from the vantage point of a philosopher, trained in the analytical tradition of socalled Anglo-Saxon philosophy. Lee 2012b examines Modern/Western Medicine (MM/WM), commonly today referred to as Biomedicine (Bm); the other two volumes look at Classical Chinese Medicine (CCM). They are premised on the supposition that all domains of intellectual-practical activities including Science, in general, and medicine, in particular (as part of Science),1 are not free of philosophical presuppositions. Positivism not-

1

This claim is not uncontroversial. An alternative view is that medicine is a craft, which happens to use science in treating the sick and the suffering. The two claims are not mutually exclusive, since both sides admit to the minimum that medicine calls upon science or uses it. This controversy should not be turned into a trivial issue about a definitional matter, simply, about how a word is used. For the purpose of this work, the term “science” is used in the following way to talk about: (a) Knowledge, which is systematic in character. (b) Knowledge, whose key concepts have methodological implications involving consequences, which can be empirically tested, though not necessarily via a Randomised Controlled Trial (RCT). (c) Knowledge which invokes, explicitly or implicitly, a model of causality, linear or non-linear. (Bm, with the exception of developments in some areas, especially of late, relies on a model, which is linear and monofactorial, while CCM relies on a non-linear, multifactorial model.)

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Chapter One

withstanding, Science and philosophy are not mutually exclusive, but invariably go hand in hand. The philosophy unearthed in this kind of “excavation” includes the following main aspects: I. The metaphysical/ontological core of any Science/medicine. II. The methodological implications of such a core–these inform and even dictate the way in which the science is conducted, and determine the conception of causality, which the science relies on. III. I and II above, in turn, may be used to determine the standard of scientificity, according to which, other systems are then judged to be “not Science”/“not proper Science”/“not sufficiently scientific” or even in more extreme terms, condemned as “unintelligible”/“plain mumbo-jumbo”. This tendency appears to be inherent in the accounts of Science espoused by not a few adherents of Modern Science and Bm. This is because they subscribe to what may be called Essentialism of Method (see Chapter Eleven). I and II above are able to demonstrate how two systems of medicine– Bm and CCM–entail the following: (a) Very different theoretical/philosophical claims. (b) Very different accounts of what constitutes disease/illness and their causes. (c) Very different forms of treating diseases/illnesses thus conceived. Lee 2012b establishes that Bm rests on Empiricism/Positivism-cumEmpiricism. Its metaphysical/ontological core includes what Lee 2017a, in Chapter Eight calls thing-ontology; it is par excellence a Newtonian science, which studies macro-sized objects, whose spatial features or properties (size and weight) alone define their identities. Ontologically, it regards all organisms, including human beings, as machines; it embodies Materialism simpliciter. Such a core implies a methodology based on quantification and measurement which, being considered to be objective properties of the objects, constitute one strand of its criteria of scientificity. These three characteristics jointly constitute sufficient conditions for the use of the term. This work contends that both Bm and CCM satisfy the characteristics in question, in spite of the differences between them. It follows that neither body of knowledge is free of philosophical presuppositions, which ought to be investigated.

Introduction

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The other strand is informed by a conception of causality, which involves a linear, monofactorial model/the Humean billiard-ball account. In turn, these various strands lead to the monogenic conception of disease as disease-entity (Lee 2012b, Chapters One to Five, Nine and Ten) as well as to the notions of RCT and Evidence-based Medicine (EBM) to determine the highest standard of evidence, against which, other forms of evidence must be judged to be inferior or sub-standard (see Lee 2012b as well as Chapter Eleven and Chapter Seven of this volume). In a nutshell, it may be summed up as atomistic, mechanistic and reductionist in character; its basic or paradigmatic science is anatomy;2 its paradigmatic technology is surgery, instantiating Engineering Technology. Its technology is increasingly high-tech. This volume is intended as a sequel to Lee 2017a, which deals primarily with themes I and II–that CCM rests on process-ontology, that Qi is the fundamental ontological category (in its two modes, Qi-inconcentrating mode and Qi-in-dissipating mode), that it is Ecosystem Science, what today one may call a post-Newtonian science,3 conducted within a Timespace framework and is wholly Wholist in orientation. Its fundamental mode of thinking is Contextual-dyadic Thinking, implying a rejection not only of Cartesian dualism but also of Aristotle’s Three Laws/Principles of Thought, while relying on what may be called Yinyang/Yao-gua implicit logic, which may be considered to be an 2

This, at first sight, may appear quaint to modern ears as today, Bm regards disease largely as a biochemical and, to some extent, biophysical entity. However, historically, anatomy was, indeed, the paradigmatic science (Lee 2012b). Lee 2017a argues that Bm rests on thing-ontology; anatomy paradigmatically rests on thing-ontology. Ontologically speaking, anatomy remains in spirit a fundamental science, especially when surgery is regarded as the highest form of medical technology. Today’s most glamorous form of surgery is no longer appendectomy, but neurosurgery of one description or another. Without anatomy, surgery cannot be successfully conducted. 3 The term “post-Newtonian science” is used here, for the simple reason that the arguments deployed in this work show that parts of Modern Science and Bm exhibit characteristics which are increasingly “post-Newtonian”. Of course, it is correct to say that CCM is just simply “non-Newtonian” or “pre-Newtonian”; these would historically speaking be correct terms, but they do not cast light, all the same, on the partial overlapping between CCM and the more recent developments in Modern Science, such as quantum physics, which is regarded paradigmatically as a post-Newtonian science, whose characteristics are similar, though not identical with those exhibited by CCM (see Lee 2017a, Chapter Eight). Hence, it would not be too misleading to refer to CCM as “post-Newtonian” from such a philosophical vantage point.

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Chapter One

analogue of modern Fuzzy Logic. Its conception of causality is dynamic, non-linear, multifactorial as well as synergistic. This volume, then, explores why CCM possesses the characteristics it does, in the light of its metaphysical/ontological core (Theme I), and the methodology such a core entails, in doing science and in practising medicine (Theme II).4 It will demonstrate the following theses. 1. Qi, as the fundamental ontological category, can be empirically tested.5 Chapter Two shows that CCM has its own methods of assessing the empirical consequences of theoretical claims made on its behalf, such as in acupuncture (and other forms of treatment). Since the 1980s, even its results can be verified via tests that are endorsed by Modern Science and Bm, that is, in biophysical terms. (See also Chapters Five and Eight.) 2. Just as Qi has been subjected to attacks mounted by sceptics, so has another important concept in CCM, namely, Wuxing, which Lee 2017a, in Chapter Four has argued, embeds the analogues of negative and positive feed-back loops in a causal chain of reasoning. Chapter Three follows this up to explore some of the complicated philosophical-historical roots which may form the basis of such scepticism. It argues that there is no need to fall prey to such an ill-conceived charge, namely, that Wuxing is a “metaphysical” notion, in the abusive sense of that term. 3. Chapter Four sets out, in detail, what is meant by claiming that CCM is Ecosystem Science. Chapter Ten reinforces this analysis by looking at its concept of Macro-Micro-cosmic Wholism (what sinologists in general call “Correlative Thinking”), which throws light not only on how CCM understands the relationship between different parts of the person-body and the nature of the functioning relationship between them, but also why CCM is known as Yidaoyi/᱃䚃५, a medicine which rests on the Yijing and the Dao of the Laozi. (See Lee 2017a, Chapters Four and Five.)

4

To mark these characteristics in this volume, certain terms such as, “Wholism” and “philosophy” will appear as “Wholism” and “philosophy” in italicised form, in order to draw attention to the differences between the uses of them in Western philosophy, on the one hand, and in Chinese philosophy in which CCM is embedded, on the other. 5 To say that a theory/concept is capable of being empirically tested should not be equated with the view that RCTs can be conducted; this entire volume is, at pains, to make clear that RCTs are not relevant to assessing the testability of CCM.

Introduction

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4. CCM’s thorough-going Wholism is demonstrated yet again in Chapter Five. As Wholes are made up of parts or components, the functioning of which is intimately bound up with one another, it follows that a seemingly trivial malfunctioning or slight imbalance between yinqi and yangqi in one part of the person-body may, if unchecked, end up turning into a major and serious malfunctioning–as the expression in English goes, a chain is no stronger than its weakest link. This explains why CCM theorists regard Preventive Medicine as the zenith of clinical excellence. 5. Chapter Six demonstrates another form of Wholism, through the concept of person as a primitive concept. The Wholism of the person-body means that the distinction between facts as objective, and emotions/values as subjective, is rejected in favour of the view that the physical and psychological/emotional characteristics of a person are intimately entwined. It follows that all illnesses have a psychosomatic dimension, and that, in all treatments, the placebo effect would occur to some extent, and should be harnessed positively to enhance the healing process. 6. Wholism also entails, as Chapter Seven argues, that CCM practises Getihua Medicine/њփॆ⋫⯇/Personalised Medicine. As every personbody is a Whole, such a Whole would be different from the Wholes of other individual person-bodies; hence, CCM’s yili/ ५ ⨶ /theory of therapeutic intervention dictates that the conditions of each person-body must be assessed and treated to address the specificities which make up its Whole at the time of presentation. Chapter Eight contributes further by focussing on two key concepts in CCM theory-practice, zhèng 6 / 䇱 /evidence-gathering for diagnostic purpose (as a short-hand translation) and fang/ᯩ/prescription. 7. CCM, at first sight, appears to uphold several absurdities. Chapter Nine sets out to dissolve them by exploring a trinity of theses, constituting a coherent unity, which this work calls PIT-ism: (a) Physiology/shengli/⭏⨶ is the basic or paradigmatic science. (b) An intimate link between physiology and bingli/⯵⨶/theory of illness. (c) An intimate link between the above and yili/theory of therapy.

6 A tonal marker is introduced to this particular word in pinyin only. The reason for this will be explained in Chapter Eight.

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8. Chapter Eleven explores the notion of Integrative Medicine/IM, demonstrating that although Bm and CCM do not talk to each other as far as Themes I and II go, there may still be some room for co-operation, provided one is careful to avoid falling into the trap laid by Essentialism of Method (as observed earlier under III above), at the level of the elimination/diminution of symptoms.

Summary of chapters Chapter Two

The Jingluo/㓿㔌 Network

This chapter deals with the following issues. 1. The Jingluo, as an integral part of the Neijing/lj޵㓿NJ(commonly acknowledged to be a, if not, the foundational text of CCM), focusses on Qi-in-dissipating mode which, in turn, is a key concept in all domains of CCM, whether this be acupuncture, herbal medicine, tuina/᧘᤯ or other forms of treatment, sanctioned by the medicine. 2. Doubts about its existence and “reality” can primarily be traced to one main source, that it appears not to exist according to the standard implied and upheld by Bm; a standard, which is subscribed to by nearly all adherents of Bm, whether they be non-Chinese or Chinese themselves. 3. To quell such doubts, the Jingluo, in the 1970s was subjected to an extended series of biophysical tests, whose outcome even surprised the lead scientist of the research team, as he had not expected the eventual outcome. These tests presupposed the null hypothesis “That the Jingluo is not real and does not exist” (H0). In the end, H0 was nullified. (This H0 crudely formulated serves only the limited purpose of a quick exposition here.) 4. The sceptics, invariably, before this series of experiments and after it, had/have chosen to ignore that CCM has its own (implied) tests and criteria for what counts as “real” and “existing”; its theory-practice implies that Qi in the Jingluo does have testable consequences via acupuncture and other treatments. Such a view approximates to “causal realism”–the effects of the postulated cause may be observable and ascertainable even though the cause itself is not observable via the naked eye or in anatomical terms. CCM uses the nostrum that pain/illness, in general, is caused by blocked qi. Unblock the qi via acupuncture and/or other treatments, and

Introduction

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the pain/the illness would diminish or be removed. The diminution of pain apart, the other predicted effects of such treatments may be either objectively or inter-subjectively determinable and are, therefore, empirically ascertainable. Furthermore, should one wish, one could even find ways of “translating” such tests into a format which is deemed to be standard in the philosophy of science. 5. Unless one subscribes to Essentialism of Method, there is no need to downgrade CCM’s own tests and guidelines noted in 4 above and elevate, only, the biophysical tests as the tests of the Jingluo’s scientificity/ existence/reality. Chapter Three

In Defence of Wuxing/ӄ㹼

Wuxing has also been subjected to critical doubt on the part of certain theorist-practitioners of medicine in China today (who form part of what is generally referred to as Traditional Chinese Medicine–TCM–in English). This chapter tries to disentangle the historical roots of such scepticism, including, ironically, the spirit of Positivist philosophy and its influence upon Chinese thought itself, since the heyday of Positivism in the early twentieth century. Chapters Two and Three should be read as an attempt to undermine the charge that certain key concepts of CCM are “metaphysical” in the abusive sense of that term. Chapter Eleven should also be read bearing these earlier chapters in mind. Chapter Four

Classical Chinese Medicine: Ecosystem Science/ Science

This chapter demonstrates the detailed implications of CCM as Ecosystem Science, which involves a nesting of a series of ecosystems, the smaller within a larger as shown in Figure 4.1. Such an exploration would render explicit why the medicine possesses the characteristics it does. 1. Ten ecosystems have been identified. CCM has no interest in the first and some in the second, focussing primarily on Ecosystems 3-10. 2. Take Ecosystem 3, the level of the visceral organ-system/Zangfu/㜿㞁, such as, that of the Spleen-Stomach/piwei/㝮㛳, which is embedded in Ecosystem 4, that level constituted by Yinyang-Wuxing, within which the Spleen-Stomach organ-system is linked to Earth in Wuxing. As each

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Chapter One

visceral organ-system is linked with a particular aspect of Wuxing, and Wuxing itself forms a Whole, all the organ-systems in the person-body are, therefore, entwined within the Yinyang-Wuxing Wholist framework. This enables the various operating modes of Wuxing to be invoked in understanding the nature of the illness, presented by a particular patient, and using an appropriate treatment for the malfunctioning of the organsystem(s) diagnosed. 3. CCM is peculiar, but only if judged from the standpoint of Bm. This chapter looks at one of these peculiarities. CCM holds that the philtrum is an important medical site in terms of theory-and-therapy, because this seemingly innocuous bit of the person-body is precisely an important cosmological/metaphysical site, the meeting place of Heaven qi and Earth qi. Intervening upon this site can produce a very palpable, inter-subjective and even, indeed, objective, checkable positive therapeutic effect. This chapter sets the scene for a more detailed exploration of the general characteristics of CCM in the chapters that follow. Chapter Five

Preventive Medicine: Shang gong

The themes explored include the following: 1. Preventive Medicine is not an add-on for CCM, but forms part of its core theory-practice. There are two senses of the term: broad and narrow. The latter is examined here. (See Chapter Four which explores the former). 2. The examination is done via the notion of shang gong/кᐕ/one with superior skills, which is regarded as the highest accolade for a physician, and constitutes the paradigm of excellence in the theory-and-practice of CCM. 3. The historical roots of the concept of Preventive Medicine are tied up with many activities, such as those of hydraulic engineering, fire-fighting and divination to mention only three, whose common aim, to prevent/avoid catastrophe, is in conformity with the Dao being regarded as the highest form of knowledge/wisdom/skill. 4. This chapter should be read in conjunction, in particular, with Appendix Three which deals with a misconception held in some sinological quarters that CCM is, in the main, the politics of the Han

Introduction

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dynasty writ large. One of the roots of such a misconception is traced to a failure to understand the concept of Preventive Medicine at the core of CCM and its related notion of shang gong. Chapter Six

Person: As a Primitive Concept in CCM

This chapter continues to explore CCM’s “peculiar” characteristics via its account of person-hood as a primitive concept establishing the following theses. 1. It relies on Contextual-dyadic Thinking, thereby implying the rejection of Cartesian Mind-Body dualism. 2. It implies a rejection of the Humean view, which holds that there is an unbridgeable chasm between Passion/Emotion on the one hand, and Reason/Rationality on the other; while the former concerns values, which are subjective, the latter concerns matters, which are factual and, therefore, objective. Empirical/factual matters are capable of objective determination and measurement, constituting the essence of Science. Subjective values are beyond the pale of Science, and must not be permitted to contaminate and undermine Science. Body belongs to Science/objectivity; Mind to subjectivity. Medicine as Science deals only with the physical facts of Body; Mind, to be “respectable” must be reduced to Body, or accessed only via Body. Body may affect Mind (as permitted under epiphenomenalism), via psycho-pharmacological drugs, but Mind/mental events cannot affect Body. 3. For CCM, the individual person-body constitutes the human being, who lives and acts in the world. The person-body intimately entwines both physical and mental characteristics of the individual. These characteristics constitute polar contrasts, such as yin and yang, but just as yin cannot be separated from yang, or yang from yin, existing always as Yinyang, they, too (the mental and physical characteristics of the individual) cannot be isolated and separated from each other, but exist always together in the individual person-body. This is the crux of the concept of person-hood as a primitive concept. It follows from such an ontological standpoint that all illnesses can, indeed, be said to be psychosomatic to a greater or lesser degree and, hence, that all treatments, to a greater or lesser extent, could produce placebo (or nocebo) effects. Such is the human predicament. Excluding such a dimension, endemic in human existence, in sickness or

Chapter One

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in health, would, indeed, amount to doing something unscientific, as it patently excludes a crucial facet of human life. Chapter Seven

Personalised/Personalized Medicine in CCM and Biomedicine: The Irrelevance of RCT and EBM

1. CCM is, au fond, Personalised Medicine which entails the following: (a) The same illness in two different patients may require different sorts of treatment. (b) Two different patients, presenting two different illnesses, may be treated by the same sort of treatment. This is another peculiarity of CCM. 2. As such, it is necessarily beyond the pale of the “rigorous” procedure, pursued by Bm, in its privileging of the twin Gold Standards of RCT-EBM. RCT is premised on, what this chapter calls the axiom of homogeneity, while CCM is premised on that of heterogeneity. It is irrelevant to beat CCM over the head with the charge that it fails to meet such criteria of “scientificity”, while ignoring CCM’s own criteria for what counts as constituting its own scientificity. 3. In other words, the placebo/nocebo effect is endemic to any treatment, no matter what the medical system might be. The evidence for this phenomenon is now empirically well-grounded, yet Bm refuses to acknowledge the implication of this truth, and spends relentless efforts in excluding it from RCTs. 4. However, Bm, of late, has also been pioneering its own version of Personalized/Precision Medicine. Could it be that this cutting-edge domain, together with the placebo phenomenon, will turn out to be the Trojan Horse which may undermine RCT-EBM, and hence, Bm’s standard of scientificity? Chapter Eight

The Concepts of Zhèng and Fang

This chapter continues the exploration of CCM as Personalised Medicine via two key concepts, zhèng/䇱 and fang/ᯩ as Zhèng-Fang Wholism. 1. Simplistically put, zhèng stands for both process and outcome–the process of gathering all manner of relevant evidence before arriving at a

Introduction

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conclusion about the current state of the patient’s illness, which is the outcome itself of the careful process of gathering and sifting evidence, via the four diagnostic techniques/sizhen/ ഋ 䇺 of looking, listening and smelling, asking, and feeling the mai/㜹. 2. Zhèng determines fang. Together they address the specificities of the illness presented by the patient, the former by ascertaining what is malfunctioning in the person-body and the latter by prescribing a treatment, which is targeted at the patient’s specific state. The concept of fang is shown to operate within the Timespace framework of CCM. 3. An analysis of some fang is given, to show how medicinals are used in the Zhèng-Fang Wholist context. 4. The difference between the medicinal Herba Artemisiae Annuae and Artemisinin is highlighted to show the profound differences between CCM and Bm in the former’s use of Materia Medica and the latter’s use of pharmacological drugs. 5. The chapter looks at food as medicine in CCM, at the fluid relationship between yao/㦟/medicinals in a fang and food. 6. It also examines the claim that the relationship between a specific cause and specific effect(s) in CCM treatments is suspect, as CCM can only deal with cases of chronic but not critical illnesses. Chapter Nine

CCM and Its Unifying Principles of Physiology, Illness and Therapy (PIT-ism)

This chapter demonstrates the unity and coherence of CCM through its principles of physiology/shengli, illness/bingli and therapy/yili. Shenglibingli-yili is called PIT-ism. It does so by exploring some features of CCM, which appear at first sight to be plain absurdities. Four such “absurdities” are scrutinised. Such a scrutiny reveals that they are not absurdities after all, but constitute the very identity of CCM. Chapter Ten

CCM as Yidaoyi: Macro-Micro-cosmic Wholism

This chapter continues to explore the identity of CCM through the thesis of Macro-Micro-cosmic Wholism, which serves also to explain why Chinese scholars and practitioners have always characterised their

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Chapter One

medicine as resting on the Yijing and the Daojia philosophical tradition, calling it Yidaoyi. What this book calls the Cyclic Ascending-Descending Law of Nature, as shown in Figures 10.1 and 10.2, is critical to such an understanding of CCM. Chapters Nine and Ten together further explore the framework of Wholism, already set out in outline in Chapter Four, within which CCM must be understood. Chapter Eleven

Integrating Zhongyi with Biomedicine?

This volume and the preceding two volumes (2012b, 2017a), constituting a trilogy, end with this chapter, looking at the project of integrating zhongyi/ ѝ५ (the medicine rooted in Chinese history and its culture) with Bm. It identifies two main contexts of IM as practised today, which appear invariably to be forms of what may be called the Assimilation Model/AM under which, one of the two medicines, Bm, could be said to be the dominant and CCM, the junior partner. It is obvious that there can be no integration at the level of their respective metaphysical/ontological cores. However, is there a way, in spite of the obvious differences at both the philosophical as well as the methodological levels, to construct a more equal rather than a less equal partnership between zhongyi as CCM, on the one hand, and Bm on the other? To be able to do so, one must abandon Essentialism of Method which, historically, since the latter half of the nineteenth century, has always privileged Western Science/Medicine as well as Western philosophy over Chinese science/medicine/philosophy. One such limited proposal is put forward for consideration which, however, at the same time, argues that such a development and evolution should not be allowed to undermine the existence and survival as well as the development of CCM as it itself sees fit, as the identity of CCM is distinct from the project of IM as TCM–they are different beasts, so to speak, altogether. Chapter Twelve

Conclusion

This gives a brief summary in ten points of the main themes of the preceding chapters. Appendix One

The Neijing: Date and Authorship

The dating of the Neijing is of importance given that it has been a, if not, the foundational text of CCM down the millennia up to the present.

Introduction

13

Different traditions of scholarship have dated it differently. Up till the 1960s, scholars had relied mainly on textual evidence; but since 1963, artefacts have been found, such as stone, bronze, and silver acupuncture needles; their discovery enables scholars to infer an earlier date for some of the contents and concepts of the Neijing. They also permit them to argue against the view that it is (in the main) a Han text simpliciter. One needs to distinguish between the concepts/content embodied in the text from the emergence of the text as a mature text–part of the former could have long pre-dated the Han dynasty. Appendix Two

De-mystifying Zhang Zhongjing

The ljՔሂ䇪NJ/Shanghanlun is considered by CCM to be a text only secondary in importance to the Neijing. Yet there is the view held in some sinological quarters that the revolutionary ideas of Zhang Zhongjing were neglected for nearly a thousand years. This appendix demonstrates that such a conception of the history of CCM is mistaken. Appendix Three

The Fallacy of Misplaced Analysis

This continues to challenge the view held within a certain sinological tradition that the Neijing is basically (though perhaps not wholly) a reflection of the body politics of the Han dynasty writ large. This kind of mistaken conception has the unfortunate consequence of deflecting attention from any serious effort to understand what the medicine (CCM) really is, a medicine, whose aim is to enable the successful diagnosis and treatment of illnesses, afflicting the person-body. It is not really a text about the Han polity in disguise; nor would it be heuristically fruitful to regard it as such from the medical standpoint. Appendix Four

De-mystifying the Legend of Bian Que

It is important to try to cut through the legends surrounding Bian Que and his life in order to appreciate the key role played by Preventive Medicine in CCM. This, therefore, should be read in conjunction with Chapter Five. Appendices One to Four deal with some issues in the history of CCM, with the aim of preventing misconceptions of the nature of CCM, through misunderstanding these historical issues and problems. They have not been explored for their own sake as the history of CCM.

14

Chapter One

Conclusion This is the single most important message which this author would like to end with: one should not use the criteria for judging dogs in a dog show to judge cats in a cat show. Such an attempt would be silly and incoherent. Bm (in the main, a Newtonian science) should be judged in terms of its own standard of scientificity, and CCM (primarily, in a manner of speaking, a post-Newtonian, Ecosystem Science), too, in turn, in terms of its own standard of scientificity. CCM is, analogously, not a dog but a cat. Dogs bark and cats miaow–so please do not condemn cats as beasts inferior to dogs, just because cats only miaow and cannot bark. Mutatis mutandis, neither should CCM judge Bm as sub-standard just because dogs do not miaow but bark. However, one should also point out that some of the newest domains of development in Bm, such as Psychosomatic Medicine and Personalized/Precision Medicine, exhibit characteristics, just as Epidemiology did in the nineteenth and twentieth centuries, which approximate to the model of CCM as Ecosystem Science. Up to now, Epidemiology has been regarded as the Cinderella of Bm (Lee 2012b, Chapter Twelve); but perhaps, it will soon come within the pale, as recently, more domains have appeared to join it, in exploring a different model of medical theorising and reasoning. An entailment of this message should also be spelt out, namely, that Essentialism of Method should be avoided at all costs by grasping that every medicine has its own metaphysical/ontological core which, in turn, entails its own methodological procedures in understanding, diagnosing and treating diseases/illnesses. Some caveats should also be entered. First, it is not the aim per se of this volume to do Comparative Medicine (from the philosophical point of view). Given that its specific aim is to render CCM intelligible to those outside the tradition, especially to those who are, in the main, familiar only with Bm, and in this sense to give CCM a “fair hearing”, it is inevitable that the author would have occasion to stray, to some extent, into the domain of Comparative Medicine. Second, this is not per se a sinological work as its aim is very different. Furthermore, this author has no professional qualification in the field. Given the nature of the project undertaken in this trilogy, it is inevitable that the author would have occasion to stray into such a domain. Lee 2017a, as well as this volume, consistently uses “wholism”/ “Wholism”/“Wholism” instead of the more usual “holism”. It is to make it obvious that the reference is actually to a whole made up of parts, which

Introduction

15

may or may not be different from and/or more than the sum of its parts. While “whole” is used reductively, “Whole” or “Whole” is not. Unless otherwise stated, passages from the Chinese are rendered into English (though often not literally translated) by this author.

CHAPTER TWO THE JINGLUO/㓿㔌 NETWORK

Introduction Lee 2017a deliberately left aside the notion of the Jingluo, but this volume must now explore this in detail, for the following reasons. 1. Any adequate and appropriate examination of this concept presupposes an adequate and appropriate grasp of that cluster of core theoretical concepts in that tradition of Chinese philosophy/science resting on the Daojia tradition as explored in Lee 2017a: (a) Qi, the fundamental ontological category (Chapter Three); (b) Process-ontology (Chapter Eight); (c) Non-linear causal modality (Chapter Eleven); (d) Wholism in its various manifestations in CCM (Chapters Six, Seven and Ten). They constitute a specific articulation of Chinese science which is Ecosystem Science. 2. The Jingluo concept is the interface par excellence between Chinese philosophy/cosmology, on the one hand, and Chinese science in the guise of CCM, on the other. This is to say, that it is the concept in which theory and practice significantly meet and are entwined as theory-practice. 3. As such, it raises methodological issues, of which the principal related ones are: is such a theoretical concept capable of empirical testing? Does it exist and if so in what manner/sense of existence? Does it have discoverable or discernible manifestations? Can these manifestations be objectively demonstrated (or at least inter-subjectively ascertainable), not simply subjectively felt by the patient?

The Jingluo/㓿㔌 Network

17

4. It is crucially important to address the set of issues identified above for at least three reasons: (a) Their investigation may give us a clue as to how to understand the notion of first formulating and then testing hypotheses in general in CCM. (The former aspect will be explored in detail in Chapter Three, while the latter will be looked at later in this chapter). (b) If the Jingluo cannot be said to be determinable and ascertainable in some meaningful sense(s) of these two terms, then CCM cannot qualify to be “scientific” in the most basic sense of that term. By this is meant that its theoretical concepts must be capable of being empirically ascertainable under certain conditions via the consequences they entail. (c) The Jingluo is often referred to as the Jingmai/㓿㜹; this is highly significant as it shows that feeling the mai/㜹, which is one of the four important techniques used by the physician in diagnosing a patient’s condition, involves ascertaining Qixue/ ≄ 㹰 (Qi and blood), the former coursing through the Jingluo. (On this latter point, see Chapter Eight for further discussion.) Sometimes, it is thought, but mistakenly, that the Jingluo is peculiar to acupuncture and not relevant to internal medication or the other treatments. On the contrary, the concept of the Jingluo is embedded crucially in all the therapies of CCM, whether acupuncture/zhenfa/ 䪸 ⌅ , moxibustion/jiuliao/ ⚨ ⯇ , massage/tuina/ ᧘ ᤯ , deep breathing/ qigong/≄࣏, or internal medication via the decoction of herbs and other medicinals/caoyao/㥹㦟. 1 (Chapter Eight also looks at the relationship between Jingluo and fang, when it gives examples of how a specific prescription/fang is drawn up by the physician and how the medicinals in it are expected to work on the patient via the Jingluo network.) If the Jingluo cannot be authenticated at (b) above, then the status of the whole of CCM could be said to be jeopardized in terms of any claim it wants to make as a “scientific” medicine.

1

Not all medicinals in a prescription are herbs, as some may be animal parts or minerals, although the majority are plants. It is customary to refer to them collectively as caoyao/herbals.

18

Chapter Two

History: a brief outline The term, Jingluo, first appeared in the Neijing (which contains two parts, lj㍐䰞NJ/the Suwen and lj⚥᷒NJ/the Lingshu (see Appendix One), with more than sixty passages referring to it. In sinological literature, the term jing is translated as either “channels” or “meridians” (the term luo as “collaterals”). Neither attempt is really satisfactory: the former makes it sound like a system of irrigation canals; the latter lacks physical connotations, as meridians (longitude and latitude) constitute a grid imposed by us upon the Earth simply to facilitate our purpose of identifying locations. Jing in Chinese means “warp”, the warp in weaving silk, the vertical threads on a loom running the entire length of the fabric.2 Luo literally means “net-like”, but in the discourse of the Jingluo, it means a branch of the jing, a small jing. It is best to refer to it as “the Jingluo network”. Two further observations must immediately be made. What does this network do in the human individual? In CCM terms, it is said to carry Qixue to the yin visceral organs and the yang visceral organs which, together, make up the Yinyang visceral organ-systems/㜿㞁/Zangfu, to keep them functioning properly. To modern ears, attuned to the Bm worldview, this is extremely problematic, as xue is blood but qi is Qi-indissipating mode3 in this context, not Qi-in-concentrating mode, which is Matter, something visible and touchable, such as blood. Blood, though, can only course smoothly in the person-body when propelled, so to speak, by Qi-in-dissipating mode. The Jingluo is about Qi-in-dissipating mode in the human being, in accordance with the concept of Tianren-xiangying/ᓄ 4 /Macro-Micro-cosmic Wholism. If Qi-in-dissipating mode occurs in greater Nature (the Macrocosm), then it must also be present in the human being (the Microcosm). If the Jingluo is about the circulation of Qi in the human individual, then it also follows from the concept of Tianren-xiangying that it is an open system, connected with both ཙ≄/Tianqi (qi of Heaven which is yang) and ൠ≄/Diqi (qi of Earth which is yin) from which it 2

See Lee 2008, 237-239 for a discussion. Note that Chinese medical texts do not distinguish explicitly between Qi-indissipating mode and Qi-in-concentrating mode; the author has borrowed the distinction from the Zhuangzi (see Lee 2017a, Chapter Three) in order to clarify matters. 4 It comes from the Daoist philosophical/Daojia/ 䚃ᇦ concept of Humankind following Ziran/㠚❦/“Nature” (set out in detail in Lee 2017a, Chapters Two, Four, Five, Seven, and Ten). It also appears as Tianren-heyi/ཙӪਸа. 3

The Jingluo/㓿㔌 Network

19

draws sustenance. Humans and greater Nature form a Whole, which constitutes Ecosystem Wholism (see Lee 2017a, Chapter Ten). Lee 2017a, Chapter Three shows that Qi-in-concentrating mode belongs to xingerxia/ᖒ㘼л, while Qi-in-dissipating mode belongs to xingershang/ᖒ㘼к. The latter may be translated in some, though not all, contexts as “energy”. At this juncture, there is no need to go over the same points again, except to add a few remarks to those made in Chapters Four and Five about the commonly made triple distinction between (the) Dao/ 䚃, xing/ᖒ, and qi/ಘ. The Dao, ex hypothesi (see later section), as a nonempirical construct, is invisible, untouchable, and so on. Xing may be divided into two sub-categories: (a) That which is both touchable and visible/ᴹ䍘ᴹᖒ, something with substance, paradigmatically, a thing (a macro-sized object celebrated in the Newtonian sciences, which is the basis of thingontology). This refers to Qi-in-concentrating mode. (b) That which is visible but not touchable, such as the reflection of the moon on water, or in a mirror. What then is Qi-in-dissipating mode? It looks, at first sight, like the Dao and is, ex hypothesi, neither visible nor touchable. If so, how can we reconcile such a status as a totally non-empirical construct with many other features it seems to have, such as that Chinese medical discourse happily talks about Qi and xue in the same breath and, on the whole, is loath to separate them, yet it recognises all the same that they are not one and the same. This becomes clear, especially, in the context of acupuncture as therapy (though not necessarily as theoretical discourse) when Qi-in-dissipating mode is involved. For instance, when a needle is inserted at a particular point/xuewei/イս, the patient reports that s/he feels a certain sensation, such as suan/䞨/sore and achy, ma/哫/numb, zhang/㛰 /distended or bloated, or zhong/䟽/heavy. This is deqi/ᗇ≄ which shows that the needling has achieved its desired reaction.5 As a non-empirical concept, it seems all the same able to produce effects through needling, which are not obviously hallucinatory on the part of the therapist and/or the patient. Also, if Qi could be separated out from blood in the context of acupuncture, then it is obviously not carried in the blood stream as Qixue. CCM claims it is carried by the Jingluo network. Yet what evidence is there that such a network exists in us? These are some puzzling issues, 5

*See Zhang Weibo 2010.

Chapter Two

20

which the exploration, in this chapter, hopes to throw light upon and even perhaps to solve. The Chinese had been looking for the Jingluo network for a long time. In the Eastern Han dynasty, an uprising occurred, led by a usurper to the throne called Wang Mang/⦻㧭 (45 BCE-23 CE) who, upon killing an enemy called Wang Sunqing/⦻ᆉᒶ, ordered his corpse to be dissected. He could have had many motives for doing so; a more intellectually respectable one was to see if the Jingluo could be found as indicated in the Neijing. The forensic investigators of the time introduced bamboo strips into the blood vessels/㹰㇑, but then concluded that the blood vessels were not the same as the Jingluo. This dissection was the first recorded event in Chinese history looking for the elusive Jingluo network. The Chinese realised that dissecting cadavers would not reveal it. Qi-in-dissipating mode, ex hypothesi, is something which is only possessed by living beings, not the dead. The ancient Chinese lacked sophisticated measuring instruments but since the twentieth century, Bm has invented many. So some Chinese and nonChinese investigators have since employed high-powered instruments relying on technologies using sound and light as well as isotopes to probe, but all without an adequately satisfactory outcome. So must one conclude that the Jingluo network does not exist after all, and that the Neijing is incorrect in claiming that it is not an empty term referring to nothing? Before continuing with this line of inquiry, let us back-track a little to give a very brief account of the number of jing that the human person is said to possess by the Neijing. There are twelve main jing, also called the Zhengjing/↓㓿; these are divided into three yang jing and three yin jing which, in turn, are divided into the hand/upper limb yin and yang jing and the foot/lower limb yin and yang jing (see Table 2.1). Yin jing of the hand ᡻ཚ䱤㛪㓿/taiyin Lung ᡻৕䱤ᗳव㓿/jueyin Pericardium ᡻ቁ䱤ᗳ㓿/shaoyin Heart Yin jing of the foot 䏣ཚ䱤㝮㓿/taiyin Spleen 䏣৕䱤㛍㓿/jueyin Liver 䏣ቁ䱤㛮㓿/shaoyin Kidney

Yang jing of the hand ᡻䱣᰾བྷ㛐㓿/yangming Large Intestines ᡻ቁ䱣й❖㓿/shaoyang Sanjiao/Triple Burners ᡻ཚ䱣ሿ㛐㓿/taiyang Small Intestines Yang jing of the foot 䏣䱣᰾㛳㓿/yangming Stomach 䏣ቁ䱣㛶㓿/shaoyang Gallbladder 䏣ཚ䱣㞰㜡㓿/taiyang Bladder

Table 2.1: The twelve Zhengjing and their associated Zangfu

The Jingluo/㓿㔌 Network

21

Those which govern the six Fu-organs/㞁 are yang in character; those which govern the Zang-organs/㯿 are yin in character. The former run on the outside of the limbs and the latter on the inside. On top of these twelve main jing6 and their luo, there are also eight others which are often referred to as qi jing ba mai/ཷ㓿‫ޛ‬㜹/“the Eight Extraordinary Jingmai” of which four are often cited: the Du mai/ⶓ㜹 /Governing Mai˗the Ren mai/ԫ㜹/Directing Mai; the Chong mai/ߢ㜹 /Penetrating Mai; the Dai mai/ᑖ㜹/Belt-constraining Mai. The spatial relationship between the twelve Zhengjing and the Eight Extraordinary Jingmai is as follows: ཷ㓿‫ޛ‬㜹 Ⲵ࠶ᐳ㿴ᖻ˖ཷ㓿‫ޛ‬㜹 Ⲵ࠶ᐳ䜘սоॱҼ㓿㜹㓥⁚ӔӂDŽ ‫ޛ‬㜹ѝⲴⶓ㜹ǃԫ㜹ǃߢ㜹䎧㜎ѝˈ਼ࠪҾՊ䱤ˈ ަѝⶓ㜹㹼Ҿ㛼 ↓ѝ㓯˗ԫ㜹㹼Ҿࡽ↓ѝ㓯˗ߢ㜹㹼Ҿ㞩䜘ՊҾ䏣ቁ䱤㓿˗ᑖ㜹⁚㹼 Ҿ㞠䜘

Rendered as: According to the distribution rule of the qi jing ba mai, these and the twelve Zhengmai are inter-connected, intersecting perpendicularly and horizontally. Amongst the Eight Extraordinary Jingmai, the Du, Ren and Chong mai begin from the Baozhong location, all coming from the Huiyin xuewei (which is located between the pubic region and the anus). (See Figure 2.1.) The Du mai goes right down the middle of the back, the Ren mai the middle of the front, while the Chong mai goes along the belly and ends in meeting with the Zhushaoying Jingmai. The Dai mai goes along the waist. (Texts within round brackets are the author’s interpolations.)

The Eight Extraordinary Jingmai have two functions: (a) Liaise with the twelve Zhengjing, forming a dense network for Qixue to circulate, thereby maintaining a balance between Yinyang in the individual person.

6

The images of the Jingmai shown in this chapter are, by and large, adapted from those found at the website http://wenku.baidu.com/link?

22

Chapter Two

(b) Act as a kind of “reservoir” for the Qi of the twelve Zhengjing, which could be said to be like the water flowing through mighty and not so mighty rivers.7 The two sets together form an entire network linking the Zangfu in the interior of the 䓛փ/shenti (which this author translates as person-body– see Chapter Six for reasons why this term is used in this author’s translation), and on the exterior, with the flesh and muscles/ㅻ㚹/jinrou as well as with the skin/Ⳟ㛔/pifu to form the Whole person-body. The account above read in the light of Chapter Four (which follows) suggests three points. 1. One could say that the Jingluo network may be construed as an ecosystem, call it Ecosystem A. 2. One must remind the reader of the following very important point, so important that it is worth raising it again, namely, that the relationship between the Zang and the Fu organs is complementary to each other as a Yinyang pairing, with the former being yin (on the outside/㺘/biao) and the latter yang (on the inside/ 䟼 /li), thereby creating in the language of Chapter Four, a Yinyang Ecosystem (based on the dyadic contrasts of yin/yang, biao/li). This may be called Ecosystem B. 3. One should point out that “super-imposed”, so to speak, on this Zangfu/visceral organ-systems/Ecosystem B is the Jingluo Ecosystem A such that the “㜿㜹㔌Ҿ㞁ˈ㞁㜹㔌Ҿ㜿”, which may be rendered as “The Jingmai of the Zang (the yin visceral-organs) connects with the fu (the yang visceral-organs)”. In other words, the Zangfu system and the Jingluo network are intertwined, forming in the language of Chapter Four, another more complex ecosystem–call it Ecosystem C. The above points are implicitly made in the Lingshu, Chapter 2/lj⚥᷒ ·ᵜ䗃NJ. The Yellow Emperor knows that in needling, one must know the precise starting and end points of the Jingmai, the locations of the Zangfu in respect of the Jingmai, the nature of the Qi-in-dissipating mode circulating in the Zangfu and the Jingluo network at different seasons of 7 For images of the twelve Zhengjing and the Eight Extraordinary Jingmai, see *“Jingluo” 2015.

The Jingluo/㓿㔌 Network

23

the year, and so on. Qibo then goes on to provide further details about the relationship between the Zangfu Ecosystem B and the Jingluo Ecosystem A, so to speak. One reads: 䈧䀰ަ⅑ҏDŽ㛪ࠪҾቁ୶DŽDŽDŽ᡻ཚ䱤㓿ҏ

Rendered as: Let me elaborate on the order. The Qi of the Lung Jingmai issues from the Shaoshang xuewei, which is on the inward facing flank of the thumb, and is called Jingmu. From here, Qi flows into the Yuji xuewei, which is located in the fleshy part of the palm at the base of the thumb (the thenar), and pertains to a kind of xue/イ called jing.8 From here, Qi flows into the Taiyuan xuewei, which is a depression, one (Chinese) inch behind the Yuji xuewei, pertaining to a kind of xue called Shu. From here, Qi flows on to the Jingqu xuewei, which is at the cunkou where the Taiyin Jingmai pulsates continuously, and pertains to a kind of xue called Jing. From here, Qi flows into the Chize xuewei, where the mai runs through the elbow, and pertains to a kind of xue called he. These are the five xuewei of the Hand Taiyin Lung Jingmai.

On these points see Figure 2.1. The passage selected and translated is but a small part of this chapter in the Lingshu. Its purpose here is simply to illustrate the specific point about the intertwining of the Zangfu with the Jingluo network, and not to set out all the details involved in the entire Zangfu-Jingluo Ecosystem C.

8

Note that this is not a xuewei, a specific acupuncture point, but it is one of five kinds of xue/イ which every Jingmai possesses, four of which are mentioned in the passage cited here.

24

Chapter Two

Figure 2.1: The Hand Taiyin Lung Jingmai and its xuewei/᡻ཚ䱤㛪㓿イ

Is the Jingluo network other than fictional? This question poses itself, in spite of the fact that as observed above, CCM has never doubted that it is real and exists. Nevertheless, many sceptics exist both inside and outside China; it is to quell such doubts that this section will explore this question, and attempt some answers. However, the full story behind this attempt can only be told later, in Chapter Eleven. Up to 1989, the sceptic would say, “yes, it is fictional”; on the other hand, the “true believer” (the CCM physician) would say, “no, it is not”, although it cannot be said to make its presence felt in the way that a rock or the Blood Circulatory System (BCS) can be said to exist. When pressed further, CCM upholders would tend to say that using the concept of the Jingluo network enables clinicians to effect cures or, at least, ameliorate the patient’s condition via its treatments. This answer is not enough to satisfy the sceptic, especially the sceptic wedded to the worldview of Bm, for a variety of reasons. The two most pertinent are: (a) The good effects could be nothing more than the placebo effect. (See Chapter Six regarding its relevance to assessing the efficacy of CCM therapies.)

The Jingluo/㓿㔌 Network

25

(b) On the surface, it looks like a piece of circular reasoning–the socalled positive consequences of CCM treatments (q) are justified in terms of the Jingluo network (p), yet the Jingluo itself (p) is justified in terms of these consequences (q). In other words, p justifies q, but q is used to justify p in turn. (This apparent circularity will be looked at again later in this chapter.) To settle this kind of controversy that surrounds the notion of the Jingluo, a particular Chinese scientist, Zhu Zongxiang/⾍ᙫ僗 (1923-) was tasked in the early 1970s by Zhou Enlai (then the Premier of China) with investigating the matter. Zhu was trained as a chemist but, in 1947, he had been a lecturer in physiology at the Beijng Medical University for nigh on a decade. In 1956, he became interested in the physiology of the heart and its related problem of high blood pressure, which led him to turn to the study of the Jingluo network, on which he later became an acknowledged authority. Since 1973, his work and that of his research team, after many years of intensive effort, eventually resulted in the publication of a work in 1989 entitled *lj䪸⚨㓿㔌⭏⢙⢙⨶ᆖ˖ ѝഭㅜаབྷਁ᰾Ⲵ、ᆖ傼 䇱NJ. This may be translated as The Biophysics of the Jingluo Behind Acumoxa: The Experimental Evidence for a Great Chinese Scientific Discovery. To arrive at experimental results which could be said to satisfy the criteria of “good” science as endorsed by today’s global science, in general, and Bm, in particular, Zhu and his team worked within the framework of biochemistry, biology, biophysics, morphology, electronics, acoustics and other scientific disciplines, adapting their techniques and technologies to accommodate and facilitate the study of the subject matter in hand.9 The work of the team could be roughly reconstructed in terms of several stages.10 1. For the experiment, it recruited people who were identified as being very sensitive in parts of their person-body at points, traditionally referred to as the xuewei/acupuncture points along a particular Jingmai. For instance, if pressure were applied on a xuewei on their finger, they would report that they felt a particular sensation (sore and achy, numb or whatever), as well as something like an electric current going right up their arm, to the Heart. When pressed at certain points along the arm, they 9

For a further assessment, see Chapter Eleven. This follows closely *Ma, 2011, Lecture 3 and *Zhu and Hao 1998. However, this author alone is responsible for the reconstruction. 10

26

Chapter Two

would feel something moving up a line, which is best described as the pathway of the Jingmai/㓿䐟㓯. The team called this phenomenon ᗚ㓿ᝏ Ր⧠䊑/xunjingganchuan xianxiang–the Propagation of Sensation along the Channels (PSC) line. The significant phenomenon which emerged in the case of these subjects was, when certain points were pressed/massaged, they not only reported that they felt a sensation, but also that the line of sensation appeared to correspond to the “route” taken by the Pericardium Jingmai/ ᗳ व 㓿 . This Jingmai begins with the xuewei called ѝ ߢ /zhongchong, at the tip of the middle finger on the palm side of the hand, then up the arm and across the chest to the Heart, involving a total of nine xuewei (see Figure 2.2). When illness affects this Jingmai, the patient will feel pain in the Heart and the Stomach, fuzziness in the head and other symptoms.

Figure 2.2: The Pericardium Jingmai and its xuewei/᡻৕䱤ᗳव㓿イ

2. This kind of sensitivity, unfortunately, is confined to a relatively small ratio of the populace (in China at least), namely 1:100; those who were not sensitive worked out to be 80%, while the rest were in-between these two extremes (*Zhu and Hao 1998, 155-162). These data left the team with a problem. They reasoned that there must be many more people who, though not said to be obviously sensitive, would probably be sensitive to some extent (whose limited sensitivity could be detected with a bit of help along the way). The key issue was to find out how many people in the population possessed this much more limited sensitivity. The team

The Jingluo/㓿㔌 Network

27

reckoned that if the proportion was not high, acupuncture, in particular, and CCM in general, would not have endured for more than two thousand years. From this they inferred that the Jingluo network must not be limited to the minority of very sensitive people who were able to feel, and express, their sensations, but was more likely to be present in the ordinary person, even though s/he may not have been able to feel any sensation with these basic tests. (Let us, here, say that the team was invoking as a default axiom, resting on the principle of charity, that the subject matter under investigation must be postulated heuristically to be correct, for the purpose of investigating it–this chapter will deal with this point in greater detail later.) 3. So the team worked on the more ordinary non-sensitive persons, to see if they could find the Jingmai in them. They attached to the ѝ ߢ /zhongchong xuewei of the experimental subject some small electrodes/ሿ ⭥ᶱ. When a very weak electric current was passed through the xuewei, the finger of the subject suddenly displayed an unexpected reaction. Following this, the team used a little leather hammer to strike the arm of the patient at points along the line indicated by the traditional account of the Jingmai. The subject at each point, following the striking of the hammer, reported the sensation of being sore and achy, numb, swollen or bloated, the same sensation as reported by sensitive subjects, especially when acupuncture needles are inserted into the nine xuewei. Furthermore, the subjects also reported that they felt a feeling of movement along the arm, going up the arm (not only simply as a sensation at an isolated point) from the finger-tip upwards. Such a set of results was very similar to what the team had found, when working with very sensitive subjects. The team marked the points with blue ink as the subject reported the sensation felt. They repeated the experiment several times to make sure that they had recorded the reactions correctly. When the team finally linked up these marks, the line produced conformed with the line produced by the exceptionally sensitive subjects. It looked as if, in ordinary people who are non-sensitive, these sensations were only felt with the help of a small electric charge and a small hammer (see *Zhu and Hao 1998, 172-175). In the case of the very sensitive minority, once the needle was inserted, they would report that they could feel the movement. With these later tests, the investigators found that more than 95% of the population produced a similar response to that of the sensitive minority of one in a hundred people in the population (see *Zhu and Hao 1998, 178-179). The team called this line 䳀ᙗᗚ㓿ᝏ

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Ր 㓯 /yinxing xunjingganchuan xian, the LPSC (Latent Propagated Sensation along the Channels11) line. 4. It was obvious to the team that the result above would be insufficient to satisfy the criteria of “good science”, as the responses of the subjects were entirely subjective in character, nothing more than reports of their sensations. Scientific data are required to be objective and measurable/ quantifiable. Furthermore, those within the framework of Bm would claim that insofar as the Jingluo system existed at all, it would be no more than the Central Nervous System (CNS). Is that so? Given that their pathways as well as their functions are different, Zhu Zongxiang inferred that these are two very different systems. However, the onus was on the team to show that the Jingluo system is not identical with the CNS. How could this be demonstrated? The team resorted to an ordinary device used in measuring electrical resistance. For this stage of the experiment, they worked on the བྷ㛐㓿㔌 㓯/the Large Intestines Jingmai, with twenty xuewei as shown in Figure 2.3. This is the Yangmingmai, which is a Jingmai, richly endowed with Qixue; it can help the individual to strengthen yangqi or to expel excess huoqi/⚛≄/qi arising from anger. A malfunctioning of this Jingmai could lead to stomach aches, constipation, dysentery and other illnesses. The team found that when the handheld end of the device scanned the person-body along the Jingmai in question, the needle of the device began to swing widely. In other words, the device had detected micro-resistivity, which caused the electric current to suddenly decrease, indicating a low impedance12 point–the team calls this the Low Impedance Point (LIP) line. The results indicated that a whole line consisting of low impedance points was discernible. The experimental set-up also included another instrument, capable of registering and recording these points via graphs, shown on the screen, which manifested a regular pattern. As the experiment progressed, the team marked on the subject’s person-body with a red pen the points which showed resistance. At the end of the experiment, they linked them all, and when they compared this experimental line with the Large Intestines Jingmai, they found that the two were identical. Up to then, other scientists in Japan and France had already demonstrated that low impedance points existed; however, their experiments had not shown that by linking them together, they could produce a line which coincided with 11

See also “Biophysical Approach” 2015. “Impedance” is defined in dictionaries as “the total resistance of electrical equipment to alternating currents”.

12

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the Jingmai. This finding accords with the claim in the Neijing that the Jingluo appears to have flow properties.

Figure 2.3: The Hand Yangming Large Intestines Jingmai/᡻䱣᰾བྷ㛐㓿イ (L14 is the fourth xuewei from the index finger)

5. The team did not stop at this stage. They further investigated a phenomenon, which they had already noticed when experimenting with sensitive subjects earlier. They recalled that when a small hammer was used to strike at certain points along a Jingmai of these subjects, the striking produced an unfamiliar sound, which could be heard when magnified by a special device. The team wondered if such sounds were

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real and if so, why should they occur in the way that they did? For this investigation, they concentrated once more on the Pericardium Jingmai. At first, the results were not encouraging, as the team members did not hear any significant difference in the sounds reported by the machine between the xuewei and non-xuewei locations along that Jingmai. However, when the instrument was adjusted and fine-tuned, they did hear differences, as the hammer moved along the Jingmai, from weaker to stronger, as the hammer moved nearer to a xuewei. This could be said to demonstrate oscillation of the Jingluo. 6. In the light of data obtained at 4 and 5 above, the team named this line the 儈ᥟࣘ༠㓯/gaozhen dongshen xian/Percussion Active Point (PAP) line. 7. Zhu and his team had succeeded in providing objective evidence for the presence of the Jingluo in the (living) human being, as given below in the abstract, in their own words in English (“Biophysical Approach” 2015): Using three biophysical methods which are … (LPSC), … (LIP) and … (PAP) method (sic) to locate three hand Yin meridians holographically in the skin region, we found that the three biophysical lines overlapped each other within 1mm in width and correspond(ed) intimately to the classical three Yin meridians of (the) hand respectively. It was also found that there are collaterals branch(ing) from the main channels with (a) similar biophysical character…. (Texts within round brackets are the author’s interpolations.)

8. The above objective evidence also permitted the team to conclude that the Jingluo is not identical with the CNS, but is an independent network, through which Qi-in-dissipating mode courses through the (living) human being. 9. According to Duan Xiangqun/⇥ੁ㗔 (in the 1989 Preface to *Zhu and Hao 1998, 4-5), the investigations of the team have yielded objective evidence for the presence of the Jingluo network as they satisfy the following five criteria: (a) The data are in accordance with CCM’s understanding of the Jingluo system, namely, that each Jingmai follows a flow pattern and together, all the Jingmai and their luo form a network, covering the whole individual being.

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(b) The phenomena, which were evident in the experiments, display a uniform continuity with no rupture. (c) The phenomena, which were evident in the experiments, are repeatable in two senses, namely, that they are in all the Jingmai, not only in the case of one or two, and that all the Jingmai have manifested the same phenomena, when studied on several, different occasions, not only on a one-off basis. (d) The phenomena are also evident in the subjects studied, whether these are human beings (male or female, young or old), or nonhuman living organisms (animals or plants). In other words, the Jingluo network appears to be universal or, at least, widespread. (e) The phenomena were found to remain stable (given that they satisfy Repeatability). 10. This study has also clarified an issue of long historical standing amongst scholars of the Jingmai, who are, on the whole, divided into two main camps. One camp holds the following hypotheses: (1a) The Jingmai does not exist (only the xuewei does) on the grounds that, if it exists, then why is it not found in anatomical terms, such as in the dissection of a cadaver or, today, by means of various scanning devices? (1b) Xuewei do not exist, only Jingmai do. However, the anomaly of this view is that if there is no xuewei, then how could one achieve effects by needling such points? The second big camp maintains that there are Jingmai and there are xuewei. The study seems to support the second position, but with this further clarification. Professor Zhu has concluded that, historically, people would have first discovered the xuewei, especially as one knows that very sensitive people exist(ed) (and probably after many years of reported sensations and therapeutic interventions from Stone Age times beginning with the use of stone needles13), the xuewei were joined up and the various Jingmai emerged. This, however, would not amount to denying that the Jingluo network, which eventually emerged as a mature system and concept in the history of CCM, is not the result of a very close relationship between theory, on the one hand, and “clinical” experience, on the other, with the latter shaping the former, and the former guiding the latter. 13 This part of the reasoning is added by this author. On the subject of the use of stone needles in antiquity, see Appendix One.

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11. Apart from investigating the Jingluo network in (living) human beings, the research team also did work on other mammals (such as the rat/dashu and the domesticated rabbit) and on plants (such as the Hami melon, the banana, the water melon, and the cucumber), and has concluded that the Jingmai network, in one form or another, is also present in them. This then, appears to show that it is probably the case that living organisms possess this characteristic. Caution is needed here because given the large numbers of animal species (even barring bacteria) and plants, more work would have to be done before one can be confident of making such a claim, although the theoretical grounds for it are clear and strong. 12. It may be fitting here to make some comments of a personal nature about Professor Zhu himself. When the Chinese government asked him to undertake the investigation in 1973, he thought he would simply be wasting his time. Indeed, he admitted later that he was determined to show once and for all that the whole subject was a piece of pseudo-science. So his actual eventual findings even surprised himself; he concluded, using his own words (as cited by *Hao 2012, Lecture 11): 㓿㔌ᱟ⭏ભสᵜ⢩ᖱѻаˈਚ㾱ᴹ⭏ભቡᴹ㓿㔌

Rendered as: The Jingluo is a special basic characteristic of life itself; where there is life, the Jingluo would be present.

Just over thirty years ago, Professor Zhu, then sixty years old, did not enjoy good health. 14 He suffered from insomnia, memory lapses, indigestion, reflux, and lack of appetite but with no feeling of hunger and, if not told to eat, would not bother to do so at all, and generally he was lacking in energy. He had tried many doctors and their medicines but nothing much had helped. When he finished his investigation, it suddenly dawned on him that he should use his newly acquired understanding of the Jingmai to treat himself. His method, he says, is extremely simple; he has called it the “312” method,15 which involves pressing only three xuewei: (a) The hegu xue/ਸ 䉧イ , which is between the thumb and index finger–the fourth point from the index finger of the Large 14 15

The following account follows closely that of *Hao 2012. See Zhu Zongxiang 2016.

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Intestines Jingmai–see Figure 2.3. Any illness at any point along this Jingmai may be treated by using the hegu xuewei, such as headaches, eye trouble, nose inflammation, toothache, throat problems, an abscess in the mouth, shoulder pains, lung problems, including coughs and wheezing, stomach problems, bowel problems such as diarrhoea, constipation, and so on. Furthermore, Professor Zhu is of the opinion that this xuewei, if needled or pressed, can prevent stroke. (b) The neiguan xue/޵‫ޣ‬イ is the fourth point from the index finger on the Pericardium Jingmai (see Figure 2.4). Any illness which occurs along this Jingmai, involving the chest, the abdominal area, and so on, giving rise, for instance, to lung/throat/or stomach problems, would improve through pressing this point. Furthermore, Professsor Zhu maintains that pressing/needling it is effective in people with Heart conditions, or suffering from asthma. (c)The zusanli xue/䏣й䟼 is the eleventh point (counting from the toe) along the Foot Yangming Stomach Jingmai (see Figure 2.4). This a powerful point, as it is located on a Jingmai, which runs right through the length of the whole person, from the nape of the neck at the back right over to the front of the head, all the way down to the toe. Any illness along its pathway can be treated by the zusanli xuewei. In a village in China noted for people with longevity, those over eighty years of age, on the day of the Winter Solstice, would burn seven small pieces of 㢮/ai/moxa at zusanli. Each piece is lit, then extinguished, then re-lit three times until all seven bits are burned up. This method of Preventive Medicine is called the ⱒⰅ⚨ᯩ⌅/scarring-ai-burning method. At the end of the session, a second degree burn would have been produced, the skin would have hardened and there would be some oozing of blood. The area would not be washed for a few days, until the skin had become normal again. What is involved is a process of stimulation, which encourages the body of the person to increase its own powers of overseeing the proper functioning of the system, as the person-body responds by repairing the damage, caused by the inflammation, induced by the burning of the ai. In so doing, it stimulates the powers of self-healing on the part of the person-body, so that the individual reaches a better level of healthy functioning.

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Figure 2.4 The Foot Yangming Stomach Jingmai/䏣䱣᰾㛳㓿イ (This image is included to give readers an idea of how traditionally the Chinese had represented the Jingmai.)

Professor Zhu, by following this regimen (given above with the barest outline), found his health had improved; in 2012, at the age of eighty-nine or thereabouts, he still cycled daily to his research institute from outside Beijing into the city, a distance each way of 15 kms. One could sum up the significance of the research team led by Zhu in establishing that the Jingluo is not a piece of pseudo-science. Using the criterion of scientificity endorsed by modern, global science, it is found to be present in the living human being, as has been claimed in the Neijing. Here is a relevant passage from the Lingshu, Chapter 11/lj⚥᷒·㓿࡛NJ:

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ཛॱҼ㓿㜹㘵ˈӪѻᡰԕ⭏ˈ⯵ѻᡰԕᡀˈӪѻᡰԕ⋫ˈ⯵ѻᡰԕ䎧ˈ ᆖѻᡰ࿻ˈᐕѻᡰ→ҏ.

Rendered as: The importance of the twelve major Jingmai in the human individual lies in the fact that life itself and health depend on their proper functioning, that all illnesses and their causes come from their malfunctioning, and likewise, treating illness lies in restoring them to proper functioning order. In other words, the study of Chinese Medicine must begin and end with the Jingmai; to determine how good a physician really is, one must look at his command of the Jingmai, that is, his knowledge of them as well as the ability to apply such knowledge in diagnosing and treating illness.

However, this author wishes to end this section by insisting that one should resist, at all cost, the temptation to draw from the investigation above, which confirms the presence of the Jingluo network, a specific conclusion, namely, that Qi in the network is Matter simpliciter and that, therefore, CCM/Chinese cosmology/philosophy is nothing but an expression of Materialism. Lee 2017a, Chapter Three has attempted to clarify this issue. Readers are reminded to refer back to it for details, that Qi is a form of Dyadism, which is best encapsulated as Em-ism, not, perhaps, an elegant coinage but at least, this author feels it does better justice to what the ancient Chinese had to say about Qi. One last comment is called for. In spite of the findings of these series of experiments, sceptics remain (in China and abroad) but without providing any evidence of methodological flaws, which might serve to undermine their validity (see “A Different Point of View” 2007).

Some methodological comments Assuming that the experiments of Zhu and his research team stand up to critical scrutiny in the long run, what general methodological comments could one make from the standpoint of the philosophy of science? Let us begin by referring briefly to a notion called the null hypothesis in the statistical testing of hypotheses, a technique used by many scientists, including the vast majority of biologists. It involves testing a null hypothesis by comparing the data you observe in your experiment with the predictions of the null hypothesis. You estimate what the probability would be of obtaining the observed results if the null hypothesis

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were true. If this estimated probability (the P value)16 is small enough, then you conclude that it is unlikely that the null hypothesis is true; you reject the null hypothesis (H0) and accept an alternative hypothesis (H1). (McDonald 2014)17

In general, H0 holds what is commonly accepted to be correct or what is in accordance with (standard) theoretical expectations; H1, by contrast, holds that things are different from such a theoretical expectation. If the experimental findings are not compatible with H0, this means rejecting it and entertaining H1 instead as a potentially correct hypothesis. When this happens, it makes the scientific community sit up and take notice, as it may imply some exciting new discovery. McDonald (2014) gives the hypothetical example about feeding chocolate to a group of chickens, to see if that makes any difference to the sex ratio in their offspring. H0 postulates that the sex ratio would be equal to the theoretical expectation of 1:1. Now, if the results, instead, show (in terms of the p-value) that upon feeding them with chocolate, there are, in fact, more females than males in their offspring, upsetting the 1:1 ratio in a big way, H0 would be rejected or nullified, and H1 would imply that something new could have been discovered about the mechanism of sex determination in chickens. As female chicks are more valuable than male ones amongst the egglaying breeds, this would make the discovery exciting, both for science and the chicken industry. One could say that, in general, the null hypothesis is boring (as it simply reflects extant theoretical understanding), and the alternative hypothesis is potentially interesting/ exciting (as it appears to challenge extant theoretical understanding). However, one should make it very clear that accepting H0 does not mean that it is true, just as rejecting it does not prove H1 to be true. Let us also pause to make clear that Zhu and Hao 1998 do not mention the null hypothesis either in the text or the index–invoking H0 is entirely 16

Rumsay 2016: The p-value is a number between 0 and 1 and interpreted in the following way: (a) A small p-value (typically ” 0.05) indicates strong evidence against the null hypothesis, so you reject the null hypothesis. (b) A large p-value (• 0.05) indicates weak evidence against the null hypothesis, so you fail to reject the null hypothesis. (c) P-values very close to the cutoff point (0.05) are considered to be marginal (could go either way).

17

Also see Shuttleworth 2008 and “Null hypothesis” 2015.

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this author’s own initiative. If one were to cast part (especially the earlier stages) of the series of experiments in the light above, then, their H0 would reflect the Bm expectation that the experimental findings would not support the CCM account of the Jingluo network. For instance, at stages 13 of this author’s reconstruction of their experimental project, outlined in the section above, the two hypotheses are presented as follows: H0 = Experimental subjects would not report that they feel any particular sensation, when pressed at certain points along the arm, moving up a line, which is best described as the pathway of the Pericardium Jingmai, with or without the help of a small electric current being passed through these points, at the time of pressing them. H1 = Experimental subjects would report that they feel a particular sensation, when pressed at certain points along the arm, and that the line of sensation would appear to correspond to the “route” taken by the Pericardium Jingmai, with or without the help of a small electric current being passed, at the time of pressing these points. The team’s experimental findings at the conclusion of stage 3 appeared to support the rejection of their H0 and the acceptance of H1. However, as already noted, accepting H1 does not automatically render it to be true. The team must move on, should they wish to establish that H1 has scientific validity, according to the standards of scientificity of Modern Science/Bm. To do this, the team must provide evidence that the sensations felt and reported go beyond mere reports of such sensations by the experimental subjects, that they can be correlated with variables, which are objective and measurable/quantifiable in terms, for instance, of electrical resistance and of sonic oscillations at the xuewei (but not at other points), along a particular Jingmai. By using three biophysical methods (LPSC, LIP and PAP) and based on their findings, the team concluded that the Jingluo appeared to operate in a way which accorded with the account of it, in the Neijing. These biophysical findings go beyond plain statistical correlations between two variables, namely, tapping or pressing at a certain point and the report of a felt sensation,18 to causal correlations, namely, between passing an electric current or tapping at a certain point and the registration of electrical resistance or sonic oscillations, whose variations can be plotted by a graph.

18

Such a correlation is weak on two counts: it may fall short of being statistically significant, and even if it passes the test of statistical significance, the second variable is simply not objectively determinable.

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Of late, the Biomedical explanation of acupuncture and its effects focuses on brain functions, as regulated by chemical messengers, such as neurotransmitters and neuropeptides, the stimulation of which, in specific frequencies at certain sites (such as the xuewei), produces the release of specific neuropeptides in the CNS. Such a release can bring about pain control (in the case of opioid peptides) and other physiological effects, such as appetite modulation in the case of the neuropeptide Y.19 We have so far glossed over the experiments of Zhu’s team from the standpoint of standard scientific/medical discourse. We think we can also cast some light from the vantage point of another discourse, namely that of jurisprudence. To begin with, one can see that H0 is a hypothesis, which a research team must do its hardest to disprove, reject or nullify. In other words, the scientists are inclined to believe that it is correct (as it is in accordance with standard theoretical expectations) but, nevertheless, feel obliged to obtain evidence, which would enable them to decide whether to accept or reject it. As the expectation is that the evidence would support H0, the scientific community would be all the more surprised if the evidence turns out to overturn or nullify it. This would make the exercise analogous to what takes place in another more familiar discourse, namely, the principles governing a criminal trial, such as a murder trial. In terms of jurisprudential thinking, a criminal trial, whether serious or relatively light, in principle, is conducted on the so-called Presumption of Innocence (PI), namely, that the defendant (D) in the dock is presumed to be innocent until proved guilty, beyond reasonable doubt. The analogy between PI and the null hypothesis may be worked out as follows, confining oneself to the inquisitorial framework for ease of illustration.20 1. In the inquisitorial system, which is common in civil law countries (as opposed to the adversarial system in common law jurisdictions), the objective is to get at the truth of the matter by undertaking extensive investigation and examination of all relevant evidence. (In the common law system, the preferred method for getting at the truth is through open confrontation between the prosecution counsel and the defence counsel, each trying to make the best case for the brief in hand (or in the words of its critics, to try to outwit the other by all rhetorical and forensic means at their command)).

19

See Han 2003 and 2004; see also Zhang Aihua et al. 2016. See “Presumption of Innocence” 2015. PI, however, must not be equated simplistically with the adversarial system; for brief accounts of the distinction between the two systems, see Ainsworth 2015. 20

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2. The procedure is in three stages: the investigation, the examination and the trial. In the first, the Public Prosecutor (PP), usually with the help of the police, would set about collecting evidence to see if a charge is justified, submitting the evidence collected to a judge. The next phase is when the judge examines the evidence submitted; he may conclude that the case should proceed to trial. His review and conclusion are then made available to both the prosecution and defence well in advance of the trial. The aim of the trial, the third stage, is to present the case to the trial judge (and sometimes the jury) in public. While the cross-examination or reexamination of witnesses is not permitted, witnesses are still questioned and challenged. After the procedure has been completed, the trial judge would then come to a decision (as juries are not necessarily part of the trial). 3. Given PI, “D is not guilty of murder” is the analogue of H0 for the court and “D is guilty of murder” is that of H1. For H0 to be nullified and H1 adopted instead, the trial judge must ensure that the evidence is assessed to be compelling and over-whelming which would be analogous to a small pvalue in the case of testing a null hypothesis. In the language of common law jurisprudence, this amounts to saying that the verdict of guilty must be “beyond a reasonable doubt”. A definition found in legal dictionaries reads as follows: The standard that must be met by the prosecution’s evidence in a criminal prosecution: that no other logical explanation can be derived from the facts except that the defendant committed the crime ….21

Admittedly, this definition is somewhat over the top, as it invokes the phrase “no other logical explanation”; barring that modification, the definition appears acceptable. If the facts stand and survive challenge during the process of the trial, the verdict of guilty follows, even if doubts remain, provided that they are unreasonable. Courts are not looking for absolute certainty, only that no reasonable doubt exists, to a reasonable person, that the defendant is guilty, given the weight of the evidence. We have already said that Zhu’s team nowhere mentioned that they were following either the methodology of the null hypothesis or jurisprudential thinking. All the same, their project appears to be compatible with both of these methodologies; so it could be illuminating to cast the team’s thinking in such terms. According to Biomedical expectations, the Jingluo network does not exist; Zhu would have accepted 21

URL = http://legal-dictionary.thefreedictionary.com/beyond +a+reasonable+ doubt.

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this as the background for the team’s H0. However, in accordance with the methodological requirement of the null hypothesis, his team would do their best to mount rigorous and robust attempts to establish evidence, which could enable them (and others) to decide whether to accept or reject H0. Then when these experimental attempts were mounted and data collected, his team found, to their amazement, that the quality and quantity of the evidence established point to a rejection of H0. This in turn, meant adopting H1, namely, that the Jingluo network functions in the way set out under H1. Professor Zhu has admitted that, as far as he himself was concerned, undertaking such a project would amount to a waste of his time. However, his professional duty required him to collect as much evidence as it was possible within his ability (given the technologies then available to his team) to mount tests, which were as rigorous and robust as they could manage, to defeat H0. When they had done so, to their surprise, they found that the evidence against H0 was such that, in their role as “trial judge”, they had no choice but to deliver the verdict that H0 had been nullified and, so, must be rejected and, instead, that H1 be accepted for further investigation.

CCM’s own understanding of the Jingluo network and the relationship between effect and cause As already observed, Zhu’s team was tasked with putting the notion of the Jingluo network on a scientific footing; it is part of the agenda of TCM as Integrative Medicine/IM in partnership with Bm, a theme which Chapter Eleven deals with. This book and its prequel are concerned with rendering CCM intelligible to those not familiar with its philosophy and methodology; it is not to be confused with TCM, which is IM. We must now turn our attention to how CCM sees itself, regarding the Jingluo network, its understanding of the relationship between acupuncture (needling at certain xuewei along a particular Jingmai) and the changes/effects, which such needling could bring about to patients with their signs and symptoms, who have been diagnosed as suffering from a particular zhèng/䇱 (see Chapter Eight). In other words, this section is concerned with what happens when CCM theorists-practitioners treat patients with their conditions and the consequences which follow. This is a vast topic and one cannot begin to do full justice to it, but, nevertheless, a few words about some aspects of it in outline are called for. Lee 2017a (Chapters Eight and Eleven) has explored in detail the Humean, linear model of causality. Here, one only needs to remind the

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reader about the Billiard-ball/cause-effect model. Billiard balls and cues are macro-sized objects that are visible; they can be weighed and touched. When the player hits a ball on the billiard table with the cue, the ball moves; this ball, in turn, hits another ball. The player himself is also visible, weighable and touchable. In this context, the cause of the motion of the balls is no mystery at all: from the viewpoint of modern philosophy and Modern Science, these are all objectively ascertainable matters. There is a causal chain at work, beginning with the player and the cue and ending with the second or third ball moving and then stopping at a certain position on the table. In other words, both the cause(s) and the effect(s) are all transparent, open to observation and to measurement. Hence, both cause and effect are intelligible within a philosophical framework, which is not only empiricist, but also resting on thing-ontology (Lee 2017a, Chapter Eight). Human beings, billiard cues, billiard balls, and billiard tables are all “things”; they are bits of matter which are not only visible, weighable, and touchable, but are also impenetrable. Lee 2017a, Chapter Three has, however, shown that Qi is the fundamental ontological category in Chinese philosophy/science/medicine, that it manifests itself in two modes, Qi-in-concentrating mode and Qi-indissipating mode. The former mode is readily understood as “things”, as macro-sized bits of matter, but the latter mode appears to stand outside the framework of Matter as “thing”, that is, of thing-ontology. Qi-indissipating mode belongs instead to process-ontology; under certain circumstances, it transforms itself into Qi-in-concentrating mode, that is, as “thing”, but that thing, under yet another set of circumstances, transforms itself back into Qi-in-dissipating mode. In this way, processes of change underlie all things in the universe, even though some of these changes, at any one moment in time, are so infinitesimally small that they are not observable by us humans, in spite of the help from instruments. Lee 2017a, Chapter Eight has shown that Chinese philosophy/cosmology and medicine uphold Macro-micro-cosmism/Tianren-xiangying. Hence, Qi-in-dissipating mode, in “Nature” out there, has a counterpart in us, living human beings. The ancient Chinese said: Ӫѻ⭏ҏˈ≄ѻ㚊 ҏˈ 㚊ࡉѪ⭏ˈ ᮓ ࡉѪ↫

Rendered as: The human being, when alive, is but the embodiment of Qi-inconcentrating mode; death occurs when Qi-in-concentrating mode transforms itself back into Qi-in-dissipating mode.

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In the human being, Qi plays a very significant role in its physiology, in the functioning of the whole living human being. The Nanjing/lj䳮㓿· ‫ޛ‬䳮NJdeclares:22 ≄㘵ˈ Ӫѻṩᵜҏˈṩ㔍ࡉ㤾ਦᷟ⸓

Rendered as: Qi is the root of human life; when the roots of a plant wither, so do its leaves.

This is endorsed by Zhang Jingyue/ᕐᲟዣ:23 “Ӫѻᡰ⭏ˈ ‫ޘ‬䎆↔≄” rendered as: “Being alive depends entirely on Qi.” The passage from the Lingshu, Chapter 11, cited in the preceding section, also shows that life and the Jingmai invariably go together, for the simple reason that Qi-indissipating mode courses through the Jingluo network. Qi-in-dissipating mode, coursing through the (living) human being via the Jingluo network, ex hypothesi, is neither visible nor touchable in the way that Qi-in-concentrating mode is visible and touchable as a thing. However, as Zhu’s team has demonstrated, it could be said to have characteristics such as the three biophysically ascertained characteristics of LPSC, LIP and PAP (referred to in the preceding section). These are discoverable (if not quantifiable in the way that data under Modern Science can be quantified in terms of mathematical equations). Although, it is xingershang, yet it is not incapable of producing an effect in the realm of xingerxia. This bears witness to that unique mode of Chinese thinking, that is, Dyadic Thinking (Lee 2017a, Chapters Three and Nine), under which two contrasting/opposing features may happily coexist. Thus: in yin there is yang, in yang, there is yin/䱤ѝᴹ䱣ˈ 䱣ѝᴹ䱤 (see Lee 2017a, Figures 22

The bibliographical details of this work are not clear. Before the Tang dynasty, the work was attributed to the Yellow Emperor, but since, it has been attributed to Bian Que. (See Appendix Four regarding Bian Que.) Chinese scholars appear to agree that whoever the author(s) might be, its content addresses some difficult/unclear aspects of themes raised by the Neijing. It advocates a specific method of feeling the mai, at the cunkou/ረਓ, on the wrist (see Figure 8.4, Unschuld 1986b and * “Nanjing” 2015). 23 He was an outstanding and very influential physician-scholar of the late Ming dynasty (1563-1640), a representative figure of the “Warm Disease” School/⑙㺕 ᆖ⍮. As a clinician, he favoured the Eight Rubric Framework of Diagnosis/‫ޛ‬㓢 䗘䇱. See *“Zhang Jingyue” 2015; Hanson 2011.

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6.4 and 7.1). Hence, Qi-in-dissipating mode, which belongs to the domain of xingershang, is perfectly compatible with the observation that it can/does have discoverable effects in the realm of xingerxia. As such, they must have causes, where the postulated cause belongs not to xingerxia, but to xingershang, which may, at first sight, appear problematic. However, if one is not prepared to give up the axiom that effects have causes, then whatever is found to obtain (as an effect) would lead one to infer that the cause (though in this context it is not observable or detectable by means of ordinary instruments in the way that blood pressure is detectable by means of a blood-pressure measuring machine) must, nevertheless, be held to be present, as it appears to have discoverable/discernible effects. Let us look at the above complicated set of issues, initially, from the standpoint of the history of Modern Science, using the distinctions between observables and unobservables, detectables and undetectables amongst scientific entities and processes, as set out by Chakravartty 2007, 15, which are shown below in Text Boxes 2.1a, 2.1b, and 2.1c and, then, we compare these with how CCM tries to capture an analogous set of issues in Text Box 2.2: Scientific Entities and Processes

Observables

Unobservables

Entities and processes that one can see/taste/touch/hear/smell with the unaided senses

Entities and processes that are not observable under certain conditions

Detectables Entities and processes that are not observable, but are detectable using instruments

Undetectables Entities and processes that are neither detectable nor observable but the existence of which is posited for theoretical or explanatory reasons

Text Box 2.1a: Observables and unobservables, detectable and undetectables

As a further elaboration of the above, see Text Boxes 2.1b and 2.1c.

Chapter Two

44

Things

Observables to unobservables gradation

What one can see/touch/smell/taste hear via the bare senses, such as a tractor and a mountain which are paradigmatic instances of impenetrable Matter

What one can feel or hear only such as the wind, which is penetrable, but whose presence is detectable via the bare senses and/or instruments

What cannot be seen/felt/heard/tasted/ touched/smelt but are posited for theoretical/explanatory reasons, such as the undetected Higgs boson (up to 2012)

Text Box 2.1b: Observables-to-unobservables through detection via instruments Unobservables whose existence is posited for theoretical/explanatory reasons

Respectable science (RS) detected by sophisticated instruments, such as viruses (since the invention of the electron microscope in the 1930s), the Higgs boson (since 2012)

Suspended status as RS (SRS) such as the Higgs boson before 2012 when “true believers” blamed the Large Hadron Collider as being not powerful enough, a view which sceptics of the time regarded as mere special pleading. Gravitational waves fell into this category until 2016

Text Box 2.1c: Fate of unobservables in the history of science

Discarded as pseudosuch as the ether

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In CCM theory Observables/things/Matter Xingerxia Qi-in-concentrating mode A corpse is a thing, embodying Qi-in-concentrating mode alone; this locked-up Qi will soon be released back to “Nature” as Qi-indissipating mode–the thing will soon be no more.

Unobservables/undetectables/not-things Xingerershang Qi-in-dissipating mode In the living individual, this Qi was not machine-detectable until Zhu Zongxiang’s experiments, which found that this Qi possesses characteristics, such as oscillation & micro-resistivity which ought to render Qi and the Jingluo network respectable to the Biomedical/scientific community.

However, CCM is not dependent upon such Bm legitimation either today or in the past. For CCM, the effects of Qi-in-dissipating mode in the living being are discoverable via certain methodological rules derived from theory such as when qi is blocked, it causes pain/н䙊ࡉⰋ/bu tong ze tong; and that treatments such as acupuncture, tuina, and decoction can eliminate a blockage and thereby the pain. For CCM (as Chapter Six shows), the concept of person-hood is a primitive one, operating within an ontological framework, which is dyadic, not dualistic in character, such that the physician in diagnosing the patient, using the techniques of looking/listening and smelling/asking/feeling the mai, is never only diagnosing the patient’s physical body but his or her person-body. The living individual is the Wholistic embodiment of both Qi-inconcentrating mode (xingerxia) and Qi-in-dissipating mode (xingershang).

Text Box 2.2: Qi in its two modes in the individual organism, alive24 and dead

Qi-in-dissipating mode, coursing through the Jingluo network, historically, has been postulated as a set of processes for theoretical and explanatory reasons set out as follows. 1. A cosmological/philosophical ground, because of the concept of Tianren-xiangying. 2. A theoretical ground, because Qi is the fundamental ontological category, the basis of all life (from which it follows that the malfunctioning of Qi in the human individual leads to illnesses).

24

The focus here is on the physical body (as thing) in order to illustrate the very limited point that the patient does present also as a physical body. CCM does not, however, simply diagnose a patient along those lines; it never departs from the axiom that the patient is a person, in whom the physical and mental aspects of person-hood are inextricably entwined, that person-hood is a primitive concept in CCM (see Chapter Six).

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3. An explanatory ground, to account for the discoverable effects, which certain treatments such as taking herbal decoctions as well as acupuncture, can and do bring about. In Chapter Eight, the effects of herbal decoctions will be explored via the notion of fang/prescription, but here as an illustration, in particular, of reason (c), we shall stick to acupuncture. Here is a rather “spectacular” instance as recounted by *Hao 2012, Lecture 10 (an acknowledged authority in China today on Zhang Zhongjing’s Shanghanlun). This occasion happened when he was on a European lecture tour. A journalist sent to cover the event, happened to be so stressed that he had a headache and felt that his head was swollen. The systolic reading of his blood pressure was 180 mm Hg and the diastolic reading was 110 mm HG or higher, which made his case, in terms of Bm, one of hypertensive crisis, amounting to hypertensive urgency. Although the normal treatment could lower his blood pressure, yet it also produced some bad side effects in that it left him feeling weak and without energy for at least a week, following treatment. In desperation, he offered himself as a guinea pig to see if the physician could do something for him. Hao used nothing more than the standard technique for treating what Bm calls HBP, yet to the European audience, it was something “astounding” and “spectacular”. That technique consists of needling and bleeding the pointy top of the ear/㙣ቆ ᯩ㹰. First the ear is rubbed until it becomes hot, soft and red. The needle is sterilised with alcohol, then used to needle that spot. Blood will immediately flow; the spot is then cleaned with sterilised cotton. When the bleeding stops entirely, a similar treatment is then applied to the other ear. Normally, with patients in China, the amount of blood shed is not great, coming out in drips and drops, but in this particular instance, a much larger amount flowed continuously, which required three large balls of sterilised cotton wool to soak it up. Hao interpreted this as a sign that excellent results would follow. After both ears had been treated, the patient reported that he immediately felt better (his head and neck felt warm, his head no longer felt swollen), and he also felt that his blood pressure had become normal (he said that he always felt a peculiar sensation, when his blood pressure rose or was high). These, of course, were merely subjective reports which in the eyes of Biomedical scientists would not count for much. However, more objective data were immediately forthcoming. When the patient’s blood pressure was measured, it was 120 at the top end and 80 at the low end, a reading considered to be normal blood pressure. (The sceptic can still put down such data to the placebo effect, or to spontaneous remission, except that in

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this case, the discoverable effect may be too close in time for that argument to hold–see Chapter Eight for further exploration of this point.) According to Hao, this technique is not only effective for HBP, but also for acute headaches, a condition called pink eye/㓒⵬⯵, conjunctivitis/㔃 㟌⚾, or stye/哖㋂㛯. He is quick to point out that such a spectacular result, from an excessively high reading to a reading considered to be normal for blood pressure, is not achieved in every case of such treatment. It is more often the case to find that the pressure had lowered, rather than rendered normal, all within a few minutes. This kind of technique works because the bleeding is said to stimulate the patient’s own self-adjusting functioning/㠚䈳ᵪ㜭 of his/her Qixue. A longer-term, but also extremely simple technique (from the standpoint of Preventive Medicine), via the stimulation of such a self-adjusting functioning of Qixue, is that of slapping/᣽ᢃ or rubbing/ᩃ᧹ spots, which feel painful. This means that the individual does not even need to know the xuewei on the various Jingmai but need only be guided by pain/ԕⰋѪ䗃 ⌅. Such spots are called Ah-shi xue/୺ᱟイ or Tianying xue/ཙᓄイ. Hao also referred to another matter, namely, how different needling techniques lead to very different discoverable effects. His father, also a physician, had treated two patients. Still a child then, he had been present at both sessions. Patient A (male), who had indicated that he had Stomach pain/㛳Ⰻ, said that his Stomach felt like a lump of ice. He was then needled at the zusanli xuewei (but also given a prescription for a decoction to be taken later). Following a few minutes of needling, the patient said he felt a current of warm Qi rise slowly from the leg to the Stomach; after ten minutes, he reported that the lump of ice in his Stomach had gone, as if it had melted away. The particular technique used is called the ✗ኡ⚛ /shaoshanhuo/“burning mountain fire” technique. Patient B (female) had been afflicted with a boil in a part of the leg, which made it very difficult for her to walk, as it felt both hot and very painful. The physician used the 䘿ཙ߹/toutianliang/“heaven-penetrating cooling” technique. After a few minutes of needling, the patient reported that the part of the leg, where the boil/⯆ was, no longer felt hot, and the pain had diminished. The difference between the two techniques is explained as follows. Every xuewei is divided into three layers, analogous to the three yao/⡫ in a gua, which are also said to constitute the notion of sancai/й᡽.25 The

25 See Lee 2017a, Chapter Two (which touches on the notion of sancai) and Chapter Five for a detailed exploration of the Yao-gua Model as a form of Wholism.

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top layer is called ཙ, the middle Ӫ, and the lowest ൠ. This may be represented as shown below based on the Qian gua.

Figure 2.5: The trigram and sancai

In the shaoshanhuo technique, when the needle is inserted into the skin, the physician pushes it down till it reaches the top Tian level, turns the needle, then, pushes further to the next Ren level, turns/twists the needle again, pushing it further down to the lowest Di level, turning the needle, using pressure. On the return journey, so to speak, the needle is gently lifted until it reaches the skin surface but without removing the needle at all. The whole process is repeated several times. This action treats the affected part, generating ✝≄/hot qi, which made the patient feel better. And the toutianliang technique˛The procedure is the reverse of the first technique. The needle is first inserted right down to the lowest Di level, and twisted/ᦫ䖜. It is then lifted three times from the Di level, to the middle Ren level and finally, to the top Tian level, till the needle reaches the skin surface. One must not pull out/remove the needle, but repeat the procedure. When the physician has done this several times, a current of cold qi will be generated, reaching the affected part of the person-body. A puzzle arises. The two procedures are mirror images of each other; but why should doing one produce a felt current of hot qi; but with the second technique, a current of cold qi? They just do, as a matter of fact. Hao reports that the following experiment has been performed, claiming to demonstrate the above at work. It involves a volume-measuring instrument used in physiology experiments, which looks a bit like a tub with water inside. On the outside is a glass tube (connected to the water in the tub), and on the tube is a scale, whose function is to register the changes in the volume of water in the tube. The experimental subject immerses his elbow/arm into the tub and an experienced acupuncturist inserts a needle into the relevant xuewei on the other arm of the experimental subject. If the acupuncturist uses the shaoshanhuo technique, then one would observe the water rising in the glass tube. Why does this happen? (The needling could have caused the capillaries to expand, thereby increasing the blood circulation.) When such a chain of effects occurs, those who are particularly

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sensitive would respond by saying that they feel a sensation of heat. When the toutianliang technique is used, the water in the glass tube falls. (This could be said to show that the capillaries in the relevant blood vessels affected by the needling have contracted, reducing blood circulation, which leads to the fall in the volume in the tube.) The kind of explanation proffered may or may not be of interest or significance to CCM theoristspractitioners, but it appears to satisfy some critics of CCM, who demand that a satisfactory explanation must invoke phenomena, which are measurable and quantifiable and for which there must be a known mechanism in Bm. Let us take one more instance to illustrate the phenomenon that acupuncture treatments can alter the mai of the patient. In a clinical situation, the physician in his/her attempt to diagnose a patient’s condition, would, amongst other techniques, feel the patient’s mai. When the diagnosis is completed and a suitable treatment has been formulated, the physician would needle in a particular manner along a particular Jingmai. After the needling session, the patient’s mai could again be felt, and the mai would be found to have altered. The details of this case are taken from *Yu and Zheng 2011, 207, which are as follows: male, aged 30 years. One evening, around 8 p.m., this young man felt a pain in the right side of his chest that was sharp and difficult to bear. He immediately swallowed some Bm patent medicine for the heart and rushed to the local hospital, which performed an electrocardiogram on him but which turned up nothing abnormal. He next consulted a CCM physician, as he was not satisfied with this result. At the time of the consultation, the patient’s complexion was deadly white, his right hand clutching the right side of his chest. He was not coughing, nor was he coughing up phlegm. Neither did he complain of Stomach pain, nor did he suffer from nausea, nor from back ache. His mai profile/㜹䊑26 reads: ਣረ⎞ᇎˈ ᐖ‫ޣ‬䛱⏙ˈ ᐖረ⊹㓶/“The mai at the cun position of the right hand is floating but full, that at the guan position of the left hand is depressed and rough (an indication that Qi is being blocked), that at the cun position of the left hand is sunken and fine”. The physician diagnosed injury to the Jingluo because of the intense heat which had invaded his Lung Jingmai; as a result of the Qi being blocked, the patient felt pain in the right side of his chest. The physician immediately needled the patient on the wrist at the guan position to get rid of the blockage; he needled the 䱣䲥⋹/Yanglingquan xuewei in order to ensure the free flow of Qi in the Gallbladder Jingmai (see Figure 2.6). Finally, he used a three-edged needle on the right hand at the Shaoshang xuewei (see Figure 2.1) to 26

Chapter Eight explores the notion of the mai in detail.

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Chapter Two

enable the Lungs to eliminate the heat in it, and get rid of blood stasis. He then performed the same procedure on the other side of the person-body. Three minutes after the end of the acupuncture session, the patient reported that the pain had greatly abated; his complexion had improved, although he also reported that when he coughed, he still felt some mild pain. When his mai was taken again, its profile had changed–ᐖረᐢн⊹ /“The mai at the cun position of the left hand is no longer sunken”. To eliminate the residual mild pain upon coughing, the patient was straightaway given three medicinals in powdered form, dissolved in roomtemperature boiled water, which he then swallowed: Ligustici Rhizoma 10g, Corydalis Tuber, 5g, and Toosendan Fructus, 5g (ᐍ㢾㓶㊹ 10gˈ ᔦ㜑 ㍒㓶㊹ 5g, ᐍᾍᆀ 5g). After several minutes, the patient reported that he no longer felt pain of any kind, and when his mai was checked again, the profile was as follows: ਣ ረ Ḅ઼ˈ ᐖ‫ޣ‬ᐢᰐ䛱⏙ᝏˈᐖረ ઼㕃ᴹ࣋/“the cun position on the right hand was soft and gentle, that at the guan position of the left hand no longer gave the impression of being depressed or that Qi was blocked, that at the cun position of the left hand the mai was gentle but had strength”. The patient was then sent home. The mai profile had changed after the treatment. The change in this case was quite immediate; as such, the postulated cause-effect chain is too short for other extraneous factor to intervene (although it is logically possible for such a factor to occur).

Figure 2.6: The Yanglingquan xuewei/ 䱣 䲥 ⋹ (GB34) on the Foot Shaoyang Gallbladder Jingmai

CCM implies, as earlier set out, a distinction between the Jingluo network and the BCS: the latter consists of vessels (that today, we call arteries and veins), which transport blood throughout the person-body, while the former transports Qi. Blood/xue is yin and Qi is yang. Hence the two systems (Qixue) co-operate to function as a Yinyang system. A blood vessel may burst; blood is leaked out into the person-body, adversely

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affecting a certain part of it; when a Jingmai gets damaged, there is Qi blockage in the person-body, adversely affecting a certain part. When blood leaks out, it leads to blood stasis/ ⰰ 㹰 , thereby causing pain. Similarly, when qi stagnates, it causes pain. Furthermore, this stagnation may move to affect other parts of the person-body. Treatment consists of two aspects: to repair the damage caused by the stagnation, and to induce Qi, in its original Jingmai, to function properly. Take this case set out in *Yu and Zheng 2011, 207-208: female, aged 40 years. In 2007, during an accident at work, a heavy object knocked against her chest. She felt a powerful pain, and when she breathed or even lightly coughed, she also felt pain. She did not cough blood, nor did she suffer from a sensation of being stifled. Nor did any bruises show up. The X-rays of her chest showed up nothing untoward. After the accident, she self-prescribed some Chinese pills (dieda wan/䏼ᢃѨ), meant for external injuries, such as bruises and swellings. This was to no effect, so she consulted the physician recommended to her by friends. Following diagnosis, the physician concluded that hers was a case of Qi stagnation, caused by injury to the Jingmai/ᫎՔዄ≄. (As her condition had nothing to do with bruises and swellings, naturally, the dieda wan was not efficacious, as it was not relevant to her condition.) The prescription contained the following ingredients: 1.㓒㰔 2.俉䱴ᆀ 3.йг㊹ 4.クኡ⭢ 5.ൠ嗉/㳟㳃 6.⸲ӱ 

Sargentodoxa Cuneata Cyperus Rotundus L Panax Pseudo-ginseng Manis Pangolin Pheretima (Earthworm) Fructus amomi

Medicinal 1 is the chief ingredient, as apart from its general property of livening blood and stopping pain/ ⍫ 㹰 → Ⰻ , it can also unblock the Jingmai, when the blockage and damage are caused by an external factor, as in the case of this patient. Medicinal 5 hastens the process of damage repair, so that qi would stop stagnating–the earthworm is well-known for its ability to regenerate itself as two whole worms when chopped into halves, and hence is used in cases when the Jingluo is not functioning smoothly/㓿㔌н࡙. Medicinals 2 and 3 are commonly used in illnesses involving Qi (caused through injuries inflicted by external factors). Medicinal 4 enters the Liver and the Stomach Jingmai to ensure the free

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flow of Qi and blood. Hence, Medicinal 2 courses27 the Liver, eliminates the stagnating of qi, rectifies qi, regulates the Jingmai, and in the process reduces pain/⮿㛍䛱≄ˈ⨶≄ᇭѝˈ䈳㓿→Ⰻ, while Medicinal 3 enters the Jingmai of the Liver, the Stomach and the Large Intestines. In this context, 2, 3 and 4 are used to disperse clotting and to stop pain. Medicinal 6 ensures that the stagnation of qi would no longer continue in the Jingmai of the Spleen, the Stomach and the Kidneys. The patient recovered. This prescription has been found to be efficacious in similar cases of qi blockage and qi stagnation down the ages, incurred through problems caused by external factors. To CCM, this kind of treatment would provide “objective” evidence that: (a) Qi stagnation can occur (in the circumstances described), thereby causing certain symptoms and signs such as, in this case, pain in the chest, pain when coughing and sneezing (when bruises and swellings have been eliminated as the obvious cause of the pain). Whenever there is blockage and stagnation of either qi or xue, CCM upholds the general methodological principle of н䙊ࡉⰋ/bu tong ze tong/blockage causes pain. (b) Certain treatments(s) can get rid of the illness by unblocking qi, eliminating the stagnation and inducing qi to function properly in the relevant Jingmai. (Remember: in CCM, blood is inextricably entwined with qi.) The sceptical reader may still suspect that this author has let CCM too easily off the hook. From the Biomedical standpoint, the cases cited above are said to be “anecdotal”, and from the standpoint of epistemology, have very little or no value; as to be “scientific”, RCTs must be conducted to eliminate, amongst other biased factors, the placebo effect. 28 Chapters Three, Six, Seven and Eleven will assess how relevant such Biomedical demands are to CCM; in the meantime, to quell some immediate doubts, it may be helpful to remind such a reader that the methods used implicitly by CCM, but rendered explicit above, are similar to those used by some outstanding practitioners of Modern Science or by philosophers of science 27

It eliminates “evils”/䛚 which prevent the Liver from functioning properly. See Eshkevari 2013. This demonstrates a plausible biological mechanism, which may be able to account for why acupuncture could have certain effects claimed for it, such as its ability to reduce stress by needling the Zusanli xuewei (see Figure 2.4). However, the article goes on to warn that, as this has only been demonstrated in rats, it remains for similar experiments to be performed on human beings to control for the placebo effect.

28

The Jingluo/㓿㔌 Network

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today. Take first the case of the claim that Qi-in-dissipating mode in the living human being does have discoverable effects, even though it is unobservable (it is not a thing, and is beyond the reach of being detected by machines/instruments, no matter how sophisticated their design, such as MRI). This form of reasoning is analogous to that employed by the scientific and philosophical community after Newton had posited gravity as a force, and proceeded to discover that it has effects, which are calculable. Gravity violates the Billiard-ball causal model. Gravity, as attraction, was argued by Newton to hold between bodies, which are not in spatial contact with one another, as the heavenly bodies are light miles away from each other. Insofar as gravitational forces arise between them, then these bodies act, and produce effects at a distance, which are, nevertheless, discernible and discoverable. Although it is only one of numerous views,29 it is not considered to be a disreputable view in the literature of the philosophy of science. Admittedly, the discoverable effects of Qi-in-dissipating mode in the living human being are not discoverable in the way in which viruses are discoverable by the electron microscope, but they are discernible and discoverable, all the same. Sometimes they can even be backed up (today) by objective readings 29

This way of putting things is meant to reflect the debate in Newtonian scholarship down the ages, how best to understand his notion of attraction. Some of these are: (a) Simply ignore it, but retain Newton’s mathematical framework merely as a useful calculating device, to predict how bodies move in relation to one another–the view of the British empiricist, Berkeley (1685-1753). (b) It has no counterpart in “reality”, as it is nothing more than a projection of the human mind–sometimes attributed to another empiricist, David Hume (1711-1776). (c) It is a consequence of the workings of ether–a view, which Newton himself is sometimes said to have held. (d) It is the working of God’s will–a view which is also attributed to Newton himself. (e) It is something which God had added to matter at the time of its creation–a view held by some of Newton’s contemporaries. (f) It is a primary quality of a body–a view endorsed it is said, by Kant. (g) It is a relational, non-intrinsic quality of matter generated by “the conspiring nature” of the bodies in any interaction–a view, Schliesser 2012 claims is found in the writings of William Gilbert (1544-1603), which could have influenced Newton himself. (h) It is real but, as a matter of fact, we know nothing more about it, except that it appears to have consequences/effects, which we can discover/discern. See Schliesser 2012.

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taken by instruments of some of its consequences or effects such as the measurements of the patient’s blood pressure, before and after the acupuncture treatment. As for invoking theoretical entities which are unobservable in principle, again, this is not a violation of the rules of theory construction as endorsed by the orthodox philosophy of science today, as represented by Popper’s account in terms of falsifiability.30 Falsifiability merely demands that from the hypothesis (whether containing unobservable entities or not), one should be able to derive from it testable consequences. Upon testing, should those consequences fail to be obtained, falsifiability demands that the hypothesis be given up as false (but remain falsifiable). What falsifiability forbids are attempts to avoid falsification (rendering the hypothesis unfalsifiable) by introducing ad hoc hypotheses to explain away why the predicted result has failed to occur. This account relies entirely, at least according to Popper himself,31 on deductive logic alone, and is referred to as the Hypothetic-Deductive Method (H-DM). In outline, and in a technically simplistic manner, the above may be recast as: the prediction requires two different sorts of propositions to act as premises (as in a deductive argument), from which logically one could derive a testable proposition. Take this example: the freezing point of water is 0oC (H)–the hypothesis subject to test. To H, attach other statements, which are called statements of initial conditions, such as this is a bucket containing water (IC), this is a thermometer (IC). H + IC entail the conclusion (C): the water in this bucket will freeze, when the thermometer registers 0oC or below. Conduct the experiment to test H as follows: fill the bucket with water and leave it outside overnight in a very cold winter. Early next morning, look at the thermometer next to the bucket to check the temperature. If the temperature turns out to be at 0oC or below, and if the water in the bucket is frozen, then H has survived falsification and is true. But suppose the thermometer registers 0oC or below, but the water in the bucket is not frozen; then, imagine the experimenter/theorist back-tracking, contending that H is correct. What is wrong is that the thermometer is not a properly functioning instrument and its reading cannot be taken to be correct. This is an ad hoc hypothesis, which could be used in an attempt to avoid the falsification of H. Suppose that in order to settle the controversy, one uses another thermometer agreed by all to be reliable, and it reads 0oC or below. Instead of admitting defeat at this stage of the game, the experimenter/theorist invokes yet 30 31

See Popper 1959 and 1963. For a critique of Popper from this point of view, see Lee 1969.

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another ad hoc hypothesis to explain away the non-occurrence of the predicted outcome, such as the water in the bucket is not pure water, that someone, mischievously, has added salt to it. Suppose that a lab test carried out on a sample of water from the bucket finds no salt in it. The experimenter/theorist continues to refuse to accept that H has been falsified, by invoking yet another ad hoc hypothesis. This, then, is what Popper means by saying that falsifiability is the hallmark of the scientific status of a hypothesis–when the logically derived prediction fails to occur at the end of the experiment, one should simply accept that the hypothesis in question is just a false claim with, however, its status as a scientific one remaining intact. 32 (There are other aspects of Popper’s philosophy of science relevant to CCM theorising, which will not be raised here, but in Chapter Three.) The CCM theorist-practitioner invokes the unobservable/undetectable theoretical “entity” 33 called Qi-in-dissipating mode in the living human being, initially for two reasons, as already observed: the cosmological/ philosophical reason of Tianren-xiangying, and the theoretical one that Qi is the fundamental ontological category. This leads to the formulation of the hypothesis that Qi exists, it is that which courses through the Jingluo network with its various xuewei, at different parts of the individual (H). Statements of initial conditions could include: this patient has high blood pressure; the place on the person-body to needle and bleed is the pointy top of the patient’s ears (IC). H + IC entail the conclusion/prediction that the patient’s blood pressure (minimally) would diminish (if not return to normal straight after the treatment). Proceed to treat the patient as set out under IC. Wait for the result of the treatment. If the blood pressure does diminish, then the predicted conclusion is correct, and hence, H under test is proved to be correct/true (but falsifiable). Imagine that the patient’s blood pressure has not diminished, but instead has gone up because of the treatment, then this would count as a falsification of H, and any attempt, by invoking ad hoc hypotheses of one kind or another to enable H to escape falsification, might be shown to be attempts to turn H into an unfalsifiable hypothesis and, therefore, would undermine its claim to be scientific (at least according to Popper). When the predicted conclusion 32

Popper appears to hold that adding ad hoc hypotheses is anathema in scientific methodology as it renders the hypothesis under test unfalsifiable, and hence unscientific. Others contest his view. For some details of this controversy, see Kuhn 1962, Lakatos and Musgrave 1970, Lakatos 1978. 33 The word “entity” here is used in a technical sense, simply to stand for that which the term “Qi-in-dissipating mode” refers to, and is not to be understood as a thing which belongs to xingerxia.

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turns out to be the case at the end of the testing, then this would show that though H itself is about something unobservable/undetectable in principle, nevertheless, it can have consequences which are discoverable and discernible. On behalf of the CCM theorist-practitioner, such a way of putting things could be articulated and formulated.

Conclusion With regard to Qi in the Jingluo network of the living human being, one hopes to have presented sufficient evidence to make a case for not rejecting/dismissing it out of hand as “mumbo jumbo”/“pseudoscience”/“unscientific”. Clearly, the theory or concept of the Jingluo network in CCM can be subjected to tests, some of which even satisfy the requirements of Respectable Science, and the Respectable Philosophy of Science, even in the absence of the kind of experiment carried out by Professor Zhu. The research of Zhu’s team adhered to the methodological requirement embodied in Bm/Modern Science. They not only collected objective evidence but also satisfied the requirement of objective/ quantifiable measurements. They also implicitly relied on the null hypothesis (H0) to uncover eventually certain discoverable/discernible characteristics of the Jingluo network, a respectable methodology in Modern Science. Furthermore, the implicit use of Popper’s H-DM in deriving a conclusion, which can be put to the test in the treatments endorsed by CCM, such as acupuncture for certain specific conditions presented by the patient, is not obviously methodologically unreasonable. H-DM consists of postulating that the hypothesis, together with certain statements of initial conditions, entails a conclusion, which is testable. This testable condition satisfies Repeatability but only in this limited sense, that CCM has used and tested these techniques down the ages for more than two thousand years. However, Chapter Eight argues that CCM, theoretically, is at odds with other assumptions for Repeatability in Bm’s clinical trials, such as those presupposed by RCT-EBM. Unlike Zhu’s team, the CCM physician used/uses no high-tech tools sanctioned by biophysical research today, but the method of checking the mai is as objective and reliable as Zhu’s methods. To be fair to CCM (as practised for more than two thousand years), one should not overlook this fundamental similarity between the old and new methods of testing a theory/hypothesis.

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These old and new methods of testing a theory/hypothesis will be examined again in Chapter Eleven, in the context of IM, when the meaning of “integrative medicine” will itself be explored between “Chinese Medicine”34 and Bm. It will also show the need to examine the relationship, on the one hand, between Bm and CCM and, on the other, between Bm and TCM, as different theoretical and conceptual issues arise in these two contexts. Nor does it appear obviously methodologically unsound to argue from the discoverable/discernible effects, which follow upon a treatment, to their putative unobservable/undetectable cause–bearing in mind the outstanding case of Newton’s notion of gravitational attraction in the history of Modern Science. Admittedly, to quell all possible doubts of a determined sceptic, one would have to work a lot harder than outlined in this chapter, but the account(s) so far given could be said to be a step in the right direction to give CCM and its theories a fair hearing. Later chapters attempt to address some other challenges mounted by the determined sceptic. However, neither this nor other chapters would have anything to say about a very pertinent issue, namely, what sort of a well-worked out metaphysics could suitably back such findings. Lee 2017a, Chapters Three, Eight, Nine, Ten and Eleven and, now, this volume give an outline of what such a metaphysics would involve. It must be capable of accommodating the following: • • • •

•

34

process-ontology (not simply thing-ontology); the peculiar and unique feature that Chinese philosophy/medicine invokes Contextual-dyadic Thinking (not Cartesian dualism); its conception of Qi in its two modes of operation, thereby, entailing “Em-ism”; the implication that it is an Ecosystem Science, which is Wholist (therefore, not reductionist) in orientation, at all levels of analysis and understanding; the implicit invocation of a non-linear model of causality, thereby, rejecting the Humean linear model of cause and effect.

This term is put within quotation marks as this author is unhappy with it as a translation of zhongyi/ѝ५ (see Chapter Eleven).

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It is obvious that the task of undertaking such a relevant metaphysics/ ontology which can do justice to the major characteristics of CCM theorising is well beyond the remit of this project. It is sufficient simply to give a fair hearing to CCM theorising, to convince readers that undertaking this further enterprise of constructing an appropriate metaphysics/ontology would not be a waste of time and effort.35 35

For one recent attempt to construct a systematic metaphysics for Modern Science, see Chakravartty 2007, which argues for what he calls “semirealism” as far as causal processes are concerned; but is his account undertaken wholeheartedly within the framework of process-ontology? CCM implies scientific realism and its related notion of causal realism. Psillos 1999, xix claims that scientific realism incorporates three theses: 1 The metaphysical stance asserts that the world has a definite and mindindependent natural-kind structure. 2 The semantic stance takes scientific theories at face-value, seeing them as truth-conditioned descriptions of their intended domain, both observable and unobservable. Hence, they are capable of being true or false. Theoretical assertions are not reducible to claims about the behaviour of observables, nor are they merely instrumental devices for establishing connections between observables. The theoretical terms featuring in theories have putative factual reference. So, if scientific theories are true, the unobservable entities they posit populate the world. 3 The epistemic stance regards mature and predictively successful scientific theories as well-confirmed and approximately true of the world. So, the entities posited by them, or, at any rate, entities very similar to those posited, do inhabit the world.

Very briefly, causal realism (at least, according to this view) may be characterised such that: (a) Causation is a real and fundamental feature of the world. (b) It consists of one event bringing about or producing another event. (c) An event instantiates a property F, which brings about another event which, in turn, instantiates another property G. In other words, properties have powers, that Fs are the powers to produce Gs. (See Esfeld 2011.) Chakravartty (2005, 22) holds that causal realism minimally rejects Humean causation, that it recognises de re necessity, that, however, the relata of causation are not events but processes. Furthermore, to cite him:

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…this process view is flexible enough to provide a framework for the analysis of causation not merely in cases of causal change, but also in cases involving static states of affairs that some think to be causal as well. Here the analysis would be given in terms of equilibrium relations, manifested in accordance with dispositions conferred by the relevant properties. It is obvious that, among philosophers of science, not only is scientific realism only one view amongst others regarding scientific theories, it is also the case that there appear to be as many accounts of scientific realism as there are philosophers, who write about it (see, for instance Psillos 1999 and 2009).

CHAPTER THREE IN DEFENCE OF WUXING/ӄ㹼

Introduction Today, in The People’s Republic of China, one can identify two tendencies:1 (a) Those who answer to the rallying call of CCM, advocating a return to, and recovery of CCM’s ancient cosmological/philosophical roots, no matter how unfamiliar and “problematic” some of its concepts may appear to modern minds, nurtured on Modern (Newtonian) Science and Biomedicine. *Liu Lihong 2003 and *Pan 2012 may be said to be representative exponents. (b) Those who find some concepts “embarrassing” and so would like to be rid of them in order to appear more “rational”, “modern”, and “progressive” and, therefore, to render it more acceptable and “scientific” to the world of globalised science and scientific thinking. Such advocates belong to TCM.2 *Deng Tietao/䛃䫱⏋ and Zheng Hong/䜁⍚, 2008, in their edited thoughtful volume may be said to be representative exponents. In particular, Wuxing, to the followers of the second tendency, appears to be the prime candidate ripe for “the chop”, while those of the first appear to consider it worth defending to the last ditch. The former may, for brevity, be referred to as the C, the latter as the Pro-Wuxing Tendency (PWT). This chapter attempts to disentangle some of the key points of disagreement between the two tendencies, to see which turns out to be a sounder claim, in several different related ways. The strategy chosen here, in adjudicating between them, is to focus on AWT as having been caught in a time warp, in that it appears to occupy a standpoint which, in the 1 2

For an account of the same debate from the 1950s-1970s, see Qiu 1982, 55-59. TCM will be briefly discussed in Chapter Eleven as Integrated Medicine.

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history of philosophy of science itself in the West, has been considered as somewhat passé. In other words, AWT seems to have subconsciously absorbed a conception of Western philosophy and its accompanying philosophy of science, by which it then judges certain key concepts in CCM, such as Wuxing, to be woefully wanting. This chapter will also look at some “internal” reasons, which have encouraged AWT exponents to be “hostile” to Wuxing as a concept/hypothesis. This in itself is curious as it is obvious that this concept has been a well-established part of CCM for two thousand, if not more, years.

Internal reasons Part of the justification for letting go of Wuxing is that the proponents of AWT claim that it has already done its real work in establishing Wuzang/ ӄ 㜿 /the five yin visceral organs Studies, 3 an extremely valuable contribution (see Chapters Four, Five, Six and Eight for details of the link between Wuzang and Wuxing). However, it is also well-known that over the centuries, Wuxing had been extended in all manner of ways without sufficiently good justification, thereby, giving the concept a bad name. In this spirit, *Deng and Zheng 2008 explore the possibility of undertaking this spring-clean. Their volume, in a nutshell, puts forward the following nuanced arguments.

3

Wuzang Studies are wider than this and are really Zangfu/㜿㞁 Studies as they involve not simply the inter-relationships between the five Zang but also those between Wuzang and Liufu/ ‫ ޝ‬㞁 as well as their links with their respective Jingmai. Naturally, they consider both the normal physiological functions as well as the pathological changes to the Zangfu when illness occurs, as shengli and bingli are intimately related. Zhang Jingyue/ᕐᲟዣ (1562-1639) called this domain of investigation Zang xiang/㯿䊑, in his book, *Classified Classics/lj㊫㓿NJ. A passage reads: 䊑ˈ ᖒ䊑ҏDŽ 㯿 ትҾ޵ˈ ᖒ㿱Ҿཆˈ ᭵ᴠ㯿䊑

Rendered as: The Zangfu are located inside (the person-body), but they have external manifestations; hence, it is (appropriate) to call them the image/picture of the Zangfu. (Texts within round brackets are the author’s interpolations.)

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1. Historically, the notion of Wuxing has been both a help and a hindrance to CCM. 2. It is a hindrance to the extent that it has/had claimed too much. For instance, Figures 4.2 and 4.3 show only the helpful side, but fail to mention that it has a muddling side, when it claims to be able to connect it up with the five animals, as shown in Table 3.1. 3. Note that the authors do not condemn outright Wuxing in this context; their more limited complaint is confined to saying that the linkage has very little, at best, or no relevance, at worst, to medical theory and understanding. The best one can say is that the pairing of Earth with the Ox is corroborated by some empirical findings that beef can definitely help to strengthen the Spleen (Earth). (However, this complaint fails to take into account that, according to the Yijing, the Ox is Earth.) 4. Such a limited contribution may then be said to be outweighed by the intellectual disadvantages of carrying Wuxing on its back. 5. Note, too, that the references mentioned in Figure 3.1, except in the Earth/Ox pairing, do not agree with regard to the other four pairings. This is seriously worrying from the point of view of clarity, precision and scientificity. Hence, Wuxing could be an embarrassment. 6. The subtlety of the volume lies in generously admitting the contribution of Wuxing to the understanding of the interrelated functioning between the five yin visceral organs/Wuzang. However, historically, having made such an invaluable contribution, Wuxing has, ironically, rendered itself superfluous, and so can be graciously retired in a dignified manner, by not invoking the concept ever again, except through its implicit invocation via the core area of study and research in the Wuzang inter-relationships. In other words, medical theory has outgrown Wuxing, which is now surplus to requirement. 7. This then raises the question: is the above argument sound and correct? But, before this chapter can examine it critically, one must first pause and turn to the external reasons, which can be traced to the Western tradition of philosophy and to a particular debate in the history of its philosophy of science.

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Wuxing Suwen: Chapter 4 Lingshu: Chapter 56 Suwen: Chapter 70 Liji lj ⽬ 䇠 · ᴸ ԔNJ Records of Rites: Yueling4

Wood

Fire

Earth

Metal

Water

Chicken/ 呑 Dog/⣜

Sheep/㖺

Ox/⢋

Horse/傜

Pig/ᖈ

Sheep

Ox

Chicken

Pig/⥚

Dog

Horse

Ox

Chicken

Pig/ᖈ

Sheep

Chicken

Ox

Dog

Pig/ᖈ

Table 3.1: The five animals and Wuxing (Adapted from *Deng and Zheng 2008, 197)

External reason: the spirit of Positivism One is tempted to trace the spirit of AWT, consciously or subconsciously, to that of Positivism and the kind of science generated by such a philosophy in the West. Very briefly, Positivist philosophy, in general (beginning with Comte, if not earlier), subscribed to three different stages of human intellectual development in its attempts to explain natural phenomena: mythological, metaphysical, and scientific. In Western Europe, by the seventeenth century, the third stage had begun to emerge, eventually leading to the triumphal achievements of Newton, in particular, and Newtonian science, in general. The first had begun with the early Greeks with their myths about the lives and loves of their gods and goddesses (see Lee 2017a, Chapter Four). The second came into existence with Aristotle and the later development of Aristotelianism with its reliance on essences. Alas, these turned out to be empty of empirical content, as they were no more than the result of a definitional sleight of hand. Aristotelianism also took up Aristotle’s four causes, which muddied the waters even further. When modern philosophy (of which Positivism was a dominant genre) emerged hand in hand with Modern Science from 4 It is said to be a late Warring States/Han text which, eventually, was adopted as a canonical Confucian text; its underlying moral principles are concerned with such matters as royal regulations, rites/ritual objects/sacrifices, education, music, the behaviour of scholars, as well as the doctrine of the mean/zhongyong/ѝᓨ. The section, entitled Yueling, is generally translated as “Proceedings of Government in the Different Months”.

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the seventeenth century onwards, two of those four causes were pronounced to be redundant. The final and formal (these raise “why” questions which, it is claimed, science cannot possibly answer), while retaining the material and efficient (these raise “how questions”, which science can answer), as these are/were amenable to observation, measurement and quantification, are the hallmarks of the scientific mode of explanation. A new broom swept through the philosophical cupboard, so to speak, clearing out concepts which are/were beyond observation, measurement and quantification. In this spirit, not only did vis dormitiva5 fall by the wayside, so did the notions of phlogiston and ether. Wuxing, then, in the eyes of the exponents of AWT, who may have absorbed this Western philosophical stance, would deserve the same fate as these discarded entities in the history of Modern Science. The medicine, as a result of this cleansing, would become leaner, cleaner, and closer to the “scientific mode” of enquiry as laid down by Positivist philosophy and Positivist science. A caveat must immediately be entered at this stage of presenting the case against AWT, namely, that it is difficult to “prove” that such a subconscious influence, like the account just given, does exist. At best, one can marshal some evidence for making the case. This includes the undeniable fact that scholar-physicians today, as well as some in the early twentieth century, are/were not unaware of some aspects of Western philosophy. To cite only one example: it concerns the exceptionally wellinformed Zhang Xichun/ ᕐ 䭑 㓟 (1860-1933), the very distinguished scholar-physician of the late Qing dynasty and early Republican period, who objected to this Positivist influence at work on Chinese thought, which he found totally unacceptable. As a result, he wrote an essay on the subject, challenging implicitly the Positivist claim that science/medicine and philosophy are mutually exclusive (see Zhang, as translated by Fruehauf 2016). Zhang Xichun argued that there is an undeniably intimate link between (Chinese) philosophy and medicine.6 However, unfortunately, some of his counterparts today are not so in tune with Western philosophical developments occurring over the last half century or more and therefore, some of them appear to be stuck in the time-warp of Positivist philosophy itself. By and large, Western philosophers have liberated themselves from the grip of Positivism and its spirit. They no longer hold that “metaphysics” is a dirty word but, instead, 5 6

This Latin term means no more than “a force which makes one sleepy”. In Chinese, its title is: lj䇪५ᆖоଢᆖⲴ‫ޣ‬㌫NJ.

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that science presupposes metaphysics (not in the abusive but the proper sense of the term), that science and philosophy are not mutually exclusive. (This is not the case with medical practitioners, some of whom, like their Chinese counterparts, may still be subconsciously stuck in a similar timewarp.) Today (and for some time now), it is very respectable for philosophers in the West to claim that a science presupposes a certain kind of metaphysics, just as Zhang Xichun had claimed against Positivism during the heyday of that philosophy. Once the restrictive parameters of Positivist philosophy are abandoned, there is, in principle, nothing objectionable to Wuxing as a concept, on the simplistic ground that it is obscurantist. However, like any other theoretical notion, it can lead people to generate hypotheses, which may turn out to be neither fruitful and productive when tested, nor exceptionally successful, such as in generating Wuzang Studies. Concentrating merely on the former context, unfortunately, may lead to a move that amounts to throwing the baby out with the bath water. The more rational strategy is just to simply retain Wuxing as a general theoretical concept (a concept rooted in Chinese metaphysics and cosmology) but distinguishing its retention at such a level from its use in a particular context, when it may fail to lead to productive, fruitful empirical consequences. This way avoids throwing the baby out with the bath water. However, before we proceed any further, we must pay some attention to an issue in the philosophy of science that seems to have a bearing on the controversy between AWT and PWT. This is the so-called Context Distinction.

