The naturalist philosophers were not alone in their desire for positions of influence as state advisors. The most famous Chinese philosopher of all time, Confucius, who was born in 552 B.C., spent his whole life looking for a feudal prince who would put into practice his teachings, which were based on a return to the ways of the ancient kings (Fig.58). Thus, the hallmark of Confucianism was its emphasis on tradition, and in this we can appreciate its potential importance in the development of “traditional” acupuncture. The Confucian school was known as the Ju Jia or school of Scholars, and Confucius himself is associated with the Five Classics, though whether he edited them or simply used them in his teaching is open to dispute. His focus was on human behavior, his stance was a moral one, and his ideal was the “jun zi” or superior man, one who embodied the moral virtues including li (ritual or decorum), ren (humanity), yi (righteousness or propriety), zhi (wisdom), xin (trustworthiness), cheng (loyalty), xiao (filial piety) and cheng (sincerity). (76)
Figure 57: ZHUANG ZI.
Second only to Lao Zi in his fame as a proponent of philosophical Daoism, Zhuang Zi is best known for his thought-provoking tales. His image fades into ambiguity in this wood carving, reminiscent of the Yin/Yang symbol itself, shown in Figure 80.
Figure 58: CONFUCIUS.
The most well-known of all Chinese philosophers, Confucius claimed he was only a transmitter of tradition, ways handed down from the ancient kings.
In summarizing the teachings of these three philosophical schools of the Warring States period, whose teachings were the principal ones to survive in traditional Chinese culture, we once again encounter the imagery of the Three Powers. The Daoists were concerned with the intangible Dao, a Heavenly concept of the ultimate guiding reality, while the Naturalists focused on its Earthly projection in the form of the concrete laws of Yin/Yang and the Five Elements. The Confucians, representative of the “middle way,” focused on the level of Man, and these three together evolved a complete and harmonious description of the universe which provided the intellectual basis for the development of traditional Oriental medicine and acupuncture. There were other philosophies that developed into schools of thought during the Warring States period, including the Legalists (Fa Jia), Logicians (Ming Jia), and Utilitarians (Mo Jia), but as these had much less of an impact on the development of medical thought, we will skip over them.
Returning to the Warring States period, it was during this time that the first book about acupuncture, the Nei Jing, was written. From this point on, the oral and written traditions of acupuncture became distinct entities. The doctors of higher status were referred to as Ju Yi(77) or scholar physicians, who gained their knowledge mostly from books, while the less prestigious doctors were called Shi Yi(78), or genealogical physicians, whose skills were transmitted from father to son, and who frequently practiced as itinerants, whence their nickname, Ling Yi or bell ringers.(79) This difference in status interestingly had no reliable correlation with the practitioner’s level of skill, as there were famous physicians from both traditions throughout history.(80) All traditional acupuncturists, however, accept the Nei Jing as the canon on which their practice is based, although there is still some dispute as to whether it was a product of the late Warring States period or the early Han dynasty. It is written in the form of a series of dialogs between the Yellow Emperor and his medical advisors, one of whom (Qi Bo) gives the following account of the origin of the traditional Oriental diagnostic principles (Fig.59):“Color and pulse are valued by Shang Di, and they were taught by the teachers of former times. In ancient times, a teacher by the name of Jiudai Ji was entrusted with the task of systematizing colors and pulses and researching into the secrets of the manifestations of Spirit; he then discovered the Five Elements ... the four seasons, the eight winds and the six directions which follow a regular pattern to which colors and pulses correspond ... To know the essential aspects of diagnosis, one should start with colors and pulses.”(81)
Now Shang Di or Lord on High, was the ancestral deity worshipped as I have indicated by the shaman-kings of the Shang dynasty–thus the principles of acupuncture and Oriental medical theory can be seen as having evolved from early shamanistic practices, as had the very character for physician, yi. When the Yellow Emperor stated that, “in ancient times diseases were cured by prayers alone . . . but nowadays physicians treat disease with herbs internally and with acupuncture externally”(82) he was most likely recounting the specific evolution of shamanistic practices over time.
Figure 59: QI Bo.
The most prominent advisor of the Yellow Emperor in the Nei Jing, Qi Bo is referred to as a Heavenly Master, having studied the medical treatment of patients from two generations prior to his own.
Considering therapeutics, the Nei Jing already emphasizes the medical skills including acupuncture and herbal prescription, which I am hypothesizing as having developed from the earlier shamanistic spiritual practices.(83) The Nei Jing does not, however, give equal attention to acupuncture and herbal medicine, but predominantly deals with the former. References to physicians in the Chinese literature prior to the Nei Jing (with the exception of Yu Fu) tended to mention acupuncture and herbal medicine together, as in the stories of Yi Yuan and Bian Que which follow, so the divergence of acupuncture and herbal medicine seems to be an accompaniment of the formation of a separate literary tradition which then followed its own line of development. Yu Fu, considered to be a contemporary of Qi Bo, is an interesting exception to the above rule, in that he is specifically mentioned as having used acupuncture and moxibustion but not herbal medicine. Some have concluded from this that he was the first true acupuncture specialist (Fig.60).