The context distinction In the (Western) tradition of the philosophy of science, the term “Context Distinction” (CD) is about the context of discovery on the one hand, and the context of justification, on the other. Some scholars have traced the use of the terms themselves to Reichenbach 1938, although it is said that he did not use or understand it 7 in the way that Popper 1935/1959 did. Ironically, although Popper called that seminal work of his, The Logic of Scientific Discovery, its main thesis is that there is no logic governing the former. Sometimes this is simply called de facto thinking, while the latter is governed by de jure thinking, which critically assesses the thoughts arising in a de facto manner in the context of discovery. To put things in a simplistic manner, Popper refined de jure thinking in terms of 7

See Eberhardt 2012.

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propositional logic using the Modus Tollens as his favoured mode. A very brief account of it and its companion, the Modus Ponens, which are both valid modes of reasoning, runs as follows. Modus Ponens holds: if p implies q, and p is true, this implies that q is true. Below is an example of such an inference. 1. If this man lying on the ground is only pretending to be dead, he will scream out in pain when you stick a knife into his thigh (a conditional statement of the form “if p then q”). 2. This man lying on the ground is pretending to be dead (the antecedent of the conditional statement is true). 3. Therefore, this man will scream out in pain when you stick a knife into his thigh (the consequent of the conditional statement is true). Modus Tollens holds: if p implies q, and q is false, this implies that p is false (-p is true). Below is an example of such an inference. 1. If this man lying on the ground is only pretending to be dead, he will scream out in pain when you stick a knife into his thigh (a conditional statement of the form “If p then q”). 2. It is not true that he screams out in pain when you stick a knife in his thigh (the consequent of the conditional statement is false). 3. Therefore, it is not true that this man lying on the ground is only pretending to be dead (the antecedent of the conditional statement is false). Both are valid forms of reasoning. Popper, nevertheless, favoured Modus Tollens, using it as the basis for his principle of falsifiability, a demarcation principle between what counts as science and what counts as pseudo-science. Popper endorsed falsificationist logic as the basis of scientific reasoning, which is deductive reasoning tout court. On the other hand, the Modus Ponens, as the basis of scientific reasoning, would turn it into confirmation logic, exposing itself ultimately to the Humean charge that there is a logical gap between premises and conclusion. Take the example cited above: no matter how many times, or over time the world over, scientists test Statement 1, and no matter the case that each time, Statement 3 is found to be true, all these instances, no matter how long the list, would still fall short of the kind of logical tightness found in deductive

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reasoning. Inductive logic invokes the logical operator “all” (such as “All men are mortal”), whereas the evidence in support of this generalisation, though very long, is ultimately a finite list of particular statements (“Socrates is mortal”, “Charlemagne is mortal”, “Hitler is mortal” … “N is mortal”). There is no logical contradiction involved in accepting the premises but denying the conclusion. Falsificationist logic, on the other hand, does not suffer from this defect, as Popper maintained (or appeared to maintain 8 ) that if one were to accept the premises, denying the conclusion could not logically be tolerated. Cast the Modus Tollens into H-DM as follows: Water freezes at 00 C (H, hypothesis to be tested). Bucket contains (pure) water. Bucket is left outside in the depth of a winter’s night. Thermometer (properly functioning) registers the temperature as minus 40 C. (2a, b, c are Statements of Initial Conditions; IC for short.) Conclusion Bucket of water will freeze as ice (C).

Premise 1 Premise 2a Premise 2b Premise 2c

H-DM may be presented as follows: H IC —— Therefore C In general, this kind of approach generated the view that the context of discovery is, at best, de facto reasoning, while the logic of a respectable kind (namely deductive logic) is only to be found in the context of justification. It is not germane to one’s preoccupation here to go into the details of the development of CD beginning from the nineteenth, and going through the twentieth century, which shaped greatly the 20th century philosophy of science (see, for example, Schickore and Steinle 2006; Weber 2005, Chapter Three; Hoyningen-Huene 1987). Given that the intellectual baggage carried by CD is not germane to the very limited purpose of this chapter (namely, to cast some light on why AWT has taken shape in China), it may be best to drop the terms “context of discovery” and “context of justification”. Instead, one would like to propose the 8

See Lee 1969.

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alternative terms, the “context of generating a hypothesis” (CGH) and the “context of testing a hypothesis thus generated” (CTH). Furthermore, the account of AWT and PWT given here simply agrees with those who challenge CD in the following way: generating a hypothesis and testing a hypothesis thus generated are really two aspects of the same epistemic exercise. Or to put it in Chinese terms, they are complementary ways, which should be conceived as a Whole, although in some contexts, it makes sense to isolate the one from the other, in order to concentrate the mind on certain features, peculiar to that aspect of the exercise. For this reason, AWT will be shown to be wrong in superannuating the Wuxing concept/hypothesis. (Furthermore, Chapters Five, Seven, Eight, Nine, and Ten show that Wuxing as Yinyang-Wuxing is an integral part of CCM reasoning in the diagnosis-treatment of illness.) The approach adopted here also agrees with the challengers of CD, that discovery is not necessarily a mere “eureka” moment, bereft of explicit rational processes of thinking of any kind.

The context of generating the Wuxing hypothesis (CGH) and the context of testing it (CTH) CGH may be considered from two aspects: (a) Does the provenance of Wuxing, as a general hypothesis, involve a case, which necessarily precludes rational processes of thinking? (b) Does the provenance of Wuxing, as a specific hypothesis, necessarily involve a case, which precludes rational processes of thinking? The short answer to both questions is “no”. Take a look at CGH(a). As Lee 2017a, Chapter Seven has explored it at length, there is no need to repeat all the details here, except to remind the reader that it went through various stages in its development (provenance, emergence and evolution) and that each of these stages did not involve a “eureka” moment, or that the idea came to people via dreams. 9 It was based on the following eminently rational processes of thinking. 9

Kekulé, the German chemist, had two dreams, which led him to his discovery of the cyclic structure of benzene. The first dream occurred in 1865 in which he saw atoms dancing around, linking to one another; when he woke up, he immediately made a sketch of what he had seen in his dream. In his second dream, he saw

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1. A combination of procedures such as observation as well as abstracting from observational patterns (characteristic of the evolutionary stage from wucai/ӄᶀ to Wuxing), leading from something concrete to a theoretical (and, hence, necessarily more abstract) schema, that is, Wuxing itself. 2. Feeding into the emergence of Wuxing are other concepts from astronomy and geography (Time and Space respectively), from Yinyang, which itself emerges out of a combination of procedures based on observation and then abstraction from observational patterns to a theoretical schema (such as the Yao-gua model) (see Lee 2017a, Chapters Three, Five, Six, and Seven). Next, look at CGH(b). Lee 2017a, Chapters Three to Seven as well as Nine and Ten, has amply shown that the emergence of the Yao-gua model, of the notions of Qi, yinqi and yangqi and ultimately, of the concept of Yinyang itself, owes much, again, to a combination of procedures. These include observation as well as abstracting from observational patterns, leading to the emergence of a highly abstract theoretical schema, which could be used as a set of analytical diagnostic tools to create order, coherence and Wholes, in diverse domains of phenomena and activities, whether these are in divination, rulership, the military, or medicine. None of these involved “eureka” moments, dreams or other irrational factors. It is clear that the ancient Chinese displayed a happy fluency in moving from the purely empirical to a less empirical level of reasoning, and then to a very abstract theoretical level, as well as back again from a theoretical/metaphysical level down to the empirical level yet again. (“Metaphysics” is used in the non-abusive sense of the term, simply to mean that which is “beyond” or “over” physics; or what in Chinese is sometimes called xingershang/ᖒ㘼к, meaning that which is above shape and form.10) The context of testing the Wuxing hypothesis (CTH) may similarly be understood through two aspects: (a) Does the testing of Wuxing, as a specific hypothesis, generally preclude rational processes of thinking?

dancing atoms forming themselves into strings, moving about in a snake-like fashion, until “the snake” of atoms formed itself into an image of a snake eating its own tail (see Verderese and Roth 2011). 10 See Lee 2017a, Chapter Four for some reservations about the usual translation of xingershang as “metaphysics”.

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(b) Does the testing of Wuxing, as a specific hypothesis in the case of diagnosing a particular patient, preclude rational processes of thinking? The short answer to both questions is again “no”. Look at CTH(a). In adopting Wuxing as a hypothesis for testing, as an earlier section of this chapter has shown, *Deng and Zheng 2008 have correctly demonstrated that, historically, the testing of such a hypothesis led to the highly successful domain of Wuzang or Zangfu/㜿㞁 Studies, which is indispensable to understanding illness in the person-body. Chapter Four gives an example of patients with premature white hair, which, in CCM, is to be understood through Wuxing, linking four of the five yin visceral organs, namely, the Kidneys, the Spleen, the Liver, and the Lungs. The explanation for this hypothesis lies in the purported respective functioning of each of the four Zang (for which empirical support is claimed on their behalf), and how the malfunctioning of each contributes to bringing about premature white hair in person-bodies. Should one wish to cast it in terms of the H-DM, beloved of Western philosophers of science, one may even do so as follows: Hypothesis:

Statement of Initial Condition:

Conclusion

Person-bodies, with malfunctioning Kidneys, Spleen, Liver, Lungs, and in the inter-relationships between them as understood under Wuxing, would possess premature white hair. Patients, whose person-bodies are diagnosed with malfunctioning Kidneys, Spleen, Liver, Lungs, and in the inter-relationships between them as understood under Wuxing, would possess premature white hair. Such patients are/will be person-bodies with premature white hair.

CTH(b) can similarly be cast to conform to the H-DM, should one so wish, as follows: Hypothesis

Person-bodies, with malfunctioning Kidneys, Spleen, Liver, Lungs, and in the interrelationships between them as understood under Wuxing, possess premature white hair.

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Statement of IC

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This patient is diagnosed (through sizhen/ഋ䇺 11 /the four techniques of diagnosing a patient’s illness, in general but, in particular, maizhen/㜹 䇺 , sezhen/ 㢢 䇺 , shezhen/ 㠼 䇺 ) with malfunctioning Kidneys, Spleen, Liver, Lungs, and the inter-relationships between them in the person-body as understood under Wuxing. This patient possesses premature white hair.

Both conclusions above under H-DM could be said to constitute explanations/predictions for the general phenomenon of premature white hair in person-bodies as well as for the particular phenomenon of premature white hair in a specific person-body. In all, one could say that CGH involves rational processes of thinking which, however, should not simplistically be identified with formallyestablished logics in the Western tradition, such as, inductive logic, deductive logic or even the more controversial abductive logic,12 although it remains true that the ancient Chinese would have used them implicitly in one way or another. On the other hand, in CTH, should one wish, one could present the reasoning in terms of H-DM, whereby the phenomenon (C) to be explained or predicted, could be derived from H and IC (functioning as premises) of such an argument. There is no need, therefore, for the exponents of AWT to find Wuxing an embarrassment even from the standpoint of this aspect of the (Western) philosophy of science tradition. It may be opportune to grab this moment to talk a little more in general about CGH and CTH as implied by CCM. For this purpose, let us take a different hypothesis (also resting on Wuxing) to reinforce the main point established above, namely, that at no point in a long-drawn-out chain of reasoning, do irrational or non-rational considerations enter the picture. Call this HK: that the Kidneys play a dominating role in bone formation. First level: HK comes from Wuxing theory itself, as bones come under the aegis of the Kidneys in the person-body (see Table 4.1). Second level: Should one be interested in pushing back further the issue of provenance, one could ask “where does Wuxing itself come from?” Lee 2017a, Chapter Seven traces it back to Yinyang/䱤䱣 theory, where it is 11 12

For details, see Chapter Eight. The origin of abductive logic is sometimes traced to C. S. Pierce.

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shown that the former is, in reality, an aspect of the latter, such that it is best to call them jointly Yinyang-Wuxing theory. Third level: Should one be interested in pushing the matter back still further, one could ask where Yinyang itself comes from. Lee 2017a, Chapter Five traces it back to the concept of yi/᱃ in the Yijing/I Ching/ lj᱃㓿NJ, which implies the notions of Qi as yinqi and yangqi, and their interactions and relationships. In other words, one could legitimately say that HK can be derived from the concepts of yi/Change, Qi, Yinyang-Wuxing. However, as it has been amply shown, Chinese philosophy exemplifies an exceptional fluency in negotiating between what are very abstract/theoretical/metaphysical concepts (call these MGC), on the one hand, and, on the other, notions, that are firmly observational and empirical (call these EGN). Indeed, the former are quite often based on the latter (see Lee 2017a, Chapter Four). Take just one example to remind the reader: yinqi and yangqi have a strong empirical basis, as they could be literally perceived/felt in the course of a day (zhouye jielü/ᱬཌ㢲ᖻ), of a year or a day (sishi jielü/ഋ ᰦ㢲ᖻ). The warmth and light of the sun during the day/Summer as well as the cold and darkness of the night/Winter are distinctly palpable. So too can the Cyclic Reversion/zhou er fu shi/ ઘ 㘼 ༽ ࿻ of day/night, Summer/Winter be observed. These three EGNs constitute, for ancient Chinese philosophy, its Laws of Nature, which generated its MGCs, such as, Yinyang, Wuxing, Yinyang-Wuxing (see Figures 7.1 to 7.4 in Lee 2017a which capture nicely such aspects of Yinyang). The brief account above of HK shows that with regard to CGH, HK is free from the taint of irrationality/non-rationality. In respect of CTH, as HK claims that the Kidneys play a dominant role in bone formation, it is expected that they would play a significant role in bone repair in cases of bone fracture; hence, in such cases buyao/㺕㦟13 for the Kidneys would make the fracture heal faster/better than without such treatment. 13 This author is reluctant to translate bu/㺕 as “to tonify”; the meaning of the term “tonify” has a superannuated ring to it, having been dropped from the Western medical vocabulary, and used only in non-serious contexts such as tonic water being used in the drink called “gin and tonic”. Tonic water contains quinine which, in the past, was seriously used as a medicine against malaria; today, the quinine content is minimal, just enough to retain the bitter taste, which is said to enhance the flavour of the gin. Buyao/ 㺕 㦟 are medicinals, which enter into fangzi/prescriptions, used when patients lack yangqi or yinqi in one or more of

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Should one be interested in casting the above in terms of H-DM, it would be as follows: HK:

IC:

C

As the Kidneys play a dominant/beneficial role in bone repair in cases of bone fracture, prescribe buyao for the Kidneys. This is a case of bone fracture (i). This is a case of bone fracture, in which the patient is ascertained to exhibit certain features (the patient’s zhèng/䇱) via sizhen (ii). This is a case of prescribing buyao for the Kidneys, upon which the fracture will heal faster/better than if no such treatment were made.

As already observed, HK is generated from EGNs and MGCs. IC (i) is purely empirical (note, though, that no observation is possible except through some theoretical framework, however lowly). IC (ii) is jointly empirical and theory-laden, as diagnosis through grasping zhèng/䇱 itself is informed by Yinyang, Yinyang-Wuxing–it may be said to rest on EGN and MGC. From HK and IC, one derives the testable conclusion, C. C is straightforwardly empirical, as a team of experts (both Bm doctors and CCM physicians) could ascertain for themselves whether the fracture has healed better or faster (relative to their respective extant knowledge of bone fractures and the healing processes involved). However, what cannot be done is a trial that conforms to the classic RCT of Bm, which bestows the “scientific” imprimatur on itself but denies it to CCM. The reasons are as follows. 1. CCM is Getihua Medicine (see Chapter Seven). The precise composition of the fangzi is tailor-made to suit the zhèng of the patient (see Chapter Eight). CCM may rely on ancient prescriptions, but each time they are invoked, the physician has to use it in a linghuo/⚥⍫/flexible manner, which means modifying the quantity of medicinals, subtracting or adding medicinals (see Chapter Eight). There are no mechanistically generated general prescriptions (although patent medicinals do exist, but only as a first-line treatment, not the acme of medical treatment), a one-size-fits-all equivalent of a Biomedical drug, usually conveniently packaged in the their Zangfu. They restore what is said to be inadequate or deficient. If a translation must be provided, it would be better to say that they are medicinals which “supplement” or “bring up to strength” that which is inadequate/insufficient.

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form of a pill. For instance, if the sizhen shows that the patient in question is also suffering from deficiencies in his/her other Zangfu, the shang gong/ кᐕ/the outstanding/superior physician must take these specificities into account in drawing up an efficacious prescription for the fractured bone in question. While Bm and its pharmacology presuppose the axiom of homogeneity amongst patients, CCM treatments presuppose that of heterogeneity (see Chapter Seven). 2. Ethical considerations may intervene to prevent RCT being carried out. In the context of CCM, the physician, morally, cannot and does not withhold treatment in order to test HK. In this, Bm also concurs. For example, in cases of cardiac arrest, the defibrillator would be used on the patient. From known positive evidence, no doctor or physician would withhold such treatment from a patient because no RCTs and/or EBM are in place. Even the most enthusiastic exponents of RCT and EBM concede (see Chapter Seven) that RCT has to be trimmed in several ways and even dispensed with, in cases of “dramatic results” that for instance, the defibrillator can bring about. 3. In these instances, both Bm and CCM are on the alert in monitoring the effects of such medical interventions; CCM has the responsibility of monitoring the testable conclusion of HK. 4. Both Bm and CCM would be (implicitly) relying on inductive/confirmation logic, Popper’s dislike of it notwithstanding. All inductive conclusions are, in principle, subject to modification, depending on the outcome of the monitoring (see Lee 2017a, Chapter Six). There is nothing regrettable about this, as knowledge, in general, is revisable; furthermore, reality itself changes over time, as the Yijing assures us. There is no absolute certainty about the future. This is the human or epistemic predicament, nothing peculiar to CCM or Bm.

AWT: throwing the baby out with the bath water? It would appear that AWT exponents have also failed to realise that discarding Wuxing as being superfluous would immediately lead to a crisis of identity for the medicine. To see this point more clearly, let us put forward this thought experiment. Suppose AWT exponents were to use analogous arguments for discarding the concept of Yinyang, would the medicine be the same as it is?

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The analogous arguments would run as follows. Historically, Yinyang made an invaluable contribution to Wuzang Studies. While Yinyang, like Wuxing, smacks of metaphysics (in the abusive sense of the term) and is, therefore, unscientific/superstitious, Wuzang Studies are eminently empirical-based investigations, and therefore, eminently scientific and respectable. Hence, let us retire Yinyang with dignity and even gratitude for the excellent services already performed. Yet, AWT exponents have not shown, nor do they show, any sign of setting their sights on expunging Yinyang from the theoretical framework of the medicine. This must lie partly, if not wholly, in their realisation that retiring Yinyang would be as good as retiring the medicine itself. In this they are right. If Yinyang constitutes the identity of the medicine, would they not also, in consistency, have to agree that Wuxing equally constitutes its identity. Wuxing is, after all, but an extended understanding of Yinyang (see Lee 2017a, Chapter Seven, and later chapters of this volume), adding enriched (more complex) dimensions to Yinyang. Both Wuxing and Yinyang are metaphysical concepts (in the non-abusive sense of the term), which, however, do yield specific hypotheses that can be empirically tested and grounded; some, though not all such hypotheses could even be said to survive Popper’s falsification logic, such as, those, which constitute Wuzang Studies. A prime example of one such hypothesis, which appears to have fallen by the wayside, is that which pairs Wuxing with the five animals. AWT exponents are entitled to discard such a specific hypothesis as sub-standard. However, this is to discard a particular, specific hypothesis, which does not, however, provide grounds for discarding Wuxing as a General Hypothesis or other specific hypotheses involving Wuxing from the medicine. In a nutshell, the medicine holds that a person’s health and his/her falling ill depend on whether, in the person-body, yinqi and yangqi are in balance. When these two are in equilibrium, the person is in a state of health, but when these become unbalanced, ill-health occurs. This is the medicine’s understanding of shengli/physiology and bingli/theory of illness and the intimate link between them via the notions of yinqi, yangqi and Yinyang-Wuxing (see Chapter Nine). Furthermore, these in turn are intimately bound up with the systemic network of the Jingmai/㓿㜹 as shown below; the medicine would not make sense without the Jingmai/Jingluo, as that system is a conduit of Qi-in-dissipating mode in the person-body.

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Zangfu

Jingmai

Wuxing

Liver Gallbladder Heart Small Intestines Spleen Stomach Lungs Large Intestines Kidneys Bladder Pericardium Sanjiao

Foot Jueyin Foot Shaoyang Hand Shaoyin Hand Taiyang Foot Taiyin Foot Yangming Hand Taiyin Hand Yangming Foot Shaoyin Foot Taiyang Hand Jueyin Hand Shaoyang

Wood Wood Fire Fire Earth Earth Metal Metal Water Water Fire Fire

Table 3.2: Relations between Zangfu, Jingmai and Wuxing

However, Chapter Nine shows that shengli, bingli and yili/theory of therapy constitute a coherent Whole, a trinity, that shengli and bingli enable the physician to ascertain the patient’s zhèng. This, in turn, seamlessly, leads the physician to opt for one (or more) out of a possible range of treatments relevant to the zhèng as ascertained (see Chapters Eight and Nine which explore this set of relationships as shengli-bingli-yili called PIT-ism by this author). This set of relationships entails that the medicine can no more dispense with Wuxing than it can with Yinyang. Moreover, the process of ascertaining the zhèng of the patient, leading to a particular fang to cope with the ascertained zhèng, is informed by Yinyang as well as by Wuxing. In other words, both are absolutely indispensable to the theory and practice of the medicine. Wuzang Studies, as a substitute for Wuxing (and, thereby, also Yinyang) would render the medicine as only a shell, as it would be no more than a mere set of empirical findings. The findings are, admittedly, very useful as a set of techniques. But alas, with their theoretical/cosmological/ philosophical, not to mention their spiritual core gutted out, the soul of the medicine would have been removed. Deprived of its core, the medicine would no longer be able to make sense of ancient prescriptions and use them in a linghuo manner in treatments, which has always been considered a hallmark of being a shang gong in CCM. In other words, the medicine would simply remain, at best, a static depot of past successes, of accumulated knowledge but without the possibility of further development and enrichment of theory-practice. We know that epidemiologically, over time and space, illnesses change in pattern or configuration (in Bm, one says that the disease-pattern alters). Hardy perennials such as extreme malnutrition and ailments originating from water pollution vanish from

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economically and socially-better organised societies. However, other new diseases such as Type II diabetes, heart problems and obesity arrive to take their place. If exponents of AWT have their way, then the medicine might be less able to cope with the appearance of these and other ailments to afflict humankind. However, the removal of its theoretical/philosophical heart would amount to undermining the most important and strikingly unique way of understanding and practising it, what Chapter Nine examines under “Absurdity 4”, namely, the seemingly outlandish and ridiculous claim that the medicine can tackle any illness, irrespective of whether the shang gong knows “the cause” of it. One would not be able to make the fullest sense of such a claim, once the medicine is robbed of Yinyang-Wuxing as a general hypothesis or as a specific hypothesis. It is best to have more strings to one’s bow rather than less, if those strings are not broken and are not there only for show. Hence, one is led to conclude that PWT exponents are correct and that Yinyang-Wuxing is part and parcel of the identity of the medicine. For this reason, it would be correct to use the term “Classical Chinese Medicine (CCM)” for that version of the medicine/zhongyi which endorses the general Yinyang-Wuxing hypothesis as an integral part of its identity and methodology. AWT exponents may be mistaken in throwing the baby out with the bathwater, because of their mistaken zeal in cleansing the medicine of so-called “metaphysical”, “unscientific”, “obscurantist”, “superstitious” notions or hypotheses. AWT exponents who wish to ditch Wuxing as an “unscientific” notion or hypothesis consider themselves as practising that medicine/zhongyi which in English is called TCM. This then constitutes a significant difference between CCM and TCM. Chapter Eleven considers other significant differences between the two.

Conclusion The main endeavour of this chapter is to show that the concept of Wuxing cannot and, must not, be rendered superfluous, as AWT exponents appear to recommend, on the grounds that it is a metaphysical (in the abusive sense of the term) notion and therefore embarrassing for the medicine to retain in its desire to be considered “scientific”. This is a gravely mistaken stance to adopt, as is shown by the nine reasons indicated below. 1. (Global) Modern Science has moved on since the heyday of Positivist philosophy in the West. Metaphysics (in the non-abusive sense of the term) and science are no longer regarded as mutually exclusive. On the contrary,

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science and its methodology cannot even be understood without exploring its metaphysical presuppositions such as wholism and Reductionism on the one hand, or Wholism and non-Reductionism on the other. 2. New kinds of sciences, going beyond the Newtonian sciences embodying the spirit of Positivist philosophy, have arisen, such as quantum physics, systems thinking, and ecology. Such developments show clearly that the relationship between metaphysics and science is a close one–a new or a different kind of science requires a new or a different kind of philosophy/metaphysics to back it. This new kind of post-Newtonian science is more like CCM, which may be called Ecosystem Science/Science (see Chapter Four). 3. The dominant strand of Bm may be understood as a Newtonian science, whereas CCM may be characterised as a “non-Newtonian” or “postNewtonian science. Wuxing is a metaphysical/cosmological concept central to CCM. Hence, it constitutes the identity of CCM. 4. Wuxing, however, is so indissolubly linked to Yinyang that it is best to combine the two as Yinyang-Wuxing. Hence, to retire Wuxing is tantamount to retiring Yinyang, as Wuxing constitutes the identity of CCM as much as Yinyang does. 5. Wuxing is also indispensable if the medicine is to operate at all properly in diagnosing illnesses by determining the patient’s zhèng which, in turn, also determines the fang/or other appropriate medical treatment, as shengli-bingli-yili constitute a Whole. 6. Without Yinyang-Wuxing, CCM would have to give up its distinctive and unique methodological claim that it could in principle cope with any illness, the “cause” of which (as used in Bm) is not even known. 7. It seems fair to conclude that the exponents of AWT are mistaken and those of PWT are correct. 8. It has been shown that, in respect of neither CGH nor CTH, is CCM guilty of introducing irrational/non-rational considerations. 9. Furthermore, should one be so inclined, it is possible to cast the relationship between Wuxing as a general hypothesis and its general conclusion, and between Wuxing as a specific sub hypothesis and its

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specific conclusion, in terms of the standard H-DM in the philosophy of science. There appears to be no inherent obstacle to this procedure. This holds in general for hypotheses in CCM, such as those looked at, in some detail in this chapter, regarding the dominant role played by the Kidneys in bone formation/repair or in the emergence of premature white hair.

CHAPTER FOUR CHINESE CLASSICAL MEDICINE: ECOSYSTEM SCIENCE/SCIENCE

Introduction The scope of this chapter is as follows: (a) Examine CCM as Ecosystem Science. Lee 2017a, Chapter Ten has set out and examined, in general, a cluster of concepts, namely, ecology, ecosystem, and ecosystem science (both in the narrower as well as its extended meaning) under Wholism/Wholism. (b) Present CCM as Preventive Medicine, in the broader meaning of that term (what may be called primary prevention). (c) Indicate the similarities as well as the differences between CCM as Ecosystem Science as well as through its concept of yang sheng/ޫ ⭏ with the explanatory model of Epidemiology in Bm and the notion of Preventive Medicine that Bm implies.

CCM, Wholism and Ecosystem Science/Science It suffices here, only to remind the reader what Wholism, in a nutshell, amounts to. It is essentially a form of Ecosystem Thinking; in this context, it encompasses the following elements. 1. It is opposed to Reductionism, which is the philosophy behind the Newtonian sciences and, hence, of Bm (see Lee 2012b, Chapters Four, Five, Six, Seven, and Twelve for an account including an important exception, which is Epidemiology, which is discussed later). 2. While Reductionism maintains that the whole is no more than the sum of its parts, and that there is only upward causation, Wholism/Wholism holds that the Whole/Whole is different from the sum of its parts, and that there is not only upward, but also downward causation (or more accurately,

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systemic causation) as well as the emergence of new properties pertaining to Wholes/Wholes (Lee 2017a, Chapter Ten). 3. Its causal model is non-linear and multifactorial, while the model, which underpins the monogenic conception of disease in Bm, is linear and, necessarily, monofactorial (Lee 2012b). 4. The causal relationships between parts of a Whole/Whole as well as Wholes/Wholes are therefore reciprocal in character (with negative and positive feed-back loops as well as synergistic effects1). That is to say, the causal arrow operates in both directions between any two or more items in an explanatory schema. The simplest way to illustrate some of these theses is via Figure 4.1, which shows ten concentric circles, with one nesting within the other. CCM is not interested in circle 1 but in the remaining nine circles marked 2-10. These circles may be called Ecosystems. Take Ecosystem 3: it is about the relationship between the yin organ and the yang organ, such that each visceral organ-system/Zangfu/㜿㞁 has a yin as well as a yang component. For example, the Spleen (yin) pairs with the Stomach (yang) as piwei/㝮㛳, the Heart (yin) with the Small Intestines (yang), the Lungs (yin) with the Large Intestines (yang), the Liver (yin) with the Gallbladder (yang), and the Kidneys (yin) with the Bladder (yang). This Ecosystem is then an instantiation in CCM of 1

Increasingly, certain areas of Bm are moving towards an analogue of the CCM model of causation. For instance, in pharmacological testing, some researchers have found amazing results, when they departed from the axiom of one drug at a time, these being the outcome of synergistic effects (see “Results of the Cancer Research UK-funded Trial” 2016). 257 women with HER2 positive breast cancer were randomised initially to receive either trastuzamab (the generic name for Herceptin), or lapatinib or no treatment. Halfway through the trial, the design was altered so that additional participants were allocated to the lapatinib group but were also given trastuzumab. Of those participants receiving both, after eleven days of treatment, 17% had minimal residual disease, 11% had no biological sign of an invasive tumour in the breast. Of those treated with trastuzumab only 3% had residual disease or complete response. Normally, women with HER2 breast cancer will be treated with surgery, chemotherapy, endocrine therapy and targeted antiHER2 drugs. Such treatments are effective but complete response is common only after three to four months, not eleven days. In the UK, trastuzumab has been available in the NHS since 2006, but lapatinib is not routinely available owing to its cost. (See Chapter Seven where this trial is used as an example of Personalized/Precision Medicine in Bm.)

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Yinyang Wholism, a fundamental Wholism. As already observed, the yin organ is called Zang/㜿, and the yang organ Fu/㞁. Together, they are often called Wuzang-liufu/ӄ㜿‫ޝ‬㞁. It suffices here to point out that in Chinese numerology, wu/five, being an odd number, is yang in character, while liu/six, being an even number, is yin in character; therefore they also form part of Yinyang Wholism as Ecosystem 3. According to the Suwen (Neijing), Chapter 11/lj㍐䰞·ӄ㜿/㯿࡛䇪NJ, the difference between Zang and Fu is briefly explained as follows: 㛳བྷ㛐ሿ㛐й❖㞰㜡DŽDŽDŽ᭵ᴠ˖ᇎ㘼н┑ˈ ┑㘼нᇎ ҏ

Rendered as: The Stomach, the Large and Small Intestines, the Sanjiao/й❖/Triple Burners, and the Bladder are generated by the qi of Heaven, which flows unceasingly, and like that qi, the function of these yang organs (Fu) is to discharge regularly and not to retain. They receive the turbid qi from Wuzang/the five yin organs, and are the quarters for administrating the progress of the contents from the food and water ingested in their successive stages through the digestive system. They first extract from them the essential qi/goodness to send on to the yin organs/Zang. They must not store the rest of the contents (that is, the dross, in contrast, to the essential goodness already extracted) for a prolonged period of time–the rectum/anus, said to be the sixth yang organ, assists in the process of expelling such waste products from the body. (In other words, they are the hollow organs for digestion and elimination.) To store is against the nature of these yang organs (as storing would lead to illness). On the other hand, the five Zang/yin visceral organs store the essential qi/jingqi/㋮≄, which they do not discharge–they can be full but not over-supplied. The Liufu transform (food, by digesting it), and transmit (the digested content), but do not store it; hence, they can be over-supplied but not full. Food and water enter the mouth, then the Stomach, which is over-supplied, but the Intestines are not (being empty). As the food passes further on (in the digestive system), the Intestines (in turn) become over-supplied, while the Stomach is not (as it has now emptied its content). (All in all) that is why it is said that the Liufu may be over-supplied but never full, and the Wuzang are full but never over-supplied.

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Figure 4.1: Ecosystem-nesting in terms of concentric circles 1 Cell; 2 Tissue; 3 Organ-system, such as the Spleen-stomach/㝮㛳 organ-system; 4 All visceral organ-systems (Wuzang-liufu/ӄ㜿‫ޝ‬㞁); 5 Entire material parts and total functioning of the person including emotions; 6 Qi in yuzhou (Macrocosm) as well as the Jingmai via the Jingluo network of the person-body (Microcosm); 7 Immediate external environment, in which a person lives (air, water, food, shelter, climate….); 8 Social/cultural environment (tribes/ethnic groups/polity); 9 Larger physical/social environment, in which a person lives (plants/animals/rivers); 10 Cosmological environment, in which a person lives (Sun/Moon/Earth….).

It would be wise to warn the reader straight away that this way of presenting ecosystem-nesting in terms of concentric circles should not be interpreted as saying that CCM is interested only in structure (that is anatomy). Far from this being the case, one of the burdens of this work is, indeed, to demonstrate that the fundamental focus of CCM is not so much on structure (as Bm is: see Lee 2012b), but on the functions performed by each Ecosystem, so to speak, and of the functioning inter-relationships

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between all these Ecosystems, in which the person-body may be said to participate. In other words, the emphasis is on physiology, not anatomy. However, it would not be in keeping with Chinese thinking to say that anatomy and physiology are mutually exclusive; Contextual-dyadic Thinking includes both, although it remains true that physiology is primus inter pares in respect of anatomy (see Chapter Nine for more details). Ecosystem 4 is probably best grasped via the concept of YinyangWuxing. (A detailed exposition of this in Chinese philosophy, in general, has been given in Lee 2017a, Chapter Seven.) Wuxing raises many issues, some of which have been considered to be controversial in the history of Chinese philosophy and medicine today (this aspect has already been scrutinised in Chapters Two and Three). However, it is undeniable that it plays a key role in CCM. This can be seen from Table 4.1. The right-hand side of the chart, that is, of Wuxing in the person-body, shows the following relationships: (a) Which Zangfu is related to which phase of Wuxing (for example, the Liver & Gallbladder organ-system is associated with the Wood phase). (b) The eyes are the sensory organ. They are the “opening” of the Liver & Gallbladder organ-system, governing the tendons/sinews. (c) The emotion associated with the Liver is anger. (d) Its vocalisation takes the form of sighing. (e) Its associated taste is sour. In other words, it is clear at a glance that from the diagnostic as well as the therapeutic standpoints of CCM, a patient’s condition can only be fully understood by a minimal grasp of the relationships listed above.

Green

Red

Sour

Bitter

White

Gatheringin/harvesting Black Storing

Transforming

Cold

Dry

High Earth Summer

Lungs

Spleen

Heart

Liver

North Winter Water Kidneys

West Autumn Metal

Damp Centre

Being born, Wind East Spring Wood coming to life Growing Summer and South Summer Fire Heat developing

Five processes Five Five Five yin Five Wuxing of qi trans- types of directvisceral seasons formation qi ions organs

Table 4.1: Wuxing in terms of Tianren-xiangying

Salty

Pungent

*Sweet (not to be confused Yellow with sugarsweet)

Five colours

Five flavours

The Environment Embedding the Person

85

Large Intestines Bladder

Ears

Nose

Mouth

Tongue

Small Intestines

Stomach

Eyes

Gallbladder

Bones

Skin & its hair

Flesh

Blood & its vessels

Shang/ Sadness/ Crying grief ୶ Fear Moaning Yu/㗭

Gong/ ᇛ

Laughing Zhi/ᗥ

Sighing Jue/䀂

PensiveSinging ness

Joy

Tendons/sinews Anger

The Human Being/Person Five sense Five yang Five Five organs Five visceral Five tissues vocalisa- musical & emotions organs tions notes their openings

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86 Wuxing Five yin organs Presiding functions

Five hua ॾ /splendours Five liquids

Wood Liver

Fire Heart

Earth Spleen

Metal Lungs

Water Kidneys

Stores blood. Dispersing & discharging

Governs blood.

Governs qi. Propagating (clear qi) upwards & descending (turbid qi).

Accepting qi. Generating marrow. In charge of reproduction.

Nails

Face (complexion)

Upholds the four limbs. In charge of transporting and transforming. In command of blood. Lips

Body hair

Hair (on head)

Tears

Sweat

Saliva

Nasal mucus

Spit

Table 4.2: Details of Wuxing in terms of the respective functions of Wuzang

Let us look at just one case to see how the relationships are worked out and invoked in the clinical context. As the patient walks through the doors of the clinic, the physician may immediately observe that his/her hair is already white or predominantly white, which does not seem to be in consonance with the perceived chronological age of the person. In other words, there may be a discrepancy between the chronological age and the biological age. What thoughts would immediately run through the physician’s mind? What is called up initially is something equivalent to Table 4.1ˈ although, as we shall see, such a chart is too simplistic and has to be supplemented by Table 4.2. From these observations, the physician would infer that the Kidneys are not functioning properly, as they are involved with maintaining the condition of the hair. (Today, this brings out a limitation of the technique of looking at female patients, as women, in particular those with premature white hair, tend to dye their hair. As a result, in this kind of situation, the looking technique becomes unreliable and the physician’s feeling the mai is fundamental to ascertaining whether the patient’s Kidneys are, indeed, deficient.) Hair is said to be the “excess of blood”/㹰ѻ։. Furthermore, hair is the ॾ/hua of the Kidneys (the external “splendour” of the Kidneys/㛮ѻॾ); hair is intimately related to the Spleen-Stomach, the Liver as well as the Kidney organ-systems. As the Liver is the yin visceral organ for storing blood, a good supply of blood ensures that the hair would be suitably nourished; the Spleen is responsible for transporting Qixue to all parts of the person, including the hair; the Kidneys hold the essential qi/㋮≄/jingqi, which conditions hair

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growth and renewal, amongst other functions. In terms of Wuxing, black (see the left side of Table 4.1) is the colour associated with the Kidneys. Hence, if the patient’s hair is not black but white (when it ought to be black, given the age of the person, and so on), if it is dull and lifeless, these should alert the physician to diagnose that the Kidneys are deficient in yangqi/ 䱣 ≄ and/or jingqi/essential qi. 1 Such a physician is not primarily bothered about direct medication to enliven the hair, but about treating the state of those organ-systems involved in generating the present condition of the hair. Only a very average/merely competent physician (who is a xia gong/лᐕ) would treat what CCM calls biao/㺘, the surface condition, while ignoring the root condition, which is ben/ᵜ. In other words, the case above concerning hair shows that there is an intimate connection between four out of the five yin visceral organs– Lungs, Liver, Spleen and Kidneys. Such a diagnosis leads immediately to appropriate treatment, as reflected in the following prescription (containing ten medicinals), which aims at improving and nourishing blood (helping the Liver and the Spleen). These are buyao/㺕㦟 for the affected organs whose improvement, in turn, brings about an improvement in the condition of the hair: 1 㜦೺

Asini Corii Gelatinum

2 ⟏ൠ哴

Radix Rehmanniae Preparata

3 ᖃᖂ 4 㖼⍫

Radix Angelicae Sinensi Rhizoma et Radix Notopterygii

5 ᵘ⬌

Fructus Chaenomelis

6 ᐍ㢾

Rhizoma Ligustici Chuanxiong

7 ⲭ㢽 8 㨏эᆀ 9 ཙ哫 10 ࡦօ俆Ѽ

Radix Paeoniae Alba Semen Cuscutae Rhizoma Gastrodiae Caulis Polygoni Multiflori

1

Processed ass hide glue in capsule form Prepared/cooked Rehmannia root Chinese angelica Notopterygian rhizome & root Common flowering quince fruit Sichuan lovage rhizome Debark peony root Dodder seed Tall Gastrodia tuber (Processed) tuber fleece flower stem

For a quick exposition, see *“Diagnosing illnesses from the state of the hair”, 2015; *Yu and Zheng 2011, 15-16 for an analysis of the prescription.

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Let us next see how this prescription comes to be constructed in terms of the functioning of each of the yin visceral organs and the relationships between them under Wuxing. Medicinal 1 is a key ingredient, as it can promote healthy hair growth as well as nourish blood. Medicinals 2, 3, 6 and 7 are buyao for blood; medicinals 8 and 10 are notable for their properties of nourishing the Kidneys’ essential qi/jingqi; and medicinals 4, 5 and 9 are capable of expelling wind and damp. This prescription would be a relevant one to use for patients who suffer from adverse hair conditions, not only prematurely white hair and dull and lustreless hair, but also hair loss (following an illness), greasy hair, dandruff, baldness (partial and even total), as well as itchy scalp. We need to pause to remind readers that Wuxing is commonly said to have two major modes of interaction between the five kinds of qi, it stands for the Mutually Engendering/xiangsheng/⴨⭏ Cycle and the Mutually Constraining/xiangke/⴨‫ ݻ‬Cycle. The following account and Figure 4.2 are simply meant as a reminder to the reader.

Figure 4.2: The Mutually Engendering and Mutually Constraining Cycles of Wuxing and their associated yin visceral-organs

The Mutually Engendering Cycle (the thicker broken lines and their arrows) runs as follows:

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Water engenders Wood Wood engenders Fire Fire engenders Earth Earth engenders Metal Metal engenders Water (The cycle restarts) The Mutually Constraining Cycle (the thinner unbroken lines and their arrows) runs as follows: Wood constrains Earth Earth constrains Water Water constrains Fire Fire constrains Metal Metal constrains Wood Furthermore, there are also two very important sub modes behind these two main modes, especially in CCM, namely, too much/taiguo/ཚ䗷 and not enough/in time/buji/ н ৺ or buzu/ н 䏣 ) or more simplistically, deficiency on the one hand or excess on the other. We will now look at their therapeutic application in CCM in a case which involves the Engendering Cycle, namely, Earth engendering Metal. This involves a male patient (aged 45 years), who had suffered from tuberculosis (of the lungs) for many years, but had been more or less successfully treated and was cured two years ago. In spite of the good turn in his medical history, he was still very thin, coughed some blood, and had no appetite. It was in this condition that he consulted a physician, who prescribed some buyao for the Spleen. After two weeks of such treatment, his condition improved; after two months, he had put on 7.5 kg. After a further few months, with the medicine he took for his tuberculosis, he was declared fit to return to work.2 TB of the lungs, obviously, is a condition that affects the Lungs. The qi of the Lungs is the qi of the Metal phase of Wuxing. Yet the prescription does not address the Lungs, but the Spleen. Why is this so? This is because the Spleen organ-system includes the Stomach and in CCM, is referred to as piwei/㝮㛳, as earlier observed. Food ingested ends up in the Stomach/wei, where, as we know, it is digested and broken down, then sent on to the Small Intestines. With the help of the Lungs, whose function is that of propagating/ ᇓ ਁ and descending/㚳䱽, the goodness from the food (the clear qi) is sent to the 2

See *Yu and Zheng 2011, 17-18.

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skin and hair, and the rest (the turbid qi) downwards to all the visceral organ-systems/ӄ㜿‫ޝ‬㞁. In Wuxing discourse, this amounts to Earth engendering Metal. In such kinds of chronic illness, especially involving the Lungs, the physician employs the therapeutic strategy of nurturing the Spleen-Stomach which, in turn, nourish and strengthen the Lungs. In other words, to improve the functioning of the Lungs/Metal, one does not treat them directly; instead one fine-tunes the Spleen-Stomach/Earth organ-system directly. When this system is coaxed to function at its best, it can, in turn, nourish/strengthen the Lungs–this is Earth engendering Metal. The next case illustrates the Constraining Cycle deployed in another therapeutic context. It concerns asthmatic patients, who often complain of feeling cold in their back, where the Heart is, and when they encounter the slightest bit of cold, they will start to cough. In CCM terms, this is because such patients harbour “phlegm, which lies low inside them”/Կ Ⱐ, a condition, which normal people do not encounter. This is because the yangqi in the Heart is deficient. For the Lungs to discharge their functions properly–of propagating and descending–they require the Heart to provide them with heat/energy. In the language of Wuxing, the Heart is involved with the qi of Fire, and the Lungs are involved with the qi of Metal. In a healthy person, Fire constrains Metal, but in asthmatic patients, the heat/Fire of the Heart is insufficient to constrain the qi of Metal. In other words, the phlegm, which is cold, cannot be dissolved and hence surfaces, while the Heart lacks sufficient yangqi to warm the person. The correct therapeutic strategy in treating such patients, then, lies in medicinals to increase the yangqi of the Heart, so that the Fire of the Heart can function properly in constraining the qi of the Lungs/Metal; in this way, the Lungs can function properly and not be “dampened” by phlegm, with which they cannot cope in their weakened state. The above diagnosis and treatment are but an entailment of organsystem Wholism, of Ecosystem 3 nesting within Ecosystem 4. Each such organ-system constitutes a Whole; and all such organ-systems constitute a bigger Whole. It follows that in each organ-system, if the yin organ is affected, its yang counterpart may also be affected, and vice versa. If one visceral organ-system is affected, it is likely that, sooner or later, another organ-system will also be affected, as all members of this greater Whole are governed by Yinyang-Wuxing. This, in turn, must be understood in two different contexts. The first is that, which obtains in the normal personbody, whose Wuzang-liufu is functioning properly. Here, Wuxing functions under the Engendering and the Constraining Cycles as shown in Figure 4.2. When the Wuzang-liufu is malfunctioning in the person-body

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of a patient, then two other significant modes come into play, the Mutually Insulting Cycle/ ⴨ ‫ מ‬/Xiangwu 3 (Figure 4.3) and the Mutually Overconstraining Cycle/ ⴨ ҈ /Xiangcheng (Figure 4.4). These two modes emerge because of changes in the person-body, which distort the Mutually Constraining Cycle. The Xiangwu/Insulting Cycle reverses the relationship between the two parties in the Mutually Constraining Cycle in such a way that the party which normally constrains becomes the party to be constrained; mutatis mutandis, that which is normally constrained now becomes the party, which constrains. An example would be a case when the Liver/Wood organ, instead of constraining the Spleen/Earth organ, is now constrained by it. (Note that the causal arrows are the reverse of those in Figure 4.2.) The Xiangcheng Cycle relates to the distortion of the Mutually Constraining Cycle, by amplifying the strength of the relationship between the party, which constrains, and that which is constrained; hence, this is a case of the Mutually Over-constraining Cycle. It may appear under two guises: (a) For instance, if Wood is too strong, then this would result in overconstraining Earth, resulting in Earth being deficient–this is Wood over-constraining Earth/ᵘ҈൏. (b) If Earth is weak, this would result in Wood over-constraining Earth, thereby leading to Earth being even more deficient–this is Earth being deficient with Wood over-constraining it/൏㲊ᵘ҈. (Note that its difference from the Mutually Constraining Cycle is marked in Figure 4.4 by the exaggerated thickness of the causal arrows.)

3

For a discussion when applied outside the context of CCM, see Lee 2017a, Chapter Seven.

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Figure 4.3: The Xiangwu/Mutually Insulting Mode of Wuxing

Figure 4.4: The Xiangcheng/Mutually Over-constraining Mode of Wuxing

No illness remains static; it develops and evolves. Let us see how such developments can affect a person-body in complicated ways under both the Over-constraining and Insulting Modes. Imagine an illness which begins with the Liver/Wood organ-system; it can go on to affect that of the Spleen/Earth organ-system, when its qi is in excess. This would be a case of the Liver over-constraining the Spleen. However, this illness may

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evolve to affect the Lungs/Metal organ-system when the qi of the Liver/Wood organ-system is in excess. This, then, would be an instance of the Liver/Wood insulting the Lungs/Metal, instantiating the Mutually Insulting Mode. An illness, beginning with the Liver/Wood organ-system, could move on to the Heart/Fire organ-system. An example would be one where the Mother’s illness affects the Child/⇽⯵৺ᆀ, as Wood (analogously the Mother) engenders Fire (analogously the Child). The illness affecting the Liver could affect the Kidneys/Water organ–this would be an instance of “the Child stealing the qi of the Mother”/ᆀⴇ⇽≄. This may be spelt out a little more as follows. First, in respect of the relation between Water/Mother and Wood/Child, if the qi of Water is deficient, this would affect its ability to engender Wood, thus constituting a case of the Deficient Mother adversely affecting the Child/⇽㲊㍟ᆀ/mu xu lei zi. If the qi of Wood is excessive, this would exhaust needlessly the qi of Water, thus constituting a case of the Child purloining the qi of the Mother/ᆀⴇ⇽≄. If illness begins in the Zang of the Mother, this illness would induce illness in the Zang of the Child. For instance, if the yin of the Kidneys is deficient, this would mean that the Kidneys/Water/Mother set of relationships cannot nourish the qi of the Liver/Wood, thereby constituting a case of yin deficiency in both the Kidneys and the Liver. As a result, yin cannot control yang, leading to an excess of Liver yang/≤ᆀ н⏥ᵘ/shui zi bu han mu, and Water/Kidneys (Mother) would cause the Liver (Child) to be unable to contain the qi of Wood. If illness occurs in the Zang of the Child, this illness would induce illness in the Zang of the Mother–for instance, if the blood of the Heart is insufficient, this would damage the blood of the Liver, thereby constituting a case of blood deficiency in both the Heart and the Liver (ᆀⴇ⇽≄ zi dao mu qi/the Child robbing the Mother of her qi). Understanding this set of possible relationships in the evolution of an illness within the Wuzang-liufu framework helps the physician to consider different possible treatments for the patient. For instance, clinical experience has this nostrum: 㿱㛍ѻ⯵ˈ ⸕㛍Ր㝮ˈᖃ‫ݸ‬ᇎ㝮

Rendered as: When the Liver is diagnosed as the site of the illness, the (experienced) physician anticipates that the illness would move to the Spleen, hence, it makes sense to treat the Spleen straight away by strengthening it.

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This nostrum is based on the Mutually Over-constraining Mode under which, the excess control, exercised by the Liver, would undermine the functioning of the Spleen (ᵘ҈൏/㛍҈㝮) which, in turn, leaves this organ vulnerable to the illness moving in to attack it. Ecosystem 5 will be left aside here, as it is dealt with in depth in Chapter Six. Ecosystem 6, in general, has been dealt with in Lee 2017a, Chapters Two (under Tianren-xiangying) and Ten (under Macro-Microcosmic Wholism). It is also analysed in Chapter Ten in this volume which investigates the operation of Qi in both the Macrocosm/Greater “Nature” and the Microcosm/the human being. Suffice it here to say a few words about how CCM, through the Neijing, perceives the relationship between the Macrocosm and the Microcosm. Before we do so, let the reader be reminded of what has been highlighted in Lee 2017a, Chapter Four: namely, that CCM, following the Laozi, Chapter 25 rests on the following dictum: Humankind follows Earth, Earth follows Heaven, Heaven follows Dao, and Dao follows Ziran.

This is Daoist philosophy/Daojia in a nutshell. At every level, including the most basic, CCM holds that parts of the human being are what they are because they correlate with or correspond to parts of Greater “Nature”. Table 4.1 shows that each of the five yin organs is paired with each of the five sensory organs, and that each of these sensory organs has “openings”, namely, eyes, tongue, mouth, nose, and ears. The word/character in Chinese for “opening” is ソ/qiao.4 Note that its top component has the character イ , which donates meaning, while the bottom component donates sound to the word. According to the Han dynasty dictionary of Xu Shen/䇨᝾, Shuowen jiezi/lj䈤᮷䀓ᆇNJ, ソ/qiao means イ which, in turn, means “empty space” or “cavity”. In the Classic of Rites/lj⽬·⽬ 䘀NJ (one of the five canons of Confucian thought), one reads˖ൠެ䱤ˈソҾ ኡᐍ which refers to what are commonly called “caves” in mountains. What could be the use/function of such qiao/caves? They act as the thoroughfare of Qi. (Readers are again reminded that Qi is the fundamental ontological category in Chinese philosophy/cosmology.) In terms of Yinyang, yinqi pertains to Di/Earth while yangqi pertains to Tian/Heaven. Although Di stores but does not eliminate/ 㯿 㘼 н ⌫ , nevertheless, yinqi must meet with yangqi of Tian, as existence is predicated on Yinyang, not on yin or yang in isolation from each other. 4

The analysis given here follows closely *Liu Lihong 2003, 296-300.

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Hence, Di has caves/cavities for this encounter of qi. The five Zang are the yin organs; their yinqi also needs to encounter the yangqi in the larger environment (ultimately in Greater “Nature”). Hence, their openings (as sensory organs) are the counterpart of caves–their respective functions are identical, to enable Yinyang to operate. This piece of cosmological reasoning also explains why the Liufu (of Wuzang-liufu), namely, the Gallbladder, the Small Intestines, the Stomach, the Large Intestines, and the Bladder do not have openings. This is because they are yang organs; their qi is yangqi, which pertains to Tian. As such, the Liufu eliminate and do not retain or store/⌫ 㘼н㯿. Tian is entirely open (Qiin-dissipating mode), not bounded as Di is (which is Qi-in-concentrating mode as thing), and so has no need for openings/caves.5 As a matter of fact, the person-body of the individual does not only have five openings, but nine altogether. Their location and arithmetic are as follows: two ears, two eyes, two nostrils, one mouth, one urinary outlet, and one faecal outlet (anus). Some are in pairs, others are single. There are three pairs and three singles; the former are above the latter (the ears, eyes and nostrils are above the mouth and the excretory outlets). The ones in pairs, remarkably, can be represented by the yin yao (- -) and the singles by the yang yao (ņ). Three yin yaos stacked one upon the other make up the Kun/ඔ trigram, while three yang yaos stacked up one upon the other make up the Qian/Ү trigram. When the Kun trigram is stacked above the Qian trigram, this makes the hexagram called Tai, and this is auspicious, as will be explained in Chapter Five. If the position of the two hexagrams were inverted (making up the Pi gua), this would be highly inauspicious, as human existence cannot be guaranteed if yinqi cannot descend and yangqi cannot ascend to meet each other. And where does yinqi/Diqi and yangqi/Tianqi meet in the person-body of the individual? In the renzhong/Ӫѝ on the face; in English, it is the philtrum or medial cleft (the vertical groove between the base of the nose and the border of the upper lip). In Bm, this place holds no great significance except that surgery must be performed on those who suffer from cleft palate/harelip. Orthodontics is also interested in this anatomical abnormality. In CCM, the renzhong is extremely significant as it is where the Yinyang encounter takes place, where Di meets Tian, and where humans are between Tian and Di, which is the literal meaning of the term renzhong. It is, therefore, a site of great cosmological/philosophical 5

However, this simplified and simplistic account necessarily has to overlook an important difference between the opening of the Heart (the tongue) and the other four openings (see *Liu Lihong 2003, 297 for further discussion).

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significance. From the point of view of CCM, the renzhong takes the following meanings: (a) Tian has five different kinds of “flavours” of Qi (Qi-in-dissipating mode), namely, dry, burnt, fragrant, “smelling of blood” and putrifying. The first enters the Lungs, the second the Heart, the third the Spleen, the fourth the Lungs and the fifth the Kidneys. These enter through the nose and are lodged (initially) in the Heart and the Lungs. (b) Di has five different kinds of tastes/flavours, as shown in Table 4.1. These enter (in foods) through the mouth and are lodged in the Stomach. (c) Hence, the nose and the mouth are two very important locations in the person-body, as they respectively stand for Tian and Di–the qi of Tian entering through the nose and the qi of Di entering through the mouth meet in the person-body. That is why the Neijing/Suwen, Chapter 25/ lj ㍐ 䰞 · ᇍ ભ ‫ ޘ‬ᖒ 䇪 NJ says ˖ Ӫ ԕ ཙ ൠ ѻ ≄ ⭏ , rendered as: “Human beings are engendered by Tianqi and Diqi acting in concert”. (d) We have earlier mentioned that the renzhong is the location where in the human Microcosm, yinqi encounters yangqi, which guarantees human existence. The Suwen, Chapter 68/lj㍐䰞·‫ޝ‬ᗞ ᰘ བྷ䇪NJsays: ዀ՟ ᴠ˖䀰ཙ㘵≲ѻᵜDŽDŽDŽз⢙⭡ѻˈ ↔ѻ 䉃ҏ

Rendered as: Qibo responds: “Discoursing Tian means talking about the primary or root aspect (of qi, namely, about the qi pertaining to cold, heat, dryness, dampness, wind and fire). Discoursing Di means talking about the locations (of qi in terms of the qi of Wood, Fire, Earth, Metal and Water). Discoursing humankind is talking about the exchange of qi.” The Yellow Emperor wants to know more about this “exchange of qi”. Qibo replies: “It is about the relative positions of Tianqi/yangqi above, of Diqi/yinqi below, and where these two meet is the space occupied by humans. That is why one says: above that space is the zone dominated by Tianqi, below that space is the zone occupied by Diqi, and the middle zone is occupied by the qi which engenders humans and Wanwu.” (Texts within round brackets are the author’s interpolations.)

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(e) This cosmological account, in turn, explains the function of the renzhong as the exterior/visible passage for the interior/non-visible encounter of yinqi and yangqi in the human individual. As Chapter Five will explain, CCM holds that from the exterior one could infer to the interior–as demonstrated even by the title of Chapter 45 of the Lingshu/lj⚥᷒·ཆᨓ NJwhich may be rendered as “Inferring from the exterior to the interior”. (f) The renzhong, therefore, is not simply a site of cosmological/ philosophical significance, but it is also an important site of treatment precisely because of that cosmological/philosophical significance. In general, the Chinese public knows what to do should someone in their midst faint and lose consciousness. They would immediately pinch the renzhong. Upon doing this, the patient would regain consciousness, as the pinching would clear the blockage in the encounter space of Tianqi/yangqi with Diqi/yinqi so that human existence could continue and not be endangered. (g) Furthermore, the characteristics of the individual person’s renzhong are indications of the state of her health and life span. A deep, long and broad groove indicates (in general) good health and longevity; a shallow, short and narrow groove indicates weak health and a shorter life. In the case of an individual born with such unfavourable characteristics, CCM says that her prenatal endowment is deficient ( ‫ ݸ‬ཙ н 䏣 /xiantian buzu). This is analogous to someone being born with a certain genetic drawback. The CCM physician simply looks at the renzhong to ascertain the health prospects of the individual, unlike the doctor in Bm who relies, in the main, on high-tech to access genes and DNA sequences, to ascertain health prospects. However, as indicated below (and also commented upon briefly in Chapter Five), this is not to say that xiantian deficiency cannot be remedied, to some extent, by ਾཙ/houtian/post-natal activities and practices, such as adopting the right diet and choosing the right lifestyle, through the discipline of ޫ⭏/yangsheng/or ޫ䓛/yangshen. (h) The account given of the renzhong by CCM encapsulates neatly the concept of Tianren-xiangying. Ecosystems 7, 8 and 9 are commented upon together under the rubric of the immediate external environment of the individual, including the physical as well as the cultural/social environments. This need not detain us for long as once we have grasped the ecosystem as a model with explanatory power, we would see that CCM is nothing but such

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Ecosystem Thinking at work. Take the physical surroundings of any organism: to thrive, the organism must have clean air, clean water, suitable nutrients, the right climate (whether macro or micro), and appropriate shelter. In other words, it must occupy the right habitat. It further requires that such a habitat does not have predators on such an excessive scale as to threaten its survival, both individually and as a species/subspecies/variety. (For details, on these points above, see Lee 2017a, Chapters Seven and Ten and Lee 2012a). It follows that for the human being to thrive and flourish, there must be access to adequate/appropriate food, water, clothing, shelter, air, and so on, or the individual would not develop properly, but will fall ill with parts of the Wuzang-liufu malfunctioning. This much is obvious. It may be more relevant to focus on the social/cultural environment in which the individual is situated. Although this aspect is not relevant to a discussion of plants as organisms, it is highly relevant to a discussion of some of the higher animals which include, not merely, the large mammals, but also birds. The elephant, for instance, is a highly organised social animal, with the female playing a leading role in the family hierarchy. When rewilding a bird such as the condor (in California, USA), those in charge must bear in mind that a bird conceived, born and brought up in a zoo would have no idea of how to behave in the wild, unlike its counterpart in Nature, which would have learned from its mother and other members of the flock, how to hunt, how to avoid predators, and so on; in short, how to survive. The zoo condor would have to be taught, through various means, to learn all these skills. (For a discussion on these points just noted, see Lee 2006.) In the case of human individuals, it is more obvious that socialisation and acculturation are part and parcel of bringing up a child to become an adult, whose personality and behaviour could, in the end, be said to be mature, reasonable and acceptable to the community, of which the person is a member. The individual is nested within several communities of which the family forms the innermost nest, followed by the clan/tribe/society and state at large. CCM understands these nested relations to be necessarily value-laden (see Lee 2017a, Chapter Eleven); hence, for CCM, the Yinyang balance in the individual person is necessarily a balance which also incorporates the values of the larger social/cultural Whole, of which the individual is a member. It follows that illness is necessarily psychosomatic in character. (This theme is covered under Ecosystem 5 and in greater detail in Chapter Six; thus there is no need for elaboration here.)

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Lee 2017a, Chapter Ten has compared the similarities in reasoning between CCM on these points and Epidemiological Reasoning in Bm, citing in particular the famous study between lung cancer and smoking, undertaken by Bradford Hill and Richard Doll (for more details on this, see Lee 2012b, Chapter Twelve). Both studies emphasise that the Epidemiological model of disease subscribes to a notion of cause, which is multifactorial and non-linear. Clearly CCM, under Yinyang-Wuxing, also subscribes to such a notion of causality which, in turn, is a clear indication that CCM is Wholist in character and is also an instantiation of Ecosystem Science at the same time. Ecosystem 9 draws attention to the fact that human communities are necessarily embedded in Greater “Nature”/the Macrocosm, sharing the same environment with other species and non-biotic items, forming one big ecological Whole/Whole. The Daojia dictum (earlier cited) is loud testimony to CCM as Ecosystem Science. Ecosystem 10 is but a further extension of Ecosystem 9, and other smaller Ecosystems nesting within it. In CCM thinking, this constitutes a very important level of understanding illness. Chapter Five will draw attention to how a Laozhongyi (a physician with a distinguished clinical track record) is able to attend minimally to a hundred and fifty patients on an average day. This particular shang gong/ к ᐕ /excellent physician achieves this feat using the technique of wangse/ᵋ㢢 (looking at the complexion) while at the same time relying on his superb knowledge of changes in the Qi cycle in Greater Nature, which has a counterpart in the qi cycle of the human being, in the course of any one year within a sixtyyear cycle/ӄ 䘀‫≄ޝ‬/Wuyun-liuqi. This knowledge is referred to in a passage in the Suwen, Chapter 9; in short, in CCM literature this concept is called ᒤѻᡰ࣐/nianzhisuojia.6 It is possible to sum up the discussion via Figure 4.5.

6

This is not an easy aspect of CCM to master and given the limited space here, it is not feasible to set out clearly in outline its most important features. For those who read Chinese and want a quick account, see *Liu Lihong 2003, 129-131, 155156, 222-223; “Nianzhisuojia” 2015.

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Figure 4.5: The Liangyitaijitu meshes with the trigrams

The grid in Figure 4.5 resembles the Chinese word for Ӆ /well, superimposed on the Liangyitaijitu; creating the nine “houses”/sectors composed of the eight trigrams plus the centre, which is Di/Earth; 1=Kan; 2=Kun; 3=Zhen; 4=Xun; 5=Di; 6=Qian; 8=Gen; 9=Li. This analysis, together with earlier comments, entails the following claims. 1. CCM is distinctly Wholist in orientation; as such it is anti-reductionist. To use a common English expression, that it is distinctly Wholist is lettered through and through. 2. Yinyang-Wuxing is a crucial concept in CCM’s understanding of the relationships between the Yinyang visceral organ-systems/Wuzang-liufu. Also, how the malfunctioning of one can affect the proper functioning of another; and how the proper functioning of one can promote the wellfunctioning of another. 3. Wuxing is, par excellence, an instantiation of Ecosystem Thinking. 4. CCM may be understood as a nest of ecosystems, the smaller nesting within the larger, such that Ecosystem 3, the (individual) organ-system, nests within Ecosystem 4 (all the organ-systems are collectively the Wuzang-liufu). This nesting progresses until they all nest within the largest, that is, Ecosystem 10, which constitutes all within our Solar System, including our Sun, the other planets and other heavenly bodies, creating a TimeSpace framework, in which health and illness can be understood and explained.

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5. This comprehensiveness of the ecosystem is summed up by the following dictum: аѪཚᶱˈа࠶ѪҼѪєԚ˄䱤䱣˅ˈа࠶ѪйѪй᡽ˈа࠶ѪഋѪ ഋ䊑ˈа࠶ѪӄѪӄ㹼ˈа࠶Ѫ‫ޝ‬Ѫ‫ޝ‬ਸˈа࠶ѪгѪгᱏˈа࠶Ѫ ‫ޛ‬Ѫ‫ޛ‬খˈа࠶ѪҍѪҍᇛ

Rendered as: One is Taiji; One divided into two is yin and yang; One divided into three is sancai/й᡽ (Heaven above, Earth below and Humankind in the middle); One divided into four is sixiang (taiyang, shaoyang, taiyin, shaoyin)˗7 One divided into five is Wuxing; One divided into six is ᡻䏣й䱤й䱣 /shouzu san yin san yang (the six main Jingmai, three pertaining to the hand and three to the foot8); One divided into seven is the asterism (Ursa Major/Great Dipper) consisting of seven stars;9 One divided into eight is the trigrams; One divided into nine is the nine “houses”, an astronomical concept for studying the movement of the stars in the Ursa Major and in other constellations.

(Texts within round brackets are the author’s interpolations.) In other words, one can say that, in the end, everything in the universe may be traced back to Taiji or Wuji referred to as One, represented as an empty circle (see Lee 2017a, Figure 6.6). Taiji/Wuji, therefore, stands for the ultimate, all-encompassing kind of Wholism in Chinese culture and civilisation and hence, in CCM. (In the light of what is said about the Dao in Lee 2017a, Chapter Four, and about the shang gong later in Chapter Five in this volume, the Dao, like Taiji, is also One.)

Preventive Medicine (Primary Meaning) in the context of CCM as Ecosystem Thinking This section explores the meaning of Preventive Medicine in the broader or primary sense, while Chapter Five will examine the narrower or secondary meaning of the concept in CCM. The section above, en passant, 7

See Lee 2017a, Chapter Six. These are (1) Foot-taiyang and Foot-shaoyin, (2) Foot-shaoyang and Foot-jueyin, (3) Foot-yangming and Foot-taiyang, (4) Hand-taiyang and Hand-shaoyin, (5) Hand-shaoyang and Hand-jueyin, (6) Hand-yangming and Hand-taiyin. 9 See Lee 2017a, Chapter Four. 8

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has already referred to the shang gong’s ability to diagnose from the complexion, that is, from the standpoint of Qi-in-dissipating mode, operating in the domain of xingerxia as well as to anticipate the evolution and development of that incipient illness. However, with regard to the primary meaning of the notion, one is talking about a stage that precedes even the context of the shang gong at work. Here, the focus is on the larger framework in which we, as human beings, ought to live should we wish to promote health, and to avoid the onset of illness as much as it is possible to do so. In today’s fashionable language, found in the West, this has to do with “lifestyle” options. In the language of the Neijing, it is to do with respecting the Laws of Nature (such as the zhouye jielü/ᱬཌ㢲ᖻ and the sishi jielü/ഋᰦ㢲ᖻ/), as these laws underpin shengli/⭏⨶/principles of physiology and bingli/⯵⨶/principles, underlying the emergence and development of illness. To grasp this last point, one must bear in mind that in CCM, health and ill-health are two sides of the same coin. Chapter Nine shows that physiology is the basic science. For CCM, physiology/shengli is about the harmonious balance of yinqi and yangqi in the human being; it is this balance which is the condition of good health. When that balance is upset, the Wuzang-liufu would malfunction, and it is this malfunctioning that generates illnesses or ill health in general (bingli). In the light of these remarks, it is small wonder that the Neijing kicks off in Chapter 1 of the Suwen/lj㍐䰞· кਔཙⵏ䇪NJwith the following exchange between the Yellow Emperor and Qibo (the Daojia master): ։ 䰫кਔѻӪ DŽDŽDŽ᭵ॺⲮ㘼㺠ҏ

Rendered as: (The Yellow Emperor) remarks: “I have heard that in ancient times people lived to a hundred years without showing a common sign of aging, such as moving about slowly. In contrast, today, people even half that age, show signs of slowing down. Is this difference due to environmental changes or is it because we have lost the way of living properly?” Qibo responds: “People in ancient times knew and practised the Dao; they acknowledged that the Dao follows Yinyang, and understood the changes and transformations between yinqi and yangqi. Furthermore, they carried out certain practices/exercises, which helped the flow of qi. At the same time, they ate properly and regularly; they rose and retired at appropriate hours and engaged in neither too much nor too little physical activities. They managed to maintain a healthy balance, neither stressing their bodies nor their minds. In this way, they could live out a lifespan of a hundred years, before death occurred. Today, people no longer pursue such a lifestyle.

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They imbibe alcohol as if they are drinking up the sauce in their food; they indulge in all sorts of excesses; they have sex when they are drunk, and in this way, they deplete the essential qi of the Kidneys. They do not know that enough is enough, but squander away their vital qi, following the diktat of instant and constant gratification. As a result, they do not keep regular hours of sleep and of rest for recuperation. Is it a wonder then they age prematurely, dying shortly after they reach fifty?”

To some readers, the critique above sounds, indeed, very “modern” and even familiar, as it appears to resonate with what our “health gurus” of today tell us, but alas, to no avail, as far as a substantial majority of the population in advanced economies is concerned. We not only eat too much, but far too much of the wrong foods. We drink too much, consume too much sugar as well as salt, and exercise too little, if at all. Qibo, should he be alive today, could roll out the critique, which he delivered some three thousand years ago, without amending his text in any small way! Lifestyle choices of a kind, which require us to exercise restraint and self-discipline, do not appear to go down too well in any culture/society, at any period of history. Today, there are also some voices which claim that one should not plead to change the nation’s habits of eating and living, as one cannot expect individuals to make heroic efforts to curb themselves. Take obesity, especially in such Western economies/societies as America and the UK. (UK statistics show that 40% of males and 30% of females are overweight, that is, with a Body Mass Index of over 25.) It is true that people do overeat, eat too much meat, or not enough vegetables/fruit; furthermore, they eat “junk food”. Exhorting them to give up such wrong kinds of foods is neither here nor there, as such foods are what is generally available and at a price they can afford, quite apart from the fact that they are “readymade”, thus enabling people to open up a packet, put the contents into the micro-wave oven for the meal to heat up, and then eat it in front of their television set with very little effort, time or energy involved. In this analysis, it is quite correct to conclude that the “industrialised” system of modern food production, if not the whole concept of existence as a sedentary one, must be drastically reformed, if not totally overthrown, if there is to be a reasonably satisfactory solution to the problem. In other words, one is asking for “pie in the sky”, as it involves putting in place Ecosystem Thinking to replace the fragmentary way of looking at the world, which began with Modernity from the seventeenth century onwards. Hence, Bm, in general, eschews such a “backward” radical stance and instead opts for an “advanced” technological solution. When patients become too obese, threatening them with an early demise, the surgeon

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could perform operations such as installing an adjustable gastric band or an intragastric balloon or performing the gastric bypass procedure, which is a combination of reducing the size of the stomach as well as by-passing part of the small intestines (also called stomach stapling). This procedure alters the size of the stomach; as a result, the patient would not be able to eat very much before feeling full. The stomach sends the food it has (partially) digested into the top part of the small intestines; however, by barring access to it, that part of the small intestines would no longer release enzymes for the further digestion of the food. In this way, enzyme activity would be reduced and so would the number of calories absorbed. Furthermore, after such an operation, should the person eat too much sugar, the body would release more insulin (a hormone), which reduces blood sugar levels, making the person light-headed and even queasy. Such sensations would cause the individual to have a feeling of distaste for the wrong types of food, thereby preventing her/him from over-eating such foods. 10 This is the high-tech solution to the problem of obesity in individuals, not a solution, available, naturally, to CCM. CCM sticks to the difficult path of self-discipline and restraint, not a prescription which modern people, in particular, would find congenial. Neither did the people of yore, as Qibo lamented. However, it remains correct to observe that sometimes, Bm could persuade governments to intervene to make certain lifestyle choices less accessible and less appealing. In the case of cigarette smoking causing lung cancer, increasingly, more and more governments are adopting measures to ban smoking in public spaces, although, in general, governments are loath to impose too prohibitive a tax on cigarettes to make people give up the habit through financial constraints, because they are worried that if such a move was to be truly effective, their overall revenue would decrease with lower cigarette sales. Preventive Medicine/Preventive Medicine in its primary meaning, necessarily involves a model of causation, which may be called the Ecosystem model, as alluded to earlier. Other chapters in this volume also point out (briefly) that in Bm today, there is another model of looking at disease and its provenance, which differs radically from the dominant conception of disease (see Lee 2012b, Chapter Eleven for a detailed discussion of the monogenic conception of disease–one disease, one causal agent). This is the Epidemiological model in Bm. Let us here then explore the similarities between it and CCM in its account of Ecosystem Thinking.

10

See “Gastric bypass surgery” 2015.

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They both share a model of causality, which is multifactorial, and where the factors reinforce one other, to produce the illness/disease. We now turn to CCM. Considerable analysis has already been raised earlier; it is sufficient here to emphasise that for CCM, for an illness to occur, an external pathogenic factor/waixie/ཆ䛚 must also meet up with an internal pathogenic condition/neixie/޵䛚. Take a very simple example of someone catching a chill when exposed to cold. The external cold is the waixie. Yet it does not necessarily mean that all other people exposed to the same condition would develop a bad cold. The patient did; this patient nursed such a severe version that he had to be given a prescription. (A prescription usually contains several medicinals whose properties are related to one another in a complex way. This is explored in Chapter Eight.) The prescription, when taken, over more than one day, helps him to get over the cold. Another person only needed to be told to take to his bed, cover himself up suitably, and to expect during the night to sweat profusely, after which, he would find himself as right as rain the next morning. The same waixie may produce three very different outcomes: those who do not succumb in any way (Category 1), those who succumb slightly (Category 2) and those who succumb severely (Category 3). CCM infers that the differences must be accounted for in terms of the absence or presence, as well as the degree of presence of another factor within the individuals themselves in the three categories involved; this other factor is that of neixie. Zhengqi/ ↓ ≄ /“correct”/orthopathic qi and weiqi/ ছ ≄ /protective qi of Category 1 are sufficient to repel the waixie, not giving it any opportunity to proceed from the exterior/biao/㺘 to the interior/li/䟼. (According to CCM, an illness, affecting the interior is more serious than one affecting only the exterior parts of the person-body.) When zhengqi and weiqi are somewhat weak, the waixie penetrates to the interior and causes a relatively milder form of the illness (Category 2). However, when these two sorts of qi are very weak, the waixie marches, as it were, through an open door to the interior, thereby causing a severe form of the illness (Category 3). In the third category, it is a case of what CCM calls neiweixianghe/޵ཆ⴨ਸ. Here, one may borrow a term and concept which are found in the Hanfeizi, namely, neiwei-xiangying/޵ཆ⴨ᓄ, a notion commonly found in military or political discourses. In fighting an enemy, an excellent strategy to pursue is to march sufficient numbers of armed men to the outside of the wall of the enemy’s city to attack it but, well in advance, to secure the help (by any means possible, bribery, blackmail or trickery) of an important official of the enemy, so that when your troops are in place outside, the traitor to his own side would cause the city gates to be opened,

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upon which your troops would just march in and capture the capital city. In that way, the objective could be won under conditions of minimal cost and maximum gain. In other words, the illness (and its degree of severity), that is, the effect, depends on waixie and neixie coexisting and cooperating with each other, acting as the cause.11 This notion of cause, in terms of neiwei-xianghe/޵ཆ⴨ਸ, is therefore multifactorial. Each of the factors involved may be a necessary condition but each on its own is not sufficient to bring about the total observed effect. However, when these factors coexist and co-operate, as it were, their combined forces bring about that effect–we then say that they are, jointly, the necessary and sufficient conditions generating the effect. We next look at the relationship between what is called xiantian and houtian in CCM.12 The former should not be understood as a static entity with which the individual is born, in the way that one’s genes are considered under Bm. Our genes are, indeed, inherited from our parents; however, genetic inheritance does not exhaust the meaning of xiantian in CCM. This concept is much wider than genetics; it includes the entire history of the pre-natal existence of the individual, covering the period from conception to birth. To ensure that the child, eventually to be born, would kick off with a good start, the parents ought not to conceive the child when one, or both, are drunk or drugged. Not only should they be healthy in body, they should also be sound in mind (that they have followed a wholesome diet and lifestyle and their mind should not be over anxious). After conception, the pregnant woman should ensure that her person-body is nourished properly and her mind should remain tranquil– she should not be startled by loud and unusual noises, or be exposed to traumatic situations. Every effort should be made to nourish that which is called, 㛾 ≄ /taiqi/qi of the uterus. After ten lunar months of uterine existence, when the child is born, that child would bear the marks of that whole history of his/her pre-natal evolution and development within the internal Ecosystem of the uterus which is also nested within the larger Ecosystem of her mother which, in turn, is nested in all the other relevant Ecosystems, discussed in the last section. The child’s xiantian would thus 11

Readers should be warned that neiwai-xianghe is not normally quite understood in the way this author is using the term neiwai-xiangying here. Normally it is used to elucidate what, in Chapter Five, the author has called, for want of a better term, the technique of determining, on the part of the physician, the conditions of the workings of the Wuzang-liufu (the Yinyang visceral organ-systems), by inferring from the observable/external signs and symptoms displayed by the patient via the theoretical axioms of CCM. 12 For some earlier discussion, see Lee 2017a, Chapters Five, Seven and Nine.

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include the kind of constitution, in general, s/he would possess, not simply by way of genetic inheritance but also by way of the kind of environment within which s/he had spent those pre-natal months. Preventive Medicine at the level of xiantian would, therefore, require the mother (also the father and the family) to take action on behalf of the foetus, to refrain from taking certain foods/drinks and drugs, and from exposing herself to those sorts of situation deemed to harm the uterine qi/ Ք㛾≄. This kind of Ecosystem perspective with regard to a pre-natal/intrauterine existence had been considered as very “unscientific” from the standpoint of Bm. Lately, a viewpoint that is more like that held by CCM has begun to be accepted (see, for instance, Whitaker and Dietz 1998, Gluckman and Hanson 2004, Perera and Herbstman 2011). The change was initiated by a rather tragic episode in Bm history. In the 1950s, doctors commonly prescribed a drug called thalidomide to pregnant women for their morning sickness. It transpired that this drug caused teratogenic effects, interfering with foetal development, leading to the birth of children with terrible defects: malformed limbs in many instances; deformed alimentary and urinary tracts; blindness and deafness in others. The drug, developed by a West German pharmaceutical company, was originally intended to be a form of mild sleeping pill, judged to be safe for use by pregnant women. However, by the 1960s, some doctors began to be concerned about its side effects. Some patients had developed nerve damage in their limbs as a result of long-term use. The US Food and Drug Administration had not approved the drug for use as the pharmaceutical company had failed to provide convincing clinical evidence to refute claims about these side effects. More seriously, it was noticed that increasingly, women who had taken the drug in their pregnancies to overcome morning sickness gave birth to children with severe defects. However, the causal link with thalidomide was not explicitly established till 1961. By then, over 10,000 affected children had been born worldwide. (For a brief account, see “Thalidomide” 2015.) The crucial thing to grasp, here, is that until the thalidomide tragedy, Bm did not believe that any drug taken by a pregnant woman could pass across the placental barrier, thereby causing harm to the developing foetus.13 This is because, until this tragedy forced Bm to alter its stance, it had simplistically held that the placental barrier is impermeable to substances/chemicals. The tragedy, however, has forced it to move closer to Ecosystem Thinking, which is characteristic of CCM– 13

See Prouillac and Lecoeur 2010; compare with Stacy 1980.

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the uterus-foetus is an ecosystem. An ecosystem is an open, not a closed system, as it necessarily exchanges material as well as energy, or if one prefers the language of information technology, it necessarily exchanges information, with the surrounding ecosystems. In the language of CCM, Qi-in-concentrating mode (as nutrients) as well as Qi-in-dissipating mode enter from the mother’s Ecosystem to the uterine Ecosystem; furthermore, changes in the uterine Ecosystem can also affect the maternal Ecosystem, as in CCM thinking, there is a reciprocal causal relation between two factors, such that the causal arrow looks as follows:

ļ CCM holds that xiantian deficiencies could be overcome, to a greater or lesser extent, with houtian measures. For instance, if one were unfortunately born with deficient Qixue/≄㹰н䏣 (blood and Qi), one could lead a life (if economic/financial circumstances permit), which does not require one, needlessly, to exhaust Qixue, to eat, sleep, rest, exercise appropriately, to supplement/ 㺕 /bu deficient Qixue. Furthermore, in accordance with the Suwen, Chapter 74/lj㍐䰞·㠣 ⵏ㾱བྷ䇪NJ, which reads˖㲊 㘵㺕ѻ/“To treat a condition of deficiency, use the method of bu”, one could take medicine to rectify one’s deficient constitution, so that illness would not overtake its subject. Under the general strategy of bu, one has to distinguish between different types of deficiency, such as qi deficiency/ 㺕 ≄ ⌅ , yang deficiency/㺕䱣⌅, and blood deficiency/㺕㹰⌅. Within these types, one also distinguishes between sub-varieties. Thus in the category of qi deficiency, one addresses deficiency in each of the five yin visceral organs. If the patient is diagnosed as a case of qi deficiency of the Heart, then under the strategy of 㺕ᗳѻ⌅ˈthe physician may prescribe either the ഋ ੋᆀ⊔/Four Gentlemen Decoction or the ‫⊔ݳ؍‬/Original Qi Preserving Decoction; if diagnosed as a case of qi deficiency of the Spleen, then, under the strategy of 㺕 㝮 ѻ ⌅ ˈ one may also prescribe the Four Gentlemen Decoction; if diagnosed as a case of blood deficiency of the Heart/㺕ᗳ㹰⌅, one may prescribe the ᖃᖂ㺕㹰⊔/Angelica BloodSupplementing Decoction; and if diagnosed as a case of yin deficiency of the Kidneys/㺕㛮䱤⌅, one may prescribe the ‫ޝ‬ણൠ哴Ѩ/Six-Ingredient Rehmannia Pill.14 14 A word of caution: CCM is not in favour of using this method of taking internal medicine, without reservation, to strengthen one’s constitution, as it is aware of the

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Until of late, Bm has tended not to emphasise the importance of diet in maintaining/promoting health or warding off disorders. That is partly because of the work of Pasteur and Koch, which ushered in the Age of Bacteriology, at the cusp of the twentieth century. This era was followed by the age of antibiotics at the end of the Second World War in the last century, which has hogged the glamorous limelight, elbowing other domains of medical investigation into the shadows. Furthermore, the monogenic conception of disease–one disease, one causal agent (be this a bacillus, a virus, a fungus, or a prion)–is most at home with the dominant reductionist, monofactorial framework of Bm itself. There are various ways that the beginning of the science of nutrition can be dated. One way is to mention the work of James Lind in 1746, when he concluded that sailors succumbed to scurvy during long journeys at sea, because their diet lacked antiscorbutic ingredients. (Vitamin C, which is necessary to prevent scurvy, is found in lemons and oranges, as well as in staples such as potatoes and grains. When crop failures in these occurred in Europe during 1845-1848, not only did famine occur but also, scurvy increased, especially in Ireland.) Lind’s claim was confined to treating/preventing scurvy amongst sailors and not posited as a universal necessity in one’s diet for good health whether on land or at sea. Therefore, this finding cannot count as a true beginning of the science of nutrition, although Lind is commonly given the honour of having implemented what today is called the RCT. Another account dates it to Claude Berthollet in 1785, who reported to the French Academy of Sciences that animal matter was mostly based on nitrogen. By the first three decades of the nineteenth century, scientists had shown that “animal substances” all contained 16% nitrogen, later referred to as protein (see Carpenter 2003). With the establishment of DNA genetics, many medical scientists took the strong reductionist line that DNA sequences could be used to cure many diseases that have a strong genetic component. As things turned out, genes and their manifestations are more complicated than originally envisaged by such scientists. Today, nearly six decades after Crick and Watson and more than ten years after the major findings of the Human Genome Project have been made public, gene therapy remains a promise of the future, rather than a present reality–the new “magic bullet” has so far not yet been delivered. Instead, there is a growing realisation that disease, by and large, does not conform to the monofactorial model of causality. (See Lee 2012b, Chapter Twelve.) Take the genetic disease fact that, unless carefully applied and monitored, it could produce iatragenic effects in some instances. In other words, one should not self-medicate without medical supervision (see *Zangfu zhengzhi 1981).

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called phenylketonuria (PKU). Only if both parents possess the allele of the defective gene in question, would the child bear the disease (which is called an autosomal recessive trait). Such offspring do not possess the enzyme, phenylalanine hydroxytase, which is necessary for breaking down the amino acid phenylalanine, found in foods containing protein. Too much phenylalanine in the body causes damage to the CNS and the brain, leading to hyperactivity, seizure, underdeveloped mental and social skills, and so on. (See “Phenylketonuria” 2015.) A blood test shortly after birth is able to establish whether a child has this rare defect. However, when PKU (as genetic defect) is diagnosed, it is not all bad news, as it does not necessarily follow that the child will grow up handicapped in the way that the theoretical prognosis has spelt out. Provided measures are taken straight away and followed up throughout the individual’s lifetime, the genetic defect does not manifest itself by way of symptoms and signs. Diet is of the essence, because many common foods contain phenylalanine in significant amounts, such as milk and eggs, not to mention aspartame (an artificial sweetener marketed as NutraSweet). A diet which avoids such foods, would avert the onset of the genetic defect as an overt disorder. This is an excellent example of Preventive Medicine in the primary sense as practised by Bm. (Note that this example is taken from clinical medicine, not Epidemiology, though it conforms to the model of causality endorsed by the latter.) In other words, the presence of the defective gene is only a necessary condition, not necessary and sufficient for the manifestation of PKU as a disorder. What brings about PKU as a manifest disorder is the combination of the defective gene plus a “normal” diet–these constitute jointly the necessary and sufficient cause of the effect (the symptoms and signs). In CCM language, as noted above, the relevant external and internal factors must arise (neiwai-xianghe), before the effect occurs. The model of causation, far from being monofactorial, is, of course, multifactorial; as a matter of fact, it involves three variables, what in Epidemiology is sometimes called the Triangle of Causation Model (see Lee 2017a Figure 10.2). Applied to PKU, the model works out as follows: Host: Agent: Environment:

The individual human being with his/her genetic defect. The nature of the diet of the individual, from birth onwards and throughout life. The social milieu, which makes early detection of the genetic defect possible, which makes resources for an appropriate alternative diet as well as support, in general,

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readily available, to the carers and bearers of the genetic defect, so that PKU would remain latent. One must also remind the reader that as observed earlier, the causal arrows work in a complex, non-linear fashion. Should there be a failure of support under the Environment variable (if, for instance, the special diet is no longer financially accessible to the Host), the Host might have no choice but to give in to a cheaper diet, which is not medically appropriate for his condition. This would lead, in turn, to the disorder becoming manifest, thereby putting the Host in a predicament in which he has no choice but to make more demands on the social/medical milieu, of which he is an integral part. Finally, we turn to the notion of ޫ⭏/yangsheng in CCM, which has a very long history (at least as long as the Neijing, as one could even argue that the text is but an extended account of the concept of yangsheng) and is, therefore, a very well-established and developed domain.15 Ultimately, it rests on the concepts of Yinyang-Wuxing, Tianren-xiangying. Its main goals are to improve one’s constitution, to avoid/reduce risks for the onset of illnesses and to prolong one’s lifespan, that is, in general, to improve and enhance the quality of life for as long as one can, which may be achieved not by any single method but by numerous methods, as we shall see. The word itself is constructed out of two characters/words, namely, yang and sheng; the latter means “life” and the former “to protect, nourish and look after” that life. The Suwen, Chapter 72lj㍐䰞· ࡪ⌅䇪NJsays: ↓ ≄ᆈ޵ˈ䛚 нਟᒢ. Rendered as: “When one’s ‘correct qi’/orthopathic qi is strong, one does not succumb to epidemic infections, in particular, (or illness, in general)”. Another passage from the Suwen, Chapter 1/lj㍐䰞· кਔཙⵏ䇪NJreads: ։䰫кਔᴹⵏӪ㘵DŽDŽDŽᰐᴹ㓸ᰦ

Rendered as: I have heard that in ancient times people known as “the perfect ones” had mastered the workings of Heaven and Earth, had fully grasped and understood Yinyang, had learned to breathe refined qi as well as to guard the spirit from external intrusion, so that their body and spirit form an integrated Whole. Such people would live long and could survive

15

See * “The concept of yangsheng ” 2015.

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(Text within round brackets is the author’s interpolation.)

This passage embodies the aspiration of yangsheng down the ages in Chinese culture and civilisation. It is revealing that a medical text entitled, Zhu bing yuan hou lun/lj䈨 ⯵Ⓚ‫ן‬䇪NJ, in the Sui dynasty of the early seventh century (610 CE), written by the leading physician of the period, Cao Yuanfang ᐒ‫ݳ‬ᯩ, did not mention any prescriptions, but over two hundred methods of yangsheng. A Western Han dynasty text entitled Huainan honglie/lj␞ই 呯⛸ NJdealt at length with the concept; it noted three elements, namely, xing/ᖒ, shen/⾎, and Qi/≄. The first refers to the person-body, where life is housed/ᖒ㘵ˈ⭏ѻ㠽ҏ; the second refers to what governs or controls the ability of the human being to self-organise and to control the personbody’s functioning properly in order to maintain life and health/⾎㘵ˈ⭏ ѻࡦҏ; and the third refers to Qi, which in mediating between the first and the second, ensures that life is strongly maintained/≄㘵ˈ⭏ѻ‫ݵ‬ҏ. Another way of presenting the concept which, today, is the more normal one is to focus on shen/⾎, qing/㋮ and Qi/≄. In modern Chinese, in ordinary discourse, the first two characters are combined to form a single word ㋮⾎/jingshen, for which dictionaries give two meanings, one as a noun referring to vigour/vitality/drive and the other, as an adjective, meaning “spiritual/mental/psychological”. For the purpose of this discussion, we need to understand the two characters/words separately. Shen may be rendered as “spirit” and jing as “essence”. As a matter of fact, the single modern word, in combining the two elements, is quite in keeping with Chinese philosophy, which rests on Dyadic Thinking. This has been emphasised all along–the spirit pertains to the mental aspect of the human being, while the essence is something which is physical, and which is governed by the Kidneys. In one basic understanding, it refers to the sperm of the male and the eggs of the female, the exact numbers of which are determined at birth, but which are released at puberty. In the case of the female, the release is evidenced by menstruation. With regard to the male, according to CCM, too much sexual activity, ending in the release of sperm, is considered as draining and weakening the person. CCM regards jing to be an important root of life. As for Qi, another constituent of the root of life, we have already also, over and over again, emphasised the role it plays either in partnership with

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xue/blood, or independently as Qi coursing through the Jingluo network. When Qixue and Qi flow unhindered, the Zangfu functions properly; mutatis mutandis, when either or both of these two flows are hindered, a malfunctioning of the Zangfu occurs, and illness would follow. However, above all, shen is the most important of the three roots of life–it can be said to be primus inter pares, as shen (with the help of Qi) is what ensures that Yinyang in the individual attains equilibrium/䱤䱣ᒣ઼, and the Zangfu works as a co-ordinated Whole/㜿㞁ॿ䈳. As a result, the Qixue flows freely with no let or hindrance/≄㹰⭵䗮. These are the necessary and sufficient conditions for good health and the prolongation of the lifespan for as long as possible. In reality, under Ecosystem Thinking, all three are interlinked; if yangsheng were to be achieved, one must cultivate all three fronts within the philosophical/cosmological framework of the balance of Yinyang, of Tianren-xiangying and of Shenxin-heyi/䓛ᗳ ਸа. As we have commented already on the first two notions, a quick word is called for regarding the last mentioned. Shenxin, too, is a dyadism, as 䓛/shen may be said, in this context, to refer to the physical aspect of the person-body, where resides the Zangfu, while ᗳ/xin refers to the spiritual/mental aspect of the person-body–the Heart as a yin visceral organ is also held to be the abode of ⾎/shen. Hence, 䓛ᗳ/shenxin literally means the “physical and the mental or spiritual aspects, forming and functioning as a Whole”. As has been observed, there are innumerable ways to achieve the goal of yangsheng; one could sort them under the following categories: diet, medication, acupuncture, moxibustion, massage, and qigong. For lack of space, one can only make a few brief comments about some of these. Diet (nutrition) is a vast subject-area. Chapter Eight shows that in CCM, food itself can function as medicine–the division is not hard and fast in all contexts. Yangsheng, through diet, is thoroughly impregnated with the notion of Tianren-xiangying, not to mention Wuxing, as eating properly is largely determined by the season (and therefore Time). There is a time to eat certain foods and a time not to eat certain foods. Just to take one example that is more relevant to the past than to today’s circumstances–one should not touch dog meat, in the summer; it should only be eaten, in the winter. Dog meat is a “heaty”/re/✝ food. The summer months are the hottest months in the year; your person-body is already hard-put to cope with heat in the greater environment, but should you introduce such a “heaty” food into your system, you would be “overheating” it, so to speak. The same logic holds true about not eating watermelon in the winter. The water-melon is a “cool” or “cold” food by its

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very nature. How do we know this? CCM says: look at the circumstances under which the water-melon grows. It flourishes under the intense heat of the summer, when other plants wilt and wither. This shows that it contains an innate property of being able to resist intense heat; hence, it possesses a cool nature, which makes it eminently a sensible food to eat at the height of summer. It cools you down. In contrast, should you be so foolish as to eat it in the depth of winter (because today’s storage and transport systems allow you to buy such a fruit in the supermarket), then you may fall prey to illness, as the water-melon would be too cold for your person-body at that time of the year, and may cause indigestion, amongst other ills. The Chinese publishing world is full of books on the subject of yangsheng; the media, including television shows discuss the subject of shiyang/伏ޫ /health through foods. Yangsheng via medication/yaoyang/ 㦟 ޫ is another huge subject. Historically, this would include alchemical medicinals. An early record of an emperor, in search of the herbs of the immortals/xianyao/ԉ㦟 as a form of yangsheng, was Qinshihuangdi, the Emperor who first unified China. He was hugely disappointed, as those whom he had commissioned, and handsomely enticed financially, to find the herbs, disappeared “across the seas”, and did not appear ever again. Later, emperors and others swallowed danyao/ѩ㦟, which seemed to be mainly mineral rather than plant-based. Alchemical substances apart, the archives of CCM are a rich source of information about more ordinary medicinals. For instance, The Materia Medica of the Divine Husbandman/lj⾎ߌᵜ㥹NJrecords more than one hundred and thirty herbs, which are said to be “sovereign”/jun/ੋ, meaning Class One ingredients, as these are excellent for the purpose of yangsheng–they are non-toxic, and taking them over a long period of time and, even in quantity, would not produce undesirable side effects, but only the positive one of nourishing Qi. Other studies in the history of CCM followed the principle laid down by this tome as well as by the work of Li Shizhen/ᵾᰦ⧽ and his Compendium Materia Medica/ljᵜ㥹㓢ⴞNJin the Ming dynasty. The ingredients approved are predominantly plants but not exclusively. Some people favour taking, on a daily basis, some liquor in which such medicinals have been steeped. Another observation worth making is that Southerners, particularly, the Cantonese, favour taking their yangsheng medicines as soup–again there are innumerable recipes for medicinal soups to suit the changing seasons of the year. Chapter Two raises an instance, which involves burning ai/㢮/moxa at the zusanli xuewei (St 36), on the part of the elderly, pursuing the ideal of yangsheng. In many families in China where the elderly live with the

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younger generation, the younger members of the family would perform massage on the older relatives. Performing exercises such as Taijichuan, not as a form of martial arts, but of yangsheng, is one of the most popular activities pursued by Chinese people whether old, middle-aged or young. Especially in the early morning, public parks and other spaces are full of participants, engaging in this form of yangsheng exercise. Others prefer what is called qigong/≄࣏ or more accurately medical qigong/५ᆖ≄࣏, also called daoyin/ሬᕅ. Figure 4.6 shows some of the daoyin postures found in the silk manuscripts from the early Han dynasty tomb, excavated in the 1970s at Mawangdui, Changsha province.

Figure 4.6: Some Daoyin postures from the Mawangdui manuscripts

The important thing to bear in mind is that yangsheng must be understood in the following terms: first, one must see the mind-body relationship not in dualist but dyadic terms, that is, they form a Whole (call it Ecosystem X). This Whole is embedded in a bigger Whole, a milieu of which the individual is but a part (call this Ecosystem Y). In turn, this is embedded in yet another bigger, that is, cosmic Whole, which is Heaven and Earth with Humankind in the middle (call this Ecosystem Z).

Conclusion 1. CCM is founded on Wholism in its many forms (Lee 2017a, Chapter Ten); this chapter is concerned only with spelling out that form, which invokes Ecosystem Thinking. 2. CCM is, hence, Ecosystem Science. 3. As such, the causal model is multifactorial and non-linear as exemplified by Wuxing, when it is applied to the diagnosing and the treating of illness in the person and, in general, to understanding the concept of illness as well as that of health.

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4. The theses above are used, in turn, to elucidate the notion of Preventive Medicine in its primary as well as broader meanings, including that of yangsheng. 5. To make the points at 4 clear, this section compares Epidemiology (the “non-glamorous” domain, the “Cinderella” of Bm (see Lee 2012b, Chapter Twelve) as a form of Preventive Medicine, in the primary sense, with its counterpart in CCM, under the latter’s notions of xiantian and houtian, and the interaction between them. More importantly, these interactions, between xiantian and houtian, serve as further evidence for the claim, that CCM is Ecosystem Science.

CHAPTER FIVE PREVENTIVE MEDICINE: SHANG GONG

Introduction Chapter Four explored the broad sense of Preventive Medicine as an integral part of CCM. This chapter explores the narrower sense, which may be regarded as the secondary meaning of the concept. It is primarily about the ability of the physician to diagnose and treat a patient, when the illness has just begun to take root, and before it begins to manifest itself as an obvious, full-blown condition in terms of signs and symptoms. This subject will be looked at under four aspects: (a) Through the distinction between signs and symptoms of an illness. (b) The origin of the notion of Preventive Medicine in Chinese thinking. (c) Through the distinction between shang gong/кᐕ and xia gong/л ᐕ, in line with CCM theory-practice. (d) A brief (and, hence, straightforward) comparison between Preventive Medicine in CCM and Preventive Medicine in Bm. The distinction between signs and symptoms exists in CCM even though it is only implied rather than stated in the text. The following points are relevant. 1. Symptoms/zhengzhuang/ ⯷ ⣦ , paradigmatically, are subjective in character about states and conditions which are accessible and ascertainable only by the patient in that s/he feels anxious, depressed, exhausted, or suffers from headaches, aches and pains. Signs/tizheng/փᖱ are those states and conditions which any observer, such as a physician/doctor, members of the family, friends as well as the patients themselves can see–wounds, fractures, and swollen joints, which are

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objectively or inter-subjectively ascertainable. 1 Signs need not be as obvious as that. For instance, increasingly in Bm, signs are detected not only via blood and urine tests but by using high-tech devices such as scanners. In CCM, in principle, signs are available for all to grasp (the techniques are not dependent on technology, whether high or low); in practice, only those with knowledge and skill can attach the correct significance to them. A medically naive person may even notice that following an accident, a person’s lips are dry, but would not assign any theoretical/clinical significance to it; only a physician would see/interpret it as a sign that the Spleen could have been damaged in the accident (as in CCM theory, the mouth is the orifice linked to the Spleen). The medically untrained would not be able to ascertain his own mai profile or that of another; nor can he read the signs regarding the complexion on a person’s face, as this requires special skills and knowledge (see Figure 5.2). 2. As regards sizhen/ ഋ 䇺 /the four techniques of diagnosis (see later section and Chapter Eight), the physician would use this technique of asking/wen/䰞 the patients to obtain their subjective reports, primarily to identify/establish symptoms, while the other three techniques are aimed at investigating signs. 3. This means that illness is diagnosed, not simply based on symptoms, but on symptoms as well as signs. 4. It follows that a patient’s own report about symptoms is not definitive of an illness. 5. The patient’s report about subjective states (feelings of exhaustion/ depression/pain) necessarily has no privileged status in the diagnosis of his/her illness, but forms a component, and an important one at that, in the diagnosis. 6. A failure to adhere to the above would render the notion of Preventive Medicine in CCM unintelligible. (For that matter, a failure to distinguish between signs and symptoms would render the notion of Preventive Medicine in Bm today equally unintelligible.) 7. A person would normally approach a physician/doctor based on subjective states of feeling unwell/pain. Increasingly, in this age of 1

Historically, CCM would not have used the terms: zhengzhuang and tizhen.

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advanced information technology, before visiting their GP, patients are likely to have typed their symptoms into their computer to get the machine to yield a list of diseases they could be suffering from, which they, then, would present to their doctors. In a consultation, a shang gong physician could detect via signs some condition other than the one presented by the patient. At this point, let us take a quick look at Brown 2015; in Appendix Four, we will show that her account about Bian Que and the concept of Preventive Medicine associated with him are deeply flawed. This is beause she has failed to distinguish clearly between signs and symptoms, and has not taken seriously the concept of diagnosis via signs. Instead, she has simplistically assumed that a patient’s illness is totally defined in terms of the symptoms that the person reports regarding his/her subjective states. As a result, she is deeply sceptical of the concept of Preventive Medicine itself, in the end writing it off as an adjunct, at best, to political discourse. She quotes from a health manual/ lj ᕅ Җ NJ , which she translates as Pulling Book (the bamboo slips are from a Western Han tomb dated to 186 BCE excavated at Zhangjiashan in Hubei province in 1984). It advocates using exercises to get rid of illnesses and to promote health and longevity as well as a good quality of life both physically and spiritually/yangsheng. She quotes a case of feeling the mai at the ankle to determine the source of an illness; and writes: … the author implied that it was possible for someone to detect the presence of illness solely through the examination of the pulse. The sick person, in other words, did not necessarily have “privileged knowledge of his or her body”, that it “was at least theoretically possible for a healer to diagnose an illness in the absence of overt symptoms or discomfort.” (2015, 52)

Brown, nevertheless, appears to take the above back by saying that contemporary sources (around the same time as the story of Bian Que, told in the Hanfeizi) … presented a different picture of therapy insofar as they stressed the patient’s feelings of discomfort over subtle cues found in the appearance or pulse. (2015, 52)

She concludes:

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This necessarily short critique, here, of Brown’s methodology acts as a brief introduction to the more detailed criticisms set out in Appendix Four.

The origin of Preventive Medicine in the narrow sense in Chinese thinking Professor Unschuld 1998 and 2009, claimed that generally, CCM can be explained in terms of the politics of the early Han Empire, a period marked by stability and power driven by a vast and efficient bureaucracy. For Professor Unschuld, the Neijing (a foundational if not the foundation text for CCM), in the main, is a Han text (Appendix One), and CCM is explained, by and large, in terms of the politics and the organisation of the early Han state. From this, Unschuld appears to imply and (almost) to justify the conclusion, drawn by him, that there is no serious subject called CCM, apart from the proffered explanation in terms of the Han Empire, its politics, its bureaucracy and its political discourse. We begin this chapter by refuting this claim. This rejection is taken further in Appendix Three of this volume. One aspect of the Unschuld claim that is not touched on in Appendix Three needs be addressed here. This will lead us directly to the topic of the origin of Preventive Medicine in the narrow sense within the history of Chinese thinking. The problem boils down to one fundamental question: historically, in Chinese thinking, what exactly was the relationship between two discourses, the medical and the political? Professor Unschuld appears to contend that medical discourse drew its inspiration, in the main, from political discourse, and is to be explained away in terms of it. However, can one categorically rule out a reverse possibility, which is: that political discourse/analysis drew its inspiration from medical discourse/diagnosis and treatment? Or indeed, possibly, from some other third discourse altogether? This chapter wishes to argue for the second and third possibilities. The notion of Preventive Medicine is an excellent starting point for examining the relationship between, not only two but three different discourses, with the third discourse focussing on a crucial notion, that of Preventive Action in general, of which preventive political measures as well as preventive medical interventions are but subclasses. It is obvious that each respective domain of ruling and healing requires preventive action. In the

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former, rulers are interested in eliminating discontent and disturbance just as these are about to raise their ugly heads; in the latter, physicians are interested in eliminating the burgeoning of illnesses just as they surface, and before they take root, becoming full-blown and difficult to treat. “Nip ‘the cancer’ in the bud” is the way forward for both the art of ruling and the art/science of healing. Furthermore, the Neijing itself makes this comparison. In the Suwen, Chapter 2/lj㍐䰞· ഋ≄䈳⾎བྷ䇪NJ, we read: ൓Ӫн⋫ᐢ⯵⋫ᵚ⯵DŽDŽDŽнӖᲊѾ.

Rendered as: The wise physician does not need to treat patients with full-blown illnesses, as he practises Preventive Medicine on them before obvious signs of illness appear; the wise ruler does not have to cope with active rebellion, as he takes preventive measures to ensure that any discontent or unrest does not turn into open revolt. To treat patients at the stage when they require to take actual medicines, to wait till rebellion is ripe, before undertaking political intervention is as foolish as those who wait till they suffer from thirst and dehydration before they start to dig a well for water, as foolish as those, who wait till the rebels are marching down the streets waving sticks, stones or staves, before they start to forge weapons to quell the revolt–it is, alas, all a bit too late.

Did the Neijing derive this comparison between the technique of healing and that of ruling from some other political Han text, or from the actual observation of Han politics and bureaucracy? It might not. Insofar as one can find such an explicit comparison in another text, that text is not a Han but a late Warring States text, namely, the Hanfeizi/lj丙䶎ᆀNJ, named after Han Fei, 2 said to have lived c. 280-233 BCE. He was a brilliant legal/political theorist of the Legalist School. 3 Appendix Four draws attention to an account of Bian Que/Qin Yueren in this text. It is somewhat curious that the Hanfeizi, which is a legal/political text should talk about the actions of a peripatetic physician. The author, however, appeared to have used Bian Que’s healing skills as an analogue of ruling skills. The case mentioned is about Duke Huan/Cai Huan, gong/㭑ẃ‫ ޜ‬of the state of Cai, according to Han Fei, but according to Sima Qian (the 2

For a very brief account, see Hsiao 2015. See Lee 1975, for a detailed exploration of this type of jurisprudential thought, as a form of legal positivism.

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historian) in his Shiji/ljਢ䇠NJ, the patient in question was Duke Huan of the state of Qi/喀. The aspect relevant to the discussion here lies, not in the discrepancies in the biographies of the said patient, Duke Huan, but the common content of the two accounts.4 This common content is about the notion of Preventive Medicine, of which Bian Que was said to have been a brilliant practitioner. It appears that Han Fei was struck by the similarity between the respective key preoccupations of the ruler and the physician. To be a good/efficient ruler was like being a good/efficient physician, like Bian Que. The truly skilful physician should be able to diagnose and, in this sense, to “foresee” what was waiting in the wings, such as death awaiting the patient, as in the case of Duke Huan. The truly skilful ruler, too, should be able to anticipate dire outcomes, based on understanding the present political situation, and making interventions to thwart undesirable outcomes, such as outright rebellion, or even more dire, the overthrow of the ruling house itself. It is therefore plausible to infer that it was Han Fei, the legal/political theorist, who was so impressed by the way in which Bian Que, a brilliant physician, employed his skills in the name of Preventive Medicine, that he drew inspiration from it to elucidate the technique of ruling. It follows that, contrary to Unschuld’s contention, political discourse, in this respect, is derivative from medical discourse and not the other way around. Ironically, it is the “organic model” of illness which “drove” the model for “political unease or dis-ease” (the words within quotes are Unschuld’s own words). It looks as if the evidence from the Hanfeizi could be interpreted to undermine Professor Unschuld’s contention. Appendix Four comments that Han Fei, to all appearances, had got the date of treating the patient (Duke Huan) wrong, at least in the light of later scholarship, beginning with that of Sima Qian. He was wrong by being some 280 years too early. If Bian Que was Qin Yueren (see Appendix Four), it would have made him a Warring States, not a Spring and Autumn, personage. However, if the point of the Hanfeizi’s narrative is not about the historical accuracy in all details about the patient, but to draw attention to the perceived similarity between the goals of both medical and political endeavours, then the discrepancy of the date of this event is neither here nor there. What is significant is the fact that the Hanfeizi invoked the narrative, which may imply that in the minds of the Chinese (in the late 4

Brown 2015 makes the case that these differences are critical, as they serve to undermine their value as medical history (see Appendix Four for an evaluation of Brown’s methodology in arriving at such a conclusion).

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Warring States period), such as Han Fei himself, the concept of Preventive Medicine had appeared as far back as the seventh century BCE. In addition, this key medical concept in Chinese medical discourse could have inspired political discourse to follow its lead, and not the other way round, as surmised by Unschuld. Let us next turn our attention to the content of the Bian Que narrative: the part shared in common by Han Fei and Sima Qian. Bian Que in his peregrination met Duke Huan whom he saw four times. Each time, from observing the Duke’s complexion, he diagnosed and prognosed the illness the Duke was suffering from. The illness became more and more serious with each visit, but up to the third visit, Bian Que assured the Duke he could successfully treat him, although he would have to use progressively more serious forms of treatment. Alas, treatment was declined until the fourth visit, when it was too late to save the would-be patient, who duly died.5 The narrative may be deconstructed in medical terms as follows. 1. At the first visit, looking at the king’s complexion, led to the diagnosis that the illness was confined to the skin/pifucou/Ⳟ㛔㞐, an illness of the exterior/biao, which could readily be treated with a compress of medicinal herbs. 2. The second visit yielded the diagnosis that the illness had entered the blood stream/xuemai/㹰㜹 and the flesh/jirou/㚼㚹, but acupuncture could have coped. 3 The third visit yielded the diagnosis that the illness by then had entered the digestive system/changwei/㛐㛳; it could be treated with the help of cauterisation, moxibustion, and decocted medicinals. 4. He said there was no need to pay a fourth visit. Based on his knowledge about the conditions of the patient, the illness would have advanced by then into the bones and the bone marrow/gusui/僘儃 which, as far as he knew, was not amenable to treatment of any kind. Death would inevitably follow. This diagnosis is entirely in keeping with the understanding of the progression of illnesses in CCM, as it came to be articulated in the Neijing. That is why some historians of medicine claim that Bian Que was a 5

For a brief account, see *Sun 2011.

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founding father of CCM. Look at this passage from the Suwen, Chapter 5/ lj㍐䰞·䱤䱣ᓄ䊑བྷ䇪NJ: ᭵ழ⋫㘵⋫Ⳟ∋DŽDŽDŽॺ↫ॺ⭏ҏ

Rendered as: The superior physician treats and cures illness when it affects only at the level of the skin. The grade below the superior physician can detect, treat and cure illness when it affects the tissues. The next grade of skill, in the descending order, will be a physician who can only diagnose the illness when it has reached the six yang visceral organs, and the lowest grade of physician can diagnose an illness when it has reached the five yin visceral organs, but by that time, the patient would be literally at death’s door.

As we shall be returning to this theme about the distinction between the superior and the inferior physician later, there is no need to pursue it further here. Let us return to Han Fei’s writings. His comments about Bian Que are found in a chapter entitled 䀓㘱/Jie Lao/“Understanding Laozi’s Teachings” which is based on the Laozi, Chapter 63. This together with its succeeding chapter, called ௫㘱/Yu Lao/“Elucidating Laozi’s Teachings” may be seen as attempts on the part of the Hanfeizi to incorporate the insights of the Laozi into the Legalist conception of law and politics. Although the relevant passage is quite long, it may be instructive to refer to it in full in spite of some repetition: ᴹᖒѻ㊫ˈབྷᗵ䎧ҾሿDŽDŽDŽ᭵൓Ӫ㳔Ӿһ✹

Rendered as: Any material thing, with form and shape, must grow or develop from small beginnings. Any state of affairs, which has endured and lasted, anything, which has conglomerated, must have been born out of accumulation, bit by bit, piece by piece. That is why the saying goes: all difficult things must have evolved from beginnings, which were not difficult but easy to handle, just as all great states of affairs must have developed from small beginnings. This means that those who wish to control affairs, must attend to details and small beginnings. The best way to maintain a long dyke to prevent its collapse is to attend to a hole in its wall, even as small as that caused by the burrowing of an ant in the earth, just as to prevent a fire from destroying a large building, one must extinguish the first flying sparks. Hence, Bai Gui could prevent floods by repairing small holes in the dyke, and the venerable old man could prevent fires from destroying large

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buildings, by plastering cracks in the walls of the chimney to make it impossible for the fire to spread. What they do are perfect examples of how one should manage affairs, by vigilantly and diligently attending to the small beginnings of potential big trouble, through nipping them in the bud. Bian Que once stood in the presence of Duke Huan of the state of Cai; after a while, he said: “Your Lordship, you are ill and the illness is just skin deep. If the illness is not treated, I’m afraid it would go deeper.” The duke replied: “I’m not ill.” With that, Bian Que left the room; the Duke then continued: “Physicians are prone to diagnose illness even when none exists, in order to display their so-called diagnostic skills to enhance their reputation.” Ten days later, Bian Que came again; this time, he said: “Your Lordship’s illness has now gone beyond the skin to penetrate the flesh. If not treated, the illness would go deeper.” The Duke ignored this warning; Bian Que left. The Duke was not well pleased. Another ten days passed by, and Bian Que appeared yet again. He said: “Your Lordship, your illness has now reached the intestines and the stomach. If not treated, the illness will go even deeper.” The Duke again ignored his warning, and was not well pleased. Another ten days passed. Bian Que came again, took one look at the Duke’s complexion, said nothing and left. The Duke sent an attendant to find out why he behaved as he did. Bian Que said: “When the illness is merely skin deep, using a hot compress of medicinal herbs would put things right. When the illness has gone into the flesh, acupuncture would be efficacious. When the illness reaches the digestive organ-system, cauterisation and decoction of medicinals would help. When the illness gets to the bone and marrow, the illness is fatal, and beyond the reach of medicine. Today, as the illness in the Duke is already in his bone and marrow, his fate is in the hands of the god over life and death. As this humble official could no longer help, he would no longer entreat to see and treat the patient.” Five days later, when the Duke’s pain got increasingly worse, he sent out men to bring Bian Que back to the palace; however, Bian Que had already fled on his way to the state of Qi. The Duke died. The lesson is this: the excellent physician treats an illness when it is skin deep, when the encounter (between physician and pathological condition) would be no more than a mere skirmish. Analogously, the fortunate or unfortunate outcome of any situation is subject to the same logic. Hence, the wise acts on the nostrum: always act early, as early intervention means that the situation is controllable.

The above quotation makes clear the following: (a) It shows that the single most important influence on the Hanfeizi’s understanding of early political interventions comes from the Laozi, which provides, in turn, an overarching conception of Preventive Action, in general, of which political and therapeutic interventions

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are merely subcategories. It is as if the Laozi has formulated a Law of Nature regarding the evolutionary development of phenomena. (b) The second most important influence comes from practical measures, such as to prevent a dyke from collapsing by repairing the smallest hole or crack in its wall, or a fire from destroying an entire building by putting out the merest spark in the chimney. The idiomatic expression–ॳ䟼ѻ๔ˈ⒳ Ҿ㲱イ/qian li zhi di, kui yu yixue–is derived from ॳиѻ๔ˈԕ㲲㲱ѻイ⒳/qian zhang zhi di, yi mayi zhi xuekui found, in this chapter of the Hanfeizi. Another related expression ॳ䟼ѻ㹼ˈ ࿻Ҿ䏣л/qian li zhi xing, shi yu zu xia/a journey of a thousand miles begins with putting the first foot forward, comes from the Laozi, Chapter 64. (c) The Bian Que story is cited as an instantiation of this Law of Nature in the Laozi and of the pragmatic nostrum regarding catastrophe prevention. The Hanfeizi implies that the notion of Preventive Medicine in CCM (c) is inspired by a and b; a, b together with (c) may be called the axiom of Catastrophe Prevention, articulating the wisdom that early intervention results in greater controllability. (d) In turn, the Hanfeizi implies that the notion of taking preventive measures in the technique of ruling invoke Preventive Action alone based on a and b or on the axiom of Catastrophe Prevention via a, b and c incorporating the notion of Preventive Medicine. This latter possibility is highly plausible given that the Hanfeizi does invoke c, even when it is perfectly possible for it to leave out c altogether, and simply cite a and b (Preventive Action) which it did not. (e) One may conclude, contra Unschuld, that the relationship between medical discourse, on the one hand, and political discourse, on the other, is not as he portrays it to be. If this conclusion is correct, then this would serve to support the charge that his understanding of CCM based, in the main, even if not solely, on an explanatory account of Han politics and bureaucracy, is mistaken. The above does not preclude the correct observation that CCM discourse does borrow, as a matter of fact, in many instances, from political discourse. However, it would be equally fair to point out that it also borrows from several other discourses, such as military, hydraulic engineering, and biological/reproductive amongst others. As for the last mentioned, we have already seen an instance of it in the Hanfeizi. Lee 2017a, Chapters Five and Six have argued that CCM is profoundly influenced by the Yijing/Zhouyi–this text uses the language of biological

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reproductive discourse to talk about the relationship between Tianqi/ yangqi, on the one hand, and Diqi/yinqi, on the other, a relationship that is fundamental to the existence of all things on Earth, including all organisms. Organisms which reproduce sexually interest the ancient Chinese most of all, as human beings are such organisms. The fundamental relationship here is between Qian/Ү and Kun/ඔ. The former, apart from standing for Heaven and yang, also stands for male; the latter, apart from standing for Earth and yin, also stands for female. It is in the nature of yangqi to rise and for yinqi to descend, but for life to occur and to be sustained, the two qi must meet. In the Yao-gua system, as Lee 2017a has demonstrated, the Tai gua/⌠খ is the auspicious while the Pi gua/੖খ is the inauspicious hexagram. This is because in the former, the Qian trigram is below and the Kun trigram is above, ensuring that the two qi would indeed meet. In the latter, the positions of the two trigrams are inverted, ensuring that the two qi, far from meeting, would increasingly pull further and further apart from each other (see Figure 5.1). In human biology, Qian is male/father and Kun is female/mother; intercourse between the two results in birth/offspring.

Tai gua

Pi gua

Figure 5.1: The difference between the auspicious Tai gua and the inauspicious Pi gua

It is true that the most significant passage from the Neijing, which borrows from the language of political discourse, is from the Suwen, Chapter 8/lj㍐䰞·⚥‫ޠ‬ᇶި䇪, which covers all twelve zangfu, bestowing on each, a rank and a role, cast in political/military/jurisprudential terms. It reads: ᗳ 㘵ˈੋѫѻᇈҏDŽDŽDŽԕѪཙл㘵ˈަᇇབྷডˈ ᡂѻᡂ ѻ

Rendered as: The Heart is the sovereign, ruling over its officials, and is the seat of consciousness, of thinking (in general), of entertaining concepts (in particular). The Lungs are like a minister assisting the sovereign, whose

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(Texts within round brackets are this author’s interpolations.) 6

According to Wiseman and Feng 1998, 22, there are two interpretations regarding the following passage from the Suwen, Chapter 8/lj㍐䰞⚥‫ ި〈ޠ‬䇪NJ˖㞰㜡 㘵ˈᐎ䜭ѻᇈˈ⍕⏢㯿✹. The first likens the office of the bladder to that of the river island, such that ᐎ䜭 (zhǀu dnj) is read as ⍢⑊ (zhǀu d· (sic)); the second (put forward by Unschuld) reads ᐎ䜭 to mean Regional Rectifier, an official title in Ancient China.

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Acknowledging that the language of CCM borrows from the language of other discourses is not tantamount to saying that CCM is not an independent discourse in its own right, but simply that it is parasitic upon and derivative from these others. It is in the nature of one discourse to borrow terms from, and invoke analogies with, other discourses. In Biomedical literature as well as in CCM, an analogy with the military appears very natural. One reads about the body or the drug fighting the disease/illness, which is the enemy. An analogy, by its very nature, draws attention to both similarities as well as differences between the two discourses involved–in other words, it is to say that treating disease is, to an extent, like fighting an enemy in battle, which, however, is not to say that diseases are like the invading enemies and their armies in all other respects. Yet in Bm, no one would charge it with being merely parasitic upon military discourse; so why should the use of analogies be a problem in the case of CCM? No one would say that Bm is not a set of related disciplines and activities, which address the problems of diagnosing diseases and their cures or control. Why then is this “principle of charity” not extended to CCM, except for the unspoken assumption that CCM has already been pre-judged to be “not medicine”, “not scientific”, and “not efficacious”? In other words, from the beginning, it has been written off as pseudo-science or plain “mumbo jumbo”. This then appears to reinforce the charge of prejudice against Professor Unschuld and what this author has called the Fallacy of Misplaced Analysis (FMA) in Appendix Three. Analogies, by their very nature, can be a rich source of inspiration in attempting to understand the target discourse, so to speak. This aspect will not be examined here, as in Chapter Three, a very important methodological distinction–between hypothesis generating (CGH) and hypothesis testing (CTH)–has already been unpicked. In order to understand a little more fully the point of invoking the analogy between the language of political discourse, on the one hand, and CCM discourse, on the other (in the passage cited above from the Neijing), in terms of bureaucratic titles and roles, one must turn to another related issue, that of understanding the relationship between the Zangfu (the yin and the yang visceral organ-systems), on the one hand, and Wuxing, on the other. An aspect of this relationship has already, to an extent, been raised in Chapter Four, in the context of diagnosing and treating illnesses. Here, one addresses the historical aspect raised by the incorporation of Wuxing into CCM, which is held to have occurred in the Han dynasty, and which then appears to constitute a compelling reason, for some scholars, to claim that the Neijing is, therefore, a Han text.

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A person called Zou Yan/䛩㹽 is said to have played a key role in articulating the concept of Wuxing. What we know about Zou Yan’s background is derived mainly from Sima Qian’s Shiji. He is said to have been from the state of Qi (today’s Shandong province), and lived during the Warring States period. There is no real consensus about his dates; some scholars think that they are 305-240 BCE? or 340-240 BCE, and yet others, that he lived for seventy years and cite 324-254 BCE?. Sima Qian said that he was a cosmologist/historian/politician/geographer/naturalist/ alchemist, a polymath in short/ 䛩 㹽 ѻ ᵟ ˈ 䗲 བྷ 㘼 ᆿ 䗘 . He was a member of the famous Jixia Academy/でлᆖᇛ, under the enlightened aegis of the rulers of Qi state. He also travelled to other states of the time, such as Yan/⠅, Zhao/䎥, and Wei/兿. His works were lost very early on, although limited fragments may be found in surviving texts.7 He is said to have been a leading member of the Yinyang School of philosophy and cosmology; he further enjoyed the distinction of being the first systematiser of the theory of Wuxing, who combined Yinyang and Wuxing, and then applied them to explain the rise and fall of states in Chinese history. His other outstanding contribution is to geography. Before him, Chinese scholars held that China was the only continent in the world. Zou Yan maintained that, apart from China, there were eight others (བྷҍᐎ䈤 /Discourse concerning the nine continents). From these few words about Zou Yan, it is obvious that the concept of Wuxing is said to have been first systematically applied in the domain of political discourse, and that the concept was borrowed by, and incorporated into CCM (into the Neijing) in the Han dynasty. (As Appendix One in this volume looks at some of the issues surrounding the claim that the Neijing is clearly a Han text only, there is nothing more to add here.) One should simply point out that the concept of Wuxing appears not to have made a definitive/mature appearance earlier than the Warring States period. However, this acknowledgement is not necessarily incompatible with holding the view that Zou Yan did not single-handedly construct the concept of Wuxing; he merely gathered together the various strands, and articulated them systematically for the first time, according to records available to us. Two matters, then, demand some attention: (a) As Zou Yan is said to have been the first systematiser of the concept known to us, one would need to say something about its

7

For one account in English, see Needham 1978, 142-143.

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related earlier notions as well as the relationship between them and Wuxing itself. (b) Whether the fact that the first systematisation of Wuxing was applied by Zou Yan to political discourse would render it peculiarly and uniquely, a political concept only.8 Lee 2017a, Chapter Seven has already given an account of Wuxing, in general, and traced some of its earlier related concepts, such as wufang/ӄ ᯩ (five different directions/the four compass points plus the centre), wucai/ӄᶀ (five material resources) and how this latter evolved from being embedded in a context of specific, concrete objects to become an abstract concept. The notion of wufang is as old as Neolithic cosmology/astronomy itself, as recent archaeological excavations inform us through findings such as the Neolithic jade carving, uncovered in the 1980s. Another artefact, a vessel called the gui/㈻, cast in bronze in the Shang and Zhou dynasties, may be said to be another embodiment of the cosmological/astronomical iconography called tian yuan di fang/ཙശൠᯩ. Tian yuan refers to the recurring (apparent) movement of the Sun in the course of a day (from sunrise to sunset) as well as in the course of a year (from Winter to Spring, to Summer, to Autumn, and to Winter); these are the Laws of Nature (the zhouye jielü and the sishi jielü), which are about astronomy (see Lee 2017a). Di fang is about the four compass points plus the centre making up wufang, which is about geography. The concept, tian yuan di fang, is an expression of the Chinese notion of Timespace (astronomy and geography). Lee 2017a, Chapter Ten argues for Timespace, that although Time and Space must be understood together, for the ancient Chinese, Time is primus inter pares; while in Western physics and philosophy, Space is fundamental and Time is a later added dimension with Einstein’s relativity physics. Hence, Timespace and Spacetime mark a significant difference between the two systems. The wucai discourse first emerged towards the end of the Western Zhou period, and can be found in two texts called the Guoyu/ljഭ䈝NJand the Zuozhuan/ljᐖՐNJ(considered to be a Spring and Autumn period text). They both mention that the five resources are earth, metal, wood, water and fire, which constitute the basic “building blocks” for human existence and survival. We make huts for shelter out of earth or wood, we grow things in soil, we make axes, knives and arrows from metal, we burn 8

For a brief account in Chinese, see *“Zou Yan” 2015; in English, see Kaptchuk 2000, Appendix F (written in collaboration with Dan Bensky).

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wood to generate fire to cook and keep warm, we use water to drink, to sail boats on water, and it makes plants grow. How did such concrete bits of matter in the end lead to a more abstract and theoretical construct, such as Wuxing? As Lee 2017a, Chapter Seven has already set forth an account of this process of transforming the concrete to become what is theoretical and abstract, there is no need to repeat the points here. Suffice it to remind the reader, that the process can be found in a chapter called “Hongfan” in the Shangshu/ljቊҖ · ⍚㤳NJor the Shujing/ljҖ㓿NJ, held either to date from the Spring and Autumn or a later period. It refers to certain more abstract properties that each xing/㹼 possesses such that Water moistens and seeps downwards; Fire burns and leaps upwards; Wood can bend and straighten; Metal is malleable and can be shaped in any way one pleases; and Earth (as soil) is excellent for sustaining cultivation. That which is moist and seeps downwards, produces the salty taste; that which burns and moves upwards, produces the bitter taste; that which straightens and bends, the sour taste; that, which is malleable and changes in shape, the acrid taste; crops, born of soil, taste sweet. A later text, towards the end of the Warring States era, called the Spring and Autumn Annals of Mr Lü/lj੅∿ ᱕⿻NJ/Lüshi chunqiu, in the steps of the Hongfan, carried further the process of setting up the schema; this text was compiled in 240 BCE, which systematically applied Wuxing to a theory of cosmic correspondences. (It could be that the author had already read Zou Yan’s work and that his thoughts were built upon those of the earlier polymath.) In other words, we can see, from wucai to Wuxing, the same processes at work. Lee 2017a, Chapters Six and Seven have set out the Yao-gua model, and argued that, although the gua system of trigrams and hexagrams undoubtedly began life as an essential part of divination, nevertheless, once set up, the ancient Chinese soon realised that, methodologically speaking, it had promise as a generalised, abstract, analytical tool. In today’s science, we would say that it was systems theory. It could well be used outside the context of divination, to help one to understand and explain phenomena in domains of theory-practice, such as medicine, the military, martial arts and the arts in general, as well as in matters of ruling and activities, all of which have nothing to do with divination. In the same way, one would like to argue that the Wuxing framework could be seen to be a general, abstract set of analytical tools, which held methodological promise in domains outside that of governance, notwithstanding the undoubted fact that Zou Yan himself was only keen to apply it to understand and explain political/dynastic phenomena. So let us return for a few brief minutes to Zou Yan’s own preoccupations. Zou Yan

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advanced what today is called ӄᗧ㓸࿻䈤/wudezhongshi shuo, rendered as “discourse about the rise and fall of dynasties in terms of the five virtues/powers”: thus tude/൏ᗧ/Earth power, mude/ᵘᗧ/Wood power, jinde/䠁ᗧ/Metal power, huode/⚛ᗧ/Fire power, and shuide/≤ᗧ/Water power. This is based on the Yinyang-Wuxing model but applied to the domain of politics, especially relying on the Mutually Constraining Mode/ ⴨㜌/‫ ݻ‬of Wuxing. Thus, Wood power constrains Earth power, Metal power constrains Wood power, Fire power constrains Metal power, Water power constrains Fire power, and Earth power constrains Water power and from there, the cycle recommences. In Chinese history, the constraining sequence would read: Yu Shun/ 㲎 㡌 was Earth power constrained/overthrown by Xia/༿ Wood power; Xia/༿ Wood power was constrained/overthrown by Shang/ ୶ Metal power; and Shang Metal power was constrained/overthrown by Zhou/ઘ Fire power. Zhou would in time (when Zou Yan was writing, the Zhou dynasty was still in existence in the form of the Warring States) be constrained and succeeded by a dynasty which would stand for Water power … Such a worldview suited the ideological needs of the rival and competing states of the Warring States period, with each hoping to be the one which would constrain/overthrow the Zhou to become the new Water power. As history turned out, it was the state of Qin/〖 which triumphed, uniting China under Qinshihuangdi, though not for long. Note, too, that Zou Yan’s application of Wuxing to the succession of dynasties is per se not a very interesting exercise from the methodological point of view, as it lacks serious explanatory power. Zou Yan invoked it in a simple-minded mechanistic manner. We shall see, in what immediately follows that, in contrast, other invocations of the concept, not necessarily later in time, are much more sophisticated from the viewpoint of methodology. Ancient Chinese thinkers had implicitly grasped the concepts of change (as set out in the Yijing), of Qi as the fundamental ontological category of change but involving the distinction between yangqi and yinqi. This leads in turn to the concepts of Yinyang, of Wuxing (in terms of the qi changes but under the two most significant operational modes of Mutually Engendering and Mutually Constraining), of Tianren-heyi/Tianrenxiangying/Macro-Micro-cosmic Wholism (for which, see Lee 2017a, Chapters Two and Ten). All formed an intertwining cluster of concepts that provide an overall methodological and analytical framework for the understanding of any domain of theoretical-practical activities, such as medical phenomena and discourse. (Chapter Ten will examine the application of Yinyang-Wuxing to medical understanding and an explanation

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at the level of both diagnosis and therapy.) The following passage from the Suwen, Chapter 66 illustrates such an approach:lj㍐䰞ཙ‫ݳ‬㓚བྷ䇪NJ: ཛӄ䘀䱤䱣㘵ˈ ཙൠѻ䚃ҏˈз⢙ѻ㓢㓚ˈ ਈॆѻ⡦⇽ˈ ⭏ᵰѻᵜ࿻

Rendered as: Nature’s Dao is but Yinyang-Wuxing; it is the law of Nature, which Wanwu follows; it is the alpha and omega of Change, the fons et origo of birth and death (growth and decline). (The text within round brackets is the author’s interpolation.)

From this perspective, there is nothing peculiarly or inherently “political” in the concept of Yinyang-Wuxing. It is simply part of the Chinese cultural and intellectual heritage, which every scholar would feel entitled to invoke, in trying to throw light upon and/or extend knowledge in his chosen domain and discourse. The important thing to consider is whether such attempts bear real fruit. In the case of CCM, the attempt was highly successful. Hence, those commentators who distort the understanding of Wuxing as a “merely or primarily political” concept, would be wrong. One should distinguish between two aspects of the matter: its use in political discourse as opposed to its use in discourses other than the political. Even if the former turns out to be correct in the history of Wuxing, that it was first used as a concept in political discourse, this does not mean that the concept did not develop/evolve to become a general analytical tool, which can be used in discourses other than the political. Once this distinction is in place, it would be incorrect to infer from the former alone that the concept in medical discourse would carry merely or predominantly political baggage. As a matter of fact, Wuxing had been known to be incorporated into medicine by the second century BCE, if not earlier. Sima Qian in his Shiji, Chapter 105 recounts twenty-five case histories of a distinguished physician of the early Western Han dynasty, Chunyu Yi/␣Ҿ᜿ (c. 215140 BCE), five of which involved Wuxing, as part of his diagnosis. The Han dynasty was established in 206 BCE. Therefore, it would not be unreasonable to infer that the version of Wuxing as a general analytical concept was likely to have emerged sometime during the Warring States period (403-221 BCE), for Chunyu Yi to have used it with such confidence in his diagnostic procedure. By the same logic, one could infer that the analytical version would not have emerged as late as the early Han dynasty itself. (See also Appendix One.) One could then plausibly

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conclude that the analytical schema would have emerged during the Warring States period, and that the application of such a set of analytical tools to medical discourse could have emerged not too long after, if not simultaneous with, Zou Yan’s use of it in the political context. (In fact, there is further evidence, earlier than the Warring States period, that CCM already relied on the concept of Wuxing or Yinyang-Wuxing at the time of Physician He in the Spring and Autumn period: see Appendix One.) Here is one of Chunyu Yi’s case histories rendered as follows.9 The patient was diagnosed with damage to the Spleen, a yin visceral organ (which is paired with the Stomach, a yang visceral organ). Chunyu Yi prognosticated that upon the arrival of Spring, qi at the diaphragm would be blocked, to be followed by the passing of blood, leading eventually to death in Summer. He said that the Stomach qi was yellow. The SpleenStomach visceral organ-system in Wuxing is assigned to Earth; in terms of the yearly cycle, Summer and Earth go together, and the colour, yellow, was associated with Earth. Under the Mutually Constraining Cycle, Wood/Spring constrains Earth. However, Earth qi, in the patient, would be exceptionally weak given the injury to the Spleen. It follows, then, that Wood qi of Spring would constrain Earth qi more than normal under the Mutually Constraining Cycle, thereby generating a condition of morbidity to such an extent as to lead to death later in the Summer. In other words, the mode of Wuxing, invoked by Chunyu Yi in this diagnosis-cum-prognosis, is the Xiangcheng/Mutually Over-constraining mode (see Chapter Four especially Figures 4.2 and 4.4 for a detailed account of this mode). To hark back to a point made earlier, readers should note that Chunyu Yi’s diagnosis-cum-prognosis in the case cited above presupposes a mature, developed and sophisticated version of the Yinyang-Wuxing framework, found in the Neijing, which is much more elaborate than Zou Yan’s relatively crude system invoked in his political discourse about the rise and fall of ruling houses in Chinese history. This difference should provide some plausible evidence for maintaining that the version appropriate to medical discourse must have already existed, in some form or other, in pre-Han times. (See Appendix One about the issues raised by the dating of the Neijing.) In concluding this section, it is reasonable to maintain that Preventive Medicine, relying on the incorporation of Wuxing into the medicine as Yinyang-Wuxing, took place during the Warring States period, a 9

Compare this rendering with Lloyd 2015, 77-78. For a totally different take on Chunyu Yi, see Brown 2015, Chapter 3.

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development, which enabled Chunyu Yi, in the early decades of the Han dynasty, to diagnose and prognosticate illnesses using that concept. One should not simplistically infer from Zou Yan’s invocation of Wuxing in political discourse that the concept did not evolve to become a general analytical schema, which could be applied in domains such as medicine even during the Warring States period. Furthermore, one should not overlook the fact that political discourse in the history of Chinese culture should not be regarded as the paradigmatic discourse, upon which other discourses may be said to be parasitic. On the contrary, there is evidence that medical discourse, through the notion of Preventive Medicine, could have acted as the source of inspiration for its analogue in political discourse. The axiom of Catastrophe Prevention is fundamental to both medicine and politics, drawn from sources as diverse as hydrological engineering and firefighting practices. Every state of affairs has small beginnings; every catastrophic state of affairs, therefore, has small beginnings, which if detected in time, means that one would be able to control the situation to avoid the catastrophic outcome foreseen. Foreseeability, controllability and prevention go together and are relevant to diverse discourses/practices, whether these be medicine, politics, childrearing, dyke engineering and maintenance, fire-fighting or other activities. There is neither need nor justification in general to privilege the political over the rest and, in particular, to privilege Han politics and bureaucracy in an attempt to understand CCM; and to “politicise” CCM–all this leads to distorting and misunderstanding it altogether.

Preventive Medicine: shang gong, zhong gong and xia gong Lee 2017a, Chapter Four mentioned a Warring States text called the Heguanzi/˪发ߐᆀNJ/Pheasant Cape Master. In Chapter 16 is a passage which refers to Bian Que and his two brothers (probably an apocryphal tale). ঃ㽴⦻䰞ᓎ᳆ᴠ˖“ཛੋӪ㘵ӖᴹѪަഭѾ˛”DŽDŽDŽ ࡋը㛑㔤DŽ”

Rendered as: The king, Zhuo Xiang asked Chong Nuan: “Can rulers govern the country properly?” Chong Nuan replied: “Have you not heard of the very famous physician of old called Yu Fu and how he treated illnesses? He could cure

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any and every type of illness; so great was his skill that the evil spirits (responsible for illnesses) could not escape his reach, but kept a respectful distance from him. When the king of Chu ascended the throne, he appointed court physicians in the same way as the ancient ruler Yao would appoint the good and the wise to help him to rule. He would not appoint his own relatives but only those who really could cure people; he would not call upon his own favourites, he would only use the skilful and experienced. After this discourse, the king of Chu, whenever he felt he was not well, would always wait for a skilled physician to treat him.” The king, Zhuo Xiang (after listening to the above exposition) said: “Fine.” Chong Nuan continued: “Have you forgotten? In the Shang dynasty, Yi Yin helped the ruler to treat the ills of the country, the greatly esteemed Jiang helped King Wu of the Zhou dynasty to do the same; likewise Baili Xi in Qin state, Shen Pao at Ying in Chu state, Yuan Ji in Jin state, Fan Li in Yue State, Guan Zhong in Qi state. These last mentioned five, all helped their respective rulers to achieve hegemonic dominance. Their skills were the same but the methods they advocated were different.” The king then asked what these differences were, to which Chong Nuan responded: “Haven’t you heard about what King Weiwen once asked Bian Que? King Weiwen wanted to know which of the three brothers in Bian Que’s family (all physicians) was the most brilliant. To this, Bian Que responded: ‘My eldest brother is the most brilliant, then my brother, and I’m the least talented.’ The King wondered why this was so. Bian Que explained: ‘My eldest brother is able to diagnose an illness and eliminate an illness, even before it manifests itself in terms of obvious signs and symptoms; hence, his reputation stays only within the family. My second brother could diagnose an illness as soon as the first set of obvious signs and symptoms appear in a patient; hence, his reputation spreads further afield, but not beyond the immediate confines of the neighbourhood. As for myself, I feel the mai, use acupuncture and moxibustion, prescribe potent drugs, rub medicated ointment on the patient’s skin and muscles; hence, my reputation spreads much further afield, and I’m well known amongst the elites.” King Weiwen then said: “That’s fine. What if one were to imagine that Guan Zhong were to apply Bian Que’s method of diagnosing and treating illnesses to ruling Qi state, would Lord Qi Huan be able to achieve hegemony over the other rival states? That is why such actors do not worry about the onset of actual illness, as even before the first obvious sign appears, they would be able to nip things in the bud, and the illness itself would never appear. This strategy of early intervention is most efficacious and the most natural. It follows that the truly excellent physician eliminates illness, while the not so talented have to fight and defeat illnesses. In the latter case, while it is true that the patient would with luck avoid death, nevertheless, the wounds would have been considerable, and he might even not be able to move his legs.” The king Zhuo Xiang then said: “Although I cannot prevent illness even before the illness has manifested itself in obvious signs and

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(Texts within round brackets are this author’s interpolations.)

The following observations are pertinent. 1. The book itself is said to be a Daojia text; its author is said to come from the state of Chu. His main ideas could be said to centre around four theses: (a) That as the world changed, our knowledge about it also changed, hence, everyone must keep learning. (b) The country, if it were to be run well, must rely on each one to do his best to make sure that it did. (c) The good/the wise/the capable must be championed, that is, given opportunities to make their contribution to society. (d) Private interests must give way to promoting the public good. As one can see, some of these ideas were pretty radical (as they would amount to the abolition of feudalism).10 It also contains chapters on the art of the military. 2. This passage cited comes from a chapter which relies on making an analogy between the skills of ruling and those of healing. It advocates the use of the wise and the talented in the two important domains of medicine and politics; more specifically, it makes the point that if in the latter domain, one were to rely at least on those whose skill and wisdom were comparable to those of Bian Que’s middle brother, society would be well run. If society were maintained at the more lowly skills of Bian Que himself, who had to rely on drugs and other therapeutic interventions, when the illness was already advanced and visible through obvious signs and symptoms, then society would be in quite a sorry state.11

10

For an account in Chinese, see *“Heguanzi” 2015; see Defoort 1997. Notice that Bian Que is presented here not as shang gong but xia gong; normally he is the former.

11

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3. In other words, the analogy presupposes the primacy of skills in the medical domain–the authors of the Heguanzi, the Hanfeizi deliberately introduced medical discourse to raise crucial points in political discourse. This again supports the claim made in Appendix Three in its critique of Professor Unschuld. 4. Note, too, that the term “ ५ ”/yi is used in the context of political discussion. In modern Chinese, the term is used as a noun; but as it is used as a verb in the passage cited, one should substitute “५⋫”/yizhi for it. Bian Que’s (apocryphal) eldest brother is shang gong/кᐕ, the truly brilliant physician; the middle brother is zhong gong/ѝᐕ, the middling brilliant but not absolutely brilliant physician; Bian Que himself is xia gong/лᐕ, the merely competent, the mediocre physician/yongyi/ᓨ५. The physician who practises Preventive Medicine is the shang gong, the truly brilliant. Another story is worth re-telling, just to emphasise the extreme importance that CCM attaches to the notion of Preventive Medicine. It concerns the late Han physician, Zhang Zhongjing/ᕐԢᲟ (150-219 CE)– for a discussion pertaining to some issues in the history of CCM, see Appendix Two. His prowess as a physician was told by Huangfu Mi/ⲷ⭛ 䉗 (215-282 CE) in his lj䪸⚨⭢҉㓿NJ/The Canon of Acupuncture and Moxibustion. Zhang Zhongjing once had occasion to talk to a scholar with distinguished literary talents, who had also risen to be an important official (an aide of the king/ֽѝ) in the State of Wei/兿ഭ, under Cao Cao. He was Wang Zhongxuan/⦻Ԣᇓ (177-217 CE). The scholar, then, was just over twenty; however, the physician told the young man that at the age of forty or thereabouts, he would lose his eyebrows and, half a year after that, he would be dead. Should he wish to escape such a fate, he must take the prescription (wushi tang/ӄ⸣⊔) offered to him. Naturally, the youth ignored such a dire warning. A little while later, the two men met again and when asked by the physician if he had taken the medicine, the young man claimed he had. Zhang Zhongjing told him that he was lying, as he (the physician) could tell by his complexion that he had not done so. Just more than ten years later, Wang Zhongxuan did lose his eyebrows, and 187 days after that, he died, aged 41. This account, in the opinion of many Chinese historians of CCM, could well have been true. However, the important thing to grasp is that such stories simply attested to Zhang Zhongjing’s immensely impressive powers of diagnosis and prognostication, in particular, to the exceptional reputation he enjoyed in the history of

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Chinese Medicine through the centuries. Zhang Zhongjing, just as Bian Que, was shang gong, the highest accolade that CCM could bestow on a practitioner.12 A passage from the Suwen, Chapter 5 may be said to accord well with the narratives about Bian Que’s and Zhang Zhongjing’s diagnostic skills. lj㍐䰞· 䱤䱣 ᓄ䊑བྷ䇪ㇷNJ˖ ᭵䛚仾ѻ㠣DŽDŽDŽ⋫ӄ㜿㘵ˈ ॺ↫ॺ⭏ҏ

Rendered as: The evil wind attacking a person may be likened to a storm whose course one can map. First, the evil wind enters the skin and its pores. Then it penetrates beyond the external surface to the interior. Hence, the truly distinguished physician (the shang gong) treats the illness at the level of the skin; the next in skill would treat the illness when it reaches the subcutaneous tissues; the next further down in the scale of skills would treat at the level of the sinews and the vessels, followed by the one who treats the five yang visceral organs (these could be said to be zhong gong); and finally the lowest in skill would treat the patient, when the illness has reached the five yin visceral organs (these would be the xia gong). When the illness had reached this most serious stage, the patient could be said to be half dead and, therefore, the chances of recovery would not be great, at best, fifty per cent.

(Texts within brackets are the author’s own interpolations.) We should note here that the categories of skill pertaining to the treatment of illness as set out above are, in turn, involved with a very important distinction between what is superficial/㺘 biao and what is interior/䟼 li in CCM theory-practice. Next, we need to clarify how these distinctions between shang gong, zhong gong or xia gong are used especially today. In general, CCM literature simply uses the distinction between shang gong and xia gong and so, by and large, the comments below would ignore the notion of zhong gong, except in some instances. Both shang gong and xia gong use the technique of wang/ᵋ/looking, one of the four diagnostic techniques in standard clinical medicine, namely, ᵋ 䰫 䰞 ࠷ (looking/listening and smelling/asking/feeling the mai). A detailed discussion of these techniques is found in Chapter Eight; for now, 12

For an account, see *Hao 2011.

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one concentrates on the role played by looking, deployed by the shang gong. All practitioners use the technique of looking; but what does each look for and look at? The shang gong looks, by and large, at the patient’s complexion and infers from this the patient’s medical past and present, then makes a prognostication about the future course of the illness for which, the patient (as a matter of fact) might not even have come to consult him about. Let us return to the story of Bian Que and his diagnosis of Duke Huan. In this narrative, Bian Que’s looking (unlike in other stories about the physician’s prowess where he had recourse to other diagnostic techniques such as to ask, to take the mai) was done in a minimal fashion. He looked only at the complexion. Looking at the complexion is, therefore, the height of the prowess of a shang gong. Such brilliant physicians need only to glance at the patient to immediately be able to diagnose and diagnose accurately–their reputation depended almost entirely on this ability. Indeed, CCM in its history is said to have distinguished four different levels of diagnostic ability which it calls: ⾎/shen/mysterious, almost divine, ൓ /sheng/wise and sage-like, ᐕ /gong/skilful or craftsman-like, and ᐗ /qiao/clever. These levels are correlated with each of the diagnostic techniques of looking, listening/smelling, asking, and feeling the mai as set out in the Nanjing, Chapter 61: ᵋ㘼⸕ѻˈ 䉃 ѻ⾎ 䰫㘼⸕ѻˈ 䉃 ѻ൓ 䰞㘼⸕ѻˈ 䉃 ѻᐕ ࠷㘼⸕ѻˈ 䉃 ѻᐗ13

to diagnosis accurately by looking/gazing is mysterious, almost divine to diagnose accurately by listening/smelling is wise and sage-like to diagnose accurately by asking is skilful or craftsman-like to diagnose accurately by feeling the mai is being opportunely clever

Surprisingly, the lowliest level of diagnostic ability, according to this account is feeling the mai. Today, probably many CCM practitioners may dispute this assessment of the technique. However, in those earlier days, there was no dispute that the highest level belonged to the technique of looking at the complexion and the lowest was feeling the mai. Zhang Zhongjing in the Shanghanlun, Chapter 2/ljՔሂ䇪·ᒣ㜹⌅NJwas of a similar opinion, although he only mentioned three diagnostic techniques and used a three-level classification of skill: 13

See *Liu Lihong 2003, 185-186.

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кᐕᵋ㘼⸕ѻˈѝᐕ䰞㘼⸕ѻˈлᐕ㜹㘼⸕ѻ

Rendered as: The shang gong only has to look and he could diagnose the illness, the zhong gong has to ask the patient/family before he could diagnose, and the xiagong must resort to taking the mai before he could diagnose the illness.

In China today, there are some physicians, who enjoy such a distinguished reputation as shang gong that they have to cope with long queues of patients. One such physician, in Nanning, whose name is Zeng Yong/ᴮ䛅, 14 on an exceptionally heavy day, is said to see up to 300 patients and, on an ordinary day, between 150 to 200 patients. Patients were processed into queues, those coming from villages and those from the city. For the sake of the argument, let us take 150 patients as a number (on an average day), and assume that the physician works eight solid hours (excluding breaks) per day. This would work out to say 3 minutes per patient. Such a physician himself, admittedly, would not be taking and making notes, pre- and post-diagnosis–his assistants would be doing that for him, including writing down the prescriptions he dictates. Incidentally, such an arrangement puts paid immediately to an argument, found often in the literature about Chinese medicine (in the West), which tries to explain away whatever success the medicine might have, on the basis that it owes its efficacy to the fact that the physician is prepared to spend as much time as the patient might wish to take over the consultation process. In contrast, a Biomedical general practitioner in the UK was recommended to schedule each appointment for ten minutes up to 2014-2015, but the average consultation in reality took/takes 12 minutes.15 TCM practitioners outside China may concur with the false impression, just mentioned, in order to emphasise the distinctiveness in handling patients under their care. Hospitals in China are, on the whole, very busy places, especially given its vast population, compared with populations in the Western world and their more favourable doctor-patient ratio. All that the particularly distinguished and experienced Laozhongyi/㘱ѝ५ could do, within the three minutes allocated to each patient is probably to make himself au fait with the notes taken by his assistants, while at the same time studying the patient’s complexion in the light of knowledge about CCM, in general, and, in this 14

See *Liu Lihong 2003, 131. Oxtoby 2010; Parkinson 2013; see also Cape 2002, for the finding that, patient satisfaction depended more on quality than quantity of time spent in the consultation process. 15

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particular case, his specialist in-depth knowledge (theoretical-clinical) of a very important notion, which is found in the Suwen, Chapter 9/lj㍐䰞· ‫ޝ‬ 㢲㯿䊑䇪NJ: н⸕ᒤѻᡰ࣐ˈ≄ѻⴋ㺠ˈ㲊ᇎѻᡰ䎧ˈнਟԕѪᐕ

Rendered as: As CCM upholds Macro-Micro-cosmic Wholism, the Qi cycle in greater “Nature” has a counterpart in the Qi cycle of the living human being in the course of a year; the relationships of Wuxing (see Lee 2017a, Chapter Seven) between different phases of the cycle occuring in both domains. For instance, the qi of Spring, Summer, Late Summer, Autumn and Winter each has its excesses and deficiencies, which do vary somewhat from year to year in the 60-year cycle as designated by the twelve Heavenly stems and ten Earthly branches system. A physician must grasp the complexities of Qi changes and transformations in greater “Nature” in order to understand such changes in the living human being, which would, in turn, allow him to understand why a person would fall ill. Even to count as a merely competent, workman-like physician, one must have a command of this matter.

(It is obvious that this rendering is hardly a literal and concise one–this author cannot, however, think of a more satisfactory means of making the passage intelligible to an English reader except by spelling out the details of the concept in the way presented.) The Nanjing/ lj 䳮 㓿 · ⾎ ൓ ᐕ ᐗ NJ , after listing and ordering its appraisal of the four diagnostic techniques, goes on to elucidate each as follows: ᵋ㘼⸕ѻ㘵DŽDŽDŽԕ޵⸕ѻᴠ⾎ˈ↔ѻ䉃 ҏ

Rendered as: The physician who can diagnose the illness in the patient by looking, does so by observing the five colours/wuse on the patient’s face as well as on the rest of the person. The physician, who can diagnose the illness by listening to the sounds emitted by the patient, does so via the five sounds/ wuyin, which are related to each of the five yin visceral organs. The physician who diagnoses by asking the patient what his/her tastes are (five tastes/wuwei), would know the source and location of the illness. The physician, who diagnoses by feeling the mai at the cunkou position on the wrists, would know if the illness is one of excess or deficiency as well as

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which Zangfu is involved. The Canon says that the physician who can diagnose in terms of asking about external indications, possesses sage-like qualities, while the physician who can diagnose in terms of internal factors/indicators possesses god-like qualities.

The four techniques mentioned above in terms of five-colours/wuse, five-notes, five-tastes and the mai are intimately related to the five yinorgans/Wuzang/ ӄ 㜿 . In this chapter we only discuss the looking technique in some detail; the others are left to Chapter Eight. Wuse is linked with Wuxing, in the following ways: the Liver, which is assigned green/blue, relates to Wood, the Heart, assigned red, relates to Fire, the Spleen, assigned yellow, relates to Earth, the Lungs, assigned white, relate to Metal, and the Kidneys, assigned black, relate to Water. The looking/wang technique is rated so highly because it is the one most associated with the notion of Preventive Medicine in the history of CCM, as shown by the Bian Que and Zhang Zhongjing narratives described earlier. The Lingshu, Chapter 38/lj⚥᷒ ·䘶亪㛕ⱖNJ says: кᐕ⋫ᵚ⯵ˈ н⋫ᐢ⯵ˈ↔ѻ䉃 ҏ

Before translating it, one must note that ᵚ in ᵚ⯵/wei bing in the first phrase does not mean “not” but “not yet”; wei bing, therefore, does not mean “no illness” but “not yet (full-blown) illness”. Hence, the quotation may be rendered as: The strength of the truly brilliant physician/shang gong lies in treating illness at a very early stage, before it reaches the stage of manifesting obvious signs and symptoms.

In other words, the shang gong diagnoses at the level of subtle signs. One could even say that it is beneath the dignity of a shang gong to treat conditions which a xia gong could handle with ease. In any case, it would be a waste of his talents which, after all, are rare. In the Lingshu, Chapter 4/lj⚥᷒·䛚≄㜿㞁⯵ᖒNJ, one reads: 哴ᑍᴠ 䛚≄ѻѝ䓛DŽDŽᴹᖒᰐᖒˈ 㧛⸕ަᛵ

Rendered as: The Yellow Emperor asks: “What happens when the xieqi/pathogenic qi attacks the person?” Qibo replies: “When the pathogenic factor which takes hold of a person is of an order which surpasses the severity

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associated with the potential for pathogenic disorder, presented respectively by each of the four seasons (that is xuxie/㲊䛚), then the illness will be severe and will make the patient shiver and feel chilly. However, when the pathogenic factor is of an order of severity no greater than what is normally associated with the potential for pathogenic disorder, presented respectively by each of the four seasons (that is zhengxie/↓䛚), then the illness is light, and is detectable only through a slight change in the complexion, it is hardly felt by the patient, who shows no other obvious signs and symptoms. The illness, then, gives the impression of being there and yet not there, being visible and yet not visible, rendering the condition difficult to diagnose.”16 (Texts within round brackets are this author’s interpolations.)

In other words, wei bing is perfectly detectable via the subtle signs of an illness (which is encapsulated in the expression 㿱ᗞ⸕㪇/jian wei zhi zhu), so subtle that it would escape the xia gong (as well as even the zhong gong). To better understand this ability, one would need to remind the reader that Qi exists in two modes, not only one, namely, Qi-in-dissipating mode as well as Qi-in-concentrating mode. Regarding the latter mode, we know that Qi has already materialised as a thing (a macro-sized object), which is visible, touchable, impenetrable, and so on; this mode operates under xingerxia, manifesting itself as something with form, shape and size. Regarding the former mode, we know that Qi operates in the domain of xingershang; it is at this level of Qi which the physician who is a shang gong can, nevertheless, discern or detect. We know, too, that according to Chinese philosophy/science, every phenomenon begins life in the domain of xingershang and then progresses to that of xingerxia–illnesses are no exceptions to this law. Qi at the level of xingershang, once detected/discerned by the physician, would lead him to infer that eventually the illness would manifest itself with full-blown symptoms at the level of xingerxia. This would be in accordance with Daojia philosophy, which postulates the transition from wu/ᰐ to you/ᴹ (see Lee 2017a, Chapter Four). That is why, when detected at the stage of incipient

16

This author translates 㢢 as “complexion”. For an alternative, see Kuriyama 1999, who translates it as “hue”. Hue is an aspect of colouration, and as such, is too narrow an understanding of what the technique of wangse entails; it involves looking at the patient’s complexion (not even solely the face but the person-body as a Whole), which includes colouration in order to “read” off the significance of Qi in the person-body of the particular patient at a particular time (see Figure 5.2).

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illness only, it would be so much easier to treat and to cure, as borne out by the Bian Que and Zhang Zhongjing stories narrated above. According to the axiom of Catastrophe Prevention (see above), the earlier the stage of intervention, the more controllable the situation. That is why, the hydraulic engineer, who is a “shang gong”, upon detecting a hole in the dyke made by an ant, would immediately repair it; he would not wait for water to seep through the hole before acting (as he would then be a zhong gong), or he would not wait for a small part of the dyke to collapse before acting (as he would then be a xia gong). While the shang gong would only need to resort to the smallest kind of repair work, which would cost nothing and very little time/effort, the zhong gong would need more equipment and more resources. The xia gong would have to bring in gangs of workers (even the army), with thousands of sand bags, and other more elaborate/sophisticated/heavier equipment and resources to prevent the dyke from collapsing totally, and causing utter havoc. The xia gong, using the words of the Neijing, is like those who start digging a well, when they are already dehydrated; or forging arms and weapons, when war has already begun–all a bit too late and at a great cost in terms of lives and other resources. Finally, the xia gong creates maximum drama and theatre, and ironically, earns a better image and even greater gratitude from society; the shang gong works as it were, in the shadow, goes about his task quietly, and generally goes unnoticed. Even worse, a shang gong’s work could even be said to be “unscientific” as one cannot prove “cause and effect”, from the Bm standpoint, that is to say. Take the case of Zhang Zhongjing’s diagnosis/prescription/prognosis of Wang Zhongxuan. Suppose that the patient did take the prescription; he then would not have lost his eyebrows and died six months later around the age of forty, but would have died, say, much later, at the age of sixty. How can one demonstrate to the satisfaction of the sceptic that the medicine prevented his premature death? Could it not simply be that Zhang Zhongjing’s dire diagnosis-prognosis was quite wrong in the first instance, and that Wang Zhongxuan would have lived to sixty, whether he took the prescription or not? History recorded that Wang did not take it, did lose his eyebrows and then died six months after at the age of fortyone. Ironically this tragic end appears to provide stronger evidence for the diagnosis-prognosis than the counterfactual history suggested. Even so, a thorough-going sceptic could always maintain that the historical narrative is simply a series of coincidences or chance events. In the case of the xia gong, although the sceptic might doubt that needling the pointy tips of a patient’s ears would lower his blood pressure (on the grounds that the pressure went down because of the placebo effect), that kind of doubt is at

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a different order from that regarding the shang gong’s ability to practise Preventive Medicine. (In this context, the xia gong concept is simply applied successfully to treating a patient when the symptoms are obvious, because the illness is full-blown. It does not imply that the physician, who can treat such cases successfully, is ipso facto not capable of possessing the skills of a shang gong which, in this context, is defined as someone whose skills are such that s/he can discern/detect incipient illness. However, the literature today takes pains to emphasise that the average, merely competent physician, that is, the xia gong, unlike the rare shang gong, should not solely rely on the technique of looking for a diagnosis.) In the discourse of Catastrophe Prevention in general, Chinese historians have been known to point out that the skills of the shang gong in CCM often went unsung and unhonoured. One such very distinguished historian was Sima Guang/ਨ傜‫( ݹ‬a scholar and poet, a high official in the Northern Song dynasty and the author of lj䍴⋫䙊䢤NJ/Comprehensive Mirror to Aid in Government). He told one of the emperors that he served, the following story about a doomsayer in a village, who had a prosperous neighbour. He warned the neighbour that his premises were likely to be burned down as the fire risks were high. The proprietor should alter the shape of his chimney, from being straight to being bent (in order to reduce the draught), and even more importantly, he should remove the logs piled up next to the fireplace itself. Naturally, the owner thought the man was talking nonsense and ignored his advice. Not long after, a fire did start in his fireplace and began to spread rapidly. Owing to the prompt and courageous behaviour of his fellow villagers, the fire in the end was put out, and his property did not burn down. All the same, these volunteer firemen were injured, some more severely than others. The grateful owner celebrated his lucky escape and also hosted a great feast to express his gratitude to all who had rallied to help him on that disastrous day. He sat the most seriously burnt and injured of the villagers at the top table, next to him, followed by those less badly injured. However, his list of guests did not include the doomsayer. Another (intelligent) villager remarked to his host that the absence of such a guest was not proper, and explained that the doomsayer should have been his most important guest because, if he had listened to his good counsel, there would have been no fire at all, no one would have been injured, and no damage to property would have occurred. Finally, the owner realised how ignorant and unwise he had been. Sima Guang told this tale to his emperor, Renzong, hoping to impress upon the ruler the importance of listening to the wise and good counsel of

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his officials in Catastrophe Prevention.17 The shang gong should always be the most honoured, although often he was/is not. The shang gong in CCM is no different from all the other shang gong engaged with Catastrophe Prevention in activities, such as the military, political, engineering, and fire-fighting domains, as they act in conformity with the principle of the Dao, that is, understanding/instantiating this grand principle within their own respective contexts to generate their own specific dao, be it of fire-fighting, diagnosing and treating illnesses or whatever. The Dao constitutes the highest form of knowledge/ wisdom/ skill–the shang gong is not so much concerned with either mere technical expertise, which is ᵟ/shu, or with instrumentation/ instruments, which is ಘ/qi. Technical expertise and instrumentation are at the level of Qi-inconcentrating mode, with things belonging to xingerxia, whereas the Dao is about Qi-in-dissipating mode and hence, the shang gong, unlike the xia gong, is working in the domain of xingershang. In other words, there is a deep underlying “methodology” embedded in Daoist philosophy (Daojia not Daojiao). The shang gong is said to possess ᛏᙗ/wuxing, the ability, as we have just said, to infer a future state of affairs from an extant state of affairs, just as the shang gong physician, Zhang Zhongjing, inferred from the complexion of the young man, his demise at an early age, nearly two decades later. This is, in fact, no more than Daojia bringing out the philosophy and its accompanying methodology, embedded in the Yijing. This truly foundational text of Chinese culture and civilisation is not simply about divination but is, at depth, about the science of change (as shown by Lee 2017a, Chapters Five and Six). These changes may occur in the domain of divination or other domains, such as the political, the military, the medical, and so on. The eight trigrams encapsulate the potential for change, from which the investigator can make inferences within his/her own domain of activities. As already noted several times, Chinese thinking is prone to invoking analogies; however, doing so is but a mere reflection of its philosophical/scientific starting point, namely, that everything in the universe is subject to Laws of Nature, governed by the changes in yinqi and yangqi. Given this underlying unity, through grasping thoroughly a subject matter in a particular domain, one would be able to see the underlying similarities and differences between it and other subject matters, and be able to cast light on the new domain, through the lenses of the old, so to speak. The Chinese call this mode of advancing

17

See *Zhao 2015.

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understanding 䀖㊫ᯱ䙊/chu lei pang tong, behind which, stand the Yijing and the Laozi. The shang gong, in CCM, by detecting the subtle signs of abnormalities in the patient’s complexion, is guided by its relationship to the Zangfu (see Figure 5.2).

Figure 5.2: Different parts of the face and their respective relationships with the five yin visceral organs/Wuzang

For instance, the Suwen, Chapter 32/lj㍐䰞·ࡪ✝ㇷNJreads˖ 㛍✝⯵㘵ˈ ᐖ人‫ݸ‬䎔DŽDŽDŽ⊇ བྷࠪҏ

Rendered as: When febrile illness occurs in the Liver, one would notice redness, first appearing on the left cheek (of the patient). When it is in the Heart, one would notice redness, first appearing in the forehead. When it is in the Spleen, one would notice redness, first appearing in the nose. When it is in the Lungs, one would notice redness, first appearing in the right cheek. When it is in the Kidneys, one would notice redness, first appearing on both cheeks. In such instances, the changes in the complexion occur before the illness really takes firm roots in the patient, and when the physician needles as soon as the changes are discerned, this would be to practise Preventive Medicine. If the redness is first discerned in a certain part of the face, and if treated immediately, the illness would be eliminated. However, if the wrong treatment was performed (such as using the bu/supplementing

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rather than the sedation technique), then the illness would be prolonged, and one would have to wait for three weeks before recovery could take place. And if another mistake were made, the patient’s fate would be sealed. In short, when the right technique is used at the right time in treating febrile illnesses, the patient would break out in a great sweat, after which s/he would recover–that is to say, the physician would have scored another triumph. (Texts within round brackets are this author’s interpolations.)

The Suwen, Chapter 39/lj㍐䰞·ѮⰋ䇪ㇷNJsays: ᑍᴠ˖ ᡰ䉃䀰㘼ਟ⸕㘵ҏDŽDŽDŽ㘼ਟ㿱㘵ҏ

Rendered as: The Emperor said: “The knowledge (which you have expounded on) can be found through reading and discussing the illnesses concerned, what knowledge of what illnesses can be obtained just by looking at the patient?” Qibo replied: “Those pertaining to the yang and yin organ-systems, as these manifest themselves in different parts of the face. Once you observe the complexion of the face, one would know the diagnosis: yellow and red indicate heat, white means cold, bluish-green indicates pain.” (Text within round brackets is this author’s interpolation.)

Preventive Medicine in CCM and Preventive Biomedicine in Biomedicine Of late, Bm has come to subscribe to the notion of Preventive Medicine. Let us say a few words by way of a quick, though simplistic, comparison between the respective ways of understanding the concept for each of the two medicines. First, it is obvious that Bm’s manner of “looking” at the patient is done via high technology, unlike CCM, which is bereft of technology of any kind. The first X-ray machine was formally exhibited in January 1896, based on the discovery of X-rays by Wilhelm Röntgen in 1895. Since then many improvements have been made, so that today it is referred to as an “x-ray imaging system”. Not only is it able to see straight through clothing, flesh and even metal, but it is also, through contrast media, able to show clearly organs, say, in the digestive and endocrine systems, by bringing them into focus through a barium meal. If the doctors wish to examine

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blood vessels or other parts of the circulatory system, they can inject contrast media into the patient’s bloodstream.18 Other high-tech machines include Positron Emission Tomography (PET), which works by detecting gamma rays, given off by a radioactive tracer injected into the body. A PET scan can, by producing detailed threedimensional images of body tissues, show what they look like and the condition under which they are working, and can help the oncologist to diagnose a cancer, and determine the stage of its development and, hence, its treatment. Such a scan can measure important bodily functions, such as blood flow, oxygen use and glucose metabolism.19 Yet another is Magnetic Resonance Imaging (MRI) which has been in use since the 1980s. It relies on a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and practically all internal body structures. It is held to be safer as it does not make use of X-rays and, hence, avoids the problems associated with ionizing radiation; but it can be more expensive and induce a claustrophobic effect on the patient as s/he is encased by the machine.20 Instruments, machines and medical technology enable the doctors to observe “directly” what is internal to the patient. Admittedly, for the expert, to “directly” see the internal organs, requires special knowledge and techniques of interpretation, which the lay person lacks–the latter would not see anything that the experts see, such as early or late cancerous growth. However, in contrast, physicians in CCM have no machines to enable them to “see” inside the patient–what they can do is simply observe in the most direct, unmediated way possible, the patient’s complexion, and discern the changes of colouration in different parts of the face (and the rest of the person’s body). Such observation and discernment form the basis for inferring what could be the state and condition of the patient’s internal organ-systems and their functioning, according to CCM theory which postulates the link between wuse and Wuzang/the five yin visceral organs, the notion of Tianren-xiangying/Macro-Micro-cosmic Wholism. All these, therefore, play a crucial role in interpreting what they see in the patient’s face. In other words, physicians in CCM have no direct access to the inside of the patient, unlike the specialists in Bm, who do, via high-

18 See “(The) X-ray machine” 2015. CT or CAT (Computed Tomography) also uses X-rays; it produces a series of two dimensional cross-sectional images or “slices” around an axis and has been in use since the early 1970s. 19 See “PET Scan” 2014. 20 See “MRI Scan” 2015.

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tech of the kind mentioned above. In the Lingshu, Chapter 47/lj⚥Җ·ᵜ 㯿NJa passage reads˖ 哴ᑍᴠ˖ ৊㮴㖾ᚦDŽDŽDŽࡉ⸕ᡰ⯵⸓

Rendered as: The Yellow Emperor says: “Since the yang and yin organ-systems are different in shape, some are thick and others thin, and they differ in look, I would like to know what sort of illnesses they could each cause?” Qibo responds: “When one observes and examines the patient in different parts of his person-body, one would know which organ-system they each correspond to as well as the state of their functioning. From this one would be able to diagnose the illness the patient is suffering from.”

Another relevant passage in a preceding chapter, which expounds on this point, is found in the Lingshu, Chapter 45/lj⚥᷒·ཆᨓ NJ. Indeed, the title of this chapter may be rendered as “Inferring from the exterior to the interior”. The passage begins with Qibo, attempting to elucidate for the Yellow Emperor, how acupuncture works by saying that the relationship between the needling and what happens to the patient, is analogous to the relation between the sun and the moon (and the objects they shine upon), to water acting like a mirror, to the drum and its beat. When the sun and the moon shine their respective light on the things on Earth below, they inevitably produce shadows; water (which is clear) will unfailingly reflect, like a mirror, things around it, while the drum, when struck, would produce sounds simultaneously. When one grasps that the shapes of things can be faithfully reflected, that drum beats come from the striking of the drum, then you would understand how acupuncture works. When the Emperor heard this analogy, he proceeded to expound on it thus, applying the analogy to diagnosis in the clinical context: ਸ㘼ሏѻDŽDŽDŽᕇᮒ֯⋴ҏ21

Rendered as:

21

A passage, which follows closely the Neijing, may also be found in a Yuan text (1347 CE) by Zhu Zhenheng/ᵡ䴷Ә, entitled Dan xi xin fa/ljѩⓚᗳ⌅㾱䇰NJ: ᴹ䈨޵㘵ˈᗵᖒ䈨ཆ, which may be rendered as: “Changes in the functioning of the internal organ-systems are necessarily manifested in visible external signs and symptoms.”

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In diagnosing, one must take into account all sorts of observations about the patient and then relate these to the further information yielded by the techniques of feeling the mai, and looking at the complexion, which give a bigger picture of the illness, as judged by the totality of such signs–these would be analogous to clear water, like a mirror, faithfully reflecting the objects above/around it. If the patient’s vocalisations/wuyin are weak and the colours/wuse are dull, this would indicate clearly that the five yin visceral organs are not functioning properly.22 This is an illustration of the correlation between external signs and internal conditions, which would be analogous to the water and its ability to reflect surrounding objects, to the sounds reverberating from the striking of the drum as well as to things (in sunlight and moonlight) casting shadows, which faithfully follow them. That is why, through grasping the signs exhibited by the patient and observing their changes, it is possible to infer conditions, which are held in the patient’s interior and the changes occurring therein. In turn, by being able to make such inferences, this knowledge/information enables the physician to better grasp the conditions of the patient’s illness. This constitutes, in a nutshell, the discourse of Yinyang (in CCM and beyond). The universe may be large but nothing in it escapes the Yinyang rubric of understanding and explaining phenomena. Let us never lose sight of this precious illuminating insight. (Texts within round brackets are this author’s interpolations.)

After the above elucidation of the method of diagnosis in CCM, let us return to the “privileged access” to the internal organs as enjoyed by the high-tech of Bm. Does it play a role analogous to that played by the shang gong, who is said to be able to diagnose and treat incipient illness, so that the illness would not become full-blown, as part of the concept of Preventive Medicine? As far as one can ascertain, scans, such as PET and MRI are used when the disease is full-blown and advanced, rather than as part of a screening programme (unless in exceptional cases). Furthermore, because they do not appear to be designed for the task of putting in practice the target of Preventive Medicine, it is not obvious that they are capable of detecting in the images they generate, incipient stages of a disease. In CCM, what the physician is looking at in the patient’s complexion is Qi-in-dissipating mode, not Qi-in-concentrating mode, whereas machines in Bm are designed to pick up, at best, the earlier stages of Qi-in-concentrating mode, not Qi-in-dissipating mode (which belongs to xingershang), as these latter concepts do not even begin to make any sense within the thing-ontology of Bm. 22

Turn to Table 4.2 for further elucidation on wuyin and wuse and their relation with the five yin visceral organs.

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There are some machines which can pick up some early stages of disease, such as lung cancer or breast cancer. In the breast screening programme which involves what is basically an X-ray machine, the breast is placed between two flat X-ray plates. Such tests are said to clear 96 per cent of those tested, but about 4 in 100 are asked to attend for more detailed tests. Of the four recalled, only one, in the end, would be found to be cancerous. The Cochrane Review, whose evidence-based medical research is held to be authoritative (see Chapters Six and Seven for a detailed examination of RCT and EBM) in 2013 concluded that for 2,000 women screened for 10 years, one would avoid the fate of dying of breast cancer. Since then, a study in Canada, which looked at the data of 25 years of breast screening, claimed that it had found no real evidence to show that breast screening prevents deaths. Furthermore, screening may throw up both over-diagnosis (as there is no method of predicting whether the early stages would turn out in the end to be either aggressive or slow in development), or under-diagnosis (failing to pick up those who already have the disease at an early stage), as some cancers are not seen at all; as well as human error, when the person reading the mammogram misreads it.23 Another area of Preventive Medicine researched since the Human Genome Project (90 per cent of whose findings were made known in 2001) is gene therapy which is defined as follows: Gene therapy is an experimental technique that uses genes to treat or prevent disease. In the future, this technique may allow doctors to treat a disorder by inserting a gene into the patient’s cells instead of using drugs or surgery. Researchers are testing several approaches of gene therapy, including: x Replacing a mutated gene that causes disease with a healthy copy of the gene. x Inactivating or “knocking out” a mutated gene that is functioning improperly.

23

Regarding these points about mammography, see “Mammography and breast screening” 2014; regarding the efficacy of screening programmes in general, see Evans, Thornton, Chalmers 2011, Chapter 4, in which the authors argue that, although screening, in principle, sounds so sensible, nevertheless, in practice, such programmes often do more harm than good for several reasons, two of which are: they do give false alarms (that is, over-diagnosis and false positives) and they are unnecessary, painful and sometimes, even mutilating interventions. They go so far as to say: “Not introducing a screening programme can be the best choice” (ibid., 49).

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Introducing a new gene into the body to help fight a disease.24

A quick comment must immediately be made to distinguish between what are called somatic gene therapy and germ-line gene therapy–the former affects only the individual, not the transmission of heritable material to posterity, while the latter involves just that gene (see Lee 2005, Chapters Two and Four). This future technology as well as the screening technology are intended to be forms of Preventive Medicine (whether they work effectively in practice or not). Thus they have certain characteristics in common: they are conducted within the framework of thing-ontology, and rest on a model of causality, which is thoroughly alien to CCM, as it is a linear, monofactorial model. (On the linear model of causality, presupposed by the dominant domain in Bm, which may be called the monogenic conception of disease, see Lee 2012b, Chapters Nine and Ten; on the non-linear model presupposed by Epidemiology, see Chapter Twelve; on the non-linear model of causality, presupposed by CCM, which is necessarily multifactorial, see Lee 2017a, Chapter Eleven.) Furthermore, this sense rests on the notion of cause as a necessary condition only. Such an interpretation of cause sits uncomfortably within the philosophical/theoretical framework of CCM, as its conception of nonlinear, multifactorial causality rests on Wuxing, which determines the mutual relationships between, and causal impacts upon, the yin and yang organ-systems in generating conditions of illness as well as underpinning conditions of health in the person. A necessary condition is simply a condition in whose absence an effect would not occur (also known as a condition sine qua non). Take the example often cited of oxygen being a necessary condition of the occurrence of fire–while the absence of oxygen would guarantee the absence of fire, the presence of oxygen does not mean that a fire would occur. It is true that taking out a person’s tonsils (tonsillectomy) would eliminate tonsillitis; but the presence of tonsils would not necessarily bring about tonsillitis, as other relevant conditions must also arise. The same logic holds, if one were to argue, that to prevent disease from occurring in a person, killing the person would prevent the occurrence of disease and suffering, as being alive is a necessary condition for the occurrence of disease and suffering. The removal of organ parts, such as the tonsils or the appendix, in the history of Bm, was a standard intervention at one time–this is to be explained by the fact that the paradigmatic science 24

“What is gene therapy?” 2015; see also Lee 2005.

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was/is anatomy, and the paradigmatic technology is surgery (see Lee 2012b, Chapters Seven and Eight). Today, while the removal of such organs is no longer fashionable, the removal of other organs includes the breasts of women, who have been found to possess the BRCA1 or BRCA2 gene, and come from a family with a history of breast cancer. The removal of the breast(s) is justified on the ground that should such a gene mutate or become altered, cancer may develop which, in other words, means that the possession of such a gene increases the risk of breast cancer, ovarian cancer and even other types of cancer. 25 In contrast, as we shall demonstrate in Chapter Nine, the paradigmatic science in CCM is physiology, and while, naturally, not ignoring dissection/anatomy as well as minor surgical interventions nevertheless, it does not focus on them. CCM does not entertain cause only in terms of a necessary condition.

Conclusion 1. The discourse of Preventive Medicine in CCM should not be distorted by a misunderstanding, which presents its logic, not as a primitive concept in its own right, but parasitic upon political discourse. Contrary to this contention, this chapter has drawn up evidence to establish that, to all intents and purposes, Preventive Medicine could have inspired political thinkers to adopt and adapt it for their own purposes in the art of ruling. 2. Furthermore, there is evidence to show that both medical and political discourses could have drawn inspiration from the same sources, first the philosophy of the Laozi (and its key concepts of wu and you) on the one hand, and very practical discourses, such as the management of dykes and the spread of fires on the other hand. They are all instantiations of what may be called the axiom of Catastrophe Prevention. 3. More specifically, Preventive Medicine in CCM is premised on two interrelated distinctions between Qi-in-concentrating mode and Qi-indissipating mode, on the one hand, and between shang gong and xia gong, on the other. 4. A xia gong can only diagnose an illness when it is already full-blown, when the illness has taken root in the patient, with its signs and symptoms clearly manifest. A shang gong has the rare talent of being able to detect and discern incipient illness via picking up subtle signs and, as a result, 25

See “BRCA1 and BRCA2: Cancer Risk and Genetic Testing” 2015.

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treatment is simple and light-handed, resulting in the avoidance of serious suffering/illness or death further down the line. 5. A xia gong operates only in the domain of Qi-in-concentrating mode, in the domain of xingerxia, whereas a shang gong operates in the domain of Qi-in-dissipating mode, in the domain of xingershang. 6. The shang gong, by using the technique of looking at the patient in a specific way, can tell by the complexion, the difference in colouration between different parts of the face, which internal organ is not functioning properly and, hence, can prescribe accordingly, to eliminate the illness at source–this is one understanding of the CCM notion of ⋫ᵜ/zhi ben, treating the illness at its roots as opposed to ⋫㺘/zhi biao, treating the illness by eliminating or controlling the symptoms only. 7. By attending to Qi-in-dissipating mode as discernible in the patient’s complexion and/or through feeling the mai, the shang gong is paradigmatically working within the framework of process-ontology. 8. In contrast, in Bm, its notion of Preventive Medicine is rooted in thingontology, in the domain of xingerxia, where Qi-in-concentrating mode (according to Chinese philosophy and CCM) operates, as its use of hightech machines relies on the material manifestations of a disease in terms of diseased cells, tissues, organs, tumours, reduced blood flow because of restricted blood vessels, and so on. As Chapter Nine as well as Lee 2012b, Chapters Six, Seven and Eight point out, in the history of Bm, anatomy based on dissection (whose emphasis is on the material structure of body parts) is the paradigmatic science. In contrast, the paradigmatic science presupposed by CCM is physiology, whose emphasis is on the functioning of the yang and yin organ-systems/the Wuzang-liufu, the complex interrelationships between them, which are governed by Yinyang-Wuxing, the relationship between xue/blood which is yin and Qi which is yang, and the relationship between Qi-in-concentrating mode, on the one hand, and Qiin-dissipating mode, on the other. CCM is primarily not interested in cadavers but in living human beings where xue and Qi circulate–the former as Qi-in-concentrating mode in the Blood Circulatory System and the latter as Qi-in-dissipating mode in the Jingluo network. Its conception of causality is non-linear and multifactorial as well as informed by Yinyang-Wuxing. Bm, on the other hand, relies on the linear and monofactorial model, which is totally alien to CCM.

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9. Both Bm and CCM make the distinction between primary (wider meaning) and secondary prevention (narrower meaning). Both would agree that catching a cancer (caused by nicotine toxins) at the earliest stage constitutes the latter while quitting smoking altogether would constitute the former. 10. Both medicines, either implicitly or explicitly, make the distinction between signs and symptoms as well as hold that the patient’s own report about symptoms is neither necessary nor sufficient for diagnosing the patient as ill or suffering from a disease-entity/illness. 11. The above themes should be read in conjunction with Appendix Four as well as Appendix Three. The latter contains additional argument to show that the earliest inspiration for the axiom of Catastrophe Prevention came from China’s attempt to control floods, by controlling, in particular, the flow of the Yellow River and its tributaries.

CHAPTER SIX PERSON: AS A PRIMITIVE CONCEPT IN CCM

Introduction Person-hood, as a primitive concept, is a distinctive feature of CCM, as it is an entailment of the key notion of Wholism, a theme set out already in Lee 2017a, Chapter Ten. That discussion has deliberately left aside this particular form of Wholism in Chinese philosophy as it is specific, in the main, to Chinese medicine, and so would be more appropriate for a detailed exploration, here. In a nutshell, what is meant by saying that person-hood is a primitive concept in CCM is to say, that the mental and physical aspects of a human being are inextricably intertwined and cannot be separated out. This kind of Wholism is, in turn, but an instantiation of Contextual-dyadic Thinking, which is distinctive of Chinese philosophy. The above remarks would undoubtedly make one turn some attention to how Bm (in the clinical trial context as well as the research context of the placebo effects as psycho-biological phenomena) understands the relationship between the mental and the physical. Again, in a nutshell, what one can say is that Bm rests on Dualism, not Dyadism. So let us first set out briefly the doctrine of Dualism, as it is understood, in the history of Western philosophy and Modern Medicine.

Cartesian dualism and its aftermath for Western philosophy and its medicine Lee 2012b argued that René Descartes (1596-1650) was one of the leading philosophical giants who pioneered the new philosophy (over-riding Aristotelianism presupposed by medieval science), which provided the underpinning for the new science. This in turn allowed the modern worldview to emerge, namely, that all naturally-occurring things in the world are but machines–this constitutes an ontological volte-face

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completing the new philosophical framework within which Modern Science, and therefore Modern Medicine, could comfortably operate. More specifically, Descartes introduced what has come to be called Cartesian dualism, which was performed upon the human individual. The two aspects–physical and mental–were re-cast in terms of two different substances, namely, Body, which is material; and Mind, which is immaterial substance. Descartes struggled to reconcile two things which, at first sight, seemed irreconcilable–the uniqueness of human beings (because of their type of consciousness) and, at the same time, their commonality with the (higher) animals. Humans, like animals, have bodies, but they also have minds (also called Reason in secular thought, or the Soul in theological discourse), which distinguish them from animals. Dualism neatly permitted Descartes to cope with this conundrum. All bodies are forms of Matter; Matter is brute and inert, subject only to the laws of motion. This was understood by the new physics, of which Galileo Galilei (1564-1642) was a pioneer, to be followed by the giant of Modern Science, Newton (1642-1726). In the old philosophy, the Soul resided in Matter, which was awkward for Modern Science. Hence, Descartes expelled the Soul/Reason/Mind from Matter, making Matter par excellence the paradigmatic object of scientific study. For Descartes, as animals had no Soul, they were only bodies and, therefore, were mere automata.1 Humans are unique in two related ways: they possess not only Body but also Soul/Reason/Mind; Mind and Body, however, are two very different substances, with Mind being superior to Body. In Western philosophy, under thing-ontology, Body for Descartes is res extensa, substance with extension, while Mind is res cogitans, thinking substance. In this way, not only did Descartes succeed in rendering human bodies as Matter to be appropriate objects of scientific investigation, but he also accommodated the theological requirement of human beings uniquely possessing Souls, which have to be saved. As Souls have nothing to do with Matter, they are beyond the domain of science and its methodology, and would be the concern not of science, but of theology alone. In this way, Descartes paved the way for science and theology to coexist, even if not always harmoniously in the Age of Modernity. 1

Such a view may sound extreme. Although not every thinker had swallowed it whole, nevertheless, it enjoyed widespread support till quite recently, as advocates of animal welfare and rights remind us. Julian Offray de la Mettrie (1709-1751), in his infamous book entitled L’homme machine, published in Holland in 1748, (but in English, two years later as Man A Machine), while championing that man-ismachine, nevertheless, did not subscribe to the extreme Cartesian thesis that animals were plain automata.

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Furthermore, of the two substances, Mind was distinctly superior to Body– this concession would please theologians, in general, and satisfy Descartes’s own religious feelings. Once this crucial conundrum had been solved by the Cartesian approach, Modern Science could safely study all bodies, including the human body, as machines. That is why, unsurprisingly, Modern Medicine was one of the first sciences to be established. Descartes did not simply make it possible for theology/religion to accommodate Modern Science. His legacy is much wider, as his general doctrine of Cartesian dualism became the entrenched mode of thinking in Modernity. Such a mode could then be applied in other contexts to strengthen a certain favoured position. In this way, Cartesian dualism permitted/permits those hostile to Modern Science and its focus on the primacy of Matter, to assert that in the Mind-Body dualism, Mind is superior to Matter, and for those who wished/wish to uphold the primacy of Matter to hold that Body is superior to Mind. In other words, this general doctrine of Dualism can logically support, on the surface, two contradictory positions. This, however, is merely appearance, as in reality there is no contradiction. What the two have in common is simply the fundamental claim that one party of a dualist pairing (it does not matter which) is primary or superior to the other party named in the Dualism. This strategy is what Plumwood 1993 called “hyperseparation”. Lee 2017a, Chapter Nine used this very strategy to critique Dong Zhongshu (Han dynasty) when, in the name of Confucian patriarchy (which he pioneered), he changed Contextual-dyadic Thinking into Dualistic Thinking; so in this sense, Dong could be said to have anticipated the Cartesian strategy.2 Hyperseparation entails the justification that the systematically privileged item possesses exclusively a certain valued property. One version of the Mind-Body dualism attributes to Mind the possession of Reason, which privileges it over Body, which is mere Matter, without any hint of Reason to it. In the Man-Woman dualism, Man is privileged over Woman, as the male is said to possess Reason, either exclusively or to a higher degree, whereas the female is said to lack Reason altogether (possessing sentiment instead); or (in the case of Kant) possessing it, at best, to a very low level. Hence, Man is superior to Woman, or in the popular language of feminist discourse, this constitutes patriarchy/“male

2

For a discussion of the author’s critique of ontological dualism in environmental philosophy, see Lee 1999, 180-184.

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chauvinism”. 3 However, as Bm rests on thing-ontology, the original Cartesian pairing of Mind over Body would not be compatible with it; it must, therefore, be replaced by the new dualist pairing of Body over Mind (Body-Mind dualism). Modern philosophy regards Matter as the primary and sole subject matter for scientific investigation. Furthermore, if all organisms including human beings are nothing but machines, machines are understood and explained in reductionist terms. One must take the bull by the horns and simply invert the relationship of superiority and inferiority between Mind and Body. Modern Medicine begins boldly to hold that Matter/Body is primary and superior. Science after all is about the investigation of Matter in an objective manner. Mind is not Matter and Mind can only deliver reports of subjective experience. To be consistently scientific, one must adopt Reductionism, Mind must be reduced to Matter/Body. At a stroke, Reductionism solved the problem of the relationship between the mental and the physical. The reduction of mental attributes (Mind) to physical attributes (Body) entailed by this replacement version of the dualist pairing solves the problem, which the original version could not. Under the latter, if Mind and Body are two different substances, how can there be a link between the two? Descartes postulated the pineal gland to be the link organ, as it was, for him, the seat of the Soul as well as of Reason. This gland is no bigger than the size of a pea, and is attached to the base of the brain; however, Modern Medicine/Science soon showed that it is an endocrine gland, producing a hormone, called melatonin, which controls growth and development as well as the functioning of the other endocrine glands in the body. Descartes turned out to have been wildly wrong in this matter. 4 Philosophers after Descartes solve this problem via Reductionism which claims that there are not two substances involved, only one, namely, Body. Scientists and some philosophers today claim that only Body/Matter exists, as the mental is nothing more than what is happening at the level of brain cells, whose functioning is the key to revealing Reason at work in the person. Neuroscience is expected to unravel the mysteries that Reason and Mind have posed over the ages. In the philosophy of mind, the strong reductionist line simply regards mental functioning to be nothing more than the activity of brain cells at the level of neurons and synapses (Churchland 1986); the less extreme end of the spectrum, nevertheless, holds that there is only bottom-up causation (at the level of the 3

One (well-known) dictionary defines “male chauvinism” as: “a man who believes that women are naturally less important, intelligent, or able than men, and so does not treat men and women equally”. 4 For a fuller account, see Lokhorst and Kaitaro 2001.

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physical/brain activity), no top-down causation (Kim 2005), never mind systemic causation (Lee 2017a, Chapter Ten), that the whole cannot exert any effect on its component parts, as the whole is no different from the sum of its parts. Brain activity, as construed according to Reductionism, could be seen to be at work in an important domain of Bm, namely, in psychopharmacology. When mental disturbance in an individual leads to socially undesirable/difficult behaviour, the preferred strategy is not via psychotherapies (psychoanalysis, counselling, and so on) but through physical interventions, such as Electro Convulsive Therapy (ECT) or the use of psycho-pharmacologic drugs. Such drugs and ECT are deemed to be the way forward, because the chain of causation runs in a straightforward manner from Matter (the chemicals in the drug or the electric forces in ECT), to Matter (other chemical/electric reactions in the brain). Bm claims that the causal mechanism involved in such a transmission is clear and unproblematic. The model of causation is an aspect of Humean causation, the Billiard-ball model, which is the impact of Matter upon Matter. Psycho-pharmacology in Bm conforms to the following causal framework: (a) The causal arrow runs from Matter (as a drug) to Matter (as Body). If the patient suffers from inflamed gums, an antibiotic could eliminate the bacteria-based infection. (b) The causal arrow may run from Matter (as a drug) to produce effects at the level of Mind. This is how psycho-pharmacological drugs work. A patient who suffers from depression (a mental phenomenon) would be prescribed an anti-depressant (a bit of Matter), which is expected to lift the depression, by having an effect on other bits of Matter in the brain. This model about states of consciousness (Mind) appears to accord with what is called epiphenomenalism, as opposed to interactionism, which Descartes advocated. Epiphenomenalism is the view that, while mental events are caused by physical events in the brain, they themselves have no effects on any physical events. The main difference between it and interactionism lies in this. Under interactionism, mental states can bring about changes in physical states, just as changes in physical states can produce changes in mental states–I decide to punch you on the nose because you have just insulted me (a mental event), the punch connects, and as a result, your nose is broken and bleeds badly (physical events); I take a psychoactive drug (a physical event) for my depression, my

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depression is then lifted (mental event). Under epiphenomenalism, the causal direction is only from physical states to mental states, but not vice versa. A mother is worried that her son may get killed fighting at the front (mental event), and her blood pressure goes up (physical event). There is then news to say that her son is on his way home, as the war is now officially over; she feels greatly relieved (mental event), and her blood pressure returns to normal (physical event). Such outcomes are not compatible, strictly speaking, with epiphenomenalism. On the other hand, epiphenomenalism can readily explain that a depressed patient, upon swallowing an anti-depressant (the drug is physical) would no longer feel depressed (a mental event). This could account for why Bm has chosen to go down the route of psycho-pharmacology and is dismissive of other forms of psychiatric interventions, which appear to adhere to interactionism (not necessarily at the level of different substances, but at the level of mental events interacting with material substances to produce physical effects) rather than epiphenomenalism.5 As the causal arrow does not and cannot run from Mind to Matter/Body, as understood in Bm, this would in turn explain the attitude of Bm to the placebo effect, which appears to stick like a bone in its throat. Initially, Bm, as we shall see, denies at the empirical level that the placebo effect is a genuine phenomenon. Today, so much evidence has been collected that denying it at the empirical level becomes itself unscientific; yet, it seems to run counter to epiphenomenalism, as it appears to instantiate a mental phenomenon causing physical effects. This leaves Bm holding the Maginot Line that the causal arrow cannot run from Mind to Body. What is the logical force of this “cannot”? Later on, in this chapter, this topic is re-visited. Chapter Seven explores the nest of problems raised in the context of RCTs as one of the twin Gold Standards in clinical Bm.

The Humean Legacy: Passion/Emotion as beyond Reason It is not simply the Cartesian legacy that modern philosophy and medicine have to cope with. Another philosophical contribution is significant, coming from Hume (a Scottish Enlightenment philosopher), who espoused the Reason-Passion dualism. It is obvious that the human being possesses not merely physical characteristics but also mental ones; that such a being possesses Reason, on the one hand, and Emotion, on the other. Which then 5

For further brief details about interactionism and epiphenomenalism, see Robinson, Howard 2012; for an account of epiphenomenalism, see Robinson, William 2015.

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is the privileged side according to Dualism? For the Enlightenment Rationalist philosophers (such as Kant), Reason is clearly superior to Emotion, which Hume called Passion (which includes emotion, feelings and desire). For Hume, Passion may be said to be superior to Reason as it is not ruled by it. If it is true that Passion/Emotion is beyond the pale of Reason, it would follow that it makes no sense to say that our preference for one thing is more (or less) rational than our preference for another. What would you like for dessert–strawberry or raspberry ice-cream? You prefer strawberry, so you ask for it. Your preference is neither more nor less rational than your neighbour’s for raspberry ice-cream. Some people adore opera, yet others find it boring. This has led Hume (Treatise on Human Nature, Part 3, Section 3) to hold that: Reason is, and ought only to be the slave to passions, and can never pretend to any other office than to serve and obey them. 6

This, then, downgrades Reason to that of instrumental reasoning only– whatever end/goal the agent cares to adopt, the only role that Reason can play is confined to what is called means/end reasoning. You wish to die as a martyr for your faith, your chosen end. What is the most efficient means you can adopt to achieve it? Leaving home to join a jihadist organisation would be one obvious way forward, but choosing to lie on the family couch simply to watch the news reports about the activities of jihadists is not. In other words, according to Hume, there is rationality of means but not of ends. Reason cannot inform you whether it is rational to become a jihadist or to be a non-violent proclaimer of the universal brotherhood of men. Once the role of Reason has been downgraded in this way, it follows that Passion plays the key role in life. We find another famous passage (Part 3, Section 3) which reads: ‘Tis not contrary to reason for me to chuse my total ruin, to prevent the least uneasiness of an Indian or person wholly unknown to me. ‘Tis as little contrary to reason to prefer even my own acknowledge’d lesser good to my greater, and have a more ardent affection for the former than the latter…

In accordance with the logic of Cartesian dualism and hyperseparation, a prominent account of the human being in Bm opts for privileging Body over Mind, reducing the latter, at best, to an epiphenomenal role; following Hume, another prominent account of the human being opts to limit the role of Reason to one of means-end efficiency only, leaving 6

See Cohon 2010, for a brief account of Hume’s moral philosophy.

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emotions/feelings/desires, which inform all our preferences, beyond the reach of Reason. Between Descartes and Hume, the notion of person-hood can no longer play the role it does in the lives we lead, both from the standpoints of promoting healthy living as well as coping with illnesses, when these strike, as we shall see. Before doing so, we need first to explore the notion of person-hood as a Wholist concept, not one bifurcated in terms of Body over Mind, of Passion over Reason. Let us recapitulate the reasoning set out so far in this chapter. Modern philosophy and Bm can be said to be saddled with certain problems left by the Cartesian and Humean legacies. These legacies are founded on Dualism and hyperseparation, as already observed and, in turn, are deeply embedded in Western philosophy itself, which adheres to Aristotle’s Law of Excluded Middle and bivalent classical logic. When Dualism and such a Law are applied to the context of the Mind-Body relationship, either Mind is superior to Body is true or its contradictory that Mind is not superior to Body is true. Alternatively, either Body is superior to Mind is true or its contradictory that Body is not superior to Mind is true. Modern Medicine claims to be scientific; as such, medicine must be part of the same ontological-epistemological-methodological framework. That framework is bounded by Materialism, that Matter is primary; hence, Body is primary and must be privileged over Mind-like Reason, which Hume has downgraded to instrumental reasoning only. Mind must be downgraded to play, at best, an epiphenomenal role in the understanding of illness. Chinese philosophy, on the other hand, subscribes neither to the Law of Excluded Middle nor to bivalent logic. Instead, it implicitly adheres to multivalent logic in the form of Yinyang logic as implicitly understood via the Yao-gua model of the Yijing. (For a detailed discussion of these points, see Lee 2017a, Chapters Four, Six, Eight and Nine.)

CCM: Mind-Body Wholism Chinese philosophy and its medicine have nothing to do with Dualism. Its broadest and most fundamental mode of thinking is what this author has called Contextual-dyadic Thinking, within which Wholism (in various forms) operates. 7 In accordance with such a philosophical orientation, CCM may be said to hold the concept of Person as a primitive concept– that is: the person is neither Body over Mind, nor is it Mind over Body; a person neither thinks only rationally nor makes preferences only in the light of Passion. On the contrary, the person is a Whole; to grasp such a 7

For a like-minded account, see *Zhang Zailin 2008.

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Whole, one must grasp both Body and Mind, both Reason and Passion. To be a (living) human being is to be a person; to be a person is to be a being, whose physical and mental characteristics are so entwined that one would not be able to separate them, and if per impossible, one could, each could not exist or endure separately and independently of each other. It is like the Yinyang pairing. Yin and yang are inextricably linked, yin cannot endure without yang just as yang cannot endure without yin; they exist as Yinyang Wholism. In the same spirit, Mind cannot exist without Body, nor can Body exist without Mind. Analogous to Yinyang Wholism, one can call this Mind-Body Wholism. This then is what is meant by saying that the concept of person is a primitive concept,8 as it is an embodiment of Wholist philosophy. Figure 6.1 attempts to show this analogy in terms of the Xiang/䊑 mode of thinking.

Figure 6.1: Superposing Person Wholism upon Yinyang Wholism; Shen/⾎ (personspirit) is yang; shen/䓛 (person-body) is yin

Let us begin by quickly noting how Chinese culture normally understands the role of Reason and whether, within it, the dichotomy between Reason and Passion (desire/emotion), so clearly made under value scepticism in modern Western philosophy, occurs. Take a look at the

8

Peter Strawson, a leading analytical philosopher of the third quarter of the last century, had also put forward arguments for the concept of person as a primitive one (see Strawson 1959). This author’s preoccupation is not the same as his, and as it is beyond the remit of this volume to pursue the differences, it suffices here simply to draw attention baldly to the fact that the two accounts are different. His is conceptual while this author argues that CCM is ontological. For a very brief account of Descartes and Strawson, see Lacewing 2015; for a critique of Strawson, see Alakkalkunnel and Kanzian 2013.

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two-character word in contemporary Chinese for “reason”–it is ᛵ ⨶ /qingli. The second character li on its own means “reason” or “principle”. Why then is there a need to add another character in front of it? One superficial way of answering the question is to say that in its long history of development and evolution, the Chinese language has a tendency to use increasingly two-character rather than one-character words (see Lee 2008). This may, at best, be a partial explanation, as in this case, the use of qing is telling. ᛵ means “feeling”, “sentiment”, and “affection”. In other words, the word ᛵ⨶/qingli may be construed as perfect evidence that Chinese culture does not recognise the Dualism so characteristic of modern Western culture, which distinguishes between Reason, on the one hand and Passion, on the other. Instead, Chinese culture recognises that Reason is informed by appropriate and/or an appropriate degree of Passion (as the context dictates), that Reason and Passion are not in conflict, though contrasting, but, nevertheless, are seen to form a harmonious Whole. This entwined relationship between Reason and Passion embodied in ᛵ ⨶ /qingli is also found in a gua, as we shall see. While Reason/Principle bids one to be humble (especially one who occupies high status/office), humility itself would elicit approbation, respect, appreciation and even love from others–this is the “content/message”, for instance, of the ൠኡ䉖 খ/di shan qian gua, where ൠ stands for lower places and, hence, the more lowly in life, and ኡ stands for mountains/hills and, hence, the higher strata in society.9 Hume has also said (in the same work as the quotation cited earlier) that: ‘Tis not contrary to reason to prefer the destruction of the whole world to the scratching of my finger.

According to the Chinese view, Hume would definitely be acting “contrary to reason”; Hume would be acting unreasonably/irrationally if he were to choose in the way that he had set out. A person making such a choice would be profoundly unbalanced and unhinged, and would suffer from mental illness, at the very least, if not be a total moral monster. Conduct this thought experiment: suppose a very powerful politician in the world, with his finger on the nuclear button, is about to press it to detonate a certain part of the world, killing people in hundreds of millions, and devastating the environment, because his little finger would suffer from 9 This is hexagram 15: the top trigram is kun (standing for Earth), the bottom trigram is gen (standing for Mountain).

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some slight discomfort, if he did not press that button. Would you “buy” Hume’s argument, or would you and others overpower him, to prevent him from carrying it out? Would he not be considered to be unhinged, and therefore unfit for office? If this were your response, could it be more than merely your subjective preference for compassion over mild personal discomfort? However, for Hume, Reason is totally divorced from feeling/sentiment/ affection; for the Chinese, feelings/sentiments/affection are built into their understanding of Reason. The former is dualist, the latter dyadic. Chinese culture does not buy the down-graded role played by Reason in the Humean account, that it is confined only to means-end/instrumental rationality. The person, in Hume’s thought experiment, could be said to exemplify instrumental rationality in his preference for pressing the nuclear button in order to relieve the slight discomfort in his little finger. Common sense and some forms of Western moral philosophy, which reject the Humean account, as well as the Chinese view appear to agree that there is not merely rationality of means to ends but rationality of ends themselves. Of course, such a claim is contentious and constitutes a central debate in the history of Western moral philosophy and remains so, today. Another way of drawing attention to the concept of person, as a primitive one, in Chinese thought and CCM, is to look at the two-character word shenti/䓛փ or the single-character word shen/䓛. 10 In one sense, either shen or ti could simplistically be translated as “body” in English. This would be a mistake, for such a translation would distort the philosophical/ontological nature of shen or shenti in Chinese culture and in CCM. We have been at pains to point out above that Chinese philosophy is not dualist but dyadic, that it is not based on thing-ontology but process-ontology. It is therefore more appropriate either to leave the term untranslated or to attempt to translate it as “person-body”.11 Though inelegant, this term has the virtue of making it clear that in CCM, in particular, and Chinese culture, in general, one cannot talk about the body without putting it into the context of the person as a primitive concept. Ti/shenti is not Body, as modern Western philosophy and Bm understand Body; either term refers, at once, to both the physical aspects (whether as a thing such as the person’s broken leg or as a process such as the person is shivering with cold, being thinly clothed, and the ambient temperature is just above freezing), as well as the mental aspects (such as the person 10

For a discussion which is close to the view held by this author, see Zhang Yanhua 2007, Chapter III. 11 Zhang Yanhua (2007, 3) has translated it as “body-person”; this author has no objection to it.

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being sad or elated, suffering from hallucinations or delusions, and talking total gibberish). The person with the broken leg may also be a person feeling depressed, lethargic or excited–the physician, in diagnosing her condition, will be addressing her broken leg but at the same time would also take in the fact that the person is, say, excited or in a very agitated state, and would try to ascertain, if the state of excitement might not have something to do with her breaking her leg. The reader must bear in mind that the CCM account of the primitive concept of person-hood as Mind-Body Wholism is itself embedded within the nest of Ecosystems discussed in Chapter Four (see Figure 4.1). A physician, in diagnosing and determining treatment in its light, could be carrying in his/her mind these various Ecosystems, the smaller one nesting within its bigger neighbour until the largest is reached. An ecosystem in this context may be said to stand for the concept of chang/൪ in Chinese thinking; just as the former in the context of ecology may be said to include everything–biotic, abiotic and the relationships between them at all levels of organisations such as that between individual and individual, community and community, and individual and community. Analogously, the latter notion may be said to be equally comprehensive, as it includes Body/Mind and Reason/Passion whenever something happens to a person and s/he reacts to it. Consider this scenario–a person is sitting quietly in a room, drinking a cup of tea, when a gust of wind suddenly bangs the door shut, startling the person, who then drops the cup held in the hand to the floor, shattering it. This scenario constitutes a chang which, to the Chinese, is only comprehensible when grasped as a Whole: in its entirety. It would be unintelligible and futile to separate out which part of the person’s behaviour is due to Reason and which to Passion, as the two are intimately entwined. Western philosophy might read the situation as one exhibiting Passion at work, as the person is startled by the unexpected noise. Is this, however, the whole truth? In one sense, to hear an unexpected, very loud noise, to feel frightened by it, and then become so agitated as to drop the cup held in the hand is all eminently reasonable as a form of behaviour. In contrast, should the wind be a gentle one, closing the door not with a loud bang, but a quiet sound, it would then not be reasonable to react with fright. Should a person do so, then such a person could be said to be unreasonably nervous. In daily life, we discriminate all the time between different behaviours displayed at different times and places by different individuals, implicitly invoking the concept of chang. In the same way, one could say that each gua in the Yao-gua model (whether as a trigram or hexagram), when applied to human affairs is a chang, which includes the dyadic (not dualist) relationship between Time and Space (as Timespace),

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Body and Mind (as shenti/person-body), and Reason and Passion (as qingli).

Biomedicine and CCM: psychosomatic disorders/illnesses From the standpoint of common sense, we believe the following observations to be true, namely, that if our Mind is disturbed in some way, for example, when we are frightened or anxious, this may bring about the following bodily effects: our heart beats faster, we feel sick (nauseated), we shake, sweat, our mouth feels dry, we feel pain in the chest, we suffer from headaches, we have a knot in the stomach, we breathe fast, and so on. And yet, such obvious observational truths were overlooked or not taken over-seriously by Bm which, by and large, for two centuries or so celebrated and still celebrates a very powerful paradigm, namely, the monogenic conception of disease. This followed the brilliant successes of Pasteur and Koch towards the end of the nineteenth century and the cusp of the twentieth, in identifying germs as the cause of disease, thereby ushering in the Age of Bacteriology (see Lee 2012b, Chapter Nine). However, in the last half-century, things have changed. It is now generally accepted (or, at least, exponents are not necessarily written off as crazy and worthy of being professionally deregistered) that, to an extent, most diseases have a psychosomatic dimension, especially in diseases such as psoriasis, eczema, stomach ulcers, or high blood pressure, which can be made worse by stress and anxiety. Hence, we next turn our attention to a pleasant surprise, at least, pleasant, from the vantage point of this author, and that is, the emergence of Psychosomatic Medicine as a branch of medicine. Psychosomatic Medicine is said to be an interdisciplinary medical field, involving relationships between psychological, social and behavioural factors and bodily processes. Some accounts of it try to trace its history back to the early Greeks to Hippocrates (460-377 BCE) and even to Anaxagoras (500428 BCE). The word “psychosomatic” itself comes from two Greek words: “psyche”, meaning “soul”, and “soma” meaning “body”. A psychosomatic disorder is then perceived to be one where the predominant emotional states (the Mind) produce adverse effects on the Body. However, Bm (working within the framework that Man is machine and that the investigation of Matter alone is scientific) goes on to say that the link between the emotional overload and the organic damage lies in the former’s reaction with the body’s nervous and immune systems–that is why, Bm, in order to analyse these links, also uses the term “psychoneuroimmunology” or even “psychoneuroimmunoendocrinology”.

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These long words are sometimes replaced by “psychophysiology” or even “Body-Mind medicine.” Bm prefers to rely on the overall theory of stress or that of fight and flight. Despite the incorporation of ancient Greek words, the notion of Psychosomatic Medicine itself did not get formal recognition until only about five decades or so ago.12 One can regard this as yet another departure from the monogenic conception of disease, joining Epidemiology, in challenging (implicitly or overtly) this still very powerful model of disease agency. One of the founding fathers of this new domain, G. L. Engel, may be seen as challenging the monogenic conception of disease, which is monofactorial and linear, with Matter impacting on Matter (that is, the Billiard-ball model of causation working within the framework of thingontology). According to Fava and Sonino 2010, Engel has developed: … a multifactorial model of illness, named later ‘biopsychosocial’. It allows illness to be viewed as a result of interacting mechanisms at the cellular, tissue, organismic, interpersonal and environmental levels. Accordingly, the study of every disease must include the individual, his body and his surrounding environment as essential components of the total system, in what Hinkle in 1967 defined as an ecological perspective.

Regarding the “holistic consideration of patient care”, Engel 1977 has written that: Psychosocial and biological factors interact in a number of ways in the course of medical disease. Their varying influence determines the unique quality of the experience and attitude of every patient in any given episode of illness.13

Textbox 6.1 is an attempt to capture in lay terms what they say about the interactions between the mental and the physical. From it, one can see that Psychosomatic Medicine is still nested within the general Biomedical framework and hence the explanation of the different levels of Mind-Body interactions relied upon is a biomedical one–emotional stressors induce increased activity on the part of nervous impulses from the brain to other parts of the body and the release of adrenaline epinephrine into the blood stream (see Knott 2014). It is also the case that treatments for psychosomatic disorders range from electroconvulsive therapy and psychotropic drugs at

12

Psychosomatic Medicine, the official organ of the American Psychosomatic Society, was founded in 1939. 13 See also Engel 1967, Hinkle 1967, and de Mello 2015.

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one (the physical) end, to hypnosis, drug abreaction, 14 group therapy, supportive psycho-therapy, and psychoanalysis, at the other (the mental) end. Physical & emotional stresses faced by the person љ Increase of stress load on the psycho-neuro-endocrine-immune-network љј Acting reciprocally on personality, genetic endowments & environmental factors љ

Text Box 6.1: Relationships in psychosomatic disorders at different levels of Mind-Body interactions (Modified and simplified from Fava’s and Sonino’s diagram of 2010)

The pleasant surprise, mentioned earlier, for this author, is that the new explanatory model behind Psychosomatic Medicine is closer to the CCM model of illness. A main, if not the only, burden of Lee 2017a as well as this volume is to argue that, unlike the reductionist, monofactorial, linear model presupposed by Bm in its most prominent and dominant domain, the explanatory model presupposed by CCM is Wholist, multifactorial, non-linear, and reciprocal. In short, it exemplifies Contextual-dyadic Thinking as well as Ecosystem Thinking and Being. However, the raison d’être of writing these two companion volumes is not to engage in the “retrospective privileging” of CCM over Bm, but to make CCM intelligible to those who only know of, or are familiar with Bm. Here, we see yet another example (Epidemiology apart) of the two medicines overlapping to an extent (see Text Box 6.2a); as a result, there is no need to regard CCM as beyond the pale, as “mumbo-jumbo”, that ex hypothesi, it is “unscientific”, while Bm is “scientific”. This, though, is not to say that the CCM framework and that of Epidemiology and Psychosomatic Medicine are identical; it is simply to say that they share certain important ontological and methodological features. The relationship between CCM and Bm about their respective ontological-methodological frameworks looks like this in Text Box 6.2b. 14

With the help of a drug, the patient is enabled to release repressed emotion.

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Figure 6.2a: Epidemiology and Psychosomatic Medicine to an extent can be incorporated into the CCM framework

Figure 6.2b: Overlapping and non-overlapping areas between CCM and Biomedicine in terms of their respective ontological-methodological frameworks

We next turn our attention to CCM. CCM goes beyond Psychosomatic Medicine to hold that all illnesses are psychosomatic as well as psychosocial in character. Chapter Four has shown this via the nesting of Ecosystems. Let us leave such generalities behind to look briefly at how, in particular, CCM sees the effect which Passions (as Hume called emotions) can have on the Wuzang-liufu/the yin and yang visceral organsystems in engendering illness in a person. The Chinese word for emotion,

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as already mentioned, is qing/ᛵ; CCM uses the term ᛵᘇ/qingzhi to highlight illnesses in which emotions play an obvious and outstanding role. Note that the character ᛵ has as a left component the radical/bushou/䜘俆, which stands for the Heart. In Chinese culture, the Heart not only governs the blood, as it is the Heart, and not the brain, which controls memory. The brain may be the storehouse but the Heart holds the key of the storehouse, so to speak (see Lee 2008, 81-83). Furthermore, the Heart is in overall charge of the emotions; emotions and memory are closely linked–one often forgets what is painful, when one is over-excited one forgets certain things, when one is calm and collected, one can recall certain memories. When one is deeply depressed, one might recall neither good times nor bad times. Li Shizhen, the great Ming Chinese physician and author of the magisterial Bencao gangmu, said that the ancient Chinese were wrong in holding that it was the Heart which controlled memory; he held, instead, that it was the brain. However, his contemporaries and those who lived after him in the tradition of CCM did not buy his so-called “modern/correct” claim. One possible reason is that the emotions had been inextricably linked with Wuxing in CCM, at least, by early Han times, if not before. Recall the following pairings between Wuxing and Wuzang and, in turn, their pairings with the five emotions.15 Wuxing Wuzang Wuqing

Wood Liver Anger nu/ ᙂ

Fire Heart Joy xi/ௌ

Earth Spleen Pensiveness si/ ᙍ/ Anxiety you/ ᘗ

Metal Lungs Sadness (grief) bei/ᛢ

Water Kidneys Fear kong/  / Fright jing/ ᛺

Table 6.1: Wuxing-Wuzang-Wuqing

It is not unknown that a person can drop dead, upon receiving exceptionally good news, long anticipated but long disappointed. The heart simply stops beating–the person died of joy. Bm would call such incidents anecdotal and therefore “unscientific”; as no RCTs could ever be conducted on this subject, either Bm would have to ignore it altogether or admit its relevance in spite of the fact that no RCT would be possible.16 15

Basically, CCM talks about five emotions (Wuqing/ӄᛵ); sometimes seven are mentioned, although the extra two can readily be accommodated within the basic five. For variations, see the Suwen, Chapters 5 and 39. 16 Such an experiment would be deemed either impracticable or unethical even if practicable.

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CCM could claim that the phenomenon bears out its theory–this aspect of CCM theorising and testing has been explored in some detail in Chapter Three. In Chinese history and literature may be found instances of such a phenomenon, which occurred, particularly, in the context of the highly regarded imperial examinations, which were the recognised career path for scholars to become officials and to gain honour and fame, if not also fortune for themselves/their families/clans. The intense focus on passing such examinations, naturally, prompted some writers to satirise them. One notable example is the Qing dynasty satirical novel by Wu Jingzi/੤ᮜể (1701-1754 CE), which is about a candidate called Fan Jin/㤳䘋 who, from the age of twenty, had sat for such exams, albeit only at a lowly (village) level on numerous occasions, all unsuccessfully. When he finally heard he had succeeded, he became a victim of mad joy, running along the streets yelling non-stop “I’ve been successful! I’ve been successful!” A passer-by, who understood what was happening (that is, from the standpoint of CCM), stopped him and told him that the government had a policy that should a successful candidate start to lose his reason, he would not be given an official appointment. It was also well known in the town that the man stood in fear and trembling of his father-in-law, the local butcher, who was then brought to the scene. His father-in-law proceeded to slap him very hard on the face. This had the effect of shocking him to his senses. He then calmed down. According to CCM, this is to use fear (Kidneys/Water) to conquer/control joy (Heart/Fire) under the Constraining sequence of Wuxing. The general method of using one emotion to overcome another emotion is clearly spelt out in the Suwen, Chapter 5 which says: ᛢ 㜌 ᙂ , that sadness/grief (Lungs/Metal) can constrain anger (Liver/Wood), in accordance with Wuxing-Wuzang. In the history of CCM itself, there is an equally famous (true) story which happened in the Ming dynasty, which concerned one, called Li Dajian/ᵾབྷ䈿, a young man from a peasant family who, unexpectedly was successful as juren/ѮӪ (the equivalent, say, of today’s bachelor’s degree). The following year, he surprised everyone yet again by being successful as jinshi/䘋༛, the equivalent of a master’s degree. His father was so excited that he laughed and laughed. This turned into a kind of laughing disorder, as the laughing became uncontrollable; this lasted for some ten years. His son sought medical help but to no avail, alas. Finally a distinguished physician heard about this unfortunate case, and sent word to the man’s father, that his son (posted elsewhere as a scholar-official) had died upon falling ill unexpectedly. On receiving this news, the old man stopped laughing and began to sob, whereupon the physician sent another

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messenger to tell the father that his son had not died after all, as miraculously, he had been saved by a very distinguished physician. On hearing this good news, the old man stopped grieving and was happy. In this way, he was cured of his laughing disorder. The strategy adopted, again, was one dictated by the logic of Wuxing-Wuqing. Recall that Wuxing covers several other sub concepts including taiguo/excess, the insulting sequence, and the over-controlling sequence. (See Figures 4.3 amd 4.4.) Excess of joy in the Heart/Fire can over-control the Lungs/Metal, which has the effect of making the latter “turn around” or “insult”/“humiliate” the Heart/Fire instead. To aid this “turn around”, so to speak, telling the old man that his son had died would produce grief, which could then be used to “stifle” the excess joy. This is called using one emotion to control another (ԕᛵ㜌ᛵ⌅/yi qing sheng qing fa), a method not so popular in modern times. Wuxing-Wuzang-Wuqing can be invoked and applied in prescriptions using medicinals or in treatments without using medicinals. The examples cited above belong to the latter method. Other non-medicinal methods used involve getting the patient to release pent-up emotions (xuanxie fa/ᇓ ⋴⌅) and shifting the patient’s perspective (gaibian guannian fa/᭩ਈ㿲 ᘥ⌅). *Hao 2012 cites this case illustrating the last mentioned strategy–a patient presented with symptoms of insomnia (of more than six months standing), sunken eyes and a black complexion. Her mai was slender but taut (mai xi er xian/㜹㓶㘼ᕖ). Her insomnia began when a neighbour bullied her, she said. The said neighbour, without consultation or agreement, had built a small kitchen against one of her own walls. In digging the foundation, the neighbour dug up a very large boulder, which she then parked in front of the patient’s house. After the kitchen was completed, the boulder, being too large, could not be manoeuvred out of the narrow lane. She had to carry her bicycle around the boulder to get inside her own house. Furthermore, her husband had said to another neighbour that the woman who had built the kitchen did consult him, and that there was no intention to insult or bully his wife, as the neighbour had never thought such a boulder could be lying underneath the ground. The patient then accused her husband of having fallen for the offending neighbour, who was much younger and prettier than herself. Professor Hao thought that he had better go and inspect this offending boulder, which he did. It was indeed very large, but at the same time very beautiful. He delved further into the history of the site and was told that, in the Qing dynasty, it was the back garden of some very high official. He suggested that, with the help of some strong young arms, the boulder could be shifted aside a bit, so that it would no longer block the entrance to her house. He

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got the helpers to scrub it clean, and then suggested that some nice plants could be grown around it–this would make a wonderfully lovely new feature just outside her house. Hao said that he would make a return visit in the next few months to admire the new landscape. A few months later, the woman returned to his consultation room, looking the picture of health. When asked how she slept, she said very well indeed. She said that the new feature was truly pretty, so much so, that she was reluctant to close the front door in the evening. Hao described the situation as qujing tong you chu/ᴢᖴ䙊ᒭ༴/to reach a tranquil spot by taking by-ways. After Hao had elicited the information (the technique of asking, wen/䰞) from the patient, he must have decided that her condition could be overcome, not necessarily through the use of medicinals. He might also have concluded that the offending boulder would be no ordinary unsightly rock, given the general location of the site. Hence, he offered to visit the patient’s home. (In Chinese garden landscaping, many boulders, which look fine and beautiful or curious are incorporated as special features. The high Qing official would have sought out such a boulder, when constructing his garden but, when his residence fell into neglect, ruin and eventual dereliction, such a boulder became buried, only to be accidentally uncovered when the neighbour of the patient dug the ground to build her own kitchen.) Hao cites another case. An entrepreneur had neither eaten nor slept for several days, was run down and feeling distinctly unwell, when he presented himself, because of severe stress, induced by problems in running his business. When he first started up his business (as a young man), he said he was full of vitality and vigour, and imbued with the spirit to succeed at all costs; however, should he have to start from scratch, all over again, he said he would not be able to do it the second time round. This added to his stress and anxiety, naturally. Given the patient’s circumstances, Hao said he would not prescribe any medicine for him straightaway, but advised him to pack a tent, and pitch it on the plains of Inner Mongolia for a week to ten days. At the end of this retreat, the patient was to return to see him again. Ten days later, he duly returned and reported his experience. He said that the moment he got to the steppes, he got out of his vehicle and was confronted by a vast expanse of green meeting the blue sky beyond the distant hills. He immediately felt better. All those confused thoughts that had been going through his head, had begun to sort themselves out. He walked a few steps, then he fell down upon the grass; as a result, all his worries, anxieties, and negative feelings of resentment, of victimhood, and so on, appeared to spill out of him through his tears. He simply cried and cried. Initially, he still could not

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sleep, but after a few nights, he could sleep without taking sleeping pills. On the last two days of his stay, he needed to be woken up in the morning, so soundly did he sleep. He wanted to know why the steppes should have such an effect on him. He was given the following explanation: a vast expanse of green leads the qi in us to come out into the opening, expansive/zhanfang/ ኅ ᭮ mode, and when that occurs, we can relax, banishing all those worries and anxieties, which have long plagued us. The ancient peoples, through observing such matters, very likely then linked the green colour with the movement of Qi in this mode/≄Ⲵኅ᭮䘀ࣘ. This is why in the Wuxing-Wuse schema (Table 4.1), green is associated with Wood. Wood is paired with Spring, when trees start to send out green shoots; Wood/Spring/green are paired with the Liver in the Wuxing-Wuzang schema. As Table 4.2 shows, a presiding function of the Liver is dispersing and discharging/shuxie/⮿⋴. The patient was full of resentment and repressed anger, which came out in his story about his own life with its many obstacles–in other words, his success was hard won, and he resented others with a more privileged background, who also achieved success but without having to put themselves to the gruelling tests that he had to undergo. The Liver is paired with anger/resentment in the WuxingWuqing schema; confronting an immense landscape of green grass helped the Liver to unload anger/resentment. Table 4.1 also shows that the eyes are the “opening” of the Liver–he cried and cried. This crying prompted by Nature cured him without the intervention of medicinals. The Suwen, Chapter 5/lj㍐䰞·䱤䱣ᓄ䊑བྷ䇪NJrecords Qibo as saying: ьᯩ⭏仾DŽDŽDŽᙂՔ㛍DŽDŽDŽ

Rendered as: In the East,17 things start to stir and there is movement as symbolised by wind; as such, one may say that wind engenders Wood, as plants begin to grow again. As the shoots have just emerged with the rise of yangqi, they are immature, and as such, their burgeoning fruit are sour, so one could say that Wood engenders sourness, and sourness engenders the Liver… In Spring, the processes of Earth energy are in full transformation, producing qi of Wood, which in the human being engenders the Liver which, in turn, produces the tendons. The colour of Wood/Liver is green. The eyes are the opening of the Liver … whose emotion is anger. Anger, therefore, damages the Liver.

17

East is the temporal-spatial location for Spring.

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To use non-medication techniques, especially that of getting a patient to alter his/her perspective, testifies obviously to the fact that CCM recognises the social as well as the psychological embeddedness of the human predicament. Unfortunately, sometimes, the social environment cannot so readily be changed–a patient’s illness, for instance, might be primarily caused by her boss bullying her at work. Well, she could change her job, her boss, and her environment; however, finding suitable alternative employment might not be so easy. Under such circumstances, a physician might have to make out a prescription containing medicinals, as faute de mieux. At other times, and in other cases, the physician may be able to combine both, using non-medication as well as medication techniques. A famous case in the history of CCM concerns the distinguished Yuan dynasty physician, Zhu Danxi/ᵡѩⓚ (1281-1358) as recounted by the equally distinguished Ming dynasty physician, Zhang Jiebin/ᕐӻᇮˈalso known as Zhang Jingyue/ᕐᲟዣ (1563-1640) . Very briefly this concerned the betrothed of a young man who had to leave home and the area on business for more than two years. The young girl pined for him, refused to eat and simply lay in bed, her face to the wall, with no interest in life whatsover. Medically, she was diagnosed as suffering from too much pensiveness/anxiety, which damaged the Spleen– hence her lack of appetite. Of course, if her betrothed were to return, her illness would vanish, would be banished by joy. As that was not possible, the physician then tried to use anger/rage, the emotion associated with Wood in order to get Liver/Wood to constrain Spleen/Earth, according to the logic of Wuxing-Wuzang. The physician succeeded–the girl cried for quite a long while, and she was given medicinals to take as prescribed. The patient, after these treatments, began to ask for food, and her condition abated. Of course, only joy could cure her completely. The families set about getting the young man to return. (For more details of this and other similar cases, see Zhang Yanhua 2007, 72-74.) A contemporary case is mentioned by *Hao 2011 in which he used both psychological techniques and medicinals to treat a patient, who was a young female student. She came to consult him, accompanied by her mother. She was very emaciated, looking depressed. Her mother explained that she had been a very lively individual until of late, when her personality seemed to change. She had also suffered from insomnia these last few months, and had lost any interest in the world around her. She was also unable to concentrate on her studies and as a result, was doing badly at the university. For all these reasons, her mother had brought her along to be examined by the physician. The physician asked the patient about her menstruation; her mother promptly intervened to assure him that her

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daughter’s period was fine. However, her daughter asked if she could speak to the physician alone, whereupon, he requested her mother to leave the consultation room. The patient then revealed that her period had stopped for the last five months. The physician asked if she had been taking slimming pills. She said yes, and had also gone on a slimming diet (she had lost nearly a third of her body weight, from 120 to 80 ᯔ jin, a jin is about a pound), and that was after a thoughtless male student, in class, had referred to her as “Fatty”. Hao read her the riot act–she must stop taking the slimming pills at once, and start to eat properly. Inadequate nutrition obviously had affected both her reproductive system as well as the brain. Regarding the latter, the patient seemed not to be aware that 20% of our energy intake goes to sustain brain activity, when engaged in mental/intellectual work. She said that when she lost a third of her body weight, her period stopped. This was not surprising, since the lack of nourishment meant that not only was there insufficient nutrition to sustain the daily purposes of living, but also, there was nothing left for the ovaries to enable them to release an egg, each month, in readiness for reproduction to take place. If she were to continue on the present course, not only would she not menstruate, but after three years, her ovaries would no longer function for good, and she would become permanently sterile. Hao diagnosed her with a deficiency in both blood and Qi and undernourishment affecting the spirit, that is, mental powers (Qixue liang xu/≄ 㹰є㲊, ㋮⾎ཡޫ), which explained her inability to concentrate, her depression, lack of motivation and exhaustion. These symptoms were compatible with her spirit suffering from depression, which accompanied her taking slimming pills. Hao simultaneously prescribed Zhang Zhongjing’s Xiaojianzhong tang/ሿᔪѝ⊔. It is used, today, in treating patients (amongst other conditions) whose spirit is low, weak and fragile/ ㋮⾎㺠ᕡ. After a year of treatment, involving assiduous discussion with both mother and daughter in helping them to cope with this specific psychosomatic illness, the patient’s health was restored; she finished her university degree and found a job after graduation. This prescription has six medicinals: Ṳ᷍ ⭈㥹 བྷᷓ 㢽㦟 ⭏ဌ 侤㌆

Cinnamoum cassia Glycyrrhiza glabra Zizyphus vulgaris Paeonia albifora Pallas Gingiber officinale Saccharum Granorum

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It has the effect of warming the person, making up for deficiency/bu xu/㺕 㲊, and holding back rapid deterioration of the condition by attuning the Middle Burner, the Spleen-Stomach to good functioning order as well as to relieve pain/઼䟼㕃ᙕ, in which gancao/⭈㥹, in the prescription, plays a crucial role. Between them, the combined medicinals can nourish “central qi”/zhongqi/‫ޫ⑙ޫޡ‬ѝ≄, achieve Yinyang balance/ᒣ㺕䱤䱣 in the patient, and attune the functioning of nutritional and defensive qi/䈳઼ 㩕ছѻᐕ. The primitiveness of the concept of person-hood means that the relationship between the mental and the physical aspects of the person is a two-way street–just as the emotions/feelings (the mental and the psychological) can affect the physical side of the person, while the physical aspect of the person-body can also affect the mental and the psychological side. A dramatic instance may be found in the records of cases written by a famous Ming dynasty physician called Miao Xiyong/㕚 ᐼ䳽 (1546-1627) (see *Luo 2011, 103-104). This case involved the wife of a friend of the physician, whose alarming state emerged six days after childbirth. From being a composed woman with a genteel disposition, her personality underwent a dramatic change. She became alarmingly violent, rushing off to the kitchen, like someone gone mad, to grab hold of a chopper, threatening to kill anyone and everyone in sight, shouting out loud that she wanted, most of all, to kill people. She was so violent that it took several people to control her. Miao Xiyong diagnosed the patient as follows: she had lost a lot of blood during labour, resulting in damage to her yin (recall that blood is yin according to CCM), in turn, causing the Liver to engender an excess of heat, owing to the yin deficiency in her person-body/㛍㲊⚛⚾. In CCM theory, when there is blood loss and, therefore, yin deficiency, the Liver is affected, as the Liver is the organ which stores blood and, furthermore, it is also the seat of the emotion of anger, as earlier indicated. His treatment consisted of two parts: he ordered that she drink a bowl of urine collected from a small child. As it was easier to collect the urine from a male, a very small boy of about three from the neighbouring family was borrowed for the occasion. She drank it and quietened down almost immediately; next, the physician wrote out the following fangzi/prescription with nine ingredients: 1 嗉喯 2 ⌭‫ޠ‬ 3 ⭏ൠ 4 ᖃᖂ

Apatite Herba Lycopi Radix Rehmaniae Recens Radix Angelicae Sinensis

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5 ⢋㟍 Achyranthes bidentate Blume 6 Կ⾎ Sclerotium Poriae Circum Radicem Pini 7 䘌ᘇ Radix Polygalae 8 䞨ᷓӱ Semen Ziziphi Spinosae 9 A bowl of child’s urine was added to above decocted medicinals The patient drank this brew and recovered fully (no relapse was recorded). This treatment is explained as follows: the urine of small children has the properties of being a little salty and cold/ ૨ ሂ and, therefore, is excellent for aiding yin to descrease fire/heat/⓻䱤䱽⚛, precisely the properties in a medicinal required for the case just cited. (It is also capable of eliminating heat from the Lungs, and a cough arising from that condition, getting rid of blood stasis and aiding the person-body to generate new blood.) The aim of the fangzi was to supplement/bu, to nourish blood. In particular, medicinal 8 has this property; this distinguished physician often invoked it in treating patients, whose Heart and Liver had been affected adversely in their respective roles of engendering blood.

The Placebo phenomenon: Biomedicine, Science and CCM As noted above en passant, the placebo phenomenon is, today, considered to be empirically above suspicion. However, the scientific basis of it is by no means altogether clear, although in the last few decades, progress has been made. Lee 2012b has set out some details about the history of the socalled placebo effect.18 The subject first emerged in the 1950s after the Second World War, when an American anaesthetist, Henry Beecher, ran out of morphine on the battlefields of Europe. His nurse, out of desperation, injected a soldier with a saline solution; to their immense surprise, they found that it produced the same effect on the patient as morphine would have done. So intrigued was Beecher by this phenomenon, that he devoted time and energy to exploring it when the War ended. However, to be taken seriously, his studies had to convince his colleagues that scientific methodology had been followed very scrupulously, ruling out that the effect, for instance, had anything to do with self-limitation (that is, patients would get better in any case even without medical intervention of any kind), or statistical regression to the mean (that is, although chronic afflictions do not “go away”, nevertheless, their severity 18

For an authoritative account, see Benedetti 2014, Chapter 1.

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or otherwise waxes and wanes, and this makes it critical not to impute efficacy to any medical intervention just because improvement follows its administration). Unfortunately, Beecher’s earlier studies were methodologically flawed, as they had failed to use any control group to make sure that the improvement on the part of the patients would have occurred, even without a placebo. Later studies did address and overcome some of these flaws. RCT, as a concept, has since been accepted as a Gold Standard, because it is said to be able to overcome the methodological flaws committed by earlier trials, such as those of Beecher, not to mention those of James Lind. However, according to the critics of RCT, not all flaws are overcome by the majority of RCTs, especially those conducted by Big Pharma, whose main objective is, not so much to advance scientific understanding of the placebo phenomenon, but more to obtain approval from governmental authorities, such as the Food and Drug Authority (FDA) in the USA (and/or equivalents elsewhere) to market their new drugs (for details of these critical comments, see Chapter Seven). A more comprehensive attempt to eliminate distortions resulting from selflimitation, regression to the mean and other biases, would require that such trials go beyond the two-arm design of the standard drug clinical trial. More adequate trials must at least include three arms, the experimental arm which gets the real drug, a second arm which gets the sham or placebo treatment, and the third which gets no treatment. Benedetti 2014, 345 writes: The difference between the no-treatment arm, which assesses the natural course of the disease, and the placebo arm, which assesses the outcome of the placebo treatments, represents the true placebo effect. This experiment is simple, as it requires the comparison between two groups only, but it merely tells us whether or not a placebo effect is present and what its magnitude is.

For further scientific understanding, one would need to construct more complex experimental studies, indeed, the more arms to an experiment, the better. This goes to show that there are two contexts which must be distinguished: the Big Pharma one, running simple-minded RCTs, whose goal is not the same as those of scientists (such as Benedetti and others), undertaking placebo research to understand what factors are the most relevant at work in producing a so-called placebo effect, and how Modern Science could explain the effect produced by such relevant factors in operation. The research in the second kind of context has now yielded extremely interesting findings, demonstrating that the placebo effect as

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studied by Big Pharma drug trials, at best, only skimmed the surface of the subject–a placebo, as understood in the latter context, is paradigmatically a pill containing inert matter, such as flour and water, sugar, etc. (matched in colour, shape and size to the experimental pill containing the real drug). Scientific research proper has shown that placebo effects can be produced not by a placebo thus understood, but by any intervention whatever, including no treatment (which itself is an intervention), provided that the intervention is given under certain circumstances. Furthermore, placebo effects can exist in all sorts of circumstances, other than the strictly narrow ones of swallowing pills (real or sham), of performing surgical operations (real or sham), or in circumstances which appear to have nothing to do with conventional Bm such as in faith healing (whether conducted in the quiet of a suburban living room in a one-to-one scenario or, in a large hall as a “spectacle” by evangelical preachers, with maximally heightened theatrical effects). See Sykes/Moerman 2006, Marchant 2016. The above leads researchers, such as Moerman 2002 to maintain that the placebo effect/response is a part of something much larger called a “meaning response”–the two do not entirely coincide but do intersect. An example of the latter which falls outside the former is his study, a very large one, involving 28,169 Chinese-American adults, matching them with nearly half a million of randomly selected controls of white people, all living in California. If the Chinese-Americans had a combination of disease and a birth year that Chinese astrology considers to be ill-fated, these died significantly earlier (1.3-4.9 years) than the “white” controls, with the same disease (which ranged from lymphatic cancer to lung diseases, such as bronchitis, emphysema, and asthma). This difference is put down to “the strength of commitment to traditional Chinese culture”; clearly, commitment to a culture involves grasping its meaning and its significance. The intervention, here, has nothing to do with a placebo, as understood under normal standard conditions; it has to do with holding certain beliefs, and believing in the meanings embodied in these beliefs. This would also cover the case of prayer healing at evangelical meetings– for the “Jesus heals” miracle to happen, the people must hold certain beliefs, and believe in the meanings embodied in these beliefs. We humans possess language in a unique way (some animals may possess language, but their languages are not coded in words, which reach as high a level of abstraction as ours). Our language embodies meanings via our beliefs; our beliefs are transmitted to us by our parents/teachers (in the larger sense of the words) who, in turn, would have learnt them from their parents/teachers. Another way of putting the same point is to say that, we, as individuals, are brought up and acculturated within a community.