Yi Yuan is related to have gone to treat the Prince of Chin in 580 B.C., but found his disease to be incurable and said, “no needle can penetrate it, no drug can reach it.”(84) The Prince of Guo, sometime between the fourth and sixth century B.C., although lying deathlike in a coma, was more fortunate. His doctor, Bian Que, revived him with acupuncture, and then completed his cure with moxibustion and herb tea(85) (Fig.61). Bian Que figures in several other legendary tales related variously by Si Ma Qian, Han Feizi and Liezi. In the most astonishing one he is reported to have performed the first, and probably only, exchange transplant of the human heart between two patients who were each anesthetized for three days with a magical liquor.(86) Another tale relates how he prognosticated the development of a mortal illness in King Yuan of Cai while the latter was still totally asymptomatic, and how despite Bian Que’s warnings, the King refused to admit he was sick until it was too late for treatment, and he died as predicted. It is often said that Bian Que was the first to systematize the four methods of examination and he is also legendarily credited with authorship of the Nan Jing (Classic of Difficulties) but this assertion at least can be rejected because the Nan Jing is a much later work. Bian Que was unfortunately assassinated on orders from the medical bureaucracy,(87) the sad fate of many a visionary, but because of his unsurpassed technical skills combined with a whole-hearted dedication to the care of his patients, Bian Que has been revered by the Chinese as the “Father of Medicine” and his birthday, the 28th day of the fourth lunar month is celebrated as a national holiday.
Figure 60: A GALAXY OF NOTABLES IN CHINESE MEDICINE.
This painting, reproduced in Hume, is said to contain the following individuals, although their identities are not clearly indicated in several cases: Huang Di, Fu Xi, Shen Nong, Qi Bo, Yu Fu, Sun Si-miao, Bian Que, Ma Shi-huang, Zhang Zhong-jing, Hua Tuo, Zhang Dao-ling, Chunyu Yi, Ge Hong and Huang-fu Mi. Generally they are the major figures sequentially from left to right and from top to bottom although the individual to the right of Sun Si-miao is skipped. The only individual in this list not described elsewhere in this book is Ma Shi-huang who was a legendary veterinarian during the reign of Huang Di, famous for treating horses, and who once cured a sick dragon with acupuncture!
Moxibustion, the therapeutic technique of burning Artemisia tinder (moxa or ai) o
n or above the skin is also less intensively discussed than is acupuncture in the Nei Jing, but because the systematics of its use are so similar to those of acupuncture, this has caused much less in the way of doctrinal splits than has the parallel development of herbal medicine and acupuncture. Moxibustion is probably as ancient a practice as is acupuncture, and was mentioned by both Zhuang Zi(88) and Mencius(89) (Fig.62). Naturally, the archaeological record is less helpful here than in the case of acupuncture, but the discovery in 1973 of silk books from prior to the third century B.C. in the tombs near Ma wang dui village in Hunan Province included two treatises concerning moxibustion along Meridian pathways that are of a much more primitive stage of systematization than is found in the Nei Jing.
Figure 61: BIAN QUE (407-310 B.C.)
Revered by the Chinese as the “Father of Medicine,” he was proficient in the use of acupuncture, moxibustion and herbs.
This has led some scholars to suggest that moxibustion was developed prior to acupuncture, but I would like to propose a variation on this hypothesis: from what I have described so far, it is likely that acupuncture originated from the shamanistic tradition still extant to the east of China in present-day Korea. Moxibustion on the other hand, might have developed separately in China as part of the doctrine of systematic as opposed to magical correspondence, and these two traditions later met and were integrated into a coherent approach. Such an interpretation is supported by Lavier’s reconstruction of the origin of traditional Chinese medical thought mentioned earlier, which is based on the idea that the original conceptualizations of systematic correspondence, typified by the doctrine of the Five Elements were developed by a Protochinese agrarian civilization, and that the mysterious forces which more closely fit a paradigm of magical correspondence, were actually a later addition, introduced into Chinese medical thought by the waves of nomadic invaders from the shamanistic cultures around these Protochinese farmers. This hypothesis is also consistent with the traditional origin of the different therapeutic techniques of Oriental medicine which was given in the Nei Jing according to the following five part correlative scheme: stone needle acupuncture in the East to treat ulcers and abscesses, herbal medicine in the West to treat internal diseases, moxibustion in the North to treat diseases due to cold, fine needle acupuncture in the south to treat rheumatic diseases and massage, breathing and physical exercises in the Center to treat paralytic diseases.(90)
Figure 62: MOXIBUSTION.
This painting by Li Tang of the Song dynasty depicts a village doctor applying moxa. The painful technique of direct scarring moxibustion is now generally replaced by gentler non-scarring techniques.