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Yet another way is to say, as Chapter Four has argued, that the individual is nested within Ecosystems, in particular in this context, Ecosystem 8, that is, our social/cultural environment. One can take it, too, as read (given that this work is dedicated to arguing that one’s genetic inheritance, one’s constitution, and one’s psychology are necessarily embedded within a social context) that our attitude to life, in general, our psychology, in particular, is socially formed. This, in turn, is to say that that we cannot understand ourselves at any level without grasping the psychosocial context, within which we live and act. It is this psychosocial dimension, which is the single most important thing to grasp, when we are trying to understand how medicine/medicine works, how illnesses, including pain, which many illnesses bring, affect us. At the heart of the meaning-placebo response is this psychosocial dimension of human existence. This chapter is devoted to demonstrating that person-hood is a primitive concept. As such, it rejects Cartesian dualism as well as Reductionism (which, in Bm, privileges Body over Mind), opting neither for privileging Body over Mind, nor Mind over Body. Instead it argues that the human being is, at once, both Mind and Body. A corpse is a mere body, but a living human being is, what we call a person. A person necessarily possesses Mind and Body or, in more philosophically correct language (that is, from the standpoint of Dyadism, not Dualism), a person possesses both mental and physical characteristics. We cannot locate a person except through the person’s body; but in locating the body of the individual person, we have also located the individual’s mind. The person’s mind is not a free-floating substance separate from that of the person’s body. Mind cannot exist independently of Body; a person’s Body is also where his/her Mind is and operates. When a person’s Mind ceases to function, what remains is mere Body, such as a corpse or a “vegetable” kept breathing, and so on, by an intricate system of machines, called the “life support system”. Hence, according to this philosophical perspective (as found in CCM), the concept of a person (embodying both physical and mental attributes entwined in a dyadic manner) is a primitive one–mental attributes cannot be irreducibly explained in terms of physical attributes and vice versa. As this view of the person is grounded firmly in both the biological nature of such a being as well as in its culture-language-beliefmeaning system of the society to which the individual belongs, the placebo effect can readily be understood to occur within such a being. Bm is wedded to epiphenomenalism (except in that domain identified as Psychosomatic Medicine), and that while Body impacting upon Body (Matter acting on Matter) is the philosophical paradigm, it could be stretched to permit Body acting on Mind (in the case of drugs; certainly it

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has no difficulty accepting that hallucinatory drugs do exist). Officially: it cannot permit the causal arrow to be in the direction from Mind to Body. Neither can it support beliefs that an intervention (such as a standard placebo) could bring about positive/placebo effects (or negative/nocebo effects)–effects that are not merely based on subjective reports by patients claiming improvement, but are objectively determinable. Scientifically established methods such as, blood and urine tests, biopsies, scans, and the imaging of relevant brain parts and functions can easily be performed to establish the veracity of these effects. Unofficially: doctors in a normal clinical context (that is, not in the context of a drug trial) have been known to administer standard placebos (in the form of pills, potions, and injections) to patients. The case cited of Becher and his nurse on the battlefield is an example of placebo effects being displayed. Such practices, however, are generally regarded as malpractices. It is argued that it is unethical to administer standard placebos when drug treatments for the patient’s condition exist; that such a deception undermines the doctor-patient relationship, even if the placebo intervention is known to produce positive results. Objections on grounds of ethics, though relevant in some contexts, do not address the Body-Mind Reductionism of Bm. This alone can explain the intellectual “horror” with which placebo effects are regarded, holding them under suspicion, to be neither “objective” nor “scientific”, when clearly they are both scientific and objective. In the Big Pharma-drug-trial context, an unspoken presupposition seems to be that placebos are not expected to produce real/objectively determinable positive effects. Their adherence, in the main, to the two-arm trial, may be said to confirm this suspicion. Such trials opt not to test a new treatment with an existing old treatment for the same condition. Should the old outperform the new, this is bad news for the industry, as it cannot hope to garner huge profits from marketing the new drug at inflated prices. Even should the new outperform the old, but only marginally, this is still bad news: as the positive difference in performance may not be impressive enough for the purpose of marketing the new drug. Testing the new against a placebo would be ideal, especially as placebos are not expected to produce positive results, and as the FDA merely requires that the new outperforms the control arm without specifying by how much, the placebo, as the control arm, would be ideal. Hence, the Big Pharma-drugtrial context is not likely to volunteer for a more complex trial design (see Benedetti 2014, Figure 11.1). The doctor-patient clinical context, par excellence, is one in which two human beings, that is to say, psychosocial beings, enter into a relationship

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of mutual trust. The patient trusts the doctor as the person with the expertise to help him/her, while the doctor trusts the patient to co-operate with him/her. By working together, they may achieve a positive/beneficial outcome; or at least, an outcome of hope and expectation (especially on the part of the patient) that the doctor’s expertise would help him/her to recover. This must, at least, be the default axiom, so to speak, of clinical medicine. In other words, this scenario provides the optimal set of circumstances for the placebo effect/response to occur; hence, any treatment, which brings about a positive therapeutic outcome, ex hypothesi, must be affected by the placebo phenomenon (the precise extent, probably, would vary from case to case), given that we are psychosocial beings. Brody (1980, 95) says: … no being can be necessarily both a biological and a cultural entity without the cultural features influencing the biological ones and vice versa (as the interplay between cultural and biological evolution illustrates). By this view, the placebo effect, in which participation in a specific cultural context produces changes in bodily condition, becomes an expected and understandable, rather than anomalous, finding.

From such a standpoint, the placebo effect/response is not a disturbing variable, which must be eliminated, at all costs. On the contrary, we should actively harness it to help achieve a positive therapeutic outcome which, after all, must be the fundamental goal of medicine. Clinical Bm regards it as a disturbing variable which must be eliminated at all costs, if it is to sustain its claim to being “scientific” and “objective”. This is a misguided stance, dictated, in the main, by its adherence to a philosophically unsound dualist model of privileging Body over Mind, and a causal model, which is monofactorial and linear. However, this criticism should not be misunderstood to mean that it is not methodologically sound to ascertain whether a new treatment is more efficacious than an old one, only to say that any treatment, no matter the extent/degree of its efficacy, is necessarily affected by an inescapable human condition, namely, that we are psychosocial beings. The type of RCTs that could be helpful in determining how much of a positive effect is contributed by the placebo phenomenon as opposed to the inherent medical properties of the treatment, would have to be a trial that is more complex in its design than the current model invoked in general by Big Pharma. With the above clarification out of the way, a few words need to be said about CCM regarding the so-called placebo phenomenon. As CCM is but the outcome of being embedded in a cosmological/philosophical framework, which is totally different from that of Bm, it follows that as a

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medicine, it would be perfectly at home with the placebo phenomenon for the following reasons. 1. It is Ecosystem Science, which includes the psychological and social dimensions of the human predicament, under Ecosystem 8 (see Chapter Four). 2. It is not based on Cartesian dualism, but on Contextual-dyadic Thinking (see Lee 2017a, Chapter Nine). 3. Methodologically, it is anti-reductionist, and its causal model is nonlinear and multifactorial. 4. It subscribes to Macro-Micro-cosmic Wholism (see Chapter Ten). 5. It regards the notion of person as a primitive concept, as argued in detail in this chapter. 6. It upholds that all illnesses have a psychosocial dimension. The concept of chang, as set out above, shows that it includes the psychosocial dimension, meaning response, and emotional response/qing gan/ ᛵ ᝏ , aspects which can assume a central role in understanding an illness, depending on the context and the particularities of the case. 7. It is, au fond, Psychosomatic Medicine. As such, it is compatible with the “meaning response” model, which could be expected to produce, to a lesser or greater extent, placebo effects/responses. This chapter has cited a case mentioned by Professor Hao in which he used no medicinals, only counselling and suggestions. The patient was shown how she could reorientate her emotions, from one of anger (which was causing the symptoms she displayed), to one of creative pleasure. In this sense, forms of counselling are intended to bring about placebo effects/responses (however, without the intervention of a placebo, as conventionally understood, in terms of shams and/or deception) . 8. This then raises a definitional matter regarding the term “placebo”. The quick and correct answer is to say that it matters little how one defines a term, provided all parties are aware that nothing of substance follows from a definition, strictly speaking, except tautological conclusions.

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Definition A: a medical intervention which is inert, which involves shamming and/or deception. Such a defintion would be found in Big Pharma drug trials, where sugar/flour and water pills, identical in size, shape and colour to the trial pill, are used in the control arm of the test. One can say that in Bm drug trials (unlike CCM), the chang it implies is solely and simply concerned with Matter, and may, therefore, be called a Material chang. Definition B: an intervention in a medical context, which involves no shamming and/or deceptions, may invoke medicinals with real/ not inert properties, or no medicinals (real or inert): all are expected to produce socalled placebo effects/responses. In other words, the sense of chang implied is more comprehensive than the Material chang, presupposed by Bm, in the domain of the monogenic, monofactorial conception of disease as a disease entity. CCM implicitly endorses Definition B; Psychosomatic Medicine as part of Bm may do so as well. Big Pharma drug trials appear to endorse Definition A.

Conclusion In the opinion of this author, one of the most distinctive characteristic features of CCM is that it focuses on person-hood as a primitive concept, as the medicine it upholds, is Wholist, dyadic in character, not reductionist and dualist, which is the dominant philosophical framework, in which Bm is embedded. As such, all illnesses are necessarily psychosomatic in character, to a greater or lesser extent–hence, the causes of an illness would include the psychosocial dimension, as would its treatment. Given such a perspective, CCM, implicitly and/or explicitly, accommodates and harnesses the so-called placebo phenomenon to its goal of curing the patient and/or ameliorating the patient’s suffering. Psychosomatic Medicine (as part of Bm) would also necessarily agree with CCM as understood above. However, Bm, in general, still dominated by the monogenic conception of disease (based on reductionist Dualism and on the linear, monofactorial model of causality) finds the placebo phenomenon disturbing and, hence, holds that it must be eliminated, at all cost, in order for such a medicine to remain “scientific” and “objective”. This, from the standpoint of CCM and Psychosomatic Medicine (in Bm), would be misguided and wrong-headed.

CHAPTER SEVEN PERSONALISED MEDICINE IN CCM AND PERSONALIZED MEDICINE IN BIOMEDICINE: THE IRRELEVANCE OF RCT AND EBM TO CCM

Introduction CCM is, and since its inception has been a form of bespoke medicine. This is to say that, since no two persons who fall ill (even of the same so-called illness), are precisely identical in the way that they present their respective person-bodies to the physician, their treatment necessarily must be tailormade to suit their own peculiar set of circumstances. This entails the recognition that there is no homogeneity and uniformity amongst patients. Without homogeneity and uniformity, the notion of RCT, considered as the Gold Standard of testing the efficacy of treatment in Bm, is not applicable. Indeed, until of late, Bm had taken great care to distance itself from CCM for fear of being tainted with the brush of being “unscientific”. Developments in Bm have been heavily impacted by the Human Genome Project (HGP); in addition, Bm has shown an increasing willingness and ability to conduct more sophisticated forms of monitoring. It has now gradually come to realise that Personalised Medicine is not simply sound, coherent and therefore, perfectly “scientific”, it has even trumpeted that this is the new sophisticated way forward. This kind of “cutting edge” research and thinking in Bm will find itself in the same bed, so to speak, with CCM. Logically, if CCM must be judged to be “unscientific” because it is beyond the pale of RCT, so must this much-trumpeted new variant of Bm; mutatis mutandis, if the latter is judged to be scientific, then, so must the former, as they are, to all appearances, together in the same boat. What is sauce for the goose is sauce for the gander. The ball is now in Bm’s court as presently understood. This chapter examines, and attempts to disentangle the web of issues involved. If the unravelling pursued here is sound, it follows that it would no longer make sense now to berate CCM

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for having failed to meet this Gold Standard of Bm, and in turn, its twin Gold Standard, EBM, as the latter itself rests on the former.

CCM: Personalised Medicine/Getihua Medicine CCM’s version of Personalised Medicine today is called getihua zhiliao fangfa/њփॆ⋫⯇ᯩ⌅. Here is *Hao Wanshan’s (2011) illustration of this concept at work. During a flu epidemic in Beijing in the 1990s, a man and a woman (husband and wife) came to consult him. The woman pleaded that she alone should be given a prescription, which would do duty for both: “just double the quantity of the herbs used, that would do nicely”. When asked why, she explained that she could claim expenses while he could not; in that way, they could save some money, given that they were suffering from the same thing after all. This showed that she had imbibed the Bm diagnostic paradigm of disease entity and treatment–same virus, same medicine, and was unthinkingly invoking it in the context of a CCM consultation. Hao, then, patiently explained that CCM does not work in that way. He must diagnose and prescribe for the individual, according to what is precisely malfunctioning in that person’s physiology. It is bespoke Personalised Medicine. Upon examining the husband, he found he was of an introverted disposition. When probed, he confirmed that he suffered from cold extremities. Hao diagnosed his condition to fall under the category of “wind-cold”/fenghan waigan/ 仾 ሂ ཆ ᝏ , with yang deficiency and yin in excess/yangxu yinsheng/䱣㲊䱤ⴋ and so, prescribed medicinals with bitter warming/xin wen/䗋⑙ properties. In contrast, he diagnosed his wife as yin deficient and yang in excess/yinxu yangkang/䱤 㲊䱣Ӓ, and her affliction fell under the category of “wind-heat”/fengre waigan/仾✝ཆᝏ. Her symptoms included deep yellow catarrh. Upon being told this diagnosis, she readily confirmed that she had a bad temper, was impulsive, that, indeed, she had always suffered from throat problems, not to mention that, since childhood, her tonsils had been flaring up, now and then. In the light of this overall picture and emerging patterns of signs and symptoms, Hao prescribed medicinals with bitter cooling/xin liang/䗋 ߹ properties for combatting her excess yang, thereby redressing her Yinyang imbalance. At the end of the consultation, the wife agreed that she had been silly in her original proposal for an identical prescription for their flu bouts; that now, they would gladly pay for her husband’s medicine from their own pocket. This tale illustrates a very important concept within the framework of Personalised Medicine, the concept of similar affliction, different treatment:

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tongbing-yizhi/਼⯵ᔲ⋫. In terms of the waixie, indeed the same external pathogenic factor had invaded the person-bodies of the two patients. However, as they had very different personality predispositions/ constitutions, their reactions to the external pathogenic factor, far from being identical, were the very opposite of each other. From this, it follows that their prescriptions/treatments were necessarily different. If biomedically tested, no doubt the two patients would each be said to be harbouring the same flu virus, but the CCM physician is not bothered at all with this biomedical finding. For CCM, there is, in principle, no one-sizefits-all diagnosis and prescription, although this is not to deny that during the height of epidemics such as SARS in the 2000s, due to the vast number of patients, physicians had no choice but to draw up a “mass” prescription as faute de mieux, as frontline strategy, to be followed by a mopping up operation in those cases with residual problems. Nor does CCM rule out processed patent medicine, which can be bought over the counter as a frontline-treatment strategy in some cases. As a matter of fact, CCM has always recognised the category and concept of “mass medication” and distinguishes between quntihua/ 㗔 փ ॆ and getihua prescriptions–the former is based on assessing symptoms such as flu, which could do duty for all patients irrespective of age, gender and other conditions, especially under the specific circumstances of having to cope with an epidemic. The latter is, of course, as we have seen, tailor-made to suit the specificities of the individual patient, taking into account all relevant conditions of the person, such as age, gender, mental state, individual constitution and their response to the xie/䛚/the pathological factor in question, which triggered the illness. This involves the diagnostic concept of zhèng/ 䇱 and its intimate relationship with treatment via fang/ᯩ, which will be explored in depth in Chapter Eight. A companion concept to “same affliction, different treatment” exists; this is called “different affliction, same treatment”/yibing-tongzhi/ᔲ⯵਼ ⋫. *Hao 2011 cites two cases to illustrate this concept. The first case concerns a post cancer operation patient, who had suffered from cancer of the intestines; he was prescribed certain biomedical drugs by his doctors to cope with the after effects of the operation. Unfortunately, these drugs resulted in severe stomach pain. His doctors then prescribed painkillers; despite these medicines, the stomach pains became unbearable, especially during the night. They consoled him that such an effect would last only six months, which he felt was no consolation at all, as he could not bear such intense pain for six days, let alone six months. Hence, he turned to CCM. The patient was obviously very weak; he also had some small patches of blood stasis on his skin. Hao concluded that this was a case of

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inflammation of the intestines, caused by his taking certain biomedical drugs, and was therefore an iatrogenic illness. In CCM terms, this was a case of insufficiency of Qi and blood, causing the pain in the Stomach. He prescribed the Xiaojianzhong tang/ሿ‫ڕ‬ѝ⊔. The prescription proved immediately efficacious as after the first decoction, the patient felt the pain diminishing; after two weeks of treatment, he reported that all pain had disappeared. The next case concerned a young female student accompanied by her mother; the details of this case have already been given in Chapter Six, under the category of psychosomatic illness. There is no need to repeat them here. Suffice it to say that she was prescribed the same prescription as for the post cancer operation patient discussed above. Recall that he diagnosed her with a deficiency in both blood and Qi and undernourishment; her mental capacity was affected, which explained her inability to concentrate, her depression, lack of motivation and exhaustion. After a year’s treatment, using a combination of medication and counselling, her health was restored. What inferences could one make? 1. CCM might strike a person who is not familiar with it, as being resolutely “backward looking”, because the Xiaojianzhong tang is a prescription found in the opus of the famous late Han dynasty physician, Zhang Zhongjing which, historically, has come to be known as the Shanghanlun (see Appendix Two). Yet it is obvious that Zhang Zhongjing himself would not have come across a condition that is clearly Bmiatrogenic in character as instanced by the post cancer operation case. What led Professor Hao to invoke this ancient prescription, rested on his observation that the patient was emaciated and weak, his complexion was lacking blood, his tongue showed patches of blood stasis, and so on. This made him conclude that the patient lacked Qi and blood in his stomach, that this closely entwined dual lack hindered smooth Stomach movements, thereby, causing extreme Stomach pain. As the Xiaojianzhong tang is a prescription advocated in the Shanghanlun (amongst other conditions) for Stomach pain, Hao, in accordance with Zhang Zhongjing’s logic in theory-therapy, judged this would be the right prescription to use in this late-twentieth-century case. (This aspect of CCM will be further explored in Chapters Eight, Nine and Ten.) Similarly, it is this same logic which led him to invoke the same prescription in the case of the young female student, as it became obvious that she, too, like the post cancer operation patient, was suffering from inadequate Qi and blood. Hence, regardless of the differences in the medical histories of the two patients and of the

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respective different proximate causes of their illnesses, the ultimate cause, according to CCM, is inadequate Qi and blood which, in one case, led to intense Stomach pain and in the second case, to depression/insomnia, weight loss, amenorrhea, and so on. This is an excellent illustration of how CCM practitioners (at different periods of its history until today) creatively renewed/renew the theory-practice of their medicine. The two cases involving the wife and husband were also diagnosed and prescribed for under Hao’s understanding of the subject, as found in Zhang Zhongjing’s Shanghanlun. 2. The instances examined, also put paid to a myth (under the aegis of TCM) that Chinese Medicine is really only good for chronic conditions, not acute ones (see Karchmer 2015). The history of CCM clearly shows that the medicine had/has always to cope with both types of situations. The case of the young female student would fall under the chronic category and her successful treatment took a year; however, the case of the post cancer operation patient would fall under the critical category, as he was in great pain, brought on by biomedical drugs. Further, the decoction produced immediate relief. (This relief should not be confused with that given by pain-killers as such pills have to be taken at regular intervals to keep the pain at bay, whereas the pain relief, here, is due to the fact, that the “offending” condition in the patient had been overcome, for good, by the treatment.) Similarly, the two cases of flu of the husband and wife would not fall under the chronic category. 3. The important point to highlight is that CCM practises Personalised Medicine, that every patient who presents him/herself to the physician is unique, in one sense, and that the treatment prescribed must also be specifically crafted to suit the unique configuration of symptoms and signs, as grasped by the physician, in the light of his clinical experience as well as his theoretical understanding of CCM. 4. Some prescriptions will be analysed in detail in Chapters Eight and Nine, to show in what precise ways the various medicinals treat the condition of the patient, in terms of CCM theory, especially of the Jingluo and the Zangfu-Wuxing. 5. Chapters Eight and Nine will also show in greater detail how Getihua Medicine and its two companion sub concepts (tongbing-yizhi and yibingtongzhi) are tied up with the intimate link between zhèng and fang, on the

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one hand and, in turn, their intimate link with the trinity constituting the principles of physiology, illness and therapy, on the other. Just to labour the point that the logic of Personalised Medicine means that a prescription successful in curing one patient with waigan would not necessarily cure others also said to be suffering from waigan. To reinforce this, * Hao 2011 cites another two (but different) cases. Case 1: As a young intern, upon graduation, Hao was sent off to a physician, with many years of clinical experience, to help him to improve his diagnostic and prescription skills. A patient with asthmatic attacks/xiaochuan/ଞை said that he had developed the symptoms during one summer (on the 1st of May), three years ago. It was very hot; he was very thirsty, very hungry and very tired, after having taken part in the march in town to celebrate International Labour Day. He drank a lot of cold water, and ate a lot of cold snacks he had with him. Even before the end of the activities for the day, he had succumbed to the first asthmatic attack. Ever since, whenever the weather turned hot (between 1st and 15th of May), he would suffer attacks. His condition would get worse as the weather got hotter. He felt tightness and heaviness in the chest. The experienced physician, who was not forthcoming in explaining things to his patients (as he believed his regional speech made it difficult for his patients to understand him), simply wrote out a prescription for seven packets of medicinals, each containing only two items: 15g of wolfberry (the Jiaoshan variety/ ኡ ᶎ ᆀ ) and 15g of non-salty (or less salty) fermented soya bean/␑䉶䉹. The patient made three visits at weekly intervals. Each time, he did not report any real improvement, and each time, the physician prescribed the same two items and the same quantity for each item. After the three consultations, the patient made no more visits. A year later, Hao ran into him; the former patient told him delightedly that he had been cured. When asked with what, he said it was that simple prescription that he took for two months and, after that, he was cured. Initially, it was true he felt no real improvement, but after a bit, he did–his chest no longer felt so tight, his breathlessness became less intense, and he was slowly able to wean himself off the biomedical asthmatic drugs prescribed by his doctors. So he continued, until he was cured, at the end of two and a half months and he had not had a recurrence since. These two items (actually they are foods) were intended to clear the heat in the Lungs/qing fei re/␵㛪✝ and to clear and disperse stagnating Qi, because of the heat in him/qing xuan yu re/␵ᇓ䛱✝Ⲵ㦟. Furthermore, he told Hao that he passed the prescription around the village, every time someone

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suffered from breathlessness or asthma. Hao asked him about his success rate; he said none. Hao, himself, after all these years, had not come across another case near similar enough to this particular patient’s condition to warrant invoking the prescription. His father and brother, who were themselves physicians, also, maintained that they had never come across that particular conjuncture of factors (both internal and external), faced by the young man in question. Hao said that the experienced physician in question had been inspired, as a matter of fact, by one of Zhang Zhongjing’s remarks, which, in fact, was not intended to treat an asthmatic case at all. Case 2: Early in his career, Hao had visited a certain village where he had met a man, who had been hobbling around with a stick for more than ten years. There was no inflammation; as he did not feel pain in the joints, this would rule out rheumatism or gout. It turned out that he suffered from severe cramps whenever he engaged in any kind of physical activity, whenever the weather turned very cold, or whenever he had to carry anything heavy. His skin was dry and itchy. An attack of cramps would wake him up in the middle of the night; he could not sleep properly. He approached Hao for help. Hao used a prescription by Zhang Zhongjing. At times, this prescription has been referred to by some physicians as ৫ԇ⊔ /a decoction to get rid of crutches or sticks. This contains shaoyao/㢽㦟, gancao/⭈㥹, pao fuzi/⛞䱴ᆀ, and shenjin cao/ըㅻ㥹. To this, Hao added other medicinals, such as mugua/ ᵘ ⬌ , sugen/ 㣿 ệ ˈ and chuanniuxi/ᐍ⢋㟍/Cyathula; this last acts as a kind of vector ensuring that the medicine reaches the parts affected. It should be noted that Zhang Zhongjing himself called the prescription Shaoyao gancao fuzi tang/㢽㦟 ⭈㥹䱴ᆀ⊔). Hao instructed him to begin with three packets and to note the results. He expected that it would eliminate cold from the patient’s body/傡ሂ (as cramps mean cold/ሂ), nourish his yang/ޫ䱣 (which indicated that the patient suffered from yang deficiency; so one must supplement/bu yang) and, in that way, get rid of his cramps. However, he could not be totally confident that the treatment would work, as the condition was chronic. The patient took sixty packets of these herbs, and found he was cured. Two or three years later, Hao revisited the village. The former patient hailed him to thank him for having cured him. He clearly no longer used a stick, could walk normally and engage in physical activities (such as carrying buckets of water from the street pump in the village to his home, when piped water to households in rural regions was still not the norm, those many decades ago). The former patient took him

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home, and produced from a drawer the original prescription, bearing Hao’s own handwriting. The prescription was now backed by numerous pieces of paper. When asked why, the grateful patient explained that it was in great demand in the village–anyone with walking difficulties borrowed it. When asked if any of these villagers benefited from it, he admitted that not many did. This is not a surprise, as this prescription was tailored to suit his conditions as diagnosed; and in any case, people who had difficulty in walking or pain in the leg, could be suffering from a variety of different conditions, such as rheumatism or gout. In any case, this fang of Zhang Zhongjing, that Hao had relied on, is not meant to cure people who have become disabled because of cramps, but was used for people who were yang deficient, whose Jingmai, as a result, had lost warmth, not received sufficient nutrients/䱣㲊㓿㜹ཡ⑙ˈ䱣㹰н䏣ˈ㓿㜹ཡޫⲴ, and whose xue was yang deficient and insufficient. 1 Hao had added sugen to the prescription to relieve discomfort in the chest/ 㜨 䰧 , as the physical disability had naturally affected the patient’s mental state as well. Two morals may be drawn from these two instances: (a) The crucial one is that Getihua Medicine would rarely work in cases other than that of the patient, for whom the prescription was tailored. This is because the physician arrived at the prescription in the light of diagnosing the precise conditions of the patient. Diagnosis would be through ascertaining the symptoms/ zhengzhuang/⯷⣦ (such as feeling pain in the stomach, when the physician pressed on it), the signs/tizheng/փᖱ (such as vomiting and diarrhoea, which onlookers could observe), and using the four diagnostic techniques (ᵋ䰫䰞࠷–wang/looking at the complexion, observing the state of the tongue; wen/listening to wheezing and heavy breathing or watching out for certain smells emanating from the patient’s person-body; wen/asking for information; qie/feeling the mai/㜹). (b) In arriving at the zhèng/䇱 and an appropriate prescription/fang/ᯩ to cure the zhèng, the physician would have arrived at such conclusions against an understanding of theoretical concepts, such as Yinyang-Wuxing which helps to determine where the imbalance between Yinyang lies and which visceral organ-system(s) is/are affected and in which way. He would have determined whether the 1

The Chinese text for the above reads: 䱤㹰н䏣⭘ޫ㹰Ⲵ㦟DŽDŽDŽᐍ⢋㟍 (ᕅ㦟л㹼Ⲵ㦟).

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patient is suffering from yang excess/yin deficiency or yin excess/ yang deficiency while, at the same time, taking into account the weather, the time of year or day, when the patient feels relatively better or worse, and so on. The physician must also consider the patient’s zhengqi/↓≄/proper qi and xieqi/䛚≄/pathogenic qi as well as the relationship between the two kinds of qi. (Zhengqi obtains when the person’s physiological functions are normal, resistance to pathogenic factors is strong and recovery after succumbing to pathogenic factors would be faster, as compared to someone whose zhengqi is insufficient and would fall easy prey to xieqi.) The discussion above of Personalised Medicine as practised by CCM is today more fashionably raised under the label “syndrome differentiation and treatment determination”, that is, bian zhèng lun zhi/䗘䇱䇪⋫.2 This author has opted not to use that phrase for the following reasons. 1. It could mislead readers through confusing a term/phrase with the concept for which the term stands. The expression itself dates only from the 1950s, but the concept it embodies is as ancient as the history of CCM itself. However, the ascendancy of this expression could lead the unwary into believing that the concept itself is only at best six decades old, and is part and parcel of TCM only. 2. Professor Hao, as scholar-practitioner, prefers the expression, getihua zhiliao to refer to the concept of Personalised Medicine/Getihua Medicine. 3. The concept of getihua zhiliao enables one more readily to raise its two companion sub concepts, tongbing-yizhi and yibing-tongzhi to reinforce its logic. In contrast, bian zhèng lun zhi does not lend itself so readily to the inclusion of these two companion concepts. 4. These remarks are not intended to imply that bian zhèng lun zhi has no merits, as it does highlight the difference in approaches regarding diagnosis and treatment between Bm and its Chinese counterpart. In the 2 For an excellent discussion of this expression and the concept behind it, see Scheid 2002, Chapter 7. This is a comprehensive account from numerous angles: its history, the political/ideological significance surrounding its appearance during the Mao era and its fortune post-Mao, its theoretical as well as practical significance behind the articulation of the concept of TCM itself, and so on.

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language used by this author, the former is conducted within thingontology based, in the main, on the monogenic conception of one disease, one disease entity (be this bacteria/virus/fungus/prion), while the latter is conducted within process-ontology, on the relationships between the symptoms and signs taken into account by the physician, and how these are understood in relation to the malfunctioning of internal organsystem(s), of the Jingmai, and other key concepts of the medicine. 5. While bian zhèng lun zhi bears a political/ideological history of an explicit nature, at a specific moment in recent Chinese history, getihua zhiliao is free from such baggage, and so is able to focus on the continuity of CCM in its longue durée, at least, from the time of Zhang Zhongjing, if not earlier, to the present. 6. The concept of 䇱/zhèng itself is of long standing; it is worth labouring two points already made en passant: Chapter Eight attempts to clarify it from the standpoint of prescription/ᯩ/fang, while Chapter Nine explores the underlying unity between the principles of physiology, of illness and of therapy/shengli-bingli-yili.

Biomedicine: Precision Medicine/Personalized Medicine Those who think of Bm, only through its dominant paradigm of the monogenic conception of disease (Lee 2012b, Chapter 9) would be surprised to learn that, of late, Bm has developed an aspect which it calls Personalized Medicine. The FDA (USA), under “Personalized Medicine” 2015a gives the following account: The term “personalized medicine” is often described as providing “the right patient with the right drug at the right dose at the right time.” More broadly, personalized medicine (also known as precision medicine) may be thought of as the tailoring of medical treatment to the individual characteristics, needs, and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow up.

Another definition may be found at “Personalized medicine” 2015b: Personalized medicine is an emerging practice of medicine that uses an individual’s genetic profile to guide decisions made in regard to the prevention, diagnosis, and treatment of disease. Knowledge of a patient’s genetic profile can help doctors select the proper medications as therapy

Personalised Medicine in CCM and Personalised Medicine in Biomedicine 201 and administer it using the proper dose or regimen. Personalized medicine is being advanced through data from the Human Genome Project.

The difference between Precision Medicine and Personalized Medicine is given in “Difference between precision and personalized medicine” 2015 as follows: There is a lot of overlap between the terms “precision medicine” and “personalized medicine”. According to the National Research Council, “personalized medicine” is an older term with a meaning similar to “precision medicine.” However, there was concern that the word “personalized” could be misinterpreted to imply that treatments and preventions are being developed uniquely, for each individual; in precision medicine, the focus is on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors. The Council therefore preferred the term “precision medicine” to “personalized medicine”. However, some people still use the two terms interchangeably.

The terminological clarification above (which indicates that the US National Research Council, in its 2011 Report, preferred the term “precision medicine” to the term “personalized medicine”) shows that CCM’s getihua zhiliao does not coincide entirely with either the Council’s own preferred term, “precision medicine” or the older term “personalized medicine”. So, strictly speaking, from this point on, in this work, only the Chinese term getihua zhiliao/Getihua Medicine is used and not translated in order to make clear the difference between the CCM account and the Bm account of Personalized/Precision Medicine. The original impetus behind the concept of Personalized Medicine for Bm comes from the HGP, when scientists realised that each individual has a unique version of the human genome. These variations can now be identified, located in the patient’s fundamental biology, through genome sequencing, which can reveal mutations in DNA. Some of these mutations have, in turn, been linked to the manifestation of diseases, such as cystic fibrosis, various cancers and others. Better still, technology also permits RNA sequencing–while DNA is more impervious to environmental influences, RNA responds quicker to environmental changes, and for this reason, can give a broader understanding of the individual’s state of health than DNA sequencing. A general technique, called GWAS (Genome-wide Association Study), was first successfully pioneered in a study involving patients with ARMD (age-related macular degeneration), when two mutations were found, each with a variation in only one nucleotide (SNPs, that is, Single Nucleotide Polymorphisms) linked with ARMD. Since then, GWAS studies have proliferated (see A Catalogue of Published Genome-

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Wide Association Studies, 2015 as well as Jha 2012 about the international Encode project, whose findings are relevant to understanding the findings thrown up by GWAS). Yet another new domain of Bm has arisen in the wake of the HGP: pharmacogenomics. Its very name is self-explanatory, as it is the study of how a person’s genes can affect his/her response to drugs. Up to 2010 or even later, pharmacology proudly bore the nostrum that no drug with beneficial effects would/could be without serious side effects–this is even called the first law of pharmacology (see Lee 2012b, Chapter 8). Today, a few years later, pharmacogenomics has dropped that claim, and now promises to “develop effective, safe medications and doses that will be tailored to a person’s genetic makeup” (“What is pharmacogenomics?” 2015). This promised sophistication would over-ride the crudeness of nearly all drugs, which are of a “one size fits all” specification, including drugs used in the case for very small babies (dosages of drugs used in drug trials are given to adults and doctors and have only guidelines to help them to adjust the dosage for non-adults). Furthermore, drug trials can only yield statistical findings, which are very relevant to answering the question: how many people would be advantageously affected by the drug test and how many would be adversely affected? They cannot answer the question facing the patient as well as the doctor in charge of the patient: given that 5% of the people in the trial had developed negative tolerance to the drug, how would this patient, in my consultation room, react to the drug if prescribed? We shall be returning to this point and other related aspects, later in this chapter. In the future, Bm expects that pharmacogenomics will make possible tailored drugs to treat a wide range of diseases including cancer, asthma, HIV/AIDS, cardiovascular and other diseases. So great is its perceived promise that even journals for financial investment have run excellent articles on it, such as Robinson and Renton 2012. 3 Another very recent entrant is in the domain of diets and nutrition. In June 2015, some Israeli scientists unveiled their Personalized Nutritional Report at a conference on the human microbiome conference in Heidelberg, Germany (see Sample 2015). The central contention of this project is as follows: foods, whether deemed to be healthy or unhealthy, can affect different people differently, as each one has his/her own biological makeup. This would clearly have implications for the diets of people who suffer from diseases such as diabetes, heart problems, and so on. For instance, blood sugar is central to the management of diabetes, not 3

For a critique, which claims that this is, at best, a vision for the future rather than reality on the ground, see Gamma 2017 in Solomon, Simon and Kincaid.

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to mention that of weight. As high levels of blood sugar can be harmful to the body, the body releases insulin to absorb this sugar, either for immediate use as energy or storage as fat. When the blood sugar load gets too high, and the body is no longer able to absorb it, then metabolic disorders ensue, such as Type II diabetes, which is on the increase, in spite of people apparently eating more healthy foods. The goal of the project is to develop an algorithm, which can take into account the variations in the biological makeup of individuals, and predict how a particular food would affect an individual. In this way, it could “warn” those whose sugar/glucose level rises dramatically following the consumption of bread, to avoid bread/too much bread, and other individuals who may react in a similar way to other foods. Part of their research also consists of looking at people’s guts, the different types of microbes in them, which play a very important role in accounting for their different reactions to different foods. As their microbiomes differ, so, therefore, would their responses differ. A dietary regimen cannot be a one-size-fits-all formula, which is measured simple-mindedly in terms of the number of calories consumed in the diet. Although the number of calories does play a role, this is not the end of the story in respect of our respective metabolisms, which is altogether much more complex. Some of its findings appear surprising–for instance, in the case of certain individuals, plain bread on its own could produce a higher glucose level than buttered bread, and in the case of others, the much maligned ice-cream turns out not to be the villain it is often made out to be. The findings of such an approach in research, though not yet replicated in large-scale studies or peer-reviewed, are endorsed by experts as moving in the right direction.4 If Personalized/Precision Medicine becomes increasingly the way forward for Bm, then the overlapping area between CCM and cutting-edge Bm would increase–Figures 6.2a and 6.2b will have to be modified to an enlarged area of overlapping as shown below:

4

See also the “Results of the Cancer Research UK-funded Trial” 2016, presented at the 10th European Breast Cancer Conference in Amsterdam (March 2016), which is said to offer an opportunity to tailor treatment for each individual woman with HER2 positive breast cancer. (This trial is also used in Chapter Four to illustrate yet another departure from Bm, as it invokes a drugs-combination to generate synergistic effects.)

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Figure 7.1˖Overlapping and non-overlapping areas between CCM and Biomedicine in terms of their respective ontological-methodological frameworks (M = Medicine; M = Medicine˅

Randomised Controlled Trials and Evidence-based Medicine Chinese Medicine (whether as CCM or TCM, the version most familiar to people outside China), in the eyes of Bm, is judged to be sub-standard, even outright unscientific, because it fails to live up to two related Gold Standards, namely, RCT and EBM.5 First, we need to grasp what these Gold Standards really amount to. Next, we need to show why CCM necessarily fails to satisfy them, exploring the reasons for its failure. It would then become obvious that all forms of Personalized Medicine (whether as Getihua Medicine or Precision Medicine, now touted as the latest advance in medical science and technology in Bm) are necessarily incompatible with the two Gold Standards that underpin “scientific medicine”. In other words, Personalized/Precision Medicine is a Trojan Horse which has the effect of undermining the very framework of Bm itself, which leaves Bm with a pyrrhic victory so to speak–either the new sophisticated medicine, which promises to be so much more effective than 5

If TCM succumbs to this criticism, it follows that so would CCM. However, the latter is not mentioned here for the simple reason that, as a matter of fact, researchers in China and elsewhere who conduct such experiments would be doing so within the framework of TCM, which is Integrated Medicine (see Chapter Eleven).

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the old “mass medicine” is scientific and if so, so is CCM; or it is unscientific, as it fails to live up to the Gold Standards, just as CCM does. This author’s own speculation is that as Personalized/Precision Medicine advances, the Gold Standards would beat a quiet retreat, and less would be heard about them, even if they were not totally superseded and abandoned. RCT per se is not new; instances of its use can be traced back to some three thousand years ago as reported in some ancient texts, both European and non-European. However, in its more modern incarnation as a systematic philosophy of science/scientific methodology, John Stuart Mill’s System of Logic (1843) is a leading classic,6 in which he set out the different experimental methods in Book Three. The Method of Difference is the most relevant to the notion of the RCT.7 Simplistically put: take four men, all Northern White Europeans with blue eyes and blond hair (characteristic A), all aged twenty-five (characteristic B), and six foot tall (characteristic C), each weighing 160 pounds (characteristic D) and each given a clean bill of health under a general medical check-up just before the experiment (characteristic E). The experimenter then fed them some mashed potatoes (characteristic a), some boiled cabbage (characteristic b), two Cumberland sausages of the same weight (characteristic c) and a glass of red wine each from the same bottle (characteristic d); however, two of them were given no dessert while the other two were treated to lemon icecream (characteristic e). An hour after such a meal, the two who had eaten the lemon ice-cream showed symptoms of food poisoning, but not the other two, who had not eaten any ice-cream. The experimenter could be sure that the ice-cream was the cause of the food poisoning, for the simple reason that eating the ice-cream constituted the sole factor (characteristic e), which differentiated those two experimental subjects who fell ill with food poisoning from the other two who did not. In all other aspects, the four subjects were similar except for characteristic e. This is to say that other things being equal, eating the ice-cream was the cause of the illness. Even before Mill articulated this method of causal inference, James Lind, the physician on board a merchant ship in 1747, is said to have used it implicitly in his treatment of scurvy amongst sailors on long voyages, who fell easy prey to the disease. (There were other doctors who employed it later such as Ignaz Semmelweiss in Vienna who, in 1847, demonstrated that puerperal fever was contagious. Its incidence was reduced significantly when medical staff conscientiously washed their hands after visiting the mortuary and touching the cadavers, before tending to patients 6 7

For a general account of Mill’s empiricist philosophy, see Wilson 2014. Mill outlines five experimental methods (see Kemerling 2011).

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in the maternity ward (see “Ignaz Semmelweiss” 2015, Lee 2012b)). Lind (Silverman 1985, 7) wrote: On the 20th of May, 1747, I took twelve patients in the scurvy aboard the Salisbury at sea. Their cases were as similar as I could have them … Two of these were ordered a quart of cider a day. Two others took twenty five guts of elixir vitriol… Two others took two spoonfuls of vinegar… Two were put under a course of sea water. Two others had each two oranges and one lemon given them each day… the two remaining took the bigness of nutmeg… The consequence was the most sudden and visible good was perceived from the use of the oranges and lemons.

One could complain that by modern standards of how RCTs are conducted, Lind’s experiment could not be said to be impeccable for the following reasons: his sample was too small (only twelve patients); he did no blinding, let alone, double blinding; he used no placebo group, nor did he create a no treatment group; and he did not randomise the patients to the six different treatments he exposed them to. (Chapter Six has shown the horror with which Bm regards the placebo effect, having identified it as producing a corrupting influence on the medicine, undermining its status to be the only scientifiic medicine in world history.) Statistically, a small sample 8 cannot eliminate chance results due to the self-limiting nature of disease, sometimes also called spontaneous remission. People tend to visit a doctor when their affliction is at its worst, then they take the doctor’s prescription and find that their condition has improved, upon which they attribute the improvement to the medication whereas, strictly speaking, their improvement might have nothing to do with the medication, as it is in the nature of many illnesses to improve on their own. Hence, their reasoning may be faulty as they could have committed the fallacy called post hoc, ergo propter hoc–it is as if people say that lightning is the cause of thunder, just because thunder follows upon lightning. Perhaps one should not use modern standards of medicine to judge eighteenth-century clinical practices. So let us simply accept that Lind was being scientific, at least, according to the scientific lights of his time. Today, Bm has improved in knowledge by leaps and bounds as well as in methodological sophistication, it is said. What would count as a properly conducted, fully scientific RCT today? Unfortunately, the answer is not as straightforward as one might expect, as we shall see, but let us 8

Today, a trial involving 337 participants, is said to constitute a small study; a large study would involve tens of thousands, a million or indeed even 3 million (see Evans, Thornton and Chalmers 2011, 35-36).

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begin with the basics. Canonically, it appears that for any test to count, it must satisfy the following criteria: (a) Single blinding–patients must not know the true nature of the treatment involved, whether they are getting the real therapy or fake therapy in order to control for the placebo effect. (b) Double blinding–not only must the experimental subjects not know which is the real medicine and which is the fake, but the medical staff administering the test must also not know. At the end of the experiment, the results would be looked at and assessed by another team, which had had nothing to do with the project up to that point. (c) Which subject would be assigned to the experimental arm (the group taking the real medicine) or the control arm (the group taking the fake medicine) must be done by randomisation, preferably by means of an algorithm, controlled by a computer. Next, we come to the harder bit. Satisfying the above three criteria amounts to satisfying, so to speak, the Gold Standard in its Platonic form. Alas, it is rare that one can achieve the Platonic level of scientificity, for the following reasons. 1. Pills are easy to fake; one can easily cause a pill made up only of flour and water to be manufactured, looking exactly as the real pill with the same shape, size and colour. (See Lee 2012b for why these things matter from the standpoint of the control of the placebo effect.) Not all medical interventions are so readily amenable to being faked–could one really fake a surgical procedure of a complicated kind? One could put the patient under general anaesthetic, then cut open the thorax, pretend to fiddle with some organ, then sew the patient up, but would this be ethical? RCTs, these days, have to be approved by a bioethics committee or two. For this reason, many pharmaceutical companies prefer to do their testing in developing countries, where the ethics code is either more modest or even non-existent, not to mention saving costs while doing so.9 9

Historically, there are grounds for saying that “perfection” in medical research trials was achieved only during the Second World War. In particular, this referred to experiments by the Japanese medical research team, officially known as Unit 371, which conducted all its experiments (including vivisection) using no fakes; the victims (thousands of them) being primarily, though not exclusively, Chinese prisoners of war and captured civilians. The results for studying the physiological changes induced by hyperthermia still underlie today’s techniques of saving the lives of those suffering from hyperthermia. The work of this research group was

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2. As Chapter Six shows, the placebo influence on human behviour is so deep and profound in many contexts, and signals of what is placebo and what is not, are picked up so systematically, even subconsciously by people (whether patients/experimental subjects/medical staff), that it seems almost impossible to control effectively for it. As a result, medical research, in many contexts, uses Open Label instead, which does away with single-blinding and double-blinding altogether. This retreat then leaves randomisation as the sole-standing criterion to constitute this Gold Standard which, in the end, is what Evans, Thornton and Chalmers 2011 mean by “fair tests of treatment”. Randomisation is a statistical tool. Why should randomisation be considered to be such a powerful technique, that adhering to it alone can vouchsafe the RCT Gold Standard? We cannot answer this question now but will address it later. One should also realise that RCT in its reduced, pared-down form is subject to still further constraints such as those listed below: (a) It does not apply to contexts which involve “dramatic results”. If a new treatment, when first tried out on patients (not simply experimental subjects, as these two categories may not cover one and the same group), with a disease known to result in imminent death if left untreated, suddenly showed great improvement or absolute recovery, then RCTwould be held to be irrelevant and dispensed with. The new drug/treatment would be immediately released for use on patients afflicted with the said disease, One such example (cited by Evans, Thornton and Chalmers 2011, 50) concerns the use of the defibrillator, applied to the chest of the patient, to restore the heart’s normal rhythm. The treatment consists of “zapping” the heart with a direct electrical current from the equipment, called the defibrillator. (b) RCTs are considered to be particularly relevant in cases where treatments produce, by and large, moderate effects, such as in the

considered to be so valuable, so objective and scientific, that the USA Pacific High Command struck a deal with the Japanese government promising no prosecution in exchange for their data (see Harris 1995, Lee 2012b, Chapter 6). It is interesting to note that, according to modern Western philosophy, the investigation of phenomena is scientific and objective only when values, which are subjective, are excluded from the enquiry. Unit 371 had adhered faithfully to this nostrum and hence, its results, not being corrupted by values such as compassion or human rights, were perfectly objective and, therefore, perfectly scientific.

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case of the relative merits of different types of hip replacement joints. (c) RCTs are relevant when doctors/surgeons disagree amongst themselves as to which treatment is the correct one–in the case of a broken leg, one lot swears by encasing the lower leg in plaster, and the other condemns it, endorsing no plaster. (d) When pharmaceutical companies introduce a new drug, they require approval to do so. (This will be examined later.) Critics of RCT appear to distinguish between two aspects, internal and external validity. They tend to say that, while RCT holds its head high on the former front (which may be interpreted to mean that such trials have no internal design flaws), it falls down badly on the latter (see Cartwright 2007; Kristiansen and Mooney 2004a and b, Pedersen 2004). For them, the biggest flaw, which undermines RCT trials, as far as external validity is concerned, lies in the unacceptable behaviour of the pharmaceutical industry and the undemanding attitude of governmental agencies in making demands on the industry, to ensure conformity to methodological requirements of scientific propriety, which has, up to now, permitted the industry to “get away with murder”. 1. The “wickedness” of Big Pharma. Everyone knows the industry is not a charity, but a business seeking profitable returns for its shareholders. In the last ten years or so, many critics have raised this set of issues (see Angell 2004, Goldacre 2012). The unacceptable aspects that most concern us, here, are the following: (a) Failure to publish the results of all tests performed amounts to the deliberate suppression of those tests which show negative results, while using questionable statistical tools to massage those results, which are positive, to make bigger claims than are justifiable. (b) Reliance on corrupt practices such as articulating a test project, funding it, hiring its own research scientists to design and carry out the project, but passing off the project as the work of medical consultants at leading universities, who appear to happily collude with such corrupt practices. (c) Employing salespeople to seduce medical staff to prescribe to patients the products of their companies, arrived at in the ways described above, using either crude or subtle forms of bribery.

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2. Regulating authorities know, but prefer so far to do nothing about the matter, in large part because Big Pharma is a very powerful lobby, which governments are loath to upset. Universities themselves are increasingly dependent on the funding by Big Pharma for their research activity–hence, the collusion, whether willingly or reluctantly given. Furthermore, regulatory authorities such as the FDA (USA), only demand of the pharmaceutical industry that their new drugs are “effective”, or “more effective” without specifying “effective in respect of what”. Hence, one cannot blame the industry for interpreting that demand to suit itself best, not in terms of the best current treatment for the same condition (which would then require what is called “head-to-head” comparison), but effective with respect to placebos. (Ironically, sometimes, even placebos do better than the drug under test!) Furthermore, as the industry is necessarily profit-driven, new drugs that involve genuinely new molecular entities (NME), either discovered or synthesised, are few and far between. These would require a greater input of resources in terms of R and D; far better, then, to concentrate on the strategy of manufacturing “me-too” drugs, which are then tested against placebos. If “effective”, these can be marketed, turning in handsome dollars/euros/pounds. Non-industry research (which requires either governmental or large charitable funding) often shows that the “effectiveness” of these “new” drugs is not what Big Pharma says it is–for instance, NIH-sponsored research in the USA (National Institutes of Health) is four times 10 less likely to be favourable than the industry-sponsored research in drug trials. (See Angell 2004, 94-97, for results arising from AALHAT, organised by the US Heart, Lung and Blood Institute, a part of the NIH which involved 42,000 participants, across 600 clinics, lasting eight years, comparing four types of existing drugs.) 3. The above is compounded by the failure of the FDA to enforce whatever existing regulations, that may be on the books to constrain the behaviour of Big Pharma. Although there may be four Phases in testing a drug (involving human beings, not animals), the industry often interprets Phase IV to suit itself. Phase I: involves a small number of volunteers (not ill but healthy people) who are given the drug in order to establish safe dosage levels, and to 10

Goldacre 2012 even says it is twenty times more likely to give results, which favour the drug it is testing than independent testing, with both sides claiming to use the RCT Gold Standard.

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study possible side effects. Often, they are not volunteers, as strictly defined as they do get paid, though the sum is very small. (This stage, actually, could be said to be methodologically suspect–healthy people cannot be equated with people who are ill; what harms the latter, may not harm the former. See comments later, which cast more light on this matter.) Phase II: involves, say, a few hundred real patients with the relevant diseased condition (but for hidden flaws, see comments below). Phase III: assuming all goes well with the above, at this next stage, the trials use a larger number of patients, from hundreds to tens of thousands, and using a comparison group of patients–that is, they tend to conform to RCT requirements. Phase IV: or “post-marketing” studies, as drugs which pass Phases I, II and III would get FDA approval, although in some cases the FDA would require the company to look for unknown side effects.11 On the whole, according to Angell 2004, these studies are construed by the industry to find new uses for old drugs, in order to reach a wider market. Big Pharma is not willing to take seriously Phase IV studies, and society, through its regulating authorities, appears equally unwilling to ensure that the industry has a duty and responsibility to monitor side effects of the drugs that have been marketed on a longer term basis. FDA (or equivalent) approval is the be-all and end-all objective of industry-sponsored drug trials, as without it, no marketing is permitted. Today, and for the last two decades, critics appear to agree that the single most important strategy to pursue is to get all trials to be registered with their protocols attached. All their results, whether negative or positive, must be published and made available in full for independent critical assessment. In addition, all financial interests and backing should be declared, as evidence shows that the type and source of funding can influence the quality of the research and the assessment of its results (see Chalmers 2006; Evans, Thornton and Chalmers 2011). When Nice (National Institute for Health and Clinical Excellence) was set up in the UK in April 1999, it tried to get the demand for disclosure of all test results incorporated into its framework, as otherwise, it cannot carry out the remit the government has/had imposed on it. This attempt was 11

Chapter Four shows that sometimes the FDA could be firm with Big Pharma, as in the case of the thalidomide drug, which it refused to approve, unlike equivalent authorities in other countries.

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unsuccessful, as the government was not willing to put pressure on the pharmaceutical industry to comply with such a requirement. Hence, Nice accepted the job of constructing guidelines regarding “value for money”, in recommending the most “efficacious” and most cost-effective drugs and treatments to the medical community, but without the necessary tools to discharge their own duties properly, 12 resulting in a half-baked, muddled compromise. 13 This fundamental defect will, in turn, infect the methodological soundness of EBM itself, as we shall see below. Appended to the RCT Gold Standard is its EBM twin. (The term itself first appeared in 1991 (see Sur and Dahm 2011)). The Cochrane Collaboration (CC) stands for these twin Gold Standards of clinical medicine. CC (a non-profit, non-governmental organisation, world-wide) came into existence in 1993, mainly through the efforts of Iain Chalmers in the name of Archie Cochrane,14 dedicated to organising and assessing medical research information in a systematic way, to enable intelligent and reliable choices to be made by patients, health professionals and policy makers, whether in government or outside government. In sum, it claims to be the instantiation of “evidence-based medicine”. Figure 7.2 shows their logo.

Figure 7.2˖The Cochrane Collaboration Logo 12 This information was divulged (by a distinguished and well-established figure in British medical circles) at a conference on EBM, held at Oxford University in 2012. 13 According to Kendall 2007 (as found reported by McGoey 2007), in the UK, a regulatory authority called the MHRA (Medicines and Healthcare Products Regulatory Agency, equivalent to the FDA in the USA) exists, that does enjoy more privileged access to the results of tests not published by corporations, such as GlazoSmithKline, but MHRA is bound never to disclose such data to anybody else, as they are protected data under the Medicines Act of 1968, which denies access to the public! The European Union’s equivalent to MHRA and the FDA is the EMEA (European Agency for the Evaluation of Medical Products). 14 Cochrane (1909-1988) was a Scottish doctor who, as a result of his war experience, later wrote his book called Effectiveness and Efficiency: Random Reflections on Health Services 1971, in which he advocated RCTs as the basis for making medicine more effective and efficient.

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The logo encapsulates excellently its intellectual message: what it means by a meta-analysis of RCTs (see Kristiansen and Mooney 2004a, 10-13): …The results of seven different randomised trials are presented in terms of odds ratios, and each horizontal line represents the confidence interval for the odds ratio of the studies. An odds ratio of 1 is indicated by the central vertical lines. The results to the left of this indicate that patients in the intervention group fare better than the controls. While two of the studies resulted in ‘significant’ improvements from therapy, the others were not statistically significant and raise doubts about the effectiveness of the therapy. This resulted in few obstetricians using corticosteroids until a meta-analysis made a numerical synthesis of the seven studies. This synthesis is represented by the diamond in the lower part of the logo: the horizontal length of the diamond represents the confidence interval of the effect size. This interval is very small, and well to the left of the vertical ‘no effect line’. In other words, there is little doubt that there is a positive effect when all seven studies are ‘boiled down’ in one meta-analysis. On the basis of this, the CC claims that ‘tens of thousands of premature babies have probably suffered … from failure to use systematic reviews’.

EBM, however, has attracted criticisms, the main ones of which are listed below. 1. EBM adheres to a dogmatic hierarchy of which (logically) 15 RCT occupies the first rung (it is the Gold Standard), downgrading other studies (in a descending order), namely, Cohort studies, Case-control studies, Case series, Case reports, and Opinions. However, RCT-EBM have not provided good evidence or, indeed, any evidence at all for advocating such a hierarchy (Thelle 2004). Furthermore, Kaptchuk has argued that whatever evidence RCT itself proffers is rendered tautologically true, as it authenticates itself (2001, 242-243): … ‘the truth is what we find out in such and such a way. We recognize it as truth because of how we find it out. And how do we know that the method is good? Because it gets at the truth.’ … any differences between masked RCTS and other research methods are due to deficiencies in the less stringent method. The ideal masked RCT is a priori considered a perfect tool and always innocent of any contribution to distortions from ‘reality’.

15 Logically this is so, because EBM rests on the results of RCTs. Sackett et al.1996 give a more generous and relaxed account of EBM in its earlier days.

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2. EBM is as good or as sound as RCTs and if RCT appears to embody bias or flaws (at least, in the eyes of its critics), this would infect the soundness of EBM. 3. We have already observed that RCT today, puts less emphasis on blinding, single and/or double, putting all its eggs in one basket, on randomisation. The researchers set out to control for factors/variables known to make a difference to the outcome of a trial–they must ensure that the experimental arm and the control arm are the same, except in respect of one characteristic/variable (according to the logic of Mill’s Method of Difference). However, the state of scientific knowledge does not permit us to identify and control for all possible relevant factors that could make a difference to the test outcome. Randomisation then, is expected to act as a surrogate, to take care of all extraneous factors not yet known or controllable, but which could be relevant. Can it bear this heavy responsiblity? 4. In some cases it may; but in principle, not in all cases. Randomisation can take care of allocation bias, but can it take care of selection bias? A study (in the USA) may be impeccably run according to the RCT Gold Standard, but it happens to have been undertaken in an area which is predominantly white; its results, therefore, hold for “White Anglo-saxon females” of a certain age. But can one extrapolate results with confidence and apply them to US females of say, Caribbean stock, or indeed, worldwide? One would be methodologically foolish to do so without hesitation. Satisfying the RCT Gold Standard of randomisation may only be a necessary, but not a necessary and sufficient, condition; scientifically reliable data relevant to clinical decision-making must be obtained, not simply through the avoidance of allocation bias but also for other types of bias, such as selection bias. To meet this kind of criticism, defenders of EBM say that systematic reviews of all properly conducted RCTs worldwide are the norm. In reality, conditions in many parts of the world are not amenable to the running of RCTs, and even if some proper RCTs were run, the results would probably be published in a language and in journals not available to medical researchers in the First World (defined as countries with “advanced/mature economies, which are politically democratic in character”). 5. Other critics have focussed on the notion of “meta-analysis” as the core of the truth in EBM (see Kristiansen and Mooney 2004a; Rasmussen 2004). They point out that different meta-analyses of the same subject may

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reach different conclusions, even when the studies included are about the same; that there is “a surprising degree of subjective interpretation involved in systematic reviews”, as independent readers and authors of these reviews rate them differently, with the latter being more positive about the treatment under review than the independent readers; and that the predictive power of meta-analysis is not overwhelming, as it appears to predict the results of subsequent large clinical trials only in two out of three cases. However, concentrating on criticising the external validity of RCTEBM, but letting the internal validity of RCT “off the hook”, make little methodological sense, as its internal validity and external validity are interlinked. One needs to grasp that critical drawbacks of the latter can be traced to flaws in the former. Furthermore, one needs to grasp that internal validity is about the setting up of the framework, within which RCT is conducted. It is equivalent to setting up an axiomatic system. In Euclidean geometry, once the basic axioms, 16 together with its basic terms are in place, one can logically deduce conclusions from them. Once basic terms, such as “point”, “straight line”, and “angle” have been defined, it would logically follow that the sum of the internal angles of such a triangle equals a hundred and eighty degrees. However, should one define the basic terms “point” and “straight line” differently from those given by Euclidean geometry, then “the sum of the internal angles of a triangle is either more than (Riemannian geometry) or less than (Lobachevskian geometry) a hundred and eighty degrees–these are non-Euclidean geometries.” (See Jacobs 1974.) Euclidean geometry is intended for use in measuring distances between points on a flat surface; its external validity holds, when we use it in normal contexts, such as, for example, in measuring the distance between two or three mountain tops. Its internal validity is of no help when we need to measure the distance between points on a curved surface–we need Riemannian geometry instead. In like manner, one needs to find the analogue of the basic axiom of RCT. To do this, one must first set out how an RCT is conducted in the briefest, crudest outline possible. 16

Euclidean geometry has five postulates/axioms, four of which were considered to be self-evident for over two millennia; the fifth appeared problematic, known as the parallel postulate. Over the centuries, mathematicians had not been successful in deriving it from the other four axioms. Around the mid-nineteenth century, the “mystery” was solved when Bernhard Riemann (1826-1866) dropped it and came to construct an alternative to Euclidean geometry. See “(The) Axioms of Euclidean Plane Geometry” 2015.

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1. Patients are identified as suffering from a specified disease for which the treatment under test is intended. 2. Out of this group, only those who are prepared to give their consent to being part of the trial would be considered as participants. 3. Once this group has been identified as set out above, such participantpatients would be randomly assigned either to the experimental or the control arm of the test. Exponents of randomisation claim its raison d’être is to prevent bias, but randomisation can adequately take care, as already observed, only of allocation bias, and not selection bias. In the case of the former, randomisation efficiently addresses the issue of members of the medical staff involved in the trial, who subconsciusly want the new drug to be seen to be efficacious. If they succeed in allocating the less ill participantpatients to the experimental group and those who are more ill to the control arm, thereby, the test results will be skewed. However, as the issue of selection bias is not explicitly addressed by RCT, it must be assumed that either it does not recognise that such a problem exists or that the problem can be conjured away, by assuming that, in respect of these other differences, they are deemed not to exist, for the purpose of conducting the RCT. It is this deeming, which appears, then, to be itself problematic. As shown above, some of the criticisms directed at RCT-EBM may be read as an implicit questioning of this very presupposition. In other words, participant-patients are deemed to be homogeneous in respect of these other features or aspects of their existence. These include their respective genetic inheritances, their environments (physical, cultural, and social), their diets, their life-styles, and so on. For this reason, this author proposes that the axiom of RCT be called the axiom of homogeneity. It is this deemed homogeneity which alone can make sense of the elevation of randomisation (in the allocation of participant-patients to either the experimental or the control arm) to the status of being the key, if not the sole strategic tool required, to get rid of all differences, which could give rise to bias, save that of the treatment itself. Without the axiom of homogeneity, randomisation would not make too much sense. The test result is cast in statistical terms. First, there is a statistically significant difference between the two arms of the test. Second, there are other concepts called P-value (see Chapter Two), confidence intervals

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(CIs)17, and NNTs18 which must be taken into account (see Akobeng 2005). These are not of great help per se to the field clinician who, not being a medical research scientist, is faced with the task of working out what relevance they could have for the individual patients under their charge– for want of a better term, one may call this “clinical relevance”. RCTs results, per se, do not appear to bear any direct relation to clinical relevance, which is what doctors and their patients are primarily interested in. Clinical relevance does not coincide with what may be called “statistical relevance”–the former is what the patients and their doctors are primarily interested in, not so much the latter. On the one hand, should there be a positive result in favour of a treatment, even if that difference may not be considered to be statistically significant (and therefore, statistically relevant), the patient-and-doctor could be interested. In other words, it looks as if, what is of clinical relevance and decisive for the patient-and-doctor, is not what may be directly endorsed by RCT-EBM. On the other hand, even if the “best” available evidence, by way of RCTEBM, confirms that a particular drug is statistically effective/statistically relevant, say, to asthma treatment, this does not mean that all asthma patients, including this particular patient under the care of a particular doctor ought to be given it. This, in a nutshell, is what some of the critical discussion of EBM is about (Greenhalgh 2014; Greenhalgh, Howick and Maskrey 2014; Kristiansen and Mooney 2004; Rasmussen 2004). Some have rallied to the defence of EBM by pointing out that EBM has no intention of robbing clinicians of their role in helping themselves and their patients to work out whether a particular treatment is truly suitable, as a patient may have her own priorities and her own values. Akobeng 2005 points out that in weighing up the potential benefits against the potential harm of the “best” available treatment, different patients-andcarers may decide differently, depending on their own personal/social beliefs and values. In some cases, their doctors might not feel it worth their while to raise the matter about systematic reviews of a particular treatment, if that treatment is not funded by the hospital/practice to which the patients belong, or when it is obvious that their patients are not insured, or are too poor to opt for treatment under private health care.

17

These refer to the estimates of what might happen if the treatment were to be given to the entire population of interest, the entire population with that disease for which the treatment had been tested. 18 NNT = number needed to treat as a popular measure of the effectiveness of a medical intervention. NNTs are calculated from systematic reviews of RCTs (see Moore 2009).

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Although this aspect is valid, it does not, however, exhaust the import of the criticisms levelled at EBM. The crux of the matter lies as follows. One ought to distinguish between two issues or criteria of relevance, which have been conflated and appear to be mutually exclusive, namely, clinical relevance and statistical relevance. The latter necessarily is expressed in statistical terms as p-value, CIs, and NNTs; the former has to do with specificities of the patient’s medical biography. Clinical relevance may be helped by taking into account statistical relevance; however, as the two criteria are not identical, statistical relevance may in some cases be only part of the story for clinical relevance, and in other contexts, may even be irrelevant, as observed. It is true that Cochrane himself was interested in the criterion of clinical relevance, and not really in statistical relevance. He and his ardent followers have not made explicit the distinction between the two criteria. It is not surprising that more than two decades after the setting up of CC and EBM, critics are able to seize upon the increasing divergence between these two criteria in the findings of CC and EBM. Increasingly, it appears that the criterion of statistical relevance is being better served than the criterion of clinical relevance, as statistical findings lend themselves readily as tools for the financial management of hospitals, for policy makers, who have to allocate limited resources to run medical establishments, and so on. The primary concern of these organisations is not about the care of the individual patient with his/her own specificities and medical requirements, but with the care of patients, as general groups or categories. That is why the difference between the two contexts may be put as follows: the latter is concerned with a general disease, say asthma, and with a general treatment for the said general disease considered to be the “best” available as determined by RCT-EBM. The former is about a different question altogether, as the “best” for this particular patient could be a treatment that falls short of the “best” as determined by RCT-EBM. That is why clinicians complain that their authority in deciding clinical relevance is being undermined, side-lined by the more powerful and therefore, “more authoritative” voice of statistical relevance, when exercised through the decisions of hospital/health-care managers. That is why some complain that CC and EBM might have sold out to Big Pharma, to managerialism, while marginalising clinical relevance and clinical authority. This discussion does not intend to adjudicate between the two sides of the debate; its real aim is simply to draw attention to the

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contradictions inherent in at least one key notion involved in the controversy.19 The flaw lies deep in the design of RCTs themselves (and therefore, by implication of EBM); this author has argued that RCT design rests on the axiom of homogeneity. Only such an axiom can secure that reliable statistical findings be obtained, although such findings are, by and large, pertinent and relevant only to decision-making on the macro-scale of patient-care, but not on the micro-level of patient-care. Ex hypothesi, homogeneity excludes specificities and particularities of individual patients. Critics of RCT are wrong in distinguishing between the internal as opposed to the external validity of RCT, laying the blame only on the flaws in its external validity. While the critique of Big Pharma is more than justified, ironically, the justification reveals that the distinction between internal and external validity is not valid, as the two are intertwined, and both are part of what may be called scientific validity. Big Pharma is obviously undermining scientific validity by the selective release of only favourable positive results, while supressing unfavourable negative results. However, Big Pharma runs tests relying, in the main, on randomisation to secure so-called internal validity. Randomisation is able to avoid allocation bias, but it cannot systematically avoid all forms of bias, including selection bias, especially in respect of the genetic inheritances, psychological/personal/social inheritances and contexts of existence between different patient-participants. These forms of bias are all masked by deeming that they do not exist and/or that their existence is not relevant to the scientific validity of the outcome. The biggest internal flaw appears 19 The difference between these two criteria has, of late, been movingly enacted in the memoir of a neurosurgeon who died of lung cancer at the age of 37 (Kalanthini 2016). He wrote:

What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own … the angst of facing mortality has no remedy in probability. … Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. When he was first diagnosed with the disease, his first instinct was obsessively to find out about survival curves and statistics, a quest he eventually realised was futile and irrelevant. He wanted to know the precise amount of time he had to live; other patients-and-their-doctors, faced not with death but with pain and suffering, want to know what good, if any, a particular treatment would do for them in their own specific predicament. Success curves and statistics are, au fond, irrelevant to their preoccupation.

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to derive from the axiom of homogeneity which, in turn, has led to masking the difference between statistical relevance, on the one hand, and clinical relevance, on the other, thereby rendering the results of RCTs to be relevant only to the domain of medical managerialism, which invokes the former but not that of patient-care, which invokes the latter.

Personalized/Precision Medicine, Getihua Medicine and the Biomedical framework This section will now explore the claim that today’s acceptance of Personalized/Precision Medicine by Bm acts as a Trojan Horse to undermine the very framework of Bm in general. Lee 2012b has argued that, for nearly two centuries, the dominant paradigm of Bm has been based on the monogenic conception of disease, that is, to say, one disease, one causal agent (bacteria/virus/fungus/prion/poison). In other words, apart from being embedded in thing-ontology (see Lee 2017a, Chapter Eleven), the model of causality that it embraces is monofactorial and linear. Personalized/Precision Medicine has moved away from that model to one which is multifactorial. To understand fully what is happening to an individual person, it is not enough just to focus on the amount of calories in the daily diet of an individual; one must also focus on the nature of the microbes in the person’s guts, in order to see why some individuals can take in the same amount of calories and not put on weight and others do; why for some people, eating a lot of foods which, on the surface, are fattening, appear not to make any difference to their weight/size/shape, while others eat the sanctioned amount of the “right” foods, and yet, end up with extra pounds. Minimally, it looks as if one must admit two variables, if not more, for a more comprehensive understanding of a person’s metabolism. RCT is predicated on the monofactorial model of causation–the treatment under test alone makes the difference to the outcome. Married to this is the axiom of homogeneity as just characterised above. Necessarily, it has nothing to say about what precise effect(s) it may have on any one individual patient, given that each individual’s constitution, genetic inheritance, and environment including diet and lifestyle, are different from those of any other individual. Furthermore, one must also take into account the synergistic results, when these different variables interact with one another in a more complete explanation of the phenomenon, namely, the same amount of caloric intake, but different results (see Lee 2017a, Chapter Eleven).

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It follows that the concept of RCT and the notion of Personalized/Precision Medicine are not compatible with each other. The latter cannot and does not logically subscribe to the axiom of homogeneity; instead it is based on the axiom of heterogeneity. Mill’s Method of Difference rests on the former. The nineteenth century was an age when (inorganic and organic) chemistry began to deliver its stunning discoveries and inventions. Admittedly, Mill’s System of Logic appeared in the middle of the century, not towards its end; it remains true that, that century began with the discovery by John Dalton of Dalton’s law, followed by Joseph Louis Gay-Lussac’s discovery about the composition of water as well as his discoveries of the chemical and physical properties of air and other gases. In 1827, William Prout classified biomolecules in modern categories, namely, carbohydrates, fats and proteins. In 1828, Friedrich Wöhler synthesised urea; in 1832 Wöhler and Justus van Liebig discovered and explained functional groups and radicals in organic chemistry. Chemistry in that age was nothing but a laboratory science, where the notion of an experiment became established. An experiment is precisely a set-up designed by scientists, specially constructed under the aegis of the monofactorial model of causation, to test what could happen when one were to hold everything else to be constant, except in respect of one characteristic only. In a science class at school, imagine the following cartoon scenario. The chemistry teacher sets up two test tubes (both identical in all respects in terms of matter, size, shape and volume). Each contains the same amount of a solution, copper sulphate. Test tube A: To one of the identical test tubes, the pupils are asked to add 10 cc of water. We designate this as Test tube A. Test tube B: To the second test tube, pupils are then asked to add 10 cc of sodium hydroxide solution. We designate this as Test tube B. Results: In Test tube B, pupils find that a precipitate of blue copper hydroxide has formed in the clear sodium sulfate solution. In Test tube A, pupils do not find such an outcome. One can say, then, that test tube B is the analogue of the experimental arm of an RCT, Test tube A, the control or placebo/no treatment arm of the RCT. The laboratory experiment in chemistry has been designed in such a way that the two arms are identical in every way save one, namely, the introduction of copper sulphate in B, but the introduction of water in A. This then satisfies the axiom of homogeneity and enables the teacher and pupils to be convinced that it is the introduction of the sodium hydroxide solution into that of copper sulphate which is the cause of the blue copper hydroxide precipitate, plus the clear sodium sulfate solution (together they form one effect).

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The axiom of homogeneity yielding one cause, one effect, as we can see, can readily be satisfied, when one is dealing with test tubes of solutions in a chemistry experiment. Test tubes and chemical solutions can be readily made to accord with identical specifications, in exactly the same way as mass-produced cars can be made in a factory to identical specifications. However, when this model is extrapolated from such a context to a quite different one, from laboratory/factory conditions to that of individual persons, who are being tested upon in RCTs, the extrapolation only works when it is made deliberately to work. That is to say, when the patient-participants in an RCT are deemed to be homogenous, save in one respect. Deeming is a useful fiction, borrowed from legal discourse; to deem that different individuals are identical in all ways except one is not to say that they are indeed identical in all ways, save one. The fiction of deeming becomes “threadbare” once the results of an RCT are applied outside the context of the experiment to the real world out there, containing patients with very different genetic/constitutional/ environmental/personal histories. These are heterogenous peoples, whom clinicians have to deal with, when working out what reaction the proposed EBM “efficacious” treatment would have on their patients. On the other hand, those in managerial charge of medical establishments, as allocators of limited resources, are not faced with such a problem and so can, happily, rely on statistical findings, such as the p-value, the CIs to endorse the most “effective” treatment sanctioned by RCT-EBM. There is no need to labour the point any further, namely, that Personalized/Precision Medicine has prised open the door further to challenge the axiom of homogeneity, the model of monofactorial causality, and therefore, of RCT-EBM. It follows that the monogenic conception of disease can only be saved if this door is shut, by expelling, not only Personalized/Precision Medicine but also Epidemiology and Psychosomatic Medicine from the domain of “scientificity”. It would seem an unaffordable price to pay. CCM is Getihua Medicine; it is, therefore, in the same boat as Personalized/Precision Medicine. In this sense, their fates are linked– condemn the one as being unscientific, condemn the other, too; endorse the one as being scientific, endorse the other, too. The ball is in the court of Bm. CCM, by standing still, being faithful for some three thousand years to the axiom of heterogeneity, to the model of non-linear, multifactorial causality, may finally be admitted into the fold of “scientificity” through the front door, because of “cutting-edge”, more sophisticated advances in Bm in the last two decades or so.

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Conclusion The main theses, which emerge from the exploration in this chapter, are formulated below. 1. The twin Gold Standards of RCTs and EBM are not unchallengeable, and their findings may not be relevant to decision-making in all contexts. 2. As EBM rests on RCTs, any flaws, if established to exist in the latter, would infect the former. 3. This chapter argues that the flaws of RCT lie not so much in its socalled external validity as many critics have pointed out, but more in its internal validity, as well as showing that both types of flaws are related, as they undermine what may just simply be called scientific/methodological validity. The distinction between internal and external validity is not a helpful one to make. 4. RCT appears to suffer from two design flaws. It presupposes: (a) The axiom of homogeneity in order to ensure that randomisation, as a tool to avoid allocation bias, would eliminate all other forms of bias, including selection bias, which it cannot do. It may help RCTs to accord with the logic behind Mill’s Method of Difference, but the price to pay is a steep one, as it methodologically obscures relevant differences between patient-participants and, in that sense, their results undermine scientific validity. (b) The linear, monofactorial conception of disease–one disease, one causal agent–is reflected in RCT in the form of the demand, one different aspect, one resulting difference only. 5. The axiom of homogeneity together with the linear, monofactorial model of causality yield results which may satisfy the criterion of statistical relevance, though not that of clinical relevance. 6. Statistical relevance does nicely with statistical probabilities, with pvalue, with CI and NNT, and provides pertinent support and evidence to decision-making at the macro-level of patient-care. Clinical relevance is concerned with decision-making at the micro-level of patient care. The first deals with generalised categories, the latter with specificities and particularities of individuals, resting on heterogeneity, not homogeneity.

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7. Personalized/Precision Medicine is said to be at the cusp of twenty-firstcentury Bm; it is not compatible with the axiom of homegeneity, only that of heterogeneity. 8. RCT-EBM, as Gold Standards of Bm, could ironically turn out to be its Trojan Horse (also see Lee 2017b). 9. This, then, raises the crucial question: will Bm condemn Personalized/Precision Medicine as being “unscientific”, or will it quietly have to revise its trademark enthusiasm for RCT-EBM? 10. CCM is Getihua Medicine/Personalised Medicine, resting on the axiom of heterogeneity and the non-linear model of multifactorial causality, and has done so, since its inception more than two thousand years ago. Would Bm be able to continue to hold it at arms-length for fear of being polluted by its inability to meet the RCT-EBM Gold Standards? However, in the event it recognises Personalized/Precision Medicine as cutting-edge twenty-first-century medicine, then by the same token, it must also recognise CCM to be as “scientific” as Personalized/Precision Medicine. 11. Getihua Medicine is intimately entwined with the twin concepts of zhèng and fang as well as with the trinity of concepts shengli-bingli-yili. This will be explored in the chapters to follow. 12. The two companion sub concepts of Getihua Medicine–tongbing-yizhi and yibing-tongzhi–can arguably cast more light on the nature of CCM as systematic medicine than the more recently-coined phrase bian zhèng lun zhi.

CHAPTER EIGHT THE CONCEPTS OF ZHÈNG AND FANG

Introduction This chapter further explores the notion of Getihua Medicine via two key concepts embedded in it: 䇱/zhèng and ᯩ/fang. The former has to do with diagnosing an illness in the patient, the latter with prescribing a particular type of treatment via medicinals for the 䇱/zhèng ascertained. In this sense, zhèng and fang are inextricably linked; it may be called Zhèng-Fang Wholism. A word of clarification is called for. Treatment via medicinals is only one form of treatment. The zhèng, when determined/identified, may be treated by other methods, such as acupuncture/䪸⌅ or moxibustion/⚨ ⌅, or a combination of both/䪸⚨. In this sense, zhèng is not simply entwined with fang but with other therapies as well; this chapter will focus on exploring the specific linkage between zhèng, on the one hand, and fang, on the other, primarily as an example of the intimate link between diagnosis and treatment. 1 It will also introduce several of Zhang Zhongjing’s fangzi to indicate, briefly, the lasting significance of his contribution to CCM; such an introduction will pave the way for a further exploration of such points in the chapters to follow. This chapter also explores two other matters, the relationship between: a) Food and medicine as conceived under CCM. b) A more detailed evaluation of cause and effect in CCM–the treatment/the cause and outcome/the effect–from the vantage point of the time interval.

Biomedicine and CCM Before proceeding to set out the linkage, a few brief words about the different perceptions regarding disease and treatment by Bm on the one 1

See Scheid 2002 and 2014.

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hand, and illness and treatment (via zhèng and fang) by CCM on the other, are called for. This present work, consistently and insistently, points out that the dominant model used in Bm can be characterised in terms of the monogenic conception of disease. This model has its beginnings in the nineteenth century, but it was not propelled to great prominence until the discoveries of Pasteur and Koch, ushering in the Age of Bacteriology in the late nineteenth/early twentieth century. Its predominance has lasted more than a century, and is not expected to run out of steam in spite of the difficulties and anomalies it has encountered. It is still a force to be reckoned with. However, as we shall see, the so-called “Age of Bacteriology” is only a manner of speaking, as it covers more than simply bacteria, although it is true that the discovery of antibiotics by Fleming and then their subsequent availability on a mass-produced scale after the Second World War have ensured that bacteria remain in the forefront of people’s awareness. Antibiotics have also been promiscuously used to eliminate not only bacteria but other infectious agents, for which they are not meant to be used, thereby causing a major crisis in Bm today, with the appearance of so-called superbugs, with which very few, if any, antibiotics can truly cope. (See Lee 2012b, Chapter Nine.) At this stage of the presentation, the presuppositions underlying this model could perhaps be helpfully summarised and briefly compared with those of CCM as follows. 1. Thing-ontology (Lee 2017a, Chapter Eight). The causal agent of the disease is an entity, a bit of Matter. The monogenic conception of disease as already remarked upon, covers more than infectious agents such as bacteria; it has also included poisons as well as genetic agents since the HGP has come to fruition. Infectious agents and poisons, if introduced into the body of the patient, would cause certain symptoms. These bits of Matter (whether bacteria, viruses, fungi, parasites, or prions), could cause diseases. One can think of examples such as tuberculosis, syphilis or peptic ulcer (bacteria); rabies or HIV (virus); ringworm or candidiasis, pneumonia-like symptoms in immune-compromised patients, such as AIDS (fungi); malaria (parasitic protozoans belonging to the genus Plasmodium, carried by the female Anopheles mosquito); scrapie or Creutzfeldt-Jakob disease (CJD) or BSE (Bovine spongiform encephalopathy) in livestock (prions). In the early days, these bits of Matter could be seen and observed via powerful machines: in the case of bacteria a compound microscope; then in the case of viruses an electron microscope. Fungi could, in some instances, be observed with a magnifying glass. Some parasites would require powerful microscopy. As prions involve the misfolding of proteins, their “detection” is more

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complicated than just using a microscope.2 Bits of Matter called poisons need no further comments, as we are only too familiar with their effects should we imbibe any, either unintentionally or intentionally. With these in mind, it is very tempting to understand the monogenic model of disease as also a model of monofactorial causation, and to say that the agent is the sole cause (both necessary and sufficient) for the occurrence of the disease. While such pathogenic causal agents enter the Body from the outside, genetic causal agents are bits of Matter, with which we are born. This fault in a gene, CFTR, causes cystic fibrosis, rendering the gene unable to make a protein that controls the movement of salt and water in and out of the cells in our bodies. This results in the symptoms observed in cystic fibrosis sufferers. As we know, genetic defects are inherited, although given the mechanism of genetic inheritance, not everyone who possesses the faulty gene, would manifest the symptoms: those who do not are mere carriers. In general, the faulty gene must be inherited from both parents before an individual would manifest the disease in question. 2. The monogenic model of disease causation. This author has consistently pointed out that it is monofactorial, linear, and Humean in character. Matter acts on Matter (just like one billiard ball hitting another billiard ball), imparting motion from the former to the latter. As Chapter Six shows, this fits in best with the model of Body-Mind dualism. As a result, Bm is most at home within a framework that privileges Body over Mind, while endorsing monofactorial causation. 3. In contrast and as already demonstrated, CCM has nothing to do with Cartesian dualism (as it upholds Contextual-dyadic Thinking). It focuses on process-ontology rather than thing-ontology, and its model of causality is consistently multifactorial and non-linear. 4. CCM does not hold that an infectious agent could, on its own always and necessarily bring about an illness in the patient. As Chapter Seven argues, an individual would succumb to illness, when several factors, both external and internal, are co-present. This maximises the opportunity for its expression in the way that it does in the individual patient. 5. To detect the presence of the causal agent, Bm today almost invariably uses high-tech, whereas CCM uses no-tech or low-tech at best. Bm invokes not simply more lowly ones, such as blood and urine tests and low 2

See Cressey 2010.

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grade equipment, such as a pressure-measuring machine, but also scanning machines of various orders of sophistication and complexity. 6. Given the profound differences above, it is best to use the term “disease” as “disease entity” with reference to Bm only, and use the term “illness” with reference to CCM. In Chinese medical texts, the word is ⯵/bing, which Sivin 1987 renders as “disorder” (Scheid 2002, 336, footnote 5 as “disease”, Farquhar 1994 as “illness”). On this point, this author is at one with Farquhar. 7. A consequence of this set of differences between Bm and CCM is that, while the latter entails no gap between the diagnosis of the illness on the one hand, and prescribing a particular treatment on the other (a theme which Chapter Nine will take forward and examine further), the former, in its history, has displayed gaps between the diagnosis of a disease and a treatment intended to be efficacious. While research in medical science has found the causal agent of a disease, no efficacious treatment may be available at the time of, or indeed, even for a considerable period after the theoretical discovery. Koch discovered the tubercle bacillus as the cause of tuberculosis as early as 1882; his vaccine, called tuberculin, was a distinct failure, and an effective treatment had to await the arrival of streptomycin in 1946; a gap of almost seven decades (see Lee 2012b).

Illnesses categorised in terms of Deficiency or Excess A reader of Chinese medical texts will come across the terms 㲊 /xu/deficiency, ᇎ/shi/excess, and that a zhèng/䇱 (see the section below) is a xu zhèng/㲊䇱/an illness arising from deficiency, or a shi zhèng/ᇎ䇱 /an illness arising from excess. What then is deficient and what is excessive? One knows that CCM considers the person to be in good health if there is a balance between yinqi and yangqi in the person-body. Should the one overwhelm the other (excess), rendering the other deficient, then the person falls ill. This set of relationships may be set out, in further detail, in terms of the figures below:

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Figure 8.1: Excess and deficiency of yinqi and yangqi in the person-body (The shaded area is yin and the unshaded yang.)

In the above: A: Balanced yinqi and yangqi (a healthy person-body). Bi: Excess/shi/ᇎ of yinqi consuming yangqi leading to a shi cold zhèng; yin pathogenic factor is bearing down on yang. Bii: Excess of yangqi, consuming yinqi, leading to a shi heat zhèng; yang pathogenic factor is bearing down on yin. Ci: Deficiency/xu/㲊 of yangqi, with an ensuing excess of yinqi, leading to a xu cold zhèng. Cii: Deficiency of yinqi, with an ensuing excess of yangqi, leading to a xu heat zhèng. The distinction between a heat zhèng/✝䇱/re zhèng and a cold zhèng/ ሂ䇱/han zhèng is very important. One often reads in Chinese medical texts down the centuries how incompetent physicians had mistaken a re zhèng for a han zhèng or vice versa and prescribed inappropriately, ending

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up nearly killing the patient. It is equally important that the physician correctly ascertains a zhèng as xu zhèng or shi zhèng. These distinctions are made very clear in terms of Bi, Bii, Ci and Cii in Figure 8.1. Au fond, as the Suwen, Chapter 5/lj㍐䰞‫ޣ‬䱤䱣ᓄ䊑བྷ䇪NJsays: 䱣㜌ࡉ䱤⯵DŽDŽDŽ䟽✝ࡉሂ

Rendered as: Excess of yin will cause a yang illness (Bi and Ci); excess of yang will cause a yin illness (Bii and Cii). Excess of yang will bring about heat (Bii and Cii), while excess of yin will bring about cold (Bi and Ci). However when heat or cold reaches its extreme limit, extreme heat may cause cold and extreme cold may cause heat. (Texts within round brackets are this author’s interpolations.)

With these distinctions in place, we can turn our attention to the notion of zhèng/䇱, a key concept in the theory-practice of CCM.

Concept of Zhèng It is imperative to distinguish between different characters/words in Chinese with zheng as Pinyin. 1. In the first tone, written as ⯷ (in the modified script but as ⲕ in the unmodified script), zhƝng, meaning an illness, refers to what in medical texts is translated as a bind (hard formation) in the abdominal cavity as in ⯷㔃/ⲕ ㎀/zhƝngjié. 2. Written as ⯷/zhèng, in the fourth tone, meaning (a) a disease as in the expression ⯷‫ى‬/zhènghòu (b) signs (objective) and symptoms (subjective) as in ⯷ ⣦ /zhèngzhuàng.3

3

This author agrees with Scheid 2002, 336, 406, but not with Farquhar 1994, who uses the character ᖱ, not ⯷.

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3. In the first tone, written ᖱ/ᗥ zhƝng, as in ᖱ‫ى‬/zhƝnghòu. This refers to an alteration in the circumstances of the patient, such as having taken a turn for the better or the worse. 4. In the fourth tone, written as 䇱 , 䅹 /zhèng, often translated as “syndrome” but sometimes as “pattern”, such as in Wiseman and Feng 1998; Scheid 2002.4 ZhƝng as in 1: is of no particular concern to this volume. Zhèng/⯷, as in 2a: is not used in CCM discourse, but is often used in literature, influenced by Bm concepts. As in 2b: it is found in CCM discourse today. As in 3: it is not used in CCM discourse, but found in literature concerning Bm terms, when these are translated into Chinese–an example is 䴽ཛᴬᖱ /Werdnig-Hoffmann’s disease. As in 4: this is the term which is key to CCM discourse. (From this point on, the pinyin zhèng, when invoked on its own, will refer to this sense only, unless otherwise indicated.) It also enters into the oft-quoted phrase 䗘䇱䇪⋫/bian zhèng lun zhi, or the not so oft-quoted phrase, 䗘䇱ᯭ⋫/bian zhèng shi zhi, translated usually as “syndrome (pattern) differentiation and treatment”. Sometimes the first two characters even appear as 䗘⯷–it is obvious that this version would make no sense and hence cannot be tolerated in CCM discourse, as ascertaining 䇱/zhèng, which is what CCM is about, is clearly not the same as diagnosing in terms of a disease or a disease entity, as Bm does. As the focus of this chapter is on the notion, zhèng, rather than on associated notions, such as bian zhèng lun zhi, let us look at the character 䇱/䅹 (the modified and unmodified versions of the character). 5 In the 4

These writers also use the word 䇱‫ى‬/zhèng hòu (see Wiseman and Feng 1998, 429, 531) who translate it as “disease pattern” as a “disease” may take “the form of different patterns” and treatment varies according to the pattern; they also use it to refer to signs, to “a group of signs of diagnostic significance”, that is, a pattern. Scheid translates zhenghou as “pattern” (Scheid 2002, 201), writing: Contemporary textbooks of Chinese medicine distinguish conceptually and practically between symptoms or signs (zheng ⯷, zhengzhuang ⯷⣦), patterns (zheng 䇱, zhenghou 䇱‫)ى‬, and diseases (bing ⯵, jibing ⯮⯵).

See also op. cit., 124, 406. 5 This account of the concept of zhèng, as embodied in the two different written versions of the character, together with their implied significance for CCM, follows closely, in the main, that given by *Liu Lihong 2004.

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modified version, on the left is the radical for speech, written in the modified style, and the character ↓, on its right. The character, in the unmodified form is somewhat differently constructed. It too has two components, the radical is the same as in the modified version, that for speech but written as 䀰/yan on the left, and the character ⲫ/deng on the right. The meaning of the component on the right, deng, indicates that it has something to do with viewing something from a commanding height, such as a hillock. Imagine a commander of an army. To get an overall idea of how various parts of his army were faring, in the absence of telescopes in the days of ancient China, he would need to ride his horse up to the top of a hill to make his observations. Alternatively, imagine an official, whose task was to make predictions about the weather in order to help the king decide whether he should lead a campaign against the enemy. For that too, he might need to climb some tower to look at the clouds over the surrounding area, and so on. In other words, the character written in the traditional font indicates very clearly that the word refers to the gathering of information, interpreting the collected data, and then giving an overall assessment of it as a coherent Whole, or should, one prefer, as a pattern. The version in the modified script as 䇱 is equally interesting and revealing. One may gloss the right hand component, ↓, in numerous ways: (a) It means “correct”/“proper”/“straight”. In this sense, it connotes truth/zhenli/ⵏ⨶, the proper dao/zhengdao/↓䚃 as opposed to xiedao/䛚䚃. Achieving the epistemological goal of truth could be said to be common to all philosophies, to all Chinese philosophies, such as Daojia or Rujia (Confucianism). (b) It also has astronomical resonance. Chinese astronomy speaks of san zheng/й↓ to refer to the Sun, Moon and Stars/Planets, and of the qi zheng/г↓ to refer to the Sun, Moon and the five planets (Jupiter is the Wood planet, Mars the Fire, Saturn the Earth, Venus the Metal, and Mercury the Water planet). Through observing the “movements” of these heavenly bodies as well as others such as the Great Bear, the ancient Chinese were able to measure the passage of time to determine when exactly were the equinoxes (vernal and autumnal); the solstices (Summer and Winter), and when the twenty-four qi-nodes occurred, establishing the Cyclic Reversion of Laws of Nature, such as the zhouye jielĦ and the sishi jielĦ. (c) The character ↓ itself has two components, → at the bottom and а at the top. The former component means “to stop”; the latter

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means “one”. In Daojia/philosophical Daoism а could stand for having attained the proper dao. To stop at “one” means to have grasped or arrived at the truth. A passage from Chapter 39 of the Laozi/lj㘱ᆀ· йॱҍㄐNJreads˖ ཙᗇаԕ␵DŽDŽDŽз⢙ᗇаԕ⭏

Rendered as: As the dao of Heaven’s qi is to be clear (not turbid), having arrived at “one” means that Heaven has attained its proper dao; as the dao of Earth’s qi is to be tranquil, having arrived at “one” means that Earth has attained its proper dao; as the dao of Spirit’s qi is to be alert, having arrived at “one” means that Spirit has attained its proper dao; as the dao of grain is to be full, having arrived at “one” means that grain has attained its proper dao; as the dao of Wanwu is to engender, having arrived at “one” means that Wanwu has attained its proper dao.

Another telling phrase is from Chapter 45/lj㘱ᆀ· ഋॱӄㄐNJ: ␵䶉Ѫ ཙл↓ rendered as: “When Heaven is clear and Earth is tranquil, the country would have attained its proper dao.” The two versions, however, share the same radical, whether written as 䇐 or 䀰 . What are the connotations of this character, which means “speech”? As lexicographer, Xu Shen/䇨᝾ (c. 58-147 CE) may not have the honour of having compiled China’s first dictionary, but he was the pioneer scholar of the Chinese language who, among other distinctions, analysed the structure of the characters. According to Xu Shen, speech is not a value-neutral term, as only truthful utterances count as yan:lj䈤᮷䀓 ᆇNJ/Shuowen jiezi says “only truthful speech is yan”/ⴤ䀰Ѫ䀰. This interpretation may rest on the view expressed by another Western Han scholar, Yang Xiong/ᢜ䳴, in his book calledlj⌅ 䀰NJ/Fa Yan, which said that “speech is the voice of the heart”/䀰ˈᗳ༠ҏ. This may briefly be elucidated as: every person harbours innermost thoughts, which are not accessible to another, unless the person expresses them via speech. In this way, social intercourse and communication become possible. For interpersonal understanding to take place and to be effective, it behoves each of us to speak truthfully, as communication would break down, if the norm is not to tell the truth (what is hidden in the heart), but to tell lies (in order to conceal what is thought). This is a philosophical/conceptual point, not merely a moral one. Imagine if the default norm is never to tell the

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truth, and other things being equal always to lie. The result would be that whatever people utter would then subvert the very goal of communication itself. That is why we should, according to this perspective, dignify truthful utterances only with the character/word yan. Zhèng enters into the word 䇱ᦞ (modified)/䅹ᬊ (unmodified) which means “evidence”. This, together with the deconstruction given above, shows that these two forms of writing the word zhèng 䇱/䅹 are huiyi zi/Պ ᜿ᆇ/meaning compound. In the case of 䇱, it is immediately obvious that it is also a xingsheng zi/ ᖒ ༠ ᆇ /semantic-phonetic compound. Many Chinese words belong to these two categories (see Lee 2008). Now, when applied to the CCM context, it becomes easier to see what the character/word zhèng means. It means that the physician has gathered in all relevant information about the patient who has presented herself before him/her. S/he has used the four diagnostic techniques/ഋ䇺/sizhen: looking, listening and smelling, asking, and feeling the mai. After gathering information via these measures, s/he finally synthesises this in the light of the theoretical principles of CCM. These principles embody concepts such as Yinyang-Wuxing, Wuzang-liufu, the twelve major Jingmai in the Jingluo network, the Cyclic Ascending-descending Law of Nature (see Chapter Ten), the twenty-four qi-nodes (Ҽॱഋ㢲≄/ershisi jieqi), and so on. Ultimately s/he is able to arrive at a diagnosis based on recognising and identifying a particular pattern of signs and symptoms, but always within the Getihua context. (On these points, also refer back to Chapters Three, Four and Five.) In a nutshell, one could say that zhèng involves “taking in everything (all evidence which is relevant) in a single overall/commanding analysis of the illness of the patient”. The concept therefore, is about “seeing clearly”/“ascertaining correctly”, and “identifying accurately” not what is more or less easy to observe, but also what is hidden to the patient (the patient would not have noticed a particular aspect, which s/he could report as a symptom). All this after careful consideration should eventually help the physician to determine the zhèng. In other words, one could say that zhèng is the process of gathering all manner of relevant evidence before concluding that the patient possesses a particular zhèng, which is the outcome of the process of gathering and sifting evidence. We next need to explore briefly the relationship between bing and zhèng. We begin by looking at the character/word ⯵ /bing which, as already noted, this author prefers to translate as “illness”. The Chinese in ancient times appear to have distinguished between being not so seriously ill and seriously ill, using two different characters/words. Let us first look

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at the character for “serious illness,” pronounced bing (fourth tone), which appears in various ancient scripts as shown in Figure 8.2(a).

Figure 8.2: (a) shows “bing” standing for serious illness, (b) shows “ji” standing for not so serious illness and (c) shows “shi”/“arrow” in various scripts

In 8.2(a), the first character (on the left) shows the Oracle Bone script; the second, the Lesser Seal script (in the middle); and the third, the Clerical script (on the right). The Clerical script shows clearly that the character has as a radical, the component ⯂ , and щ as its second component. However, the Oracle Bone and the Lesser Seal scripts seem to give a different picture, as they do not use the radical ⯂. So we need first to pay these aspects some close attention. The story told by the Oracle Bone version is this: a seriously ill person is someone, who would find it difficult to stand up, to move or run about, and would be greatly in need of leaning on something, but would prefer to lie down. If you turn the page anti-clockwise till the word appears horizontally, you will see that it

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consists of someone lying down on a bench or a simple bed, made up of a plank over two supports. This version is clearly a pictograph/xiangxing zi/ 䊑ᖒᆇ. The Lesser Seal script shows the bed, but no longer the person lying on it. The simple bed graph has evolved to ⡯, the radical for the character “bed.” Although this version does not share with the Clerical script the radical ⯂, it does share with it the second component, щ. щ, standing as a character/word in its own right, is pronounced bing (third tone). It gives the sound to the word for illness, although it does not also donate the tone. It is not merely a semantic-phonetic compound, but also a meaning compound. щ does a lot more work than simply donate the sound. What additional content and meaning are donated? First, we need to clarify what meaning it has in its own right as an independent word. To do this, one must again refer very briefly to Chinese cosmology in terms of the system of coordinates called “the ten heavenly stems and twelve earthly branches”/ཙᒢൠ᭟/tiangan-dizhi, which we have already come across. щ /yang/Fire is position number three in the heavenly stem category. This position is highly significant; it, together with its complement, the fourth position б/ding/yin Fire, signifies South, which means heat/Fire/yangqi, reaching its maximum at the Summer solstice. Just to recall briefly certain basic features of Chinese civilisation for the reader: the historic centre of Chinese culture lay in northerly latitudes in ѝ ৏ /zhongyuan (whose centre roughly and partially coincided with today’s city of Luoyang in Henan province). The south side is therefore the sunny side, and the north is the side from which the cold blasts come. For regions north of the Tropic of Cancer, the Summer solstice marks the point when the sun reaches its zenith, after which, as we all know, the sunlight hours get increasingly shorter and its heat gets less intense. Chapter Ten explores the relationship between the person-body and the larger natural environment beyond which it is embedded as a smaller Ecosystem, nesting within a larger one. This means that Microscopic Qi corresponds with Macroscopic Qi, under the concept of Tianren-xiangying. Although the sun’s seasonal great outburst of heat and light is good for the natural environment enabling Wanwu to grow/flourish/mature, nevertheless sometimes the Qi of our person-body fails to harmonise with the seasonal Qi of Nature. Hence CCM considers too much heat in the person-body a bad thing, as it upsets the balance between yin and yang. Indeed, according to CCM, many illnesses appear to be caused ultimately by an excess of yang over yin. It is very fitting that щ bing should be incorporated into the meaning of bing/⯵/illness. The word is

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there, not merely as a phonetic marker, but also as the bearer of an exceedingly significant cosmological/medical load (see *Liu Lihong 2004, 151-156, 178-199). щ represents ᗳ, which not only refers to the organ (yang) called the Heart but also the spirit (yin), as in CCM, the personbody embodies Wholism. The Heart governs the spirit, and when the spirit is calm and peaceful, no illness will occur as reflected in the expression: ㋮⾎޵ᆸˈ ⯵ᆹӾᶕ˛ In ancient Chinese, what is the character/word for “not so serious illnesses”? It is pronounced ji/⯮. Its forms in the various scripts are shown in Figure 8.2(b) with the Oracle Bone and Bronze scripts on the top line, and the Lesser Seal and Clerical scripts on the bottom line. The two versions on the top line look very much alike; each shows a man being hit by what appears to be an arrow. The Lesser Seal version, on the left of the bottom line, shows what happens to a man wounded by an arrow–he would be ill, lying in bed and so, it uses the “bed” radical. The Clerical version, on the right side of the bottom line, uses ⯂ as a radical, and its second component–the character for “arrow” (shi)–has become stylised, no longer looking like an arrow, but like this: ▮. In the three earlier scripts, the arrow looks very much like an arrow, and so, their versions of the arrow are pictographs/xiangxing zi. Now look at Figure 8.2(c) depicting various versions of ▮. The top line shows three Oracle Bone versions, the middle line, four Bronze script versions, and the bottom line, one Lesser Seal version. There are many versions of this word in the Oracle Bone script and even the Bronze script, probably because China, during the late Shang period (ca. 16th–11th century BCE), was very violent. Presumably, many men were wounded by arrows, a very important war weapon. In cases where the arrow did not immediately kill the victim, and the victim survived, the chances of his recovery would be pretty good, given that those requisitioned to fight would, on the whole, be healthy men. The experience of the time would have borne this out. Those who suffered from ⯵/bing, on the other hand, were not people who would have been healthy but for a wound. The cause of their illness was much more complex. Experience taught the ancient Chinese that their chances of recovery were, probably, on the whole much slimmer than those of the merely wounded. Hence, ⯵/bing was used to describe serious illness and ⯮/ji, the less serious kind. In the history of the development of the Chinese language, the two characters have been combined into one word, to become a two-syllable word ⯮⯵/jíbìng, translated, often indiscriminately as “illness” or “disease”.

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This then leads one to look more closely at the distinction above, and to see its justification in the theory of CCM. When a healthy male (a soldier) was shot by an arrow, the cause of his fallen condition was obvious, namely a sharp instrument/weapon had penetrated part of his person-body; his poor state had nothing initially at least to do with his own person-body having malfunctioned. When someone falls ill, not because he has been wounded by an arrow or by a sword, but because his own system is malfunctioning, this constitutes “more serious” illness. This should not be misinterpreted to say that CCM only believes in internal pathogenic states as the cause of an illness, and denies that external pathogenic factors are of significance in generating illness. Far from this being so, it is the burden of this exploration of CCM to show that the model of causation it invokes is a multifactorial, non-linear one. Chapter Four has shown that an external pathogenic factor such as a flu virus would affect different people very differently, some recovering after a night’s rest, and others developing more serious symptoms, as the flu lingers. This is because the condition of the patient depends on the interaction between the external pathogenic factor and the internal state of the person-body, primarily in terms of his zhengqi/↓≄. In other words, one could say that although both sorts of factors are causally significant, it remains correct to observe that for CCM, the internal factors are primus inter pares–if one’s zhengqi is adequate, the external pathogenic factor would have no or little effect, and one would not succumb to illness or only to a very mild manifestation of the illness. CCM’s understanding of illness rests on the Qi cycle in the personbody (which is the Microcosm functioning in consonance with the Qi of the Macrocosm). When the relation between these two systems deviates in any significant way, illness befalls the person. The job of the physician is to grasp zhèng, to identify where and why the malfunctioning occurs and, then, to prescribe a treatment to eliminate that malfunctioning. This makes it clear that illness for CCM is not a disease entity (which rests on thingontology), but an “illness process”, as CCM operates within the framework of process-ontology. That is why this author is not in favour of translating the term bian zhèng as “syndrome differentiation”. Bm uses the term “syndrome”, but without great precision. Generally, it is used to describe a collection of symptoms and signs or some other medical characteristics, implying that Bm has not, to date, found a physical cause to account for it. In contrast, diseases are said to refer to conditions that harm the body and explain the bodily conditions that they cause. Some diseases do cause syndromes, but not all syndromes are caused by diseases, as there are many other factors that can cause

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syndromes, such as mental disorders and accidents, to name but two. Furthermore, not all diseases cause syndromes (as we have seen above in the cystic fibrosis example, being a carrier of a defective gene does not lead to the cystic fibrosis syndrome. In the same way, Chapter Four has also shown that inheriting the PKU gene from both parents does not always and necessarily lead to the PKU syndrome). A syndrome may indicate several diseases (Chronic Fatigue Syndrome is one such example). On the other hand, several different diseases can all cause the same syndrome. The two terms “disease” and “syndrome” are sometimes even used interchangeably–for instance, is HIV the syndrome or is it the disease? Is AIDS a syndrome? AIDS was called a syndrome before Bm research identified the HIV virus as its cause; yet many still today call AIDs a syndrome. What is even more confusing is that for others, the HIV infection is the disease, and AIDs is the syndrome caused by it, as someone can have the HIV virus but may not develop AIDS (on the HIV/AIDS controversy, see Lee 2012b, Chapter Nine). Bm usage tends to use the term “syndrome”, when medical science does not know the cause, and the term “disease”, when medical science has discovered the causal agent, be it a virus, a prion or a bit of faulty gene. However, as preceding comments show, such a distinction may not always be adhered to (see “Syndrome and Disease” 2015; “Difference between syndrome and disease” 2015). It follows that zhèng should not be translated as “syndrome” for two main reasons. 1. A syndrome is a mere collection of signs and symptoms, which have come to the attention of doctors, but for which they have to date, no explanation within the Bm paradigm of looking for causal agents under the monogenic conception of disease. 2. The monogenic conception of disease is wedded to the monofactorial model of causation as well as to thing-ontology–Bm looks for bits of Matter (whether bacteria, viruses, DNA sequences, and so on) as causal agents. The monogenic conception of disease in any form and variant is just incompatible with the CCM theoretical/explanatory framework. Zhèng does not refer to a mere collection of signs and symptoms (observed at a lowly empirical level) but as we have seen, it is the result of the empirical exploration of signs and symptoms, informed at each stage of the exploration by the theoretical concepts of CCM. While syndromes in Bm

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may amount to GOK/God only knows, zhèng embodies a form of reasoning according to bingli/⯵⨶, to CCM’s principles, which account for the processes leading to the emergence of the illness and the bingli in turn, leading to the principles of yili/५⨶/how to treat the identified zhèng. As we shall see in further detail below, the zhèng is the outcome of the process of ascertaining the state of illness of the patient which, in turn, leads to the appropriate treatment. If it turns out that the physician has not properly grasped the zhèng, he will misdiagnose, which means that at best the treatment prescribed would bear minimally efficacious results, that the patient would neither improve nor deteriorate and, at worst, it would mean that the patient gets worse, if not dies.6 There is another phrase, favoured by CCM writers, who may have reservations about the phrase bian zhèng lun zhi which is Ѥ䇱䗘䊑/lin zhèng bian xiang (see *Li Yubin 2009). This is rendered as “identifying the illness profile in the clinical context” which this author is more inclined to use, if one must invoke a phrase to encapsulate the character of the ascertaining zhèng-prescribing process in CCM. Another good reason for avoiding the pinyin term bian zhèng is that it is also used to translate “dialectics” in Chinese literature on Marxist Dialectical Materialism, which is written as 䗙䇱 as in the expressions 䗙䇱⌅/bianzhèngfaˈ䗙䇱 䙫䗁/bianzhèng luoji. This could seriously confuse and mislead a reader into regarding the relationship between yinqi and yangqi as a dialectical matter, or to think that Chinese cosmology/philosophy and hence CCM are forms of Dialectical Materialism. To grasp zhèng, the CCM physician relies, in the main, on sizhen/ഋ䇺 /the four diagnostic techniques. Regarding the technique of wangse, Chapter Five shows that it involves observing and studying the complexion, the qi as manifested in different parts of the face, and indeed, even of the whole person-body of the patient, not to mention the behaviour and comportment of the patient in order to look for clues as to how to ascertain the patient’s zhèng. In the course of the consultation, the physician might notice that the patient sipped piping hot drinks from a thermos flask by the bedside, in spite of the fact that it was the height of summer and very hot. The patient’s preference for hot drinks rather than room-temperature liquid would be highly significant, as it could be a sign that s/he is cold inside and hence suffering from yang deficiency/䱣㲊 /yangxu.

6

In this respect, CCM is no different from any other kind of medicine–a misdiagnosis followed by an inappropriate treatment could, indeed, kill a patient.

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The technique of wén/ 䰫 refers to the functions of two of the physician’s sensory organs, not one: to the ear which can pick up sounds or noises emitted by the patient (such as heavy breathing, coughing in particular ways and at particular moments, wheezing, and so on); and to the nose which can pick up certain odours emitted by the patient that are relevant to the process of ascertaining the zhèng. If the patient suffers from foul mouth odour, this signifies generally that there is heat in the Stomach, indicating a re zhèng/✝䇱; if the patient emits a “fishy” smell, this may mean a xu han zhèng/㲊ሂ䇱, an illness arising from yang deficiency (see Figure 8.1). Asking involves probing the patient (as well as the patient’s family) about the history of the patient and details regarding the particular illness, including its onset, which led the patient to seek help from the physician. The physician would note the year and/or the season of the onset, as this could be relevant to his ultimate understanding in terms of zhèng. In general, and in more recent times, the technique of qiemai/࠷㜹, out of the four techniques, is considered (by many physicians) to carry the greatest weight on the grounds that the mai does not lie.7 Chapter Four shows that a patient might have dyed her hair black when, in fact, it has gone prematurely white, which would mislead the physician about the functioning state of the Kidneys–therefore, wang is subject to certain limitations.8 The technique of asking may be hampered by the fact that people’s recollection of the onset and/or the circumstances which surround their illness may be faulty. In addition, it may be hampered by the fact that sometimes a patient, out of embarrassment would conceal relevant information. Some people might not want even to reveal to their physician that they frequent brothels, and may have been exposed to sexually transmitted illnesses. In contrast, the mai is not readily subject to conscious or subconscious manipulation on the part of the patient. The physician can detect that a woman is pregnant even when the woman does 7

A story is told about how the Emperor He/઼ᑍ (89-105 CE) of the Eastern Han dynasty decided to test the court physician, Guo Yu/䜝⦹, known for his skills in feeling the mai. One day, he summoned the physician to read the mai of a few court ladies; however, he included in the group, the hand of a catamite. The physician, after exploring the mai of each of the hands proffered, then held on to the hand of the catamite, and told the Emperor that the mai of this person was different from those of the others, that the person was not a female. (See *Zhao Yang 2006. For an alternative account, see Kuriyama 1999, 54-55.) 8 As for examining the complexion of the patient, some female patients may come for a consultation heavily made up, in order precisely to disguise their unhealthylooking complexion.

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not know it herself, or is not prepared to divulge such information to the physician. *Hao 2012 cites an example of a patient aged 42, who said her period had stopped for three months, and wondered if this could be premature menopause. She said that she had no hot flushes, sweating or other symptoms of the onset of menopause. She also did not suffer from insomnia and had not undergone any disturbing experience of late. Neither did she report any stiffness or pain in her joints, in the fingers upon waking in the early morning. However, her mai was particularly slippery/ ━/hua. Given her responses to the various questions posed to her, Hao concluded that she must be pregnant, as slippery mai in a female is in keeping with being pregnant–one could say that this was Hao’s conclusion in the light of the zhèng before him. She denied this could be so; she said she had been trying unsuccessfully for eight years to conceive, had consulted numerous doctors who had pronounced her sterile. She maintained that she could not possibly be pregnant as she showed none of the normal symptoms associated with pregnancy. Hao held his stance, and suggested that she could do a Bm pregnancy test to determine whether his diagnosis had any basis, whether the zhèng he had arrived at was correct. She did just that and to her immense surprise found the result of the test to be positive–she was indeed three months pregnant. However, before she left the physician’s consultation room, she rushed to the basin, turned round to tell the physician that she was then having a reaction to the pregnancy for the first time, and promptly threw up into the basin.9 The pulse as understood in Bm, and the mai as understood in CCM show distinctly that they do not refer to one and the same thing; and that these two notions belong respectively to very different philosophical/ scientific frameworks, as Kuriyama 1999 has demonstrated so clearly and well. The former is firmly embedded in anatomy, and the latter in 9

Hao actually used this case to illustrate the psychosomatic character of her inability to conceive. Eventually, she divulged that though she and her husband were on very good terms, nevertheless her husband had told her before their marriage that his family, for several generations had only ever produced one male offspring in each generation. If she failed to produce a male offspring upon marrying him, his family line would come to an end. Before any act of intercourse, she would be chanting to herself that she must produce a son. In the end, she produced neither son nor daughter, and was written off as sterile. The couple finally adopted a girl from their village three years before she consulted the physician. She felt much better as at least now she could be a mother. As a result, she relaxed, became more at peace with herself, and finally conceived. CCM practitioners have been known to advise some couples to adopt, should they wish to conceive a child of their own.

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physiology (a difference, which will be explored in greater detail in Chapter Nine). Kuriyama (1999, 37) points out that by the nineteenth century, doctors had firmly come to the conclusion that the mai was a piece of sophistry: “It couldn’t be otherwise since any theory of the pulse that floated free of a ‘fundamental anatomical knowledge of the human body’ had to remain error-ridden.”10 When the doctor puts his hand on the patient’s wrist to feel the pulse, all he can feel is the pulsing artery; as Kuriyama ibid puts it: “The language of the pulse was an idiom of diastole and systole. Beyond rooting the pulse in the heart and the arteries, anatomy defined what and how doctors trained their fingers to feel.” This, in turn, implies that the pulse is firmly embedded within thing-ontology (while the mai is firmly rooted in process-ontology). In trying to understand the mai, it is best to look at the character/word for it in both the unmodified and modified scripts. They are respectively written as:

㜸

㜹

They share a common radical; it is the character/word ᴸ/yue, which can refer to the moon/ᴸӞ as well as to a month (in this context). The Chinese month is, by and large, a lunar month–hence, the two meanings are inextricably entwined. In CCM itself, the moon/the month play a significant role in the lives especially of females, as the menstrual cycle is connected with the moon cycle of 28 days–on this topic, readers may refer to Lee 2017a, Chapter Ten. (Incidentally, the English word “menstruation” is based on the Latin word for “month”, mensis; it is considered normal for the cycle to occur between 23 to 35 days according to Bm. Commonly, though, people use the word “period” and speak of “period pains”.) According to CCM, the onset time of the monthly period in each woman is steady and regular, and the interval between periods is a lunar month. The full moon and the onset of menstruation are intimately linked. The word for menstruation, ᴸ㓿/yuejing, is a two-syllable word. Jing refers to the vertical threads on a loom, which run through the cloth being woven; it is about something which continues, is unbroken in contrast, to the warp, which refers to the horizontal threads on a loom, woven into the vertical threads with the help of a shuttle. Derivatively, jing means “classical/ canonical texts”, as these texts are regarded as enduring, forming a 10

The doctor was one called Johann Ludwig Formey whose book, Versuch einer Wurdigung des Pulses, was published in 1823.

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continuous line of descent, handed down from generation to generation (see Lee 2008). Yuejing is then something that happens regularly every month in an unbroken manner, during the entire period of a woman’s life, when she is capable of reproduction. (The French word is les règles, which strictly speaking means regularities in this context. One could then say that the meaning of yuejing is caught by the combination of the French word and the word “menstruation” in English, based on the Latin for “month”.) The moon in Chinese cosmology/astronomy has strong links with water, as it is said to be constituted of the essence of the qi of water (see the Huainanzi/lj ␞ ইᆀ· ཙ ᮷ 亪䇝 NJ :≤ ≄ ѻ㋮ 㘵Ѫ ᴸ ). The right component of each of the two versions of the word mai shown earlier involves water, either directly or indirectly. In the unmodified script, the component means a tributary. In the modified script, the component ≨ basically means “permanent”, or “enduring forever”. The evolution in the writing of this character, ≨, is shown in Figure 8.3:11

Figure 8.3: Character for “yong”/permanence in various fonts

A is the Oracle Bone Script; B is the Bronze; C, the Lesser Seal; and D, the Standard Script. One can see that the character ≨ comes from the flow of the water and waves in a river, such as the mighty Yangzi River, which the Chinese always refer to as Changjiang/䮯⊏, literally, the Long River, the river that flows across the width of the country. To the Chinese mind, the waters of such a river endure and last. In the Book of Poetry/lj䈇 㓿ઘই≹ᒯNJ, the following phrase is found: “⊏ѻ≨⸓ˈнਟᯩᙍ”: the Changjiang is so long and so broad that it is not easy to get through/across it, thereby suggesting that it stands for the notion of permanence, which embodies, in turn, the concepts of Time and Space. The word mai (written as 㜹 in the modified script) stands for (relative) permanence, for as long as the individual is alive it will exist, just as China would be there as long as the waters of the Changjiang continue to flow. 11

See *Yulin Quhua 2007, 476-477.

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Mai, in both the modified and unmodified scripts, is huiyi zi/meaning compounds, not simply xingsheng zi/semantic-phonetic compounds, where the right-hand as well as the left-hand components of the character both donate meaning. To feel the mai, or to grasp its profile is precisely to ascertain how well or poorly is the patient, which part of his/her person-body is not functioning too well and in what manner. The mai, in the clinical context for CCM physicians, is an entrée to the person-body (involving no tech at all). It enables them to access a lot of information, as it is the site of some extremely significant concepts of CCM, that is, of Qi and blood/≄㹰–Qi coursing along with the blood, as well as Qi in the Jingluo network–of the Wuzang-liufu/Yinyang visceral organ-systems. It has to be felt on both hands, with the physician feeling it at three different positions on each hand, and at different levels at each position. From the mai image/profile/ 㜹䊑 at each of these six positions, the physician would be able to tell the state of the visceral yang and yin organs respectively associated with them. 12 Such subtle information is conveyed via the felt characteristic/ quality of the mai, not only whether it is floating/⎞, or sunken/⊹, but also whether it is large/བྷ or small/ሿ, lax/៸ or tight/㍗, quick/ᙕ or slow/㕃, and so on. Readers should take note that this account here is very limited and over-simplified, as its aim is merely to outline some of its main aspects (see Figure 8.4 below) rather than all aspects, which the trainee physician has to master in order to be truly competent in understanding an illness via the mai.

12 Bian Que/Qin Yueren is said to have invented this much more readily accessible method of ascertaining the mai profile than other earlier method(s).

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Figure 8.4: The three positions on each hand and their links with the Wuzang-liufu in terms of the floating or sunken characteristic of the mai Adapted from Kuriyama 1999, 26-27.

In the above: Left: Cun/ረ/Inch (a) Floating: Small Intestines; (b) Sunken: Heart Guan/‫ޣ‬/Bar (a) Floating: Gallbladder; (b) Sunken: Liver Chi/ቪ/Cubit (a) Floating: Bladder; (b) Sunken: Kidneys Right: Cun (a) Floating: Large Intestines; (b) Sunken: Lungs Guan (a) Floating: Stomach; (b) Sunken: Spleen Chi (a) Floating: Sanjiao; (b) Sunken: Pericardium Ascertaining the mai profile is nothing more than an attempt to ascertain the Yinyang balance in the patient’s person-body, in order to understand (and then treat) the illness which the imbalance has caused. Yin, as one knows, is dark; yet the Moon (during the main part of its cycle) is bright. Where does its light come from? The ancient Chinese said, it comes from the Sun, which is yang, and therefore, bright. The moon’s

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brightness attests to the relationship between the Sun, Earth and itself; from the standpoint of CCM, this reflects the advance or retreat of yangqi– when yangqi advances to its maximum, the whole Moon lights up (at the Full Moon), and when yangqi retreats altogether, the moon is not visible at all (at the New Moon); at other times in the lunar cycle, only a part of the Moon would be visible (see Lee 2017a, Figure 6.7). In Chinese cosmology, the relationship between the tides and the Moon is as follows: when yangqi, operating on the Moon, is at its maximum, it causes water (which is yin and characteristically still) to rise, forming high tides, at the Full Moon. However, when yangqi retreats to its minimum, during the New Moon, low tides occur. CCM upholds MacroMicro-cosmic Wholism/Tianren-xiangying; this cosmological relationship of the rise and fall of the tides has then an analogue in the person-body, that is, in the xuemai/㹰㜹. Blood contains water; water is yin, and yin means rest and tranquillity; yet the blood in the person-body moves. For CCM, it moves because qi which is yang causes yin to move–hence, xuemai is nothing but yin and yang acting together, which generates mai (“ 䱣 ࣐ Ҿ 䱤 䉃 ѻ 㜹 ”: *Liu Lihong 2004, 174). Although the ancient Chinese knew that the Heart does move blood around, for them this explanation was superficial; it goes beyond, to invoke the concept of Yinyang as an explanatory concept in this context, in spite of the fact that it is what in Western philosophy is called a metaphysical concept. (Chapter Ten will explore further the relationship in CCM between metaphysics and science.) The Neijing says that investigating the mai is ascertaining the state of Yinyang in the person-body/“㜹ԕ‫ן‬䱤䱣”. The Suwen, Chapter 5/lj㍐䰞䱤䱣 ᓄ䊑བྷ䇪NJsays: 䱤䱣㘵ˈ ཙൠѻ䚃ҏDŽDŽDŽ⋫⯵ᗵ≲Ҿᵜ

Rendered as: The law governing the universe is the law of Yinyang, which is the foundation of Wanwu, the source of all changes, the root of life and death, the locus of the spirit. In treating an illness, one must always get to the root cause, and that is the Yinyang imbalance, which must be put right so that yin and yang would form a harmonious, balanced Whole in the individual patient.

How do we discover that the patient suffers from Yinyang imbalance? One does so by feeling the mai. This is an important reason why CCM attaches so much significance to the mai as a foremost diagnostic

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technique. (However, this is not to say that, in the history of CCM, there have not been very distinguished physicians who through the technique of looking alone, could diagnose at a glance what was wrong with the patient.)13 Today, generally it is the mai that carries the most weight in sizhen, but this does not mean that there may not be occasions when the physician may overrule the information obtained from the mai profile, when it conflicts with the rest of the information obtained under the other techniques. The principle, when the mai cedes precedence in the way just outlined, is called 㠽㜹Ӿ䇱/she mai cong zhèng. Wiseman and Feng (1998, 458-459), cite the example of ✝ 㔃 㛐 㛳 /re jie chang wei/ “gastrointestinal heat bind, characterized by abdominal pain, constipation, and a thick parched yellow tongue fur, the appearance of a slow fine pulse”. In this context, the physician considers the slow fine mai to reflect the “misleading effects of the condition”, which are, “the interior heat bind impairing Qi dynamic and the smooth flow of blood through the vessels”. The “thick parched yellow tongue fur” indicates a ᇎ 䇱 /shi zhèng/ repletion/excess zhèng, while the “appearance of a slow fine pulse,” which on its own would indicate a 㲊 䇱 /xu zhèng/deficiency zhèng, in this context is regarded as a “false/misleading” mai as it does not agree with the shi zhèng indicated by the “yellow tongue fur.” The mirror image is ֈ 䇱 Ӿ 㜹 /she zhèng cong mai. According to this principle, when the information gathered via the other techniques is at odds with the mai profile, the physician allows the latter to take precedence over the former. Wiseman and Feng (1998, 458) cite the case of an internal heat block with a rapid sunken pulse and reversal cold of the limbs, the pulse faithfully represents the true condition. The signs only reflect the misleading appearance of cold due to confinement of heat in the interior.14 13

For an account in Chinese of the relationship between zhèng and mai, see *Liu Lihong 2004, 178-198. 14 At first sight, the two principles appear confusing, as they seem to imply that the mai is not part of the zhèng. Zhèng should be understood as a concept about the process of diagnosing an illness which takes into account all the relevant evidence, symptoms and signs, the history of the illness in the patient, the condition of the patient her/himself and so on, before arriving at an overall appraisal in the light of CCM theory. It is obvious that such a process involves sifting, grading and prioritising one piece of evidence/information over others, until the physician is satisfied that the zhèng which emerges is the correct one, providing the basis for treating the patient. As observed earlier, zhèng is both process and outcome.

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In this context, the “rapid sunken pulse” indicates a repletion/excess zhèng involving internal heat/޵✝ᇎ䇱 while the cold limbs indicate a xu zhèng/ repletion zhèng, but these are not matched by the mai diagnosis, which is eliminated. Only the experienced physician would be able to cope with such a complex diagnosis. Although the mai does not lie, what it can reveal about the state of the patient’s person-body is, of course, subject to the skill of the physician in feeling the mai–mastering it appears not to be a simple matter. To prevent mediocre physicians from misdiagnosing patients, it is listed as the fourth and the last, in the history of CCM. The less than expert physician of the mai should not let his findings of it override the information he has gathered by using the other three methods (see *Luo 2011, 134). The subtleties of mastering it therefore, led physicians to try to find additional reliable methods less difficult to acquire. One additional method is what is called shezhen/ 㠼 䇺 /tongue diagnosis. By the Yuan dynasty, the first publication on the subject had appeared. It was by someone called Ao/ᮆ, with the titleljᮆ∿Քሂ䠁䮌ᖅNJ/Ao shi shanghan jinjing lu/The Bronze Mirror Record on Shanghan by Mr Ao. Unfortunately, this book has long been lost. By the Ming dynasty (during the reign of the Jiajing Emperor, if not before), this technique was well-established at least in the repertoire of physicians at the cutting edge of their profession. Today, it is routine for the physician to ask the patient to show the tongue. Strictly speaking, since Yuan times, a very important sub-technique has been introduced into sizhen, as looking at the fur of the tongue can be subsumed under the wang technique. The fur of the tongue (shetai/㠼㤄) could be black, very red, or white (all abnormal); there could be cracks along the side (which may indicate Heart problems). The shape of the tongue is also relevant to the diagnosing process. If one is ever in doubt about one’s reading of the mai, then checking against the findings of shezhen should help to confirm one’s reading of the mai profile. (Shezhen is a vast subject in its own right.15) The history of CCM shows that many less than competent practitioners have misdiagnosed and caused their patients great grief, even death sometimes. They claimed that the patient’s zhèng was that of shi/ ᇎ (excess/repletion), when it was a case of xu/㲊/deficiency. Re zhèng/✝䇱 (an instance of shi zhèng) involves an excess of heat/yang. Appropriate treatment requires the use of heat-clearing medicinals. Han zhèng (an instance of xu zhèng) requires, as appropriate treatment, the use of supplementing/bu medicinals (what in Chinese are called བྷ 㺕 ሂ 㦟 15

For a text in English, see Maciocia 1987.

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/dabuhan yao). From this, it is easy to see why it is so important to be able to distinguish the former from the latter in the clinical context, as prescribing heat-clearing medicinals in a case of a han zhèng or supplementing/bu medicinals in a case of a re zhèng could lead to disaster. To prevent such misdiagnosis and mistreatment, the less than excellent physician on the mai front would be well advised to look at the patient’s tongue to see whether the fur of the tongue is black or white. If the former, he would get confirmation that the patient’s zhèng is shi zhèng/re zhèng and should therefore use the xie/⌫ /draining technique, not the bu/㺕 /supplementing technique. If the latter, this would indicate the cold state of the person-body/䓛փབྷሂ/yang deficiency, and the physician therefore should use, not heat-clearing but supplementing/bu medicinals. This brief discussion of shezhen has already strayed into the territory of the concept of fang, which the following section is devoted to exploring. Before doing so, let us sum up what the concept zhèng amounts to. It is the process and outcome of ascertaining the patient’s illness via sizhen (including investigating the mai and observing the fur of the tongue) from a comprehensive and consistent account of the signs and symptoms presented by the patient. This set of data should be understood through that cluster of theoretical concepts central to CCM. These include Yinyang-Wuxing, the Laws of Nature (the Cyclic Ascending-Descending Law, the sishi jielü, the zhouye jielü, the evolving nature of an illness in terms of the deficiency of yinqi/yangqi, and the excess of yinqi/yangqi to determine the precise site of the malfunctioning in the person-body, that is, which Zang/㜿 or which Fu/㞁, which visceral organ-system(s)/㜿㞁 is/are most affected, and so on. All these would in turn enable the physician to ascertain whether the patient’s illness is one of re zhèng/shi zhèng or of han zhèng/xu zhèng. In addition, it allows the physician to weigh up the relationship between zhengqi/↓≄/“correct” qi and xieqi/䛚≄ /pathogenic qi in the patient’s person-body. With this image/picture/xiang/䊑 in place, the physician would then be able to prescribe appropriately by addressing straightaway the particularities and specificities of the patient. Ascertaining zhèng is to practise Getihua Medicine.

Concept of Fang A prescription is a fang/fangzi/ᯩ/ᯩᆀ; the very act of constructing a prescription is called kai fang/ᔰᯩ. One of the literal meanings of fang is “direction”; the literal meaning of constructing a prescription is “opening up/pointing out a direction”. Such a revelation is bound to come as a

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surprise to those who are not familiar with CCM, as in Bm, prescribing/ prescription has no such connotations. As Bm operates within thingontology, its prescription/drugs/treatments are bits of Matter acting on other bits of Matter in order to kill off yet another bit of Matter which the diseased body harbours, such as bacteria/virus/defective Matter (a DNA sequence). One may understand the notion of direction either in temporal or spatial terms. We can look at the weather chart and predict that cool weather is coming later in the month, or at the signpost for a particular place, which would be pointing west. Lee 2017a, Chapter Ten argues that until relativity physics was established in the twentieth century, Modern Science, primarily as Newtonian sciences, focused on space alone; after Einstein, we now talk of Spacetime, adding a fourth dimension, the temporal one, to the three spatial ones of length, width and height/depth. In contrast, Chinese cosmology, philosophy and science have always upheld Timespace–an indissoluble Dyad–but with Time being primus inter pares in respect of Space. CCM operates within such a Timespace framework resting on processontology. Take the sishi jielü. East is not simply the place where the Sun rises, and West the place/space/direction where the Sun sets. East is also that time of the year/day called Spring/morning, when yangqi ascends/ increases towards Summer/noon, when the qi of Wood prevails. West is that time of the year/day we call Autumn/twilight, when yangqi is on its descent/decreasing, in the direction of Winter/night, when the qi of Metal prevails. South is the time of the year/day we call Summer/noon, when yangqi reaches its maximum, when the qi of Fire prevails. North is the time of the year/day called Winter/night when the qi of Water prevails, when yinqi reaches its maximum and yangqi has diminished (even descended into the bowels of the Earth or sunk into the vast expanses of water on the Earth’s surface called oceans/lakes/rivers). As the above account is important, one might be forgiven for labouring the point that within such a framework, an illness is not a disease entity, but the misbalance between yinqi and yangqi in the person-body, leading to the malfunctioning of the Wuzang-liufu. One should also reiterate another significant point about CCM: the concept of Tianrenxiangying/M-cosmic Wholism (Lee 2017a, Chapter Ten). This chapter has shown that ascertaining the mai is nothing but ascertaining the balance between yinqi and yangqi in the person-body, and that when the mai of a patient is an unseasonal mai, this portends trouble, unless the patient takes an appropriate prescription/treatment to redress the unseasonal mai (Lee 2017a, Chapter Seven). The Summer mai seasonably is vigorous and

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large/⍚ 㜹. The Winter mai is seasonably quiet. Why should this be so? Under Tianren-xiangying, in Winter, yangqi is on the retreat with yinqi at its maximum; yang stands for motion/activity, while yin stands for rest/ tranquillity/stillness. It follows that the seasonable Winter mai would be quiet, while the seasonable Summer mai would be robust. Should a patient display the Summer mai in Winter, the physician would predict trouble, as the patient’s person-body is already suffering in Winter from an excess of yangqi. Just think what would happen when Summer arrives–this excess of yangqi would overpower the person-body; to that yangqi would be added the heat/yangqi of the external environment, which is reaching its peak during that season. This aggravation could result in killing the patient. Hence, medicinals and/or other treatments must be prescribed to return the person-body to the state-of-normality-for-theseason. Given the concepts of Tianren-xiangying/M-cosmic Wholism, the aim of treatment is to remove Qi imbalance in the person-body to harmonise with Qi balance in Greater Nature, under the sishi jielü. The goal of a fangzi is simply to alter the Yinyang imbalance in the person-body of the patient; it does so through the particular properties of the various medicinals, chosen to enter into its composition. The patient’s personbody may, at the time of presentation, be suffering from either excess yang or yang deficiency, or from excess yin or yin deficiency. In the example just cited, where the patient displayed excess yang, presenting a Summer mai profile even in the depth of Winter, the fang prescribed could be said to be an attempt to simulate a Winter mai profile in the person-body. Therefore, in accordance with the shengli/⭏⨶/principles of physiology, the bingli/⯵⨶/principles underlying the emergence and continuance of illness and the zhili/⋫⨶/principles of treatment, in such cases, other things being equal, the physician would select those medicinals with “cooling properties” (see *Liu Lihong 2004, 153-156, 176-177). How would CCM know which medicinals have such properties, and which properties have the opposite property of being able to bu/supplement yangqi in the person-body, should the patient’s zhèng show that s/he is suffering from excess yin and, therefore, yang deficiency? Chapter Four has commented that certain foods such as watermelon are considered to have cooling properties and others, such as dog meat, have “heaty” properties. The watermelon is known to grow and ripen in the great heat of the summer (especially in semi-arid regions); when other plants wilt and die, the watermelon thrives, thereby, demonstrating that its “constitution” can resist such heat; hence one infers that it would possess cooling properties. Some commonly used medicinals, such as banlangen/

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ᶯ 㬍 ṩ /Radix isatidis, yejuhua/ 䟾 㧺 㣡 /Flos chrysanthemi indici are considered capable of clearing heat from the person-body. Unlike the watermelon, fuzi/䱴ᆀ/Radix aconiti lateralis grows in cold regions with little sun and much snow. This is evidence that its “constitution” can withstand severe cold; hence one infers that it would possess “heaty” properties, which make it eminently suitable as a medicinal for treating patients suffering from yang deficiency. Others falling into this category of interior-warming medicinals include dried ginger/Rhizoma Zingiberis. The very well-known ginseng/Ӫ৲/Radix ginseng is buyao. In general, medicinals are categorised in terms of their qiwei/≄ણ /flavour of their qi, that is, in accordance with the qi of a particular season. Those which are qihan/≄ሂ are associated with Winter, those which are qiliang/≄߹, with Autumn, those which are qire/≄✝ with Summer and those which are qiwen/≄⑙ with Spring. This method of classification makes obvious the focus on the temporal dimension in the concept of Timespace in CCM. This comes out quite clearly, for example, in the names of three famous fang which can be found in Zhang Zhongjing’s Shanghanlun:16 the Qinglong tang/䶂嗉⊔, the Baihu tang/ⲭ㱾⊔, and the Zhenwu tang/ⵏ↖⊔. Han culture believes that at each of the four main compass points, a mythical beast reigns supreme–the Blue Dragon/ qinglong presides over the East/Spring, the White Tiger/baihu over the West/Autumn, the Black Tortoise with the Serpent coiled over it/Xuanwu/⦴↖ referred to in the Zhenwu tang, over North/Winter, and the Vermillion Bird/zhuque/ᵡ 䳰 (a composite beast, whose parts are made up of parts of different real birds) over the South/Summer. The colours of these mythical beasts are the colours of Wuxing. They also represent constellations in ancient Chinese astronomy.17 When a physician prescribes the Tortoise with Serpent Decoction, he would be helping the patient’s person-body to attain the qi of Winter, or the qi of night-time (in the circadian sequence/zhouye jielü, which is a sub-set of the sishi jielü). Zhang Zhongjing in the Shanghanlun is said to determine zhèng in accordance with the rubric of the Six Stages/ й 䱣 й 䱤 , namely, the Greater Yang Stage/ཚ䱣, the Bright Yang/䱣᰾, the Lesser Yang/ቁ䱣, the Greater Yin/ཚ䱤, the Lesser Yin/ቁ䱤, and the Terminal Yin/৕䱤.18 Take the medicinal mahuang/哫哴/Herba Ephedrae, which gives its name 16

See Appendix Two and Chapter Nine on the Shanghanlun and Zhang Zhongjing’s outstanding contribution to CCM. 17 See “(The) Chinese Sky” 2015 for an image. 18 The English terminology here follows Maciocia 1989, 479-480.

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to the decoction for treating patients when their zhèng belongs to the Greater Yang stage. The qiwei of this decoction is mildly hot/⑙✝; its nature is expansive and capable of easing the Lungs and hence of easing breathing problems/ᇓ㛪ᒣை. After taking it, the patient would sweat, as if one were in the great heat of Summer. According to Zhang Zhongjing, such a patient is likely to improve during the hours between nine in the morning to three in the afternoon/ᐣॸᵚ, in the zhouye jielü and in the sishi jielü, in the summer months. In other words, the purpose of using this decoction is to enable the person-body to simulate the qi of Summer, in order to achieve a certain therapeutic goal. Let us next take a close look at this fangzi, Bu zhongyiqi tang/㺕ѝ⳺ ≄⊔, now readily available in the form of pills. It is meant for patients who come under the following range of conditions: damage due to exhaustion or irregular and improper eating habits. (Today, many young females suffer from the latter in their attempt to lose weight.) Such patients could then suffer from a condition which, in CCM, is called zhongqi xiaxian/ѝ≄л䲧/the downward collapse of zhongqi. There is a qi called zhongqi (related to the Spleen-Stomach organ-system), which underpins the proper functioning of the person-body. In Wuxing, the Spleen is Earth and Earth occupies the centre in the schema of the five locations or directions/wufang (see Lee 2017a, Chapter Seven). If the person is under-nourished, leading to qi deficiency/≄㲊, then zhongqi would only go downwards/ѝ ≄ ੁ л 䎠, rendering him/her weak and feeble, the patient being barely able to summon up enough qi to sustain the effort of talking, and ending up disinclined to speak. The person would also feel dizzy/ཤᲅ, and the complexion would be pale and white/㝨㢢㣽 ⲭ. Furthermore, some patients may suffer from the prolapse of the anus, and in the case of female patients, prolapse of the uterus. According to the principles of physiology/shengli, when we eat, food goes down to the Stomach and later the Intestines; but when there is a deficiency of zhongqi, this slow-moving metabolic process of first digestion, and then the absorption of nutrients no longer functions properly, resulting in the food simply leaving the person-body quickly as loose waste. According to CCM’s understanding of the nature of illness/bingli, this condition occurs because of the malfunctioning, not only of the Spleen but also of the Lungs, brought on by qi deficiency. The relationship between the Spleen and the Lungs is explained in terms of Wuxing: the Spleen belongs to Earth, and Lungs to Metal. Under the Engendering Cycle, Earth engenders Metal. When the Spleen is not discharging its job properly, then the Lungs will be weakened in the absence of adequate nutriments.

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Hence the root of this illness lies with the Spleen-Stomach organ-system; in accordance with the principles of therapeutics/yili, the treatment must address the problems there. (Chapter Nine explores the trinity/Wholism of shengli-bingli-yili.) Eight medicinals enter into the composition of this fangzi: 1. 2. 3. 4. 5. 6. 7. 8.

哴㣚 Ӫ৲ ᖃᖂ ⲭᵟ 䱸Ⳟ ॷ哫 Ḥ㜑 ⛉⭈㥹

huangqi renshen danggui baishu chenpi shengma chaihu zhi gancao

Radix astragali seu hedysari Radix ginseng Radix angelicae sinensis Rhizoma atractylodis macrocephalae Pericarpium citri reticulatae Rhizoma cimicifugae Radix bupleuri Broiled radix glycyrrhizae

Medicinal 1: This can improve the person-body as a first line of defence, increasing resistance against any external pathogenic factors (gubiao/പ 㺘). For instance, if someone is prone to catching a cold whenever and wherever when others do not, it would be appropriate for such a person to take this medicinal, together with Medicinal 4, and an additional one called fangfeng/䱢仾/Radix saposhnikoviae, which exists even as a patent medicine, in powdered form, called yupingfeng san/⦹ቿ仾ᮓ. This is the lead medicinal in terms, not only of its medicinal property, but also in terms of quantity; it is buyao. Medicinal 2: This buyao is well-known for its property of supplementing yuanqi/‫≄ݳ‬/qi, which sustains life. Medicinal 3: When Qi is deficient, so is blood, as Qi and xue go together as a Yinyang dyad in CCM; this medicinal then is intended to address the problem of preventing deficiency in Qi, causing deficiency in xue and vice versa. Medicinal 4: It addresses the problem caused by the weak, malfunctioning Spleen-Stomach organ-system which affects, in turn, the Lungs–this medicinal works upon Qi in the Jingmai of the Lungs to supplement Qi in the Jingmai of the Spleen/㺕㝮㓿ѻ≄. Medicinal 5: Its property is to moderate the effects of all the buyao in the fangzi, which may end up by over-stepping the mark in eliminating Qi

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deficiency in the person-body, resulting then in the patient feeling uncomfortable and tight in the chest; the addition of some tangerine peel can prevent this iatragenic effect from occurring. It is considered to be a Qi-regulating medicinal/⨶≄㦟. Medicinals 6 and 7: In this zhèng, it is not merely that the patient is suffering from Qi deficiency, but also Qi deficiency in a particular way. Qi sinks downwards and is incapable of lifting itself up, thereby, breaking the cycle in accordance with that fundamental Law in CCM, the Cyclic Ascending-Descending Law of Nature. To put this Law simplistically, what goes up must come down–hence, Qi, which goes up, must come down as shown in Figure 10.1. Similarly, in the person-body, should health be maintained, Qi cannot just simply go down, no more can Qi just go up and never come down. These two medicinals in this fangzi, used sparingly, are addressing this problem of enabling Qi to ascend. Medicinal 6 enables Qi of the Bright Yang Jingmai to ascend, while Medicinal 2 enables Qi of the Lesser Yang Jingmai to ascend, as it is in the nature of that Qi to ascend (see Figure 10.3, which shows how Qi works in the person-body). Medicinal 8: This supplements the qi deficiency of piwei/the SpleenStomach organ-system. Together with Medicinals 1 and 2, this group of three is able to eliminate what is called xuhuo/㲊⚛, the fire/heat, which arises because the zhongqi/ ѝ ≄ /qi of the Sanjiao and the SpleenStomach of the person-body is deficient, thereby affecting adversely the person-body’s ability to digest food and, in turn, absorb/benefit from its nutritional properties. Such a detailed analysis/deconstruction of a fangzi shows one thing clearly, namely, that the reader does not need to be distracted by the specific language sometimes used in such a discourse when it invokes political terminology. Traditionally, fangzi categorise the medicinals that enter into their composition in terms of the relationship between the Sovereign and his Officials/jun chen/ੋ㠓. The lead medicinal is called the “sovereign” and the rest are “officials” using the various grades of office-holders found in ancient Chinese bureaucracy. The deconstruction given above deliberately eschews such language, in order to show that nothing hangs on the political/bureaucratic terms whatsoever, that therefore there is no need to attach much significance to them from the medical/scientific point of view. In this way, one would avoid falling into

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the trap into which some sinologists appear to have fallen (see Appendix Three). The above fangzi, to treat that zhèng called zhongqi xiaxian, comes from a very distinguished physician of the Southern Song dynasty, called Li Dongyuan/ᵾьී (1181-1251). It is still used today.19 Chapter Nine will explore further this curious “absurdity” of CCM, which consistently relies, not merely on ancient canonical texts but also on ancient prescriptions to treat illnesses–this is not simply absurd but also unintelligible to Bm thinking. The following chapter will attempt to dissolve this “mystery”.

Qinghao, qinghaosu, fangzi and Biomedical pharmacology The deconstruction of the fangzi above brings out an important point very clearly–prescriptions in CCM are very exceptionally based on one medicinal only. They are nearly always composites, with each medicinal playing an assigned specific role in addressing a particular aspect of the patient’s zhèng. The items form a causal Whole; together they produce a synergistic effect. (A synergistic effect is one which is greater than the sum of the effects of each causal item taken separately and in isolation from one another–see Lee 2017a, Chapter Eleven for some detailed discussion). This philosophy of pharmacology is distinctly different from that of Bm, which upholds: one drug in one prescription. Furthermore, the drug is not visibly recognisable as the original item (be it a plant or whatever else) from which it is derived, as Bm pharmacology only seeks out the active ingredient which it abstracts from the source. This philosophy of pharmacology is dictated by the framework within which Bm is constructed: it rests on thing-ontology, as Matter/Materialism. Hence one bit of Matter (the active ingredient) is expected to be the causal agent. This acts on another bit of Matter (the bacteria or virus, killing them/it). As such, it is committed to the notion of disease-entity, to Reductionism (only what is perceived as the active ingredient is retained from the source, everything else is deemed to be irrelevant and discarded). It relies on the linear, monofactorial model of causation (one cause, one effect with the causal arrow in one direction only, from the perceived cause to the perceived effect, thereby, ruling out plurality of causes interacting in a reciprocal as well as in a synergistic manner). In contrast, the medicinals drawn up in a fangzi, are constructed within a framework resting on process-ontology. It focuses on the malfunctioning of Qi 19

The deconstruction of this fangzi follows *Luo 2011, 45-46.

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processes as the basic cause of illness, on Wholism at every level of understanding the functioning as well as the treatment of the malfunctioning of the person-body. Hence it has no truck with the reductionist outlook of the so-called active ingredient extracted from a medicinal, as this is entirely alien and anathema to its Wholist orientation. It is predicated on a non-linear, multifactorial model of causation, exhibiting both negative and positive feed-back loops, reciprocity and synergism. The differences between these two philosophies of pharmacology could not be better illustrated than taking a detailed look at what today in Bm is called artemisinin/qinghaosu/䶂㫯㍐, the “wonder drug” discovered in the last few decades to combat malaria. It is very timely to look at this drug today, because the Nobel Medicine and Physiology Committee in 2015 awarded half the prize money to the Chinese medical researcher, Tu Youyou/ነખખ (1930- ). The project of finding such a drug was ordered by Mao Zedong at the time of the Vietnam War, when North Vietnamese soldiers were constantly falling prey to malaria. A new drug was urgently needed as the medicine of choice at that time, chloroquine, was rapidly being rendered ineffective. By the 1960s, the parasite was increasingly becoming resistant to it. Some 500 Chinese researchers worked on this project, whether from the standpoint of Bm pharmacology or from that of so-called Traditional Medicine/TCM. Tu turned her attention to the latter domain as she had been trained in both medicines. She and her team eventually succeeded in identifying the plant Herba Artemisiae Annuae/䶂 㫯 /qinghao, commonly called sweet wormwood, and using ether, succeeded in isolating the active ingredient, today called artemisinin. By carefully going through the medical texts of the ages, the research team managed to find the plant mentioned in a prescription for febrile conditions typical of malaria in a fourth century text,lj㛈ᖼ༷ᙕᯩNJ/A Handbook of Prescriptions for Emergencies, the work of the well-known alchemist-cum-physician Ge Hong/㪋⍚ (c. 284-346 CE).20 For an account of the whole procedure of turning qinghao into qinghaosu, see Tu 2011. (See also Unschuld 2015.) Although the Nobel Prize came more than forty years after the event, artemisinin illustrates (not for the first time nor is it the last) the tendency of regarding CCM’s materia medica as a rich seam for the pharmacological industry to mine. There is even such a subject called ethno-botany dedicated to such a task, with pharmaceutical corporations investing in such a potentially rich source of materia medica 20

This text also mentioned medicinals in treating smallpox, typhoid and dysentery (see Hanson 2015).

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for their exploitation. This mining is done with the following justification: the non-Bm use of medicinals is at best considered “primitive”, “crude”, “unrefined”, “low grade empirical data” or even dangerous (mahuang/ Herba Ephedrae is officially so regarded by the FDA in the USA), or at worst “unscientific”. The original medicinal, after all, is not uniform (as it is a plant and plants, even if genetically engineered to have identical genomes, may turn out to differ from one another owing to some differences in their environments). Naturally, the amounts of the so-called active ingredient are not identical. The “unscientific” qinghao is transformed to become the “scientific” artemisinin/qinghaosu by undergoing the reductionist procedure mentioned above, endorsed by the philosophy of pharmacology. Biomedical pharmacology uses its own criterion of efficacy, which has nothing to do with the notion as understood by CCM in their use of medicinals in a fangzi. Ex hypothesi, a fangzi, even if declared to be efficacious and invoked down the millennia, is not “scientific” in the eyes of Bm pharmacology, which relies on RCT-EBM, the twin Gold Standards of efficacy and scientificity. It is not surprising, then, that no one in the Bm establishment seems to find it pertinent to recognise the fact that historically the medicinal must have proved efficacious, otherwise why should Ge Hong, one thousand seven hundred years ago have recorded it as a treatment for malaria? Presumably, physicians had used it even before Ge Hong and physicians after him have continued to use it down the centuries. Admittedly, such usage has not been found recorded in the surviving literature available to historians today. Commentators, on the whole, have ignored this history and simplistically celebrated the reductionist product itself. This is not to deny that qinghaosu has indeed done a great deal of good, saved a great deal of suffering and many lives since its introduction as the medicine of choice to treat malaria. Nor can one deny that Tu richly deserves the award of the Nobel Prize. It simply draws attention to the rich irony involved, and the inherent problems embedded in the reductionist framework of Bm pharmacology, when it mines the materia medica, which belongs to another tradition of medicine. The award may be considered to be long-delayed, though perhaps not long in the history of the decision-making of the Nobel Awards Committees, but long in terms of the fate of artemisinin and its potency as a “magic bullet” against malaria. By 2015, there is plenty of evidence that the drug’s efficacy is no longer proof against the parasite’s evolved resistance to it. In addition, the female Anopheles mosquito which hosts the main offending parasite, Plasmodium falciparum and spreads it, had also evolved to meet the challenge posed to its existence by insecticides. The evolution of drug

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resistance in the history of fighting malaria had already reared its ugly head, as earlier remarked upon–the parasite had rendered chloroquine useless by the 1960s. However, Tu 2011, points out that her work and that of other Chinese researchers had convinced WHO (by 2005) that the way forward is via what is called Artemisinin Combination Therapy (ACT). This acts as an analogue of the complex composition of a fangzi–these combine two active ingredients with different mechanisms of actions. WHO currently recommends five ACTs, the selection of which particular regimen depends on local strains of the offending parasite. ACTs, as a first-line treatment, had been adopted as policy in 79 countries by 2013 (see WHO 2015). Is this move sufficient to hold back the curse of the parasite developing drug resistance? Alas, the latest monitoring and research show that ACTs are running into difficulties. It appears that the parasite is fighting back (see Mbengue 2015; Tun 2015; Dondrop 2009; Taylor 2009). The hypothesis, that active ingredients per se (even used together in combination therapies) may lend themselves as easy prey to the evolution of drug resistance, should not be dismissed in a cavalier manner, as Tu 2011, herself hints (but without spelling it out). Towards the end of her essay, she writes: However, the use of a single herb for the treatment of a specific disease is rare in Chinese medicine. Generally, the treatment is determined by a holistic characterization of the patient’s syndrome, and a prescription comprises a group of herbs specifically tailored to the syndrome. The rich correlations between syndromes and prescriptions have fuelled the advancement of Chinese medicine for thousands of years.

Bm should do well to pay heed to her intimation as to where the solution could lie.21 The next section will explore in greater detail what Tu 2011 has written (as just cited above).

Biomedicine and Getihua Medicine from the standpoint of Zhèng and Fang Let us take an example of high blood pressure (HBP) to examine in some detail how Bm and CCM would each respectively diagnose and prescribe in practice. In Bm, HBP is a disease that is easily diagnosed and readily treated (through controlling it rather than by curing it–see “Blood Pressure” 21 Tu worked within the TCM rather than the CCM framework; her remark shows that on this point she sees eye to eye with CCM.

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2015). Today, Bm would advise patients to change their life-style, eat more fruit and vegetables, take less salt, cut down on weight, drink less alcohol and exercise more. Such measures, though helpful in general (and even if followed by the patient), may not be sufficient to keep the blood pressure sufficiently low. Medication would be required, and depending on the condition of the patient, this would include ACE inhibitors, which block the body from producing a chemical called angiotensin II. Upon entering the blood stream this chemical causes the blood vessels to narrow. ACE is the medicine of first choice, and is said not to have any truly serious side effects (in the sense of life-threatening effects) although in some cases it may bring on a dry cough, dizziness, tiredness, weakness, rash, headaches, and changes to one’s sense of taste. Taking HBP medicines would be life-long, as stoppage means the return of the condition. CCM would see eye to eye with Bm on the need for patients to alter their diet and their life-style. As we know, not all patients would welcome such a prescription. *Li Yubin (2009, 138-139) cites the case of a rather heavy-set female patient in her “fifties”, with a reddish complexion, who had been suffering from HBP for a decade. Given her weight, it was not surprising to learn that she complained of shortness of breath when walking, and had a lot of catarrh. She informed the physician that every autumn she would go to the hospital (the Bm side) to have some medicine to reduce the chances of blood clotting, to prevent the probable onset of a stroke. She was not unhappy with this arrangement, but had decided to turn to CCM in the hope of a better outcome. Her mai turned out to be a big, forceful slippery mai/ 䶎 ᑨ ᴹ ࣋ Ⲵ ━ བྷ ѻ 㜹 . It was a taut mai, although not taut in such a way as to suggest hardness/㍗䊑ѻѝˈ⋑ᴹਁ ⺜Ⲵᝏ㿹, nor was it really too deep/нᱟᖸ␡. Such a mai in the context of the patient’s medical history, body weight, complexion and other symptoms and signs, led the physician to ascertain the zhèng as follows: she suffered from a serious stagnation of Wood qi/ᵘ≄䛱┎ᗇ࡙ᇣ. From this zhèng, the physician also concluded that an altered diet (less meat, more vegetables and fruit) maintained for two years should do the trick; however, the physician also believed that such a patient would not be able to keep to such a regimen for such a long period of time. Hence, his prescription was based on two formulae (ping wei san and er chen tang /ᒣ㛳ᮓਸҼ䱸⊔), which contained some Herba Ephedrae/哫哴. This was meant to treat her ruddy complexion, a sign that she was suffering from deficiency of yangqi, which makes the yangqi float on the surface/㲊 䱣⎞䎺; Herba Ephedrae is said to permit the open smooth flow of yangqi/

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ᇓ 䙊 䱣 ≄ . The physician also saw fit to add (fresh, not processed) Crataegus/Hawthorn/ኡὲ to his prescription, as the patient’s constitution was basically sound and could withstand a considerable amount of this ingredient–hawthorn does not differ from the effect of er chen tang, but enhances its effect, helping to dissolve the catarrh. We have already pointed out that the patient was someone prone to enjoying good food, but also of a nature not to take kindly to exercise. Hawthorn is said to produce a slimming effect–this patient was given it to help her lose weight more readily. From the perspective of Wuxing, her more than hearty appetite for rich foods pointed to the Earth qi being somewhat congested (Earth is related to the Spleen-Stomach visceral organ-system) and this in turn led to Wood qi stagnating, ultimately causing her HBP. Arriving at this zhèng enabled the physician to prescribe medicinals which would dissolve the fat accumulated in the person-body to clear the congestion and stagnation in the Stomach and the Liver. Under the Constraining Cycle in Wuxing, Wood constrains Earth; but under the Insulting Mode/⴨‫( מ‬see Chapter Four), Spleen-Stomach/Earth could adversely affect Liver/Wood. The raison d’être of the prescription is first directly to dispel the excess Earth qi leading to congestion which then dispels the stagnation of the Wood qi–the two processes together would take care of lowering blood pressure in the patient. In other words, the physician did not directly prescribe anything which has the immediate effect of lowering blood pressure. By sorting out the malfunctioning of Earth qi and Wood qi, returning the person-body to a harmonious relationship within the Wuxing framework, the patient’s HGP would be cured. After several decoctions, she reported that her catarrh had lessened, she was no longer quite so short of breath when walking, her bowels moved better, and her complexion was no longer so ruddy–in CCM terms, this last was a sign that yangqi was no longer floating on the surface, but had turned inwards. By the time her treatment was completed, she had lost a significant amount of weight, her blood pressure had stabilised around 130/90mmHg (when she first consulted the physician, her records showed around 160/110mmHg), and she said she felt like a new person, being able now to do the full range of housework, light and heavy, as well as to take part wholeheartedly and energetically in the affairs of the wider family. This patient was a case of HGP caused basically by diet and life-style. Let us look at another HGP case, also cited by *Li Yubin (2009, 140-141), which exhibited a considerable psychosomatic dimension to the illness. The physician mentions that this kind of case is fairly common in the rural parts of China and amongst elderly females. The face of such a patient usually shows signs of having borne a life-time of hardship, and such

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patients would also be likely, if given the opportunity, to pour out their woes. It requires an effort to ascertain the mai of such a patient. Their tongue profile is more obvious and is usually as follows: mildly red, moist and somewhat fat/␑⏖⮕㜆, and the cover of the fur of the tongue is slippery and greasy/━㞫. These two profiles indicate that stagnating qi has caused the Middle Burner/Zhongjiao of the patient to malfunction, thereby bringing on HBP. In sum, it is a case of stagnating Wood qi. From the purely medication point of view, it is not difficult to prescribe for such cases. It is obvious that the most relevant to use is Si ni san/Counterflow Cold Powder/ ഋ 䘶 ᮓ 22 or Rou si ni san/ Ḅ ഋ 䘶 ᮓ , adding some peppermint/㮴㦧 and xiangfu/俉䱴/Rhizoma cyperi rotundi, with the aim of rendering Liver/Wood qi to operate smoothly. Peppermint in particular also has the property of being mild and so is specially recommended for use in the case of young children and the elderly. Xiangfu is also able to treat a condition peculiar to and often reported by HBP patients with a psychosomatic dimension to their illness, that is, their person-body feels intermittent bouts of being hot and then cold–xiangfu is part of the root of the plant, oval in shape, covered with tiny hairs. The synergistic properties of these two medicinals are very efficacious in expelling stagnated qi through the pores. Stagnated Wood qi would adversely have affected the function of the Middle Burner which in turn would have meant that the patient’s appetite would be poor. To address this problem, this fang could use either of the two formulae earlier mentioned. Although the patient would feel much better as a result of taking the prescribed medicine, this does not mean that their HBP would become normal. To achieve this result, they would have to undergo this treatment for at least a week before their blood pressure would begin eventually to decrease. As for the psychosomatic aspect of this illness, taking medicine of the kind prescribed above on its own is not sufficient. The physician would have to advise such patients not to allow their feelings of resentment and anger (emotions pertaining to the Liver) to dominate their lives. This piece of advice undoubtedly, can more readily be proffered by an outsider than implemented by the patients themselves. Physicians, alas, have no power to reform society so that such women could live more fulfilling lives and thus would feel less frustrated, less angry and less resentful of the way that others treat them within their restricted social contexts. Li Dongyuan, one of whose fangzi has been deconstructed in the section above, lived at a time when the interest in medical discourse was at 22

ഋ䘶⊔/Counter-flow Cold Decoction is a “hot” formula for treating a cold zhèng: it contains dried ginger, fuzi/aconite and gancao/liquorice.

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its height. There was a craze for collecting famous fangzi, which had both good and bad effects in the history of CCM during the Song dynasty. The major bad effect was that mediocre physicians simply regarded these fangzi as tablets of stone which they then applied mechanistically. Indeed, some of them were literally carved on stone such as those of Li Dongyuan. The good effect was that such methods of propagation were an efficient and cheap way of transmitting knowledge and information to a wider circle. (Publishing a book cost a lot of time and effort, as everything had to be done calligraphically, first by hand before printing through a laborious process of assembling carved characters.) Transmission of knowledge in any culture is a matter of the utmost importance. (See *Luo 2011, 58, 65, 106.) A fangzi, no matter how ancient and venerated, such as those composed by Zhang Zhongjing (Han dynasty) and Li Dongyuan (Song dynasty), cannot be mechanistically applied, given the CCM framework. All fangzi must be intelligently adapted by the physician in the light of the patient’s zhèng, medical history, constitution and all other relevant circumstances, under Getihua zhilao. The operative word is linghuo/⚥, which may be translated as “flexible”, with the built-in connotation that the flexibility and versatility are informed by an intelligence that can analyse and understand the clinical situation in the light of CCM’s shenglibingli-yili. Generally speaking, the mediocre practitioner/xia gong would use a fangzi without intelligent adaptation; such practitioners are not likely to achieve impressive records of success. The linghuo editing, modifying and adapting of a fangzi, in the light of the zhèng of the specific patient in the clinical context may, in the main, take the following forms: (a) Changing the quantity: less of one and more of another medicinal, and/or (b) subtracting and/or adding new medicinals, or23 23

An impressive example of this may be found in the writings of a famous physician, Zhang Xichun/ᕐ䭑㓟 (1860-1933). He recalled that in his youth, a shang gong managed successfully to treat a case of severe constipation (which in CCM’s term is one of 䱣᰾㞁ᇎ/yangming fu shi) with a single medicinal, when the standard fang for such an illness, called བྷ᢯≄⊔/Da chengqi tang/Major Purgative Decoction, derived from Zhang Zhongjing’s Shanghanlun, had failed to achieve the anticipated result. The medicinal prescribed in question was ေ ⚥ԉ /Weilingxian/Radix Clematidis. Once taken, the patient immediately rushed to the toilet, moved his bowels, and recovery immediately began. The mystery lies in the fact that, although the medicinal has some diuretic effect, its real strength lies in expelling wind-damp/仾⒯, thereby unblocking the Jingluo. When Zhang Xichun

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(c) the most radical method, which is to analyse and comprehend thoroughly a fangzi, drawn up by a famous preceding master and then use the principles of shengli-bingli-yili to compose one’s own to cope with the zhèng confronting oneself. This then in turn would make one a potential shang gong, a master physician in one’s own right. Chapter Seven has mentioned such a form of the linghuo use of a classical fangzi from Zhang Zhongjing’s Shanghanlun; that fang is the Xiaojianzhong tang/ሿ‫ڕ‬ѝ⊔. Recall that Professor Hao Wanshan was treating a patient suffering severe stomach pains, following a successful cancer operation of his intestines and the taking of painkillers, prescribed by the patient’s doctor. This was an iatrogenic condition, a condition whose precise and specific history would be unknown to Zhang Zhongjing, who lived nearly two thousand years ago, well before the emergence of Bm. Yet Hao, through applying the logic of shengli-bingli-yili, precisely the very principles that led Zhang Zhongjing to compose such a fangzi centuries ago, realised that this classical fangzi (with some editing and modifying, no doubt) was the right one to use. It is precisely this kind of linghuo use of classical fangzi which has kept CCM alive, relevant and flourishing down the ages, till today. As CCM is embedded within process-ontology, an illness is not something that is a static entity; nor is the state of the patient’s personbody static. In general, depending on the complexity of the zhèng, a physician has to monitor the response of the patient’s person-body to the first prescription. Upon taking the first fangzi, if it is well targeted (ሩ⯷л 㦟), the patient would improve, although this does not necessarily mean asked the shang gong why it had worked, the explanation was as follows: the capability of Qi transformation in the patient’s Zangfu had been impaired; as a result, there was qi stagnation, which prevented the Zhang Zhongjing fang from achieving its desired effect. However, once the additional medicinal had unblocked the Jingluo, the medicinals of the original fang, which stayed in the patient’s system for all those few days, would at long last be able to work their anticipated effect. In other words, this shang gong had simply, in a linghuo manner, modified the original fang, adding one more medicinal. Metaphorically, the shang gong said the additional medicinal was the fuse, which set off the cannon. A distinguished physician of today, ։♋勼/Yu Yingao, has distinguished between two methods of diagnosis and treatment–between ⌅⋫/fa zhi/“straight down the line application of the relevant fang” and ᜿⋫/yi zhi/“attending to the meaning and significance of the relevant fang for the zhèng in hand” (see *Yu 2009). On Zhang Xichun, see *Luo 2014a.

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that the patient has been put right once and for all. Other aspects of the zhèng may have to be addressed at this or even a later stage. The same procedure of the sizhen would have to be adhered to, at each consultation. The zhèng at a particular moment in time must be ascertained and determined, and a new fangzi would be prescribed. In the second and later fangzi, the quantity of a medicinal in a preceding fangzi may have to be modified; indeed the medicinal itself may be left out altogether, and new ones added. At the same time, the shang gong is always sensitive, especially in cases where the patient is female and of reproductive age, that a certain mai profile may mean that she is pregnant; as this possibility cannot be written off, the physician would be careful not to prescribe certain medicinals, which though pertinent to the zhèng, may also compromise the pregnancy itself. In other words, great care and attention would be paid by a shang gong to the complexities of the patient’s personbody as presented to him for diagnosis. (See *Luo 2011for detailed case histories, as recorded by shang gong from the Song to the Qing dynasty.) It would be appropriate to outline a detailed case study instantiating and illustrating the points set out in the three sections above. This case illustrates the close relationship between zhèng and fang, the use of the classical fangzi in a linghuo fashion, the changing nature of the fang to reflect the on-going changes in the person-body of the patient to reflect the fundamental feature about the nature of CCM, being embedded within process-ontology, and the careful and thoughtful manner with which the physician approaches the specific circumstances of the patient, confronting him (in Getihua Medicine). This is a case which occurred towards the end of the Ming dynasty, recorded by a distinguished physician of the time called Yu Jiayan/௫హ䀰 (1585-1666) in his bookljሃ ᜿㥹NJ/Yuyicao.24 The patient was female; a physician, called in earlier by the family, pronounced that, as she was at death’s door, there was no need to go to the extent of making out a prescription. This particular physician had a reputation for being an expert on feeling the mai, claiming he could tell from the mai profile when precisely a patient would breathe his/her last. However, a member of the household thought that all the same it would be best to have a second opinion, and so the family hurried to fetch Yu Jiayan to her bedside. Yu examined her, told the family that the doom and gloom that had descended, were quite unnecessary, that her condition was not over-serious and could be readily treated. He pronounced that the condition was due to the qi of the Middle Burner not being able to descend/ѝ❖≄ᵪ໵ຎˈሬ㠤ѝ❖≄ᵪн䱽 㘼ᐢ, thereby bringing 24

This presentation follows that given by *Luo 2011, 139-142.

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about the following symptoms for the last twenty days or so: phlegm was coming from the depths of the Stomach, foaming in her mouth, she could not eat, she had stopped urinating, and her large bowels had ceased to move. This zhèng was one of 㞸≄/ge qi. Now, the obvious fangzi to use would be that set out by Zhang Zhongjing in the Shanghanlun, called ᯻㾶 ԓ䎝⊔/xuanfu daizhe decoction, but with some modification to suit the specificities of the individual patient. This fangzi contains among others two main ingredients, xuanfu hua/Flos inulae, a phlegm-resolving medicinal and daizheshi, the mineral hematite, entering the person-body via the Stomach Jingmai. Amongst its other properties, it can also treat efficaciously ౾ 㞸 /ye ge/dysphagiaocclusion (Wiseman and Feng 1998, 163). Although this mineral is not toxic, nevertheless the patient’s condition presented the physician with a problem. He could not locate her chi mai which indicated that her qi was deficient. However, as she was at a young reproductive age, what if by chance, she was pregnant? If this was a possibility, then one should not use the medicinal called daizheshi/ԓ䎝⸣ in this fangzi, as it could cause an abortion of the foetus. Instead, Yu Jiayan substituted chishizhi/䎔⸣㜲 /Halloysitum rubrum, and combined the modified fangzi with another called ‫ੋޝ‬ᆀ ⊔/Six Gentlemen Decoction, a supplementing formula, which could deal with a zhèng arising from qi deficiency in the SpleenStomach organ-system and phlegm congestion. The moment that the patient imbibed the above combination of medicinals, her nausea eased and her condition improved, such that after three days, she recovered. However, the patient’s family was not exactly satisfied with such a result, as she had not moved her bowels for more than a month, and agitated for the physician to use medicinals to get her bowels to move. Yu Jiayan stood his ground, arguing that the qi of the patient’s Spleen-Stomach organ-system was too weak to withstand such medicinals and more to the point, the patient had hardly eaten anything at all during the preceding weeks, and so he advised them to be patient and wait for her appetite to recover, and for her to take in more nourishment before her bowels would begin, naturally, to move again. Of course, his prediction came true, as after a while, her bowel movements became normal again. Should he have used medicinals, such as danggui ᖃᖂ /Radix angelicae sinensis, dihuang/ൠ哴/Rehmannia glutinosa lisbosch, to hasten the process, he could have run the risk of harming the foetus the patient could have been carrying (should she have been pregnant). Indeed, as things turned out, her pregnancy soon became obvious. She eventually delivered a healthy infant, thanks to the extreme intelligence, care and

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attention to detail in the physician’s determining of zhèng and fang; in a word, applying fang to zhèng in a linghuo manner.

Fang and food: food as medicinal CCM does not draw a hard and fast line between food and medicine. Chapter Four has referred briefly to an aspect of the subject under the notions of yangsheng/ޫ⭏/yangshen/ޫ䓛 and shiyang/伏ޫ to promote health, well-being and longevity as part of the meaning of Preventive Medicine, in the primary sense of the term. Food, if it is to do any good, must not only be capable of being digested but also of being transformed as Qi. Rule number one in shiyang is never to overeat; overeating means overloading the Stomach. To function properly, the Stomach must make certain motions, its walls contracting then stretching/㹅ࣘ. A thoroughly full and over-stretched Stomach cannot do that, which in turn prevents it from carrying out its function of digesting food and transforming it into Qi. Stuck in the Stomach, the food starts to putrefy, the process of putrification affecting flesh and blood, causing the complexion to be pale, and the skin to be coarse. Over the long term, such conditions would lead to more serious illnesses, such as stroke, tumours, and the degeneration of the Wuzang-liufu. Another is to take into account the person’s constitution in selecting food for consumption. Individuals who are prone to damp qi/⒯≄䟽ⲴӪ should be mindful of building up the Spleen’s function of transporting moisture/⌘᜿‫ڕ‬㝮䘀⒯ and so should not take too much alcohol, as alcohol generates damp heat/⒯✝. People who are yin deficient and prone to excess yang, should cultivate yin, eliminate heat/ޫ䱤␵✝ and hence they should not take foods which are pungent and hot/䗋䗓 such as chillies, as foods with such qiwei could drain the person-body’s fluids, which are yin in character. As CCM rests on the sishi jielü as a Law of Nature, under M-cosmic Wholism/Tianren-xiangying, what one eats in pursuit of such goals depends on the season of the year, in accordance with the fundamental Cyclic Ascending-and-Descending Law of Nature: (a) With the rise of yangqi in Spring, one should eat fewer oily, greasy foods or foods whose qiwei is pungent and hot, but more vegetables, such as spinach, celery, cabbage/ধᗳ㨌, and yam/ shanyao/ኡ㦟. Li Shizhen mentions spring onions, garlic, and chives amongst

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other foods. These are excellent for the purpose of nourishing yang and building up the qi of the Spleen/ޫ䱣‫ڕ‬㝮. (b) With yangqi reaching its maximum in Summer, bringing its load of damp and heat, one should eat foods which can help eliminate damp, such as hyacinth bean/ᡱ䉶 , white gourd/melon/ߜ ⬌ˈ barley/ 㮿 ㊣ , carrots, lotus, and hawthorn/ ኡ ὲ . These can strengthen the Spleen and aid digestion/‫ڕ‬㝮⎸伏. (c) With yangqi in retreat in Autumn, and the air becoming cooler and drier, one should eat pears, yuzhu/Rhizoma Polygonati Odorati, lily bulb/baihe/Ⲯਸ/Bulbus Liliiˈand white fungus/䬦㙣, foods with yin-nourishing and dampening-down dryness properties/⓻䱤⏖⠕. (d) With yangqi in storage/concealment in Winter, one can take sesame, mutton, prawns, Wolfberry/ᷨᆀ, chestnuts and walnuts which are foods with supplementing properties/㺕伏 ⢙. In principle, anything which is not poisonous (if taken in normal portions) can be a medicinal if it contains the appropriate properties to be part of a fangzi for a particular zhèng. Earlier on, one has referred to the urine of a small child being added to a prescription. Of course, urine is not food, but if even urine could be used in a fangzi, then why not ordinary foods? For instance, garlic is a very common ingredient in many a cuisine, but especially Chinese cuisine. It can play a very important role under certain circumstances. Here is one such case. The patient came very late at night to consult the physician; he had been suffering for a week from a very bad sore throat, which made it very painful for him to swallow, even difficult to speak. His voice had become hoarse and barely audible by the time he presented himself. He had been to a doctor who had prescribed some antibiotics, but to no avail. His mai profile was as follows: on both hands, at the cun position, the mai was floating, quick in succession and tight/ৼረ⎞ᮠ㍗; on both hands, at the chi position, the mai was sunken, slight, and without strength/ৼቪ⊹㓶ᰐ࣋. The point of his tongue was red, the root white. At the end of the consultation, the physician concluded that the zhèng was one which involved, first, the patient’s heat/fire causing inflammation of the throat (however, this heat is not heat due to an excess of yang fire, but to yin deficiency–a case of xuhuo/ 㲊 ⚛ ); this was followed by exposure to cold. Hence, the zhèng was one which included both cold and heat/fire. This kind of zhèng, in general, is referred to as ሂ व⚛/han bao huo, literally meaning “cold enveloping fire”–the external cold envelops the depressed internal heat. This consultation took place very late at night when all the pharmacies had closed. What was to be

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done, short of letting the patient suffer the whole night until the next day, when a pharmacy could sort out the fangzi? At that point, the physician worked out a readily accessible substitute in a linghuo manner, which could do the job of coping with the zhèng, namely, humble garlic of which every kitchen has plenty. Instructions were as follows: (a) Take two garlic cloves and peel and crush. Then use as a compress on either sole, at the acupuncture yongquan point/⎼⋹イ–Figure 8.5. (b) Take another four or five garlic cloves, bruise and open them up, put in a bowl, add water (just off the boil), steep, and then drink as tea.

Figure 8.5: The yongquan xue/⎼⋹イ: the dot on the sole of the foot

This fangzi worked for the following reasons: the external use of garlic at that particular acupuncture point caused the xuhuo/㲊⚛ to descend. This descent of huo furthermore relieved the cold around the waist. The garlic tea, taken internally, was able to dispel the cold enveloping the throat. In this ingenious manner, using both external and internal strategies, which could overcome both cold and heat at once, the garlic enabled the patient to improve overnight to a large extent. When the patient presented himself the next day, the throat was no longer painful, he could swallow comfortably and his voice was no longer hoarse or barely audible. The physician then prescribed another fangzi to take care of the residual problems; after three decoctions, the patient fully recovered.25 25

This account follows*Yu and Zheng 2011, 115.

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The yongquan xue is the first point on the Kidney Jingmai, which controls the flow of fluid. The point itself is the outlet for the fluid in question, hence its name as yong means “water springing forth” and quan, “spring/water”. It is also a fangzi to use in treating sunstroke. Compresses and such forms of external medicament are applied at this point. What could be more typical foods in Chinese cuisine than preserved egg/pidan/Ⳟ㳻 26 and soya bean curd? A patient presented himself but indicated that he was not prepared to take a decoction of any kind. His zhèng turned out to be a case of excess heat in the Stomach/㛳✝, causing him to feel that he had not eaten enough and therefore, he was hungry all the time, a condition which CCM calls ⎸ 䉧 ழ 侕 /xiaogu shanji. A standard fangzi to treat it would include some heat-clearing medicinals such as gypsum/Gypsum Fibrosum, zhimu/⸕⇽/Rhizoma anemarrhenae, huanglian/ 哴 䘎 /Rhizoma coptidis, huangqin/ 哴 㣙 /Radix scutellariae. Given the patient’s idiosyncratic attitude to decoction, the physician simply prescribed foods which can clear heat. He was instructed to prepare the following dish: two preserved eggs and four pieces of doufu/䉶㞀/raw soya curd roughly mashed and mixed together, then seasoned with a little salt and sesame oil. It was to be divided into two portions to be eaten twice during the day. The dish was to be taken for a week. This food prescription worked admirably, as reported in this case (see *Yu and Zheng 2011, 37). Let us next consider the bitter gourd/㤖⬌/Momordica charantia L., a vegetable used in Chinese (as well as Indian) cooking. It grows in regions with a high temperature but also a considerable amount of moisture in the soil. As its taste is somewhat bitter, its nature is cold/cool/hanliang/ሂ߹ and so can act as a heat-clearing medicinal. The late Ming dynasty distinguished physician-cum-scholar, Li Shizhen (1518-1593), in his posthumously published magisterial Compendium of Materia Medica/ ljᵜ㥹㓢ⴞNJ, writes: 㤖⬌DŽDŽDŽ⳺≄༞ޫ

Rendered as: The bitter gourd tastes bitter, is cold/cool in character and is not toxic. It can diminish pathological heat, alleviate exhaustion, clear the Heart, improve vision, and benefit Qi in the person-body, strengthening it. 26

These “chemically cooked” duck eggs can be bought at Chinese groceries; they could also be made at home, though not in a modern kitchen/household. The process requires a longish period of maturation.

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This accords with the view that the bitter gourd can strengthen the Spleen, improve the appetite, be used as a heat-clearing medicinal, improve eyesight as it can lower huo in the Liver (recall that the eyes are “the opening” of the Liver), stop diarrhoea, cool the blood and expel toxins from the person-body. It can be used externally to treat boils, for example, or when one feels bloated, by mashing it up (to release the juice) and then applying it to the affected parts of the skin. Or it can be sliced, and the slices used to rub the prickly heat that young children tend to suffer from in the great summer heat. As a soup, boiled with the meat of mussels, it is excellent for lowering blood sugar, and is especially good for diabetic patients prone to yin deficiency with heat in the Stomach/㛳䱤㲊ᴹ✝㘵. However, as a food in particular, one should not overdo it even when it is very hot during the summer, as too much of it could damage the qi of the Lungs and the Spleen.27 The next food we will look at quickly is a fruit, the pomegranate. This fruit is not native to China, but was introduced from the Middle East by one called Zhang Qian/ᕐ僎, and has been domesticated there for more than two thousand years, since the early Han dynasty during the reign of Han Wudi (c. 140-187 BCE). It has been commonly used as a medicinal in pomegranate-producing areas in China to treat a variety of illnesses, using all parts including the rind of the fruit, the kernels, the flowers, the leaves and the roots of the tree. Depending on the parts used, in Chinese pharmacological terms it could be sweet, sour, gently warm or astringent. The various texts which refer to it28 say that it can treat diarrhoea, the loss of semen, and hangovers, and even stop one from getting drunk; the water in which its leaves are boiled can be used to treat skin ulcers and rashes, stop gum bleeds, treat dry throat conditions, flush out the Bladder, kill worms in the person-body, and many other ills. They warn that eating too much of the fruit can injure the Lungs and damage teeth. Let us concentrate on its ability to treat diarrhoea. On this point, there is agreement between at least one text in Arab medicine and the Chinese texts (see Kahl 2007, 245). This is not surprising as the plant has come from that part of the world, probably being native to Iran/Afghanistan.29 (However, the research of this author has failed to find evidence of whether this particular fangzi came from Arab medicine, several centuries after the fruit had arrived in China, or whether it went from China to the Middle East. Note, however, that the Arab version translated by Kahl 2007 27

See *“Kugua” 2015. See Lee, “The Pomegranate” (unpublished). 29 Bear in mind that the language of Persia/Iran is Persian, not Arabic. 28

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differs somewhat from the Chinese version.) CCM recommends a green unripe pomegranate. Wash, do not de-rind, cut the fruit into pieces with the rind intact and (today, simply) put these through a fruit juicing machine. Drink the juice. The Arab version recommends using both sweet and sour pomegranate juice to which honey and pressed pennyroyal are added, then boiled down to half the amount, to drink whenever needed; it does not refer to the use of the rind. Let us end this section by looking briefly at a medicinal which may appear to occupy a somewhat ambiguous status as food–from one point of view, it should count as food as it comes from an animal which we eat, and yet it is not food, as it is a specific part of the animal that we normally discard, save when we want to use it as a medicinal. What is this strange ingredient? It is the yellow detachable skin from the inside of the (edible) gizzard of the chicken (and other birds), called jineijin/ 呑 ޵ 䠁 . An objective for referring to it is simply to show that the Chinese Materia Medica is very rich indeed; not only does it include many foods, it also includes things like jineijin which, in its fresh form, would be totally unknown and a mystery to readers, who only buy portions of chicken, plastic wrapped and possibly vacuum-packed, from their supermarkets. There is more than one way of processing it: the main one being simply to let it dry out on its own. In this form, it is particularly good at helping digestion, getting rid of stagnation/ ሬ ┎ , dissolving/transforming accumulated gunge/ॆ〟, and transforming/dissolving blood stasis/ॆⰰ. The famous nineteenth/twentieth-century physician-scholar, Zhang Xichun was of the opinion that it can perform the latter two functions for all the Wuzang-liufu, not just for the Spleen-Stomach organ-system. For instance, he prescribed it (together with some ⭏ 䞂 ᴢ /shengjiuqu, used in the fermentation of wine) for a patient, a young male, who felt that there was something blocking his Stomach, so that food would not go down. He had had this condition for several years. The mai on the right hand was sunken, which confirmed that the Stomach was malfunctioning. Upon taking the fangzi, the food went through, and the patient regained his appetite. Next, a female patient who had developed a lump in her belly, was suffering great pain, could not get out of bed and could not eat, was also successfully treated by adapting, in a linghuo manner, a fangzi of Zhang Zhongjing called the Lizhong tang/ ⨶ ѝ ⊔ . However, two of the medicinals were left out; others were added that can liven blood and dissolve blood stasis/ ⍫ 㹰 ॆ ⰰ as well as a considerable amount of jineijin. Zhang Xichun treated a young girl, who had just begun to menstruate. On a very hot summer’s day, she ate a lot of cold fruit. Immediately, she had a runny tummy. After continuous diarrhoea for a

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while, her period stopped. When she presented herself, her cheeks were very red and she was coughing badly. Moreover, she was very thin. It was obvious that the qi of the Spleen was deficient/ 㝮 ≄ 㲊 , causing an insufficient supply of Qixue/≄㹰. With insufficient blood, her period naturally ceased. She was prescribed Zisheng tang/䍴⭏⊔ which included jineijin. After a few days, the patient improved, and soon after recovered fully. The fangzi did two things: on the one hand, it supplemented/bu the Spleen, and on the other, it livened the blood and dissolved blood stasis; furthermore, the jineijin could improve the appetite and with an improved appetite, the Qi-and-blood was replenished/ ≄ 㹰 ᶕ Ⓚ . With such treatment, her menstruation returned to normal. (Jineijin is often used in combination with baizhu/ⲭ ᵟ /Rhizoma atractylodis macrocephalae to treat amenorrhoea.) Zhang Xichun mentioned another case: a male who developed a lump/ वඇ under the left armpit, which was several inches in diameter and very painful. The patient had lost his appetite and hence lost weight. The zhèng arrived at was one brought about by the accumulation of greasy qi, affecting particularly the Liver/㛍〟㛕≄. The fang prescribed–Zhiliao Zangfu jiju/ ⋫ ⯇ 㜿 㞁 〟 㚊 /Treating Zangfu’s Accumulation Formula– consisted of jineijin plus chaihu/Ḥ㜑/Radix bupleuri, in the proportion of three to one, with the former as the lead medicinal, reduced to powdered form, to be taken thrice daily, each dosage being а 䫡 ॺ , roughly equivalent to 5.6g. Chaihu is used in this fang because it has the property of soothing the Liver qi/㡂 㛍≄/shu ganqi; jineijin is used to dissolve clotting and liven blood/ॆⰰ⍫㹰. Ten days later, the patient’s lump had disappeared. The ability of jineijin to play this role lies in the specific anatomy of chickens/birds. Being toothless, they need to ingest some small stones which help their stomach to grind the food. The gizzard is the organ which dissolves these stones; hence CCM uses its lining as a powerful solvent of lumps/tumours in the person-body. The literal translation of jineijin is “the gold inside the chicken”. Jineijin today is also used for a similar range of cases. For instance, *Luo 2014a says he has successfully treated the following patient. The patient was a small child who had been coughing for two months. The fur of his tongue was unusually thick, especially in the middle and back portions; this indicated that the Spleen was not functioning properly. These were signs that the child was suffering from what CCM called shiji/ 伏〟 (literally, the “accumulation of food gunge”). The fangzi used jineijin, processed not by plain drying, but by adding some vinegar and then frying

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the pieces lightly till they dried. The physician also added some medicinals for treating the cough. After three decoctions, the child recovered.30

Assessing the cause-effect relationship: treating chronic and acute illnesses in CCM This section turns to a matter arising from two related aspects of CCM which seem to have entered the consciousness of the public who are not over-familiar with that medical tradition. Such a public believes that, at best, it can deal with (some) chronic illnesses but not acute ones,31 and that the purported effect would only occur, if at all, after a considerable interval following the treatment. In these respects, it differs from Bm, which deals superbly with acute or emergency conditions. Chapter Three refers to the effect of using the defibrillator, an outcome considered to be so impressive that Bm exempts it from the RCT Gold Standard. Furthermore, Bm implies and endorses the view that for the relationship between a specific treatment and a specific result to count as cause-effect, it should satisfy the following conditions: (a) The shorter the interval in time between the intervention and the result, the less doubt would be cast on its status as cause-effect. The person has just suffered from SCA (sudden cardiac arrest); treat with a defibrillator right away. Provided defibrillation is done within minutes of SCA, the expected result of the intervention is sure to occur upon the immediate application of the electric shock. The interval between administering the shock and the heart starting to beat again, follows as close to simultaneity as it is possible; this then would qualify the relationship for cause-effect status without reservation or doubt. Appendectomy, which is the standard intervention in the case of acute appendicitis, may also qualify, as the removal of the inflamed appendix would immediately bring about the elimination of the life-threatening symptoms for which the patients have presented themselves. (b) The presence of acute illness plus the ideal of near simultaneity in the occurrence of cause and effect remove the possibility of selflimitation and/or regression to the mean (see Lee 2012b and 30

This author has followed the account of jineijin found in *Luo 2014, including all the case studies, in his lecture on the medicinal. 31 See Karchmer 2015 for an account of how this has come about, since the establishment of TCM in China from the 1950s.

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Chapter Six). Many illnesses run a short course; patients would get better anyway without medical intervention of any kind. Although chronic illnesses do not disappear by themselves without medical intervention, it remains true that they wax and wane–they get worse for a bit, then better for a bit. If the intervention were to take place during a period when the illness is at its worst, to be followed by improvement, one could be led to infer that the treatment has causally brought about the improvement when, as a matter of fact, the improvement would have occurred even in the absence of the treatment. So, one must be on one’s guard against fallacious reasoning of this sort, the post hoc, ergo propter hoc fallacy.32 (c) This set of ideals may be considered as a kind of “magic bullet” in the methodology of determining cause and effect in Bm. It is often, if not invariably implied that this prototype of the ideal relationship between cause and effect is to be found in Bm alone, thereby forming part of its entitlement to the status of being the only scientific medicine in the history of human civilisation. As this claim has not been subjected to critical scrutiny, as far as this author is aware, let us attempt it here. For instance, can similar “magic bullets” be found in CCM? If plausible methodologically sound cases can be found, then the status of being “scientific” from this limited perspective, at least, cannot be withheld from CCM. One would wish to examine here three instances involving patients who are unconscious, have HBP 33 and suffer from menorrhagia. These examples have been chosen for the following methodological considerations: (a) They are acute rather than chronic illnesses. (b) They are relatively simple conditions for which there is ready agreement, as these are clear, not vague (such as back pain and headaches). They are objectively determinable by medical staff (not based on the subjective reports of patients about their own 32

Thunder, for instance, always follows lightening, but lightening is not the cause of thunder. When two events, X and Y, are observed to follow each other, invariably one would be tempted to infer that X is the cause of Y, the effect. To so infer amounts to committing the fallacy of post hoc, ergo propter hoc. 33 HBP is generally a chronic condition; this does not preclude blood pressure rising quickly and so severely as to be considered a hypertensive crisis, which can present as hypertensive urgency or hypertensive emergency. A systolic reading of 180 mm Hg (or higher) or a diastolic reading of 110 mm Hg (higher), obtained consistently over a few minutes, constitutes a case of hypertensive crisis.

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conditions), measurable and quantifiable (apart from direct observation, one could use machines to determine the precise details of a person’s heart, brain and physiology in the case of unconsciousness, of the pressure of a person’s blood, and the amount of menstrual blood being lost). Similarly, after the CCM treatment proposed, the result of such treatment may also be objectively ascertained, bypassing subjective reports (“I’m feeling much better now”) on the part of the patients. For the sake of the experiment, let us imagine that a team of doctors diagnose the patients involved using their normal battery of tests. They then randomly assign the patients with one lot going to the experimental arm (that is to CCM physicians), and another to the control arm (do nothing, provided there is agreement that this would not violate their ethical guidelines, including the consent of patients to participate in the experiment). At the end of the experiment, let us imagine that another team of doctors would assess all the patients without knowing which patients belong to the experimental or the control arm. They too, use their normal battery of tests to assess the outcome of the trial. In other words, CCM physicians have nothing to do with the choice of patients, the allocation of patients, and the assessment of the results of their treatment– all these are in the hands of Bm. CCM physicians are only responsible for their own diagnosis and treatment. 1. Unconscious patients Suppose n number of unconsciousness patients have been allocated to CCM physicians. After examining the patients in accordance with their own diagnostic norms, they then choose the option of restoring the patients’ consciousness by pinching their philtrum/renzhong (see Chapter Four). Upon pinching the philtrum, the patients immediately regain consciousness. This then would be a plausible analogue to the use of the defibrillator, restoring the heart beat in SCA–the time interval between the medical intervention and the anticipated result would be as near to simultaneity as it is possible to be. 2. HBP patients (in cases of hypertensive urgency) The CCM physicians might decide that the best treatment for the patients assigned to them would be to needle the top of their ear, letting out some blood (see Chapter Two). Patients would report an improvement. However, the real test of success (from the vantage point of this experiment) would depend on the objective readings of the blood pressure before and after the

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treatment. The time interval may not be as near to the ideal of simultaneity in (1), but it is near enough. 3. Menorrhagia (abnormal uterine bleeding: AUB) patients Such patients’ menstrual flow is so heavy that they need to use double sanitary protection, and yet find that their sanitary pads soak through with blood every hour for several consecutive hours. Their sleep is interrupted by the need to change sanitary protection. Such bleeding, lasting for longer than a week, would lead to symptoms of anaemia such as tiredness and shortness of breath. There are numerous causes which could bring about such a condition, but let us confine ourselves to those which involve the growth of uterine fibroids.34 In the case of women who have had children and no longer wish to have any more, Bm would resort to hysterectomy especially, when other less invasive treatments fail to stem the flow. According to CCM, AUB of this kind may causally be traced to three basic conditions: blood stasis/ⰰ㹰, qi stagnation/≄┎, and congealing due to cold/ሂࠍ. There are three jingfang which the physician could invoke. 1. 㹰‫؟‬䙲ⰰ⊔/Xuefu sui yu tang, used primarily in cases where blood stasis predominates. 2. 䘽䚕ᮓ/Xiaoyaosan was prevalent in the Song dynasty, and can be found in the collection of prescriptions called ljᆻ˹ཚᒣᜐ≁ਸࡲተᯩNJ /Song˹ taiping huimin heji ju fang which is used mainly in cases where qi stagnation predominates. 3. ⑙㓿⊔/Wenjing tang found in Zhang Zhongjing’s/lj䠁फ़㾱⮕NJ/Jin kui yaolüe, is used primarily in cases where congealing occurs, owing to cold. It is an interior-warming formula. All three could help to clear all the three conditions; the selection of the most appropriate depends on the physician’s ascertaining of the patient’s zhèng, and the physician’s linghuo manner in handling the fang in question.

34

This form of menorrhagia is called endometrial hyperplasia, which may or may not involve uterine cancer. For the purpose of this imagined experiment, let us assume the simpler non-cancerous version.

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As space is limited, let us just look at the Wenjing tang and see how the medicinals in its composition could help to eliminate the condition. This fang is addressed to a zhèng, where blood stasis and qi stagnation are brought about because two of the eight Extraordinary Jingmai–the chong mai/ߢ㜹 and the ren mai/ӱ㜹35–are in a state of deficiency and cold/㲊 ሂ. The former is the meeting point of Qixue and hence is regarded as the Sea of Blood/㹰⎧; the latter is in charge of the uterus. The relationship between these two Jingmai and menstruation is an extremely intimate one. Gynaecological illnesses, from infertility to amenorrhea, dysmenorrhea, menorrhagia, and so on, could be traced to the malfunctioning of these two Jingmai. When these are cold and deficient in yangqi, blood congeals, with blood stasis causing stagnation; in turn, such conditions lead to menstrual pain as the flow of blood would not be smooth. By warming the Jingmai, thus eliminating cold as well as nourishing blood, while getting rid of blood stasis at the same time, the condition of the patient would improve. The fang includes twelve medicinals; their respective dosages (given in today’s measures) are: 1.੤㥡㩨 9g 2.Ṳ᷍ 6g 3.ᖃᖂ 6 g 4.ᐍ㢾 6g 5.㢽㦟 6g 6.⢑ѩⳞ 6g 7.䱯㜦 6g 8.哖ߜ 9g 9.Ӫ৲ 6g 10.⭈㥹 6g 11.ॺ༿ 6g 12. ⭏ဌ 6g

wuzhuyu guizhi danggui chuanxiong shaoyao moudanpi ejiao maidong renshen gancao banxia fresh ginger

Fructus Evodiae Ramulus cinnamomi Radix angelicae sinensis Rhizoma ligustici Chuanxiong Paeonia lactiflora Cortex moutan radicis ass hide glue Radix ophiopogonis Radix ginseng Radix glycyrrhizae Rhizome pineliae Zingiber offiicnale Roscoe

These may be analysed under four categories: Category A (“Sovereign Medicinals”/ੋ㦟): Medicinal 1 is an interiorwarming medicinal which enters the Liver-Stomach and the Kidney Jingmai. Its flavour is hot and bitter 䗋㤖/xin ku–as such, it can perform 35

See Chapter Two for some details.

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the functions of dispelling/ ᮓ as well as expelling/ ⋴ . Its warming property/བྷ✝ can get rid of pathogenic cold. For all these reasons, it can get rid of menstrual pain. Medicinal 2 is also warming and can therefore dispel pathogenic cold, enabling blood to flow smoothly. Category B (“Ministerial” Medicinals/㠓㦟): Medicinals 3, 4 and 5 enter the Liver Jingmai; they can enliven and nourish blood and get rid of blood stasis. Medicinal 6 enters the Liver and the Heart Jingmai and can also enliven blood, eliminate blood stasis as well as get rid of a rise in the person-body temperature owing to a deficiency in Qixue and/or yangqi, as in the case of 㲊✝ xure. Category C (“Assistant” Medicinals/ր㦟): Medicinal 7 tends to yin and can nourish blood in the Liver as well as the Kidney yin, thereby lessening (internal) dryness. Medicinal 8 is mildly cold, and can nourish yin as well as clear xure. They help Medicinals 1 and 2 to lessen dryness. Medicinals 9 and 10 enter the Spleen, and can nourish qi. Medicinal 11 enters the Spleen-Stomach organ-system; together with Medicinals 9 and 10, it can strengthen the Spleen-Stomach, thereby helping to get rid of blood stasis. Medicinal 12, being bitter and warming, can warm the inside and dispel cold; together with Medicinal 11, it can warm the centre and harmonise the Stomach. Category D (“Ambassadorial” Medicinal/֯ 㦟): Medicinal 10 may be singled out to be put into a special category in its own right, as it is a medicinal which enters into almost all prescriptions–it has the overall function of harmonising all the other medicinals in a particular fang. All in all, this fang can warm and nourish Qi and xue as well as expel blood stasis; at the same time, it is buyao, relying on medicinals with warming properties, but not overdoing the warming thereby generating dryness. It is typically a fang that can be said to satisfy the Daojia ideal of combining polar opposites as a harmonious Whole. It is crucial to grasp that although a fang, such as the above, consists of numerous medicinals, each with its own respective properties and function, nevertheless these medicinals should not be regarded as separate causal items. The efficacy of a fang is the effect of Fang-Wholism. It follows that it should be regarded as a single treatment, and not twelve different medical interventions simply because the fang is composed of twelve different medicinals. In the same way, when several acupuncture points are chosen to treat a particular condition, the insertion of these needles should not be

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understood as different medical interventions, but as a single treatment from the Wholist standpoint. This fang differs from other medical treatments (in the examples chosen earlier above) only in the time interval between the medical intervention and the anticipated result–Example 3 appears to be further from the ideal expressed in Examples 1 and 2, as the first decoction would probably not stop all the bleeding immediately, but it would take three decoctions or even more (in some instances) to eliminate it. Bleeding, however, is expected to diminish to a significant extent even after the first decoction. From this vantage point, all three Examples may qualify to be “magic bullets” as 3 satisfies the same conditions as 1 and 2, although it is true that 3 is slightly more problematic in that it needs more than one decoction to totally eliminate the menorrhagia. Having said that, one must straightaway concede that the imagined experiment concerning Examples 1, 2 and 3 cannot satisfy the presuppositions of the RCT Gold Standard for some reasons which have already been set out earlier but which are worth emphasising again here. 1. Chapter Seven argues that to make sense of randomisation as a crucial technique in the methodology of RCT, one must postulate that RCT presupposes the axiom of homogeneity. The same chapter also shows that CCM, in contrast, is Getihua Medicine, that is Personalised Medicine, resting on the axiom of heterogeneity. These arguments are augmented by those set out here (Chapter Eight). No fang/treatment, no matter how relevant it may appear to the case in hand, can simplistically be applied, as it is the zhèng which determines fang. Hence, the physician, in the light of the zhèng arrived at, in a linghuo manner, modifies or tailors the (most generally relevant) fang to the specific zhèng of the specific patient under his/her care at the time. This is what is really meant by Getihua Medicine in diagnosis and treatment. 2. While Bm regards the placebo effect with deep suspicion, and cannot find room theoretically to accommodate it, in contrast CCM is perfectly at ease with this phenomenon, and finds ample theoretical room for it. Indeed, Chapter Six argues that the concept of person-hood in CCM is a primitive one and that, from such a theoretical vantage point, the placebo effect could even be said to be derivable and, as argued in Chapter Seven, it could be happily harnessed to help bring about the healing effect. However, of late even Bm has realised that for practical reasons, RCT cannot in an experimental set-up, successfully preclude the placebo effect;

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in the spirit of the strategy “if one cannot beat them, then join them”, RCT proponents have now simply admitted Open-Label interventions, giving up on the requirement of double-blinding (see Chapter Seven and Evans, Thornton, Chalmers, 2011). One could say that while the theoretical difference set out under (1) above is not reconcilable between Bm and CCM, the theoretical difference under (2) of late has become less thorny as, on practical grounds, there is more agreement than meets the eye at first sight. It seems reasonable to conclude that “magic bullets” between cause and effect, may be found in both Bm and CCM, and that therefore one can challenge the claim endorsed (implicitly) that Bm, alone, from this standpoint is entitled to the status of being “scientific” in the history of human civilisation.

Conclusion 1. This chapter, in the main, has looked at the concepts of zhèng and fang to show the specific ways that the latter is entwined with the former (which is also intimately related to other forms of treatments apart from the taking of medicinals via a fang). The physician prescribes the medicinals (in a fang), which address the signs and symptoms presented by the patient, but only in accordance with the zhèng arrived at, through the process of sifting all relevant evidence. Zhèng and fang are intimately entwined to form what may be called Zhèng-Fang Wholism. 2. An analysis of zhèng has shown that it is an entailment of Getihua Medicine. 3. The chapter has also explored the specific role played by each medicinal in a fang determined by the zhèng, which the physician has arrived at, regarding the patient at the moment of presentation. As a fang is almost invariably composite in nature, the medicinals together constitute FangWholism. 4. CCM entails that the concept of fangzi, no matter how venerable the fang in the history of the subject, is incompatible with its mechanistic application, but that it must be adapted and modified in a linghuo manner, to the specificities of the zhèng of the patient, such that Zhèng-Fang Wholism would always be obtained.

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5. Several fangzi are cited, related to or derived from Zhang Zhongjing’s Shanghanlun and Jinkuiyaolüe. They serve to illustrate the important contribution he made to CCM, pointing the way to a further exploration of his achievements in the chapters to follow. 6. The chapter shows that the boundary between medicinals and food is not a clear one, as many foods can act as medicinals (and therefore count as medicinals in a fang) when they are used in a context to treat a patient, identified with a certain zhèng. Indeed, CCM regards medicinals and foods to belong to the same source/㦟伏਼Ⓚ–between them, they maintain and sustain health and well-being, or restore to health a person who has fallen ill. As part of Preventive Medicine, one may also cook delicious soups using some medicinals. CCM recognises food therapy/ 伏 ⯇ in its repertoire. 7. A person judged to be ill is different from a well person in that, unlike the latter, one or more of the organ-systems are malfunctioning; it is the business of the physician to identify, through the process of ascertaining the zhèng, which organ-system or organ-systems are malfunctioning and how to determine the precise imbalance between yinqi and yangqi. The yinqi in the malfunctioning part(s) may be overwhelming/exuberant/in excess, with the yangqi, in contrast, being insufficient (yang deficiency). Such a zhèng is referred to as 䱤ⴋ䱣㲊/yin sheng yang xu. Or the yangqi may be overwhelming/exuberant/in excess, so much so that it damages yinqi, a zhèng referred to as 䱣ⴋ䱤Ք/yang sheng yin shang. 8. In exploring Zhèng-Fang Wholism, this chapter en passant has referred to the principles of physiology/shengli (the principles governing the normal functioning of all parts of a person-body). It also addresses bingli (the theoretical understanding of why a person falls ill when parts of a person-body malfunction, departing from the norms of shengli); and yili (the principles of treatment which follow from the identification and ascertainment of the zhèng presented by the patient). This trinity of principles constitutes the coherence and Wholism of CCM as a single theoretical system, which the next chapter will explore in detail. 9. Contrary to a commonly held belief in some quarters outside the CCM tradition, CCM can treat both chronic and acute cases. In the latter domain, in some cases the alleged causal link, between the illness and the treatment purported to control/cure it, is no more or less “instantaneous” than the link between, say, applying the defibrillator and getting the heart of the

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patient to start up again. In other words, the postulated causal link between the treatment and the outcome in CCM, in acute cases and their treatment can be said to be above board in the same way, that an analogous link in Bm, is beyond suspicion. 10. The chapter has also shown a key difference between CCM pharmacology, which is Wholist, and Biomedical pharmacology, which is reductionist, via exploring the transformation of qinghao in the former to become qinghaosu in the latter.

CHAPTER NINE CCM AND ITS UNIFYING PRINCIPLES OF PHYSIOLOGY, ILLNESS AND THERAPY (PIT-ISM)

Introduction This chapter is about the underlying unity and coherence of CCM, as systematic medicine. The acronym PIT stands for physiology, illness and therapy. The unifying principles in Chinese are called: (a) Shengli/⭏⨶ (principles of physiology). (b) Bingli/⯵⨶ (theory of illness). (c) Yili/५⨶ (principles of treatment). In CCM, these three domains and their underlying principles are inextricably entwined; in grasping one, one has implicitly grasped the other two. If the physician has truly understood (a), then s/he should know how to diagnose (b), to grasp the zhèng presented by the patient, following which, s/he ought (c) to know how to treat the patient with the zhèng as ascertained under (b). Or should one prefer to put the case the other way round, one could say: should the physician know how to treat the patient under (c), this would imply s/he has grasped the zhèng under (b) which, in turn, would imply s/he knows the principles under (a). This intimate relationship constitutes shengli-bingli-yili Wholism/PIT-ism. Grasping PIT-ism would immediately allow us to explain away some characteristics which would, no doubt, strike those outside the tradition (especially those only familiar with Bm) as being distinctly absurd. Some of these “absurdities” would include the following: On the whole, CCM appears to ignore anatomy; its medical textbooks are ancient classics, some more than two thousand years old. These have been used as foundational texts for students being taught the medicine; its CCM physicians invoke and apply fangzi, which may also date back nearly two

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millennia. While such a backward-looking orientation makes CCM look immediately ridiculous to the modern Bm mind, an important forwardlooking claim, though less well known to those outside the tradition, would appear to be equally ludicrous and laughable should it be more widely known, namely, that CCM claims to be able (in principle) to treat any illness whatever “its cause”, and whether “its cause” is known or not. Two questions immediately present themselves. 1. Are all those claims genuine, and not wholly the bad-mouthing of CCM, by its hostile critics? 2. If they are genuine, does it follow that CCM would become the laughing stock of the world, as it ought to be? The short answer to question 1 is a firm yes; far from it being the strawman put up by its enemies, it proudly wears the positive answer as a badge of honour. The short answer to question 2 is a firm negative. Should the world be prepared to give CCM the opportunity to make its principles of reasoning–PIT-ism–heard, loud and clear, then those who are not prejudiced and determined to shut out another system of thinking without bothering first to find out what it upholds, would begin to appreciate where the truth of the matter lies.

Absurdity 1 Lee 2012b, Chapter Seven has shown that Bm/MM rests on the ontological volte-face that humans are machine. From that fundamental axiom, it follows that Engineering is the approach for the study of the human being from the medical point of view. Engineering is that domain of enquiry which, paradigmatically, illustrates the philosophy that all forms of existence are machines. Machines are (human) artefacts, which are constructed out of certain basic building blocks; that which is constructed can also, therefore, be dismantled/deconstructed, and later reconstructed, should that be our wish. Old steam train engines are sometimes shifted from one site to another, stripped and dismantled into their component parts for cleaning; malfunctioning parts are replaced by functioning components, sometimes cannibalised from other engines, and finally, the restored, reconstituted/reconstructed engine would work satisfactorily again. Engineering implies Reverse Engineering, which involves no loss, as the whole is nothing more than the sum of its parts. This in turn embodies

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the philosophy of Reductionism. Bm (a Newtonian science) may be said to embody two essential characteristics: it is reductionist, and its ultimate building blocks are bits of Matter (be these organs/tissues/cells/genes/ DNA molecules), as it rests on thing-ontology. Given such a philosophical framework, it is not surprising that it celebrates (both as a matter of the history of the medicine and its spirit) anatomy as the central discipline (see Lee 2012b, Chapter Seven for details). Anatomy is the study of the structure of the human being, both external and internal. Externally, it is about the skeleton (one bit of bone/Matter is structurally connected to another bit of bone/Matter, just as one bit of the car, its four wheels/Matter are structurally connected to the steering wheel, another bit of Matter). Muscles cover the skeleton–a bit of (soft) Matter being structurally connected to a bit of (hard) Matter. Within the rib cage, constructed out of bone and tissue/muscle, are other soft bits of Matter called organs. To master all these structural relations (traditionally),1 anatomy must proceed through the pathology laboratory, through the dissection of human cadavers, where everything can be laid out for inspection. From its inception in the seventeenth century, MM had presented its credentials as “scientific medicine” precisely because its foundational science was/is anatomy/dissection. 2 The well-known medical schools in Padua, Bologna, and Uppsala, all boasted spectacular dissecting theatres; some of them are extant today. In times past, contemporary leading professors of anatomy would display their scientific prowess by performing dissections in public under dramatic/theatrical circumstances. These operations often provided the middle class with a new form of entertainment. In England, surgery left the barber’s shop when Parliament enacted an Act on 2 May 1745, rendering it respectable as scientific technology by the mid-eighteenth century. It was the obvious technology to partner anatomy (the science), as both anatomy and surgery can be seen to be compatible with the spirit of Engineering (and even Reverse Engineering). Although the Royal College of Surgeons (in England) was only established in 1800, the path to respectability had been paved slowly in the preceding two centuries, especially by the work of military surgeons, such as the great barber-surgeon, Ambroise Paré (1510-90). As a military surgeon, he applied the principles of Vesalius’s anatomy to the treatment 1 For an approach which claims to be appropriate for medical training, today, see Louw, Eizenberg and Carmichael 2009. 2 The “colonised” Chinese mind (see Chapter Eleven) first began to denigrate their own medicine as “superstition” on the ground that it was/is not based on anatomy– for an account, see Scheid and Karchmer 2015.

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of war wounds. He set out five reasons for surgery, which have all come to pass and have not, in general, been surpassed since: To eliminate that which is superfluous, restore that which has been dislocated, separate that which has been united, join that which has been divided and repair the defects of nature.

Paré had put his finger on the right spot–surgery is nothing but Engineering and Reverse Engineering. The history of surgery has borne out his agenda brilliantly: it is to render the human machine leaner, more efficient, with defective/useless parts removed, and new, more efficient substitutes, put in place. Hence, (seemingly) redundant parts may be removed. In this spirit, many children in the USA (particularly of middleclass parents in certain states) were routinely, at one time, subjected to tonsillectomy to prevent inflammation and its associated problems. Paediatricians held that this set of lymphoid tissues play(ed) no significant role in the human body, such as its immune system. Fractured bone parts must be repaired; amputated limbs must be replaced by prosthetic ones; diseased organs must be removed or replaced by either transplanted ones or by non-organic manufactured substitutes (such as heart pacers and/or stents); blocked arteries must be unblocked (such as angioplasty), and so on (see Lee 2012b, Chapter 6). A notable historian of medicine, Roy Porter (1996, 96) had made this point well: …surgery was human engineering; as with car maintenance, one peered under the bonnet and repaired faulty parts. Nowadays, transplant surgery permits, for the first time, replacement of parts that are beyond repair. Mechanical and reductionist approaches found their culmination in sparepart surgery.

As Bm is embedded in thing-ontology, it follows that structure (that which occupies Space) takes precedence over function (that which occurs in Time), in keeping with Western philosophy and its science, which privilege Space over Time (at least under the Newtonian sciences). Hence, physiology could be said to play a kind of second fiddle to anatomy/dissection. Historically, while anatomy began, even before the official emergence of MM in the seventeenth century, physiology only became established as a science much later, during the nineteenth century under Claude Bernard (1813-78), who was the father of physiology, just as Andreas Vesalius (1514-1564) was the father of anatomy in the sixteenth century. In contrast, CCM is embedded in process-ontology; hence, the relationship between anatomy and physiology is reversed, with anatomy/dissection playing

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second fiddle to physiology. (As CCM’s account of the latter is very different from that given by Bm,3 the term, when used in CCM contexts, will be italicised as physiology.) Physiology is about function–the proper/normal functioning and malfunctioning of the various organs and organ-systems in the personbody. When these are functioning in a normal manner (yinqi and yangqi are in balance), the person is healthy. When these malfunction (there is excess or deficiency in yinqi or yangqi), the person falls ill. Qi operates under two modes, Qi-in-concentrating mode as a bit of Matter (thingontology) and Qi-in-dissipating mode (process-ontology), but with the latter, being primus inter pares or, indeed, in one sense, more basic than the former. In Chinese cosmology/philosophy, as one knows, Qi-indissipating mode operates either as yinqi or yangqi. In the Macrocosm, whichever of these two qi predominates during the zhouye jielü and the sishi jielü is determined by Time rather than Space, which explains why, for such a philosophy, the term Timespace is more relevant, whereas even in the non-Newtonian sciences, the term Spacetime is more to the point. Under Tianren-xiangying/ཙӪ⴨ᓄ, what holds in the Macrocosm holds also in the Microcosm; the same relationship between yinqi and yangqi should arise in accordance with the zhouye jielü and the sishi jielü. (Tianren-xiangying is the term normally used in medical discourse, while the expression Tianren-heyi/ ཙ Ӫ ਸ а , is generally used in other discourses.) That CCM is focussed on physiology, rather than anatomy can be clearly demonstrated by the notion of the Sanjiao/й❖/Triple Burners in Chinese physiology. The Sanjiao are part of the Liufu/the six yang visceral organs,4 corresponding to the six yin visceral organs (the Heart, Liver, Lungs, Spleen, Kidneys and Pericardium); these together make up the six visceral organ-systems/Wuzang-liufu. The five other yin visceral organs have anatomical manifestations. For example, the Heart in its anatomical manifestation can be located in the person-body in CCM,5 in 3 4

For an account of it in Bm, see Lee 2012b, Chapter Seven. Suwen/lj㍐䰞‫ި〈ޠ⚥ޣ‬䇪NJ, Chapter 8 says: й❖㘵ˈߣ␾ѻᇈˈ≤䚃ࠪ✹

Rendered as: Sanjiao is the official in charge of irrigation, controlling the water passages. 5

This is to say, it exists as part of thing-ontology.

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the pathology lab and in the operating theatre in Bm. On the other hand, the Sanjiao have no similar anatomical manifestations. From the standpoint of Bm and anatomy, the notion would be an absurd and ridiculous one, as it is a purely physiological organ, so to speak. Its role is entirely physiological, as it is said to play distinctive functional roles within the physiology of the person-body. It is said to consist of three parts, the upper, middle and lower jiao. It connects with the Pericardium with which it is externally as well as internally related. Its primary functions are to govern the various forms of qi; in particular, it is the avenue for the Primordial/Original Qi/‫≄ݳ‬/qi, which sustains life. It originates from the ㋮/essence of the Kidneys, stored in the dantian/ѩ⭠ and borrows as a “conduit” the Sanjiao to co-ordinate the functioning of the Wuzang-liufu, including, therefore, the processes of digestion. The upper jiao is in charge of that part of the person-body from the diaphragm upwards; the middle jiao, between the diaphragm and the umbilicus; while the lower jiao, is from the umbilicus downwards.6 In terms of the visceral organ-systems, the upper jiao covers the Heart, the Lungs, the Pericardium, the throat and the head; the middle jiao, the Stomach, the Spleen and the Gallbladder; and the lower jiao, the Liver, the Kidneys, the Intestines and the Bladder. Though the notion of the Sanjiao has attracted some controversy down the ages, nevertheless, CCM uses it in determining zhèng and in treatment, in a word in shengli-bingli- yili Wholism. The above brief summary of the relationship between yinqi and yangqi in the Microcosm/person-body should not be misunderstood to mean that CCM is ignorant about anatomy/structure, or that anatomy/structure is irrelevant altogether to its preoccupation. It is just simply to say that anatomy/structure on the one hand, and physiology/function on the other, are not a manifestation of Dualism but Dyadism. As Dyadism, it says that function is primus inter pares in respect of structure; that the burden of explaining, and in turn, of treating an illness, does not lie, so much in shoring up structure as in restoring proper functioning. As for Bm, in contrast, structure takes pride of place, ahead of function, and in treating a disease, the burden often lies not so much in function as in structure (Matter). Hence, a paradigmatic as well as favoured mode of medical intervention for Bm is surgery, which involves the modification of bits of Matter in the body/organs or parts of organs or tissues or their replacement by inorganic bits of Matter (heart pacer/prosthetic limbs, and so on), or by organic bits of Matter (organ transplants or stem cell manipulation in the future). 6

This view may be traced to the Nanjing, Chapter 31, and the Lingshu, Chapter 18.

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We have seen in Chapter Eight that Western medical scholars have (had) difficulty with the notion of the mai, as unlike the pulse in Bm, the mai in CCM is not tied down to anatomy; hence, they dismiss(ed) it as “mumbo-jumbo” (at least, historically, they did so). We have seen, too, that CCM holds that ascertaining the mai profile is ascertaining the state of Yinyang in the person-body. Yinyang, to put it bluntly, is not an anatomical notion, a thing which occupies space in the person-body. Is there any evidence, in the history of CCM, that Chinese physicians and others had (a fair degree of) anatomical knowledge via ancient texts? To begin with, the Neijing itself provides us with some evidence. The Lingshu, Chapter 12/lj⚥᷒ 㓿≤NJsays: ཛ‫ޛ‬ቪѻ༛DŽDŽDŽばѻཊቁ

Rendered as: A normal size adult (male) possesses skin, muscle and Jingmai; as a living individual, one could examine him by touching him. When he is dead, one can do an autopsy on him, and determine the state of his solid visceral organs, whether they are firm or not, the size of each of the hollow visceral organs, how much cereal (food) is contained in the Stomach and the Intestines. (Texts within round brackets are this author’s interpolations.)

The Lingshu, Chapter 31/lj⚥᷒㛐㛳NJcontains a description of the entire length of the digestive system, beginning with the mouth, where food enters, and ending with the digested waste leaving the person-body via the anus as faeces. Precise measurements are given for each of these parts. The following extract gives a flavour of the endeavour: ૭䰘䟽ॱєDŽDŽDŽཆ䱴Ҿ㝀к

Rendered as: The larynx weighs 17 ounces and is 1.97 inches wide. The distance from the larynx to the Stomach is one foot six inches. The Stomach is curvy and sinuous in shape and can bend and stretch; its length is two feet eight inches; at its widest, its circumference is 1.5 inches and its diameter is 6.6 inches; its capacity is 3.5 litres. The Small Intestines are attached to the spine at the back; they lie coiled up; the coiling goes from left to right and is overlapping, with sixteen turns; the Small Intestines meet up with the Large Intestines, at a place just above the navel.

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In the Lingshu, Chapter 14/lj⚥᷒㛐㛳NJ, one finds measurements of different bones, such as the diameter of the head, the distance between the shoulder and the elbow, and that between the elbow and the wrist. Chapter Two (of this volume) cites a detailed case of dissecting a cadaver during the Eastern Han dynasty. The under-privileging of anatomy/dissection and surgery (the latter occurred in the case of minor operations only7) in CCM is sometimes laid at the feet of Confucian teaching, which was not in favour of opening up the person-body of the living or mutilating the body of the dead. This point has some validity but standing behind it, another matter needs exploring to bring out why such a teaching might itself have reflected the cultural background, against which CCM itself as well as Confucianism are to be understood. The Yijing/lj᱃㓿NJexplicitly invoked the primacy of the notion of change, and implicitly the notion of Qi as well as the everchanging relationship between yinqi and yangqi. Furthermore, Chinese culture, in general, and CCM, in particular, upheld Macro-Micro-cosmic Wholism via the concept of Tianren-xiangying, which is primarily concerned with the notion of Qi-in-dissipating mode, as already observed. Furthermore, CCM is interested in the concept of health, understood as the harmonious balance between yinqi and yangqi in the person-body. Indeed, it is the presence of Qi which lays down the boundary between the living and the dead. The living possess this Qi, variously named: Primordial qi/life-sustaining qi, “Correct” or Orthopathic Qi/↓≄/zhengqi/qi, which enables the person-body to combat illness, or Essential Qi/㋮≄/jingqi/qi, which maintains the proper functioning of all the organ-systems in the person-body. Ex hypothesi, the dead lack Qi-in-dissipating mode8, as well as jingqi or zhengqi. It follows that dissecting a cadaver is not likely to advance medical knowledge about illness and the appropriate treatment of illness. Medicine is about promoting the health of the person-body as well 7

The exception to this is the famous Hua Tuo/ॾև (circa 145-208 CE) in the history of CCM, a physician-cum-surgeon, who pioneered major surgical procedures, and is said to have invented anaesthetics (see Dharmananda 2015a, amongst his achievements). 8 While the myriad things/Wanwu (including the abiotic) all possess Qi, the biotic differs from the abiotic in that it also possesses life/sheng/⭏. This means that these other forms of qi are applicable to it. A corpse is without life and, hence, could be said to belong to the abiotic or ex-biotic domain, which only possesses Qi-inconcentrating Mode (which, indeed, would shortly return to the greater environment beyond as Qi-in-dissipating Mode). The living organism, on the other hand, embodies both Qi-in-concentrating Mode as well as Qi-in-dissipating Mode; the latter Qi courses through its Jingluo network. (Recall Text Box 2.2.)

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as ridding the person-body of various ailments, when a malfunctioning of the various organs and organ-systems occurs. Au fond, health and its mirror image, ill health, are about the functioning or the malfunctioning in terms of the harmonious or lack of harmonious relationship between yinqi and yangqi in the individual person-body/Microcosm. From this perspective, it seems unnecessary to investigate, so whole-heartedly or so obsessively, the structure and the structural/anatomical relationships between parts of the body. So while CCM focuses on physiology and function, Bm focuses on anatomy/structure. CCM rests on process-ontology, Bm on thing-ontology. CCM does not depart from the starting point of the person-body as an organism (albeit a distinctive one as human consciousness manifests greater complexity than non-human consciousness); Bm sees humans not as organisms but as machines. CCM sees the patient’s person-body through the lenses of what this book calls Ecosystem Science (and hence is Wholist in orientation), while Bm (as a Newtonian science in its dominant domain) sees the patient’s body as the bearer of disease, and the relationship between that body and the cause of the disease in simplistic linear terms (and hence is reductionist in orientation).

Absurdity 2 Bm education and training make a clear distinction between medical texts and texts which belong to the history of medicine. The latter (falling under the domain of the humanities) date back to the seventeenth century, and are mainly studied by historians who are interested in them as history textbooks. The former are scientific books, written by medical practitioners/research scientists, solely to serve as texts for the training of medical students. After a course of study, students would be examined on them, and should they pass the series of examinations, they would be given a certificate, and ultimately be authorised to practise as doctors. Generally, such texts have a relatively short shelf-life. Those, which go through numerous editions, are, in reality, new textbooks rather than marginally edited copies of the original. Their short life-span is entirely understandable as the sciences and scientific investigations make constant progress. Hence, textbooks must be kept updated to include the latest discoveries and inventions. The turnover of knowledge is now said to be so high that electronic publication is the route for the fastest dissemination of knowledge. One cannot wait for a new textbook to be written. By the time these findings are incorporated into hard copy, they would no longer

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be new and may, indeed, have been much modified, if not superseded entirely by later information. No medical school would require students to read the writings of Vesalius (1514-1564), which established the prime importance of anatomy and surgery in Modern Medicine such as his De Humani Corporis Fabrica/On the Fabric of the Human Body. Yet in contrast, it is de rigeur for students of CCM to master the Neijing, a text which matured probably in the early Han dynasty. The operative phrase here is “matured as a text”, as there are parts and concepts in it predating that period of Chinese history by a good few centuries (see Appendix One of this volume). Not only is it a foundational text, it is also a text, which is held by CCM practitioners as a Vade Mecum, which serves to deepen their knowledge and understanding of CCM long after graduation and the completion of formal training. It is to be discussed amongst like-minded practitioners; to be consulted, should one be confronted by difficult cases in the clinical9 context. It is most definitely not a text only for historians interested in the history of CCM. It is integral to the theory and practice of CCM physicians. It is alive today, more than two-and-a-half millennia after the first appearance of some of those ideas contained in the text. On the surface, it sounds like madness. However, the madness is only superficial, as the crucial focus upon it illustrates, precisely, the intimate relationship, in particular, between shengli and bingli. It reflects the unity and coherence underlying the principles of physiology and of the origin of illness in the person-body, and of health via the concept of yangsheng/ yangshen, as explored in Chapters Four and Eight. In other words, if one has fully grasped what keeps the person-body alive and functioning well, then ipso facto, one would also grasp what brings about illness, what makes the person-body fall prey to pathogenic factors–good health and flourishing, on the one hand, and being ill, on the other, they are mirror images of each other. The Neijing (in its extant form), which makes this link absolutely clear, renders it peculiarly suitable as a foundational text down the centuries; as well as a text that informs the thinking and practice of CCM physicians throughout their lives. In this sense, one can draw an analogy between the role played by, say, the Bible in the lives of many Christians, and that played by the Neijing in the lives of CCM physicians. To these committed Christians, the Bible is no mere historical text, but a “living” embodiment of their worldview. Analogously, to CCM physicians, the Neijing is no mere historical text, but a “living” embodiment of that conception of the medicine whose 9

The term “clinical” is a modern import, with the arrival of Mm/Bm.

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theoretical notions they put into practice in their daily clinical lives to treat patients. Many things have changed, but the same principles of understanding health and illness remain unchanged, and are invoked in the diagnosis of what ails patients today, just as they did more than two thousand years ago. Of course, the test of the pudding is in the eating.

Absurdity 3 A similar role in the history of CCM is played by yet another text, namely, the Shanghanlun/ljՔሂ䇪NJ and the Jinguiyaolüe/lj䠁फ़㾱⮕NJ, both of which were part of an original work, the Shanghanzabinglun/ljՔሂᵲ ⯵䇪NJby Zhang Zhongjing. His opus was completed probably by the middle of the first decade of the third century CE, that is, towards the end of the (Eastern) Han dynasty. It has a variegated history. (For details and some of their implications for the understanding of Zhang Zhongjing’s contribution to CCM, see Appendix Two.) Chapters Six, Seven and Eight above mention the use today by CCM physicians of some of the fangzi/prescriptions, advocated by Zhang Zhongjing. This, then, constitutes Absurdity 3, that CCM invokes forms of treatment of two thousand years’ standing, a practice, which clearly has no counterpart in the history of MM/Bm. In the latter medicine, new drugs are put on the market all the time, even though it is true that on the whole, they are “me too” drugs only. What is more to the point is that Bm rapidly discards old drugs for new (sometimes even when the new ones are not necessarily more efficacious than the old (see Chapter Seven and Lee 2012b, Chapter Eight for some discussion of Big Pharma)). Any treatment, before the arrival of mass antibiotics at the end of WWII, would have long gone out of fashion, if not been totally forgotten. The therapy most heavily relied on before the advent of antibiotics was bloodletting, a timehonoured practice, dating back to Hippocrates and Galen–this was recommended as late as 1923 by Sir William Osler in that year’s edition of his Principles and Practice of Medicine (first published in 1892), which for forty years was the standard textbook of clinical medicine. Blood was removed by three main sub-techniques: leeching (leeches suck the blood), drawing blood from a vein (venesection) by a doctor with the aid of a lancet (hence, the name of the leading medical journal The Lancet), and cupping, the gentlest of the three techniques. 10 The Lancet in 1911 10

These techniques are also used in Chinese Medicine, of which cupping/ᤄ㖀⌅ is commonly used today. Leeches are used but mainly in dried form as part of a fangzi for decoction, being regarded as a powerful medicinal for eliminating blood

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published an article advocating the use of venesection for treating HBP and cerebral haemorrhage, among other conditions. Indeed, bloodletting through two millennia had been invoked to treat nearly every disease, ranging from acne, asthma, diabetes, fever, gout, and poisoning (including carbon monoxide and mustard gas poisoning suffered by the victims of such gas attacks in the trenches of the First World War in 1916), to being a general regimen for maintaining health and longevity. Today, if a general practitioner were to advocate such techniques for any of the conditions listed above, maximally, the GMC would strip the doctor of his/her licence to practise and minimally, it would severely reprimand and send the person for re-training. 11 Yet CCM physicians pride themselves on invoking the fangzi of Zhang Zhongjing and other distinguished physicians down the ages, albeit using them in a linghuo manner, to cope with conditions which would not have existed and, therefore, would have been unknown to the Han and other earlier physicians. This seeming absurdity can be explained away by pointing out that just as the Neijing makes clear the intimate entwining of shengli and bingli, the Shanghanlun makes clear the intimate entwining of bingli and yili (which, in turn, implies the intimate entwining of these two with shengli). In other words, one could say that the work of Zhang Zhongjing is considered to have completed the work initiated in the Neijing by binding shenglibingli-yili into a coherent trinity as Wholism, which constitutes CCM theory-practice. To appreciate the nature of Zhang Zhongjing’s contribution via his writing,12 one must go back to the days before he practised and articulated his thoughts. In a nutshell, one could say that before his time, bingli-yili (by way of prescriptions13) appeared to pass each other by. The students/ stasis and clots. Bloodletting was more often used in the past than today, especially in hospitals, although it still has its place–for instance, a standard, simple but powerful technique of dealing with HBP is to use a needle to prick the top of the ear to let blood out (see Chapter Two). However, the use of these techniques in CCM would differ from their use in the history of MM. 11 This is not to deny that leeches play a limited role in Bm today, in reconstructive and plastic surgery; research is also looking into the anticoagulant produced in the saliva of some leeches. 12 This assessment is not universally unchallenged and unqualified, as it is said that even by articulating this view, he had successfully transmitted it. This does not necessarily mean that the idea(s) behind it were original to him. This matter would not and cannot be further pursued. The account given here follows *Hao 2011. 13 This stricture, strictly speaking, did not apply to acupuncture. An equivalent problem, however, exists as shown by the Lingshu of the Neijing, which gives no or little information about the xuewei, their names and locations. This at first sight

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apprentices knew the theoretical writings extant and available at the time, including the Neijing (which sets out the shengli-bingli link) but as they accompanied their masters in treating patients, the master’s ability to write out prescriptions seemed to be confined to the empirical level of observation, rather than a real understanding of the link between shenglibingli, on the one hand, and yili, on the other. There appeared then, to be two different, somewhat unrelated spheres or semi-detached, if not completely detached domains of medical activity. In the domain of theoretical literature, in the Shanghanzabinglun, Zhang Zhongjing mentioned that he himself had read the following canonical texts: the Suwen/lj㍐䰞NJ, the Jiu chuan/ljҍধNJ (this last is said to be the Lingshu of the Neijing), the Bashiyi nan/lj‫ॱ ޛ‬а䳮NJ which is the Nanjing/lj䳮㓿NJ, the Yinyang da lun/lj䱤䱣བྷ䇪NJ (now lost, but which he incorporated in large part into his own writing), and the Tai lu yao lu/lj㛾㜚㦟ᖅNJ (also lost; it is postulated that it could have been on gynaecology and paediatrics). Historically it is said that seven schools were represented by the seven great classical texts, being The Huangdi nei and wai jing/The Yellow Emperor’s Inner and Outer Canons/ lj哴ᑍ޵ཆ㓿NJ, The Bian Que nei and wai jing/The Inner and Outer Canons of Bian Que/ljᡱ呺 ޵ཆ㓿NJ, The Bai shi nei and wai jing/The Inner and Outer Canons of the Bai Clan/ljⲭ∿޵ཆ㓿NJand the Pang Pian: Twenty Five Rolls/ljᯱㇷҼॱӄধNJ. As one can see immediately, alas, even by the time of Zhang Zhongjing, only The Huangdi neijing had survived. The theory of the Neijing did not refer, by and large, to therapeutic measures or experience. The second domain was the therapeutic context of yili. One needs first to talk briefly about the term jingfang/㓿ᯩ/“classical prescriptions” which before Zhang Zhongjing’s articulation of the view, found in his writings, had two different origins or sources.

is puzzling, but bear in mind that the ancient Chinese were primarily interested in pursuing the Dao at the level of xingershang, not xingerxia. The names and locations of the xuewei would belong to the techniques, shu/ᵟ, to xingerxia, and not the Dao. The first publication on the subject of the xuewei is a text dated to the end of the Western and the beginning of the Eastern Han dynasty (138 BCE-106 CE), entitledlj哴ᑍ᰾า㓿NJ/Huangdi Mingtang jing, which had collated, for the first time, all the relevant material in other medical texts of pre-Qin and Han times. Its authorship is unknown, and had long been lost although during the period between the Kingdom of Wei/兿 (220-265 CE) and the Jin/ᱻ dynasty (265-317 CE), numerous versions of it still circulated.

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First source: This came from ‫⛬؞‬/xiulian practitioners who followed the Daojia tradition of yangsheng, through the internal techniques of controlling their organ-systems (neigong).14 Those who succeeded would have attained the Dao/ᗇ䚃/de dao, but at the same time, would also have gained medical knowledge and understanding, thereby, becoming 䚃५ /dao yi. Their works were considered as classics or canonical works/㓿ި /jingdian and their prescriptions were called jingfang. (It should be noted that attaining such knowledge would not have been the original aim of engaging with xiulian.) Second source: This was totally different. Pre Zhang Zhongjing, jingfang were simply those prescriptions which a physician would use with little or no reference to the theory of medicine. In the main, he relied upon his own intuition as well as his own extensive knowledge of which medicinals would work, given the symptoms and signs presented by the patient. For instance, the physician would prescribe a list of medicinals for patient A with a specific set of signs and symptoms. Patient A, having taken the prescription, after a few days, would report back to him that he was now feeling fine, that is, the prescription was efficacious. The physician would then put that prescription into one drawer. Another patient B would come along presenting a different set of signs and symptoms. In similar fashion he would draw up prescription B. A few days afterwards, the relatives of patient B would report back to him that B had not improved, and then later, perhaps, that B had died. The physician would put this sort of prescription in a separate drawer, perhaps marked as inefficacious prescriptions. After a while, the two drawers would become full. He would then empty drawer B and discard its contents. In the case of the contents of drawer A, he would carefully categorise them and collate them under different illnesses and their symptoms. In this empirical fashion, a repertoire of efficacious prescriptions would be constructed and then, presumably, handed down to the next generation taught by the master. In the last four decades or so, prescription manuscripts (written on bamboo slips or on silk), have been recovered: in 1972 from WuWei/↖ေ (in present-day Gansu province, dated roughly from the late Western Han dynasty); also in 1971-1974, from Mawangdui/傜⦻ึ (in present-day Hunan province), which dated from the early Western Han dynasty. These are all jingfang in the above sense of the term. For lack of a better term, one may call these “empiric prescriptions.” 14

Some would also engage with alchemy, to find solutions for prolonging mortality, attenuating the processes of aging, and postponing death (lian dan/⛬ѩ).

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It is held that Zhang Zhongjing integrated the two domains of theory and practice, uniting the context of medical canons with those of diagnosis and treatment. Or to put the matter in another way, his writings united shengli-bingli-yili, laying the foundation for a systematic medicine, 15 where theory/li/ ⨶ , methodology/fa/ ⌅ , prescription/fang/ ᯩ and medicinals/yao/㦟 were brought together as an integrated system under the notion of what this book calls Zhèng-Fang Wholism. Chapter Eight has explored at some length the notions of zhèng and fang as well as the relationship between them. In this way, a new (third) meaning of the term jingfang emerged, as this sense of the term reflects the integration of theory with clinical experience, combining yijing/५㓿/canonical medical texts with jingfang. In this sense, too, one can say that the term bian zhèng lun zhi/ 䗘 䇱 䇪 ⋫ , which emerged half a century or so ago, actually referred to ideas and concepts, central to Zhang Zhongjing’s account of Chinese medicine, which had/has remained active in the history of CCM throughout the last two millennia or so. However, these ideas and concepts could be discussed more suitably under Getihua Zhiliao fangfa/њփॆ⋫ ⯇ᯩ⌅ rather than under bian zhèng lun zhi, as Chapter Seven has done, when it deals instead with the concepts of tongbing-yizhi/similar afflictions, different treatments and yibing-tongzhi/different afflictions, same treatment. In the light of the above, Absurdities 2 and 3 would be removed once it is realised that there is a systematic link between shengli, bingli and yili– shengli explains bingli and together they lead to yili. The Neijing provides the shengli and the bingli, while the writings of Zhang Zhongjing integrate these two domains of medicine with the domain of the fangzi/prescriptions, which are addressed to the zhèng as ascertained by the physician, in coming to grips with the illness presented by the individual patient before him. Hence the Neijing and the Shanghanlun (together with the Jinguiyaolüe) are considered as foundational texts for CCM, even today. At the same time, the fangzi of some two thousand years’ standing are still invoked and used (in a linghuo manner) to treat patients today. As CCM has suffered no paradigm shift in its theory of medicine, the classical prescriptions down the ages are still relevant in the therapeutic domain. This, however, is not the case with the history of MM/Bm, which suffered a paradigm shift from the humoral theory of medicine inherited 15

This remains true irrespective of whether these ideas were original to Zhang Zhongjing himself or that he merely articulated and transmitted them in his own writings, or whether the prescriptions he wrote about originated from his own experience or were obtained from those of others.

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from the early Greeks to the disease-entity view. This shift began to emerge during the modern period of European history, until it reached its zenith with the monogenic conception of disease, through the pioneering research of Pasteur and Koch, to name just two intellectual giants. Hence, it would be absurd for medical schools to include in their syllabus the writings of Hippocrates and Galen. However, it is not at all absurd for CCM physicians to continue to teach and practise, by and large, in the way of their predecessors, down the millennia; nor is it at all absurd for such physicians to regard the Neijing and the Shanghanlun as their Vade Mecum. It becomes obvious from reading Chapters Seven and Eight in conjunction with this chapter where the real achievements of Zhang Zhongjing lie in one’s understanding of CCM. Curiously enough, Unschuld (1998, 31-33) has given an excellent account of an aspect of Zhang Zhongjing’s contribution related to those above, although in keeping with his own interpretation; Unschuld holds that this was ignored by Zhang Zhongjing’s compatriots for nearly a thousand years (see Appendix Two for a critical examination of this thesis). Zhang Zhongjing’s insights as found in his Jinguiyaolüe/lj䠁फ़㾱 ⮕NJare presented by Unschuld below: When they saw that the liver was diseased, then they knew that the liver was about to transmit [the evil qi] to the spleen. For this reason, they supplemented the spleen [with the right qi]. At the end of each season, the spleen flourishes, and cannot contract any evil; at that time, no supplementation should be given. The practitioners of medium ability know nothing of the transmission with the body. When they see a liver disease, they do not solve this problem by supplementing the spleen [with the right qi].

Unschuld then follows it up with his own comments on Zhang Zhongjing: Zhang Ji follows the above-quoted passage with an example of how disease of the liver is to be remedied. The qi of the liver is supplemented with foods or drugs of sour flavour. This is supported with foods and drugs of burning qi and bitter flavour. Drugs with sweet flavour are to be used in order to achieve a regulating balance. Sour flavour penetrates the liver; burning qi and bitter flavor enter the heart; sweet flavour enters the spleen. The spleen is capable of damaging the kidney. When the qi of the kidney is weak, water does not flow. When water does not flow, the fire qi of the heart blazes and afflicts damage on the lung. When the lung has suffered damage, metal qi cannot move, and when this happens, the qi of the liver increases, and the liver is healed.

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In other words, Zhang Zhongjing (or Zhang Ji, the name used by many sinologists) was the first to make explicit the link between Wuxing and medicinals. It is indeed correct to say that this part of Zhang Zhongjing’s work (Jinguiyaolüe) did not come to light till the Song dynasty. From this alone, one cannot infer that all physicians who lived after Zhang Zhongjing’s death towards the end of the Han dynasty and before 1065 (the Song dynasty), would necessarily have no conception of the link for the following related reasons. 1. They held him in extremely high regard for centuries before the Song dynasty, presumably, because they realised that he had made this link (see Appendix Two for details). 2. More importantly, they would not have made much medical sense of his prescriptions without relying on the postulated link.

Absurdity 4 As mentioned at the beginning of this chapter, this absurdity is not so well known to those outside the tradition of CCM. It is the apparent boast that CCM can, in principle, diagnose and treat any condition of illness presented by the patient, without knowing “the cause” of the illness. All that is required is that the physician should arrive accurately at the zhèng presented by the patient before him. Naturally, the operative words in the opening sentence of this section are “in principle”, as mediocre physicians would not be capable of achieving such results. Only the shang gong could accomplish such a feat. Even granting this qualification, the claim must still seem mind-boggling, even ludicrous to a doctor trained in Bm. Is it so absurd? The short answer is “no”, once one has grasped fully what the last chapter and this one have set out to investigate and explore. The fuller answer would take more space and time to present and to defend. Let us begin by explaining the remark about the ignorance of “the cause” mentioned above. Take this example. A famous shang gong in the Ming dynasty, Miao Xiyong/㕚ᐼ䳽 (1546-1627) recorded this case.16 A patient, who had not reported anything untoward beforehand, suddenly suffered severe bouts of diarrhoea. When he ate and swallowed anything, he felt a needle-like stabbing pain in the throat, followed by Stomach pain, then diarrhoea. The patient described his circumstances in the following manner. 16

See *Luo 2011, 116-119.