In addition to presenting historical material on diagnostics and therapeutics, the Nei Jing contains voluminous theoretical and practical information on all the different aspects of traditional Oriental medicine, tying them together into a seamless whole in such a thorough and elevated manner that it is still treated as the “Bible.” We don’t know who actually compiled the Nei Jing, but undoubtedly, it was a group effort with numerous revisions. It consists of two parts, Su Wen (Simple Questions) and Ling Shu (Spiritual Pivot) of 81 chapters each. Su Wen is primarily about fundamental theory, while Ling Shu is primarily about the practice of acupuncture and was originally called Zhen Jing (Acupuncture Classic) prior to the seventh century A.D. The standard edition in use today dates to 762 A.D., when it was compiled by Wang Bing-ci, who is believed to have added at least seven chapters of his own to replace those already lost by his time.(91)
Closely connected to the Nei Jing in both time and spirit is the Nan Jing(92) or Classic of Difficulties, probably written in the first century A.D.(93) and again of unknown authorship, although as mentioned, it has spuriously been attributed to Bian Que. It derives its name from the fact that it is composed of a series of 81 (!) questions and answers about unresolved issues in the Nei Jing. One of the cardinal issues that it tackles is that of the proper assignment of positions on the radial artery for the pulses of the twelve main Organs and Meridians, which assignment is used in performing “pulse diagnosis,” the most important diagnostic method in traditional acupuncture. From the pulse, the acupuncturist gleans information about the functioning of all the components of the human organism, and from sequential readings, can tell if the patient’s health is improving or not in response to treatment. The version of the pulse positions given in the Nan Jing is not the only one considered to be correct by traditional acupuncturists, but it was the one which spread to other countries early on, and thus forms the basis for the styles of acupuncture taught and practiced most widely in Japan, Korea and the West.(94) The major alternative set of assignments which were proposed over one thousand years later, in the Ming dynasty (1368-1644) are by contrast the ones which became the predominant traditional teaching in China and this divergence of traditions has been a source of confusion that has continued into the present(95) (Fig.63).
In discussing these early Classics, we’ve crossed from the Warring states Period (480-220 B.C.) of the Zhou dynasty to the Han dynasty (202 B.C.-220 A.D.) without mentioning the intervening, though brief Qin dynasty (221 B.C.-207 B.C.) which was a time of massive change in China. It was the only time the proponents of the Legalist school (Fa Jia), the least humane of the different philosophies, had the dominant voice in government. In their struggle to overturn the traditional beliefs of their adversaries, they ordered the burning of all books except those having to do with divination, agriculture and medicine. Thus, the development of acupuncture was fortunately less affected than most other aspects of Chinese life by the “fires of Qin.” The other event for which the Qin dynasty is both famous and infamous was the building of the Great Wall, an undertaking completed at enormous human expense. The Chinese themselves have always viewed the Qin dynasty with extreme distaste,(96) so without further ado let us return to the ensuing Han dynasty.
Figure 63: PULSE POSITIONS
(A) shows the Han dynasty assignments common to the Nan Jing (c. 100-200) and Mai Jing (280). The pulse in the deep position at the proximal location on the right wrist was redesignated as the Pericardium at least as early as the Yuan dynasty, and is taught as such by the inheritors of this tradition (i.e. the Five Element schools including LA) today. This distinction is of minor practical consequence since the meridian pathway for both Life Gate and Pericardium has been identical, the Hand Jue Yin Meridian, since the Nan Jing. (B) shows the Ming dynasty assignments from Zhang Jie-bing’s Complete Book (1624) which are the basis for the teachings about the pulse incorporated in TCM at present. It is based on morphologic considerations (material) rather than the Five Element (energetic) considerations found in A. This figure is based on material in Kaptchuk-1 (p. 300), Mann-1 (p. 133) and Birch (p. 4).
Aside from the bronze needles recently discovered in Inner Mongolia, the earliest metal acupuncture needles excavated by archeologists of which I am aware were found in the tomb of Liu Sheng who was the elder brother of Han dynasty Emperor Wu dating to 113 B.C. Four gold and five silver needles were recovered from the tomb in Hebei province in 1968, and the better preserved gold ones are shown in Figure 64.
There were several famous doctors in the Han dynasty who left their stamp on traditional acupuncture. Chunyu Yi(97) (born in 216 B.C.) had his biography included in the Historical Records primarily because of his meticulous defense in 154 B.C. against an accusation of malpractice, which defense was preserved in court records and then relayed to us by Si Ma Qian (Fig.65). In it, Chunyu Yi related 25 clinical case histories from his practice, based on detailed records that he kept of each of the patients he treated. These records enabled him to estimate his percentage of successes and failures, and thus find a guide to more accurate treatment. For this he became known as the “father of case histories.”(98) However, it was his description of the advice he received from his teacher, Yang Qing, to throw away his “recipe books” (fang shu) and follow instead the Pulse Treatise of Huang Di and Bian Que that makes his story most relevant
for present day practitioners who are still divided over the issue of “formula” versus “energetic” treatment. Yang Qing had tutored Chunyu Yi for three years in the techniques of pulse palpation and diagnosis by the five colors, the presumptive content of the lost text he cited, thus connecting him back to the energetic tradition started by Jiudai Ji.(99) Chunyu Yi was renowned for his prognostic abilities, due no doubt to these techniques.
In the Footsteps of the Yellow Emperor Page 7