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First, he felt a rush of qi ascending from the left side of the Stomach, then, from the right side. After several such bouts, he would feel the urgent need to go to the toilet, which turned out to be a very painful experience– he felt as if his anus was on fire. As soon as such an episode had ended, he would feel the urgency to rush to the toilet; the whole cycle would begin again. Any food he might have taken, was passed out, undigested. The family of the patient got several physicians to attend to him–one said he should stop eating altogether, another that it was a case of heat stroke, and yet another that he had been exposed to cold. Naturally, each prescribed according to his own diagnosis. This lasted for a month. The patient, who was originally a man on the fat side, ended up as skin and bone. Miao Xiyong, then, suddenly reappeared in town, having been away all this while; he was immediately taken to see the patient, who then showed him the numerous prescriptions of the several physicians he had consulted, in the last month. When Miao Xiyong felt his mai, it was one which was surging and powerful as well as rapid/⍚ བྷ 㘼 ᮠ . From this, and other signs and symptoms observed, the physician inferred that it was a case of re zhèng/ ✝䇱. However, he had not a clue what had brought this condition about. He could not name “the cause” of the re zhèng confronting him, although he had no doubt in his own mind that all the evidence was pointing to the presence of re zhèng. As he was sure that he had not misdiagnosed, what he did was simply to prescribe as the zhèng demanded, namely, to use heat-clearing/␵✝ medicinals. He reasoned that that should do the trick. He accordingly drew up the following fangzi: huanglian/哴䘎/Coptis, bai shao/ⲭप/Paeoniae Radix Alba, juhong/₈㓒/Citri Exocarpium Rubrum, cheqianzi/䖖ࡽᆀ/Plantaginis Semen, baipiandou/ⲭᡱ䉶/Dolicho lablabL, baifuling/ ⲭ 㥟 㤃 /Poria Alba, shihu/ ⸣ ᯋ /Herba Dendrobii, and zhi gancao/⛉⭈㥹/broiled Glycyrrhizae Radix. He also worked out that the patient’s yin was not in a good state, and that it had to be nourished. Furthermore, the patient’s Spleen-Stomach had been badly affected; so his prescription must also take care of that aspect, by including medicinals that had the property of strengthening that organ-system and of introducing dampness to it. He left very specific instructions regarding the administration of his fangzi. First, having decocted the ingredients, one must add some very cold water from a deep well to cool down the decoction; second, a cup of urine from a small (probably male) child must be added to it. (Such urine, amongst other properties, is capable of nourishing yin and lowering fire/⓻ /䱤䱽⚛.) He also said to the patient not to bother showing his prescription

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to other physicians as they would only ridicule it, and discourage him from taking it; on the other hand, should he want to live, he had better take it. The patient, that very evening, took the first lot as instructed. He reported instant relief; he said he felt that his Stomach had entered a different world of coolness. For the first time, he slept through the night, without waking up to rush to the toilet. After taking three decoctions, he had basically recovered; the diarrhoea had disappeared. During his month-long illness, he could only bear to take very cold food, but, after his recovery his appetite was whetted by the thought of food that was neither too hot nor too cold. However, the patient had not fully recovered his appetite, and so remained very thin and emaciated. Miao Xiyong prescribed some pills which, amongst other medicinals, included ginseng/Radix Ginseng and huangqi/哴㣚/Astragali seu Heydysari, which were meant to improve the patient’s yangqi, especially to strengthen yangqi in the Spleen-Stomach. Another medicinal, baishao/ⲭ㢽/Radix Paeoniae Alba, was to harmonise his yinxue/䱤㹰. This together with the zhi gancao/ࡦ⭈㥹/processed Radix Glycyrrhizae–both taken from Zhang Zhongjing’s Shaoyaogancao tang/㢽㦟⭈㥹⊔–had the ability of transforming yinqi, thereby aiding the rise of yangqi in the patient. Three other ingredients in the pill–shanzhuyu/ ኡ㥡㩨/Corni Fructus, shanyao/ኡ㦟/Dioscoreae Rhizoma, and shu di/⟏ ൠ哴/Rehmanniae Radix Conquita–each, respectively could supplement/ bu the Liver, Spleen and Kidneys. The medicinal, wuweizi/ ӄ ણ ᆀ / Schisandrae Fructus, had the property of constraining/᭦ᮋ the qi of the Lungs; furthermore, as the Lungs and the Large Intestines form a single visceral organ-system, this medicinal would also then be able to lessen/constrain the qi of the Large Intestines and, at the same time, it could supplement the qi of all the Zang organs. The medicinal niuxi/⢋㟍 /Achyranthis Bidentatae Radix, played the role of strengthening the back and the legs. The final ingredient was ziheche/㍛⋣䖖/Placenta Hominis–it is in fact the human placenta which, in this context, was meant to supplement qi and to enrich blood, restoring the patient’s yuanqi/ Primordial qi. The patient took these pills for three years, over which period he became stronger and eventually regained the state of well-being he had enjoyed before the diarrhoea attacks. There is an amusing and revealing sequel to this story. The physician told the patient (who was an old friend, in reality) that to recover fully, ideally, he should refrain from sexual intercourse for at least a year. The patient accepted this advice; he dissolved the arrangement in his household by sending away all his concubines. When these concubines had been

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dismissed, a family servant then dared to reveal that those attacks were the result of the deliberate poisoning of the master, by one of the concubines who, bearing some grudge, had secretively introduced into his food some croton/ ᐤ 䉶 /Crotonis Semen. Chinese medicine does use this as a medicinal, but always in very small doses and very carefully. As was obvious in the case of this particular victim, the dosage was neither small nor subtly administered, such that the person almost died from the effects of the massive poisoning. The victim reflected profoundly on his own life; as a result of this experience, he decided to give up the pleasures of the flesh to lead the disciplined life of a student of medicine, apprenticing himself to his friend, and eventually helping him to edit and publish his medical writings. Back to the real point of citing this example: it is to illustrate the way in which CCM actually works. Often, the physician does not know what has brought about the condition he finds in the patient consulting him. The physician, however, must be sure that he has accurately ascertained the zhèng of the patient–that is all that really matters. In the case cited above, if at the time of the diagnosis, Miao Xiyong had known about the croton poisoning as the (external) cause, this would have been nice to know, but it would not necessarily, as we have seen, have been of definitive help to him in deciding that the zhèng was a re zhèng, and to prescribe accordingly. Indeed, those physicians whom the patient had initially consulted had failed to grasp the case as a re zhèng; however, their failure to do so was not due to their lack of knowledge in general about croton poisoning. In other words, knowledge about the poisoning was neither a necessary nor a sufficient condition to grasping the case as a re zhèng. The ability to do that depended on how good the physician was, whether he was a shang gong, or only a zhong gong (a mediocre physician), or even a xia gong (one with even less understanding of PIT-ism). The knowledge that it was a case of croton poisoning might have helped a zhong gong and certainly a xia gong at the time the patient fell ill, to diagnose his condition properly, as they could have recalled what Li Shizhen/ᵾᰦ⧽ (1518-1593) in his Compendium of Materia Medica/ljᵜ 㥹㓢ⴞNJhad written about the appropriate antidotes to such poisoning, which included huanglian, gancao, baishao, and very cold water amongst other medicinals. However, unfortunately, this work could not have been available to them or indeed to Miao Xiyong himself. Although it is known that Miao Xiyong was a voracious reader and scholar, it remains unlikely that he would have read Li Shizhen’s tome which, after all, only appeared posthumously in 1596 (following his death in 1593, three years after he had completed it), but with very limited distribution. Similarly, the edition

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in 1603 also suffered from limited distribution. It was not until 1640, just before the Manchu invasion, establishing the Qing dynasty in the country, that the book finally achieved proper distribution and dissemination. 17 Miao Xiyong died in 1627 and it seems unlikely that he would have read the work by the time he treated his friend, Zhuang Lian/ᒴᮋ (later his disciple and editorial assistant). Certainly when he, at the age of seventeen, shut himself away for a whole decade to study all the extant medical writings he could lay his hands on, Li Shizhen’s opus would not have been one of them, as that part of his life fell during the first of the three decades, during which Li Shizhen was completing his masterpiece. Miao Xiyong, as we have been at pains to emphasise, did not have to know how specifically to treat croton poisoning; he needed only to know how to treat re zhèng, knowledge which came from his intense study of medical texts, written well before the publication of Li Shizhen’s work, such as the Neijing and the Shanghanlun. In the history of CCM, physicians had been known to treat illnesses for which “the cause” as indicated above was not known. Take malaria and cholera. Here is how a distinguished physician of the nineteenth century, Wang Mengying/ ⦻ ᆏ 㤡 (1808-1869?), 18 treated malaria/ ⯏ ⯮ . It was commonly called “ᢃ᩶ᆀ”/dabaizi, for the simple reason that sufferers would suddenly feel very hot, then suddenly very cold, a variation occurring with regularity. (Historically, the record of success was not very high.) This particular patient also vomited; he could not keep anything down. After a month of unsuccessful treatments by physicians, he visited his old friend, Wang Mengying. By then he had already lost a lot of weight. When Wang completed his sizhen, he concluded that it was a case of “wet malaria of the foot taiyin jing”/䏣ཚ䱤⒯⯏, which called for Bu huan jing zheng qi san/ н ᦒ 䠁 ↓ ≄ ᮓ , a prescription meant to facilitate the movement of Qi, to transform dampness, to harmonise the Stomach to stop the vomiting/㹼≄ॆ⒯ˈ઼㛳→અ. The patient took three lots and recovered. Wang then prescribed some buyao to help him to fully recover. Unfortunately, in the autumn of the following year, the patient fell ill again with the same illness; he had, however, kept the prescription of the year before, which he duly took, another three lots. The same result followed– he recovered. When he eventually met Wang Mengying again, he mentioned this episode. Upon reflection, Wang concluded that this illness could recur with regularity. To prevent that from happening, he wrote out 17

For a brief account of the publication history of Li Shizhen’s opus, see Dharmananda 2015b. 18 See *Luo 2011, 255-262.

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a new prescription, which was meant to “nurture Earth such that strengthened Earth would be able to overcome dampness”/䲚൏㜌⒯; he instructed the patient to take it the following summer. That autumn, there was no recurrence of his malarial attacks; nor did they ever occur again in his lifetime. This prescription was invoked, in accordance with the concept of Wuxing (see Figure 4.2). Wang Mengying treated another malarial patient, whose signs and symptoms varied somewhat from those of the first, as his hot bouts outnumbered his cold bouts. They occurred not daily, but every other day. After only two such attacks, the patient had already lost a lot of weight. The physician found the following mai: it was a taut and fine mai/ᕖ㓶㜹; also it palpated rapidly, especially at the chi position. These attacks occurred at night. As the patient’s lips were very dry, he enquired if there were other symptoms the patient could report, upon which the patient said he felt thirsty and wanted to drink water all the time. In the light of all these reports and observations, the physician concluded that this was a case of “heat malaria of the foot shaoyin jing”/ 䏣 ቁ 䱤 ✝ ⯏ . His prescription was as follows: xuanshen/ ⦴ ৲ /Scrophularia Ningpoensis Hemsl.), shengdi/⭏ൠ unprocessed/raw Rehmannia Glutinosa, zhimu/⸕ ⇽/Anemarrhena, mudanpi/⢑ѩⳞ/Cortex Moutan Radicis, digupi/ൠ僘Ⳟ /Cortex Lycii, tiandong/ཙߜ /Asparagus Cochinchinensis, guiban/嗏ᶯ /Chinemys Reevesii, fuling/ 㥟 㤃 /Poria,  shihu/ ⸣ ᯋ /Dendrobium, sangye/ẁਦ/Folium Mori. The patient took one decoction and recovered. The physician followed up with another prescription, the aim of which, this time, was to nourish the patient’s yin/⓻䱤. Note that Prescription 1 did not contain any of the medicinals usually invoked in a prescription for malaria, such as qinghao/䶂㫯/Herba Artemisiae Annuae or chaihu/Ḥ㜑 /Bupleuri Radix. A third case of malaria was found in Wang Mengying’s records, this time, a female who had also been treated by several physicians, but without success. Her mai was taut and fine but also rapid/ᕖ㓶㘼ᮠ; furthermore, when the mai was pressed, it did not respond/᤹ѻн啃. For her, Wang resolved to prescribe medicinals which were meant to supplement/bu her yin/㺕䱤ѻ㦟, as her yin was judged to be deficient. The prescription included: siyang shen/㾯⌻৲/Radix Panacis Quinquefolii, shudi/⟏/Radix Rehmanniae Glutinosa, muli/ ⢑ 㳾 /Concha Ostreae, zishiying/ ㍛ ⸣ 㤡 /Amethystum seu Fluoritum, guiban/嗏ᶯ/Plastrum Testudinis, biejia/匆⭢ /Carapax Trionycis, gouqizi/ ᷨ ᶎ ᆀ /Fructus Lycii, danggui/ᖃ ᖂ /Radix Angelicae Sinensis, dongchongxiacao/ߜ㲛༿㥹/Cordyceps, longchi/嗉喯

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/Apatite, ejiao/ 䱯 㜦 /Asini Corii Gelatinum, maidong/ 哖 ߜ /Radix Ophiopogonis, longyan/嗉⵬/Arillus Longyan, gancao/⭈㥹/Glycyrrhizae Radix, putaogan/ 㫢 ṳ ᒢ /Syzygium Jambos (L) Alston, hongzao/㓒 ᷓ /jujubes, lianzixin/㧢ᆀᗳ/Plumula Nelumbinis), xiaomai/ሿ哖/wheat, and so on. Again, it looked as if the physician was deliberately ignoring direct treatment for the patient as an obvious case of malaria. Yet within ten days of taking his “curious” prescription, the patient had recovered. What lay behind this phenomenon, accounting for the success between the zhèng he had arrived at and his fangzi? Wang Mengying’s explanation may be summarised by the points below. 1. Contrary to so-called common sense, if he were to prescribe medicinals dealing head-on with the malaria, the chances of success would be far less, if not virtually nil, than by prescribing medicinals, which only indirectly and obliquely, dealt with the matter. 2. The above paradox can be unravelled readily, when one realises that not everyone who is exposed to the malarial pathogenic factor, would succumb to malaria. The difference between these two categories of people lay in the fact that those who did not succumb to the illness had a far healthier person-body system of functioning than those who did. The patient succumbed precisely because her person-body system was malfunctioning–the proper balance between yinqi and yangqi had been upset. As a result, the (external) pathogenic factor took advantage of this imbalance to attack the person-body. 3. Each of the three patients exhibited his/her own specific/peculiar form of malfunctioning, enabling the malaria to manifest itself and affect them, therefore, in somewhat different ways. 4. When their specific manifestations of malfunctioning have been ascertained and addressed, by way of the medicinals appropriate to helping their person-bodies to recover, this would, in turn, mean that the personbody’s new-found strength and proper functioning would come into play. This then would eliminate the malarial pathogenic factor. That is to say, health would be restored to the individual. 5. The zhong gong and the xia gong who addressed the malarial condition directly in their prescriptions, were physicians who did not thoroughly

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know about or did not really know how to treat what led to the manifestation of malaria in their patients/“५㘵⋫⯏, 㘼н⸕⋫ަᡰԕ⯏”. 6. In a nutshell, the above is the logic and the methodology of CCM’s unity and coherence under shengli-bingli-yili Wholism (PIT-ism). 7. Curiously enough, the zhong gong and the xia gong who saw the malaria as their main, if not their sole target, behaved much more in accordance with the logic of Bm. A major concern of Bm is to look for the disease-entity, which causes the effect, then to set about discovering or designing cures to kill off (or at least to damage) the disease-entity in question. This ideal has been known to exist well before medical research has discovered the disease-entity that causes the disease. This was the case with malaria. On 6th of November 1880, Charles Louis Alphonse Laveran, a French army surgeon stationed in Algeria, noticed parasites in the blood of a patient suffering from malaria for which he was awarded the Nobel Prize in 1907. This could be said to be the first stage in the understanding of the disease-entity; it was not until 1897 that Ronald Ross was able to make his landmark discovery that malaria was propagated by the anopheline mosquito; upon dissecting the stomach of such a mosquito, which had previously lived off a malarial patient, he found the malaria parasite/Plasmodium falciparum in its contents. Until 2006, the standard drug for treating malaria was what today we call quinine. Quinine is found naturally occurring in the bark of the cinchona tree–this was the discovery of the Quechua people, who were/are indigenous to Peru and Bolivia. With the Spanish conquest of South America, the Jesuits, who accompanied the military as missionaries to convert souls, took the bark back to Europe in the seventeenth century; it was first used in Rome in 1631 to treat malaria. Much later, in 1820, the active ingredient of the bark was isolated and named “quinine” by two French scientists, Pierre Joseph Pelletier and Joseph Bienaimé Caventou. To impress the Qing Emperors, the Jesuits also introduced the bark to the imperial court to relieve its sufferers. However, it was certainly not available to the common people, who, if they were exceptionally fortunate, would find a shang gong like Wang Mengying to treat them and, if not so fortunate, would end up with some zhong gong and xia gong, whose grasp of CCM was too shallow and inadequate to do the patients much good. We will next look at cholera. Wang Mengying did not regard malaria as such a difficult illness to handle. As we have seen, he relied on the general logic and methodology of CCM as well as that particular strand of CCM pioneered by Ye Tianshi/ ਦ ཙ ༛ (1666-1745) and others, who

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formed the Wenbing School/ ⑙ ⯵ ᆖ ⍮ . 19 The School’s key concepts included shure/᳁✝/Summer heat, shi wen/⒯⑙/damp and warm, and fuxie/Կ䛚/latent pathological factor. He considered cholera to be a greater scourge. The Chinese term is huoluan/ 䴽 ҡ 20 which, literally, means “sudden confusion”. Wang Mengying had written a history of huoluan/ lj 䴽 ҡ 䇪 NJ /Discourse on Huoluan, which was destroyed during the Taiping Rebellion but which he later revised and republished in Shanghai, in 1862. He held that huoluan had been endemic in China, although this view was not held by even some of his contemporaries. The first pandemic occurred in China in 1820-21. By the time he wrote his treatise Wang Mengying had lived through three of them. In the West, John Snow (1813-1858), considered to be one of the founding fathers, if not the founding father, of Epidemiology, made a thorough study of the pattern of the disease in a particular area of London during the cholera epidemic of 1854, and concluded that it was a waterborne disease (see Lee 2012bˈChapter Ten). His recommendation, to remove a pump from Broad Street, caused the death rate in the neighbourhood to fall dramatically. He had no idea then of the exact nature of the contagious agent, as the bacterium, Vibrio cholerae, was not discovered till 1854 by Filippo Pacini (1812-1883), and it was not till 1883-1884 that Robert Koch isolated it, and grew it as a pure culture. Snow simply surmised that the disease must be connected with some polluting matter from the sewerage, which had entered the water supply somewhere along the distribution chain. Here are three cases of cholera during a particular epidemic treated by Wang Mengying: Patient 1: The sanitation of Hangzhou and its surroundings, where Wang Mengying practised (at a certain stage of his life) was undoubtedly unsavoury, providing an excellent opportunity for huoluan to take hold. There was an outbreak in Hangzhou in the summer of 1837. Wang was called out early one morning. This was his first patient, a female. The night before, she had diarrhoea, followed by the loss of her voice; she was confused. She was in great pain and very thirsty, but each time, after taking some water, she vomited. She suffered from severe cramps, with the legs being quite rigid. Her mai was taut and fine, almost non-existent 19

See Hanson 2011. For an account of the controversy as to whether the term huoluan refers to what is understood as proper Cholera asiatica, and whether proper Asiatic cholera was indigenous to China or was an import from India, see MacPherson 1998. 20

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at the chi position on either hand/єњቪ㜹䐏⋑ᴹլⲴ. Wang felt that the present manifestation of huoluan was somewhat different from cases he had read about, or attended to, in the past, and so called it “䴽ҡ䖜 ㅻ”/“huoluan affecting the jin”. 21 This would have inclined him to the view that this particular variant of huoluan could well have been an Indian import.22 However, the question of whether it was the older well-known huoluan or this new variant, did not throw Wang off. He simply adhered to the logic and methodology of CCM as a unified and coherent system, in the way already described: simply to ascertain the patient’s zhèng. He summed it up as follows: a case of summer heat and damp, lurking beneath, unable to surface, thereby blocking the usual mechanism for Qi to function properly, impeding the normal cycle of ascending-descending Qi and hence, bringing about the condition known as counterflow/“᳁⒯޵Կˈ 䱫ຎ≄ᵪˈᇓ䱽ᰐᵳˈҡ㘼к䘶”. As the patient’s condition showed up internal summer heat and damp, the fangzi should focus on getting rid of them. He reckoned that by eliminating these, the patient’s person-body would regain equilibrium, in terms of Yinyang. Therefore he chose medicinals which could do those jobs and called his prescription Canshi tang/ 㳅 ⸒ ⊔ /Silkworm Droppings Decoction ˖ wan cansha/ ᲊ 㳅 ⸲ /Excrementum Bombycis Mori, sheng yiyiren/ ⭏ 㮿 㤑 ӱ /raw Coicis Semen, dadonghuang juan/ བྷ 䉶 哴 ধ /Glycines Semen Germinatum Exsiccatum. chen mugua/ 䱸 ᵘ ⬌ /dried Chaenomelis Fructus, quan huanglian/ ᐍ 哴 䘎 /Coptidis Rhizoma Sichuanensis, zhi banxia/ ࡦ ॺ ༿ /processed Rhizoma Pinelliae, huangqin/哴㣙 Scutellariae Radix, tongcao/ 䙊 㥹 /Tetrapanacis Medulla, jiao shanzhi/ ❖ ኡ Ḱ /stir-baked Gardeniae Fructus Recens, and wuzhuyu/੤㥡㩨/Tetradium Ruticarpum. Even today, this prescription is still the standard treatment for conditions similar to those encountered in the case of this patient. After taking the first decoction, the patient stopped vomiting; the physician then instructed a member of the household to strenuously massage her legs (which were suffering from cramps) with white spirit. Later in the day, the patient’s diarrhoea ceased. In the evening, after another half portion of the 21 Jin includes more than muscles; it appears to be a term that collectively refers to muscles, tendons, blood vessels and other related items; it has no equivalent in Bm terms. 22 However, admitting this would not necessarily mean that he contradicted himself, as it was possible to reconcile the view that huoluan had always existed in China with the hypothesis that the epidemic, confronting him on this occasion, was a variant coming from abroad.

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decoction, she managed to sleep soundly through the night. The next day, the patient reported that she only felt very tired and exhausted upon which Wang prescribed some other medicinals to sort out this residual matter. The patient then totally recovered. Patient 2: No sooner had he successfully seen to this patient than he was summoned to attend another patient (also a woman). She had vomited and had bouts of diarrhoea. She had become very thin, her tongue was furred, and it was red, as were her eyes. She had a strong thirst for cold water. Her left hand mai was taut but had strength to it/ᐖᕖᴹ࣋ and the right hand mai was slippery and large/ᴹ㜹━བྷ. Upon completing his sizhen, Wang concluded that, even under more normal circumstances, this patient suffered from heat in both the Liver and the Stomach. Added to this, was more heat brought about by the huoluan. He decided that his best strategy was to get rid of this excess heat. To this end he prescribed a modified form of the White Tiger Decoction/Baihutang/ⲭ㱾⊔, a heat-clearing formula, but minus two of its medicinals, namely, jingmi/㋣㊣/a kind of sticky rice and gancao/⭈㥹/Glycirrhizae Radix. He also added sheng di/ ⭏ ൠ /Rehmanniae Radix Exsiccata seu Recens, pugongying/ 㫢 ‫ ޜ‬㤡 Taraxaci Herba cum Radice, yimucao/⳺⇽㥹/Leonuri Herba/Motherwort, huangbai/哴᷿/Phellodendri Cortex, mugua/ᵘ⬌/Chaenomelis Fructus, sigualuo/э⬌㔌/Luffae Faciculus Vascularis, and yiyiren/㮿㤑ӱ/Coicis Semen. Upon taking one decoction, the patient stopped vomiting; after yet another, she recovered. Patient 3: This turned out to be a friend who, in the end, was also a patron, as he helped Wang Mengying to publish a book of his. By the time the physician got to his bedside, the patient’s mai was barely palpable, he had become deaf, his four extremities were icy cold, yet he was sweating profusely and his voice was hoarse. He had already lost weight, and by this time, was skin and bone. All these signs and symptoms meant that the patient was at a truly critical stage of the illness. He was so weak that, if nothing could be done to help him recover some strength, it was obvious that the end was nigh. His yangqi was very deficient and almost nonexistent. Wang immediately instructed the household to make a strong ginseng drink to restore yangqi in his person-body. He next prescribed buyao for his yangqi as well as to get rid of damp. After this decoction, the patient’s condition improved; he was on the way to recovery. However, soon after, the Taiping Rebellion forced Wang to flee from the place, where both the patient and physician lived. During this period, the patient (friend and patron) fell ill again but without Wang Mengying at his side, he died.

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The cases cited concerning how Wang Mengying treated malaria and cholera, show clearly the labour-intensive, time-consuming method by which CCM coped with illnesses, whether chronic or critical, in spite of the fact that he had no idea of the respective causes of these two illnesses (that is, as understood in Biomedical terms). They also illustrate how CCM practised/practises its Getihua zhiliao, its related sub-concept of tong bing yi zhi/਼⯵ᔲ⋫. The patients were suffering from malaria or cholera, but ultimately, their zhèng was somewhat different and hence, each patient had to be prescribed medicinals which were specifically designed to deal with their particular zhèng. CCM, in a nutshell, relies on its unity and coherence, under shengli-bingli-yili, which enable its practitioners (at least the shang gong) to successfully treat patients, through grasping the respective zhèng which, in turn, determines the appropriate forms of treatment for each patient. Let us conclude this section by looking briefly at a more recent instance, when it appeared that CCM had to cope with an illness which was first reported officially to have appeared in the winter of 2002 in Guangdong, China, for a short period before dying down (towards the end of 2003). This is the Severe Acute Respiratory Syndrome/SARS. In Chinese, it is called 䶎ިර㛪⚾ (shortened to 䶎ި). SARS became a worldwide phenomenon, with over 1,700 cases in the People’s Republic of China (including Hong Kong) and more than 200 in Canada and Singapore. Globally, the total number of incidents reached 8,437, affecting 29 countries, with total mortality estimated at 10%-12%. From the standpoint of Bm, the cause of SARS was found very quickly, following three weeks of intensive work, day and night, by Canadian researchers. The disease agent is a coronavirus (so SARS was renamed Corona Virus Pneumonia, although this term did not really catch on). This discovery was not accompanied by any effective curative drug(s) or preventive vaccine. Palliative measures were put in place, but antiviral drugs, glucocorticoid, immunomodulator and other conventional medicines were also invoked. In the end, the rapid containment of the outbreak was due to successful public health measures–isolation, quarantine, the sharing of information and the results of monitoring–undertaken both at the national and the international levels (see WHO 2004, Chapter 5). As far as China was concerned, SARS provided an excellent opportunity to treat patients within the framework of an integrated therapy with Western and Traditional Chinese Medicines (see Dharmananda 2003, WHO 2004). However, from the vantage point of the understanding of CCM in this work, what was more relevant is Report 5 in the publication of WHO (2004), concerning eleven patients admitted to the Ministry of

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Health China-Japan Friendship Hospital in Beijing after 8 May 2003, and treated without the intervention of conventional Biomedical drugs. Nor were antibiotics used, unless the patients showed clear signs of bacterial infection. The symptoms exhibited include a cough, fever, headache, inertia, shortness of breath, an aversion to cold, a feeling of oppression in the chest, diarrhoea, myalgia/㚼Ⰻ, and dyspnoea/બ੨ഠ䳮/≄ை. The patients selected for this study all complied with the standard criteria for the diagnosis of SARS. They had been infected not more than ten days before admission to hospital, and also had not been treated systematically with hormones and antiviral drugs before being hospitalised. They were also not patients with severe SARS. This experimental group was matched by the control group comparable in terms of number, gender, age, and the medical criteria for selection–in other words, while the experimental arm was exposed to Chinese medicinals, the control arm was exposed to Bm treatment. Report 5 mentions that 12 prescriptions were drawn up; one of them, prescription 4, was not used on the experimental arm of this study, as it had been designed especially for treating patients who had received glucocorticoid. 23 The patent preparations used were all medicinals approved by the State Drug Administration and readily available over the counter. The experiment addressed treatment under the five stages of development of the illness: incubation, pyretogenic, cough and gasp, collapse and convalescent. However, the pyretogenic stage was itself divided into three sub-stages: onset, strong fever and toxic heat. The symptoms of the onset sub-stage included fever, a cough, headache, muscular stiffness, a reddened tongue with white or greasy furriness and a slippery mai. Treatment consisted of medicinals which dispel wind and heat and expel toxin and damp, constituting Prescription 1 and consisting of: xian lugen/勌㣖ṩ/fresh Rhizoma Phragmitis 30g, rendongke/ᗽߜ、 /Lonicera Japonica (Caprifoliaceae) 30g, chantui/ 㵹 㵅 /Periostracum Cicadae 6g, jiangsang/‫ܥ‬ẁ/Bombix Batryticatus 6g, almond 10g, sheng yiyiren/⭏㮿㤑ӱ/raw unprepared Coicis Semen 30g, and peilan/֙‫ޠ‬ /Herba Eupatorii 6g. This was used in combination with an intravenous drip containing shuanghuanlian powder and houttuynia jicai/ 㮪 㨌 /Houttuynia Cordata Thunb for injection. The symptoms of the second sub-stage, the strong fever sub-stage (the retention of pathogenic heat in the lungs) included a high fever, a cough, 23

Prescriptions 1, 2, and 3, out of the eleven drawn up, will be quoted in what follows. However, readers should be warned that this author modified the nomenclature somewhat, in order to make things clearer, and to conform to the format adopted in this book in presenting medicinals.

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thirst, hyperhidrosis, a reddened tongue with thick or greasy and yellowish furriness, and a slippery mai. Treatment aimed at clearing heat to help ventilate the Lungs, and to eliminate toxins, to promote blood circulation. This fangzi was called SARS Prescription 2, which included the following medicinals: zhi mahuang/⛉哫哴/honey-fried Herba Ephedrae 6g, sheng shigao/⭏⸣㞿/raw Gypsum Fibrosum 30g, almond 10g, rendongke/ᗽߜ 、/Lonicera Japonica (Caprifoliaceae) 30g, lugen/㣖ṩ Rhizoma Phragmitis 30g, huangqin/哴㣙/Radices Scutellariae 10g, sangbaipi/ẁⲭⳞ/Cortex Mori Radicis 30g, and chi shao/䎔㢽/Radix Paeoniae Rubra 30g. This decoction was used in conjunction with an intravenous drip of qingkailing/ ␵ ᔰ ⚥ injection, houttuyinia injection, and danshen/ ѩ ৲ /Salvia Miltiorrhiza injection. The third sub-stage, which is the toxic heat sub-stage, was marked by intense heat in both Qi/≄࠶䇱 and ying/㩕࠶, with an accumulation of toxins and stagnant heat in the Lungs. Fever would have lasted for more than five days. Symptoms included a persistent high fever, a flushed face, a cough, shortness of breath, a dark reddened or deep red tongue with yellow, thick dry or dark furriness and a slippery or deep mai. The aim of treatment, and the principles relied on, were to eliminate heat, to remove toxins from the person-body, while promoting blood circulation. The fangzi drawn up was SARS Prescription 3, which included the following medicinals: sheng shigao/⭏⸣㞿/raw Gypsum Fibrosum 60g, lugen/㣖ṩ /Rhizoma Phragmitis 60g, huangqin/哴㣙/Radices Scutellariae 15g, gan dihuang/ ᒢ ൠ 哴 /dried Rehmannia Glutinosa 30g, shuiniujiao/ ≤ ⢋ 䀂 /Cornu Bubali to be decocted first, 60g, dahuang/⭏བྷ哴/raw Radix Rhei 6g, chi shao/䎔㢽/Radix Paeoniae Rubra 30g, and honghua/㓒㣡/Flos Carthami 10g. This decoction was used in conjunction with an intravenous drop of xingnao-jing/䟂㝁䶉 injection, houttuynia injection and Slavia Miltiorrhiza injection. From eleven prescriptions, the above three used for this case study have been chosen simply as examples of some of the medicinals, selected to treat the illness at that particular stage of its development in the patients. The Report claims success. The criteria used to assess this success included the following: allaying fever, restoring lymphocyte levels, and improving the absorption of inflammation; no toxic or other side-effects observed were associated with the use of large amounts of glucocorticoid

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and antiviral drugs. The treatment also cost significantly less in terms of medication and the number of days of hospitalisation required.24 What is of interest is to point out that the disease-entity discovered so quickly was not germane to the therapy proposed to treat the illness. The treatment merely followed the logic and methodology of CCM. The practitioners in Guangdong appear to have taken the lead, with the rest of the country following in their wake. Some of the reasons are rooted in regional history and geography. From the historical point of view regional differences in climate, geography and even culture helped to create the southern wenbing perspective as opposed to the shanghan/ Ք ሂ perspective of the north. These differences are set out clearly in Hanson (2011, 7-22, 162-169). SARS was treated under the concept of wenbing/⑙ ⯵/warm illnesses.25 Hanson 2011, 165 writes: Today the Chinese “Warm Diseases” category includes the afflictions biomedicine class as acute infectious diseases. They are also febrile diseases due to a climate-sensitive external pathogen that causes one’s temperature to rise and fever symptoms to set in. The most virulent and contagious forms of wenbing become epidemics.

This provides evidence, yet again, for the claim that not knowing “the cause” of an illness, as an external pathogenic factor or disease-entity is neither a hindrance nor a particular help to CCM, as it is the unity and coherence of the principles under shengli-bingli-yili Wholism/PIT-ism, which are critical to the practice and understanding of the medicine.

Conclusion From the standpoint of the unity and coherence of the principles of physiology, illness and therapy (PIT-ism), which constitute the essence of CCM, it is not ludicrous for CCM to embrace the precepts highlighted below. •

24

Focus on physiology rather than anatomy/dissection.

For a critical assessment of TCM in the treatment of acute respiratory tract infections, from the methodological standpoint of RCT and EBM, see Wu, Yang, Zeng and Poole 2008. 25 Hanson translates the term wenbing/⑙⯵ as “warm disease” unlike this author, who prefers “warm illness”.

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•

• •

Use ancient classical medical texts as foundational teaching material (and not merely as historical texts for historians interested in the history of the subject). Invoke prescriptions, some of which are some two thousand years old. Claim that knowing or not knowing “the cause” of an illness (in the sense in which Bm understands “the cause” of a disease in terms of a disease-entity, which can be a bacterium/virus/parasite/ fungus/DNA sequence/poison) is neither necessarily a hindrance nor a help in grasping the nature of the illness, which affects the person-body of the individual and of treating it.

The four “Absurdities” when critically assessed, show that, paradoxically, CCM is both backward- and forward-looking, at one and the same time. Even in those contexts when it is most backward-looking (such as in the domain of invoking ancient prescriptions), it is never a slavish exercise. All successful fangzi have to be understood, adjusted, and modified in a linghuo manner to address the zhèng, as ascertained by the physician, when the patient presents with specific signs, symptoms, and constitutional characteristics, within a particular context of time, such as a day, a season in the year, or even the year itself (on that last point, see Chapter Five). It is forward-looking, as it claims/claimed to be able to cope with any new illness, such as SARS in the first decade of this century, or malaria and cholera in centuries well before the respective “cause(s)” of these diseases were known to the world of MM. As far as this author is aware, Chinese physicians have not been known to be associated with the treatment of Ebola; in principle, however, should they be involved, they would consider that their understanding of the unity and coherence of CCM, as set out in this chapter, would stand them in good stead to work out an appropriate programme of treatment, just as some of them had done during the short-lived SARS epidemic. Of course, this is mere speculation, but speculation, nevertheless, well worth toying with. It is also worth re-emphasising the point that CCM’s focus on physiology/function rather than anatomy/structure renders it suspect in the eyes of Bm, especially when some of its key notions, such as the Sanjiao (discussed in this chapter under Absurdity 1) and the Jingmai network (examined in Chapter Two) have no anatomical referents. The chapter also briefly explored the work of Zhang Zhongjing, who is considered to have integrated the domains of shengli and bingli, on the one hand, and yili, on the other which, up to then, had more or less existed separately. Prescriptions had long existed as mere “empiric prescriptions”

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in their own right, without being related to the theory, as characterised in the Neijing and other theoretical texts, during the life-time of Zhang Zhongjing himself. Shengli and bingli as theoretical concepts of CCM may be considered under the domain of xingershang/ᖒ㘼к, as an expression of the Dao; fangzi, on the other hand, belong to the level of xingerxia/ᖒ 㘼л, a domain which is empirical, and therefore, capable of being directly tested and assessed. Zhang Zhongjing’s ability to provide a link between the domains of xingershang and xingerxia is an instance of what Chinese culture, through the ages, considers to be a treasured goal, namely of ҈к ੟лˈа㜹⴨᢯/cheng shang qi xia, yi mai xiang cheng. To put this in yet another way, Zhang Zhongjing provided the basis of integrating theory and practice such that CCM became a systematic, coherent, unified Whole (Zhèng-Fang Wholism) in terms of what this book calls PIT-ism/shenglibingli-yili Wholism.

CHAPTER TEN CCM AS YIDAOYI: MACRO-MICRO-COSMIC WHOLISM

Introduction Among Chinese practitioners and scholars CCM is known as Yidaoyi/᱃䚃 ५. This means that it is the medicine based on the Yijing (as well as the Ten Wings of the Zhouyi) and the Laozi/Daodejing (Daojia/Daoist philosophy, in general). This explains why Lee 2017a spends so much space and effort in exploring the philosophy/cosmology embedded in the Book of Changes as well as some key Daoist philosophical texts. Unless one can grasp fully their philosophical and cosmological ideas, one cannot begin to understand CCM. Qi, in its two modes (Qi-in-concentrating mode and Qi-in-dissipating mode) is the fundamental ontological category, operating within a framework which rests on process-ontology. These concepts in turn are shown to entail numerous forms of Wholism, of which Macro-Micro-cosmism (for short, we will call it M-MW) will be looked at in greater detail here in order to demonstrate what is meant by the nostrum that CCM is Yidaoyi.

Tianren-xiangying, the Cyclic Ascending-Descending Law of Nature, Macro-Micro-cosmic Wholism and Yidaoyi Chapter Four has already explored one aspect of the meaning of Yidaoyi via the concept of the renzhong/philtrum. This chapter continues the exploration of Tianren-xiangying/ཙӪ⴨ᓄ (set out in Lee 2017a), which sinologists, on the whole, translate as “Correlative Thinking”. This author prefers to call this Macro-Micro-cosmic Wholism (M-MW for short), casting it in ontological rather than epistemological form, as it is closer to how the CCM theorist-practitioner means by the term. The key aspect of this notion is that humans, like all other Wanwu (organisms as well as abiotic entities on Earth/in the universe) are generated from Qi; hence Qi, which exists in Greater Nature/the Macrocosm, necessarily also exists in

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humans/the Microcosm. Macrocosmic Qi exists not only under the two modes just mentioned, but also under its dyadic aspects of yinqi and yangqi which, though separately identifiable, they are yet, nevertheless, so entwined that in the one is found the other, in the other is found the one; the one cannot endure without the other–what this book calls Yinyang Wholism. Microcosmic Qi operates in the same fashion. Macrocosmic Qi changes according to the sishi jielü (the seasons in a year or a day) and the zhouye jielü (the rhythm of the day/night sequence). These two sequences may be regarded as Chinese Laws of Nature (Lee 2017a), which are subject to Cyclic Reversion/zhou er fu shi/ ઘ 㘼 ༽ ࿻ . The sequence– Spring/Summer/Autumn/Winter–is repeated year after year; the sequence–daylight/noon/twilight/night–is repeated day after day. If Macrocosmic Qi is subject to such cyclic changes, so is Microcosmic Qi. This chapter would add embellishments to these two Laws and show how they are, in fact, derivatives from another more basic law, the Cyclic Ascending-Descending Law of Nature. Macrocosmic Qi and Microcosmic Qi move in an orderly manner through the cyclic sequences. The movements/motions consist of risingfloating-descending-sinking/ॷ⎞䱽⊹/sheng-fu-jiang-chen. Yangqi rises in Spring, floats in Summer, descends in Autumn and sinks in Winter, only to rise again next Spring. And again, yangqi rises in the early morning, floats by noon, begins to descend in the afternoon, and sinks by twilight and nightfall, only to rise again in the morning of the following day. It is this unbroken chain of movements in this cyclical manner, which ensures the endurance of Wanwu (in particular, organisms of which, we, humans, are but one) on Earth. This Cyclic Reversion of sheng-fu-jiang-chen regarding both Macrocosmic Qi and Microcosmic Qi is called yuanyundong/ശ䘀ࣘ, following the usage of a very distinguished physician of the late Qing dynasty and the first half of the twentieth century, called *Peng Ziyi/ᖝᆀ⳺ (18711949),1 who was known to have written a work, called Shiyan xitong gu zhongyixue/ lj ᇎ 傼 ㌫ 㔏 ਔ ѝ ५ ᆖ NJ , which may be rendered as Instantiating Systems Thinking in Classical Chinese Medicine. Unfortunately, after his death the work disappeared from view; very fortunately, after many decades of dedicated searching, finally, scholars managed to obtain a copy (or two) in 2005. After editing by Li Ke/ᵾਟ, it was published in 2008, under the title *Yuanyundong de gu zhongyixue/

1

He was originally from Yunnan province and belonged to the Bai/ⲭ ethnic group. “Ziyi” was his courtesy name/ਧ/hao.

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ljശ䘀ࣘⲴਔѝ५ᆖNJ, which may be rendered as Classical Chinese Medicine: Its Cyclic Motions. This book is considered by some scholars as the fifth canonical text of CCM, to be added to the Neijing, the Nanjing, the Shanghanlun and the Materia Medica of the Divine Husbandman. Peng Ziyi is credited with having demonstrated so clearly and consistently, for modern times, the influence of the Yijing on CCM via the cyclic reversion of sheng-fu-jiang-chen which, for short, we may refer to as the Cyclic Ascending-Descending Law of Nature. In other words, CCM, as a medicine rests on Wholism, in particular on M-MW. This twentieth-century work could be said to be a descendant in spirit and substance of another very important text published earlier in the Qing dynasty, during the reign of the Emperor Qianlong by the scholarphysician, Huang Yuanyu/哴‫ݳ‬ᗑ (1705-1758); he was in fact appointed as Court physician. He wrote numerous books. He admired the Yellow Emperor, Qibo, Bian Que2 and Zhang Zhongjing, calling them the four sages/saints of Chinese medicine. He considered the Neijing, the Nanjing, the Shanghanlun and the Jinguiyaolue3 to be canonical texts. One of his most famous works, now republished, isljഋ൓ᗳⓀNJ/Xi sheng xin yuan, which may be rendered as The Four Sages of Chinese Medicine: The Spiritual Fountain-head. The passage is a detailed example of the closeness between the two texts (of Peng and Huang); *Huang Yuanyu 2009 wrote: ≤ǃ⚛ǃ䠁ǃᵘDŽDŽDŽᱟѪӄ㹼ҏ

Rendered as: Water, Fire, Metal and Wood (of Wuxing) are but names of the four images of the processes of Yinyang, that is, they respectively stand for Water-taiyin (Greater Yin), Fire-taiyang (Greater Yang), Woodshaoyang (Lesser Yang) and Metal-shaoyin (Lesser Yin). 4 These four images stand for the ascending and floating, on the one hand, as well as the descending and sinking, on the other, of Yinyang. Should one wish to separate out and identify each of these processes separately, then one speaks of the four processes of ascending, floating, descending and sinking; should one speak of them as a Whole, then that Whole is Yinyang. The same point may also be made by saying that these four images of the 2

See Appendix Four, which demystifies the legends surrounding Bian Que. The latter two works are both by Zhang Zhongjing (see Appendix Two for their bibliographical details in the history of CCM). 4 For details, see Lee 2017a, Chapter Six. 3

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processes are the result of the transformative powers of zhongqi. The four images of the processes change and evolve from one to the other, like the wheels of a carriage, taking a year to complete a cycle. Yang rises during the first half of the year, while yin descends during the second half of the year. When yang first arises, this would be Spring/East; when yang has arisen completely, this would be Summer/South. When yin first descends, this would be Autumn/West; when yin has descended completely, this would be Winter/North. Spring promotes engendering, Summer promotes growth–in the language of Wuxing, these processes of change are said to constitute the qi of Wood and Fire and, as a result, too, Spring is warm and Summer is hot. Autumn promotes gathering in and Winter storing–in the language of Wuxing, these processes of change are said to constitute the qi of Metal and Water, and as a result, too, Autumn is cool while Winter is cold. Earth (the fifth concept in Wuxing) has no special season assigned to it, as the qi of Earth is present in all the four seasons, the last eighteen days of each in particular; however, it is most typically felt in the middle of the sixth (lunar) month. Earth in Wuxing plays the role of harmonising and holding together the four processes of ascending, floating, descending, and sinking. (Texts within round brackets as well as those highlighted are this author’s interpolations.)

Before proceeding further, it would be wise to address an anomaly, which appears to have arisen between the two texts of *Peng/Li and *Huang. While the former consistently speaks of yangqi ascending, floating, descending and sinking, the latter distinguishes between the two halves of the cycle, and favours referring to the ascent of yangqi, on the left-hand side of the circle/cycle, and to the descent of yinqi on the righthand side. Is there then a real contradiction between the two accounts? No, as these are different perspectives on the same subject. Yin and yang are not mutually exclusive, neither are they independent of each other, yin is always present in yang and yang in yin, as shown in the Liangyitaijitu. In the set of trigrams, the pure yang gua/Qian and the pure yin gua/Kun are theoretical limits in the abstract and therefore have no empirical instantiations. In reality, even at the height of Summer, when heat/Fire is at its height, yinqi is nevertheless present, as shown in the Li gua; even in the depth of Winter, when cold/Water is at its most severe, yangqi is, nevertheless, present, as shown in the Kan gua. What is significant in the processes of Qi transformation in the course of a year/a day at any one moment, is the proportion of yinqi to yangqi; whether at a particular stage of these changes, yangqi predominates over yinqi or yinqi predominates over yangqi. Furthermore, as yangqi increases, yinqi diminishes; mutatis mutandis, as yinqi increases, yangqi diminishes. To say that yangqi

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ascends and floats is shorthand for saying that yangqi predominates over yinqi on the ascending-floating left-hand side of the circle/cycle; to say that yangqi descends and sinks is shorthand for saying that yinqi predominates over yangqi on the descending-sinking right-hand side of the circle/cycle. To put the matter in yet other words, on the left-hand side, both yangqi and yinqi are ascending and floating, it is just that during these two processes of Qi transformation, yangqi predominates increasingly over yinqi; on the right-hand side, both yangqi and yinqi are descending and sinking, it is just that during these two processes of Qi transformation, yinqi increasingly predominates over yangqi. Hence, there is no contradiction between the two different versions used in *Peng/Li and *Huang.

Figure 10.1: The Cyclic Ascending-Descending Law of Nature with regard to Macrocosmic Qi5–yangqi ascends, and then floats on the left-hand side while it descends and sinks on the right

Both versions would agree with what this author has called the Cyclic Ascending-Descending Law of Nature with regard to Macrocosmic Qi. This may be presented in terms of Figure 10.1. To recap a little, in this kind of xiang/image/figure, what ascends is on the left, what descends is on the right; what is on the top is South and 5

The figures in this chapter are based on some figures in *Peng/Li 2008, but subject to two limitations. First, they have been modified and/or embellished to some extent, in accordance with this author’s own understanding of the text and second, there is a lack of technical expertise in electronically constructing them. Should these turn out to be faulty, this author, alone, should be held entirely responsible.

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Summer/noon, what is at the bottom is North and Winter/night; what is on the left is East and Spring/morning; what is on the right is West and Autumn/late afternoon. Towards the end of Winter, yangqi begins to ascend; this is officially marked in calendrical terms as lichun/ ・ ᱕ /Spring Establishes. The yangqi proceeds to float upwards until it reaches its maximum at the Summer Solstice/ ༿ 㠣 . When yang reaches its maximum, it must begin to descend, which is officially marked in calendrical terms as liqiu/・⿻/Autumn Establishes. At the Summer Solstice, the sun’s rays beat down on the Earth in straight vertical lines, but at liqun, they fall on the Earth’s surface as oblique lines. As yangqi descends further, the process is called sinking, reaching its depth at the Winter Solstice/ߜ㠣. This Law of Nature applies in both abiotic and biotic Nature, which Figure 10.2 attempts to capture. When understood in the context of the former, this Law is borne out by the experience of miners, who work in very deep mines. They report that, paradoxically, it is in the depth of Winter that they feel very hot, so much so that they work naked; in Summer, they feel so cold that they keep all their clothes on, including overcoats, just as the Law predicted. Yangqi does not simply descend into the bowels of the Earth, where deep mining takes place; it also descends beneath the Earth’s watery surfaces, where it enables water to retain a higher temperature than on dry land. When the land around a vast lake as well as its surface are frozen in the depth of Winter, the water beneath the ice in the lake is not frozen, and fish as well as other organisms can live and survive. 6 Figure 10.1 shows the Kan gua looking like this: ; it encapsulates the information just mentioned by showing that yangqi is “trapped” by the yinqi; nevertheless, it is still there, having beaten a retreat, but ready to re-emerge at lichun. When understood in the context of biotic Nature, this Law of Nature is best instantiated in the case of plants, especially deciduous plants in the temperate zones. We readily observe that trees start to send out shoots, and their sap begins to stir and rise in early Spring; the leaves grow as the Sun gets hotter by the day until after the Summer Solstice, when heat begins to decline; soon after that in the Autumn, the trees begin to shed their leaves, 6

Science explains this phenomenon by saying that the surface ice acts as an insulation screen, preventing the cold from penetrating to the water underneath it. The Chinese explanation talks instead of the withdrawal of yangqi into the depths of water, with the yangqi being “caught” by the yinqi which surrounds it. The language of the two discourses may be different but the explanation each proffers is similar.

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the sap returning to their roots, and come Winter, the trees are bare, but in readiness for the next cycle of the ascending-descending of yangqi the following year. The Law can readily explain the series of biological processes, which take place in front of our very eyes from year to year. These biological/physiological processes are the basis of organic existence; when such processes are disrupted so that they no longer arise in the normal manner, organic life fails to thrive, if not die. In human beings, too, they lead to illness and sometimes death.

Figure 10.2: Macroscopic Qi in terms of the trigrams and the Cyclic Reversion of the Ascending-Descending Law of Nature in Abiotic and Biotic Nature

Macrocosmic Qi, in the ways just characterised above, gives rise to the following version of the sheng-fu-jiang-chen formulation: chun-sheng, xia-zhang, qiu-shou, dong-cang/ ᱕ ⭏ ༿ 䮯 ⿻ ᭦ ߜ 㯿 , rendered as: to engender in Spring, to grow in Summer, to mature/gather in Autumn, and to conserve/store in Winter. Yangqi in Spring is born again, in Summer, it grows to full strength, in Autumn it attenuates, and in Winter, it conserves/stores itself. The Cyclic Ascending-Descending Law of Nature with regard to Microcosmic Qi is represented in Figure 10.3.

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Figure 10.3: The Cyclic Ascending-Descending Law of Nature with regard to Microcosmic Qi in the person-body

The accounts so far of Qi (whether Macrocosmic or Microcosmic), have singled out two calendrical periods for emphasis, namely, liqiu and lichun because the former marks the beginning of the descent of yangqi in Autumn (the beginning of the descending cycle), while the latter marks the start of its re-emergence in Spring (the re-start of the ascending cycle). However, the Chinese calendar does not simply divide the year into twelve months, but into twenty-four “periods”/Ҽॱഋ㢲≄, each reflecting the nature of the kind of qi that is representative of that “period”. Strictly speaking, a qie/㢲 is a node, such as that found on the bamboo. The bamboo is smooth between nodes, but the nodes disrupt that smoothness. Hence, when used in the context of the progression of Qi processes during a year, the term “node” marks the change of Qi; for that reason, it may be more accurate to translate the term jieqi/㢲≄ as qi-node, rather than qiperiod. This schema, in the past, was extremely important in a predominantly agricultural society, determining the rhythm of life, when to plough, to sow, and so on, all depending on the qi-node concerned. In CCM, it continues to be extremely important as Microcosmic Qi follows the same pattern as Macrocosmic Qi. Beginners in CCM must master this

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or their chances of progressing in the subject, never mind, mastering it, would be faint. The twenty four qi-nodes may be shown as in Figure 10.4 with 1 as the beginning of the Descending process, and 13 as that of the Ascending process of the cycle.

Figure 10.4: The twenty-four qi-nodes within the Ascending-Descending framework

In the above, the line of dashes represents the divide between what is above and what is below the surface of the Earth. The twenty-four qi-nodes are set out in the table below. 1 Liqiu/Autumn Establishes/・⿻ 2 Chushu/Limit of heat/༴ ᳁ 3 Bailu/White dew/ⲭ䵢 4 Qiufen/Autumn equinox/⿻࠶ 5 Hanlu/Cold dew/ሂ䵢 6 Shuangjiang/Hoar frost descending 䵌䱽 7 Lidong/Winter Establishes/・ߜ 8 Xiaoxue/Light snow/ሿ䴚 9 Daxue/Heavy snow/བྷ䴚 10 Dongzhi/Winter solstice/ߜ㠣 11 Xiaohan/Mild cold/ሿሂ 12 Dahan/Severe cold/བྷሂ

13 Lichun/Spring Establishes/・᱕ 14 Yushui/Rain falling/䴘≤ 15 Jingzhe/Insects suddenly awakening/᛺ 㴠 16 Chunfen/Spring equinox/᱕࠶ 17 Qingming/Clear and bright/␵᰾ 18 Guyu/Rain for the grains/䉧䴘 19 Lixia/Summer solstice/・༿ 20 Xiaoman/Grain beginning to fill out/ሿ┑ 21 Mangzhong/Ears of grain forming/㣂⿽ 22 Xiazhi/Summer solstice/༿㠣 23 Xiaoshu/Slight heat/ሿ᳁ 24 Dashu/Great heat/བྷ᳁

Table 10.1: Names of the twenty-four qi-nodes

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It may be relevant here also to point out that the notion of the equinox has two meanings for Chinese cosmology and hence, CCM: the more familiar one is that during the equinox, between the equator and the Tropic of Cancer (or the Tropic of Capricorn), the hours of daylight and darkness are equal; significantly, it is also the time when yangqi at the Earth’s surface and yangqi beneath that surface, are equal in strength. In a nutshell, according to *Peng/Li 2008, the concept of the twentyfour qi-nodes captures the following information. The heat from the Sun, which reaches its maximum at the Summer Solstice on the Earth’s surface descends in the Autumn/Autumn Establishes, reaching Earth’s water beneath its surface to be stored there safely, by the Winter Solstice. When Spring approaches/Spring Establishes, heat/yangqi re-emerges from below, to join the yangqi of the new cycle to float upwards, until it reaches its maximum at the Summer Solstice. In this Cycle of AscendingDescending Qi, as shown in Figure 10.4, zhongqi/ ѝ ≄ is present as represented by the Liangyitaijitu in the middle. Zhongqi is Earth’s qi (as it is the qi of the Spleen-Stomach visceral organ-system which, in Wuxing, belongs to Earth). Figure 10.3 shows that Earth’s qi/Diqi is surrounded by Tianqi/yangqi–the co-presence of the two is the foundation of all life. The Tai gua is auspicious primarily because it stands for the right relationship between yin and yang, making life both possible and capable of enduring; the Pi gua, on the contrary, stands for the wrong relationship between yinqi and yangqi which spells catastrophe/death and other woes (see Figure 4.1). We have already mentioned the two Laws of Nature, the zhouye jielĦ and the sishi jielĦ. The former is divided into twelve hours; one should bear in mind that each ancient Chinese hour covers two hours in our modern schema of the 24-hour clock. This means that the analogues of the four seasons in a year/day work out as follows: (a) Spring: ট ᰦ /mao shi, that is, 05.00h to 07.00h (dawn) in the zhouye jielĦ. (b) Summer: ॸᰦ/wu shi, that is, 11.00h to 13.00h (noon). (c) Autumn: 䝹 ᰦ /you shi, that is, 17.00h to 19.00h (late afternoon/twilight). (d) Winter: ᆀ ᰦ/zi shi, that is, 23.00h to 01.00h of the following day (night). The CCM physician must pay attention to the above as far as Microcosmic Qi is concerned. For instance, the physician expects the heat of a re zhèng/✝䇱, which affects the Large Intestines and the Stomach

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(as discussed in the Shanghanlun), to increase between the hours of 15.00 and 19.00, that is, shen you shi/⭣䝹ᰦ. Patients who suffer from nocturnal emissions or wet dreams and those from vaginal discharge/䚇㋮ⲭᑖ, will start discharging in the middle of the night. Physicians can expect wenbing/⑙⯵/fever without chills in Spring, and huoluan/䴽ҡ/cholera in Summer. On the other hand, human health, according to CCM, is at its best during Autumn and Winter in the course of the year. Should there be a disturbance in the Laws of Nature in the Macrocosm, this would in turn produce a disturbance in Microcosmic Qi, giving rise to illnesses in people. In the normal course of events, the yangqi of the Macrocosm in Winter is stored/conserved; should the particular winter be mild, then the yangqi stored and conserved in the water below Earth’s surface would unseasonally emerge. CCM regards this stored yangqi in the Macrocosm as the root of zhongqi/ѝ≄, and in the person-body (the Microcosm), as the qi of the Spleen-Stomach, which embodies the qi of Earth, the basis of life. If what should be stored is not stored, but “escapes”, this prematurely released yangqi will turn into xieqi/ 䛚 ≄ /pathogenic qi, leaving the person-body in a condition of deficiency/オ㲊. When the winter is unseasonably mild, expect more deaths and the appearance of illnesses, including plagues. Spring relative to Winter is mild; however, if Spring becomes unseasonably mild, the yangqi in the water below the Earth’s surface would rise, but at too great a pace, thereby rising too much. This abnormal malfunctioning would also increase the number of deaths, and lead to the emergence of many more illnesses among people. In the normal course of events, yangqi/heat rises to the maximum in Summer, ultimately producing condensation as rain (water, evaporated by heat, first ascends as clouds in the sky and then descends later as rain), which helps to bring down the heat. Should Summer turn out to be very dry, with no rain, then the yangqi and its heat cannot descend; under such circumstances, cholera and other illnesses would appear. In the normal course of events, Autumn is cool, with yangqi being in a state of readiness to descend. If Autumn is unseasonably dry and desiccating/⠕, then the heat of yangqi cannot be gathered in; it will dissipate, not descend. This would, in turn, render people vulnerable to the common cold/ᝏ߂, as well as stir up wind/feng in the person-body. Should qi pertaining to the bottom half of the person-body be adversely affected, then at the cusp of Spring, such people would be weakened and, therefore, be vulnerable to wenbing/ ⑙ ⯵ . Should qi pertaining to the left side of the person-body be adversely affected, then

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such people would be vulnerable, at the cusp of Summer, to a chest condition called gansai/ᒢຎ. Should qi pertaining to the right side of the person-body be adversely affected, such people would be vulnerable, at the cusp of Winter, to a dry cough.

Axiomatic construction of CCM in terms of its Laws of Nature At this point in our discussion, it may be helpful to draw up an axiomatic construction of Qi and its processes in both the Macrocosm and the Microcosm. This will show how these Laws of Nature explain both the proper functioning of the person-body when health is maintained, as well as its malfunctioning when illnesses emerge. It may be presented as follows: I

Qi is the fundamental ontological category.

II

Qi exists in two basic forms, yangqi and yinqi.

III

The system is Sun-driven, with yangqi as primus inter pares in respect of yinqi.

IV

Qi operates under two modes, Qi-in-concentrating mode and Qiin-dissipating mode.

V

Qi-in-dissipating mode is primus inter pares in respect of Qi-inconcentrating mode, and is the Qi, which is found in the Jingluo network.

VI

Macro-Micro-cosmic Wholism (M-MW)–Microscopic Qi replicates the character of Macroscopic Qi.

VII

Under M-MW, Macroscopic Qi and Microscopic Qi operate in terms of cyclic reversion.

VIII

The most basic Law of Cyclic Reversion/zhou er fu shi is understood in terms of the processes of the Ascending, Floating, Descending, and Sinking of yangqi and yinqi.

IX

This Law has derivative Laws of Nature, namely, the zhouye jielĦ, the sishi jielĦ and the ershisi jieqi schema.

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This Law is also expressed in terms of the processes of Birth/Engendering, Growth, Maturing/Gathering-in, and Declining/Storing/Death–sheng-zhang-shou-cang/⭏䮯᭦㯿. This version is particularly apt for characterising the processes found in biotic Nature.

From this axiomatic set-up, one may derive the following basic conclusion: these Laws of Nature, concerning the processes of Qi in both the Macrocosm and the Microcosm, guarantee the proper functioning of the person-body and hence, health. Deviations from them engender a malfunctioning of the person-body and, hence, illnesses in one form or another. That is why, according to CCM, once one has grasped the principles of physiology/shengli, one has also grasped the principles which bring about and govern illnesses/bingli. Simultaneously, one would also have grasped the principles behind the correct diagnoses of illnesses as well as the appropriate treatments/yili to eliminate them and to restore patients to health or, at least, to ameliorate their suffering brought on by their illnesses–PIT-ism, an aspect already explored in Chapter Nine.

The Person-body: the Laws of Nature, Wuxing and the Jingluo Network To understand the physiology of the person-body, which governs its proper functioning is also to understand why and how the person-body falls prey to illnesses through malfunctioning. Hence, *Peng/Li 2008 insists that Figure 10.5 is almost the single most important xiang that a novice must fix in his mind, and all practitioners must carry in their heads at all times. It is, perhaps, not an exaggeration to say that it captures the key information of CCM, which may be spelt out in the theses listed below. 1. The framework is in accordance with the axiomatic structure set out in the section above. 2. The basic Cyclic Ascending-Descending Law of Nature, which governs Microcosmic Qi in the person-body (as much as it governs Macroscopic Qi), determines how the Jingluo as a network is said to exist within the person-body and how each Jingmai is related to its respective Zangfu, in accordance with Wuxing. 3. There are twelve principal Jingmai (see Chapters Two and Eight for details), divided as follows:

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(a) Three yang (taiyang, yangming, shaoyang), and three yin (taiyin, shaoyin, jueyin); (b) These in turn are divided into hand and foot Jingmai. 4. The above then gives a total of twelve. 5. The hand Jingmai runs from the hand to the head; the foot Jingmai runs from the head to the foot. The three hand yin Jingmai run from the chest to the hand, and the three foot yin Jingmai run from the foot to the chest. 6. Take the complementary Jingmai, labelled 1A and 1B in Figure 10.5. They are both hand Jingmai; both are associated with Metal under Wuxing. 1A refers to the Large Intestines (which is a Fu and, therefore, a yang visceral organ), whose counterpart is the Lung (a Zang and, therefore, a yin visceral organ); together, the Lungs and the Large Intestines form a Zangfu, a Yinyang visceral organ-system. Hence, too, the Jingmai of 1A is the hand yangming Large Intestines jing, while the Jingmai of 1B is the hand taiyin Lung jing. Metal qi of 1A is distinguished from Metal qi of 1B in terms of the former being referred to as Geng (yang) Metal qi, and the latter as Xin (yin) Metal qi; geng/ᓊ is the seventh position, while xin/ 䗋 is the eighth in the Ten Heavenly Stems schema. Geng and Xin are always used in relationship to Venus (in astronomy), which the Chinese call the Metal planet/䠁ᱏ. 7. Metal qi is the qi of the West/Winter, exemplifying the mode of gathering-in/contracting/᭦ᮋ. In the person-body, the Metal qi of the Lungs moves from above/South to below/Autumn & Winter and hence it descends on the right side of the person-body. In contrast, the Metal qi of the Large Intestines moves from below/Winter to above/Spring & Summer and hence it ascends on the left side of the person-body. Qi in this pair of Zangfu, together, completes a circular motion. While the hand Lung (main) jing runs from the chest to the hand, in the descending direction, its subsidiaries (luo/㔌) run through the Large Intestines. In contrast, while the hand Large Intestines (main) jing runs from the hand to the head, in the ascending direction, its subsidiaries run through the Lungs. Furthermore, while yangming is associated with the dryness of Metal, taiyin is associated with the wetness of Earth; hence the Large Intestines jing would have the yangqi of Metal and the Lungs jing would have the yinqi of Earth.

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8. To reinforce the points made above, let us look at just one more complementary pair labelled 3A and 3B. They both involve the foot Jingmai–3A is the jing which runs through the Gallbladder, while 3B runs through the Liver. The Gallbladder is a yang visceral organ while the Liver is a yin visceral organ; together, they form the Zangfu referred to as dangan/ 㛶 㛍 . In Wuxing, this Zangfu is associated with Wood. However, the Wood qi of the Gallbladder is labelled jia/⭢ (yang Wood) while that of the Liver is labelled yi/҉ (yin Wood) in order to distinguish between them–jia is the first, while yi is the second position in the Ten Heavenly Stems schema. 9. Wood qi is the qi of the East/Spring, with the function of dispersing and discharging/shuxie/⮿⋴. In the person-body, the Wood qi of the Gallbladder jing moves from above/South to below/Autum & Winter; hence it descends on the right side of the person-body. In contrast, the Wood qi of the Liver jing moves from below/North to above/Spring & Summer; hence it ascends on the left side of the person-body. Qi in this Zangfu, together, completes a circular motion. While the foot Gallbladder jing runs from the head to the foot, in the descending direction, its luo run through the Liver. In contrast, while the foot Liver jing runs from the foot to the head, in the ascending direction, its luo runs through the Gallbladder. Furthermore, while shaoyang is associated with xianghuo/⴨ ⚛, jueyin is associated with the yinqi of Wood; hence the Liver jing would bear the yinqi of Wood, while the Gallbladder jing would not only have the qi of Wood, it would also have the qi of xianghuo. 10. These complementary arrangements with regard to the two pairs of Zangfu and their Jingluo detailed above,7 based on their contrasting/polar characteristics, are entirely in keeping with the fundamental mode of thinking identified as Contextual-dyadic Thinking.

7

For an account of the six pairs as shown in Figure 10.5, see *Peng/Li 2008, 10-11.

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Figure 10.5: The Jingluo in the Person-body as governed by the AscendingDescending Law of Nature in respect of Macrocosmic Qi. The dashed line represents the division between what is above and below the Earth’s surface In the above: 1A = Geng Metal qi of Hand Yangming Large Intestine Jing/᡻䱣᰾བྷ㛐㓿ᓊ䠁 ѻ≄ 1B = Xin Metal qi of Hand Taiyin Lung Jing/᡻ཚ䱤㛪㓿䗋䠁ѻ≄ 2A = Ren Water qi of Foot Taiyang Bladder Jing/䏣ཚ䱣㞰㜡㓿༜≤ѻ≄ 2B = Gui Water qi of Foot Shaoyin Kidney Jing/䏣ቁ䱤㛮㓿Ⲩ≤ѻ≄ 3A = Jia Wood qi of Foot Shaoyang Gallbladder Jing/䏣ቁ䱣㛶㓿⭢ᵘѻ≄ 3B = Yi Wood qi of Foot Jueyin Liver Jing/䏣৕䱤㛍㓿҉ᵘѻ≄ 4A = Bing Fire qi of Hand Taiyang Small Intestine Jing/᡻ཚ䱣ሿ㛐㓿щ⚛ѻ≄ 4B = Ding Fire qi of Hand Shaoyin Heart Jing/᡻ቁ䱤ᗳ㓿б⚛ѻ≄ 5A = Xianghuo Fire qi of Hand Shaoyang Sanjiao/᡻ቁ䱣 й❖㓿⴨⚛ѻ≄ 5B = Xianghuo Fire qi of Hand Jueyin Pericardium Jing/᡻৕䱤ᗳव㓿⴨⚛ѻ≄ 6A = Wu Earth qi of Foot Yangming Stomach Jing/䏣䱣᰾㛳㓿ᠺ൏ѻ≄ 6B = Ji Earth qi of Foot Taiyin Spleen Jing/䏣ཚ䱤㝮㓿ᐡ൏ѻ≄ Ten of the qi listed above use the temporal schema called the Ten Heavenly Stems/ ཙᒢ/tiangan to distinguish between the qi associated with each wuxing.8 8

For a very brief account of this ancient Chinese system (ཙᒢൠ᭟/tiangan-dizhi), to record the chronological sequence of events, see “Heavenly Stems & Earthly Branches” 2015.

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Contextual-dyadic Thinking Before concluding this chapter, it may be helpful here to remind the reader that the dyadic mode of thinking is integral to CCM, in the way that MMW is a fundamental part of it. While the latter is a distinct matter of ontology, the former could be said to stride between epistemology and ontology. Lee 2017a, Chapter Nine has explored it and called it Contextual-dyadic Thinking, opposing it to Dualism, so characteristic of thinking under Western philosophy since Descartes. That chapter has set out in some detail the differences between Dualism and Dyadism; so there is no need to repeat them here. However, the chapter in question looks at Contextual-dyadic Thinking in Chinese philosophy in general and not when it is applied in CCM. It is time now to fill in this lacuna. To labour an obvious point yet again: yin and yang are not mutually exclusive but intimately entwined as Yinyang. Recall the Liangyitaijitu, which sums up the Yinyang relationship so admirably, and one should, perhaps, reproduce it here to remind the reader what it looks like–the eye, so to speak of the white fish (which stands for yang) is black (which stands for yin), while the eye of the black fish is white.

Figure 10.6: Liangyitaijitu

The Suwen, Chapter 4/lj㍐䰞䠁फ़ⵏ䀰䇪NJsays: ཛ 䀰Ӫѻ䱤䱣DŽDŽDŽ᭵ԕ ᓄཙѻ䱤䱣ҏ

Rendered as: Yinyang, which is found in greater Nature/the Macrocosm, is similarly found in the person-body/Microcosm. It is in accordance with the Laws of Nature, the zhouye jielü and the sishi jielü. The exterior of the person-body is regarded as yang, the interior as yin; the back as yang and the front as yin. In respect of the Zangfu/the visceral organ-systems, the Zang organs, the Liver, Heart, Spleen, Lungs and Kidneys are yin (their function as

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solid organs is one of transforming and storing). The Fu organs, the Gallbladder, Stomach, Large Intestines, Small Intestines, Bladder, and Triple Burners/Sanjiao are yang (their function as hollow organs9 is one of receiving and passing on). And how would we know that in the personbody, there is the concept of yin within yin and yang within yang? We know this by considering how the seasons (Time) bring about illness in the Zangfu. For instance, an illness occurring in Winter (yin), which affects the yin organs is yin in yin (such as the Kidneys, which are considered to be the most yin amongst all the yin organs, and are found in the lower part of the body). An illness occurring in Summer (yang), which affects the yang organs is yang within yang (such as the Heart, which is considered to be the most yang amongst the yin organs, and found in the upper part of the body). An illness occurring in Spring (yang), which affects the yin organs is yang within yin (such as the Liver, which is also considered to be yang, though not as much as the Heart amongst the other yin organs). An illness occurring in Autumn (yin), which affects the yang organs is yin within yang (such as the Lungs, which are yin though not as yin as the Kidneys amongst the yin organs), but are found in the upper part of the body (which is yang). This means that, in treating illnesses in the various solid visceral organs in the person-body using acupuncture, the physician must bear in mind the relationships between yin and yang in respect of season/Time as well as location/Space. In other words, both diagnosis and treatment are understood and conducted within the framework of Timespace. The back is yang. The Heart is considered as the yang within the yang, because it is also found in the upper part of the person-body (which is yang). Similarly, in Wuxing, it is paired with Fire. The Lungs are considered to be the yin within the yang (as in Wuxing, they are paired with Metal, which pairs with Autumn, when yinqi begins to increase at the expense of yangqi, which begins to decline). The Stomach is yin; the Kidneys are regarded as yin within yin (as in Wuxing, they are paired with Water (yin), which pairs with Winter (yin), and are located in the lower part of the person-body (yin)). The Stomach is yin; the Liver is considered to be yang within yin (as in Wuxing, the Liver is paired with Wood, which is paired with Spring, when yangqi begins to increase at the expense of yinqi, which begins to decline). The Stomach is yin; the Spleen is considered to be the utmost yin within yin (as in Wuxing, the Spleen is paired with Earth, which is yin, and is situated on the Taiyin Jingmai). This classification permits one to understand the relationship between the solid (the male) and the hollow (female) visceral organ-systems within the (Contextual-dyadic) rubric of polar characteristics, yin/yang, surface/interior, internal/external which, in turn, is to be explored within the wider framework of Macro-Micro-cosmic Wholism/Tianren-xiangying. (Texts within round brackets are the author’s interpolations.) 9

The exception is the Sanjiao–Chapter Nine addresses this matter.

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The passage is not easy to render intelligible to a reader outside the tradition of CCM. This rendering struggles between the demands of brevity on the one hand, and of clarity on the other, as well as against the temptation simply to present it, entirely, within the terms introduced in this book to characterise CCM. This author has succumbed, to an extent, to the last-named problem, and compromised regarding the first. However, the passage does present in a nutshell the themes of Timespace and particularly, in this context, of Contextual-dyadic Thinking. This itself straddles between ontology (of M-MW/Tianren-xiangying and the implications of such concepts) and epistemology-cum-methodology (of drawing up a classificatory rubric, to explore and present knowledge about the functioning of the person-body). As such, it may be relevant here to draw out in greater detail the nature of this approach in CCM. Those details are summarised below. 1. First and foremost, note that this author calls this “Contextual-dyadic Thinking”; it is about Dyadism; furthermore, this Dyadism is contextrelated and may therefore also be called perspectivism. In other words, any dyad, which one cares to look at, whether it be yin/yang, male/female, or large/small, has no fixed referents. This is a point which rests on Daoist philosophy (Daojia), and is made clear again in this volume in Chapters Three and Five. 2. Dyadism (as opposed to Dualism) confers no privileged status on one over the other. Ontologically speaking, the two terms cannot exist independently of each other–being inextricably entwined, they form an intelligible Whole. Yinyang is just such a Whole–yin cannot exist without yang and vice versa. On the conceptual level, it means that the one is unintelligible in the absence of the other. 3. Dyadism, embedded within Contexualism, and then applied to an investigation of the relationship between the various visceral organs and organ-systems in the person-body, yields a rich and complex matrix bounded by two vectors. These are that of Time (the four seasons in the annual cycle and their analogues in the Chinese 12-hour system in the daily cycle), and Space (the locations of the Zangfu). In this way, the matrix is one within Timespace (see Lee 2017a, in particular, Chapter Ten). 4. As in CCM, the temporal is primus inter pares in respect of the spatial dimension: let us begin with Time, the sishi jielü and relate it to the dyads

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Winter/Summer and yin/yang. For details, refer to the sections above in this chapter. Here, the reader will just be reminded that the Winter Solstice is the depth of yin, while the Summer Solstice is the height of yang. This is to say that, while yangqi in the former is at its thinnest and yinqi is at its greatest, in the latter, yangqi is at its optimum and yinqi is at its minimum. During the equinoxes, yinqi and yangqi are about equally distributed between the surface of the earth and beneath its surface. 5. In terms of spatial locations, the upper part of the person-body is yang and the lower part is yin. So if one relied on this distinction alone, it would imply that the chest (being in the upper part) must be resolutely yang, while the Stomach (being in the lower part) would be resolutely yin. CCM also uses another dyadic distinction, which holds that the back is yang, while the front is yin–therefore, it follows that as both the chest and the Stomach belong to the front of the person-body, they are both yin. It also follows that, relative to the context of distinguishing between the front and the back, the chest is yin; relative to the context of distinguishing between the upper from the lower part of the person-body, the chest is yang (while the Stomach is yin). One can say that while the chest is not resolutely yang (in all contexts), the Stomach is yin within yin, as it qualifies to be yin under two very different criteria of distinguishing between what is yin and what is yang regarding the visceral organs. The context, at all levels of analysis, is key. When the context is about the contrasting pair, upper/lower, it is clear that the former is yang and the latter is yin; when the context is the contrasting pair, front/back, the former is yin and the latter is yang. Indeed, context in all discourses without exception is key– a person in the context of her own natal family is a daughter; of her marital family she is a wife/daughter-in-law; of school, she is a pupil or teacher; of a hospital, she is a patient or doctor/staff; of a shop, she is a customer or serving staff. One is all of them at once, or only one of them, depending on the context, involving changes in Time and Space. Contextual-dyadic Thinking is foundational to Chinese philosophy/medicine. The Dao does not change but specific dao(s) do (Lee 2017a, Chapter Four). 6. In the distinction between the solid and hollow visceral organs, Zang are solid and yin; Fu are hollow and yang. The yin/yang pairing may be applied at any level of constructing a classificatory system for the purpose of analysing phenomena related to one another in a complex systemic way. Hence, the Zang (solid) visceral organs in turn, can be classified as having a yang aspect and a yin aspect, such that in CCM discourse, one talks of Heart yang/Heart yin, Liver yang/Liver yin, and so on. The same holds

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with regard to the surface of the person-body/exterior, such that the back is yang while the abdominal surface/front is yin. 7. Text Box 10.1 displays how the parts of a person-body in CCM, under Contextual-dyadic Thinking, involving the yin/yang pairing, are classified. Yang Upper part of person-body Exterior Back

Yin Lower part of person-body Interior Abdominal (front) surface

Fu Gallbladder Small Intestines Stomach Large Intestines Bladder

Zang Liver Heart Spleen Lungs Kidneys

Qi

Xue (Blood)

Jingmai Those passing over the surface of the back & outer face of the limbs

Jingmai Those passing over the surface of the abdominal aspect & inner face of limbs

Text Box 10.1: Classification of the parts of the person-body under Contextualdyadic pairings

Conclusion This chapter is intended to bring out the following observations. 1. The significance of CCM in terms of its identification and reference as Yidaoyi. One of the meanings of the term yi, in the very title of that canonical text called the Yijing, is change. Macrocosmic Qi is changing all the time in the course of the (ancient) Chinese twelve-hour day as well as in the course of the year–the zhouye jielü and the sishi jielü, in the terminology of this book, are Laws of Nature. In Chinese cosmology/ philosophy, the most fundamental concept to grasp about this everchanging Qi, is the relationship between yangqi and yinqi in the course of a day/year. These sets of changes are captured via the xiang/䊑 mode of thinking in the eight trigrams as well as the sixty-four hexagrams of the Yijing. That basic pair of polar contrasts–yin and yang–informs the Laozi (although it is correct to observe that the text itself does not invoke them

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by name), which expresses the relationship in the form of the Dao, of the Dao expressing itself as engendering one, one engendering two, two engendering three and three engendering Wanwu. (For details, refer back to Lee 2017a, Chapters Three, Four and Six.) Chinese scholarship has always understood “one” as “taiji” of the Yijing, “two” as yinqi and yangqi, and “three” as the relationship between these two qi forming a harmonious Whole, in dynamic equilibrium with each other. Once that dynamic equilibrium is established, Wanwu (of which Life on Earth, and human life, is a part) emerges and flourishes. 2. The Laozi also says: Humankind follows Earth, Earth follows Heaven, Heaven follows Dao, and Dao follows Ziran. In other words, Humankind follows Ziran. Ziran is where Macrocosmic Qi operates. This Qi follows the fundamental Law of Nature, namely, the Cyclic Law of AscendingDescending Qi, of which the zhouye jielü and the sishi jielü laws are derivatives. 3. Furthermore, if Humankind follows Ziran, then the Laozi could be interpreted as implying M-MW, through the concept of Tianren-xiangying. The Laozi also implicitly distinguishes between the metaphysical Dao, on the one hand, and the specific dao on the other; the former yields the latter in particular contexts of enquiry. In this spirit, following the teachings of the Yijing and the Laozi, the ancient Chinese established the specific dao of medicine. 4. If one had to put in a nutshell what CCM, the specific dao of medicine is about, as *Peng/Li 2008 has shown, it would be the axiom of the Cyclic Reversion of sheng-fu-jiang-chen regarding both Macrocosmic Qi and Microcosmic Qi, which is the concept of yuanyundong/ശ䘀ࣘ. This book has called it the Cyclic Ascending-Descending Law of Nature. If this Law of Nature functions without let or hindrance, both in Macrocosmic Qi and Microcosmic Qi, then the flourishing of Wanwu and good health in the person-body of the individual would ensue. Should the flow of Macrocosmic Qi face disruptions, this would affect the flow of Microcosmic Qi, and give rise to illnesses in the person-body. Should the flow of Microcosmic Qi in the person-body be disrupted (because the person’s zhongqi/ѝ≄ is deficient), then the person would fall prey to illnesses. Restoring health, on the part of CCM, consists of restoring the proper flow of Microcosmic Qi in the person-body, using a range of treatments, which include the decoction of medicinals, acupuncture,

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moxibustion, cupping, massaging, qigong, daoyin, nutrition, counselling/ psychotherapy and many others besides. 5. This chapter also demonstrates that CCM, instantiating Chinese cosmology/philosophy, rests on the notion of Timespace rather than Spacetime. Time is primus inter pares in respect of Space. Time pertains to Tian/the Sun and its (apparent) motion, while Space is Di/Earth; Timespace is about the changing relationships between Tian and Di in the Sun-driven universe which is yuzhou. The processes of Qi transformation, both in the Macrocosm and the Microcosm, mark nothing but changes in the relationship between yangqi and yinqi in the course of a day and of a year. Spring/morning is the time when yangqi rises, Autumn/afternoon is the time when yangqi decreases as yinqi increases and both descend; East is not simply the place, where the Sun rises and West, where the Sun sets. In the relationship between the Sun and Earth, it is the qi of the Sun in the course of a day and a year, which changes–more of yinqi and less of yangqi or more of yangqi and less of yinqi, at any one moment in time. This is what is meant by saying that CCM, resting on the Yijing, presupposes that the Universe (at least our universe of which our Earth is a member) is a Sun-driven universe (see Lee 2017a, Figure 6.8). 6. This chapter also amply demonstrates that CCM, as far as its cosmology/philosophy go, primarily rests on process-ontology rather than thing-ontology. The Cyclic Ascending-Descending Law of Nature is about the processes of Qi transformation (from less of yangqi/more of yinqi to more of yangqi/less of yinqi) during the course of a day/year and during the twenty-four qi-nodes, both in the Macrocosm and the Microcosm. It is concerned primarily with Qi as the fundamental ontological category, and of Qi-in-dissipating mode as the mode, which is primus inter pares in respect of Qi-in-concentrating mode. 7. As Contextual-dyadic Thinking is central to the Chinese way of understanding the world, it is not then surprising to see that CCM invokes numerous dyadic pairings, in constructing a classificatory schema of the various parts of the person-body, for the purpose of diagnosing and treating illnesses, when these various parts malfunction and when they lose Yinyang balance/equilibrium.

CHAPTER ELEVEN INTEGRATING ZHONGYI WITH BIOMEDICINE?

Introduction The first thing that must be done in this chapter, is to clarify certain key terms used. Up to now, this work has mainly referred to Classical Chinese Medicine/CCM. It has also referred to Traditional Chinese Medicine/TCM. Chapter Three has explored one significant difference between CCM and TCM. The latter wishes to retire the concept of Wuxing, as it finds it “obscurantist”/“unscientific”/“metaphysical” in the abusive sense of that term, while the former embraces it, as part of its identity. Chapter Eight has discussed the difference between the medicinal called qinghao and the pharmacological drug derived from it called qinghaosu. The former is found in the materia medica of CCM, but the latter is the product of the efforts of TCM researchers, familiar with CCM’s materia medica, to uncover it and turn it into qinghaosu. TCM embodies an attempt to integrate zhongyi/ѝ५1 with Bm. TCM is therefore Integrative Medicine (IM). In other words, the title of this chapter deliberately poses a rhetorical question, to which the short answer is “no”. One system of medicine cannot be integrated with another system without compromising its own 1

This term cannot, and will not, be translated into English as “Chinese Medicine”, for fear that an English reading public would identify it with TCM only (see, for instance, Scheid 2002). In Chinese, “zhongyi” simply refers to that medicine which, in one form or another, is practised today in China but whose roots go back at least two and a half thousand years. The term today in China may take two forms: what, in English, may be referred to as CCM (which does not want to compromise its historic philosophical/cosmological roots as found in the canonical texts), or TCM which does, as TCM is Integrative Medicine/IM. For instance, the title of *Liu Lihong’s book, which makes a passionate plea for CCM, is Sikao zhongyi, which may be translated as Systematic Exploration of Chinese Medicine or Systematically Exploring Chinese Medicine. It is obvious, then, that “zhongyi”, in Chinese usage, cannot be equated with TCM. For the purpose of this book, zhongyi will be presented as CCM-zhongyi or TCM-zhongyi/IM.

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integrity (at the level of its metaphysical/ontological core and the methodological implications of such a core, as well as at the level of treatment). However, the matter cannot be disposed of with such a swift, summary dismissal, as it hides many issues which ought to be excavated and brought to light. To begin with, one should distinguish between two contexts in which IM is undertaken around the globe today. The first is the Chinese project, whose goal is to integrate zhongyi with Bm. This has been a declared policy of the Chinese government for the past five decades or so. The second is primarily in the Western world, an initiative which is, by and large, free of any governmental support, and whose remit is wider than that of the first, as the “other” medicines to be integrated with Bm may include Ayurvedic medicine and homeopathic medicine,2 just to name two, other than zhongyi. For the purpose of this brief and limited assessment, Dong 2013 and WHO (2004, Reports 6, 7, 8, 9)3, on the one hand and Lake 2007 and NICCAM 2016 4 on the other, may be taken as fair representatives respectively of the two contexts.5 The first appears to be motivated by a sense of pride; it is about zhongyi as an outstanding achievement of Chinese culture and civilisation. It is no less motivated by a desire for modernisation: an impulse born out of the necessity for the reform and rejuvenation of that civilisation, after it had suffered humiliation at the hands of Western imperialists in the nineteenth century and the first half of the twentieth century. The second appears to be born out of disappointment with Bm itself (at least some aspects of it), as it seems to fall short in some cases/domains. The attitude is somewhat tinged with humility, in approaching so-called “complementary” others, in an open-minded effort to learn about their strengths, while recognising the weaknesses of one’s own medicine; above all to come to grips with the respective weaknesses and strengths of both Western and non-Western medicines. However, in spite of the ecumenical 2

See Hansen and Keppel 2017. This publication was issued by WHO in 2004, based on the WHO International Expert Meeting on SARS held in Beijing in October 2003. These Reports are based on treating SARS cases, using IM in China including Hongkong. 4 This stands for the National Center for Complementary and Alternative Medicine; it is under the aegis of the NIH, USA (its new name is NCCIH/National Center for Complementary and Integrative Health). Lake claims his methodology differs from that of NIH-sponsored studies (see Lake 2007, 59). 5 Dong is at the Institute of Integrated Medicine, Huashan Hospital, Fudan University, Shanghai; Lake is at the Department of Psychiatry and Behavioral Sciences, Stanford University Hospitals, California. 3

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spirit of the second project (as represented by Lake), it nevertheless implies that Bm is the conventional/dominant medicine of Modernity, while the other medicines are complementary to it. The first project ultimately shares a similar standpoint, as will be shown. They are not free from inconsistencies; as Lake (2004, 2007) has carried out a more systematic examination of the core themes of IM, this chapter will pay it considerably more attention. Next, one needs to explore what could be meant by “integration” of the Chinese and the Western in the two contexts already identified. Let us also understand integration, as seems natural, to mean assimilation, where the one medicine is to be assimilated with the other. In the light of the discussion above, the chapter ends with an appeal for peaceful coexistence between Bm, TCM/IM and CCM in China today. Given that Bm and CCM-zhongyi differ at the level of their respective metaphysical/ontological cores and of their respective methodological differences, the only way forward, if one wants to aim at a respectful and dignified relationship between these medicines, is peaceful coexistence.

Integration as assimilation We have said that it seems natural to understand integration in terms of assimilation. (Call this the Assimilation Model or AM for short.6) Here is one justification for saying so, by looking at an analogue in another discourse, namely, political discourse. An example of AM in recent European history can be found in the case of Western European Jewry, but in Germany and France only.7 Jewish Emancipation8 occurred step by step in France and Germany. Emancipation, however, was dependent on acculturation (a less radical term than assimilation) (see Richarz 2008). 6

“AM” is meant to stand for “the concept of the Assimilation Model” rather than simply for “the Assimilation Model”. 7 The operative words are “Western European” in general, and “France and Germany” in particular. Assimilation, as characterised in this chapter, only occurred in these two Western European countries. This discussion then, necessarily excludes Jewish communities which existed during the same period in other parts of Europe. In Russia, the Haskalah Movement did not, for a variety of political and social reasons, so much lead to assimilation as to produce a modern Jewish community, without losing its Jewish identity, in terms of adhering to its language and religious practices. 8 Jewish Emancipation in Germany and France meant the abolition of discriminatory laws against Jews, the recognition that Jews were/are the equals of other citizens, as well as formally granting them citizenship.

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With Emancipation, there emerged the Haskalah Movement, sometimes referred to as the Jewish Enlightenment, which began with the Berlin philosopher, Moses Mendelssohn (1729-1786). Its main goal was: …to lead the Jews out of the religious ghetto, to integrate the Jewish with the non-Jewish world, and to bring separation to an end in favour of nonJewish tendencies, customs and knowledge. The pre-requisites for such integration were modernisation and ending the centuries-old blending of religious and social life. (Schumacher-Brunhes 2012)

Modernity in the form of secularisation and urbanisation meant that the followers of the Haskalah dropped Yiddish, and accepted German or French education as the method of integration/assimilation. As a result, many Jews achieved great distinction as scientists, musicians, bankers, and manufacturers (amongst the elite professions), as well as in less exalted occupations that previously were closed to the Jewish peoples in those two countries. In other words, they lived their lives as other citizens, to all intents and purposes. Alas, such an assimilated/acculturated/integrated world was shattered with the rise of Nazism, leading up to the Holocaust in the twentieth century. The point of citing the Emancipation-Haskalah Movement (in Germany and France) is simply to work out in analytical/structural terms whether AM involving zhongyi and MM/Bm is analogous to that in the political discourse of German and French Jewry outlined above. It is obvious that the Jews in those two countries recognised that German or French culture was the dominant culture (call it X), and that their own traditional culture was not (call this Y). AM, in this context, appears to imply a relationship which does not amount to one of equal partnership. This is not to say that the Emancipation-Haskalah Movement did not involve a melding together of the two cultures in a more or less Wholistic fashion. By the time of the rise of Nazism, one could distinguish in this domain, three different cultural groupings in Europe: the dominant European-Christian group(s) on the one hand; and on the other, the Jewish Emancipated-Haskalah group (primarily in Germany and France); and the traditional Jewish group(s) in other parts of Europe, who were not (for a variety of reasons) caught up so much with assimilation under the Emancipation-Haskalah Movement. When the framework is borrowed, would one be able to identify analogous groupings to shed light on the relationship between Bm, on the one hand, and zhongyi, on the other?

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The Chinese project of IM We next turn to the Chinese project. It is necessary to distinguish between two attempts that occurred at different historical periods: the present ongoing project since the 1950s, and that which occurred roughly during the first three decades or so of the twentieth century. Chinese scholars rightly remind us that the project of integrating the two medicines in China– Chinese and Western (zhongyi and Western Medicine/WM)–did not begin, under the auspices of the PRC government. First, we explore the earlier project, as pioneered by Zhang Xichun, the distinguished scholarphysician of the late Qing dynasty and early Republican period (see Hsu 2001, Andrews 1996, Scheid 2002, Buck 2014, Raphals 2015, *Luo 2011, 2014a, 2014b). He was appointed director of the first ever established zhongyi hospital in Shenyang, 1918, a project of which he was a leading light. When WM was first introduced into China in a significant manner in the nineteenth century, he familiarised himself with it, and taught himself basic Western sciences, such as biology, physiology, even mathematics. He wrote profusely about zhongyi; later, some of these writings appeared as a book, in which were also recorded his own efforts to integrate zhongyi and WM. This book, calledlj५ᆖ㺧ѝ৲㾯ᖅNJ/The Assimilation of Western Medicine to Chinese Medicine, has turned out to be very influential. More than 70% of zhongyi practitioners of two decades ago, if not, today, rated it as having influenced them most, out of a list of ten zhongyi authorities. In it, he recorded Western drugs used in China at the time, noting their medicinal properties and the purpose of their use. Although many of these drugs had long been retired, nevertheless, his record of them is of historical interest. From 1918, his pioneering work on the incorporation of WM into zhongyi became widely known in the country. In 1926, he left Shenyang for the relative calm of Tianjin, and in 1927 he opened a clinic in the city, called ѝ 㾯 ५ ≷ 䙊 ५ ⽮ , a clinic and institute for promoting the integration of Chinese and Western Medicines. The cases he dealt with at this time were recorded, through updating his important and influential book which, in turn, became even more influential. In particular, he had written about two Western drugs, aspirin and quinine that he had incorporated into his fangzi. At that time, many young people had succumbed to wenbing/⑙⯵ (see Chapter Nine). In some cases, the illness became what is called 䱣᰾㞁ᇎ䇱/yangmingfu shi zhèng. The zhèng in question presented itself in one patient as follows: dry, solid stool, high temperature and a mai that was taut but with strength/བྷ‫ׯ‬⠕㔃ˈਁ 儈✗ˈ㜹䊑ᴹ࣋ᴹ⛩ᕖ. Zhang Xichun prescribed Baihutang/ⲭ㱾⊔, a Zhang Zhongjing formula, to which he had added some ginseng, because

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the patient’s proper qi/zhengqi/↓≄ was inadequate. The classical formula itself has only four medicinals of which one is gypsum; Zhang Xichun used raw gypsum/⭏⸣㞿, as this medicinal would aid the ginseng to restore the proper qi of the patient. After taking this decoction, the patient’s temperature became normal, but he developed a new symptom, showing signs of being confused. To cope with this condition, Zhang Xichun prescribed some aspirin, as in his reckoning, gypsum, which is a heat-clearing medicinal, was insufficient to clear out all the heat in the person-body; the aspirin would help it to do so via the emergence of a rash/⯩. The patient recovered after that rash attack. He also used quinine, which he called jinjinashuang/䠁呑㓣䵌. This drug was the drug of choice in Western medicine for treating malaria at that time, though it was not successful in treating all cases of malaria. With such recalcitrant cases, Zhang was successful, using quinine in conjunction with raw/unprocessed gypsum. According to The Divine Husbandman’s Classic of Materia Medica, this medicinal is somewhat han/cold in character. Down the centuries, owing to an erroneous understanding of its character, physicians had used it with great caution, and in very small quantities, believing it to be extremely han in character. Zhang Xichun was confident that this was a mistaken view; he used it in large quantities; he instructed his patients to decoct two large bowls of the unprocessed gypsum (one catty/ᯔ,which is roughly one pound) and to take it until the heat had gone, and then to take some quinine. He analysed the nature of aspirin within the framework of Chinese pharmacology; a herb’s flavour is crucial in determining its functional properties when introduced into the person-body of the patient (see Table 4.1 about the flavours of herbs in terms of Wuxing and Tianren-xiangying). He wrote: ަણ⭊䞨ˈަᙗᴰழਁ⊇ǃᮓ仾ǃ䲔✝৺仾✝⵰Ҿ‫ޣ‬㢲֌⯬Ⰻˈަਁ 㺘ѻ࣋৸ழ㺘Ⱇ⯩

Rendered as: The flavour of aspirin is somewhat sour; its characteristic capabilities include bringing on sweating, dispelling wind, getting rid of heat and wind-heat, which induce pain in joints, as well as bringing out to the surface, fever rash.

In other words, Zhang’s understanding of integration is in terms of assimilation; it amounts to commandeering Western drugs to put them to

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use within the framework of CCM-zhongyi. The spirit of his project was but a reflection of the prevailing political (in the larger sense of the word) sentiments of the time. Towards the end of the Qing dynasty and in the early decades of the Republican era, when faced with the challenge presented by Western military and scientific-industrial might, the Chinese felt the need for reform in order to survive. This reform was dictated by a very ancient important philosophical distinction in Chinese civilisation between փ/ti and ⭘/yong: the former may be translated as “foundation/ basis”, and the latter as “use/instrumental value”. (Ti may also be represented by ᵜ/ben which means “basis” or “foundation”; for example, the expression ԕӪѪᵜ/yi ren wei ben/the basic or foundational ethical value is humanity, humaneness.)9 This distinction is found in any domain of activity, be it calligraphy, painting, martial arts or medicine. Every domain of activity has two aspects to it, namely, an internal and an external, which the practitioner must cultivate together and simultaneously. Ti refers to the philosophy and theory presupposed by the activity, constituting the internal aspect. Doing calligraphy is not simply wielding the writing brush in a particular physical manner (this is the external aspect which is waigong/ཆ࣏). Rather, it is wielding the brush in such a way that it must be accompanied by inner self-cultivation/neigong/޵࣏, which then would find expression in the manner and spirit in which the brush is held and the strokes are made; in other words, the inner and the outer affecting the piece of calligraphy ensuing as a Whole. In contrast, modern/Western civilisation is different, with its focus on techne–in fighting, the emphasis is on the power of the gun held in the hand, the more powerful, the better. The soldier is trained simply to operate the killing machine as efficiently as possible. One killing machine is more powerful than the one it superseded and is, therefore, better. The modern machine gun is more powerful/better than the Gatling gun; the fighter planes of today are more powerful/better than those which were used during WWII. The expert handling and use of the machine is all. In Chinese martial arts, the expert is not simply someone who knows how to see off the opponent with the sharpest knife or sword available, but it is the melding together of the quality of the weapon with his own inner strength and spirit, in which the act of fighting is carried out. The introduction of modern/Western thinking into China has, unfortunately, eroded away or downgraded ti, privileging only yong. Today in Bm, diagnosis is done in the main by tests performed by machines, and 9

It is interesting that in jianti today, ti/փ is written with ren/Ӫ as bushou and with ben/ᵜ as the second component.

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machines have no souls. Such a worldview which, today, is politically and culturally more powerful than the ancient Chinese one, is bound to erode away the inner aspect of zhongyi, through downgrading and undermining its ti, unless one (such as those who are committed to CCM-zhongyi and ensuring its survival) were consciously to resist such an erosion. However, in the first two decades of the twentieth century, the incursion of WM into China was still in its early days. It was possible for Zhang Xichun to mount his research assimilating some Western drugs within a framework, which could be said to accord with the expression ѝ փ㾯⭘/zhong ti xi yong, rendered as “The foundation is Chinese culture/ civilisation with Western science and technology as its hand-maiden, an instrument to enhance its scope and its flourishing”. In other words, in Zhang Xichun’s understanding of the relationship between zhongyi and WM, the former is X, as it is ti or ben, and the latter is Y, as it is yong. Zhang’s AM project was conducted within the metaphysical Wholist framework of what today one calls CCM-zhongyi; this means that the ti/ben of zhongyi remained intact. However, and unfortunately for the Chinese, the pioneering work of Zhang did not act as a flood-gate for such research; instead, his work in the end amounted to only a trickle which soon dried up. We will next turn our attention to the on-going project, initiated in the 1950s, which seems to constitute the mirror image of Zhang’s attempt at integration as assimilation. At one important level, though not the only one, it manifests itself in the great interest which Bm takes in ethno-botany, through its search for plants whose medicinal properties could be turned into pharmacological products. Chapter Eight has looked in detail at the identification of one such plant–Herba Artemisiae Annuae–from which is extracted its active ingredient, artemisinin, the transformation of qinghao into qinghaosu. This transformation entails that Bm is X (the dominant/senior partner, indeed, is ti/ben) and zhongyi is Y (the lesser/ junior partner or yong). If one were to retain the traditional Chinese distinction between ti and yong, the original expression, zhong ti xi yong (which applied to Zhang Xichuan’s project) would have to be inverted to read xi ti zhong yong/㾯փѝ⭘. The medicinal qinghao is only of use to Bm (which is ti) when the whole herbal has been reduced to qinghaosu, (which is yong), the drug containing the active ingredient of qinghao.10

10

Lake 2007, xv writes: The increasing use of herbs or other natural substances as medicines is an example of increasingly accepted empirical approaches that do not require

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This project is then isomorphic to that of Zhang Xichun, for which aspirin and quinine, on their own, would be of no use to zhongyi. They would only be useful if they had been “domesticated” within the framework of the Chinese Materia Medica and its use, as understood by zhongyi (that form which today we call CCM), in terms of its trinity of shengli-bingliyili, constituting its ti (see Chapter Nine). The next example of integration as assimilation in terms of xi ti zhong yong is not quite so simple, and comes from Chapter Two, which gives a reconstruction of Zhu Zongxiang’s experiments, in which he and his team attempted to show that the Jingluo really exists and is not fictional. In a straightforward sense, one can even argue that the team is doing nothing more than evaluating one system of theory-practice using the methods of another system of theory-practice. At this level, there would be no hint at all of AM, as the findings are agnostic in respect of such a project. However, at another level, one might begin to detect AM at work. Chapter Two notes that this set of biophysical experiments was commissioned by the Chinese government, which is behind the IM Project as already observed. The thinking behind the commission could be articulated as follows. Jingluo is such a crucial part of zhongyi, any attempt to incorporate that part of CCM-zhongyi into TCM-zhongyi would be a critical error, unless it could be shown to exist (independently of CCMzhongyi’s own assessment of its validity), by the standards of biophysical scientificity. Such a rationale would imply that, if the experiments had not been successful in establishing biophysical data for the Jingluo, then, the concept of the Jingluo would have to be written off as fictional and abandoned, as far as TCM-zhongyi/IM is concerned. Recall, too, that Professor Zhu was himself, to begin with, a sceptic regarding the existence of the Jingluo. We have seen in Chapter Two that the H0, if formulated explicitly, would have been in accordance with the Biomedical theoretical expectation that the Jingluo would not, crudely put, be said to exist; that is, detectable through biophysical methods. It is fitting here to remind the reader that Chapter Three argues for the intelligibility of Wuxing as part of the identity of CCM-zhongyi. This argument is against those who suspect the concept, regarding it as “metaphysical” (in the abusive sense of the term) and hence are keen to changes in the basic theoretical or methodological framework of western science as it exists in the early 21st century. Obviously, no change in “the basic theoretical or methodological framework of western science” is required, because the herbs are simply incorporated into the framework, through transforming their properties, say, from qinghao to qinghaosu.

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exclude it from the TCM framework, as such a theoretical framework can only admit material, which approximates, as much as it is possible, to the criterion of scientificity, endorsed by Modern Science/Medicine. One can see then the spirit of AM at work, with Bm as X (ti/ben) and zhongyi as Y (yong). What does such an investigation, led by Zhu Zongxiang, against such a postulated background, presuppose in detail? 1. It is clear that CCM-zhongyi has implicitly, through the centuries, proffered a set of criteria for its existence in terms, for example, of the effects that needling at certain xuewei would produce. In terms of the philosophy of science, this may be called causal realism. (See Chapter Two for a brief account as well as for the causal outcomes of acupuncture treatments based on the experience of Hao Wanshan; see also Text Boxes 2.1a, 2.1b, 2.1c and 2.2.) 2. In the eyes of sceptics, these CCM-zhongyi criteria either do not count or they are insufficient to warrant the status of being scientific. What then warrants scientificity? The claim that the Jingluo exists, is real and has real effects, must be matched by its compatibility with the criterion of existence, endorsed by Bm. In other words, the Jingluo exists, if and only if it can be shown to exist in the laboratory in ways analogous to those used by the Large Hadron Collider underneath Geneva, to demonstrate through its experiments, the existence of the Higgs boson. 3. Some Zhongyi defenders in China may, with relief, invoke the results of these experiments, as they appear to have pulled the rug from under the feet of those who mount their sceptical attacks from the standpoint of Bm. 11 The Chinese government, and probably, some Chinese people (outside the CCM community) need no longer feel uncomfortable with the concept of the Jingluo, as this fundamental component of the medicine can be justified not solely in terms of what CCM-zhongyi considers to count as “reality”. Some Chinese have even labelled the discovery of the “reality” 11

Alas, this heroic effort until today has not penetrated beyond China’s borders, not even amongst those who ought to know–witness what Lake (2007, 13-14) has to say about Qi, which he claims to be a metaphor. Furthermore, he holds that qigong (this technique, for “concentrating qi” in order to use the power of Qi to perform healing and other tasks) belongs to the lowest possible category of clinical medical approaches, which he calls the “intuitive approach”. “By definition, intuitive clinical medical approaches are not susceptible to analysis or verification using available empirical methods” (Lake 2007, 58); see also 62-63.

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of the Jingluo as the fifth great Chinese contribution to Humankind, the other four being the inventions of the compass, gunpowder, paper-making and printing (made familiar in the West by Joseph Needham). However, sad to say, even in China, the perception of this discovery has not been uniformly warm and welcoming, as sceptics exist aplenty, who are/were determined to remain unmoved. This scepticism, probably, in the end, led the Institute of Biophysics, under the aegis of the Chinese Academy of Science to stop funding the research (see “A Different Point of View” 2007), although this did not deter the professor from carrying on with his new-found enthusiasm for the Jingluo network, which underpins (Classical) Chinese Medicine, in other ways. What does the above really show? Three points are worth noting. 1. It is Bm that ultimately defines scientificity. The status of scientificity is bestowed on a certain domain, if and only if it conforms to the requirements: the experiments designed to ascertain its existence are repeatable, measurable and quantifiable via biophysical mechanisms endorsed by Modern Science, in general, and Bm, in particular. Professor Zhu’s experiments appear to satisfy these requirements. This shows that, from the standpoint of what counts as scientific, Bm is X (ti/ben), the senior partner; and zhongyi is Y, the junior partner who is permitted to serve as a handmaiden to Bm; hence, it falls into the category of yong rather than ti/ben. In other words, au fond, this model does not so much approximate to Zhang Xichun’s project; it leans towards that of the artemisinin type of project. They embody xi ti zhong yong. 2. At another level, it shows something even more fundamental, namely, Essentialism of Method (see following section), which entails that only Modern Science/Medicine counts as “proper” science/medicine. CCM rests on process-ontology, especially on Qi in its Qi-in-dissipating mode; on physiology/functioning in its non-linear, multifactorial model of causation. This is very different from Bm, which rests on thing-ontology, anatomy/structure, and on the Humean Billiard-ball causal model. Thus even biophysical evidence for the Jingluo appears insufficient to overcome the deeply engrained prejudice against CCM. Further, resistance remains against what is considered to be its “alien” metaphysical framework and its methodological implications for doing science.

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3. Karchmer 2017 correctly identifies the above points as a manifestation of the “Postcolonial predicament of Chinese Medicine,”12 a predicament shared by both the “coloniser” such as Professor Floris Cohen (see Chapter Twelve) and the “colonised”, the Chinese sceptics, who remain impervious to evidence, even when these are presented in biophysical terms.

The TCM project at the level of drug use The TCM-zhongyi project, at this level, constitutes the most common strand of IM, whether practised in China or in the West. This level involves the following. AI. Zhongyi medicinals (and other treatments) are said to be efficacious in varying degrees in many instances. This is to say that they relieve totally or ameliorate substantially a particular symptom pattern,13 such as fever, diarrhoea or whatever other patterns of illness. In some cases, they produce better results than Bm drugs in respect of a certain symptom pattern, producing less serious or no side effects.14 AII. Such medicinals said to satisfy AI above, when used in conjunction with Bm drugs, are effective in the following senses: (a) They can reduce (some) side effects of Biomedical treatment and drugs, such as radiation, chemotherapy, corticosteroids (principally prednisone), oral contraceptives, oral abortifacients, antibiotics and anti-psychotics (Lake 2004).

12

On the concept of post-colonial mentality, see Chakrabarty 2000. The term used by Lake 2004, 2007. 14 In contrast, Lake 2004 says: 13

Emerging evidence suggests that chronic use of certain antipsychotic medications up-regulates the brain’s dopamine system, exacerbating and prolonging psychotic illnesses. In some cases, side effects (including weight gain, tremor, and liver toxicity) are so serious that 50% of bipolar patients opt to stop using the medication in spite of the demonstrated efficacy. Lake holds that while “all Chinese and Western treatments can cause side effects or toxicities, Chinese medicine limits the potential magnitude and consequences of risks”.

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(b) They may be used (deliberately) in conjunction with Bm drugs to produce better results than using Bm drugs alone, in the amelioration of a certain symptom pattern. (c) Recent evidence shows that certain zhongyi treatments are effective in conditions for which Bm has none to offer, such as in age-related memory loss and other kinds of memory problems (Lake 2004). For Lake, a passionate advocate of IM in the West (at least in the domain of mental health care), the merits go beyond the above for a mixture of other reasons. There is the practical one, using TCM-zhongyi treatments cost patients less than Bm treatments, even if both are efficacious to the same extent. The second is the theoretical one, as zhongyi increases the patient’s feelings of control or empowerment (coherence in healing), which promote the process of healing itself. Thirdly, as zhongyi’s framework is Wholistic, treating the whole patient rather than the major complaint can help patients experience an improvement in symptoms other than the major one presented. We shall be returning to Lake 2004 later. However, so far, this account is at best partial, and one needs to look at it in the light of Lake 2007, where he spells out more systematically and in greater detail the relationship between Bm and “complementary others”. He invokes the following distinctions. I. Three modes of assessing evidence for any medical intervention in respect of a symptom pattern: Substantiated, Provisional and Possibly Effective (Lake 2007, 58). Substantiated: evidence which is compelling: … use of the approach reliably enhances the accuracy or specificity of assessment finds, or improves treatment outcomes with respect to a specified cognitive, affective, or behavioural symptom (which includes) compelling positive evidence from rigorously controlled studies.

Provisional: based on strong evidence from research and clinical observations. Possibly Effective: evidence which is limited or inconsistent research and clinical evidence. II. Three general classes of conventional and non-conventional medical modalities: Empirically derived, Consensus-based and Intuitive. It appears that what is Empirically-derived could be Substantiated, Provisional and Possibly Effective. The class of Consensus-based modalities falls short of

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Substantiated, although it may eventually qualify as Provisional and, in some rare cases, even qualifying as Substantiated, while others would be Possibly Effective, because of inconsistent findings. This latter class rests on the endorsement by a professional medical society, as ex hypothesi, it lacks “compelling evidence”. The third class of Intuition-based modalities, by definition, is not susceptible to analysis or verification using extant empirical methods, and so would be assessed, ex hypothesi, as Possibly Effective, only, although in principle, it cannot be ruled out that, in some distant future, some may be designated as Provisional or even Substantiated. Lake implies the following relationship between I and II above: (a) Empirically-derived is paired with Substantiated, constituting the highest form of scientificity. (b) Consensus-based cannot be paired with Substantiated and at best it can be paired with Provisional; it may also be paired with Possibly Effective. (c) Intuitive approaches are paired, at best, with Possibly Effective. Lake’s implied pairing as set out, in turn implies the following hierarchy of scientificity (in descending order) and, hence, of guidelines in his account of IM. 1. Modalities and approaches whose outcomes are Substantiated–the paradigmatic cases that qualify are those which pass the twin Gold Standards of RCT-EBM. In the case of RCT, Lake is even stricter than Evans, Thornton and Chalmers, 2011, as he demands double-blinding (Lake 2007, 63) as well as randomisation, whereas the British writers rely only on randomisation in the main (see Chapter Seven). As a result, in the opinion of Bm experts, such as those sponsored by NCCIH in the USA and by CC in the UK, nearly all, if not all those studies involving nonconventional medical approaches fail to reach such a standard.15 15

“For most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used” (NCCIH 2016b). “Most Cochrane systematic reviews of TCM are inconclusive, due specifically to the poor methodology and heterogeneity of the studies reviewed. Some systematic reviews provide preliminary evidence of Chinese medicine’s benefits to certain patient populations, underscoring

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Choose Substantiated over other approaches, whether conventional or non-conventional, which fail to satisfy this highest criterion of scientificity 2. Modalities and approaches, whose outcomes are Provisional, for instance, in the context of conventional approaches, those Bm drugs that are Consensus-based (such as “off-label” ones), and in non-conventional approaches, some Chinese ones (CM) which he, Lake, had identified as: (a) Effective when Bm drugs are not. (b) More effective than Bm drugs even when these are effective. (c) When such CM approaches, used in combination with Bm treatments, are more effective than using effective Bm treatments alone.

3. When 1 and 2 above are not available, use approaches whose efficacy is verified as Possibly Effective, but whose putative mechanism of action may be unverifiable. 4. Do not use any approaches whose efficacy is unverified or refuted and whose putative mechanism of action is unverifiable. The above guidelines have been extrapolated and pared down from those given by Lake 2007, but the essential spirit of such a project is contained in them. Guideline 1 is singled out for special comment as it typically embodies a concept of integration, which considers Bm to be the dominant (X) and zhongyi the contributory or complementary component (Y). 16 This means that Bm is the senior partner/X, and zhongyi is the junior partner/Y. When all is said and done, the RCT-EBM Gold Standards define scientificity in the context of drug testing; as zhongyi does not rise to such standards, they must be downgraded to Guideline 2 and, in some cases, even to Guideline 3. Such a perspective is analogous to that version of AM as illustrated by the conversion of qinghao to qinghaosu, when Bm is ti and zhongyi is yong. This, then, is what TCMzhongyi amounts to. the importance and appropriateness of further research. These preliminary findings should be considered tentative and need to be confirmed with rigorous randomized controlled trials” (Manheimer 2009). 16

This chapter focuses only on zhongyi as the non-conventional medical modality in the IM project, unlike Lake 2007, which covers several.

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Exploring the incoherence of Lake’s account of IM It seems odd at first sight to charge the model of IM, worked out in such systematic detail, with incoherence, as Lake himself appears only too well aware of the pitfalls that could be lying in wait for him. He is very careful in making it absolutely clear that Bm/“conventional medicine” in his terminology and zhongyi/“nonconventional medicine” cannot be integrated, at the level of their respective metaphysical cores. Lake (2007, 3-4) writes: Many nonconventional treatments, and the systems of medicine from which they originate, rest on assumptions that are fundamentally at odds with the philosophical position of Western medicine, which argues that the causes of illness are invariably reducible to physical or biological factors. Nonconventional systems of medicine rest on other assumptions, including the role of complex nonlinear processes in illness causation, the nonlocal nature of space-time, and the corollary view that consciousness has nonlocal effects on health and illness. Further, mind-body and energetic approaches argue that the role of consciousness in healing is not explainable using contemporary scientific models of brain functioning. From an integrative perspective, health and illness are manifestations of complex dynamic interactions between psychological, physical, biological, social and, spiritual factors at multiple hierarchic levels of organization in space and time.

Compare the above with Chapters Four and Six in this volume, in particular, to see how much Lake and Lee see eye to eye with each other on this point regarding the respective metaphysical/ontological cores of Bm and of zhongyi. However, profound differences between them remain, which lead this author to charge Lake with what may be called Essentialism of Method, in spite of his declared open, ecumenical stance. What then is Essentialism of Method? Although this is not the place to demonstrate in full its provenance and its detailed nuances, a very brief outline here is called for. Simplistically put, it is: (a) In every intellectual domain of activity, there is only one method of conducting it, which is deemed to be the correct/proper way. (b) It follows that, whatever method deviates from the “correct/proper” way, is deemed to be sub-standard/inferior/even unintelligible. (c) In the context of different medical systems and practices, it follows that only one way of undertaking the activity is the “scientific”/ “correct” method, and other systems would be deemed to be “not scientific”/“less scientific”/“pseudo-scientific”; it turns out that Bm/WM, since the nineteenth century–its theory/method/practice–

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has been deemed to embody “scientificity”, and other systems of medicine are deemed to be “not scientific/pseudo-scientific/not so scientific”. Essentialism of Method may be seen, in many contexts, as part of what is sometimes called Eurocentrism, a view that came to the fore during the second half of the eighteenth century, when Europeans began to view nonEuropean cultures as inferior to their own. Surprisingly, it can be traced to the heart of the Enlightenment, in the very writings of Immanuel Kant (1724-1804), often dubbed the greatest Enlightenment or indeed, even the greatest philosopher of all times, trumping Aristotle or Plato. Leibniz (1646-1716) and his better-known followers (Wolff and Bilfinger) and others preceding them such as the Jesuits in the seventeenth and eighteenth centuries, had held very positive views about Chinese culture, in general, and philosophy, in particular (see Lee 2017a, Chapter Nine). Kant appears to have pioneered a radically contrary evaluation of Chinese and other non-European cultures and peoples. For forty summers or so, in his lectures on geography (Physical Geography 1756-1796), Kant told his audience that the Chinese … lack talents almost as much as the Negroes do. They have not distinguished themselves in the sciences in so many centuries, so that not a single one of them has become famous and one might learn something from them … there is a nation [the Chinese], that has no talents for invention or insight into matters of the mind … (in the field of moral philosophy) that the entirety of Confucian morals consists of ethical sayings that are intolerable because anyone can rattle them off … (that the Chinese) never get very far in those sciences at which one arrives through concepts. (For these quotations, see Reihman 2006; Bernasconi 2002.)

In 1764, 2: 252, Kant observed: What trifling grotesqueries do the verbose and studied compliments of the Chinese contain! Even their paintings are grotesque and portray strange and unnatural figures such as are encountered nowhere in the world. They also have the venerable grotesqueries because they are of very ancient custom, and no nation in the world has more of these than this one.

Kant also famously pronounced that “philosophy is not to be found in the Orient” (Ching and Oxtoby 1992, 223). For two centuries afterwards, this mantra was assiduously taken up first by Hegel, then Husserl,

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Heidegger, Gilbert Ryle 17 (elected Waynflete Professor of Metaphysical Philosophy at Oxford University after WWII), Derrida (1930-2004) and nearly every philosopher, of note or unnoted, in the West, until very recently. Kant’s works in the Critical Period (1780-1789) are held to constitute a high-water mark in the European tradition of philosophising, and it appears, undoubtedly to many, that any other way of philosophising (especially in non-European cultures) would not count as doing philosophy, or doing it “correctly/properly”. Kant’s low opinion of the intellectual/cognitive capabilities of nonEuropeans can be directly traced to his racism–he is indeed the pioneer of scientific racism (Bernasconi 2002). (On the above, see also Lee 2017a, and Lee unpublished, “Kant”.) Kant’s sense of European superiority could be seen as part of the rise of Modernity, beginning in the seventeenth century in Western Europe and culminating, it is said in Newton’s achievements in science, the Industrial Revolution in Britain in technology and Kant’s Critiques in philosophy. These achievements were accompanied by military might and command of the seas, which enabled several European powers to establish their empires around the world–this era of Western imperial expansion and colonisation began with the rise of Portugal as a global sea-power from the late fifteenth century. For those who unwittingly/subconsciously follow(ed) Kant, it was crystal clear that one would not touch zhongyi with a barge pole, as it is/was, without a shadow of doubt “unscientific”. For the more discriminating such as Lake, not all of it is sub-standard, and can be rescued, provided such parts can be accommodated within the pale of “scientific” medicine, as TCM-zhongyi tries hard to do. This shows that Essentialism of Method in intellectual domains18 exists today in two forms: (a) The fearsome version, just outlined above, pioneered by Kant, based on racism. 17

The first words uttered by the good professor to this author (quite unprovoked), when she arrived in Oxford to do a postgraduate degree in philosophy in the early 1960s were: “There is no such thing as Chinese philosophy.” 18 Essentialism of Method can be shown readily to lead to a reductio ad absurdum, once one departs from the intellectual to the non-intellectual domains of activity. The French may claim that their cuisine is the first/best in the world; even French pride in their culinary genius does not make them claim that it is the only cuisine or the only “proper/correct” cuisine in the world. If they were to do so, they would become a laughing stock in the world.

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(b) An attenuated version adhered to subconsciously and unwittingly, in the medical context, by theorists such as Lake, that has nothing to do with racism and the denigration of non-European others. It is simply the view that the highest standard of medical scientificity is to be found in the Twin Gold Standards of RCT-EBM. Subconsciously following Version (b) led Lake to postulate a conception of IM which runs into incoherence. This appears to be a consequence of his failure to realise that the metaphysical/ontological core (ti/ben) that underpins any domain of theory-practice, possesses its own respective methodological implications, which can be tested, even though its own core claims per se may not easily lend themselves to empirical testing. It is Lake’s failure to grasp what is highlighted above, which leads him to Version (b). As Lake has pointed out, the metaphysical core of Bm includes: Materialism-cum-Empiricism and Mind-Body dualism, to which may be added thing-ontology. On the other hand, zhongyi embodies Contextualdyadic Thinking, Em-ism, process-ontology and Wholism (as Lee 2017a clearly shows). Methodological implications of the metaphysical core of Bm include Reductionism (in this context to reduce that which can be observed to exist via the bare senses/instruments to physical, quantitative and measurable dimensions); and linear, monofactorial causality as embodied in the Humean Billiard-ball model of causation. In contrast, the methodological implications of CCM-zhongyi include non-Reductionism of Body to Mind (or Mind to Body); a model of causation which is multifactorial and nonlinear; and a dynamic model of interrelated systems (whether these are individual organ-systems, the totality of organ-systems or other larger systems within which the person-body is embedded). CCM-zhongyi is Ecosystem Science, which postulates systemic causation, not merely upward causation (see Lee 2017a, Chapter Ten). Curiously, at another level, Lake appears to grasp the above in a limited way, but perhaps not fully enough. Take what he says about qigong which amongst all the other zhongyi modalities, he consigns to the merely Intuitive “for which empirical evidence of a putative mechanism will probably not be forthcoming for many decades, if ever” (Lake 2007, 62). Yet he also admits that (P)atients who receive qigong treatments frequently experience physiological changes that may be associated with the claimed effects of qigong, for example, “energy” flowing from a qigong master resulting in beneficial

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changes in autonomic activity. … accumulating evidence supports claims of consistent beneficial physiological effects. (ibid.)

These beneficial claims, as predicted or expected of qigong theorypractice, are dismissed by Lake as “sub-standard”. Qigong is dismissed as being unscientific for a simple reason. It is unlike, say, an antibiotic which counts as really “scientific” and effective against a disease-entity like the salmonella bacteria that causes food poisoning. In other words, what counts as truly “scientific” is what follows from the metaphysical core of Bm and its methodological implications. This amounts to Essentialism of Method, albeit in an attenuated form–Lake in the end elevates RCT-EBM to the highest, if not, the only, level of scientificity. In other words, Version (b) of Essentialism of Method married to AM, at the hands of Lake subconsciously would assign Bm to X (the officer class), and zhongyi to Y (the subaltern class), as it fails to satisfy the Twin Gold Standards of RCT-EBM. What is even odder is what follows. Lake is fully aware that zhongyi, as a “nonconventional other”, is not merely Wholistic but, also, is Personalised Medicine, what this book calls Getihua Medicine. Furthermore, Lake himself also advocates Personalised Medicine in his conception of IM. He writes: Integrative approaches to health in general and mental illness in particular emphasize assessment and treatment approaches that address the unique symptoms of each patient (Lake 2007, 7).

In addition: There is growing evidence for a homeodynamic rather than homeostatic model of body-brain-energy-environment interactions at complex biological, psychological, energetic and spiritual levels of organization of the body in space and time… Homeodynamic efficiency describes the extent to which complex psychophysiological factors maintain mind-body in the optimal range of functioning. This paradigm describes continuously changing dynamic factors that influence the causes and conditions of health and illness (Lake 2007, 39).

Grasping the above fully should have made Lake realise that it would make no sense to privilege the findings of RCT-EBM over other methods of assessing “nonconventional” medical modalities (such as CCM-zhongyi), elevating their deliverances to the category of Substantiated, in the set of the empirically derived, while downgrading the “nonconventional” others to Provisional or Possibly Effective only. While a non-dynamic, linear,

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monofactorial system of medicine based on thing-ontology, and therefore, the primacy of Matter would imply in its wake the methodological procedure of RCT-EBM, Chapter Seven has shown that RCTs only make sense by presupposing the axiom of homogeneity, in order to render randomisation intelligible which, in turn, would render RCT outcomes in statistical terms intelligible. Chapter Seven argues that randomisation only prevents allocation bias, not selection bias; it also distinguishes between statistical and clinical relevance. The former could be said to enable those in managerial charge of health care at the macro-level to make rational decisions, regarding the allocation of scarce resources. It appears, largely, beside the point for those who are faced with decision-making at the micro-level of health care, with what is “the best” treatment for patients (in the care of doctors/ physicians) with their own very specific needs, within very specific psychological/social/financial conditions. For doctors and their particular patients, the “best” treatment may not be dependent on RCT outcomes (and the meta-reviews of EBM), but on factors of clinical relevance. Furthermore, Chapters Seven and Eight have demonstrated that zhongyi as Getihua Medicine presupposes the axiom of heterogeneity, which regards every patient to be different in significant respects from other patients. Patients may present themselves faced with the same external pathological threat, so to speak. Patients differ in their basic constitutions, their age, their sex, their psychology, their lifestyle, the physical environment in which they live, their specific medical history, and so on, and as a result the physician would not be prescribing identical treatments for all of them. Getihua diagnosis-treatment lies clearly beyond the pale of RCT-EBM. It is not simply the case that zhongyi outcomes will for now be granted the status of Provisional, but that, in the distant or not so distant future, when physicians have learnt to become methodologically “more sophisticated”, the stigma of Provisional could then be exchanged for the laudatory one of Substantiated. If zhongyi were to become “methodologically more sophisticated” as understood in terms of RCTEBM, CCM-zhongyi would lose its identity. Chapters Seven, Eight and Nine have demonstrated that the identity of CCM-zhongyi is tied up with its concepts of Getihua Medicine, of zhèng and fang, and of the unity of shengli-bingli-yili (PIT-ism). Hence, Version (b) of Essentialism of Method, which privileges RCTEBM (leading Lake and others to assess a “nonconventional” approach, such as zhongyi to be sub-standard and to designate its outcomes as at best Provisional), is beside the point. In other words, Essentialism of Method

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is as absurd as judging a cat by the standards of dogs in a dog show, when it has already been conceded that a cat is not a dog. Since the 1950s, the on-going IM project known as TCM (primarily in China) as well as its slightly more recent counterpart in the West, appear to accord with the xi ti zhong yong orientation. With this orientation, Bm is the senior/officer partner (ti/ben) and zhongyi is the junior/subaltern partner (yong). Furthermore, the assimilation of zhongyi as yong is carried out within a framework (ti/ben) which rests on thing-ontology, on linear, monofactorial causation, and which is reductionist, not Wholist in character. As we shall indicate later, this results in a serious challenge, facing TCM-zhongyi.

A respectful partnership: coexistence, not integration for CCM-zhongyi To explore this possibility, we must begin by looking more closely at the relationship between two criteria of assessing treatment outcomes. Lake 2007 has respectively called these “Empirically derived” and “Consensusbased”. The former is a very wide-ranging term indeed; however, Lake appears to have given it a very restrictive, narrow meaning so that it coincides with “Substantiated”/“compelling evidence”. We have already shown that Substantiated, in turn, is equated with the deliverances of RCT-EBM. This then has the unfortunate implication of excluding “Consensus-based” from the broad reference of “Empirically derived”. Does this matter? What exactly does “Consensus-based” assessment amount to? Lake equates it with the opinion of experts, which counts in the absence of what he calls “compelling evidence” (whatever is Substantiated/conforming with the methodology of RCT-EBM). Lake (2007, 58) writes: By definition, the evaluation of empirically derived modalities requires the assessment of empirical evidence. In contrast, the validation of modalities that are perpetuated through professional consensus or are based on intuition does not rely on rigorous demonstrations of empirical evidence. In other words, modalities that are maintained through consensus, which comprise the majority of conventional and nonconventional assessment and treatment approaches in current use, are frequently endorsed by a professional medical society in the absence of compelling empirical evidence. (The emphasis, in italics, is this author’s interpolation.)

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The operative phrases are those emphasised; these simply reflect the values embodied in EBM methodology, which makes RCT occupy the highest rung, and others are (in descending order), namely, Cohort studies, Case-control studies, Case series, Case reports, and Opinions. Note that throughout his book, Lake is ecumenical in spirit in the sense that he is prepared to admit that not all of Bm conforms to RCT-EBM. This ecumenical spirit serves to muddy the waters if due care is not taken to point out an underlying factor. It may be fair to castigate as “substandard” those Bm modalities that have fallen short of Bm’s own RCTEBM Gold Standards; but it is less than fair or even meaningful to castigate a “nonconventional medicine” like CCM-zhongyi for not having met them. CCM-zhongyi does not and cannot aspire to the methodologically “dizzy” “heights” of RCT-EBM. To repeat, CCMzhongyi does not and cannot adhere to the “rigours” of RCT; it does not adhere to the requirement of “objective” and quantifiable data in determining the efficacy or otherwise of its treatments. There are patients and their doctors who may wish to find some such measures for CCMzhongyi treatments: Chapters Two and Five have shown some examples. These are patients/their families who would want to assure themselves that the treatment has really produced positive results; that such results are “real” and can be objectively ascertained and measured via Bm tests. However, the physicians themselves do not rely on them to account for, or justify CCM-zhongyi theory-practice, preferring to adhere to its own set of criteria of assessment about its own treatments. These include the following. A1. The change in the mai profile from an abnormal one to one considered by CCM-zhongyi theory to be normal for individual patients (with their own specificities in terms of age, gender, lifestyle, personal constitution, and medical history), the time of year (whether it is Summer or Winter), and other circumstances deemed to be relevant from the CCM standpoint when patients present themselves to the physician. A2. Expected changes in certain signs of the patients following a specific treatment. These would be responses to questions such as the following: Ɣ Ɣ Ɣ Ɣ

how often does the patient now urinate/defecate in a day/week? have the attacks of diarrhoea diminished? has the patient’s excessive sweating decreased? has the amount of catarrh the patient produced lessened?

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Ɣ are the patient’s hands and feet still excessively cold or are they now warmer? Ɣ is the patient walking better than before? Ɣ can s/he now walk without the help of a stick? Ɣ can the patient get out of bed and walk by himself? Ɣ has the patient’s appetite improved? Ɣ has the patient gained some much needed weight? Ɣ has the patient’s complexion/se improved? Ɣ is the patient less anxious/agitated/depressed than before? Ɣ is the patient feeling less/no pain? Ɣ is the patient sleeping better?, and so on. A3. If one so wishes, one can turn some (though not all) of these into quantifiable matter (for instance, the amount urinated each time and how often in a day could conceivably be quantified). However CCM-zhongyi practitioners do not do so. All these signs, however, could be said to be inter-subjectively verifiable–not only the physicians but family/friends can “see” for themselves whether or not the patient has improved. Thus, s/he would have improved if s/he: is now eating more and enjoying his/her food more, can now get up to walk unaided when s/he could not before, is no longer bent over in pain, his/her diarrhoea attacks have greatly diminished if not vanished altogether, and his/her hands and feet are no longer icy cold. Admittedly, today, family/friends may not, on the whole, be in a position to feel the mai (although historically, many households could). This then, has to be left to the physician(s); but this, too, is an inter-subjectively determinable matter amongst physicians, who are recognised as properly qualified. A4. Patients’ reports about how much better they feel after treatments are considered to be “subjective”, and, in the eyes of Bm, to have no validity. However, in the eyes of zhongyi, they are relevant and significant. The patient’s felt response is a clear indication of the success or otherwise of the treatment, as CCM-zhongyi itself does not buy objective-subjective dualism. It is a medicine, which recognises that illnesses are, to a greater or lesser degree, psychosomatic in character; it is a medicine, which considers the patient in a Wholist manner. CCM-zhongyi is premised on the assumption that the “body” is no mere body (a thing, mere Matter) but a person-body with emotions as well as consciousness. Chapter Six argues that the concept of person-hood is a primitive one. CCM does not subscribe to that version of Cartesian dualism known as Body-Mind dualism, which underpins Bm.

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The comments above make the following points, as far as CCM’s assessment of its own treatments is concerned. B1. It may be said to fall into Lake’s category of “Consensus-based” (the consensus of CCM experts). B2. These experts, however, arrive at the assessment based on observing what is inter-subjectively determinable, namely, signs of the patients before and after their treatment. B3. These experts are capable of distinguishing between those changes, which are expected and anticipated, or those which are not, given zhongyi’s theory-practice about the nature of illnesses. Zhongyi practitioners recognise that a patient’s illness can be misdiagnosed, that a re zhèng diagnosed as a han zhèng or vice-versa with their respective different prescriptions, could and sometimes would lead to fatalities. Misdiagnosis and entailed mistreatment must be rectified by other more competent physicians. B4. Clearly, such a type of assessment does not conform to the methodology of RCT-EBM. It may be worth labouring a point already made, that to judge it as sub-standard, because of its failure to do so, is itself a gross failure of logic and understanding. B5. Nor is it obvious that such an assessment methodology is not empirically grounded as well as theory-driven, just as Bm’s own method of assessment in terms of RCT-EBM is empirically grounded as well as theory-driven. B6. The respective theories of Bm and CCM-zhongyi are different, and their metaphysical/ontological cores are different; hence, so are the methodological differences, implied by their respective metaphysical/ ontological cores. B7. CCM’s observations of signs and reports of symptoms from patients, of the anticipated/expected changes in them following, from its theorypractice of shengli-bingli-yili fall back, ultimately, on inductive as well as deductive logic. This method is not exerted explicitly but relied upon implicitly; it is a method of procedure which in general has been adhered to, in varying degrees, since the dawn of systematic reasoning in the history of Humankind.

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With all this clarification out of the way, we can now consider the matter of whether one can construct a different framework (theoretical as well as political in the larger sense of the term). This framework would not privilege Bm, through privileging the RCT-EBM twin Gold Standards, over other methods of assessing the outcome of treatments in CCMzhongyi. It can be built up using the following steps. C1. Abandon the obsession with RCT-EBM as the highest accolade of “scientificity”. These standards are set up (unwittingly perhaps) for CCMzhongyi to fail, and to be stigmatised as inferior, if not totally worthless. One ought to recognise and appreciate that RCT and EBM are not universal standards that can be applied to all other medicines such as CCM-zhongyi. Furthermore, it is the case that they do not even obtain in all domains of Bm; rather they are specific standards which, at best, hold only under certain very restrictive circumstances–they fail to obtain in Epidemiology. Regarding such Bm domains, one can only use “lesser” methods of scientificity, such as Cohort studies, Case-control studies, Case studies and Expert Consensus, if and when the so-called Substantiated criterion fails to obtain. C2. With regard to CCM-zhongyi treatments, use whatever method of “scientificity” is endorsed by CCM-zhongyi itself, such as those set out above under A1-A4, B1-B7 and C1-C5 (here). C3. It is appropriate to remind oneself of Aristotle’s nostrum (Nichomachean Ethics, I, iii) that one should not demand more certainty than the subject allows. In other words, “Expert Consensus” should not be stigmatised as carrying less methodological weight than the twin Gold Standards of RCT-EBM, in the case of CCM-zhongyi. C4. Respect its metaphysical/cosmological core and its methodological implications for “doing” medicine. C5. The partnership is about the care and the good of patients–that is the shared goal. At this level, an institutional partnership should ensure that the patient’s wishes be respected as to which medicine they would like to turn to for help. We have written the above from the standpoint of the relationship between CCM-zhongyi and Bm. However, we need to briefly comment, and in brief outline the relationship between TCM-zhongyi/IM and Bm.

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D1. The TCM/IM practitioner identifies a symptom or symptom pattern that can be treated, by and large, using criteria as set out under A1-A4. D2. However, TCM/IM/zhongyi feels the need to subordinate the criteria A1-A4 to the methodology embodied in RCT-EBM, in order that they stand a chance of being given the “highest accolade of scientificity”. The consensus of Bm experts is that TCM/IM treatments fail to clear those hurdles, and thus fail Lake’s Substantiated criterion at best, only satisfying the Provisional status of “scientificity”. D3. This then leads to Contradiction One: Chapter Seven has argued that RCT-EBM presuppose the axiom of homogeneity if these Twin Gold Standards are to have purchase. That chapter has also shown that zhongyi is Getihua Medicine/Personalised Medicine; such a medicine necessarily presupposes the axiom of heterogeneity. D4. Contradiction Two: Lake 2007 has admitted that the metaphysical core/ti of zhongyi is different from that of Bm. Lake, as shown earlier, has not grasped that. Therefore, their respective methodological implications would also differ. TCM theorists and practitioners are logically left with the option of living with such a contradiction or of abandoning the metaphysical core of zhongyi. The latter option would mean that TCM would severely compromise, if not totally abandon its identity as zhongyi. D5. To retain some identity with zhongyi, TCM can at best play a limited hand-maiden role to Bm, at the technical level of efficacity in the use of medicinals as listed under AI and AII, but whose efficacy would always be relegated to the Provisional status of “scientificity”. A relationship such as this between TCM and Bm necessarily privileges Bm/the X partner over TCM-zhongyi/the Y partner. It follows that CCM-zhongyi does not, cannot and must not follow such a path. It follows that the most reasonable strategy to pursue is to permit adequate space and resources for all three medicines in China: Bm, TCM and CCM (two different forms of zhongyi). Certainly, over time due to the slow processes of development and evolution, there may indeed emerge three distinctive medicines. Following the analytical structure of AM as exhibited in the Emancipation-Haskalah Movement, Bm is equivalent to the dominant European/Christian cultural grouping; TCM-zhongyi (with its contradictions outlined above intact) being equivalent to assimilated Jewry in Germany and France under the Emancipation-Haskalah Movement,

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and CCM-zhongyi roughly equivalent to the traditional cultural grouping consisting of those who were outside the German/French EmancipationHaskalah Movement. If one may use another analogy, this time from the philosophy of zoos, Lee 2006 has argued that zoo animals are a distinctive kind of animal (the analogue of TCM-zhongyi as IM) which is neither a domesticated animal, such as cats or dogs (the analogue of Bm), nor an animal in the wild, such as the polar bear in the Arctic or the penguin in the Antarctic (the analogue of CCM-zhongyi). Zoo animals are fine, if understood in their own right, but what one must not do is designate them as “wild animals in captivity”, as that is a contradiction in terms.

Conclusion The main points which have emerged from this chapter’s exploration, may be summarised as follows. 1. This exploration begins by understanding the notion of integration as assimilation in an analogous discourse, namely, political discourse, taking for inspiration the Emancipation-Haskalah Movement in the history of European Jewry but only in Germany and France. Assessing it from the standpoint of the analytical-structural relationships involved between the Jewish community and the larger/host community, one concludes that the latter is the senior partner/officer (X) and the former is the junior partner/ subaltern (Y). 2. With this in mind, we then turn to examine two different attempts at constructing the Chinese project of IM. The first was initiated by Zhang Xichun in the early decades of the twentieth century, and the second under TCM from the 1950s, to see if both fit in with the analytical framework presupposed by the Emancipation-Haskalah experiment in Germany and France. 3. It turns out that Zhang Xichun’s project does fit in with the formal analytical structure of AM. The author has looked at Zhang’s work via the traditional distinction in Chinese culture and civilisation, between ti/ben and yong, and has concluded that it is a case of zhong ti xi yong. This means that zhongyi for Zhang is X and WM/MM is Y, or one could say, more charitably, that zhongyi is primus inter pares in respect of WM. When Zhang undertook his research, zhongyi was, in today’s terms, CCMzhongyi; that medicine was wholly Wholist in orientation. For Zhang, then, the aim of his project would have been to produce a version of IM in

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which the “complementary other” (Y, MM/WM) would become melded with its senior partner (X, CCM-zhongyi) to form a new kind of seamless Whole. 4. Although the TCM project as IM (whether conducted in China or outside China today) may be said to conform to the formal analytical structure of AM, it is different from Zhang Xichun’s project in several crucial ways as set out below: (a) It may be said to be the mirror-image of Zhang’s project, as it is a case of xi ti zhong yong. This means that Bm is X this time and TCM-zhongyi is Y. (b) Bm takes the lead and sets the tone; its philosophical foundation (historically and dominantly today) is wholist not Wholist, that is to say, it is reductionist. (c) Certain methodological implications follow from Bm’s metaphysical core, chief of which is its adherence to the notion of scientificity, which privileges the twin Gold standards of RCTEBM. (d) Bm (in the main) rests on thing-ontology and its model of causation is Humean and linear; zhongyi (up to now in either version), on the other hand, rests on process-ontology and presupposes non-linear, multifactorial causation, what this book and its prequel call Ecosystem Science. (e) Zhongyi is also Getihua Medicine, resting on the axiom of heterogeneity; in contrast, RCT-EBM, elevated by Bm (X) to be the embodiment of scientificity, presupposes the axiom of homogeneity. (f) TCM theorists and practitioners, as far as this author knows, have not confronted head on the profound differences listed above, for the simple reason that they have failed, on the whole, to identify or admit that a serious challenge arising from these differences even exists. How TCM eventually meets this challenge remains to be seen. 5. In the meantime, this author very much hopes that ample space, resources and opportunity will be given to CCM-zhongyi, for it to flourish and evolve, as its theorist-practitioners see fit, just as ample space and resources are given to TCM-zhongyi as IM to flourish and evolve, as its practitioners and theorists see fit. This way forward is not new as shown

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by the “three paths” policy pursued in the 1980s (see Scheid and Karchmer 2015, 169). 6. Above all, it means respecting CCM-zhongyi’s distinctive metaphysical/ontological core (its ti/ben), its trinity–shengli-bingli-yili as PIT-ism–which dictates its own distinctive set of criteria for assessing the outcome of treatment/yili as indicated under A1-A4 and B1-B7. 7. In this sense, what is called for is peaceful coexistence between the two versions of zhongyi (CCM-zhongyi and TCM-zhongyi), with adequate support for both to flourish and evolve. 8. If TCM/IM were to evolve further and further from CCM-zhongyi’s metaphysical/ontological core and its methodological implications, TCM would depart further and further from its historical philosophical/ cosmological roots and become a very different “beast” from CCMzhongyi, even further away from what it is already today. This author lacks any crystal ball to see into the future as to how it would develop and evolve; however, two main options remain open: (a) To live with the contradictions identified earlier. (b) To give up, for instance, Getihua Medicine and its associated theoretical assumptions and practice, in order to remove the contradictions, in which case TCM would be in danger of losing its identity as zhongyi in any form recognisable today.

CHAPTER TWELVE CONCLUSION

Summary in ten points It may be fitting to remind readers yet again that this volume forms part of a trilogy, the other two volumes, being Lee 2012b and Lee 2017a. These, read in conjunction with this concluding volume, may be said to have made at times in outline, and at other times, in greater detail, the following points. 1. The respective metaphysical/ontological cores of Bm and CCM are very different. The former includes Materialism, thing-ontology, and Cartesian dualism; the latter Em-ism, process-ontology, and Contextual-dyadic Thinking. 2. Each core entails its own methodology and its own concept of causality. The Bm core entails Reductionism (to the most fundamental level, such as physics, chemistry and more recently, to biophysics, and molecular genetics/biology) and the Humean billiard-ball model of causality, which is linear and monofactorial (found in its dominant monogenic conception of disease). The CCM core entails non-Reductionism (what is at a higher level of organisation cannot be reduced to what is at a lower level), a nonlinear, multifactorial model of causality, Ecosystem Science and hence is Wholist in character. 3. As Ecosystem Science, it follows that CCM’s own characteristics are distinctive and obviously different from those possessed by Bm. Apart from being Wholist, it differs from Bm in at least two significant ways: (a) It does not subscribe to the objective-subjective and fact-value dualisms. This means that the objective is not privileged over the subjective, facts over values. CCM-zhongyi has its own criteria of what counts as “scientific”, as success or failure.

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(b) It implies the axiom of heterogeneity, not of homogeneity, as is the case with Bm. Its account of shengli-bingli-yili Wholism/PIT-ism enables it to diagnose and treat (via Zhèng-Fang Wholism) the condition of illness in each patient, in a way that addresses the specificities of the individual; this is Getihua Medicine, in keeping with its axiom of heterogeneity. 4. Its axiom of heterogeneity and its rejection of the fact-value dualism go hand in hand with its concept of person-hood as a primitive concept, in which Emotion/Passion is not divorced from Reason/Intellect. This entails that every illness has a psychosomatic dimension and that the placebo effect is not an embarrassment, but may be harnessed to further the healing process. 5. Embedded in its conception of illness, based on Qi Wholism, is the notion of Preventive Medicine, both in the broad and narrow meanings of the term. The latter rests on the axiom of Catastrophe Prevention–its inspiration appears to have come from practical activities such as preventing dykes from bursting and fires from spreading, by attending to the first sign of the slightest flaw which dykes and chimneys displayed. Grasping this enables one to see that the discourse of CCM is not parasitic on political discourse, and that preventing illness in the case of medicine and preventing an uprising/rebellion/revolt in the case of politics/ruling the state are nothing but the instantiation of the axiom of Catastrophe Prevention. There is a well-known Chinese expression that embodies this insight: ཡ ѻ∛ৈ, 䉜ԕॳ䟼/shi zhi hao li, miu yi qian li/a small initial inaccuracy could later lead to great errors. This then categorically puts paid to the claim advocated by certain sinologists such as Professor Unschuld that CCM is to be explained simplistically, if not totally, in terms of the politics of the Han dynasty. 6. Its Macro-Micro-cosmic Wholism/Tianren-xiangying shows that CCM is Yidaoyi/᱃䚃५, a medicine that rests on the foundations of the Yijing, of yinqi and yangqi, the changing relationships between them under the Laws of Nature. These include the zhouye jielü, the sishi jielü, the concept of zhou er fu shi (Cyclic Reversion), and its related Ascending-andDescending Law of sheng-fu-jiang-chen, of the Laozi (which lays down that while Humans follow Earth, Earth follows Heaven, Heaven follows Ziran and also that the Dao engenders one, one engenders two, two engenders three and three engenders Wanwu).

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7. Given the differences set out above between the respective philosophical frameworks of Bm and CCM, not surprisingly, it follows that any meaningful integration between the two medicines is not possible, without CCM compromising, indeed, losing its identity, given that any form of IM involves an unequal relationship. Today, in this unequal relationship, naturally Bm would be the officer (X) class and CCM the subaltern (Y). TCM, on the other hand, is such a version of IM. As such, it faces internal inconsistencies, and is in danger of severely compromising, if not, losing its identity as zhongyi anchored to its traditional cosmological/philosophical roots. However, as TCM is in its early days of development, one cannot predict with confidence how it will eventually shape up. What one can advocate with confidence is a peaceful coexistence for CCM-zhongyi, TCM-zhongyi and Bm, leaving each with plenty of room and space as well as resources and opportunities for their respective consensus of experts to preside over their evolution as they see fit. 8. Bm, of late, has increasingly developed in the direction of multifactorial causation, process-ontology, and Ecosystem Science as shown in branches of medicine identified as Epidemiology (the oldest of such developments), Psychosomatic Medicine and Preventive Medicine (see Poole 2016). Indeed, Bm, at this very moment, is undertaking a new project in a similar spirit, namely, that being pioneered by Professor Jeff Gordon (Washington University in St. Louis) in his study of gut microbes, in which his team regards the relationship between the microbes (the residents of the guts), the guts themselves together with the nutrients flowing through them as constituting an “ecosystem”–the Whole constitutes the microbiome. Such an approach is expected to eventually bring great benefits to the understanding and treatment of numerous diseases, including obesity (see Yong 2016). 9. This shows that the model implied by CCM will increasingly be recognised, ironically, as being at the “cutting edge” of science, rather than written off as “a magnificent dead end”, in the words of Cohen (2015, 99). We see that even in as careful a scholar as Professor Cohen, there is a temptation to fall for Essentialism of Method, which, in the opinion of this author, amounts to judging cats in a cat show by the standards of dogs in a dog show. Cohen appears to be mistaken in conceiving the evolution of knowledge in terms of mere linear progression, which it is not. There are many surprising twists and turns–the twenty-first century may well see “Ecosystem Science”/non-Newtonian science emerging as the new

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dominant model of scientific knowledge. “Ecosystem Science” is what the ancient Chinese pioneered as their science, of which CCM is an outstanding instantiation. Relying on Essentialism of Method and the view that knowledge progresses in a linear fashion, Cohen concludes that the path of Chinese scientific knowledge led to a “magnificent dead end”, primarily through a sleight of hand via the strategy of linguistic stipulation. Implicitly, he has defined the term “science” in a certain way, from which it necessarily follows that only European science leads to progress and an increase of knowledge. Philosophically speaking, definitional truths are neither compelling nor fruitful, as they are no more than the Humpty Dumpty Method of semantics and pragmatics. In Alice Through the Looking Glass, Lewis Carroll made Humpty Dumpty say “When I use a word, it means just what I choose it to mean–neither more nor less”. When Alice challenged this by observing that “The question is whether you can make words mean so many different things”, Humpty Dumpty responded: “The question is which is to be master–that’s all”. To grasp CCM properly, one needs to “de-colonise” the mind, on the part of both the coloniser 1 and the colonised, 2 by rejecting the exceptionalism of Modern Science/Medicine, entailing Essentialism of Method, which is an off-shoot, after all, of Eurocentrism. 10. CCM has a history of, at least, two thousand five hundred years. It has been in continuous use by many millions in China down the ages to the present. Right now, it is attracting serious attempts to recover the ground lost to Bm (for slightly over a century) and TCM (in the last five decades or more). For these and other reasons, CCM should merit UNESCO bestowing upon it the status and respect of being part of world patrimony. It would not be out of place for it to be put on its Lists of Intangible Cultural Heritage. In 2010, acupuncture and moxibustion were included, but as these come from the main stable of CCM-zhongyi, logic demands that the same accolade be bestowed on the totality of that system of medicine. Acupuncture is only properly understood in terms of CCM’s core concepts, such as the Jingluo network, Yinyang-Wuxing, shenglibingli-yili (PIT-ism), zhèng and its relationship with fang, Qi-indissipating mode and its relationship with Qi-in-concentrating mode, 1

Professor Cohen is a recent illustrious representative of the mind of the “coloniser”. 2 The millions of Chinese in China and outside China, who remain sceptical about CCM-zhongyi, writing it off as “unscientific”, instantiate the mind of the “colonised” (see Scheid and Karchmer 2015).

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Contextual-dyadic Thinking, process-ontology, non-linear, multifactorial causality, Ecosystem Science, and so on.

APPENDIX ONE THE NEIJING: DATE AND AUTHORSHIP

Introduction The Huangdi neijing/lj哴ᑍ޵㓿NJ/the Neijing has been a foundational, if not the foundational text of CCM down the ages to the present. CCM practitioners emphasise that studying it–understanding its concepts and ideas and their implications–is a life-time preoccupation. It is not a text which one simply reads for the purpose of passing an examination and promptly forgets about afterwards. It is a veritable vade mecum as Chapter Nine has argued. As such, it is important to explore at some length the issue of dating it and its possible authorship. Lee 2017a, Chapter Two draws attention to one major methodological consideration in the historiography of dating an ancient text, as its precise authorship and the date of its appearance are often unclear and hence contentious. It points out that one ought to distinguish between two distinct, though related, aspects of the matter: (a) The actual content (or part of the content) of the text in terms of the notions and concepts discussed. (b) The text, in its entirety, emerging as a complete mature text. The former (in parts) could pre-date the latter. One should distinguish between the older/oldest parts of a text (in terms of its content and/or style) and the rest of the text, as well as the text in its entirety known to us. In other words, the issues surrounding the dating of an ancient text are not a simple, straight-forward matter. Furthermore, from the methodological standpoint in dating the Neijing: one must also distinguish the textual from the non-textual approach; the former merely examines the content and style of the text, while the latter rests on archaeological finds such as material instruments/tools. Until lately, only the former was available and used for dating the Neijing.

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The textual approach Naturally, Chinese scholars over the centuries have debated this matter, at great length. Their opinions can roughly be divided into three types respectively, favouring: (a) The Western (Early) Zhou: these included Shao Yong/䛥䳽 in the Song dynasty; Sang Yue/ẁᛖˈFang Yizhi/ᯩԕᲪ in the Ming dynasty; Wei Litong/兿㦄ᖔ in the Qing dynasty. (b) A period between the later Zhou dynasty and the Qin-Han dynasties: these included Cheng Hao/〻仒, Sima Guang/ਨ傜‫ ݹ‬in the Song dynasty; The Compendium of Knowledge in the Four Domains/ljഋᓃ‫ޘ‬ҖNJin the Qing dynasty. (c) The early Western Han period.1 Chinese scholarship today also more or less, reflects a similar spectrum of opinions. The representative of (c) may be said to be the distinguished historian of CCM, Ma Jixin/傜㔗ᯠ. Ma was the expert in charge of deciphering and sorting out the medical texts found in 1973 in tomb number 3, an early Han dynasty family burial site of a husband, wife and son at Mawangdui in Changsha. He reiterated in 2011 that he remained convinced that the language/content of the Neijing is consonant with the text being an early Han text.2 According to *Liu Changlin (1980, 7), on the whole, contemporary historians of CCM maintain that the Neijing is a Warring States text (b), although historians of Chinese philosophy tend towards the Qin-Han period (c). However, Liu’s own position is more nuanced, as he holds that although as a mature text, it is primarily an early Han text, there are passages in it which can be dated to the Warring States period. 3 In sinological literature, the representative scholar of the Han school of dating is Professor Unschuld 1985, 20034 (see Appendix Three). 1

For a brief but succinct account of details to back these views, see *(The) Neijing: dating it” 2011, 2014. 2 *The Neijing: explaining and revealing its secrets Lecture 1, 2011. 3 For some detailed arguments, see* Liu Changlin 1980, 10-15. *Liu (1980, 17) is right in claiming that some chapters of the Neijing must be considered as Han texts, and it would be futile to maintain otherwise. 4 In the 2003 Preface, he writes: “Available evidence suggests that at the basis of the Su wen is a layer of texts written beginning in the second or first century BC, with some of its conceptual contents possibly dating from the third century BC.” He claims he is close * to Liu Changlin whom he cites approvingly. However, Unschuld’s understanding of Liu’s assessment may not be correct, as Liu Changlin

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However, since Harper 1998, there too has been a shift to an earlier date of the text such as the Warring States period. Views (a) and (b) may be found in some pre-1980s textbooks and teaching material such as that published by the historical research unit of the College of Chinese Medicine in Beijing/ेӜѝ५ᆖ䲒५ਢ⹄㓴ˈ entitledljѝ५५ᆖਢ䇢ѹNJ; this publication attributes the date of the Neijing to the Spring and Autumn-Warring States periods.5

The non-textual approach Of late, there have been some even bolder voices in Chinese scholarship. In particular, two scholars play leading roles: one is Liu Guangting/ࡈ‫ݹ‬ ӝ, a practitioner of CCM and a keen student of Mongolian Medicine/ (1980, 17) says that the earliest parts of the so-called “original material”/৏㒲֌૱ in Suwen can be dated to the Warring States period. In other words, while it may suit Unschuld to cite Liu in support of his own claim that the Neijing is a Han text, Liu’s own more nuanced qualifications may make what he says consonant with the claim that the Neijing is both a Han and a pre-Qin-Han text. Furthermore, *Liu Changlin (1980, 19) points out that ␣Ҿ᜿/Chunyu Yi, in the twenty-five medical cases attributed to him, made use of the concepts of Yinyang/䱤䱣, Wuxing/ӄ㹼, biaoli/㺘䟼, hanre/ሂ✝, shangxia/кл, dongjing/ࣘ䶉, youyu-buzu/ᴹ։н䏣, Jingluo/㓿㔌, and Zangfu/㜿㞁. These are all concepts also used in the Neijing. This leads Liu, however, to claim that the Neijing, as mature text, would be dated later than Chunyu Yi–at best, he argues that the two belonged to the same period or that the Neijing emerged a little later than Chunyu Yi’s writings. One should bear in mind that the Chunyu Yi account consisted of medical cases and therefore was not intended as theoretical discourse, which the Suwen was/is–from this standpoint, the fact that the former account was not as full and as sophisticated as the latter is not surprising and from that it may be too simplistic to infer, as Liu Changlin seems to have done, that the Neijing could be a little later than Chunyu’s account. Note that Chunyu invoked these key concepts with great fluency and confidence in his diagnoses. His case histories, as reported by Sima Qian in his Shiji, seem to point to the probability that these key concepts pre-dated both Chunyu and the Neijing, indicating therefore that they were already in existence during the Warring States period. This then would be in agreement with Liu’s own claim that the Neijing is at once a Han text/as mature text as well as a pre-Qin-Han text/ containing key concepts which predate Qin-Han history. (Many of these concepts mentioned in Chunyu Yi’s cases have already been commented on, philosophically, in Lee 2017a and are further discussed in this volume. See Chapter Five for a more detailed account of Chunyu’s incorporation of Wuxing into medical discourse.) 5 For details, see *Liu Changlin 1980, 10.

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Mengyi/㫉५; the other is Huang Hanru/哴≹݂, a historian of CCM as well as a student of the medicines of the Chinese ethnic minorities such as Zhuang Medicine/Zhuangyi/༞५. The former wishes to push the text to the pre-Spring and Autumn period of the early Western Zhou dynasty, while the latter holds that dating it even to pre-Western Zhou would be sustainable. In other words, if these views stand up to critical scrutiny, then some of the concepts of the Neijing could be said to be between three thousand to four thousand years old, or even older. Upon what evidence do these bold claims rest? Not on textual evidence; but primarily on nonscript artefacts.6 Before looking at their evidence in detail, one must say something about the composition of the Neijing as we know it. The text contains two parts: the Suwen/lj㍐䰞NJ/Basic Questions and the Lingshu/⚥᷒/Divine, Spiritual or Numinous Pivot. Today, the earliest extant copy of the Neijing dates only from the Qing dynasty; its lineage could only be traced to the Northern Song. The Lingshu was not called by that name pre-Tang dynasty.7 Unfortunately, the Northern Song managed to lose the text; this loss was made good when a copy from the Korean court arrived as tribute to the Emperor Zhezong/ ᆻ ଢ ᇇ . When he received this precious tribute, he caused it to be printed, disseminated and studied. Again, unfortunately, this version was lost in the turmoil towards the end of the Northern Song. Quite unexpectedly, an intact copy of the Neijing was in the possession of a minor official called Shi Song/ਢፗ in Sichuan province, who very generously donated it to the court and the public. With the twists and turns in the history of cultural artefacts as delicate as books (bamboo/silk manuscripts or later paper-printed), it is almost impossible now for scholars to track and determine definitively the changes and differences, both great and small, in content. This means that there must be significant changes between the numerous versions of the

6

The account given by and large follows *The Neijing: explaining and revealing its secrets 2011, Lectures 1, 2, 4. 7 Zhang Zhongjing, in his Shanghanzabinglun (late Han dynasty), in mentioning the books he had studied, referred to the Suwen and the Jiujuan/ lj ҍ ধ NJ . (Incidentally, this shows that the name Suwen for this part of the Neijing had existed well before Zhang Zhongjing.) The latter has been taken to refer to what came to be called the Lingshu. This name made its first known appearance in the writing of the eighth-century CE Wang Bing/⦻ߠ, who edited the Neijing, based on the very copy used by none other than Zhang Zhongjing himself (see Appendix Two).

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text, edited by different hands at different times, handed down the ages. Textual investigation is, therefore, necessarily limited. In recent decades, the discovery of physical objects from early times has provided new avenues for research. Some scholars, through the discovery of non-script artefacts, have eagerly gone down another route to try to unravel and cast light on some of the many issues that have dogged a fuller understanding of the Neijing regarding its date(s), its provenance in terms of its concepts, and so on. These finds are primarily of implements, which experts (in archaeology, language and culture, historians and practitioners of CCM) have identified as acupuncture needles. Let us begin with a list of such implements which eventually have enabled scholars such as Liu Guangting and Huang Hanru to construct the evolutionary lineage of acupuncture instruments, starting with stone needles/ bianshizhen/⹝⸣䪸, and ending with today’s fine, hair-slender needles/∛ 䪸. Chronologically, in terms of the times of their discoveries, the finds may be listed as follows. 1. In 1963, in Inner Mongolia, at a New Stone Age site/ཊՖཤ䚃⍬ was found the first stone needle/bianshizhen/⹝⸣䪸ˈmeasuring 4.5 cm in length, with a pointy sharp end, but with another side showing something like a curved blade/ᡱᒣᕗ࠳ for cutting and scraping.8 2. In 1976, in Guangxi province in South-west China, in Wuming county/ ↖呓৯, in a Han tomb (at a place called 䍥⑟ᐲ㖇⌒⒮), three silver needles, 9 clearly recognisable as acupuncture needles, were discovered. The tomb belonged to a local high official during the early Western Han dynasty. This discovery testifies to the importance of acupuncture as a therapy of the time. 3. In 1978, in Inner Mongolia/ਹṁ᷇ਜ‫⽮ޜ‬, three bronze needles were found, which are called ⹝䪸/bianzhen,10 because they bear a resemblance in both appearance and function to the stone needles (mentioned at 1), except that they are made of bronze, not stone. These have been dated to the Warring States period.

8

For images of these implements, see *“Bianshizhen” 2015. For an image, see *“Bronze Han silver needles” 2015. 10 For an image, see * “Bianzhen” 2015. 9

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4. In 1985, also in Wuming county, but about a hundred kilometres away from the 1976 site, in a village called Matou/傜ཤґ, a peasant came across an object which, when cleaned up, looked like a bronze tray. This accidental discovery led experts, in turn, to identify the ground nearby as a massive ancient burial site. They concluded that its date would not be later than the Warring States period and even more astoundingly, its several hundred tombs could be dated even to the Shang-Zhou period (see Chinese Historical Periods and Dynasties). Excavated objects include bronze and jade artefacts. Amongst these artefacts are two small bronze objects which are under 3 cm longˈ0.6 cm wide and only 0.1 cm thick, making them implements that are flattish-squarish-longish/ᡱ䮯ᯩᖒ.11 The puzzle was: why should these two small objects be part of the tomb goods? What role would/could they have played in the life of the person buried in the tomb? They do not look like sewing needles given their shape, yet the end is very sharp indeed and seems capable of stabbing something soft. One of the archaeologists, Huang Yunzhong/哴Ӂᘐ, decided that they look like some kind of medical implement. He turned to Huang Hanru, the historian of Chinese Medicine. The two agreed that they are medical instruments of some description. They managed to get a replica made of the better preserved object. Could they be surgical implements? They finally decided that they were acupuncture needles. In constructing the evolution of acupuncture implements, the thinking of Liu and Huang could be said to have run along the lines set out below: (a) The oldest would naturally be the stone needles, as exemplified by the 1963 find in Inner Mongolia. Medical historians acknowledge that the stone needle is the ancestor of what are called acupuncture needles; these would have been fashioned by New Stone Age ancestors.12 11

For an image, see * “Bronze needles” 2015. One could postulate the following plausible scenario, according to Liu Guangting: a Stone Age hunter, in pursuing an animal could have sprained his ankle, which meant he could no longer hunt for a while. Instead, he would drag himself around gathering fruit and nuts. In so doing, his swollen ankle could have scraped against a stone with sharp edges, which would have caused him great pain. However, after the initial agony, he would find that the pain had decreased, and even that the ankle was becoming less swollen. After many such experiences and observations, the Neolithic peoples would have concluded that stabbing with a sharp edged stone on the sore spot could be a helpful therapeutic intervention. They might also have noticed, according to Liu, that when a part of their body ran 12

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(b) The next type to develop would be the bronze bian needles/ bianzhen found in 1978 in Inner Mongolia. People had left the Stone Age behind and entered the Bronze Age, which could be safely dated to the Shang dynasty if not to the preceding Xia dynasty.13 (c) Perhaps sometime later, the bronze needles emerged, as exemplified by the two found in Guangxi in 1976. Their appearance no longer looked like the bronze bian needle at (b) above, although all the three implements at (a), (b), and (c) could perform the function of piercing through flesh. (d) In this series of four finds, the last to emerge would naturally be the silver needles, found in Guangxi in 1976 in an early Western Han tomb. Not only were these needles not made of stone or bronze; in shape they bear a very close similarity to acupuncture needles. Coming upon them for the first time, one would not hesitate to identify them immediately as such. However, there remain puzzling gaps in this reconstruction. For instance, the Neijing mentions nine types of acupuncture needle jiu zhen/

up against something hard, such as rock or wood, pain in another part diminished– for example, when the foot stumbled against a rock, the pain or condition in the stomach decreased or improved, or when the head hit a tree trunk, diarrhoea became less, and so on. They then no longer simply looked for such sharp-edged stones lying about, but systematically started to fashion a therapeutic instrument which today we call “stone needles”. From “found” technology, they proceeded to craft-based technology (see Lee 2005, 58, 79). In other words, their technology went hand in hand with their science. In the last few decades, in many parts of China, several sites have turned up bianshi needles of slightly different shapes, but all with a very sharp pointy end. There are also shapes with a knife-edge side to them making them look like stone scalpels for dressing wounds, removing pus, and bleeding. Bianshi, as a therapeutic implement, was already well-known by Han times, as the meaning of the word ⹝ is given in the dictionary, Shuowen jiezi/lj䈤᮷䀓 ᆇ NJ, as “⹝ , ԕ ⸣ ࡦ ⯵ ҏ”/stone used to treat illness. The dictionary was completed in 100 CE but only published in 121 CE. 13 The late Shang dynasty is noted for its magnificent bronze artefacts as ritual vessels of different shapes and sizes. Such brilliant complex designs are an expression of mature art and craft as well as of metal technology; from it one could legitimately infer that such a technology must have emerged long before the late Shang period.

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ҍ䪸;14 it seemed to Liu Guangting that the three silver Han needles bore great similarities to some of the types described by the Neijing, especially two types which only have sharp point but no blade edge. However, the Neijing only gives a description of the nine types of needles but not an account of their origins. What we see today of these nine types are simply reconstructions of these implements based on the Neijing’s description of them. Unfortunately there are just no extant copies of any of the originals. Furthermore, how would the bronze bianzhen of 1978 found in Inner Mongolia, and the bronze needles of 1985 found in Guangxi, stand in relation to the jiu zhen of the Neijing? Some light was cast on this puzzle when Liu and Huang looked up the Neijing. There is a passage which refers to the use of small needles. A passage, in the Suwen Chapter 12/lj㍐䰞·ᔲ⌅ᯩᇌ䇪, reads: ަ⯵᥋Ⱙˈ ަ⋫ᇌᗞ䪸. ᥋Ⱙ/luanbi . This not easy to translate directly into English– the first character refers to tautness in the muscles, and the second to pain in the muscles and in the yang organ-systems. Anyway, in a case of luanbi, small needles are used to treat it. The second passage is from the Lingshu, Chapter 1/lj⚥᷒·ҍ䪸ॱҼ৏NJ which reads˖ሿ䪸ѻ㾱ˈ᱃䱸㘼䳮‫ޕ‬, which may be rendered as: the important thing about small needles is that it is easy to learn to use them but difficult to be really good at using them. Now, might not the 1985 bronze needles fit that description, according to Liu and Huang? Recall their dimensions–about 3 cm long, 0.6 cm wide and 0.1 cm thick. Compared with the long needle described in the jiu zhen set, they are ten times smaller in size and hence could count as “small needles”. This provides evidence for the two scholars to conclude that the two bronze (1985) needles are the predecessors, at least of some of the jiu zhen,15 while the three silver Han needles (1976) are the successors of the jiu zhen. 16 17 After the appearance of the jiu zhen, implements with the

14

This is found in the Lingshu, Chapter 1/lj⚥᷒· ҍ䪸ॱҼ৏ㅜаNJ, which says that the nine types of needles are of different shapes and lengths: “ҍ䪸ѻ਽ˈ਴ н਼ᖒ˖DŽ DŽDŽDŽҍ䪸∅⸓DŽ” For some images, see *“Jiu zhen” 2015. 15 This qualifying clause, “at least, of some of”, is added by this author, and should not be attributed to Liu and Huang, whose claim is wider, namely that the “small needles” are distinct from the jiu zhen, and their appearance preceded that of the latter. 16 The jiu zhen as well as the Han silver needles are both made of metal. Forging metal had emerged by the Western Zhou, if not earlier, and by the later Zhou (Spring and Autumn–Warring States periods), the technology had become very common. Liu Guangting hypothesises that the jiu zhen could have made their appearance by the later Zhou period.

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blade function were no longer produced, leaving only the function of piercing intact. The final stage of development appears to rest with the ∛ 䪸/hao zhen/hair-slender needles,18 which acupuncturists use today. What implications does the above proposed lineage in acupuncture implements have for dating the Neijing, and in casting some possible light on its authorship? To answer this question, one must first remind readers that there is an intimate link between the two parts of the Neijing, namely, the Suwen and the Lingshu. The relationship between them is sometimes put somewhat simplistically by saying that while the former deals with the theory of CCM, the latter is about the techniques of a specialised branch of Chinese Medicine, called acupuncture: how to needle and where to needle (䪸⌅/zhenfa). This is not correct, as we shall see below. Before doing this, let us first remind the reader that Lee 2017a has attempted to explore many of the key theoretical concepts of the Neijing through the philosophical and cosmological ideas of the Yijing, the Laozi, and the Zhuangzi as well as the Huainanzi.19 As shown in that exposition, scholars (in China), down the ages, have acknowledged that the last three mentioned texts are Daojia texts. Daojia thinking, in turn, has emerged from the Yijing, and it could be claimed as the fons et origo of all Daojia texts (although, of course, other schools of thought, such as Confucianism, also legitimated themselves in terms of the Yijing). Down the ages, Chinese scholars have also held that the Neijing is a Daoist text, that CCM could not be properly grasped and practised unless the Yijing and the Laozi are themselves understood. CCM is yiyi/᱃५, a medicine which embodies the insights of the Yijing. In the same spirit, the dao of CCM is but an aspect of the Dao of the Laozi, when applied and understood in the medical domain. Furthermore, Wang Bing, in the eighth century CE during the Tang dynasty, who edited the Neijing, was/is acknowledged to be a Daoist, well versed in the texts of the Daojia tradition; this would also explain his preoccupation with editing the Neijing, as it was/is perceived to be a text imbued with Daoist philosophy. In other words, CCM in reality is yidaoyi/ ᱃䚃५ (see Chapter Ten).

17 However, this interpretation on the part of Liu (and Huang) may not be entirely uncontroversial, as some scholars maintain that wei zhen/small needles are not something different from jiu zhen but identical to it (see *“Two meanings of wei zhen” 2015). 18 For images, see *“Hao zhen” 2015. 19 These are Lee’s chosen texts that however should not be interpreted to mean that there are no other texts relevant to the understanding of CCM.

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What then are some of the key theoretical ideas of CCM, given such a philosophical lineage as just outlined? These include: the fundamental ontological category of Qi and its two modes (Qi-in-dissipating mode and Qi-in-concentrating mode), Yinyang, Wuxing (Yinyang-Wuxing), polar contrasts, such as dong/jing ࣘ䶉, you/wu ᴹᰐ, shang/xia кл, li/biao 䟼 㺘ˈand so on. However, there is one concept which Lee 2017a has not dealt with, and that is the Jingluo (㓿㔌) network mentioned above. In sinological literature, Jingluo is translated as meridians or channels and their branches. Chapter Two in this volume examines this system in detail; it is sufficient here to mention only that this concept is key to all aspects of CCM including prescriptions based on medicinals from the Chinese materia medica, cauterisation/jiuliao/⚨⯇, breathing exercises/qigong/≄ ࣏, massage/tuina/᧘᤯ as well as acupuncture with which the Jingluo is most familiarly associated. What this shows is that, in reality, both the Suwen and the Lingshu share the same set of concepts, although it is true that the Lingshu, unlike the Suwen, does not state them all the time, throughout the text. Both parts complement each other, forming a unity as a total text. Acupuncture cannot be understood without the theoretical framework of the Suwen, nor could the latter be understood without the notion of the Jingluo, which acupuncture instantiates paradigmatically. As observed earlier, bianshi existed during the New Stone Age. It is not possible to argue that the hunter-gatherers of that era grasped what later thinkers articulated in terms of the Jingluo and the acupuncture points/xuewei/イս. Nevertheless, one could safely argue that the minimal, basic and simplistic theoretical understanding of how the person-body functions on the part of these early peoples would lay the beginnings for a system of medicine, which has come to be identified as CCM. It is likely that theoretical ideas, even barely articulated, might have led them to fashion tools; and that in an elementary sense, theory and practice went hand in hand. As the Stone Age was left behind, theory and practice became more complex, more sophisticated, resulting in the bronze needles (found in Guangxi in 1985), which could be dated to the Shang-Zhou periods of Chinese history, and could be related to, if not be,20 the direct forerunner of the jiu zhen of the Neijing. This gives Liu Guangting evidence for believing that (parts of) the Neijing (containing the oldest concepts and ideas) could have emerged earlier than, but not later than, the

20 Again, this qualifying phrase reflects this author’s opinion rather than that of Liu himself.

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Spring and Autumn period. 21 On the other hand, while Huang Hanru agrees with Liu on this point, he himself is prepared to date the emergence of the idea of the Jingluo to a period even earlier than Liu’s. The issue of the authorship of the Neijing has also been contentious. The text takes the form of questions and answers between the Yellow Emperor as the interrogator, and Qibo as the main (though not the sole) respondent to the questions and queries posed. There are 164 exchanges in total, of which Qibo is responsible for 107. The Yellow Emperor is regarded as a legendary figure though not quite a mythological one (at least, in the eyes of the Chinese), who lived during 2712?-2599 BCE. He is often credited as having introduced to Chinese civilisation wooden carts, boats and houses, the bow and arrow, the compass, as well as writing. He is perceived as a cultural hero and is regarded even as the patron saint of Daoist philosophy as he is said to possess all the virtues which a Daoist ruler ought to possess. In the Neijing he is not portrayed as having bestowed Chinese Medicine on the people; instead he is presented as an eager and willing pupil sitting at the feet of Qibo (one of his court officials) to get all the knowledge he could from his teacher. Is Qibo equally as legendary as the Yellow Emperor? In some Han stone carvings, he is portrayed as a mythological figure, half-man, halfbird, with an acupuncture needle between his fingers ready to treat a patient.22 In spite of such an unpromising image, the two scholars, Liu and Huang, set about searching for information to see if Qibo might not after all be a historical person. One should bear in mind that the ancient Chinese had the habit of transforming historical personages who had made great contributions to their culture and civilisation into mythological characters. For instance, in medicine (see Appendix Four) a distinguished physician, called Qin Yueren/〖䎺Ӫ, who lived during the Warring States period, was referred to as Bian Que (the name of a mythological bird) giving the misleading impression to later scholars that the name did not belong to a real historical person. Similarly, in other domains examples of such a process of transformation can be found. For instance, Confucius, Laozi and others all became gods. Temples were built in their names, with statues of them put up at the main altars. Fortunately, the fact that these philosophers were turned into gods did not always mislead later scholars into believing that they were merely mythological figures, for the simple 21 This is contrary to the conclusion reached by *Liu Changlin (1980, 10) based solely on the textual approach, that the Neijing or parts of it could not have emerged during the Spring and Autumn period, never mind the pre-Spring and Autumn periods. 22 For such an image, see *“Qi Bo” 2015a.

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reason that the recorded evidence for their real existence was overwhelming, at least in the case of Confucius himself. Laozi was not so fortunate, as some aspersions have been cast on his status as a historical figure, because his biographical details are not as clear and straightforward as in the case of Confucius. Their search has turned up a passage from a book written and published in 1927 by a distinguished Japanese scholar on the history of CCM and a CCM practitioner called Yumoto Kyushin/⊔ᵜ≲ⵏ, whose original name was Yumoto Shirouemon. He was a keen student of the writings of Zhang Zhongjing23 in particular, but also of pre-Han medical writings in general. His book is called Huang Han yixue/ljⲷ≹५ᆖNJ, which could be translated as Pre-Han and Imperial Han Medicine.24 The author records a passage he has found in his historical research: ᱄㘵ዀ՟ԕᦸ哴ᑍ 哴ᑍশѵᐸԕᦸԺቩ শ㓿⊔ ཚ‫ ޜ‬᮷⦻ ५઼ ࡠ 〖䎺Ӫ ࿻ᡀㄐਕ ԕᦸॾ䱰

Rendered as: In the past it is held that Qibo transmitted his knowledge to the Yellow Emperor, who in turn transmitted it to Yi Yin;25 the line of descent then 23 See Appendix Two for his place in CCM history and Chapters Seven, Eight, and Nine for his fundamental contribution to CCM. 24 Its Japanese title is Koukan igaku. Yumoto Kyushin was initially trained in Western medicine, graduating in 1901; upon the death of his eldest daughter in 1910, he began to turn his attention to CCM, and began to publish the results of his research in 1927. A Chinese version of the book came out in Hong Kong in 1936. A recent Chinese translation of it appeared in 2007, translated by Zhou Zixu/ઘᆀ ਉˈpublished by the Chinese Materia Medica Press/ѝഭѝ५㦟 ࠪ⡸⽮ (see *Huang Han yixue 2015). (On these various points, this author would like to thank Jingling Hu Marriott of the University of Manchester.) 25 He was a noted prime minster of Tang/⊔, the first ruler of the Shang dynasty, whom he assisted to come to the throne and then to rule the country. After the death of Tang, he continued to serve the state through several more rulers for a total of some fifty years. Not only was he a distinguished political theorist and practitioner, he was also reputed to be an exceptional cook, in charge of the imperial kitchen. Furthermore, he was noted for his medical skills and knowledge, as he was the leading shaman during this period of the Shang dynasty. In Shang times, the shaman was also the person with medical skills and knowledge. Indeed, according to Shuowen jiezi, the word ⋫ which is the term used in political discourse to mean “to rule” (see Appendix Three) and in medical discourse to mean “to treat”; a scholar of archaic Chinese (Kang Yin/ᓧ⇧) has pointed out that

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Appendix One went by way of Tang,26 Taigong,27 King Wen,28 the physician He29 right the way down to Qin Yueren,30 to Hua Tuo.31

This then appears to set out the lineal descent of Chinese Medicine as well as to confirm the existence of a person called Qibo, who was the founding father of Chinese Medicine. 32

the word, ቩˈas an ideogram looks very much like a hand holding a needle ready for insertion during an acupuncture session. Amongst the artefacts excavated from the Mawangdui tombs are some medical texts attributed to Yi Yin (see *“Yi Yin” 2015). 26 He was the first ruler, the founder of the Shang dynasty. 27 The name “Taigong” was bestowed on him as a mark of popular appreciation long after his death. His formal name was Jiang Ziya/ဌᆀ⢉, a distinguished political and military theorist, who served Zhou/㓓, the last king of the Shang dynasty. Disgusted by the decadence and corruption of that court, he resigned and retreated to “the wilderness”, biding his time, wishing fervently for the demise of the Shang regime. When that happened, he re-emerged to serve the succeeding Zhou dynasty after he had turned eighty (see *“Jiang Taigong” 2015). 28 He is the founder of the Zhou dynasty and is also reputed to have formulated the hexagrams of the Yijing. 29 He was a distinguished physician of the Qin state during the period of the Spring and Autumn period. He invoked the concepts of Yinyang, sishi/the four seasons (in a year/day), Wuxing, wuyin/five sounds, wuse/five colours, wuwei/five flavours/tastes as well as liuqi/six kinds of qi to explain how they could be involved in causing illness. For this reason, he is often regarded as a founding father of medical theory. For some details, see *“Yi He” 2015. 30 This is Bian Que (see Appendix Four). 31 He lived towards the end of the Eastern Han dynasty (145-208 CE), a contemporary of Zhang Zhongjing. In the history of CCM, he is especially renowned for his discovery of an anaesthetic called mafeisan/ 哫 ⋨ ᮓ , which enabled him to go beyond minor to major surgical operations. His skill as a physician spread far and wide. Cao Cao, a powerful political figure of the time, suffered from unbearable headaches. Hua Tuo was summoned to treat Cao Cao whom he successfully treated with acupuncture. Furthermore, he offered to cure Cao Cao permanently through a major surgical operation, opening up the skull, a procedure which was misinterpreted as an attempt to assassinate the patient. Cao Cao imprisoned Hua Tuo and finally killed him. Hua Tuo asked his gaoler to pass on his medical writings to posterity; understandably, the gaoler was too frightened to accept such a responsibility. Hua Tuo burnt his collected work, called the Book of the Blue Bag/䶂೺, before his death, and his wisdom and knowledge thus were lost to posterity. For some details, see Dharmananda 2015a; *Hua Tuo” 2015. 32 For more details about Qibo and the clan to which he belonged, see * “Qi Bo” 2015b.

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Though not mentioned by Liu and Huang, a roughly similar passage can be found in the work of the Eastern Han historian Ban Gu/ᯁപ (32-92 CE). A medical section, the Fang zhilüe/lj ᯩ᷍⮕ NJof his work entitled Hanshu/lj≹Җ 㢪᮷ᘇNJreads: ཚਔᴹዀ՟ǃ؎ ᣺, ѝц ᴹᡱ呺ǃ⌠ ઼ 33

Rendered as: In very early ancient times, there was Qibo and Yu Fu, in the middle ages, there were Bian Que and Tai He (the same person referred to as “physician He” in the earlier passage cited). (Text within round brackets is the author’s interpolation.)

Another passage can be found in a later text, Diwang shiji/ljᑍ ⦻ц 㓚NJ in the writings of Huangfu Mi/ⲷ⭛䉗 (215-282 CE), which mentions the Yellow Emperor, Qibo and Shennong (by implication). It reads:

34

哴ᑍ৸֯ዀ՟ ቍણⲮ㥹ި५⯇⯮ Ӻ㓿ᯩ ᵜ㥹ѻҖ૨ ࠪ✹ .

Rendered as: The Yellow Emperor directed Qibo to taste many herbs, to understand their healing properties so that they could be written down and recorded, a project which had inspired others to follow, leading to the appearance today (that is, by the time of Huangfu Mi) of many classical prescriptions/fang(s) and books on herbs. (Text within round brackets is this author’s interpolation; emphasis is also this author’s.) 33

The Hanshu covers the history of Ancient China to the end of the Western Han dynasty (see *“Hanshu” 2015); * “Ban Gu on Qibo, Yu and Bian Que” 2015. 34 For a brief but succinct account, see * “Diwang shiji” 2015. This book covers that period of Chinese history from the Three Sovereigns and Five Emperors/йⲷ ӄᑍ to the end of the Han dynasty, which involves several thousand years. It filled in many details either ignored by Sima Qian or glossed over by him; in particular, this book looks at the period before the Yellow Emperor to include Fuxi/Կ㗢 (2852 BCE) and Shennong/⾎ߌ preceding the Xia dynasty (2194-1675 BCE). (However, this period of ancient Chinese history, for lack of archaeological evidence to date, is sometimes said to be part of Chinese mythology rather than Chinese history.)

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Qibo is indeed the fons et origo of CCM as portrayed in the Neijing. As he was the Emperor’s physician, in accordance with custom and practice, the work must be presented as a joint effort of both the Sovereign and the Official. Chinese physicians throughout the ages have considered themselves as Ā ዀ 哴 Ր Ӫ ā /the successors of Qibo and the Yellow Emperor and call the medicine “ ዀ 哴 ѻ ᆖ ”/the intellectual discipline initiated by Qibo and the Yellow Emperor. The above discussion based primarily on the archaeological finds of acupuncture implements in the past few decades, provides some plausible grounds for claiming that the oldest contents and concepts of the Neijing could have emerged not during the Han dynasty, not even during the Warring States period, the Spring and Autumn period, but pre-Eastern Zhou, during the Western Zhou itself (c. 1046-771 BCE). Furthermore, it has offered some evidence for holding that Qibo is not merely a mythological figure but that he could have become mythologised as halfbird and half-man out of respect and admiration for his knowledge, and that he could lay claim to being the founding father of CCM.

Conclusion Plausible claims on dating the Neijing based on evidence discovered may be summarised as follows. 1. The archaeological discoveries in Inner Mongolia, Guangxi and elsewhere show evidence that the precursors of the jiu zhen/nine needles, as described in the Neijing, could be dated back to even the Stone Age (via bianshi/stone needles) and to the Xia/Shang dynasties via the bronze needles ( 䶂 䬌 ⹝ 䪸 ); that, in turn, the jiu zhen are themselves the precursors of the silver needles of the early Western Han. As technology cannot be divorced from the theoretical ideas it embodies, no matter how primitive (as from a later standpoint they might appear to be), so from this succession of designs and technologies down the ages, one can infer that the ideas and concepts embodied in these artefacts would also have emerged long before the Han dynasty. Hence, the Neijing cannot be regarded as a Han text, simpliciter. 2. Methodologically, it is crucial to distinguish the older contents of the Neijing from the later contents, between what *Liu Changlin 1980 calls the “original material” on the one hand, and the “additional material” on the other. The former can be dated to even the Western Zhou, while the latter definitely belongs to the Han dynasty. Once this distinction is kept in

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mind, the question of the dating of the text as a whole becomes not so important. One can simply acknowledge it as both a pre-Han and a Han text. Adherents of the view that the Neijing is a Han text could, in one sense, be said to be correct, but only in a trivial sense of the term “Han text”. By this is meant that as the “additional contents” are indeed additions made during the Han dynasty, it follows that the book which has come to be called the Neijing, containing such later materials, necessarily is a Han text, as the Neijing has been implicitly defined as a Han text. However, one could also choose, should one wish, to define the Neijing as a pre-Han text, by only referring to the older contents, leaving out the later Han additions. One could then say that the Neijing actually is made of two Neijings–the former is the new Neijing and the latter the old Neijing. As nothing of substance rests on such verbal moves, it is somewhat pointless to make them. It is far more relevant to the history of CCM to bear in mind that many, if not, all of the key ideas and concepts of CCM could be dated to pre-Han, to the Warring States, some even to the Spring and Autumn periods and indeed in some cases, beyond to at least the Western Zhou. 3. Qibo might not have been a mythological figure and could well be the author, or at least, the main systematic articulator of nearly all the key ideas found in the Neijing. 4. A concept which is said to be a Han addition to the Neijing is Wuxing. However, this must not be misunderstood to mean that Wuxing, as a concept, only emerged in the Han dynasty, only that up to the Han dynasty, the Neijing (as we know it today) had not yet incorporated it formally into its text, whereas other discourses, such as the military or the political had expressed it. In turn, this does not mean that CCM had not relied on Wuxing in understanding and diagnosing illness long before its formal incorporation into the Neijing, as evidenced in what we know about “physician He ५ ઼”, who lived during the Spring and Autumn period (see footnote 29) as well as in some of the twenty-five medical cases of Chunyu Yi (reported in the Shiji). This last exhibits fluency with Wuxing as a medical concept, intimating that such a concept must have entered medical discourse long before the Han dynasty. (Chapter Three explores the status of Wuxing from the viewpoint of scientific methodology.) 5. Most important of all, one must bear in mind that whatever conclusions one might draw today, based on the evidence so far available, would be subject to revision in the light of further evidence in the future, if not to

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invalidate, but at least to modify them. In other words, these conclusions are necessarily provisional.

APPENDIX TWO DE-MYSTIFYING ZHANG ZHONGJING LIFE

Life Zhang Zhongjing/ᕐԢᲟ (150-219 CE) is heralded by the Chinese as one of the greatest physicians in the history of CCM. He lived towards the end of the Eastern Han dynasty. He was a contemporary of Cao Cao/ᴩ᫽ (155-220 CE, founder of the State of Wei), of Liu Bei/ࡈ༷ (161-223 CE, founder of the State of Shu, another state during the period of The Three Kingdoms) as well as of the famous physician and surgeon, Hua Tuo/ॾև (who died c. 208 CE and was said to have performed major surgical operations in the history of CCM). He was a native of Nanyang/ই䱣 in Henan province which today is just within the boundary of the city of Dengzhou/䛃ᐎ, where there is a village called Zhangsai/ᕐຎᶁ. In his youth he knew a well-known person called He Yong/օ仉; this man made two predictions which turned out to be correct. He predicted that Cao Cao would be great which indeed, he was; he also predicted that Zhang Zhongjing would become a great physician as his quick mind and general personality would provide the right characteristics for such a profession. He studied initially under an excellent physician in his village called Zhang Bozhu/ᕐ՟⾆, noted for his clinical skills. He quickly surpassed his teacher. Yet, in the major official historical records of the time such as the History of the Late Han Dynasty/ljਾ≹ҖNJ as well as the History of the Three Kingdoms/ljйഭᘇNJ, there is no dedicated entry for Zhang Zhongjing. But fragments of information could be found in the book written by his first editor as well as other sources down the ages. In his youth, he was recognised as being full of filial piety; such a youth was called xiaolian/ᆍᓹ.1 Today, historians, on the whole, would

1

This was not an official post obtained through examinations but was merely the result of the nomination by local communities, who were impressed by the virtuous conduct of certain young people. (See Seidman 2012, 1 for an alternative

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not doubt this possibility. From this group, the Court would choose candidates to appoint as officials. It was also held that he was elevated to high office as the mayor or prefect of Changsha/䮯⋉ཚᆸ. No official record of such an appointment exists or ever had existed. In the Ming dynasty in 1632 some peasants, while digging a well, uncovered a tombstone upon which was inscribed the words “This is the tomb of the Mayor or Prefect of Changsha, the doctor Zhang Zhongjing”/䮯⋉ཚᆸᕐ ԢᲟ५⭏ѻໃ. This then, became the chief source of the belief that he had held such an office, as the font and style of the writing appeared to conform to those of the Jin period/ᱻԓ, which followed the end of the Han dynasty. This tombstone still exists. In 1981, when the tombstone was cleaned and looked at again, the museum housing it discovered a plinth on which it stood, at a corner of which was carved a date–equivalent to 330 CE, a hundred and ten years after his death. Some scholars have concluded that this is evidence that he did hold high office. However, the plinth and the tombstone itself were made of different materials; furthermore, the stone mason did not put the date squarely and neatly in the middle of the plinth, but in a corner with the characters carved in a messy untidy manner, as if as an afterthought. Not all scholars are equally convinced that the tombstone was erected just a mere hundred-odd years after his death, but that it could have been a much later memorial erected after it became popularly accepted that he had held that post, before he became a full-time physician. The most telling evidence for this sceptical conclusion is that the term yisheng/५⭏/doctor/physician did not appear in the entire corpus of known Chinese writings down the centuries. As late as 1589, he was referred to by a very different term. The term commonly used to refer to outstanding physicians in Chinese history was sheng/൓ or yasheng/ӊ൓;2 the term yisheng/५⭏ must therefore be a later term, probably towards the interpretation). Zhang Zhongjing did not pass any official examination at any stage of his life; he never presented himself at any. 2 The term sheng literally means “sage”; in general the status/honour of sheng was bestowed on someone who had achieved great heights in mastering whatever domain of knowledge or activity engaged in, be it poetry, medicine, and so on. The term yasheng in pre-Yuan dynasty (1279-1368 CE) texts was used to denote people who had achieved near-perfection, if not absolute perfection, in their chosen activities; literally, it means “second only to a sage”. This expression may plausibly be explained by the fact that Confucius was the paradigmatic sage in Chinese culture. Others, no matter how illustrious therefore could not, without disrespect be labelled a sage/sheng, not even Mencius/ᆏᆀ; hence he must be referred to as yasheng. The term, though looking at first sight to be a left-handed compliment, in reality is an expression of great esteem.

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very end of the 16th or the beginning of the 17th century. It is neither here nor there whether he held public political office, as his achievements lay in the field of medicine. So great did his reputation become after his death that the term “Changsha” is used to refer to him or to his writings. There are numerous other stories about him. One interesting one concerns his prognostication of a young scholar and official, the details of which are explored in Chapter Five. During Zhang Zhongjing’s lifetime, Sima Qian’s Historical Records/Shiji mentioned 22 natural disasters, which included drought, floods, landslides, earthquakes, locust blights, famines, and dykes bursting. It also coincided with a long period of unrest with continuous wars, including those preceding the Three Kingdoms period (220-265 CE) as well as those occurring during it. This meant that the economy suffered and production declined. The conjuncture of natural disasters, economic chaos and war would inevitably lead to all sorts of unimaginable social ills. When people were driven from the land, poverty, hunger, illnesses, even cannibalism occurred, with death and corpses everywhere throughout Zhongyuan, China’s heartland. Under such circumstances, epidemics naturally flourished. As a matter of historical fact, the said Wang Zhongxuan/⦻Ԣ ᇓ (177-217 CE), the scholar/official who died young (see Chapter Five), left a poem which provides a vivid account of the dreadful conditions of the time; as he himself fled plague and disasters, he saw an emaciated mother, in desperation abandon her infant in the bushes by the road because she could not cope. She turned back for a moment when she heard her child cry, but walked away in despair, as she could not even keep herself alive. The poem reads: ࠪ䰘ᰐᡰ㿱ˈⲭ僘㭭ᒣ৏ˈ䐟ᴹ侕ྷӪˈᣡᆀᔳ㥹䰤ˈ亮䰫ਧ⏅༠ˈ ᥕ⌚⤜н䘈ˈᵚ⸕䓛ᡰᖰˈօ㜭є⴨ᆼ.

Cao Zhi/ᴩἽ (192-232), Cao Cao’s literary-talented son, had also left a description of the horrors of that time. In lj䈤⯛≄NJ/Shuoyiqi/On Plague and Its Qi, he wrote: ᇦᇦᴹ‫ܥ‬ቨѻⰋˈᇔᇔᴹਧ⌓ѻ૰ˈᡆ䱆䰘㘼⇚ ˈᡆ༽᯿㘼ї

Rendered as: Every family suffered from the pain of death and bereavement, every house emitted loud cries of weeping and lamentation, entire families died, entire clans had been wiped out.

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It is claimed that Zhang Zhongjing wrote, in the Preface to his book, that of his own extended family/clan with more than 200 people, twothirds had died; 70% of those who perished died from the epidemic raging then from 196 CE: ։ᇇ᯿㍐ཊ, ੁ։ҼⲮ. ᔪᆹ㓚ᒤԕᶕ, ⣩ᵚॱい, ަ↫ӑ㘵, й࠶ᴹҼ, Քሂॱትަг.

Historians have calculated that roughly half of the Chinese population could have perished in total. As a result, Zhang Zhongjing was not only determined to help relieve suffering but also seized the opportunity to study the epidemic, to collect as much information as he could, including the prescriptions used by physicians at large to handle effectively some of the cases involved.3 Another view disputes the provenance of the Preface, or at least the paragraph cited. 4 However, the historical facts remain correct that the China of that period faced dreadful disasters and its people suffered immeasurably through famine, epidemics and death. Zhang Zhongjing, whatever his motives for taking up a medical career, would, under the circumstances have come to acquire an immensely rich clinical experience plus pharmacological knowledge of the appropriate medicinals.

The fate of his work following his death5 Paul Unschuld is one of the world’s leading sinological authorities on the history of CCM. He has consistently maintained in his numerous 3

See *Hao 2011, Lecture One. Brown 2015 argues that this Preface is not original and did not appear till the eleventh century CE, during the Song dynasty, written in 1065 by those in charge of the Song Imperial Bureau of Editing Texts. Brown claims that the Preface seeks to present Zhang in the image of Confucius “thereby bolstering claims that the curative arts represented a counterpart of the classics and thus a pursuit befitting of a gentleman (p. 16).” It reflected the fact that increasingly more literati were turning to medicine as a profession, as the opportunities of a shrinking empire and its civil service made it necessary to pursue an alternative career. Brown’s claim may or may not be news to Chinese historians of CCM; as this author is not a historian of CCM, the matter will just be raised here en passant, but it would be just as well to look at a reference to the works of Wang Tao and Gan Bozong, during the Tang dynasty mentioned later in this Appendix, which is pertinent to this matter. 5 The account which follows is at best, very sketchy and cannot do justice to the full story. For the twists and turns regarding the fate of this work in the light of the latest scholarship today, see*Qian 2009, Interview Three. 4

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publications concerning Zhang Zhongjing’s influence on CCM that his ideas were ignored for eight hundred to a thousand years following their publication in late Han times, and that it was only during the Song dynasty that his achievements and contribution were acknowledged and taken up.6 6

Unschuld (1985, 169) writes: It was only during the Sung [Song]* and Chin [Jin 䠁] epochs that a larger circle of scholars became interested in the surviving fragments of Chang Chi [Zhang Ji**, that is, Zhang Zhongjing].

He continues in the same vein in Unschuld 1998, 32-33: Zhang Ji was the first writer, and for a thousand years to come, the last, to attempt to incorporate the use of drugs into the doctrine of the five phases. … These thoughts*** were plausible for Zhang Ji: for later writers for centuries they were not. The pharmaceutical tradition remained free of the theories of systematic correspondence until the 12th century, developing independently on purely pragmatic and empirical bases. The doctrines of the five phases and of yin and yang remained limited to life-style and the tradition of influencing qi. Their only instrument was the needle. As recently as Unschuld 2009, 64, he repeats the same thesis: In 200 AD, an author named Zhang Ji … applied the discoveries of the new science to the effects of the medical substances in the body… No one paid attention to him. For almost a thousand years, his example found no imitators… until the eleventh century. In 2009 115, in Section 46 subtitled: Zhang Ji’s Belated Honors, he writes: Zhang Ji, who in 200 AD had taken the first steps to create a scientific pharmacology and was then largely ignored for a thousand years, now arrived at unhoped-for honors. Barnes (2005, 22) implies that she accepts the Unschuld thesis that Zhang Zhongjing’s work was ignored for a thousand years or so. Furthermore, Endnote 7, on the same page gives a somewhat garbled account of the work attributed to Zhang Zhongjing during the Song dynasty. This is a pity, as this book shows a sensitive understanding of CCM, invariably not shown in sinological literature, on the subject. (*Texts within square brackets are this author’s interpolations.) ** Unschuld opts, in the main, for the birth name (ming/਽) of this physician, that is, Ji/ᵪ, instead of his name at maturity (at 20), his zi/ᆇ. (On the difference

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Some Chinese historians of zhongyi are also of this opinion (see Liao 2011, 31). Is this view correct? It appears not, as the evidence marshalled below clearly demonstrates.7 Zhang Zhongjing probably finished writing the Shanghangzabinglun/ ljՔሂᵲ⯵䇪NJ8/Discourse on Cold Damage and Other Illnesses by the middle of the first decade of the third century CE. He said he took about ten years to accomplish this task. He mentioned the year of Jian’an/ᔪᆹ, which is equivalent to 196 CE.9 We can roughly take it that the completion date was a few years after 200 CE. His book contained 16 chuan/ধ, which may be called “chapters”. He would have written on either bamboo or wooden slips; in spite of the fact that paper had already been discovered, it remained expensive and generally unavailable. These slips were tied together with strings made either from silk or hemp. After his death, the volume fell into decay. It was rescued by someone, an imperial physician called Wang Shuhe/⦻਄઼ (c. 180-c. 270 CE),10 who was said to be a between these two kinds of names in a person’s biography in ancient China, see Lee 2008, 120.) According to Chinese convention, when addressing a person with status and achievements, one uses his zi in order to show respect. Chinese writers/texts always refer to this Han physician whom they held/hold in great respect as “Zhang Zhongjing”, or “Zhongjing” and even as “Changsha”. Sinological literature, on the whole, uses “Zhang Ji”–Farquhar 1994 uses “Zhang Zhongjing” once, but otherwise “Zhang Ji” and on two occasions “Master Zhang”. *** The thoughts refer to what Zhang Zhongjing had written in what has come to be his work called, since Song times, Jinguiyaolüe/lj䠁फ़㾱⮕NJ(see the account later in this Appendix and Chapter Nine). 7 For details of the convoluted history of Zhang Zhongjing’s work in English see Seidman 2012; in Chinese, see *Qian and Hao 2005; *Hao 2011, Lecture 2. This author’s account follows closely that of Hao, who is acknowledged as a leading authority on Zhang Zhongjing and his ideas, in China today. 8 Note that this is the book that Zhang Zhongjing wrote; it was long after his death that the content came to be published as two books, one of which is what today we call the Shanghanlun, of which more later. There seems to be confusion amongst certain sinologists regarding this matter (see Lo 2013, 40) who appears to have given a somewhat confused historiographical account of Zhang Zhongjing’s original text. 9 As Brown 2015 does not address this particular point, one does not know what she would have made of these dates. 10 There appears to be no consensus regarding his dates; different sources mention different years, varying from c. 180-c. 270 CE, 201-280 CE, or even 265-316 CE. If the latter were correct, he could not have been Zhang Zhongjing’s pupil, or at least, not a direct one. If he were indeed a disciple, then the earliest of the three listed above would make sense. Whether he was a pupil or not, or even whether he

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pupil of his (or an admirer and adherent of his new approach to medicine). The fall of the Han dynasty in 220 CE was succeeded by the Period of the Six Dynasties, 220-589 CE which includes the Jin/ᱻ dynasty (265-420 CE). These were troubled times. Nevertheless, Wang Shuhe collected, collated and edited the fragments from the original. He could reconstitute only 10/juan and 22 pian/ㇷ. It is this edited volume by Wang which came eventually to be called the Shanghanlun. In his own book, the Maijing/ lj㜹㓿NJ/Classic of Mai, Wang also incorporated a substantial amount of that material. In the Preface to his Maijing, Wang Shuhe wrote: ཛ५㦟Ѫ⭘ˈᙗભᡰ㌫DŽ઼呺ѻ࿉ˈ⣩ᡆ࣐ᙍ˗ԢᲟ᰾ᇑˈӖ‫ى‬ᖒ䇱ˈ а∛ᴹ⯁ˈࡉ㘳ṑԕ≲傼

 Rendered roughly as: Ascertaining the mai is an important technique in diagnosing illness, but it is no easy matter to read it accurately. Yet without such precise and accurate assessment, one could end up prescribing the wrong medicinals, causing the illness to get worse or even the patient to die. Bian Que (traditionally one of the most distinguished in the history of CCM but see Appendix Three) and Zhang Zhongjing were illustrious practitioners of feeling the mai (although they were also known to be supreme adepts at the even more impressive technique of wang/ᵋ as practised by the great master physicians in the history of CCM, as shown in Chapters Five and Eight), yet they must be very careful indeed in this matter of feeling the mai, in the context of the patient’s totality of symptoms and signs, before making up a prescription, as there was (is) simply no room for mistakes. (Texts within round brackets are this author’s interpolations.)

The point of citing this passage is not to show the complexities in ascertaining the mai profile, but to use it as evidence that Wang Shuhe was sufficiently impressed by the Han physician’s skill in feeling the mai and his use of medicinals in the light of arriving at the patient’s 䇱/zhèng, to equate his excellence with that of Bian Que. This then bears ample was born several decades after Zhang Zhongjing’s death or before, it remains correct to maintain that when he came to know of the work in question, he cared about its contents passionately enough to spend so much of his time and effort in reconstituting it as best as he could. This again shows that Zhang Zhongjing was neither forgotten nor neglected, during even the very troubled times in Chinese history, which immediately followed his death and the end of the Han dynasty.

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testimony to the very high regard in which he held Zhang Zhongjing. Furthermore, his entire labour of love in rescuing the manuscript, costing him an immense amount of time, effort and energy, was also itself an expression of how much he appreciated and esteemed Zhang Zhongjing’s concepts in medicine. So, through Wang Shuhe’s Maijing, if not Zhang Zhongjing’s own work edited by Wang, physicians during the Period of the Six Dynasties and after would come to know the late Han physician’s ideas and his pioneering work in medicine. There is an additional acknowledgement of the outstanding regard in which he was held during the Jin/ᱻ dynasty by Huangfu Mi/ⲷ⭛䉗 (215-282 CE), who wrote a book considered to be a classic, as it was the first book dedicated solely to acupuncture in the history of CCM; it is called The A and B Canon of Acupuncture and Moxibustion/ljⲷᑍ䪸⚨⭢҉㓿NJ. In the Preface, he wrote that Zhang Zhongjing’s prescriptions were related to those of one particular school of practitioners (there were eleven different schools in total at the time he lived) implying that he, Zhang Zhongjing, went beyond them; his own prescriptions giving excellent results in clinical experience: Ẳ⯡ẍ‫⛋ݳ‬ᷳㇵ炻㑘䓐˪䤆⅄㛔勱˫ẍᷢ˪㰌㵚˫炻ẚ㘗孢⸧Ẳ⯡ ˪㰌㵚˫ᷢ㔘⋩⌟炻䓐ᷳ⣂樴 (See *Qian and Hao 2005, 11.11 )

Yi Yin/Ժቩ, mentioned above, is considered to be the “patron saint” of Chinese cuisine. (For other details about this remarkable person, see Appendix One.) This was because he held that the art of successful cooking was akin to that of successful ruling/⋫བྷഭ㤕✩ሿ勌–if you are good at one, you would be good at the other. At the time of Zhang Zhongjing, his name was also associated with a school of physicians claiming to use the prescriptions in a collection attributed to him, called Ժ ቩ/lj⊔⏢㓿NJ/Yi Yin’s Book of Decoctions. Such a claim on the part of those who followed Yi Yin would sound not simply extraordinary but also unintelligible, unless one realises that the philosophical concepts behind these three domains of seemingly disparate activities are, as a matter of fact, identical. To cook brilliantly, to rule intelligently and wisely, and to be an outstanding physician, one must grasp the ideas of Yinyang, Wuxing and other related notions such as the five tastes ӄણ/wuwei. Later, in the 11

For an alternative interpretation see Brown 2015, Chapter 6.

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history of the development of Chinese thought, this cluster of concepts came to be called 䱤 䱣 ӄ 㹼 ᆖ , the academic discipline of YinyangWuxing, which forms the backbone of CCM (see Lee 2017a, Chapter Seven).12 Furthermore, Huangfu Mi went on to sing Zhang Zhongjing’s praises in the passage cited above, adding: ᡰ㪇䄆ˈަ䀰㋮㘼ྗ˗ަ⌅㉑㘼䂣ˈ䶎␪㚎ሑ㾻㘵ᡰ㜭৺

Rendered as: The literary quality of his writing was superb and subtle, his methods of diagnosis and treatment were pared down to essentials yet detailed. However, his approach could not be readily grasped by those with a shallow outlook and limited vision.

This was high praise indeed. Tao Hongjing/䲦ᕈᲟ (456-536 CE) lived during what is called the period of the Southern and Northern dynasties, and is regarded as an important figure in the history of CCM. This was especially true of his work in collating and clarifying the writings of other physicians on (Chinese) materia medica regarding their relationship with The Divine Husbandman’s Materia Medica/lj⾎ߌᵜ㥹㓿NJ (which, as a mature text, had emerged some time during the Western Han dynasty, if not before). In his Bencaojing jizhu/ljᵜ㥹㓿䳶⌘NJ, he recorded that there were “four classics and three schools”/ഋ㓿йᇦ. His work led him to conclude that the extant version of The Divine Husbandman’s Materia Medica showed signs of revision and augmentation in late Han times (towards the end of the Eastern Han dynasty), from which he inferred that Zhang Zhongjing and Hua Tuo could have had a hand in this. He could be wrong in this 12

The story of Yi Yin’s excellence in cooking, ruling and prescribing illustrates two things: that the concepts of Yinyang and Wuxing had already emerged, albeit in an embryonic form, even by early Shang times, and that this philosophical framework survived and evolved down the millennia to embrace not only the domains of medicine, ruling, and cooking, but also military strategies and science, in general and indeed in all aspects of Chinese culture (see Lee 2017a and this volume, Appendix One). See *Qian 2009, Interview 2 for a detailed discussion of the relationship between the prescriptions of Zhang Zhongjing and Yi Yin’s Book of Decoctions as mentioned by Huangfu Mi, whose content was incorporated in Tao Hongjing’s/䲦 ᕈᲟ,lj䖵㹼䇰ӄ㜿⭘㦟⌅㾱NJ, found amongst the Dunhuang Cave documents– on the latter, see Tao Hongjing, Zhang Dachang and Qian Chaochen 2008.

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hypothesis, but his remark could be construed simply as evidence that Zhang Zhongjing had not been forgotten and his reputation ignored, in the three hundred years since his death in 219 CE.13 During the Tang dynasty (618-906 CE), a very famous physician in the history of CCM, Sun Simiao/ ᆉ ᙍ 䚸 (581-682 ˛ CE), in his first monumental book, Essential Prescriptions Worth a Thousand Pieces of Gold for Meeting All Emergencies/lj༷ᙕॳ䠁㾱ᯩNJhad written: 㰇⋿ 宠ⶰ䦀ẚ㘗天㕡ᶵỈ. This line has sometimes been misunderstood and taken to mean that the work of Zhang Zhongjing was ignored, when what Sun had meant was that the work was not readily available. It was guarded jealously by those who possessed copies, who were living in Jiangnan [south of the Yangzi River which indicates Southern China as opposed to Northern China located on the plains north and south of the Yellow River]. In this volume, he included some material which he could lay his hands on, from the work of Zhang Zhongjing. Today, scholarship accepts that this was because Sun Simiao at that time did not himself possess a copy. However, thirty years later, in another major work (Qian jin yi fang/ljॳ 䠁㘬ᯩNJ), which he wrote to complement his earlier book, in two of its 30 volumes he incorporated the whole of the so-called Shanghanlun. By then, he had acquired a copy of the Sui dynasty (581-618 CE) edition of the text. In his second monumental tome, he was determined to make all of its contents more readily available to all practitioners and students. 14 Furthermore, in the first chapter of his first book, Essential Prescriptions which is entitled “Education of Superior Physicians”, Sun Simiao mentioned a whole list of “must know” key concepts regarding CCM as well as key medical texts, not to mention key cultural texts such as the

13

See Fan 2013. On one occasion, Sun Simiao’s chief disciple, in his absence, treated a patient, who was suffering from ⱳ䰝/longbi (the first character refers to small drops of urine and the second to none at all), unsuccessfully, using different methods, including one of Zhang Zhongjing’s prescriptions called Wuling san/ ӄ 䴦 ᮓ . When Sun arrived home and was told about the patient, he sent his disciple to the kitchen to prepare a meal. He saw the disciple cleaning some spring onions–he took one, cut off a piece at an angle, introduced it into the man’s urinary outlet, blew through the spring onion and, lo and behold, the man started to pee. This story is usually told to illustrate Sun’s sometimes rather idiosyncratic methods in his treatment (see *Ji 2014). The point of this story, in this context, is a different one–to demonstrate that Zhang Zhongjing’s method of diagnosis and accompanying prescriptions were in use, not ignored, during Tang times. 14

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Zhouyi. Among the names of physicians and their texts cited is that of Zhang Zhongjing.15 Another work in the Tang dynasty which also incorporated a good deal of Zhang Zhongjing’s writings is Waitai Miyao/Medical Secrets of an Official/ljཆਠᇶ㦟NJ, published in 752 CE by Wang Tao/⦻⏋ (c. 702772 CE). A reference to Zhang Zhongjing could be found in a book also published during the Tang dynasty, by the scholar Gan Bozong/⭈՟ᇇ. He had written a work entitled A Record of Eminent Physicians/lj਽५ᖅNJ (a work no longer extant today), in which he gave some details about Zhang Zhongjing (which The History of the Late Han Dynasty/ljਾ≹ҖNJ did not record), such as the place where he was born, his birth name and name at maturity, that he was on the list of “filial and pure youth” of his time, and that he become mayor or prefect of Changsha. (ᕐԢᲟˈlj≹ҖNJᰐՐ 㿱lj਽५ᖅNJӁ˖ই䱣Ӫˈ਽ᵪˈԢᲟѳަ ᆇҏˈѮᆍᓹˈᇈ㠣䮯⋉ཚᆸ.)

Today, we know about this Tang publication because during the Song dynasty, under the aegis of the Imperial Bureau of Editing Medical Texts/ ṑ↓५Җተ, the official in charge wrote a preface in 1065 CE concerning the Shanghanlun, in which he said that although Zhang Zhongjing was not given any recognition in the History of the Later Han Dynasty, nevertheless Gan Bozong’s A Record of Eminent Physicians published during the Tang dynasty did include him. A significant piece of evidence regarding the very high esteem, which Zhang Zhongjing enjoyed during the Tang dynasty may be found, surprisingly, in the preface to the edition of the Huangdi neijing by Wang 15

The original from ljབྷ५ҐъNJ reads: ࠑ ⅢѪབྷ५ˈᗵ享䉉lj㍐䰞NJlj⭢҉NJlj哴ᑍ䪸㓿NJǃ᰾า⍱⌘ǃ ॱҼ㓿㜹ǃй䜘ҍ‫ى‬ǃӄ㜿‫ޝ‬㞁ǃ㺘䟼ᆄイǃᵜ㥹㦟ሩǃᕐԢᲟǃ⦻ ਄઼ǃ䱞⋣ইǃ㤳ь䱣ǃᕐ㤇ǃ 䶣䛥ㅹ䈨䜘㓿ᯩDŽ

The works mentioned in the passage above are: the Suwen, The A and B Canon of Acupuncture and Moxibustion by Huangfu Mi (which citation incidentally puts a question mark over Brown’s 2015, Chapter 6 interpretation of the reputation of Huangfu Mi) and a book that scholars seem to think is what, today, is called the Lingshu of the Neijing (or at least the book would have covered, by and large, the same material as the Lingshu). The physicians and their works mentioned included Zhang Zhongjing, Wang Shuhe, and Huangfu Mi.

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Bing/⦻ߠ in 762 CE, upon which today’s version of that text ultimately rests. In that preface Wang Bing stated that he had been frustrated for years with extant copies of the Neijing available to him as these were, by and large corrupt, suffering from various kinds of internal inconsistencies. Good fortune dictated that at long last he had access to a proper version from his master; even greater good fortune awaited him as this specific copy turned out to be the personal copy that had once belonged to none other than Zhang Zhongjing himself: ᒨ䙷ⵏ㓿ˈᔿѪ嗏䮌DŽ㘼цᵜ㓠㕚ˈㇷⴞ䟽ਐˈࡽਾнՖDŽDŽDŽᰦ Ҿ‫⭏ݸ‬䜝ᆀᮻาˈਇᗇ‫ݸ‬ᐸᕐ‫〈ޜ‬ᵜˈ᮷ᆇᱝᲠˈѹ⨶⧟ઘˈаԕ৲ 䈖ˈ㗔⯁ߠ䟺

Rendered as: Fortunately, I came across a copy of the Canon which could serve as an excellent exegetical tool and guide, while the popularly extant copies were full of errors or inadequacies, with duplications in their tables of contents, inconsistent passages throughout…. At the study/library of my teacher Mr Guo, I received from him the personal and private copy of the Ancestral Master, Lord Zhang. The text in this version is very clear, its argumentation impeccably ordered. With such a guide in hand, any suspect or dubious point was readily cleared up as fast as melting ice.

(The quotation in the original Chinese is from *Guo 2010.) Note that Wang Bing referred to Zhang Zhongjing in the most respectful of terms, something that would be totally inexplicable if Zhang Zhongjing had been ignored since the publication of his great work towards the end of the Han dynasty. But even more telling than the above citations and tributes paid to the late Han physician was the role played by his writing in the Tang Imperial Examinations in Medicine/Yiguan kaoshi/५ᇈ㘳䈅. The records show that the Neijing and the Shanghanlun carried equal weight in the syllabus, covering ten topics each. From 759 CE onwards, students at such examinations were tested in the following areas. 1. Ten topics: principles of medicine and prescription. 2. Two topics based on The Divine Husbandman’s Materia Medica/lj⾎ ߌᵜ㥹㓿NJ (pharmacology). 3. Two topics based on the Maijing.

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4. Ten topics based on the Suwen (Neijing). 5. Ten topics based on the Shanghanlun. 6. Two topics: prescriptions for zhabing.16 As Zhang Zhongjing’s opus occupied such an important place in the official medical examinations, one could infer that copies of the text in diverse forms must have been in existence to satisfy this demand in Tang times. But as these were manually transcribed, not printed, they would have been costly.17 To summarise the above: the evidence cited amply shows that Zhang Zhongjing’s work, in one form or another, was in continuous circulation: since Wang Shuhe’s rescue of the fragments in the early years of the period of the Six Dynasties (the Jin dynasty); right through to the end of the Tang dynasty–eight hundred years or so, not due to oversight, but to high esteem. His reputation therefore in the history of CCM did not have to await the Song dynasty (960-1279 CE) to rescue him from oblivion, as he never suffered it. This is quite contrary to the pronouncement of at least one leading sinologist, today. It is true that the Song rulers were keen on scholarship, on editing ancient texts, and on collecting antiquities; furthermore, movable type printing18 had been invented which made book publishing for the first time, a relatively fast process. The emperors were also greatly interested in medicine–the Imperial/National Bureau of Editing Medical Texts/⚥⭞㟉㬋⋣Ḏ⯨ was set up,19 and the text of the 16

This information is taken from *Hao 2011, Lecture 2. The records also show that candidates who obtained 70 per cent or above, would be entitled to the status of officially recognised physicians at the national level; those, who just failed to reach such grades would be accorded a lower status, that of regional practitioners; as the grade went further down, the candidate would only qualify as a local practitioner. There was a cut-off point, below which candidates were deemed to have failed the examination altogether. 17 The Japanese came to China on serious cultural expeditions to take back with them Chinese texts, ideas and artefacts–Tang copies of the Shanghanlun, some of which still exist in Japan today, were probably amongst such freight. 18 This invention is attributed to Bi Sheng/∅᰷ (990-1051 CE), who carved out the characters in wood. Block printing however had already been discovered during the Tang dynasty. 19 The founders of the Song dynasty, namely, the Emperor Taizu (r. 960-976) and his successor, Taizong (r. 976-997) had already begun to initiate medical text publishing projects even before the military control of territories gained had been

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Shanghanlun appeared in 1065. Upon its re-publication, the official in charge, as we have already cited, approvingly recycled in the preface to this edition the high praise accorded to Zhang Zhongjing by the Jin dynasty scholar, Huangfu Mi. Given the imperial interest in medical texts during early Song times, a very interesting thing occurred. In the reign of the fourth Song emperor Renzong/ᆻԫᇇ (reign: 1022-1063), an academician, while going through the imperial archives, found some fragments of a text that were in very poor condition, on worm-eaten bamboo slips, called thelj䠁फ़⦹࠭㾱⮕ ᯩ䇪NJ/Essential Prescriptions from the Golden Coffer and the Jade Case. Upon further examination based on style and content, the scholars of the Imperial Academy at that time agreed that they constituted the missing parts or some of the missing parts of the Shanghanzabinglun and hence, with imperial approval, they restored them as lj 䠁 फ़ 㾱 ⮕ NJ /Jinkuiyaolüe/Essential Prescriptions from the Golden Coffer. From the Song onwards then, the original Shanghanzabinglun appeared, and continues to appear today, as two separate texts, the Shanghanlun and the Jinkuiyaolüe. Another reason that the Shanghanlun became an object of such interest from the publication point of view was that a country in south China which the Song had just subdued,20 had no choice but to offer up its own treasured copy of the Shanghanlun to the Song Emperor Yingzong/㤡ᇇ (reign: 1063-1067). The Emperor was so excited that he let this be known throughout the medical world, and immediately caused a new edition to be published. As a result, it is true that it was only during the Song Dynasty that the Shanghanlun became available as a free standing publication in its own right, by imperial decree. It first came out in big font/བྷᆇ, but this proved too expensive for ordinary practitioners. The Emperor then decreed that the publication should be in small font/ሿᆇ, which was cheaper to produce, and that such copies were to be sold but not for profit. finalised. The establishment of a central administration for the empire appears to have gone hand in hand with that of collating medical knowledge, and administering medical relief (see Goldschmidt 2008, Hinrichs 2013). 20 When the Tang dynasty ended, China disintegrated into many different independent states. The early Song emperors were determined to unify China again from their base in North China; they did not, in the main, rely on force but “soft power” to bring these states back into the fold. This policy was not unsuccessful; there was one exception, the Southern State of Jing/㥶ইഭ, located north of today’s City of Wuhan in Hubei province. The king of that state at that time was called Gao Jichong/儈㔗ߢ.

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Unfortunately, the Song publications of the work are no longer extant. The version used today is the Ming 1599 edition by Zhao Kaimei/䎥ᔰ㖾, which was based on a Song edition/ᆻ⡸.

Conclusion One may conclude that Zhang Zhongjing and his revolutionary ideas had not been neglected for nigh on a thousand years before the Song dynasty rescued them from oblivion, contrary to what Professor Unschuld, consistently and persistently maintains. It would be fair to admit that when his writing became readily available under the aegis of Song imperial publishing, it led to a great outburst of interest at the theoretical and therapeutic levels and grabbed the attention of the literati. Nor should it be denied that Song officials invoked Zhang Zhongjing’s approach in their attempt to stamp out what they considered to be harmful and superstitious shamanic medical practices, especially within the context of coping with the epidemics which assailed Song society, as it had in Zhong Zhongjing’s own time, in the dying years of the Han dynasty (see Goldschmidt 2009, Hinrichs 2013, Despeux 2001). Needless to say, his reputation had not faltered since Song times. It suffices to cite just one example of the high regard in which he was held. In the eighteenth century (Qing Dynasty), a distinguished scholarphysician of the day, Xu Dachun/ᗀབྷὯ (1693-1771) considered the work of Zhang Zhongjing (which has, as already earlier observed, come down to posterity as the Shanghanlun and the Jinkuiyaolüe) to stand shoulder-toshoulder with Shennong’s Divine Husbandman’s Materia Medica, the Huangdi neijing and the Nanjing/ lj 䳮 㓿 NJ . Furthermore, he said of Zhang Zhongjing ཛԢᲟ‫ˈ⭏ݸ‬ѳॳਔ䳶 བྷᡀѻ൓Ӫˈ ⣩݂ᇇѻᆄᆀ

Rendered as: Zhang Zhongjing could be said to count as one of the sages of history; his place with respect to medicine is comparable to that of Confucius with respect to that philosophical tradition which that sage had established. 21 21

Of course, this may reflect Xu Dachun’s attempt to trace the lineage of “elite” medical learning and medical texts back to antiquity, to pre-Han and Han times. Furthermore, this assessment occurred during a period in Qing scholarship which based itself on the methodology of “evidential research”/ 㘳 䇱 /kaozhèng; it

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Professor Unschuld is indeed correct in saying that Zhang Zhongjing’s approach was revolutionary; how revolutionary his view was is obvious from the exploration of CCM in this volume. This author’s disagreement with Unschuld lies merely in this–he appears to have erected a mystery when none exists, and thereby created a myth to reinforce that mystery. Unfortunately, in this way he has perpetrated almost single-handedly and successfully an error in sinological understanding of the history of CCM as well as, more importantly, of the nature of that medicine itself in the minds of his readers. At times, Unschuld appears to overlook clues in his own writing which if explored more conscientiously and thoroughly, could have prevented him from falling victim to the myth he has created. Consider the following passage from Unschuld (1998, 36-37): With the exception of the prescription works of Zhang Ji around A.D. 200, two distinct traditions of medical literature developed after the Han Dynasty: pharmaceutical and prescription literature that did without the theories of yin and yang and the five phases, and hardly cared about the state of qi, and acupuncture literature that cultivated precisely these notions. To what extent the two traditions were strictly separate is uncertain. Sun Simiao (ᆉᙍ䚸 581-682?), the most famous physician of the Tang period, who has been revered since the 13th century as the god of pharmacy, was versed in acupuncture as well as pharmacy.22

deployed as strategies the critical comparison of texts and philological analysis to recuperate the original form and meaning of Han texts (including those of Zhang Zhongjing), which in its opinion had been obscured by the neo-Confucianism of Song scholarship. This viewpoint was embodied in the Imperially Compiled Golden Mirror of Medical Learning/Yucuan yizong jinjian/ljᗑ㈑५ᇇ䠁䢤NJ drawn up primarily for the use of court physicians, constituting the one purely medical compilation sponsored by the court of the Emperor Qianlong. Later, in 1773, Qianlong commissioned what is called theljഋᓃ‫ޘ‬ҖNJ/Siku quanshu, sometimes rendered in English as the Complete Books of the Four Treasuries (see Wu 2013). (Note, however, that Wu 2013 has unfortunately, given a garbled account of Xu Dachun’s assessment of Zhang Zhongjing’s work as a member of the “four great masters” of “the Jin and Yuan (sic) period”.) One of the subjects covered was medicine; and this entire compilation only admitted books that conformed to the kaozhèng methodology, although in criticism, it must be said that in the compilation of works selected to enter the project, many books which contained anti-Manchu sentiments were destroyed under Qianlong’s censorship. 22 This quotation has left out the tonal markings of words in pinyin.

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The critical part of the passage above has been italicised for the reader’s benefit. Readers are invited to ponder it and work out for themselves (using the exploration undertaken in this Appendix) how Professor Unschuld could have saved himself from creating two myths about the history of CCM, if only he had paid more attention, amongst other considerations, to the implications of what he has written about the work of Sun Simiao. The two-related myths are: (a) Two distinct traditions of medical literature developed after the Han dynasty; (b) The emergence of the above can be traced to the fact that the development in CCM, pioneered by Zhang Zhongjing, had been systematically ignored for nearly a thousand years.

APPENDIX THREE THE FALLACY OF MISPLACED ANALYSIS

What is this fallacy? What is the Fallacy of Misplaced Analysis (FMA)? This author has created the term to draw attention to a stance adopted by certain scholars (or, at least, by one distinguished sinological authority on the history of CCM) in interpreting and understanding medical phenomena not in a direct but an oblique, manner. At first glance, it appears to be both useful and insightful; however, upon critical scrutiny, it can be revealed as being deeply flawed methodologically speaking, and as having failed to do justice to the phenomenon under investigation. In order to show precisely what FMA amounts to, one needs, first, to reconstruct, on Professor Unschuld’s behalf, his own interpretation and understanding of CCM. The reconstruction would include the following steps. 1. To hold that the Neijing is, primarily a Han text–call this PHT for short. 2. To imply Essentialism of Method which permits him to conclude that CCM is not scientific, and therefore not capable of being efficacious as a medicine–call this EM for short. 3. Step 2 implies that there is a need therefore, to explain the endurance and continuity of CCM throughout Chinese history in extraneous terms, terms which no longer have anything to do with it as medicine per se, but through political or sociological understanding, instead–call this PExM for short (Political Explanation of the Medicine).1

1

The philosophy of science debates how a hypothesis may persist in spite of falsification (see Popper 1950, Kuhn 1962, Lakatos and Musgrave 1970, Lee 1984). This is not the route which Professor Unschuld follows.

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4. Steps 2 and 3 together with step 1 lead to the more precise thesis that the essential characteristics of CCM are generated by the characteristics of Han politics–call this HPExM for short (Han Political Explanation of the Medicine). To demonstrate that the theses set out above involve committing FMA, we need to critically scrutinise each of them in turn. PHT is, basically, an empirical thesis. Appendix One has examined it and found it wanting in many ways. This basis of Unschuld’s understanding of CCM/the Neijing may be unsound. (We shall have occasion, however, to refer to it again in assessing PExM and HPExM later.) Chapters Six, Seven and Eleven, in particular, not to mention the rest of this volume as well as the whole of Lee 2017a, are an extensive attempt to critique EM, finding it wrong-headed and unsound. The following passage from Unschuld (1998, 81) eloquently testifies to his reliance on EM to dismiss CCM as “unscientific” which, in turn, permits him to fall back on the default position that an “unscientific” medicine cannot be efficacious: Also for decades, countless Chinese and Japanese investigations have been made to determine the effect of traditional formulas. The methods used in these studies are rarely in keeping with the strict requirements of modern pharmacological research. As a result, reports regularly appearing in the Chinese press of drugs being “over 90% effective” defy unequivocal interpretation, and so far have not led to any enrichment of the international pharmacopoeia to speak of. Despite this, a large number of traditional drug producers in China manufacture proprietary brands for sale at home and worldwide to a receptive clientèle of largely Asiatic origin.

As some of the arguments for rejecting it have already been set out, and further discussion is found in Appendix Four, there is no need to repeat them. It is PExM and HPExM that need close attention traightaway.

CCM as (Han) body politics writ large Unschuld observes that CCM draws on an analogy between the body and the body politic in general. Unschuld (1998, 23) has confidently written: A basic idea that runs through Chinese medicine is that an evil cannot gain access where “right” (↓ zheng) dominates. This maxim, understandable both politically and medically, corresponds to the goal of Confucianism to

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Appendix Three allow no cause for rebellion and prevent crisis by setting the affairs of state in order early, and leading the people toward correct behaviour before things get out of hand. The political analogy of medicine and statecraft was a natural one for the authors of The Inner Canon of the Yellow Thearch; it found expression in the dictum of the classics that the sages intervene therapeutically before a disease has arisen, in the same way as they intervene to impose order before unrest has broken out. The Chinese term for “intervene therapeutically” and “intervene to impose order” is the same (⋫ zhi).

This passage raises three points in support of the claim that CCM’s notions are derivative of political notions, to be broken down into three sub-claims: (a) Implicitly and generally, political discourse preceded medical discourse; CCM’s explanatory power lies in this precedence, and is parasitic upon it. (b) The notion of Preventive Medicine in CCM is an implication and illustration of (a). (c) The deconstruction of the character/word zhi ⋫ is evidence for (a). Let us first look at sub-claims (a) and (b) to see whether the evidence cited could support PExM and HPExM. To do this, we have to recapitulate some points already made–the reader is urged to read the above passage in the light of a bibliographical discussion (see Appendix One) about the Neijing. Unschuld implies that the notion of prevention in CCM is derived from Chinese politics and philosophy at the time the Neijing was maturing as a text. Unschuld 1998 is silent about when it emerged as a formal mature text; Unschuld (1985, 56), however, dates it to the second century BCE, that is, to the early Han dynasty. As Appendix One has shown, Chinese scholars over the centuries have debated this matter; their opinions can be divided into three types of view: (a) Western Zhou; (b) Eastern Zhou dynasty and the Qin-Han dynasties; (c) Western Han.

If (a) is endorsed, it supports the theory of the emergence of the Neijing by and large as a formal mature text that might even have preceded the birth of Confucius himself (551-497 BCE); therefore it would not reflect the political situation of Confucius’s own time. If the date is assigned to the Eastern Zhou, under (b), which includes both the Spring

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and Autumn (770- 476 BCE) as well as the Warring States (475-221 BCE) periods, then one supports the thinking that Confucius’s ideas had already made their appearance, but they had fallen on deaf ears. In all likelihood, these ideas were not heeded despite having been hawked to the rulers of the various states which existed during Confucius’s own lifetime and during the lifetimes of several generations of his disciples after his death. However, such an interpretation ignores the fact that the political philosophy, adopted by the numerous states during the Warring States period, right down to the establishment of the first Chinese empire under Qinshihuang/〖࿻ⲷ, was Legalism ⌅ᇦ/Fajia.2 It was not until the early part of the Western Han dynasty (206 BCE-24 CE) that the ruling clan incorporated the teachings of Confucius and his disciples as official state ideology, with the help of the philosopher, Dong Zhongshu/㪓Ԣ㡂 who converted, in the opinion, of this author, Contextual-dyadic Thinking into Dualism (see Lee 2017a, Chapter Nine). From this fact, it logically follows that Unschuld must postulate that the Neijing is primarily a Han text, appearing as a formal mature text only after the incorporation of Confucianism as an official Han ideology. It would have to be a somewhat late Han text, as an official ideology would take some time to filter down to another domain of enquiry and discourse such as medicine to form the basis for its theoretical framework. This, indeed, is a very important point to grasp. This process could take the dating of the Neijing as a mature text even to the Eastern Han period. On the other hand, Chinese scholars today, in the main, do not find themselves able to endorse the Neijing as PHT; the majority favour a Warring States date, while others may even wish to push it further back in time, given the archaeological finds of the last few decades, as Appendix One has set out.3 In other words, the latest findings would even tend to argue for a date earlier than the Warring States period rather than support the claim of it being primarily a Han text. From the bibliographical standpoint of the dating of the Neijing, one may conclude that sub-claims (a) and (b) fail to support Unschuld. 2

When Qinshihuangdi established the first empire in 221 BCE, he indeed laid down the framework within which Chinese history unfolded for more than two thousand years. He introduced numerous reforms, which included standardising Chinese writing, weights and measures. However, one thing he did not change was the philosophical basis on which the new empire was to be run; he retained Legalism, which firmly favoured administration by (impersonal) law (see Lee 1975, 1989) as opposed to administration by men and rites, as advocated by Confucianism. 3 See also* “The Neijing: explaining and revealing its secrets” 2011.

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Appendix Three

Furthermore, sub-claim (b), from the standpoint of assessing it substantively, also fails to survive critical scrutiny. The simple reason is that one of the clearest expressions of Preventive Medicine may be found in Bian Que. (See Chapter Five, for a detailed exploration of the concept of Preventive Medicine in CCM and Appendix Four for Bian Que’s supposed role in formulating and practising this concept.) If one accepts the dates of the Neijing and Bian Que, as argued in this book, then both writings would have preceded the appropriation of Confucian political philosophy as official Han ideology. Furthermore, contrary to what Professor Unschuld maintains, one could even conclude that it was medicine rather than politics or political philosophy which led the way, that the notion of Preventive Medicine in CCM–“intervene therapeutically”–could have led/inspired the Confucians to think of “intervening to impose order”, rather than the other way around. Further evidence for asserting this counter claim may be found in the Hanfeizi, a famous late Warring States political (Legalist/Fajia) text, which appears to show that political discourse, according to Han Fei, was derivative of medical discourse (see Chapter Five as well as Appendix Four). Sub-claim (c) endorses the view that the use of the character/word ⋫ /zhi in both the medical and political contexts supports Unschuld. In fact, it does not. A quick deconstruction of the character would immediately reveal that the history of its origin and use tells a very different story. Unschuld is quite correct to say that ⋫ /zhì does indeed mean to “rule/govern”. First, note that the meaning of zhi is extensive, going beyond politics and medicine. It can even be used to talk about teaching someone a lesson, ⋫Ԇ/zhi ta. Indeed, its earliest use–and this is critical– was in the context of river engineering, to control a river to prevent flooding. At first sight, this appears to be both curious and puzzling, but a moment’s reflection shows that it is neither curious nor puzzling. Note that the character/word actually has the water ≥ radical. According to Xu Shen’s (Han) dictionary, originally it was the name of a river–a tributary of the Yellow River, the location of which can be traced to the north-east of China. That dictionary records the character as xingsheng zi, a semantic-phonetic compound as it has two components. The first is the “water” radical, and the second on the right gives the sound (see Lee 2008). Later, the name of the river was used to mean “control of a river.” This meaning of managing the flow of rivers led then to talk of controlling or treating illness and social behaviour, as well as ruling or governing a country and its people. It looks as if that in the temporal order of appearance in the use of the word zhi as a verb, priority goes to the context of hydraulic engineering, then medicine, followed by ruling. Minimally,

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the domains of medicine and ruling both drew upon the same source, namely, treating/taming rivers. That the context of hydraulic engineering appears critical would not come as a surprise to anyone familiar with Chinese history and its culture. The heroic feats of the great Yu/⿩ of the Xia Dynasty (c. 21st to 16th century BCE), one of China’s greatest cultural heroes, are well known to every Chinese child down the ages. They were to do with controlling the course of the Yellow River/哳⋣. That river was at once China’s joy and its sorrows–joy, because without it, Chinese civilisation might not have emerged or developed the characteristics it possesses; its sorrows, because the river’s floods, throughout China’s history, had wrought great destruction and brought immense grief. China’s engineers had no choice but to develop techniques to control its course. These included dredging, digging channels to divert the flow both over and under the ground, damming, and so on. China’s system of agriculture has always depended on controlling water in all forms, including extensive canal irrigation. The relationship between water control and government was an intimate one. If the emperor failed to get the river under control, there would be flooding. Or if there was prolonged drought and the irrigation channels no longer brought sufficient water from another area, then there would be famine. Floods, drought, famine, and illnesses all led to political unrest and even uprisings. If the harvest was poor, the people would be unable to pay taxes to the landlords and the emperor. Faced with such precarious outcomes and dangerous threats, the emperor would feel that the Mandate of Heaven might at any time be withdrawn from him. It was very natural for the ancient Chinese to derive the notion of control and management, in general, as well as that of political control and government, in particular, ultimately from the name of a river and from the practical activity of controlling/taming its waters. As for the relationship between controlling a river and treating illness, it is equally not so difficult to grasp its closeness, once pointed out. As we have seen, Chinese culture was born along the banks of the Yellow River, which runs like a great artery through the heartland of that civilisation, in Zhongyuan/the Central Plains. Water is essential for life, not only in the sense that one would die very quickly for want of (clean) water to drink, but also that one would die for want of food to eat. Water is required to grow food. The circulation of blood (and Qi) in the person-body would then be analogous to the waters of a great river–blood is both water and nutrition, carried to every part of the body, just as the great river(s) brought food and water to all parts of Zhongyuan, along the banks of its waterways. That is why in CCM, the kind of mai felt is regarded as a key

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indicator of how well or badly the different organ-systems of the body are faring, just as the political and social well-being of Zhongyuan would be measured by how well the river performed its task of ensuring that the essential elements for survival were made available to the people dependent on it. In Western medicine, the pulse is significant because it tells you the rate of the heartbeat. In CCM the mai is a measure of the balance of Yinyang in the person-body and is therefore a key diagnostic tool, helping the physician to determine the nature of the patient’s zhèng as well as the treatment for the condition, some details of which are explored in Chapter Eight as Zhèng-Fang Wholism. In Chinese, politics is ᭯⋫/zhengzhi. In English and other European languages, such as French and German, the word “politics” comes from the Greek for a city, polis. Ancient Greek states were primarily city states. In the eyes of people in the West since the nineteenth century, the most celebrated was Athens because it was a direct democracy, where the freemen of the city gathered in the forum to discuss and vote on all matters concerning the running of the city. Politics were the affairs of the polis. While the word “politics” in the West is rooted in the Greek polis, in contrast, traditional Chinese civilisation did not have the notion of polis, never mind democracy. What could the word “politics” in Chinese mean? The word ᭯⋫/zhengzhi tells its own story in Chinese political philosophy. We have already taken a quick look at zhi; we now need to say something about ᭯/zheng. The character has two components: on the left is ↓/zheng and on the right, the radical ᭥ stands for “to strike or hit.” But to strike what, is then the crucial question. Obviously, it strikes ↓ /zheng. In Jiaguwen/Oracle Bone script, Jinwen/Bronze script, Xiaozhuan/Lesser Seal script, and Lishu/Clerical script, the character ↓/zheng looks like this:

Figure A3.1: Character for ↓/zheng in various scripts

In the Oracle Bone and Bronze scripts, there are clearly two components: the square or circle at the top, which stands for a head, hence representing a person, and the word for “foot” at the bottom; this shows the person marching or walking straight up north. This combination is taken to mean being “determined to hit the target with no deviation.” In the Oracle Bone script, this word was normally used in the context of an army marching to war; the original meaning was a military one. In the Lesser Seal and

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Clerical scripts, the foot appears as →, and the head is replaced by a horizontal line. ↓/zheng stands for “being upright/unbiased/balanced”. It is huiyi zi, a meaning compound. It is a word which is rich in meaning; it has only positive meanings, such as: “straight”; “upright” (in the physical sense); “situated in the middle” (therefore, “balanced/unbiased”); “precise/ exact”; “honest”; “upright” (in the moral sense); “right”; “pure”; “just” (in the moral sense); and “correct.” Used as a verb, it means “to rectify.” It implies that the ruler was expected to carry out policies that were correct, just, honest, and balanced (not favouring only one sector while ignoring the rest). These abstract desirable qualities were made more concrete by that cluster of Confucian ideals, which includes ren ӱ/co-humanity, yi ѹ /doing what is morally/socially/aesthetically proper, embracing the Golden Rule, and li ⽬/acting in accordance with codes of behaviour which in turn embodied ren and yi. The Analects/ lj 䇪 䈝 NJ , one of the Confucian classics, contains a passage which may roughly be rendered as: a ruler who rules in accordance with moral principles would be like the pole star, being a pivot around which the other stars would move/Ѫ᭯ԕᗧ, 䆜㤕े 䗠, ትަᡰ㘼Շᱏ‫׋‬ѻ. Confucius, in The Analects, when asked by one of his students to explain the notion ᭯/zheng, glossed the word as follows: ᭯ involves ↓ /zheng. If you, as the ruler/leader were to be upright, just, and correct in your conduct, who would dare not to be similarly upright, just and correct?/᭯㘵ˈ ↓ ҏ DŽ ᆀᐵ ԕ ↓ ˈ 䜝ᮒ н ↓ ˛ More concretely, the ruler’s policies were expected to advance the welfare and interests of those whom he ruled, rather than his own private interests. Should he advance the latter at the expense of the former, he could be criticised. It was the task of his high officials to keep him on the straight and narrow. Of course, in reality, many rulers would simply ignore such criticisms at best and at worst, would order the critics to be dismissed from office or even killed. Many such good officials resigned and some even committed suicide, as they were thrown into such deep despair at their own impotence in curbing and changing the corrupt ways of the ruler. Unschuld 2009 continues to reinforce PExM and HPExM by holding explicitly or implying the following theses. 1. The early history of Chinese culture/civilisation knew no such thing as science. At best, from time immemorial people had known of mere “banalities” (Unschuld 2009, 12), such as day follows night and the passing of the four seasons each year–in other words what Lee 2017a, Chapters Four, Seven, Nine, and Ten have called the Laws of Nature, such

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as the zhouye jielЪ and the sishi jielЪ, Unschuld calls these “banalities”, thereby, ignoring the role that these Laws of Nature play in establishing Chinese science in general, such as astronomy and CCM, in particular. 2. Unschuld concedes that by the third century BCE, Chinese science had emerged whose theoretical framework was constructed in terms of the “doctrines of yin-yang and the five agents” (Unschuld 2009, 16). 3. What could have intervened between the period of mere “banalities”, starting from time immemorial to the third century BCE, which could conceivably make the ancient Chinese elites (if not the masses) go beyond such “banalities” to construct the theoretical framework of Yinyang and Wuxing? The compelling answer, according to Unschuld (2009, 12-15), lies in the times of dreadful unrest and fighting during the Warring States period (475-221 BCE), and the people’s desire for order and peace. Of course, people throughout history had desired order and peace, but why should it assume such significance for the Chinese people at that juncture of their history? Well, fortunately for them, after roughly two and a half centuries of utter turmoil, one strong man/strong state arose to subdue the other rival states (by then reduced to a mere six) and that was the state of Qin, whose ruler, then, reincarnated himself as Qinshihuangdi, the founding father of the Qin empire. Unfortunately, again, alas for the Chinese people, that empire was very shortlived, a mere fourteen years, before the Han dynasty (206 BCE to 220 CE) replaced it. 4. The Han dynasty then completed the project of the unification of China begun by the Qin dynasty, in administrative terms. In ideological terms, the Han dynasty made a major innovation and that was, to appropriate Confucian ideas as the basis of its own official ideology. 5. This ideological innovation was made possible because during the Warring States period, while military mayhem was the order of the day, other things were happening in the domain of letters: the emergence of a new moral/social/political/philosophy as pioneered by Confucius, … a philosopher (who) recognized the need for order. To change the plight of the time, order was needed. He gave the term dao to this order. With the image of the dao, the Way, he coined the term that would become the foundation for Chinese ideas of order, for interpersonal relations just as for all other events in the universe. The “cataclysmic turmoil” of the Warring States period led Confucius (sic) to assume that healing could be attained if man again saw himself to be part of a whole. The individual, it follows

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from the teachings of Confucius, must be brought to realize that his actions are meaningful for the well-being of the whole entity. (Unschuld 2009, 15)

6. Confucian ideas of order, its conception of the dao of order helped to create the idea of the state (forged under the Qin and Han dynasties) as a large organism with many parts, all linked together to a centre. Unschuld (2009, 51-52) wrote: The new state organism offered China an experience it had never known before. It was the experience of being an organism consisting of several units, where each unit contributed to the well-being of the whole. All units were connected by a network of roads. Only if the traffic on these roads ran smoothly, if a person could travel without hindrance and transport foods from one place to another, was this state organism in order. This was something completely new. For some philosophers of the time, the effect of this new economic and social organism on their worldview was so profound that they could not avoid internalizing the model as a whole, extending it even to their understanding of the body. Thus, the body organism in the new medicine was nothing but the state organism transferred onto the body. The various ideas that authors of the time recorded about organ function did not originate in the body’s powers of expression. They originated in the reality of the new state. Now we can understand why an author suddenly had the idea that the body organism is an integrated collaboration of five governors who govern their respective subjects from their palaces and are linked among themselves by manifold paths, creating a greater whole through their exchanges. The human organism, the observers and creators of the new medicine realized, rested on the same structures as the organism of the unified state. The word they used for “healing” was therefore the same word that was already used for “governing”: “ordering” (zhi). They considered “illness” (bing) of the human organism to be the same as the “chaos” or “social unrest” (luan) of the state organism. The wise ruler (sic), they wrote, does not heal illness but regulates the human organism so that no illness will develop. The wise ruler does not bring order to social unrest but governs the state organism so that no social unrest will arise. (Text in italics is this author’s own interpolation; it is to focus the reader’s attention.)

How ought one to assess Unschuld 2009, just characterized above? Earlier on, some critical comments were made such as that the character/word zhi had a very ancient lexicographical lineage, that the Neijing is not HPT but contains key concepts which date to the Warring States period, if not earlier. The consensus of Chinese scholarship today favours the opus in parts as belonging to the Warring States; there is no

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need here to set out the arguments in detail yet again. One very important critical observation must now be made and, that is, about theses 5 and 6 above. As set out above, it is historically incorrect. Confucius could not have been led by the events of the Warring States period to formulate any new ideas with regard to “healing”, either in the medical or the political context, for the very simple reason that Confucius (551-497 BCE) died about twenty-two years before the Warring States period (475-221 BCE) began; he lived and died during the period preceding that of the Warring States, in the latter part of the so-called Spring and Autumn period (770-476 BCE). Unschuld could have been more careful with chronology and said that it was the sage’s later disciples who articulated the new analogy between the political and medical contexts. His chronology though false and incorrect, serves the purpose of providing “evidence” for Confucius’s insights that the “health” of the Whole depends on each individual part contributing to the “goodness” of the larger entity/organism, of which the component is but a part. Insofar as Confucius had thought of the part/Whole relationship for articulating his political philosophy, he could only have drawn inspiration from the politics of his own time. Although the period in which he lived was disordered, it was not quite disordered in the way that the Warring States period had been. His prescription for restoring the decaying Zhou rule to its original correct/zheng/ ↓ position was a philosophical prescription which could be summarised under the doctrine of the rectification of names/↓਽/zheng ming.4 No texts (at least known to this author) exist which claim to report ideas taught by Confucius referring to a centralised and unified state organisation in the style of the later shortlived Qin dynasty and the Han dynasty, as a pre-condition for the restoration of order and a return to peace and security. Thesis 5 is not only historically faulty but also substantively irrelevant. Nor is it correct for Unschuld to say that Confucius “gave the term dao” to his conception of order. (See Lee 2017a, Chapter Four for a detailed exploration of the distinction between the metaphysical Dao, on the one hand, and the specific dao of, say, rulership, medicine, and so on, on the other.) Neither did Confucius himself introduce the term or the concept of the Dao, often translated (as Unschuld does) as “the Way”; the Laozi did. The term then became common intellectual property, although it is true that the specific dao of the rectification of names was much associated with Confucius.

4

For a brief account, see “Confucius: rectifying names” 2014.

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However, Unschuld may have struck a slightly better foothold for his view in the passage below (Unschuld 2009, 16): … the origin of the doctrines of yin-yang and the five agents … was initially conceived of expressly–and the sources are very clear about this– to explain social and political change. Only in a second step was the doctrine of the five agents expanded to explain all kinds of change. Change is the temporary dominance of certain agents. … Today, one generally speaks of the doctrine of the five agents. The yin-yang doctrine of the dualistic correlation of all phenomena seems to have avoided taking this initial detour through the explanation of social relationships. From its earliest appearance in historical sources, it has been applied to the totality of natural phenomena. (Text in italics is this author’s interpolation.)

A critical assessment of the above passage may be confined briefly to the points below: the partial validity in Unschuld’s account lies in highlighting the first systematic articulation of the doctrine of Wuxing by Zou Yan/ 䛩 㹽 (c. 305-240 BCE) who then did apply it to political discourse to explain the rise and fall of states. 5 However, Lee 2017a, 5

See Littlejohn 2012, Lee 2017a, Chapter Five. The relevant passage from Mr Lü’s Spring and Autumn Annalslj੅∿᱕⿻NJreads: Ҽᴠ˖ࠑᑍ⦻㘵ѻሶ‫ޤ‬ҏˈཙᗵ‫ݸ‬㿱⾕Ѿл≁DŽ哴ᑍѻᰦˈཙ‫ݸ‬㿱བྷ 㷮བྷ㶬DŽ哴ᑍᴠ˖“൏≄㜌DŽ”൏≄㜌ˈ᭵ަ㢢ቊ哴ˈަһࡉ൏DŽ৺⿩ ѻᰦˈཙ‫ݸ‬㿱㥹ᵘ⿻ߜнᵰDŽ⿩ᴠ˖“ᵘ≄㜌DŽ”ᵘ≄㜌ˈ᭵ަ㢢ቊ䶂ˈ ަһࡉᵘDŽ৺⊔ѻᰦˈཙ‫ݸ‬㿱䠁࠳⭏ᯬ≤DŽ⊔ᴠ˖“䠁≄㜌DŽ”䠁≄㜌ˈ ᭵ަ㢢ቊⲭˈަһࡉ䠁DŽ৺᮷⦻ѻᰦˈཙ‫ݸ‬㿱⚛䎔Ѽ㺄ѩҖ䳶Ҿઘ⽮DŽ ᮷⦻ᴠ˖“⚛≄㜌DŽ”⚛≄㜌ˈ᭵ަ㢢ቊ䎔ˈަһࡉ⚛DŽԓ⚛㘵ᗵሶ≤ˈ ཙф‫ݸ‬㿱≤≄㜌DŽ≤≄㜌ˈ᭵ަ㢢ቊ唁ˈަһࡉ≤DŽ≤≄㠣㘼н⸕ᮠ ༷ˈሶᗉҾ൏ Rendered as: Whenever rulers declared themselves as emperors, there must appear signs from Nature. In the case of the Yellow Emperor, extraordinarily large earthworms and mayflies appeared, which the emperor interpreted to mean that the qi of Earth predominated; as a result, the colour of the Emperor’s insignia and official vestments was yellow (the colour of Earth in Wuxing). When it came to the time of Yu, contrary to what was normal for the season, it was found that vegetation did not die back in the autumn and

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Chapter Seven argues this does not mean that the origins of Wuxing, contrary to what Unschuld holds to be the case, lay in political discourse. Instead, its origins had links with numerous sources, including wucai/ӄᶀ; most crucially of all, it is an account of Qi, the most fundamental ontological category in Chinese philosophy. As such, Lee 2017a has argued that Wuxing is but an extension of the concept Yinyang, and should be presented as the doctrine of Yinyang-Wuxing. Yinqi and yangqi and their relationship in terms of Yinyang constitute the subject matter of the Yijing, the understanding of the gua/trigram/hexagram in terms of their yao as an articulation of process-ontology, of change and of Wholism, which lay down the philosophical/methodological framework for Chinese science (that is, all domains of explanatory investigation into phenomena, whether physical, social, political, military, medical, or whatever). Curiously enough, even Unschuld himself seems to acknowledge the point just made (see the last sentence, in italics in the passage cited above). This then in turn appears to undermine the very stance which he appears so very keen to uphold. Unschuld (2009,107) complicates the presentation of PExM and HPExM by saying that the Han dynastic experience had seared itself so very deeply into the Chinese psyche that Chinese culture and civilisation never departed from it “until the beginning of the twentieth century”. Dynasties rose and fell, states formed and disappeared, “foreign rulers came to China” to establish their own dynasties such as the Yuan and the Qing dynasties, “(b)ut each time, the foreign rulers eventually became even more Chinese than the Chinese themselves–they adapted to the high Chinese culture” (Unschuld 2009, 107), This seems then to say that while winter, which the emperor took to show that the qi of Wood predominated; as a result, the colour of Yu’s insignia and official vestments was green. During the time of Tang (⊔ not ୀ), a metal blade emerged from water, which the emperor interpreted to mean that the qi of Metal predominated; as a result, the colour of Tang’s insignia and official vestments was white, as white was the colour of Metal. This continued till the time of King Wen (Zhou dynasty), when there appeared birds with red plumage bearing inscriptions from books of elixir, which King Wen understood to show that the qi of Fire predominated; as a result, the colour of his insignia and all official vestments was red. (According to Wuxing,) Fire would be succeeded by Water, when signs from Nature would show that the qi of Water would predominate, as Water constrained Fire; when the qi of Water predominated, the colour would be black. This would be succeeded eventually by Earth, as Earth constrained Water. (Texts within round brackets are this author’s interpolations.)

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political realities on the ground changed drastically, nothing changed at the level of high culture, which must include not only Confucianism but also Daoism and Buddhism. These worldviews apart, high culture must surely also include canonical texts, such as the Yijing, the Laozi, and the Neijing; Lee 2017a has argued that the last two named cannot be understood except in the light of the first. Would this then not entail an about-turn on the part of Unschuld? Recall that PExM and HPExM hold that CCM-theory is derivative of political discourse; that Unschuld holds that political discourse since the Han, had not departed from Confucianism. One can grant that Unschuld is, by and large, correct in this latter claim, but he has nothing to say about the great Daojia/䚃ᇦ texts such as the Yijing, the Laozi, and the Zhuangzi, not to mention the Neijing itself, which all continued to exercise great influence amongst the people, in particular, the educated. The ideas of Daoist philosophy (Daojia) address themselves primarily, though not exclusively, to the domain of natural phenomena, while those of Confucian philosophy address themselves nearly exclusively to the domain of human affairs and social phenomena, with the aim of orienting politics towards its own ideals/values. In the history of Chinese culture, these two philosophies had always co-existed, even if it is true that the official ruling ideology (since early Han times) was Confucianism until the end of the Qing dynasty. In the light of the discussion above, one may conclude that PExM and HPExM have failed to survive critical scrutiny. However, Unschuld appears so wedded to them that he even proceeds to extrapolate from their CCM context to the wider context of medicine in general, be it ancient Greek or MM–call this GPExM (Generalised Political Explanation for all Medicines). In this self-imposed task of accounting for fundamental changes in medical outlooks in all societies via the political impulse, Unschuld (2009, 69) writes: That is what we are interested in. Finding the impulses that, in the two millennia of the Greek and Chinese history of medicine, led to such fundamental changes of heart. The impulse was never the observation of the body. The organism’s power of expression never sufficed to lead to such changes of heart. It was always the actual or aspired-to structure of human society–along with hints from nature–that provided the impulse.

What outstanding examples exist in the history of WM/Bm in support of GPExM? Unschuld cites many, but to give a flavour of his methodological stance, two will suffice. First is the doctrine of the four humours that emerged towards the end of the fifth century BCE, said to

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have been introduced by Polybus to explain illness and health. Unschuld (2009, 73) comments: This step was definitely not prompted by the expressive power of the body. That much is certain. But it was complemented by the body’s own expressiveness! This is how fundamental progress came about in ancient medicine and also in the medicine of the following centuries up to the present. The impulse for new thinking always came from outside the body. First came changes in the social structures in which the Greeks lived or aspired to live. Structures triggering a shift in thinking can be real or ideal– actually prevailing or fervently aspired to. The structures that led to the rethinking in ancient Greece were those of the polis democracy.

In other words, “polis democracy” was the real cause of the emergence and acceptance of the doctrine of the four humours, replacing the more simplistic doctrine of the single “element” which came, presumably, to be perceived as passé, because that doctrine itself was caused by the politics of monarchy. Unschuld (2009, 74) writes: The monistic or, to put it bluntly, “monarchistic” view of the “rulers” of a fundamental element must have naturally yielded to the new view of a larger number, in this case a quartet, of basic parts to a living organism. Whether it is four or five or six is trivial. The important thing is that the idea prevailed that several fundamental elements carried, in their mixture, a complex structure and thus made life possible for this structure. The details come from the graphic nature of the body. After the basic structures imposed themselves from the outside onto the body like a matrix, the reality of the body could deliver material to fill up the fundamental structures…. Only a balance of all those involved [namely, all the individual freemen participating in polis democracy] can guarantee harmony and peace in the polis. Only a balance of all the humors and elements can guarantee health in the human organism. Any excess is harmful. Medèn agàn was the Greek equivalent of the Chinese doctrine of the mean. It originated in the social realms and of course also found entrance into the view of the organism.

Again, this author has no intention of painfully assessing the claims made above and their implications in detail. It suffices to limit oneself to three critical comments: (a) Professor Unschuld appears not to have provided any evidence in support of his assertion–he has merely asserted it. His method seems to consist of putting forward a hypothesis which is then

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held to be correct, just by sheer force of articulation and assertion on his part. (b) Although this author would not wish to hold (certainly does not hold) that the Greek doctrines of the four elements and the four humours are identical to the Chinese concept of Wuxing, nevertheless, they have this in common: that there are several “items” involved in their respective frameworks which appear to be related to one another in certain ways. Unschuld himself, as is evident in the passage quoted, appears to perceive some kind of similarity between the two schemas. Yet he fails to perceive that herein lies a problem for his account, that while in the Greek case, the schema was caused by “polis democracy”, the same could not be said to hold in the Chinese case, which had no conception of democracy, either in theory or practice. Hence it follows that a similar conception of the “body organism” can be caused by either of two conflicting systems of politics, one “democratic” and the other “monarchistic”; one decentralized and the other highly centralized; the “many” as opposed to the “one”. Furthermore, Unschuld fails to realise that while democracy was confined to the polis of Athens, the doctrine of the four elements/humours was part of the common intellectual property of the Greeks in all the other Greek states of the time which were not democratically organised. (c) His methodology, if one may be permitted to conclude, is highly eccentric if not downright bizarre. The second example for scrutiny occurs in a section entitled “Harvey and the Magna Carta” (Unschuld 2009, 157-161). This “case-study” is presented in two parts. The first consists of saying that Harvey’s discovery of the circulation of blood is caused by “a model image” which was the Magna Carta. Has anyone examined William Harvey’s political views? Did he ever mention his idea of the state, of society? Let us risk a hypothesis here, whose validity can only be speculated until someone uncovers Harvey’s idea of the state and of society. For this picture of the body, of the organism, we suspect that Harvey had a model image. Perhaps he was not at all conscious of it himself, because he lived in his model image. It was the Magna Carta. Harvey transferred reality onto the constitution of the human organism. The clergy and nobility forced the Magna Carta on the king on June 15, 1215. The final version was sealed by Henry III ten years later. It secured the freedom and rights of the landed nobility against interventions by the crown. It also intervened in trade and laid down a

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This author has no choice but to admit frankly that Professor Unschuld’s rich imagination, moving at such a breathless pace, has left her far behind. Hence, it would be wise simply to confine oneself only to two observations: (a) In this claim, the distance travelled between “cause” and “effect” can now cover four centuries, with no offer of any intervening mechanism which could account for the transmission of cause to effect, and no shred of evidence, in any guise or form, in its support. According to this line of fantasy reasoning, perhaps in the dim and indistinct future, someone might uncover Harvey’s thoughts about the Magna Carta in a cache of his manuscripts which, as far as this author is aware, no one has ever speculated (except for Unschuld himself) could exist. Suppose, per imposibile, such a manuscript were to come to light, would this provide evidence that Harvey’s discovery of blood circulation was caused by his knowledge of the Magna Carta? Not necessarily, unless that manuscript were to spell out in every detail how the politics of the Magna Carta led him step by step to formulate the thesis of blood circulation. Unschuld himself has failed to exercise his fertile imagination to show such details, leaving his readers (or at least this particular reader) in the fog about the whole matter. (b) It would occur to anyone with some familiarity with English history, to realise that the Magna Carta as a political/constitutional document could not have acted, under any imaginable circumstance, as the “model image” for Harvey’s discovery of blood circulation. The reason is obvious as curiously enough, even Unschuld has acknowledged, namely: that the Magna Carta is the record of a new pact between the monarch and his (noble) subjects. At Runnymede, by the river Thames on 15 June 1215, King John bowed to the demands of his aggrieved barons, the most important and the most cited is the clause “to no one will we sell, to no one deny or delay right or justice”. This has constituted the touchstone for civil liberties in English history, according to the majority of English historians. Furthermore, in the run-up to the exhibition mounted by the British Library in 2015 to mark the 800th anniversary of the Magna Carta, a curator at the British Library had successfully uncovered a little known medieval poem, written nearly eight hundred years ago by some monks living in the Scottish borders,

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giving an independent account, the earliest of that event and its outcome at Runnymede. It is the Melrose Chronicle, written in Latin; translated, it begins thus: A new state of things begun in England; such a strange affair as had never been heard; for the body wishes to rule the head, and the people desired to be masters over the king.

The puzzle arises: how could Unschuld claim that Harvey’s discovery of the key role played by the heart in the circulation of blood could have been derived from this political “model image”. This author is truly foxed. The second half of this “case-study” consists (as far as one can make out) of claiming that the role played by the heart in Harvey’s account of blood circulation could/would have been explained by the speculation that Harvey was a Royalist during the period of the Civil War in England. Although we know nothing about Harvey’s political views from other sources, from direct witnesses, we can risk making another hypothesis. Irrespective of the Magna Carta, Harvey, it is certain, was a loyal follower of the crown. During the civil wars, he sided with King Charles I (16001640), who was, as is known, prone to absolutism. That may have influenced William Harvey. The ruler is the sun in the state, the heart the sun in the organism. The heart, or rather the ruler, determines trade and mobility. If the ruler is doing well, then everything runs smoothly. If the ruler falls victim to bad influences, the state apparatus falls into ruin. This or something very similar may have been William Harvey’s political model image. We can see only the view of the body that he developed. … His model image was the English king as primus inter pares–the heart as primus inter pares. The organs in the periphery–even the blood and the muscles–each possessed their own power to move themselves and to react to stimuli, like the clergy and the landed nobility. All used the same standardized weights and measures so that trade and change could function–circulation. (Unschuld 2009, 160-161)

Again, this scrutiny would confine itself to making two observations only: (a) A king (who is not a constitutional but an absolutist monarch such as Charles I), ex hypothesi, is not and cannot be primus inter pares amongst his nobles/courtiers; by definition, the relationship, between the king as supreme ruler/sovereign and the nobility or commoners as his subjects, was one of higher/lower in the hierarchical political structure. The king was their lord/liege/

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master/sovereign to whom they must all bow low and deeply and whose will they must obey (or suffer the consequences). (b) The political “model image” of the first half, derived from the Magna Carta contradicts the political “model image” of the second half, derived from the absolutist monarchism of Charles I.

Conclusion 1. PHT, in the light of critical scrutiny remains at least “not proven”, to borrow a term from Scottish jurisprudence, if not decidedly refuted. 2. EM is methodologically flawed and confused, as it is analogous to judging cats by the standards of dogs in a dog show; ideologically, it is of a piece with Eurocentrism (see Chapter Eleven). 3. PExM and HPExM turn out to be historically unsound and therefore, substantively, irrelevant to the understanding of CCM. 4. PExM and HPExM also seem to have committed the fallacy of post hoc, ergo propter hoc (if one event precedes another event, the latter is said to have been caused by the former) or that, if two events happen more or less concurrently but with the first occurring somewhat earlier in time, then the first has caused the second event to happen. Unschuld appears to argue that, because the Han dynasty provided stability, security and order through its centralized efficient administration, this “model image” has caused the emergence of the theoretical framework of the Neijing/CCM. (In GPExM, he seems to think that the Magna Carta must have caused Harvey to articulate the concept of the heart in charge of blood circulation, because the Magna Carta had preceded Harvey’s discovery by several centuries.) 5. Apart from the specific methodological flaws exposed above, there is even a more radical flaw which Chapter Five has demonstrated, namely that political discourse in ancient China was inspired by medical discourse (not the other way round), that both, in turn, were based on engineering and other practical discourses; that all these discourses rest on the axiom of Catastrophe Prevention. 6. GPExM, apart from sharing the methodological flaws found in PExM and HPExM, appears to have descended into the realm of the totally speculative and the fantastical, indeed, even, of the absurd.

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7. There may, albeit, be a scintilla of truth in the generic thesis that political discourse could inspire medical discourse, but it is expressed in a very indistinct, confused and incoherent manner. It appears to be hinting at a valid issue in the philosophy of science, namely, the distinction between the context of hypothesis-generation, which may be metaphysically/ religiously/politically inspired and the context of testing empirically such a hypothesis via its implication(s). This distinction was referred to, and very briefly discussed in Lee 2017a, Chapter Four; its full exploration is dealt with in Chapter Three of this volume. 8. It appears justified, from the critique above, to lay against Professor Unschuld the charge of having committed FMA and even, at times, of the further charge of having descended into incoherence and/or sheer fantasy.

APPENDIX FOUR DE-MYSTIFYING THE LEGEND OF BIAN QUE

Why Bian Que is controversial Bian Que/ᡱ呺 is a controversial figure in the history of CCM. On the one hand, he has been hailed as one of the most distinguished physicians, if not the most distinguished of them all; and on the other, sceptical scholarship has gone so far as to say that he was no historical personage but a legendary figure. What then is the truth? Sceptical scholarship rests its case on the following considerations: (a) The very name itself is suspect. For a start, que is simply the name of an auspicious bird which is called xi que/ௌ呺, the bird which brings joy and happiness. When a physician cured people of illnesses wherever and whenever, he would naturally bring joy and happiness to the patients and their families. Hence, the name Bian Que in ancient China could be a mere generic name for physicians who were exceptionally talented and skilful; it did not necessarily refer to a specific named individual who lived and practised medicine with exceptional distinction. (b) The physician Bian Que, if he did exist, had two other names: Qin Yueren/〖䎺Ӫ and Lu yi/঒५, Physician Lu. (c) The said physician has also been assigned different locations as far as his provenance was concerned: Sima Qian/ਨ傜䗱 in his Shiji said he was from a place in today’s Hebei/⋣े; other sources said he came from today’s Shandong/ኡь province, a place called Lu near Bohai/⑔⎧ in what used to be the Lu state (hence Lu yi/ Physician Lu). (d) The dates are equally problematic: there are at least three different famous tales about his talents spread nearly three hundred years apart. The first involved the patient Duke Huan/ẃ‫ޜ‬, said to have taken place in 695 BCE; the second, a high personage in 㲒ഭ/state

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of Guo, in 655 BCE; and the third, in 309 BCE, involving 〖↖⦻ /Qinwuwang, the king of the Qin state. Notwithstanding the scepticism noted above, the consensus in Chinese scholarship today is that a real person with immense healing skills, who came to be called Bian Que did exist, and that very likely this person was Qin Yueren, also referred to as Physician Lu. He lived either during the Spring and Autumn or the Warring States periods (the Eastern Zhou dynasty). If one were pushed to be more precise, some historians think that he would have lived during the Warring States period. Bian Que was a peripatetic physician, curing the sick as he passed through the numerous states which made up the China of that time.

Some biographical details Two distinguished Han historians devoted space to him in their accounts of the dynasty, the more famous of the two being Sima Qian (145-86 BCE). The other is Ban Gu/⨝പ (32-92 CE), who took up the history of China where his predecessor left off. In hislj≹ҖਔӺӪ㺘NJ/Hanshu gujin ren biao in which he had recorded all the important figures in Chinese history up to the Han dynasty of his day, classified according to different categories of their achievements, he mentioned a physician called Qin Yueren from Bohai, Shandong. Historians know that this person was known to have died in 309 BCE in the state of Qin/〖; after that date, no further sightings or recording of his activities occurred or had been found. Sima Qian in his Shiji narrated how Bian Que came to acquire his miraculous healing skills. In his youth he worked as a very minor official looking after guests in a government establishment. A frequent visitor for more than ten years referred to as Chang Sang/䮯ẁੋ, a gentleman of great virtue, took a liking to him. This person claimed to possess a secret prescription which he wanted to pass on to him, but he first had to swallow a medicine with dew water/к ⊐ ѻ ≤ . The young man followed the procedure as ordered; thirty days later, he could see through the personbody to the internal organs. Bian Que then used this skill to treat patients– he came to possess a kind of X-ray ability to see the insides of a patient, the basis of his diagnostic skills. This account is of a piece with a tradition, which included Shennong/ ⾎ ߌ /the Divine Husbandman, a legendary figure in the history of CCM, who pioneered the construction of a materia medica. Shennong was said to possess a similar ability; he tasted herbs as he walked along, observing their properties, including their effects on him,

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but his exceptional eyes could see through his own internal organs, noting the passage of the herbs, as they passed from his mouth to the various organ-systems. Shennong had bags slung over his shoulders–after tasting and observing the effects of the plants he had collected, he would put the non-toxic ones in one bag and the toxic ones in the other. This story about Bian Que is, in all probability, legendary. People were so impressed and astounded by his talents that they embellished his reputation in this fashion, making him the recipient of a god-like property from a god-like being, disguised in the form of a visitor with immense virtue, to a governmentrun guest-house. Many accomplishments and feats of healing were laid at his feet. One would have to sort out the merely apocryphal from the historically possible. A spectacular example of the former is the following: a Daojia (fifth century BCE?) text called the Liezi/ljࡇᆀNJrecounted that Bian Que had conducted heart transplantation/ᦒᗳᵟ between two people. One of these had great ambition but little will power and the second, limited ambition but excellent will power. Bian Que was said to have thought that a swap of hearts would make each a more “harmonious” person. He was said first to have given them a medicine (presumably with anaesthetic properties) to put them to sleep for three days, during which he transplanted their hearts. The theoretical justification for this mutual heart transplantation may or may not lie within the logic of CCM, as explored in Chapter Six; as for the technical side of the operation, it leaves nothing but room for doubt. Other more plausible examples include Bian Que’s discovery of niuhuang/⢋哴/Calculus bovis/ox bezoar, a commonly used ingredient in prescriptions. The story went that he was preparing a medicine called qingmengshi/䶂⽎⸣ for a neighbour who had suffered a stroke. The patient’s son had killed the family ox and found a stone in its gallbladder. He removed it and went to show Bian Que this curious object–this was niuhuang. Just as the two men were talking, some other member of the family appeared, distraught, reporting that the patient had suddenly taken a dramatic turn for the worse. Bian Que rushed out but without the medicine he was preparing to administer to the sick man. He then asked the patient’s son to go back to his own house to fetch the qingmengshi. This person, in his agitation, simply grabbed what he found on the table; neither did Bian Que look too carefully, thinking it was the qingmengshi he needed, which he proceeded to grind to a powder to administer to the patient. In reality it was niuhuang. Fortunately, the medicine turned out to be efficacious. When Bian Que returned home, he discovered the mistake. Seeing the good results, the next day he deliberately introduced some niuhuang into

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the medicine for the neighbour, with continuing progress and success. Finally, he experimented with its use in other cases and found it good and efficacious. Is this wholly legendary and baseless? It sounds plausible. Maybe the story as purveyed (which came to be recorded by Sima Qian) is meant to illustrate a way in which new ingredients can be introduced into the pharmacopeia. Indeed, prescriptions which are called jingfang/㓿ᯩ, were built up in precisely this way, based entirely on experience and used in countless cases over the centuries and millennia (see Chapter Nine, but also Chapter Eight and Appendix Two in the context of exploring Zhang Zhongjing’s singular achievements in the history of CCM). Doubts have also been cast on an episode of his remarkable diagnostic ability (already referred to above). Two accounts of this case are found in historical texts, each differing somewhat from the other. The first is in the Hanfeizi/lj丙䶎ᆀNJ1 and the second is in Sima Qian’s Shiji/ljਢ䇠NJ. The patient (reported in the first source) was a very powerful political figure; he was the Duke Huan/Cai Huan gong/㭑ẃ‫ ޜ‬of the state of Cai. The second account refers to the patient as Duke Huan of the state of Qi 喀.2 The first text preceded the latter; on historiographical grounds, the former should carry more weight in a conflict of data. The fact is, no Chinese historical records ever mentioned anyone called Duke Huan of the state of Cai. On the other hand, there was indeed a person called 㭑ẃ‫ן‬ /Duke Cai Huan; however he was recorded as having died in 695 BCE, thus his death preceded Bian Que (if Bian Que was Qin Yueren) by some 280 years. Furthermore, the state of Cai was annihilated in 447 BCE, again a few decades before the birth of Bian Que/Qin Yueren (some scholars have gingerly dated this to c. 407 BCE). Sima Qian said it was in Qi state that Bian Que saw Duke Huan. If Qin Yueren/Bian Que is argued to be a Warring States personage, then Sima Qian’s account fits better than that of the Hanfeizi. As history turned out, the state of Qi during the Warring States period was built on the same site as the old state of Cai during the Spring and Autumn period. From the standpoint of CCM the variations between these two accounts are not considered to be significant. What is significant is their common content: they both deal with the concept of Preventive Medicine and the role played by it in CCM itself. This understanding is reinforced by another story recounted in another Warring States text, the Heguanzi/ ˪发ߐᆀNJ/Pheasant Cape Master, which added further richness to the 1

Han Fei (c. 280-233 BCE) was a philosopher belonging to the Legalist School/Fajia; his text, the Hanfeizi is a late Warring States text. 2 See *“Bian Que’s diagnosis of Duke Huan” 2014a, b, c.

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theme of Preventive Medicine about Bian Que and probably, his apocryphal two brothers, in order to illustrate the role of the shang gong in Preventive Medicine. Chapter Five has explored the set of issues about this very important concept in CCM; there is no need to repeat the arguments here. The third episode is recounted by Sima Qian. Bian Que passed through Guo state/㲒ഭ, a state in the Western Zhou dynasty. He heard from a high official that the crown prince had died and everyone was in deep mourning. He asked for details about the condition of the prince at the time of his death. He was told by a high official that the prince had suffered from irregular blood circulation and as a result his internal organs were damaged, leading to death. Bian Que also ascertained that the death had just occurred, as only half a day had passed, and that the deceased had not yet been enclosed in his coffin. (In other words, on this occasion he relied initially on the diagnostic technique of wen/䰞/asking.) He next asked to be taken to see the crown prince, claiming that he would be able to help restore him to life as he had not truly died. The high official at first scorned the idea, but as Bian Que explained briefly how he had arrived at the hypothesis, the official became more impressed and agreed to take him. Bian Que explained in part that he could ascertain from the person’s history as to what could be wrong with the internal state of his personbody, and when that internal state had been ascertained, he could then also explain the external conditions of the patient (from external signs and symptoms to internal conditions and then back again to external signs and symptoms). Based on what he had heard from the official, Bian Que had come to the conclusion that the prince’s blood circulation was irregular; the patient had succumbed to xieqi/䛚≄/pathogenic qi. Further, that his internal organs had been badly affected by certain pathogenic factors, as a result of which he succumbed as he did. When he arrived at the court, he met the king himself and further ascertained from the king the circumstances regarding the crown prince. In the light of this, he told the king how he would proceed: he would feel the two internal-facing sides of the limbs of his son, ascertain whether they were still warm as well as whether any breath at all was coming through the nostrils. When he finally examined the crown prince, he found that there was still a very slight breath in him; his body was still warm and he could feel his mai, albeit a very feeble one, and so on. (In other words, he used the technique of touching–qie/ ࠷ , as well as feeling the mai/qiemai/ ࠷ 㜹 .) Bian Que diagnosed a condition called shijue/ቨ৕, a coma which put the person in a corpse-like state. He ordered one of his pupils immediately to apply acupuncture at a point/xuewei on the top of the prince’s head (called

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baihui/ⲮՊ). He instructed another pupil to rub some heated herbs on the arms, starting from the armpit, downwards and upwards. Following these two treatments the prince began to breathe palpably and regularly and eventually woke up. Bian Que then prescribed medicinals for him to take. After some twenty days, the prince fully recovered. Bian Que said that it would be a great mistake to think that he had performed a miracle, raising people from the dead. He had merely used his skills as a physician to diagnose the patient as being not truly dead, and took appropriate measures to get the patient to recover from his coma–that was all. This event was said to have occurred in 655 BCE, a date which again preceded the birth of Bian Que/Qin Yueren by nearly 250 years. This narrative serves to add weight to the sceptical claim that Bian Que was a legendary, rather than a historical figure, in the history of CCM. Sima Qian had also written that Bian Que was held to have laid down six categories of patients that a physician should not treat–“the six refusals to treat”/‫ޝ‬н⋫. The historian had carefully implied his own doubt about the authenticity of this account by refraining from using the normal device of enunciating these assertions as direct speech, thereby attributing them to Bian Que, such as: Bian Que said … /ᡱ呺ᴠ: …. The point to grasp is that Bian Que had been credited with being a pioneer in the history of CCM, establishing what today is called “medical ethics”, a professional code of conduct for physicians/doctors. Bian Que’s undoubted real achievements include the following. While journeying from Shandong/ኡь in the east to the state of Qin/〖 in the west, he noticed that different regions would present different illnesses. In the state of Chao/䎥ഭ, he observed that many women suffered from obstetrical and gynaecological problems–so he initiated a “specialism” in female problems of reproduction/ྷ、५ᆖ. In Luoyang/⍋䱣, he noticed that many older people had ear and nose problems–so he initiated an ear and nose “specialism” (er bi yixue/㙣啫५ᆖ). In yet another region, he observed that infants faced many more illnesses than elsewhere–this led him to initiate paediatrics/xiaoer yixue /ሿ‫ݯ‬५ ᆖ.3

3 In the context of CCM a specialism should not be equated with Bm’s understanding of the term–hence, the quotation marks. In Bm, a specialist in paediatrics, ex hypothesi, is not a specialist in gerontology and vice versa, whereas CCM physicians dealt/deal with whatever illness is presented by the patient, who could be of any age/sex/constitution. A “specialist” in the CCM context is merely a physician who happens to have a special interest/clinical experience/successful clinical record with certain sorts of illness, and not that he was/is ignorant or

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The basic diagnostic framework of CCM consists of sizhen/ഋ䇺 for determining 䇱/zhèng (as Chapter Eight has shown in detail), in all of which Bian Que was held to be a shang gong. He was credited with having established a more accessible location for feeling the mai on the wrist. Bian Que’s great diagnostic skill based on feeling the mai, can be illustrated by a famous story which Sima Qian had recorded. One day, the physician was going through Jin state/ ᱻ ഭ and was approached to examine someone called Yue Jianzi/䎺ㆰᆀ. This man had fallen into a coma. When Bian Que felt his mai, he assured the household that as the mai was there, though fine, there was no need to worry about the patient– he would recover within three days. Promptly, after two and a half days, the patient regained consciousness and was quite well. On this occasion Bian Que had prescribed no treatment. This story bears some resemblance to the story about the crown prince of Guo state. He was similarly acclaimed to be a master of the diagnostic technique wang/ᵋ. He only needed to take a look at the complexion of the patients to diagnose what was deeply wrong with them. The truly great physician in the eyes of CCM could rely on this technique alone for an accurate diagnosis (see Chapters Five and Eight). Bian Que throughout Chinese history was loved and admired by the common people; they built temples and shrines and erected monuments in his honour. Even today about ten such temples still exist.

Bian Que and Sima Qian Sima Qian recounted the death of Bian Que/Qin Yueren in detail. The physician arrived in Qin state to find that the king, Qinwuwang/〖↖⦻, had fallen ill. He said he could treat the man. The other physicians in attendance were greatly jealous of his reputation and advised the king not to use him, as his skill was not as great as his reputation would lead one to believe, and that his treatment might even make the king worse. Unfortunately, the king accepted this malicious advice. As a result Bian Que left the country. But a particularly jealous rival sent an assassin to murder him on his departing journey. This episode occurred in 309 BCE; after this report of his death there were no more sightings or reports about Bian Que/Qin Yueren and his activities. That is why some historians have argued, as earlier mentioned, that if this date of his death is correct he

professionally under-qualified/unsuccessful with the normal run and range of illnesses.

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would have lived sometime during the middle to the late Warring States period. Why did Sima Qian devote so much importance to Bian Que/Qin Yueren?4 Part of the reason might well lie in the fact that Bian Que’s death in particular had produced a deep resonance in his own biography. Sima Qian might have felt that he suffered the fate of being a eunuch because people at court were jealous of him and his talents. He lived during the reign of Hanwudi/≹↖ᑍ, the early Han emperor who was determined to subdue, and ultimately succeeded in subduing the powerful northern tribe called the Xiongnu/सྤ. The dynasty was thus rendered secure from external threats from the north. On one of the numerous campaigns against the Xiongnu, one of Hanwudi’s generals was routed; Li Ling/ᵾ䲥 felt he had no choice but to surrender tactically, to secure his own and his men’s survival. When Hanwudi heard of the surrender, he was furious. Sima Qian, unlike all the other officials in attendance, alone proffered a few words of amelioration on behalf of Li Ling, but actually he had meant them also to offer some comfort to the emperor. In mitigation on behalf of Li Ling, Sima Qian reminded the emperor that he was in charge of a rather small force in the face of overwhelming enemy strength, that his surrender was tactical and, therefore, was not betrayal, and that he would, if he could, escape and return to the Han court. This defence in turn provoked a rage in Hanwudi who, then, meted out a punishment to Sima Qian, which turned out in the end to be worse than death. The emperor gave him three options: death, redeem his offence by paying an extremely large sum of money to the court or become a eunuch. He could not afford payment as he had no personal or family wealth to speak of; neither could he afford death, as he was determined to finish his own opus, the Shiji, a project begun by his father, which he felt obliged to complete, out of filial piety. He chose castration, which was Hobson’s choice. Both Bian Que and Sima Qian suffered tragic fates; after death, both were honoured greatly by posterity. In that sense, they had triumphed over the pettiness and the malice of the “moral dwarves”/ሿӪ of their times.

Bian Que, the Hanfeizi and the Fallacy of Misplaced Analysis The above section has looked into Sima Qian’s possible motive for giving so much space to Bian Que. In his history, he had created a category of 4

This follows closely *Sun Liqun 2011.

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celebrated personages other than emperors and members of the ruling elites; it seemed very natural that a celebrated physician should thus be included. Chapter Five shows that the Hanfeizi has also devoted space to the subject of Chinese Medicine, especially to Bian Que. What could have motivated the Hanfeizi to do so, given that he was not writing a general history of China but on political/legal philosophy, on the art of rulership? Is it not curious that he should have touched on Bian Que? What could Bian Que signify for him? These questions are not raised here as idle speculation because exploring them could well throw light on the Fallacy of Misplaced Analysis (FMA), which this author argues (in Appendix Three) could be attributed to Professor Unschuld and those who share his view. Chapter Five, through an analysis of the account of Bian Que in the Hanfeizi, has concluded that contrary to Professor Unschuld’s contention, political discourse, in this respect, is derivative from medical discourse and not the other way round. In reality, it is the “organic model” of illness which “drove” the model for “political unease or dis-ease”. It looks as if the evidence from the Hanfeizi could be said to undermine Professor Unschuld’s contention that the causal relationship is the reverse. Readers may recall that the last section has pointed out that the Duke Huan narrative in the Hanfeizi is earlier than that in the Shiji. Furthermore, that the Hanfeizi had referred to the duke as Duke Huan of Cai state; that the event was said to have occurred nearly three hundred years before the birth of Bian Que/Qin Yueren. In other words, the spurious nature of the date of this event was neither here nor there for the Hanfeizi. The fact that this text is invoked indicates that it is significant. From this, one could perhaps infer that in the minds of the ancient Chinese such as Han Fei, the concept of Preventive Medicine had appeared as far back as the seventh century BCE, and that this key concept in medical discourse could have inspired political discourse to follow its lead, and not the other way round, as articulated by Professor Unschuld. We have also referred above to the tale about the diagnostic skills of Bian Que and his (supposed) two brothers (explored in detail in Chapter Five) in the Heguanzi (a Warring States text). This may be seen as further evidence that there was a well-established tradition in ancient Chinese thought to compare the art/skill of ruling with the art/skill of preventive healing. This in turn appears to imply that the latter skill was independent of the former, and that, furthermore, the former might even have taken inspiration from the latter. In order to bring out the above points more clearly, we need to look critically at Brown 2015 who, without making Unschuld’s thesis the focus

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of her study, nevertheless reinforces it. She is right in holding that Bian Que is cast as the protagonist emphasising “preventive care within the Chinese medical tradition”. She maintains the following theses. 1. Bian Que is merely legendary or better still a figure conjured up and created by “court persuaders” in the Warring States period to make their point about state-craft: … to make a rhetorical point (about the importance of rooting out political ills) rather than to provide a model of diagnosis”. (op. cit., 14)

The episode about Bian Que and Lord Huan is found after all in a classic of state-craft, with chapters entitled “The Way of the Ruler”, “Wielding Power”, and “Difficulties of Persuasion”, to name only three. These court persuaders used the term bubing bing/н⯵⯵/“the ills that do not ail” (the Neijing uses wei bing/ ᵚ ⯵ ) to stand for the concept of Preventive Medicine. 2. The earliest references to Bian Que occurred not in the Hanfeizi but in another chronicle, the Stratagems of the Warring States/Zhanguoce, c. third century BCE, in which Bian Que was shown as absolutely insisting on the need to resort to harsh measures even against obvious ailments, such as swellings and abscesses. A second episode depicted Bian Que’s audience with the king of Qin state who was ill. However, Bian Que’s remedy to cure the king met with objections from his courtiers who held that the remedy could leave him impaired in his hearing and his sight. When the king raised such possible negative side effects of the proposed treatment, Bian Que was reported to have angrily retorted: “If this is how the state of Qin is governed, then it will perish as soon as Your Majesty acts” (op. cit., 53). 3. Bian Que also figured in another Warring States text, the Heguanzi in the story about the three brothers in his family. This text, too, is political discourse. 4. However, in spite of the above, one should not necessarily infer that these stories about the feats of Bian Que were totally groundless in the sense that there was a total absence of “some core beliefs about the body”; they were based “at least loosely on elements of curative practice, elements that would have been recognizable to the audience” (op. cit., 50).

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5. Such a narrative took another serious turn at the hands of Sima Qian in his Shiji, who found a new way to read the Bian Que and Lord Huan episode, turning it and earlier accounts of similar acts from a political metaphor to become medical reality. So when did authors begin to treat the episode not as a political parable but as an actual historical event? The first sign of the episode being read in this way is relatively late, the Records of the Grand Historian of Sima Qian ... By extracting earlier anecdotes about Bian Que from works of persuasion and explicit discussions of statecraft, Sima Qian wove together the various strands of legends and textual fragments in a narrative about the career and life of a healer. In so doing, he primed future readers to see the persuader’s material in a biographical light, paving the way for later interpretations of the episode as medical history. (op. cit., 59-61).

6. After Sima Qian, Chinese medical theorists promptly … availed themselves of the imaginative potential of metaphors. In the process of reassembling textual fragments into literal pieces of the “ills that do not ail” not only made for catchy stories but were also “good to think with” (op. cit., 62).

For the purpose of making critical comments, let us first discuss points 1-4 above: (a) No one disputes that the texts cited by Brown are texts in political discourse, and that they were trying to make a point about political strategy in referring to Preventive Medicine; as a matter of fact, the Hanfeizi could also be read as a text in jurisprudence.5 Hence, the point at issue does not lie in this, but in the methodological flaws embedded in her account. (b) (2) simply points to something obvious about CCM, that it was/is a medicine, which covers both Preventive Medicine and curative medicine. Bian Que, a renowned practitioner of the former is also a renowned practitioner of the latter. (2) does not uniquely entail the gloss Brown has put on it. (c) Brown appears not to realise that (4) above undermines points 1-3. While she shows good caution, she fails to pursue to its logical conclusion the point she has raised at (4).

5

See Lee 1975.

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(d) Had she done so, she might have realised that the political parable and use of metaphor she has so carefully delineated would have no purchase whatsoever without satisfying two prior conditions. (e) The first is: the fragments of medical knowledge must have existed at the time of, if not earlier than, these political persuaders. (f) The second: this body of knowledge, which included Preventive Medicine, must not be doubted and held in suspicion, but must be believed in or minimally held to be plausible by those whom the persuaders wanted most to convince, namely, the ruling elite of the time. (g) Use the following thought experiment. Suppose for a moment that no such body of medical knowledge existed or that Preventive Medicine was totally without any empirical basis, or considered as mere superstition. At best, would not the ruling elite have found the rhetorical analogy between the political and the medical invoked by these persuaders less than compelling even if intelligible? At worst, would they not have decapitated them as a fitting punishment for having wasted their time, and taken them to be gullible two-year-olds? Minimally, they would have banished such persuaders from their presence. However, no texts mentioned such an aftermath. (The sentences in italics are for emphasis.) (h) The fact that these ruling elites took the persuaders seriously implied that the corpus of medical knowledge (which Brown does not deny had existed though only as fragments) would have existed independently of political discourse and the end to which political discourse put it to its own rhetorical use. (i) Brown has put the political cart before the medical horse. As Chapter Five argues, the axiom of Catastrophe Prevention, which underpinned Preventive Medicine and other domains, opened the way for the court persuaders to work upon their targeted audience. If it were not evidentially rational to believe that dykes would eventually collapse if small cracks and holes were not repaired, but instead left to become bigger, leading ultimately to greater disaster, which rulers would be so silly as to allow themselves to be bored by such tales of every major disaster having small beginnings? If it were not evidentially rational to believe that physicians, who were shang gong could diagnose an illness well before the sufferer of the incipient illness began to show obvious signs and symptoms, which ruler would pay attention to such tall tales of medical feats? (j) One may then conclude that Brown’s methodology at points 1-4 is deeply flawed.

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Let us now turn to points 5-6. (a1) (5), point-blank, amounts to turning Sima Qian from being a historian to being a fabulist. Per se, there is nothing wrong in principle with such a charge, serious though it is (as Sima Qian is invariably cited to be one of China’s great historians if not the greatest), but it should be one backed by ample evidence, a move Brown has failed to make. (b1) Even if it turned out that Sima Qian was incorrect in postulating that Bian Que was not a mere legendary figure but that, in reality, the name referred to a historical figure called Qin Yueren, whose death occurred in 309 BCE, then arguments must be marshalled to demonstrate the falsity of identifying Bian Que with Qin Yueren. Brown does nothing of the sort. Instead she implies that Sima Qian was no historian but a fabulist. (c1) She appears to have portrayed Sima Qian as having singlehandedly crafted and created the concept of Preventive Medicine in the history of CCM by a stroke of his fabulist brush. In the absence of telling evidence, it is hard to believe that this could be true. (d1) The possibility then remains that Sima Qian did not craft the concept of Preventive Medicine off his own bat; instead it seems likely that he too, like the rulers of the states during the Warring States period, held that there was independent evidence of some compelling sort for the belief that the concept was not empirically baseless (as even Brown herself concedes). (e1) Concerning (6), it makes not only the people of the Han dynasty gullible to Sima Qian’s fabulist claim about the concept of Preventive Medicine, it also makes all theorists-practitioners of CCM down the two millennia since, fall easy prey to the supposed historian’s fabulist claim. Perhaps, it could be that when they have read Brown 2015, they would all then discard the notion of Preventive Medicine as unintelligible mumbo-jumbo and acknowledge the “greatness” of Sima Qian in having crafted the concept, in their revised history of CCM.

Conclusion If the various strands of the argument put forward in this Appendix stand up to critical scrutiny, then the following claims may be sustained.

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1. Bian Que is not a mere legendary figure in the history of CCM;6 it is highly likely that he was Qin Yueren who lived during the Warring States period. 2. The legends spun around the real person, putting the existence of the legendary figure back about three centuries (as recounted in texts, such as the Hanfeizi and the Shiji) may be read as signs of the veneration of, and respect for, the exceptional skills of the historical physician. Chinese culture favoured such expressions of honour (in texts among the educated); amongst the ordinary people, expressions of honour took another form transforming the distinguished person into a god, erecting statues to him in temples dedicated to him, before which they would come to light joss sticks and pray. 3. The concept of Preventive Medicine was/is considered in the history of CCM to be both powerful and of the utmost significance–physicians who embody that set of relevant skills were/are considered to be the most excellent and the most distinguished. They were/are the shang gong. 4. This concept of Preventive Medicine was/is just a very potent exemplar of the more generalised concept of Preventive Action and hence is invoked by thinkers such as Han Fei. Chapter Five demonstrates that the key concept of Preventive Action, invoked in the chapter entitled Yu Lao in the Hanfeizi, rests ultimately on and draws inspiration from the Laozi itself. This concept (subsumed under the axiom of Catastrophe Prevention) could be applied to every sphere of human activity, such as maintaining dykes to prevent their collapse, fire-fighting, medicine and ruling; it embodies the philosophy of management in Chinese culture and civilisation. It is a little like the Dao, itself above specific dao, but can give rise indefinitely to specific dao, such as the dao of medicine, the dao of ruling, the dao of the military, the dao of running a business/family/ household, the dao of maintaining buildings/constructions, the dao of preventing dykes from bursting, of preventing fires from spreading, of preventing illness from getting a hold of and taking over a person, and so on. 5. Appendix Three has added another strand to the themes mentioned above. Probably the earliest inspiration for grounding the concept of 6

Brown apart, another recent implied scepticism about Bian Que in sinological literature is found in Lo 2013, 52.

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Preventive Action came from flood control, to prevent the flooding of the Yellow River. 6. From the vantage point of the axiom of Catastrophe Prevention, it matters little whether political discourse is derivative from medical discourse or vice versa. What is important in demolishing the UnschuldBrown thesis lies in the fact that medical discourse does not appear to have drawn its inspiration from political discourse in Chinese culture and civilisation. The evidence even points to the other way of understanding the relationship. 7. The above critique if correct would show that the Unschuld-Brown thesis which this author has called FMA is flawed at the very core of its contention (as set out in Appendix Three and Chapter Five), and not merely methodologically flawed in details. 8. It also shows that the account in Brown 2015 in respect of Bian Que is methodologically flawed as she had put the political cart before the medical horse.

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CHINESE HISTORICAL PERIODS AND DYNASTIES

Palaeolithic Period ᰗ⸣ಘᰦԓ

ca. 1,7000,000 – 8000 BCE

Neolithic Period ᯠ⸣ಘ ᰦԓ Yangshao Culture Ԡ並᮷ॆ Hemudu Culture ⋣࿶⑑ ᮷ॆ Dawenkou Culture བྷ⊦ਓ᮷ॆ Majiayao Culture 傜ᇦチ᮷ॆ Longshan Culture 嗉ኡ᮷ॆ

ca. 8000 – 2000 BCE ca. 5000 – 3000 BCE ca. 5000 – 2500 BCE ca. 4300 – 2500 BCE ca. 3300 – 2050 BCE ca. 2300 – 1900 BCE

Xia Dynasty ༿ԓ

ca. 21st – 16th century BCE

Shang Dynasty ୶ԓ

ca. 16th – 11th century BCE

Zhou Dynasty ઘԓ Western Zhou 㾯ઘ Eastern Zhou ьઘ Spring and Autumn Period ᱕⿻ᰦԓ Warring States Period ᡈഭᰦԓ Qin Dynasty 〖ԓ Han Dynasty ≹ԓ Western Han 㾯≹ Eastern Han ь≹ Three Kingdoms Period йഭᰦԓ

ca. 11th century – 221 BCE ca. 11th century – 770 BCE 770 -221 BCE 770- 476 BCE 475 – 221 BCE

Jin Dynasty ᱻԓ

221 – 207 BCE 206 BCE – 220 CE 206 BCE – 24 CE 25 – 220 CE 220 – 265 CE 265 – 420 CE

Northern and Southern Dynasties ইेᵍ

420 – 589 CE

Sui Dynasty 䲻ԓ

581 – 618 CE

Tang Dynasty ୀԓ

618 – 907 CE

Five Dynasties ӄԓ

907 – 960 CE

Song Dynasty ᆻԓ Northern Song ेᆻ Southern Song ইᆻ Yuan Dynasty ‫ݳ‬ԓ

960 – 1279 CE 960 – 1127 CE 1127 – 1279 CE 1279 – 1368 CE

Ming Dynasty ᰾ԓ Qing Dynasty ␵ԓ The Republic of China ѝॾ‫઼ޡ‬ഭ The People’s Republic of China ѝॾӪ≁‫઼ޡ‬ഭ

1368 – 1644 CE 1644 – 1911 CE 1911 – 1949 CE 1949 -

GLOSSARY OF SOME CHINESE TERMS IN PINYIN

ai 㢮/ moxa ben ᵜ/ basis bagua ‫ޛ‬খ / trigrams biaoli 㺘䟼/exterior (surface), interior bian zhèng lun zhi 䗘䇱䇪⋫; bian zhèng shi zhi 䗘䇱ᯭ⋫/ syndrome (pattern) differentiation and treatment biao ben 㺘ᵜ /surface, root bing ⯵/ illness (also translated as disease, disorder) buyao 㺕㦟 /medicinals used in making up for deficiencies regarding yin qi or yang qi in the patient to restore yinyang balance (the) Dao; dao 䚃 (left untranslated but usually translated as “Way”) Daojia 䚃ᇦ/Daoist philosophy ershisi jieqi Ҽॱഋ㢲≄/ twenty-four qi-nodes fang ᯩ/ prescription or direction, the direction indicated by zhèng which fang seeks to follow in order to restore Yinyang equilibrium in the person-body getihua treatment њփॆ⋫⯇ /Personalised Medicine

(treatment based on assessing the zhèng of the patient); quntihua 㗔փॆ⋫⯇ / “mass” diagnosing and medication Hanfeizi lj丙䶎ᆀNJ/ Book by Han Fei (c. 280-233 BCE) hanre ሂ✝/cold, hot houtiantu ਾཙ/ Later Heaven Configuration Huangdi neijinglj哴ᑍ޵㓿NJ /The Yellow Emperor’s Canon of Inner Medicine or the Neijing jingqi ㋮≄/ Essential Qi, the qi which maintains proper functioning of all the organsystems in the person-body Jingluo 㓿㔌 / often translated as channels/ meridians and their collaterals, but best rendered as “the Jingluo network”; Jingmai 㓿㜹 / best left untranslated (literally: jing is that along which mai courses) Jinkuiyaolüelj䠁फ़㾱⮕NJ/ what was a part of the original Shanghan zabing lun, now existing as a separate book Laozi lj㘱ᆀNJ/ the Laozi or the Daodejing

478

Glossary of Some Chinese Terms in Pinyin

Liangyitaijitu єԚཚᶱമ/ commonly referred to as the Yinyang symbol Lingshu lj⚥᷒NJ/Divine, Spiritual or Numinous Pivot (part of the Neijing today) mai 㜹/ translated as pulse but best left untranslated as it is not the pulse of Biomedicine; qie mai ࠷㜹/ feeling the mai or ascertaining the mai profile nei xie ޵䛚/ internal pathogenic condition; wai xie ཆ䛚/ external pathogenic factor pi-wei 㝮㛳/ Spleen-Stomach visceral organ-system qi ಘ/ instrumentation, instruments; or carrier/䖭փ /zaiti Qi ≄/ no adequate English translation; best left untranslated Qi-in-concentrating mode/≄ 㚊 Qi-in-dissipating mode/≄ᮓ qi Diqi ൠ≄ / qi of Earth (which is yin); Tianqi ཙ≄ / qi of Heaven (which is yang ) qigong ≄࣏/exercise based on deep breathing qinghao 䶂㫯/ Herba Artemisiae Annuae; qinghaosu 䶂㫯㍐ / artemisinin qingli ᛵ⨶/ reason Qixue ≄㹰/ Qi and blood renzhong Ӫѝ / philtrum sancai й᡽/ the three talents/ powers–in a trigram, Heaven is

the top yao; Earth , the bottom yao; humans, the middle yao Sanjiao й❖/ Triple Burners shang xia кл /above, below shang gong кᐕ / paradigm of the excellent physician with superior skills; xia gong лᐕ/ a merely competent physician Shanghan zabing lun ljՔሂᵲ ⯵䇪NJ(by Zhang Zhongjing) Shanghanlun ljՔሂ䇪NJ/ a part of the original Shanghan zabing lun shen ⾎; jing shen ㋮⾎/ personspirit sheng-fu-jiang-chen ॷ⎞䱽⊹/ the Cyclic Reversion Law of Nature of the rising, floating, descending, sinking processes of Macrocosmic and Microcosmic Qi/qi shengli ⭏⨶/ principles of physiology bingli ⯵⨶/theory of illness yili ५⨶/ principles of therapy sheng-zhang-shou-cang jielĦ ⭏ 䮯᭦㯿/ the Law of Nature concerning the processes of Birth or Engendering, Growth or Maturing, Gathering-in or Declining, Storing shenti 䓛փ/ person-body shu ᵟ / (technical ) expertise, art Sima Qian ਨ傜䗱/ referred to often as the Grand Historian in Chinese historiography; Shiji/ ljਢ䇠NJ: his great opus

Classical Chinese Medicine

sishi jielü ഋᰦ㢲ᖻ/ Law of Nature about the four seasons in a year or in a day shiyang 伏ޫ / concept of promoting health and longevity through food (nutrition) sizhen ഋ䇺 (ᵋ䰫䰞࠷) / the four diagnostic techniques (looking, smelling as well as listening, asking, and feeling the mai ) Suwen lj㍐䰞NJ/ Basic Questions (a part of the Neijing today) Taiji ཚᶱ / (sometimes translated as) the Great Ultimate ti փ yong ⭘/ foundation or basis, use or instrumental value tizheng փᖱ/ signs of an illness Tian ཙ/literally Heaven; cosmologically, it is more than a spatial location Tian yuan di fang ཙശൠᯩ/ an expression in cosmology which refers to heavenly motions being cyclical over geographical space, which appears as flat and twodimensional Tianren-heyi ཙӪਸа /MacroMicro-cosmic Wholism Tianren-xiangying ཙӪ⴨ᓄ/ Macro-Micro-cosmic Wholism (commonly translated as “Correlative Thinking” which is not followed by this author)

479

tongbing-yizhi ਼⯵ᔲ⋫/ same affliction, different treatments; yibing-tongzhi ᔲ⯵਼⋫/ different afflictions, similar treatment tuina ᧘᤯/ massage wanwu з⢙/ (left untranslated, but is commonly translated as “the myriad things”) wang se ᵋ㢢/ looking at the complexion as a diagnostic technique weiqi ছ≄ / protective qi wucai ӄᶀ/ five material resources wufang ӄᯩ/ five directions, locations: the four compass points plus the centre Wuji ᰐᶱ / (sometimes translated as) the Void wuse ӄ㢢/ the five colours Wuxing ӄ㹼/ could be translated as Five Phases (of Qi Transformation) but best left untranslated wuyin ӄ丣/ the five sounds wuzang ӄ㜿/ the five yin visceral organs wuzang-liufu ӄ㜿‫ޝ‬㞁/ the five yin and six yang visceral organ-systems xiang 䊑/ mode of accessing, characterising the world via images used in the Yijing to describe Wanwu and the processes of Qi transformation in the universe xiantiantu ‫ݸ‬ཙമ / Former Heaven Configuration

480

Glossary of Some Chinese Terms in Pinyin

xiangcheng ⴨҈/ Mutually Over-constraining Cycle of Wuxing xiangke ⴨‫ ݻ‬/ Mutually Constraining Cycle of Wuxing xiangsheng ⴨⭏/ Mutually Engendering Cycle of Wuxing xiangwu ⴨‫מ‬/ Mutually Insulting Cycle of Wuxing xieqi 䛚≄/ pathogenic qi xingershang ᖒ㘼к/ that which occurs at the level above or beyond things with shape and size xingerxia ᖒ㘼л/ that which exists at the level of things with shape and size xu 㲊/ deficiency; shi ᇎ/ excess xuewei イս/ a location along a Jingmai where the acupuncture needle is inserted yangqi 䱣≄/ qi which is yang in character; yinqi 䱤≄/ qi which is yin in character yangshen ޫ䓛; yang sheng ޫ ⭏ / concepts of cultivating the person-body to keep healthy, to prolong life but even more importantly to ensure good quality of life both physically and spiritually yangxu yinsheng 䱣㲊䱤ⴋ/ yang deficiency and yin in excess; yinxu yangkang 䱤㲊 䱣Ӓ/ yin deficiency and yang in excess yao 㦟/ medicinals; jun yao ੋ㦟 / the “sovereign” or lead

medicinal in a fang; chen yao 㠓㦟/ the “official” medicinal yao ⡫ / the yang or the yin component in the construction of a trigram or a hexagram Yidaoyi ᱃䚃५/ the medicine based on or derived from insights of the Yijing and the Dao of the Laozi Yijing/ I Ching lj᱃㓿NJ/ Book of Changes yinyang 䱤䱣 / the dyadic relationship between yin and yang as Wholism Yinyang/yao-gua 䱤䱣⡫খ/ the system of trigrams and hexagrams as determined by the dyadic relationship between yin and yang you wu ᴹᰐ/ you: what falls in the domain of xingerxia (of things); wu: the complementary polar contrast of wu (nothing/empty/void) yuzhou ᆷᇉ/universe yuanqi ‫≄ݳ‬/ Primordial qi which sustains life yuanyundong ശ䘀ࣘ/ the Cyclic Reversion of the Laws of Nature Zangfu 㜿㞁/ the visceral organsystems zhenfa 䪸⌅/acupuncture; jiufa ⚨⌅/ moxibustion zhèng 䇱/ usually translated as “pattern differentiation”; it refers to the process and the outcome of gathering evidence for a diagnosis of the specific conditions of illness in the

Classical Chinese Medicine

person-body of the patient (but left untranslated in this book) han zhèng ሂ䇱/ a cold zhèng mai zhèng 㜹䇱/ zhèng of patient ascertained via the mai zhèng leading for example, to ᇎ䇱/excess zhèng re zhèng ✝䇱/ a heat zhèng se zhèng 㢢䇱/zhèng ascertained via the complexion she zhèng 㠼䇱/zhèng ascertained via the tongue xu zhèng 㲊 䇱/ deficiency zhèng zhengqi ↓≄/ “correct”ˈ orthopathic qi/ the qi which enables the person-body to combat illness zhengzhuang/⯷⣦/symptoms of an illness zhong qi ѝ≄/ qi of the Centre (Earth); Sanjiao; and SpleenStomach

481

zhong ti xi yong ѝփ㾯⭘ / Chinese culture is the foundation, Western science and technology are its handmaiden; xi ti zhong yong 㾯փѝ⭘/ Western science/medicine is the foundation, Chinese Materia Medica is its handmaiden zhongyi ѝ५/ an indigenous Chinese medicine but as practised in China today could take either of two forms as CCM-zhongyi or TCMzhongyi zhou er fu shi ઘ㘼༽ ࿻ / the Cyclic Reversion Law of Nature, the AscendingDescending Law, yuanyundong zhouye jielü ᱬཌ㢲ᖻ/Law of Nature about the (apparent) daily rising and setting of the sun

INDEX

A acupuncture, 4,6, 13, 17, 19, 23, 25, 38, 40, 45, 46, 49-50, 52, 54, 56, 113, 123, 125, 137, 139, 152, 225, 270, 280, 296, 335, 339, 350, 374, 380-82, 384-86, 388, 390, 400, 403, 408, 434 acupuncture (ancient) needles excavated, 13, 380-82 acupuncture points/xuewei, 19, 21, 25-38, 40, 47-50, 52, 55, 114, 296-97, 350, 385, 434 hegu/ਸ䉧, 32-33 yanglingquan/ 䱣䲥⋹, 49-50 yongquan/⎼⋹イ, 271 zusanli /䏣й䟼, 33, 47, 52, 114 acute and chronic illness in CCM, 90, 275-84 Age of Bacteriology/antibiotics, 109, 171, 226, 269, 295, 313, 352 See Koch; Pasteur Age of Modernity, 160 Akobeng, 217 allocation bias, 214, 216, 219, 223, 361 See randomisation; RCT; selection bias axiomatic construction of CCM 329-330 See Macro-Micro-cosmic Wholism Analects/lj䇪䈝NJ, 417 analytical/ diagnostic tool, 69, 132, 134-35, 416 See Yijing; Yinyang/Yao-gua implicit logic anatomy/structure, 3, 83-84, 151, 156-57, 242-43, 274, 285, 287-94, 315-16, 351 See Engineering Technology; surgery

Angell, 209-11 See Big Pharma; RCT anger, 28, 84-85, 175-76, 179-80, 182, 189, 263 See Liver organsystem; wuqing;Wuxing Aristotle/Aristotelianism, 3, 63, 166, 357, 366 Four causes, 63-64 Law of Excluded Middle, 166 aspirin, 345-46, 349 See Zhang Xichun Assimilation Model/AM, 12, 343, 345, 349, 368 See EmancipationHaskalah Movement; IM; TCM; Zhang Xichun astronomy (Time) and geography (Space), 69, 131 See tian yuan di fang; Timespace axiom of Catastrophe Prevention, 126, 136, 146-48, 156, 158,372, 428, 441, 443 See Hanfeizi; Laozi; Preventive Medicine; Unshuld axiom of heterogeneity, 10, 74, 221-22, 224, 281, 361, 367, 369, 372 See CCM; Getihua Medicine; RCT axiom of homogeneity, 10, 74, 216, 219-23, 281, 361, 367, 369, 37212, 85, 252, 255-60, 328, 423, 430 See BM; RCT axiomatic structure/system, 215, 330 B Ban Gu/ᯁപ, 389, 431

Classical Chinese Medicine ben(ᵜ)/ biao(㺘), 22, 87, 105, 123, 140, 157, 255, 287, 378, 347 See polar contrasts Benedetti, 183-84, 187 Berkeley, 53 Bernasconi, 357-58 Bernard, 288 Berthollet, 109 Bian Que/Qin Yueren, 13, 42, 119, 121-26, 136-41, 144, 146, 245, 297, 320, 386, 388-89, 299, 414, 430-444 See Preventive Medicine; shang gong; Fallacy of Misplaced Analysis; Unschuld bian zhèng lun zhi/䗘䇱䇪⋫, 199200, 224, 231, 240, 299 See Getihua Medicine; tong bing yi zhi; yi bing tong zhi; Zhèng-Fang Wholism Big Pharma, 184-85, 187-88, 190, 209-11, 211, 218-19, 295 See Angell; RCT Billiard-ball model, 3, 41, 53, 163, 172, 351, 359, 371 See Hume/Humean bingli//⯵⨶, 5, 11, 61, 75-76, 78, 102, 200, 224, 240, 252, 254-55, 264-65, 283, 285, 290, 294, 29699, 308, 312, 315-17, 330, 349, 361, 365, 370, 372, 374 See PITism; shengli-bingli-yili; Unschuld; Zhang Zhongjing Biomedicine /Bm, 1-4, 6,8, 10-12, 14, 18, 20, 24-25, 28, 37, 40, 4546, 49, 56-57, 73-74, 76, 78, 8081, 83, 95, 97, 99, 103-07, 109-10, 116-18, 129, 146, 150-59, 162-66, 169-75, 185-206, 220, 222-28, 231, 238-39, 242-43, 251, 257-61, 265, 276-78, 281-94, 296, 310,359-69, 371-74, 423, 435 See CCM biophysical, 3-7, 28, 30, 37, 42, 56, 349, 351-52 See Jingluo; Integrative Medicine; Zhu Zongxiang

483

bitter gourd, 271-72 See food as medicine bloodletting, 295-96 blood stasis/ⰰ㹰, 50-51, 183, 19394, 273-74, 278-80, 295 Book of Poetry/lj䈇㓿NJ, 244 Hill and Doll, 99 See epidemiology Brown, 119-120, 122, 135, 396, 398, 400, 403, 438, 440-44 bu/㺕(supplementing technique), 42, 72, 108, 182, 249-50, 254-55, 269, 306 bu tong ze tong/н䙊 ࡉⰋ, 45, 52 bubing bing/н⯵⯵, 439 See Preventive Medicine; wei bing buyao/㺕㦟 (supplementing medicinals), 72, 87 See xie/⌫ (draining technique) buzu/н䏣, 89, 97, 378 See taiguo C Cao Yuanfang/ᐒ‫ݳ‬ᯩ, 112 Cao Zhi/ᴩἽ, 395 Cartwright, 209 categories/conditions of illness in CCM deficiency/㲊, 91, 93, 106, 143,181-82, 192, 198,228-29, 240-41, 248-49, 254, 256, 261, 269, 272, 274, 279-80, 283, 328 See buzu excess/ ᇎ, 143, 228-29, 248-49, 264, 345 See taiguo han zhèng /ሂ䇱, 229, 241 re zhèng /✝䇱, 229, 241, 249-50, 302, 304-05, 327, 365 shi zhèng (ᇎ䇱) /xu zhèng (㲊䇱) , 228, 230, 248-50, 345 Carroll, 374 causal realism, 6, 58, 350 See Psillos

484 causation, 58-59, 80-81, 104, 110, 162-63, 172, 220-21, 227, 238-39, 257-58, 351, 356, 359, 362, 369, 373 See monofactorial; linear; Billiard-ball; Humean; multifactorial; non-linear; synergistic cause and effect in Preventive Medicine, 146 See Bian Que; shang gong; Zhang Zhongjing cause and effect, treating acute illnesses in CCM, 225, 275-82 Caventou and Pelletier, 308 CCM (identity, theory, practice) See Chinese Laws of Nature; Contextuial-dyadic Thinking; Dyadism; Getihua Medicine; Laozi; Macro-Micro-cosmic Wholism; multifactorial; nonlinear; person-body; PIT-ism; process-ontology; polar contrasts; Preventive Medicine; synergistic; Wuxing; Yidaoyi; Zhèng; ZhèngFang Wholism CCM-zhongyi, 341, 343, 347-50, 359-71, 373-4 See IM; TCMzhongyi Context Distinction, 65-68 See Popper Context of Generating Hypothesis /CGH, 68-69, 71-72, 78, 129 context of justification, 65, 67 Context of Testing Hypothesis/ CTH, 17, 68-72, 78, 129 testing two Wuxing hypotheses, 7074, 79, 86, 88 Central Nervous System/CNS, 28, 30, 38, 110 Chakrabarty, 352 Chakravartty, 43, 58 Chalmers, 154, 206, 208, 211-12, 282, 354 chang/൪, 170-71 Chinese Laws of Nature, 72, 102, 131, 148, 232, 250, 319, 327-30, 334, 338, 372, 417-18

Index Ascending-Descending/ॷ⎞䱽⊹, 12, 234, 250, 256, 268, 310, 318-22, 324-27, 329-33, 339-40, 372 Cyclic Reversion (the most basic Law)/ઘ㘼༽࿻, 72, 232, 31829, 339, 372 Processes of Birth, Growth, Gathering-in and Storiage/⭏䮯 ᭦㯿, 330, 321 Four seasons/sishi jielĦ/ഋᰦ㢲ᖻ, 145, 232, 250, 327, 329, 336, 372, 388, 418 Cyclic Motions/ yuanyundong (ശ 䘀ࣘ), 319-20, 339 See Peng Ziyi Daily Rising and Setting of the Sun/zhouye jielĦ (ᱬཌ㢲ᖻ), 72, 102, 232, 250, 288, 327, 329, 336, 372, 418 Chinese Materia Medica, 273, 349, 385, 387 See Shennong; Li Sizhen Chinese philosophy, 4, 16, 41, 57, 72, 84, 94, 112, 145, 157, 159, 166, 169, 334, 337, 358, 377, 422 See Laozi; Contextual-dyadic Thinking; Dyadism; MacroMicro-cosmic Wholism; multifactorial; non-linear; process-ontology; Qi; yinyang/ yao-gua implicit logic Chinese knowledge of anatomy revealed in ancient texts, 20, 29192 Chinese science See CCM; Chinese philosophy Ching and Oxtoby, 357 cholera, 305, 308-09, 312, 316, 328 See Snow; Wang Mengying Chunyu Yi/␣Ҿ᜿, 134-36, 378, 391 See Physician He; Wuxing; Unschuld Churchland, 162 Chinese (ancient) scripts Bronze/䠁᮷, 237, 416

Classical Chinese Medicine Clerical/䳦Җ, 235-37, 416-17 Oracle Bone/Jiaguwen (⭢僘᮷) , 235, 237, 244, 416 Lesser Seal, 235-37, 244, 416 Chinese writing meaning compound/huiyi zi/Պ᜿ ᆇ, 234, 236, 245 417 pictograph /䊑ᖒᆇ, 236-37 semantic-phonetic compound /ᖒ ༠ᆇ, 234, 236, 245, 414 clinical relevance, 217-18, 220, 223, 361 See RCT; statistical relevance Cochrane, 212, 218 Cochrane Collaboration, 154, 212, 354 See EBM; RCT-EBM Cohen, 373-74 Comte, 63 concept of person, 159-190 See Dualism; Dyadism person-body/䓛փ , 4-5, 8-9, 11, 13, 18, 22, 25, 28, 33, 48, 50-51, 55, 70-71, 75, 83-84, 90-92, 9596, 105-06, 112-14, 152, 167169, 171, 182-83, 198, 22829, 236-38, 240, 245-47, 249-56, 258, 262-63, 265-68, 271-72, 274, 280, 283, 289-94, 307, 310-11, 314, 316, 325, 328-40, 346, 359, 364, 385, 416, 431, 434 confirmation logic, 66, 74 See deductive logic; inductive logic Contextual-dyadic Thinking, 3, 9, 57, 84, 159, 161, 166, 173, 189, 227, 332, 334-40, 359, 371, 375, 413 Correlative Thinking, 4, 318 See Macro-Micro-cosmic Wholism; Tianren-xiangying Counter-flow Cold Decoction/ഋ䘶 ᮓ, 263 craft-based technology, 382 Crick and Watson, 109 cystic fibrosis, 201, 227, 239

485

D Dao/the Dao/the metaphysical Dao, 4, 8, 19, 101-102, 148, 297-98, 317, 337, 339, 372, 384, 420, 443 See specific dao (s) Dalton, 221 dantian/ѩ⭠ˈ 338 Daodejing/lj䚃ᗧ㓿NJˈ 370 See Laozi; the Laozi Daoist philosophy/Daojia (䚃ᇦ) 22, 110,117, 162, 171, 174, 271, 370, 393 Daojiao/䚃ᮉ, 174 See Daojia daoyin/ሬᕅ,135-36, 397 de re necessity, 68 See causal realism deductive logic, 54, 67, 71, 365 deemed, 216, 222, 356-57 See axiom of homogeneity definition/definitional, 1, 189-90, 200, 350, 354, 362, 427 See linguistic stipulation definitional truth, 374 Deng Tietao/䛃䫱⏋ and Zheng Hong/䜁⍚, 60 See Wuxing, AWT deqi/ᗇ≄, 19 See acupuncture Despeux, 407 Dharmananda, 292, 305, 312, 388 diagnosis and treatment, 13, 90, 120, 199, 225, 265, 277, 281, 299, 335, 401 diagnosis-cum-prognosis, 135 See Bian Que; Preventive Medicine; Zhang Zhongjing Dialectical Materialism, 240 diet/nutrition, 97, 106, 109-14, 181, 202-03, 216, 220, 256, 261-62, 268, 340, 415 See shiyang direction either in temporal or spatial terms, 251 disease/disease-entity, 2-3, 14, 7677, 81, 99, 104-05, 109-10, 119, 129, 153-58, 171-72, 184-85, 190, 192, 200-02, 205-08, 211, 216-28,

486 230-31, 238-39, 251, 257, 260, 290, 293, 296, 300, 308-09, 312, 315-16, 360, 371, 373 See monogenic conception of disease; thing-ontology divination, 8, 69, 132, 148 See Yijing Dong Zhongshu/㪓Ԣ㡂, 161, 413 See Contextual-dyadic Thinking; Dualism Dualism, 159-61, 165-66, 168, 186, 190, 290, 334, 336, 413 See Dyadism Body-Mind dualism, 162, 172, 187, 227, 364 Body-Mind Reductionism, 187 Cartesian dualism, 3, 57, 159-66, 189, 227, 364, 371 See Plumwood; Reductionism Duke Huan, 121-25, 141, 430, 433, 438 See Bian Que; Preventive Medicine; Unschuld dynamic, 4, 248, 339, 356, 359-60 See process-ontology Dyadism, 35, 113, 159, 186, 290, 334, 336 See Dualism E Earth, 7, 62-63, 76, 84-86, 89-92, 94, 96, 100-01, 115, 127, 132-33, 135, 144, 168, 173, 180, 232, 254, 262, 306, 321, 323, 327-28, 331, 333, 335, 421-22 See Wuxing EBM, 3, 10, 74, 154, 191-92, 204, 212-14, 217-19, 222-23, 315, 361, 363 See RCT; RCT-EBM Ebola, 316 ecosystem 7, 22, 80-81, 97, 100-01, 108, 170 Ecosystem A (Jingluo), 22-23 Ecosystem B (Zangfu), 22-23 Ecosystem C (Zangfu-Jingluo), 22-23 Ecosystem of the uterus, 106, 108 Ecosystem-nesting, 83

Index Ecosystem 3, 7, 81-82, 90, 100 Ecosystem 4, 7, 84, 90, 100 Ecosystem 5, 94, 98 Ecosystem 6, 94 Ecosystem 8, 186, 189 Ecosystem 9, 99 Ecosystem 10, 99-100 Ecosystem Science, 3-4, 7, 14, 16, 57, 80-81, 99, 115-16, 189, 293, 359, 369, 371, 373-75 Ecosystem Thinking, 80, 98, 10004, 107, 113, 115, 173 Ecosystem Wholism, 19 Eight Rubric Framework of Diagnosis/‫ޛ‬㓢䗘䇱, 42 Einstein, 131, 251 Emancipation-Haskalah Movement, 343-444, 367-68 emergence of Wholist/Wholist properties, 81 Em-ism, 35, 57 See Contextualdyadic Thinking Emotion/Passion, 9, 164-67, 174, 372 See Hume/Humean Emperor He/઼ᑍ, 241 Engel, 172 Engineering/Engineering Technology, 3, 286-88 Enlightenment, 164-65, 344, 357 Epidemiological model of disease, 117 Epidemiology/Epidemiological reasoning, 14, 80, 99, 104, 110, 117, 155, 172-74, 222, 336, 366, 373 epiphenomenalism, 163-65, 186 See Mind-Body dualism Essentialism of Method, 2, 6-7, 12, 351, 356-58, 360-61, 373-74 cat show/dog show, 14, 362, 368, 373, 428 Eurocentrism, 357, 374, 428 the "colonised" Chinese mind, 287, 352 ether (unobservable, undetectable entity), 44

Classical Chinese Medicine Evans, Thornton and Chalmers, 154, 206, 208, 211, 282, 354 Evidence-based Medicine/EBM, 3,10, 56, 74, 154, 191-92, 204-220, 222-24, 259, 355, 359-69 See RCT Expert Consensus, 366 See Lake F fact-value dualism, 371-72, 336 Fajia/⌅ᇦ, 413-14, 433 See Hanfeizi Fallacy of Misplaced Analysis/FMA, 13, 129, 410-29, 438, 444 See Preventive Action; axiom of Catastrophe Prevention; Preventive Medicine (CCM); Unschuld fang/fangzi/ᯩ , 5, 10-11, 17, 46, 73, 76, 78, 182-83, 193, 195, 198, 200, 224-26, 250-57, 259-60, 279-83, 296-99, 302, 310, 314, 316, 361, 372, 374, 389, 402, 416 Zhang Zhongjing's fangzi, Baihu tang/ⲭ㱾⊔, 253, 311, 345 Lizhong tang/⨶ѝ⊔, 273 Qinglong tang/䶂嗉⊔, 253 Shaoyao gancao fuzi tang/㢽㦟 ⭈㥹䱴ᆀ⊔, 197 Xiaojianzhong tang/ ሿᔪѝ⊔, 181, 194, 265 Wenjing tang/⑙㓿⊔, 278-79 Wuling san/ӄ䴦ᮓ, 402 Zhenwu tang/ⵏ↖⊔, 253 Deconstruction of two fangzi, Wenjing tang, 277-280; Bu zhongyiqi tang/㺕ѝ⳺≄⊔, 254-56 Analysis of other fanzi, 305-14 See jingfang Fang Wholism, 280, 282 See ZhèngFang Wholism Farquhar, 228, 230, 398

487

Fava and Sonino, 172-73 FDA, 1, 187, 200, 210-11, 259 food and/as medicine, 268-75 See garlic food as Preventive Medicine/伏ޫ, 114, 268 food therapy/伏⯇, 283 Formey, 243 Fruehauf, 64 function of dispersing and discharging/shuxie/⮿⋴, 332 Fuxi, 309 fuzi/䱴ᆀ, 263 fuzzy logic, 4 G Galen, 295, 300 Galileo, 160 garlic, 268-70 Gay-Lussac, 221 Ge Hong/㪋⍚, 258-59 geography, 69, 130-31, 315, 357 See Spacetime; Timespace Getihua Medicine/њփॆ⋫⯇, 5, 73, 192-200, 224-25, 260-268, 281-82, 360-61, 367, 370, 372 Gilbert, 53 ginger, 253, 263, 279 ginseng, 51, 253, 255, 279, 303, 345-46 Goldacre, 209 Goldschmidt, 407 Gordon, 373 Greenhalgh, Howick and Maskrey, 217 gua/ খ (trigram and hexagram) See Kun gua; Qian gua; Pi qua; Tai gua; Yinyang/Yao-gua implicit logic

488 H Hanfeizi /lj丙䶎ᆀNJ, 105, 119-26, 139, 433, 438-89, 443 Hanson, 42, 258, 315 Hao/ 䜍зኡ, 32, 46-48, 177-81, 189, 192-99, 242, 265, 350 Harper, 378 Harris, 208 Harvey, 425-28 High Blood Pressure/HBP, 46-47, 260, 276, 296 Hypothetico-deductive Method /HDM, 54, 56, 67, 71-73, 79 See Popper Heart organ-system, 20, 25-26, 33, 76, 81, 86, 90, 93, 96, 108, 113, 127-28, 144, 149, 175-77, 183, 237, 246-47, 249, 271, 280, 28990, 334-35, 337 Heguanzi/˪发ߐᆀNJ 136, 139, 433, 438-39 high-tech in Bm, 3, 97, 104, 118, 151, 153, 227 Hinrichs, 407 Hippocrates, 295, 300 houtian/ ਾཙ, 97, 106, 108, 116 See xiantian Hua Tuo/ॾև, 292, 388, 393, 401 Huainanzi/ lj␞ইᆀNJ, 384 Huang Yuanyu/哴‫ݳ‬ᗑ, 320 Huangfu Mi/ⲷ⭛䉗, 389, 400-01, 403, 406 huiyi zi/Պ᜿ᆇ/meaning compound, 234, 245, 417 Human Genome Project, 109, 154, 201 Hume/Humean, 3, 9, 40, 53, 57-58, 66, 163-65, 168-69, 174, 227, 351, 359, 371 See Passion/Emotion and Reason in Hume; Humean Billiard-ball causation, 3, 163, 351, 359 huoluan/䴽ҡ, 309-10, 328 See cholera

Index hyperseparation, 161, 165-66 See Dualism; Plumwood I illness (concept of in CCM), see PIT-ism/shengli-bingli-yili; wuxing; yidaoyi; yinyang-wuxing illness process, 238 See processontology Integrative Medicine/IM, 6, 40, 56, 341 See Assimilation Model; Emancipation-Haskalah Movement; Lake; TCM/TCMZhongyi; Zhang Xichun inductive logic, 67, 71, 82 Inferring from the exterior to the interior, 97, 152 See biaoli (polar contrasts) Integrative Medicine/IM, 7, 47, 399, 400, 402 See Assimilation Model, 15, 402, Emancipation- Haskalah Movement, Lake, Zhang Xichun, TCM interactionism, 163-64 See Dualism; epiphenomenalism inter-subjective, 7, 8, 16, 118, 36465 J Jesuits, 308 Jha, 202 jieqi (㢲≄)/qi-nodes , 234, 325, 329 jineijin/呑޵䠁, 273-75 jingfang/㓿ᯩ, 278, 297-99, 316 WuWei/↖ေ, 298 Mawangdui, 298 Zhang Zhongjing, 298-99 Jingluo/Jingmai network (㓿㔌), 67, 16-59, 83, 157, 195, 234, 245, 329-33, 349-51, 374, 385-86 Jingluo in the Person-body, 330-332. See Peng Ziyi; yuanyundong

Classical Chinese Medicine Jingluo and testing its biophysical properties, 24-35 Methodological comments on biophysical testing, 35-40 See null hypothesis; presumption of innocence jingqi/㋮≄, 82, 86-88, 292 Jingkuiyaolüe/lj䠁फ़㾱⮕NJ, 283, 406-07 Jixia Academy/でлᆖᇛ, 130 John Stuart Mill’s System of Logic, 205, 221 Method of Difference, 205, 214, 221-23 Kahl, 272 Kalanthini, 219 Kan gua/ ൾখ, 374, 377 Kant, 161, 165, 357-58 See Essentialiam of Method; racism and Eurocentrism Karchmer 195, 275, 287, 352, 370, 374 Kekulé, 687 Kendall, 212 Kidney(s) 20, 52, 70-76, 79, 81, 8588, 93, 96, 103, 108, 112, 128, 144, 149, 175-76, 241, 246, 271 279-80, 289-90, 300, 303, 333-35, 338 Kidney organ-system, 86 Kim, 163, 185 Koch, 109, 171, 226, 228, 300, 309 Kristiansen and Mooney, 209, 21314, 217 Kuhn, 55, 410 Kun gua/ඔখˈ 95, 100, 127, 168, 321 See Qian gua Kuriyama, 145, 241-43, 246 L La Mettrie,160 Lakatos, Lakatos and Musgrave, 55, 410 See Khun; Popper Lake, 342-43, 348, 350, 352-67

489

Laozhongyi/㘱ѝ५ˈ 99, 142 Laozi/lj㘱ᆀNJ/Laozi 㘱ᆀ, 4, 94, 124-26, 149, 156, 233, 338-39, 372, 384, 386-87, 420, 423, 443 Large Intestines Jingmai, 20, 28-29, 32-33, 81, 128, 303, 327, 331 Laveran, 308 Law of Excluded Middle, 166 See Aristotle Lee, 1-4, 14, 16, 18-19, 35, 40-42, 47, 54, 57, 63, 68-69, 71-72, 75, 80-81, 83-84, 91, 94, 98-99, 101, 104, 106, 109-10, 115-16, 121, 126-27, 131-32, 136, 143, 145-46, 155-57, 159, 161, 163, 166, 168, 171, 173, 175, 183, 189, 200, 202, 206-08, 220, 224, 226, 228, 234, 239, 243-44, 247, 251, 254, 257, 272, 275, 286-89, 295, 309, 31820, 334, 336-37, 339-40, 356-59, 368, 371, 376, 378, 382, 384-85, 398, 401, 410-11, 413-14, 417, 420-23, 429, 440 Leibniz, 357 Li Dajian/ᵾབྷ䈿, 176 Li Dongyuan/ᵾьී, 257 Li gua/⿫খ, 321 Liangyitaijitu/єӯཚᶱമ, 100, 321, 327, 334 Li Yubin, 240, 261-62 Liezi/ljࡇᆀNJ, 432 See Bian Que Lind, 109, 205-06 linear, 1, 3, 40, 57, 81, 155, 157, 172-73, 188, 190, 220, 223, 227, 257, 293, 359-60, 362, 369, 371, 373-74 See non-linear; monofactorial; multifactorial linghuo/⚥⍫, 73, 76,264-66, 268, 270, 273, 278, 281-82, 296, 299, 316 linguistic stipulation, 374 Littlejohn , 421 Liu Changlin/ࡈ䮯᷇, 377-78, 386, 390

490 Liu Guangting/ࡈ‫ݹ‬ӝ, 378, 380-81, 383-85 Liu Lihong/ࡈ࣋㓒, 60, 94-95, 99, 141-42, 231, 237, 247-48, 252, 341 Liver organ system (Wood, anger), 20, 51-52, 70-71, 76, 81, 84-87, 91-94, 128, 144, 149, 175-76, 179-80, 182-83, 246, 262-63, 272, 274, 279-80, 289-90, 300, 303, 311, 332-35, 337-78 Lo, 398, 443 Lobachevskian geometry, 215 Lung Jingmai, 27, 28, 57 Lung organ-system (Metal, grief), 20, 23-24, 33, 49-50, 70-71, 76, 81, 85-86, 87, 89-90,, 93, 96, 12728, 144, 149, 175-77, 183, 196, 246, 254-55, 272, 289-90, 300, 303, 313-14, 331, 333-35, 432, 338 Luo, 182, 249, 257, 264-66, 274-75, 301, 305, 345 Lüshi chunqiu/lj੅∿᱕⿻NJ, 132 M Ma Jixin/傜㔗ᯠ, 377 MacPherson, 309 Macrocosm/Macroscopic Qi, 18, 83, 94, 99, 238, 289, 318-19, 322, 325, 328, 330, 333-34, 338-90 Macro-Micro-cosmic Wholism (MMW), 18, 41, 45, 55, 85, 94, 97, 111, 113, 133, 151, 236, 247, 25252, 268, 289, 292, 318, 335-36, 339, 372 See Tianren-xiangying Magna Carta, 425 28 See Unschuld mai/㜹, mai profile/㜹䊑, 11, 17, 23, 42, 45, 49-50, 56, 86, 119, 140-44, 153, 157, 198, 234, 241-51, 263, 266, 269, 273, 291, 306, 363-64, 399, 416, 434, 436 feeling the mai/ ࠷㜹, 11, 17, 42, 45, 86, 119, 140-01, 143, 153,

Index 157, 198, 234, 241, 247, 249, 266, 399, 434, 436 mai positions chi/ቪ, 246 cun/ረ, cunkou/ /ረਓ, 23, 42, 49-50, 143, 246, 269 guan/‫ޣ‬, neiguan/ ޵‫ޣ‬, 49-50, 246 Maijing/lj㜹㓿NJ, 399-400, 404 malaria as treated in CCM, 258, 305-08 See Wang Mengying Manheimer, 355 Marchant, 185 Materialism/Matter, 2, 35, 166, 258, 359, 371 See Reductionism; thingontology McDonald, 36 See null hypothesis medicinals, 14, 21, 58, 84, 85, 102, 103, 106, 124, 135, 145, 147, 207, 209, 210, 211, 212, 213, 220, 221, 224, 228, 229, 230, 262, 290, 293, 294, 297, 298, 299, 300, 301, 302, 305, 307, 308, 309, 310, 312, 319, 320, 325, 327, 329, 347, 348, 351, 352, 353, 355, 357,358, 361, 362, 363, 364, 365, 366, 397, 405, 412, 430, 451, 464, 467, 468, 507, 554, 558 Medicinals, See Getihua Medicine; Zhèng-Fang Wholism heat-clearing medicinals, 249-50, 271-72, 302, 311, 346 mahuang/哫哴/Herba Ephedraeˈ 254, 259, 314 interior-warming medicinal, 253, 278-79 menorrhagia/AUB, 278-79, 281 menstruation/ᴸ㓿, 112, 180, 24344, 274, 279 metaphysical/ontological core of BM, TCM/IM and CCM, 2, 4, 12, 14, 342-43, 356, 359, 365, 370-71

Classical Chinese Medicine

491

"metaphysical" in the abusive and non-abusive senses, 4, 7, 65,69, 75, 77, 341, 349 Miao Xiyong/㕚ᐼ䳽, 182, 301-05 See cholera Microcosm/Microscomic Qi, 18, 83, 94, 96, 238, 289-90, 293, 319, 324-25, 327-30, 334, 339-40 See Tianren-xiangying Modern Science and Medicine/ Bm, 2-4, 37, 41-43, 52, 56-58, 63-64, 77, 160-61, 184, 251, 350-51, 374 Modus Ponens/Modus Tollens, 6667 See Popper Moerman, 185 See Placebo meaning response, 185-86 monofactorial, 1, 3, 81, 110, 155, 157, 172-73, 188, 190, 220-23, 227, 239, 257, 259, 361-62, 371 See Humean; linear; non-linear. multifactorial monogenic conception of disease, 3, 81, 104, 109, 155, 171-72, 190, 200, 220, 222, 226, 239, 300, 371 See disease/disease-entity moxibustion/⚨⯇, 17. 123, 137, 139, 225, 340, 374, 400, 403 multifactorial, 1, 4, 81, 99, 10506,110, 115, 155, 157, 172-73, 189, 220, 222, 224, 227, 238, 258, 351, 359, 369, 371, 373, 375 See monofactorial; non-linear

Lingshu/lj⚥᷒NJ,18, 22-23, 34, 42, 63, 97, 144, 152, 290-92, 296-97, 379, 383-85, 403 Suwen/lj㍐䰞NJ, 18, 63, 82, 96, 99, 102, 108, 111, 121, 124, 127-28, 134, 140, 143, 149-50, 175-76, 179, 230, 247, 289, 297, 334, 378-79, 383-85, 403, 405 dating of the Neijing, 12, 135, 376-92 Newtonian science, 2, 14, 19, 63, 78, 80, 251, 287-88, 293 post-Newtonian/non-Newtonian science, 3, 78, 289, 373 NICCAM, 342 Nice, 211-12 nocebo, 9-10, 187 See placebo non-linear, 1, 14, 16, 57, 81, 99, 111, 115, 155, 157, 173, 189, 222, 224, 227, 238, 258, 351, 359, 369, 371, 375 See multifactorial non- Reductionism, 57, 78, 100, 189, 359, 371 See CCM; emergence; non-Reductionism; Wholism null hypothesis, 6, 35-40, 56 H0, 6, 36-40, 56, 349 H1 (alternative hypothesis), 36-40 nutrition/diet, 109, 113, 181. 202, 256, 340, 415 See shiliao

N

objective, 2, 5, 7-9, 28, 30, 37-38, 41, 46, 52-53, 56, 106, 118, 162, 184, 187-88, 190, 208, 211, 230, 263, 276-77, 371 See intersubjective objective-subjective dualism, 264, 371 observables/detectables, unobservables/undetecables, 4345, 55-57, 145, 349 See causal realism ontological volte-face, 159, 286 See La Mettrie

Nanjing/lj䳮㓿NJ, 42, 141, 143, 290, 297, 320, 407 Needham, 130, 351 Neijing/lj޵㓿NJ 6, 12-13, 18, 20, 29, 34, 37, 82, 94, 96, 102, 111, 120-21, 123, 127, 129-30, 135, 146, 152, 247, 291, 294, 296-97, 299-300, 305, 317, 320, 376-80, 382-86, 390-91, 403-05, 407, 41014, 419, 423, 428, 439

O

492 organ-system Wholism , 7-8, 18, 81, 83-84, 86-93, 100, 106, 125, 129, 135, 150-52, 155-57, 174, 198200, 245, 250, 254-56, 262, 267, 273, 280, 283, 289-93, 298, 30203, 327, 331, 334-36, 359, 383, 416, 432 P Pan Yi/█⇵, 60 Pacini, 309 Paré, 287 Passion/Emotion, 9, 14, 164-72, 208 See Humean Pasteur, 109, 171, 226, 330 pathogenic qi/䛚≄, 128, 144, 199, 250, 328, 434 See proper qi Peng Ziyi/ᖝᆀ⳺, 319-20 See yuanyundong Personalised Medicine See Getihua Medicine Personalized/Precision Medicine, 201, 203-224 person (as primitive concept), 159190 person-body, 4-5, 8-9, 11, 13, 18, 22, 25, 28, 33, 45, 48, 50-51, 55, 70-71, 75, 83-84, 90-92, 95-96, 105-06, 112-14, 145, 152, 16769, 171, 182-83, 198, 228-29, 236-38, 240, 245-47, 249-58, 262-63, 265-68, 271-72, 274, 280, 283, 289-94, 307, 310-11, 314, 316, 325, 328-40, 346, 359, 364, 385, 415-16, 431, 434 pharmacogenomics, 202 pharmacology (difference in Bm and CCM), 250-68 active ingredient, 259-60, 299, 308, 348 qinghao/qinghaosu (artemisin), 11, 257-60, 284, 306, 341, 348-49, 351, 355 Tu Youyou, 258-60

Index Phenylketonuria (PKU), 110 See Ecosystem Science philosophy of science, 35-40. See causal realism; CGH; CTH; context distinction; HDM; null hypothesis; Popper philtrum, 8, 95, 277, 318 See renzhong phlogiston (undetectable entity), 64 See ether physician He/५ ઼ , 135, 176, 38889, 391 See Wuxing Physician Lu, 430-31 See Bian Que physiology See shengli Pi gua/хখ, 95, 127 See Tai gua PIT-ism, 5, 11, 24, 76, 285-317, 330, 361, 370, 372, 374 See shenglibingli-yili placebo, 5, 9-10, 24, 46, 52, 146, 159, 164, 183-90, 206-08, 210, 221, 281, 372 See Nocebo; RCT Plumwood (hyperseparation) 161 See Dualism polar contrasts/characteristics, 9, 280, 332, 335, 338, 385 biaoli/interior-exterior/㺘䟼, 22, 97, 105, 140, 152-53, 248, 33435, 338, 378 Tianqi / ཙ≄, Diqi /ൠ≄, 8, 18, 95-97, 127, 327 tiyong/փ⭘, 348 See Zhang Xichun Positivism, 1, 2, 7, 63-65 See "metapysical" Presumption of Innocence (PI), 38 See Context of testing a hypothesis (CTH) Preventive Action, 120, 125-26, 443-444 Preventive Medicine in Bm, 80, 104, 110, 116-18, 150, 153-55, 157, 373 Preventive Medicine in CCM, 5, 8-9, 13, 33, 47, 80, 101-158, 268, 283, 412, 414, 433-34, 438-43 See

Classical Chinese Medicine axiom of Catastrophe Prevention; Bian Que; Brown; Hanfeizi; Preventive Action; shang gong; xia gong; Unschuld primary (broad) meaning, 101-115 narrow meaning, 117-158 Primordial/Original Qi (‫)≄ݳ‬, 290, 292, 303 process-ontology, 3, 16, 41, 57-58, 157, 169, 200, 227, 238, 243, 251, 258, 265-66, 288-89, 293, 318, 340, 351, 359, 369, 371, 373, 375, 422 Prout, 221 Psillos, 58-59 See causal realism Psychosomatic Medicine, 14, 17174, 186, 189-90, 222, 373 pulse, 119, 137, 242-43, 248-49, 291, 416 See Bm; CCM Q Qi (fundamental ontological category), 3-4, 16, 41, 45, 55, 94, 133, 318, 329, 340, 385, 422 essential qi/㋮≄, 82, 86-88, 103, 292 proper (correct) qi/↓≄, 105, 128, 199, 238, 250, 292, 346 yinqi/䱤≄, yangqi/䱣≄, 5, 28, 69, 72, 75, 87, 90, 94-97, 102, 127, 133, 148, 179, 228-29, 236, 240, 247, 250-52, 261-62, 268-69, 279-80, 283, 289-90, 292-93, 303, 307, 311, 319, 321-29, 331, 335-40, 372, 422 Qi- in-concentrating mode/Qi-indissipating mode, 3, 6, 18-20, 22, 30, 41-43, 45, 53, 55,75, 95-96, 102, 108, 145, 148, 153, 156-57, 289, 292, 318, 329, 340, 351, 374, 385 qi stagnation/≄┎, 51-52, 265, 278-79

493

Qian and Hao, 398, 400 See Unschuld; Zhang Zhonging Qibo/ዀ՟ and the Yellow Emperor/ 哴ᑍ, 22-23, 42, 96, 102-04, 144, 150, 152, 179, 297, 320, 386-87, 389 -90, 412, 421 qigong, 17, 113, 115, 340, 350, 35960, 385 qingli/ ᛵ⨶, 168, 171 See ReasonPassion dualism Qixue/≄㹰,18-19, 21, 28, 47, 50, 86, 108, 113, 128, 181, 274, 27980 quinine, 72, 308, 345-46, 349 See Zhang Xichun quntihua/㗔փॆ, 193 R racism and Eurocentrism, 357-58 See Essentialism of Method randomisation, 207-08, 214, 216, 219, 223, 281, 354, 361 See allocation bias; RCT; selection bias Rasmussen, 214, 217 RCT, 1, 3,-4, 10, 52, 56, 73-74, 109, 154, 164,175, 184, 188, 191, 204224, 259, 275, 281-82, 315, 35455, 359-63, 365-67, 369 See EBM; RCT-EBM axiom of RCT, 215-16 internal and external validity, 20809, 215, 219, 223 RCT-EBM, 10, 56, 213, 215-18, 222-24, 259, 354-55, 359-63, 36567, 369 irrelevance to CCM, 10, 204-220 Reason in CCM See qingli Reason-Passion dualism, 164-68, 171 See Hume reciprocal causal relation, 81, 108, 173, 257-58 See synergistic; Wholism rectification of names/↓਽, 420

494 Reductionism, 3, 78, 80, 109, 16263, 173, 186-87. 190, 257-59, 284, 287-88, 293, 359, 362, 369, 371 See non-Reductionism; whole/wholism; Wholism; Wholism Reichenbach, 65 Reihman, 357 relativity physics, 131, 251 renzhong/ Ӫѝ, 95-97, 277, 318 See philtrum Repeatability, 31, 56, 351 Richarz, 343 Röntgen, 150 Ross, 308 Rujia/ ݂ᇦ, 232 Rumsay, 36 S Sample, 202 sancai/й᡽, 47-48, 101 SARS, 193, 312-16, 342 Scheid, 199, 228, 230-01, 287, 341, 345 Scheid and Karchmer, 287, 370, 374 Schumacher-Brunhes, 344 Seidman, 393, 398 selection bias, 214, 216, 219, 223, 361 See allocation bias; RCT self-limitation, 183-84, 275 See spontaneous remission semantic-phonetic compound/ᖒ༠ ᆇ, 273, 275, 285 Semmelweiss, 205-06 sezhen/㢢䇺, 71 See Four Diagnostic Techniques /sizhen shang gong, 8-9, 74, 76-77, 99, 10102, 117, 119, 136, 138-42, 144-49, 153, 156-57, 264-66, 301, 304, 308, 312, 434, 436, 441, 443 Shanghanlun/ ljՔሂ䇪NJ, 13, 46, 141, 194-95, 253, 264-65, 267, 283, 295-96, 299-300, 305, 320, 328, 398-99, 402-07

Index Shanghanzabinglun/ljՔሂᵲ⯵ 䇪NJ, 295, 297, 379, 406 See Jinguiyaolüe; Shanghanlun shen/⾎, jingshen/ ㋮⾎, 112-14, 121, 141, 143, 167, 181, 237 See person shen/䓛, shenti/䓛փ, 22, 97, 113, 144, 167, 169, 250, 268, 395 See person-body shengli//⭏⨶, 2, 11, 61, 75-76, 78, 102, 200, 224, 252, 254-55, 26465, 290, 294, 296-97, 299, 308, 312, 315-17, 330, 349, 361, 365, 370, 372, 374 See physiology shengli and bingli/⭏⨶⯵⨶, 61, 76, 294, 296, 316-17 shengli-bingli-yili/⭏⨶⯵⨶५⨶, 11, 76, 78, 200, 224, 255, 264-65, 285, 299, 308, 312, 315, 317, 349, 361, 365, 370, 372, 374 See PIT-ism (Wholism); Yidaoyi Shennong/ Classic of Materia Medica, 346, 389, 407, 431-32 shezhen/㠼䇺, 71, 249-50 Shiji/ljਢ䇠NJ, 122, 130, 134, 378, 389, 391, 395, 430-31, 433, 43738, 440, 443 See Sima Qian shiyang/伏ޫ, 114, 268 See diet/nutrition Shuowen jiezi/lj䈤᮷䀓ᆇNJ, 94, 233, 382, 387 signs, 117-19, 121, 144-45, 149, 153, 156, 198, 230-31, 248, 274, 313, 216, 346, 363-65, 434 See symptoms signs and symptoms, 40, 52, 106, 110, 117-19, 137-38, 144-45, 152, 156, 158, 192, 195, 200, 231, 234, 238-39, 248, 250, 261, 282, 298, 302, 306, 311, 316, 399, 441 Sima Guang/ਨ傜‫ݹ‬, 147, 377 Sima Qian/ਨ傜䗱, 121-23, 130, 314, 378, 389, 395, 430-31, 43337, 440, 442

Classical Chinese Medicine Sivin, 228 sixiang ഋ䊑, 101 sizhen/ഋ䇺/Four Diagnostic Techniques, 11, 71, 73-74, 118, 140, 143, 198, 234, 240, 248-50, 266, 305, 311, 436 asking/䰞, 11, 45, 118, 140-41, 143-44, 178, 198, 234, 241, 434 feeling the mai/࠷㜹, 11, 17, 42, 45, 86, 119, 140-41, 143, 153, 157, 198, 234, 241, 247, 249, 266, 399, 434, 436 listening and smelling/䰫, 11, 45, 140, 234 looking/ᵋ, 11, 86, 140-44, 147, 150, 248 looking at the complexion/ᵋ㢢/㢢 䇺, 99, 123, 141,145,153, 15657, 239, 252, 293, 303, 420, 426 looking at the tongue/㠼䇺, 24950, 263 fur of the tongue /㠼㤄 (shetai), 249-50, 263 Small Intestines, 20, 76, 81-82, 85, 89, 95, 128, 246, 291, 335, 338 Snow, 309 See Epidemiology Song dynasty, 147, 257, 264, 278, 301, 377, 396-97, 403, 405-07 soya bean curd (as medicine), 271 space, 89, 111, 113, 114, 118, 134, 292, 325, 339, 351, 370, 417, 422, 431, 433, 438, 503, 510, 557 Space, 79, 154, 200, 284, 292, 336, 337, 392, 393, 394, 397 Spacetime, 131, 251, 289, 340 See Timespace specific dao, 148, 337, 339, 420, 443 specific dao of medicine, 339, 443 Spleen organ-system, 7, 20, 52, 62, 70-01, 76, 81, 83, 85-87, 89-95, 108, 118, 128, 135, 149, 175, 180, 182, 246, 254-56, 262, 267-69, 272-74, 280, 289-90, 300, 303, 327-28, 333, 335, 338

495

spontaneous remission, 46, 206 statistical relevance, 217, 220, 223 See clinical relevance Strawson, 167 structure/anatomy, 83, 151, 157, 287-88, 290, 293, 316, 353 See Bm subjective, 9, 16, 28, 46, 117-19, 162, 169, 187, 208, 215, 230, 27677, 364, 371 See objective Sun Liqun/ᆉ・㗔, 437 Sun Simiao/ᆉᙍ䚸,402, 408-09 surgery (Engineering Technology) , 3, 81, 95, 104, 154, 156, 287-88, 290, 292, 294, 296 symptoms, 6, 26, 40, 52, 106, 110, 117-19, 137-38, 144-45, 152, 15658, 177, 181, 189, 192-93, 195-96, 198, 200, 205, 226-27, 230-31, 234, 238-39, 242, 248, 250, 261, 267, 275, 278, 282, 298, 302, 306, 311, 313-16, 353, 360, 365, 399, 434, 441 synergistic/synergism, 4, 81, 203, 220, 257 systemic causation, 81, 163, 359 systems theory, 132 T Tai gua/⌠খ 127, 327 See Pi gua taiguo/ཚ䗷, 89, 177 See buzu; Wuxing Taiji, 101, 339 See trigram; Liangyitaijitu; Wuji Taijichuan/ཚᶱᤣ, 115 See yangshen Tang Imperial Examinations in Medicine/५ᇈ㘳䈅, 404 See Unschuld; Zhang Zhongjing Tao Hongjing/䲦ᕈᲟ, 401 See Unschuld; Zhang Zhongjing TCM/TCM-Zhongyi, 7, 12, 40, 57, 60, 77, 142, 195, 199, 204, 258, 260, 275, 315, 341, 343, 349-50,

496 352-55, 358, 362, 366-70, 373-75 See AM; IM; Lake thalidomide, 107, 211 Thelle, 213 theory-practice in CCM See PITism; zhèng thing-ontology, 2-3, 19, 41, 57. 153, 155, 157, 160, 162, 169, 172, 200, 220, 226-28, 238-39, 243, 251, 257, 267, 288-89, 293, 340, 351, 359, 361-62, 369, 371 See BM; process-ontology tian yuan di fang/ཙശൠᯩ, 131 See astronomy and geography; Timespace tiangan-dizhi/ཙᒢൠ᭟, 236, 333 See Timespace Timespace, 3, 11, 100, 131, 170, 251, 253, 289, 335-56, 340 See Spacetime tongbing-yizhi/਼⯵ᔲ⋫ and yibing-tongzhi /ᔲ⯵਼⋫, 193, 195, 199, 224, 299 See bian zhèng lun zhi; Hao treating chronic and acute illnesses in CCM, 275-82 See Karchmer Triangle of Causation Model, 110 See epidemiology trigram/ bagua (‫ޛ‬খ), 48, 95, 10001, 127, 132, 148, 168, 170, 321, 324, 338, 422 Triple Burners/ Sanjiao (й❖), 20, 76, 82, 128, 246, 256, 289-90, 316, 333, 335 See physiology Trojan Horse, 10, 204, 220, 224 See Personalized/Precision Medicine; RCT tuina /᧘᤯, 6, 17, 45, 385 Type II diabetes, 77, 203 U UNESCO, 374

Index unity and coherence of CCM, 11, 285, 295, 308, 312, 315-16 See PIT-ism Unschuld, 42, 120, 122-23, 126, 128-29, 139, 258, 300, 372, 37778, 396-97, 407-09, 410-29, 43844 See Fallacy of Misplaced Analysis; Zhang Zhongjing V visceral organ-systems (yin/yang) See individual organ-systems (Heart; Kidney; Liver; Lung; Spleen); organ-system Wholism; Wuzang-liufu W Wang Bing/⦻ߠ, 379, 384, 404 Wang Mang/⦻㧭, 20 Wang Mengying/⦻ᆏ㤡, 305-09, 311-12 Wang Shuhe/⦻਄઼, 398-400, 403, 405 Wang Zhongxuan/⦻Ԣᇓ, 139, 146, 395 Wanwu/ з⢙, 96, 134, 233, 236, 247, 292, 318-19, 339, 372 wei bing/ᵚ⯵, 144-45, 439 See bubing bing; Preventive Medicine wenbing/⑙⯵, 309, 315, 328, 345 WHO, 260, 312 wholism/whole, 14-15, 78, 80-81, 163, 286, 369 See Reductionism Wholism/Wholist, 14-15, 78, 80-81, 99, 344, 369, 373, 419 See nonReductionism Wholism/Wholist, 3-5, 8, 10-12 1419, 22, 45, 47, 57, 68-69, 76, 78, 80-82, 90, 94, 99-101, 111, 113, 115, 133, 143, 145, 151, 159, 16671, 173, 189-90, 225, 232, 237-40, 247, 251-52, 255, 257-58, 268, 280-85, 290, 292-93,296, 299, 308,

Classical Chinese Medicine 315, 317-20, 329, 335-36, 339, 347-48, 353, 359-60, 362, 364, 368-69, 371-72, 416, 420, 422 See Macro-Micro-cosmic Wholism; multifactiorial; non-linear; nonReductionism; person-body Wholism; shengli-bingli-yili Wholism (PIT-ism); Yidaoyi; Zhèng-Fang Wholism Wiseman and Feng, 128, 231, 248, 267 Wöhler and Justus van Liebig, 221 Wu Jingzi/੤ᮜể, 176 wucai/ӄ᡽; 132, 422 See Wuxing wufang/ӄᯩ, 131, 254 See Timespace; Wuxing Wuji/ᰐᶱ, 101 See (the) Dao; Taiji wuqing/ӄᛵ, 175, 177, 179 See Wuxing wuse/ӄ㢢, 143-44, 151, 153, 179, 388 See wufang; Wuxing wuwei/ӄણ, 143, 303, 388, 400 See wufang; Wuxing wuyin/ӄ丣, 143, 153, 388 See wufang; Wuxing Wuxing, 4, 7-8, 60-78, 84-92, 10001. 111, 113 115, 129-36, 143-44, 148, 155, 157, 175-77, 179-80, 195,198, 234, 250, 253-54, 262, 301, 306, 320-21, 327, 330-35, 341, 346, 349, 374, 378, 385, 388, 391, 400-01, 418, 421-22, 425 See Yinyang-Wuxing Anti-Wuxing Tendency (AWT), 60-61, 63-65, 67-68, 71, 74-75, 77-78, 262 Child purloining the qi of the Mother/ᆀⴇ⇽≄, 93 Deficient Mother adversely affecting the Child/⇽㲊㍟ᆀ, 93 Pro-Wuxing Tendency (PWT), 60, 65, 68, 77-78 Mutually Constraining/⴨‫ݻ‬, 8889, 91, 133, 135

497

Mutually Engendering/⴨⭏ , 88, 133 Mutually Insulting/⴨‫מ‬, 91-93 Mutually Over-constraining /⴨҈, 91-92, 94, 135 Wuzang-liufu/ӄ㜿‫ޝ‬㞁 (yin-yang visceral organs), 82-83, 90, 93, 95, 100, 102, 157, 174, 234, 245-46, 251, 268, 273, 289-90, 106 See organ-system Wholism X xi ti zhong yong (㾯փѝ⭘)/ zhong ti xi yong (ѝփ㾯⭘), 348-51, 362, 368-70 See AM; IM; Lake; TCM; Zhang Xichun xia gong/лᐕ, 87, 117, 136, 138-40, 144-48, 156-57, 264, 304, 307-08 See shang gong; Yidaoyi xiang/䊑, 61, 167, 250, 322, 330, 338 See ancient Chinese writing xiantian/ ‫ݸ‬ཙ, 97, 106-08, 116 See houtian xie/⌫ (draining technique), 250 See bu (supplementing technique) xieqi/䛚≄ (pathogenic qi), 144, 199, 250, 328, 434 See zhengqi/↓≄ xing/ᖒ, 19, 61, 112, 124, 144, 381, 383 xingershang (ᖒ㘼к)/xingerxia (ᖒ 㘼л) , 19, 42-43, 45, 55, 69, 102, 145, 148, 153, 157, 297, 317 Xu Dachun/ᗀབྷὯ, 407-08 Xu Shen/䇨᝾, 94, 233, 414 See Shuowen-jiezi xuemai/㹰㜹, 123, 247 Y yang deficiency, 108. 192, 197, 199, 240-41, 252-53, 283

498 yang deficiency, yin in excess/ yin deficiency, yang in excess, 192, 268 yin deficiency, 93, 108, 182, 199, 272 yangshen (ޫ䓛)/yang sheng (ޫ⭏), 80 , 97, 268 Yang Xiong/ᢜ䳴, 250 yaoyang/㦟ޫ, 114 Ye Tianshi/ਦཙ༛, 308 Yidaoyi/᱃䚃५, 4, 11-12, 318, 338, 372, 384 See CCM-zhongyi; Laozi; shang gong; Yijing Yijing/Zhouyi/Book of Changes, 4, 12, 62, 72, 126, 133, 148-49, 166, 292, 299, 318, 320, 338-40, 372, 384, 388, 422-23 yili/५⨶ See PIT-ism Yinyang School, 130 Yinyang Wholism, 82, 167, 319 See Contextual-dyadic Thinking; Dyadism Yinyang/Yao-gua implicit logic, 3, 47, 69, 95, 127, 132, 166, 168, 170, 321, 323, 327, 422 Yinyang-Wuxing, 7-8, 68, 72-73, 75, 77-78, 84, 90, 99-100, 11, 133-35, 157, 198, 234, 250, 374, 385, 401, 422 Yong, 373 Yu, 265 Yu/⿩, 415 Yu and Zheng, 49, 51, 87, 89, 270 Yu Jiayan/௫హ䀰, 266-67 Yu Yingao ։♋勼, 365 yuanqi/‫( ≄ݳ‬Primordial/ Original qi), 255, 303 Yumoto Kyushin/⊔ᵜ≲ⵏ, 387 yuzhou/ᆷᇉ, 83, 340 Z Zeng Yong/ᴮ䛅, 142 See Laozhongyi

Index Zhang Ji/ᕐᵪ 301, 397-98, 408 See Zhang Zhongjing Zhang Jiebin/ᕐӻᇮ, 180 Zhang Jingyue/ᕐᲟዣ, 42, 61, 180 Zhang Weibo, 19 Zhang Xichun/ᕐ䭑 㓟, 64-65, 26465, 273-74, 345-46, 348-49, 351, 368-69 See IM Zhang Yanhua, 169, 180 Zhang Zailin/ᕐ޽᷇, 166 Zhang Zhongjing/ᕐԢᲟ, 13, 46, 139-41, 144, 146, 148, 181, 19495, 197-98, 200, 225, 253-54, 264-65, 267, 273, 278, 283, 295301, 303, 316-17, 320, 345, 379, 387-88, 393-409, 433 See fangzi; PIT-ism; shengli-bingli-yili; Unschuld Zhao Kaimei/䎥ᔰ㖾, 407 Zhao Yang, 241 zhèng /䇱, 5, 10-11, 40, 73, 76, 78, 193,195, 198, 200, 224-226, 22850, 252-54, 256-57, 260-71, 274, 278-79, 281-83, 285, 290, 299, 301-02, 304-05, 307, 310, 312, 316, 327, 345, 361, 365, 372, 374, 399, 416, 436 Zhèng-Fang Wholism, 10, 225, 28283, 299, 317, 372, 416 zhèng and fang, 230-59 zhengjing/↓㓿, 20-22 zhengqi (↓≄)/proper qi, 199, 346 See xieqi zhi ben (⋫ᵜ)/ zhi biao (⋫㺘) /treating the symptoms, treating the root cause(s),157 zhongqi xiaxian/ѝ≄л䲧/the downward collapse of zhongqi, 254, 257 zhongqi/ѝ≄, 182, 254, 256, 321, 327-28, 339 zhongyi/ѝ५, 12, 57,77, 99, 142, 319, 341-45, 347-53, 355-56, 358-

Classical Chinese Medicine 74, 396 See CCM-zhongi (under CCM); TCM/TCM-zhongyi Zhou Enlai, 25 Zhu Danxi/ᵡѩⓚ, 180 Zhu Zongxiang/⾍ᙫ僗, 25, 28, 32, 45, 349-50 See Jingluo

499

Ziran, 18, 94, 339, 372 See Laozi Zou Yan/䛩㹽, 130-33, 135-36, 421 See Wuxing Zuozhuan/ ljᐖՐNJ, 131