In the Footsteps of the Yellow Emperor

by Peter Eckman, MD

  Figure 64: GOLD NEEDLES.

  These needles from the Han dynasty show vastly improved workmanship compared to the Zhou dynasty bronze needles pictured in Figure 40.

  Another Han dynasty physician, Guo Yu (first century A.D.), a disciple of Fu Weng, the Old Gentleman of the Fu river, who wrote a treatise on acupuncture and also developed his own method of pulse diagnosis, had his biography included in the Annals of the Latter Han. There he gives the traditional point of view in the ongoing controversy about how exacting a practitioner must be in locating the acupuncture points for treatment:

  Figure 65: CHUNYU YI (216-155 B.C.)

  The “father of case histories” who used his clinical records to defend himself against an accusation of malpractice.

  “Even the slightest, hairline deviation, when inserting an acupuncture needle is an inexcusable professional blunder. The skillful practice of acupuncture depends upon perfect coordination of the mind and hands. It can be learned, but not described in words.”(100)

  Guo Yu’s point of view is noteworthy because the fervor of his beliefs carries an implicit expression of the reliance traditionalists place on virtue (de), which is lost when acupuncture is separated from its traditional roots.(101)

  The most astonishing physician of the Han dynasty was no doubt Hua Tuo (also known as Fu and Yuan Hua) (110-207 A.D.) who was memorialized in the Annals of the Latter Han, the History of the Three Kingdoms, and a popular novel, The Romance of the Three Kingdoms (Fig.66). While he contributed to practically every branch of medicine, his face and name are indelibly associated with acupuncture, appearing as the trademark of the first brand of acupuncture needles to be exported by China. In the practice of acupuncture he was noted for the use of only one or two points per treatment during which he would tell his patients what they should expect to feel; as soon as they reported these sensations the needles were withdrawn and the illnesses were subsequently cured. (102) The simplicity and power of his style of acupuncture set a standard aimed at by many subsequent practitioners, though largely ignored by others. In honor of his contributions to acupuncture, the series of Extraordinary acupuncture Points located one half inch lateral to the spine were named “Hua Tuo Jia Ji” Points,(103) and it is believed that he used these locations in preference to the more commonly used back Shu Points.(104) It is not as an acupuncturist, however, that Hua Tuo is most famous, but rather in his role as the “father of surgery.” He discovered a method of herbal anaesthesia and performed numerous operations on every part of the body including the viscera and brain. In fact, it was his recommendation of brain surgery to Emperor Cao Cao whose headaches he diagnosed as being due to a brain tumor, which cost this great physician his life. Unfortunately, Cao Cao suspected that the proposed operation was a clever attempt at assassination, and took his revenge by having Hua Tuo decapitated at the age of 97!(105) One of Hua Tuo’s more famous operations was his debridement of a poisoned-arrow wound in the arm of General Guan Yu, an immensely popular war hero who was subsequently deified. When Guan Yu was wounded in battle, Hua Tuo was called to operate and offered his anaesthetic potion. Guan Yu merely laughed and distracted himself with a game of “Go” while the surgery proceeded. This tableau has been a favorite subject of Oriental artists (Fig.67). Hua Tuo also originated several modalities of physical therapy including hydrotherapy and therapeutic exercises. The latter he developed into the game of the five animals patterned after the tiger, deer, bear, monkey and crane, which undoubtedly were originally correlated to the Five Elements but whose details have unfortunately been lost along with virtually all the rest of Hua Tuo’s discoveries, including his herbal anaesthetic and a vermifuge for insects in the stomach (Fig.68). A book called the Classic of the Central Viscera has been attributed to him, but most commentators believe it to be the work of an unknown Daoist who used Hua’s name for its prestige.(106)

  Figure 66: HUA TUO (110-207 A.D.)

  The “father of surgery” who operated using herbal anaesthesia, he was also a brilliant acupuncturist, using only one or two points per treatment.

  Having touched on Hua Tuo’s pharmaceutical contributions, it is appropriate to note that starting “in the Han dynasty, people became interested in herb medicine and lost their enthusiasm in acupuncture and moxibustion“(107). One can only speculate on what factors were responsible for this change. The Han dynasty was a peculiar one, split in the middle by Wang Mang’s usurpation of the throne, and philosophically it may similarly be broken into two parts: the former Han period (202 B.C.-9 A.D.) gave birth to the last of the great philosophical Daoist classics, the Huai-Nan Zi (c. 122 B.c.),(108) while the later Han period (25 A.D.-220 A.D.) saw the origin of religious Daoism based on two rebellious groups known as the “Way of Great Peace” or “Yellow-Turbans” on the one hand and the “Way of the Five Bushels of Rice” or followers of the Daoist “Pope” Zhang Dao-ling on the other(109) (Fig.69). As Daoism was the major philosophical and spiritual basis for traditional Oriental medicine, it is not unreasonable to suspect that as Daoism changed, so would Oriental medicine. Practitioners of the healing arts at this time were called “fang shi” or masters of prescriptions, and it is in this category that one finds Hua Tuo. De Woskin traces the lineage from wu shi (shamans) to fang shi to dao shi (Daoist adepts).(110)

  Figure 67: HUA TUO AND GUAN YU

  Hua Tuo is seen operating on General Guan, debriding down to the bone, while the latter blithely ignores him in favor of the challenge of a game of “Go.”

  Figure 68: TAO YIN.

  Various systems of therapeutic exercise have been incorporated into TOM throughout history. Hua Tuo developed the “game of the five animals” during the Han dynasty, and although his system has been lost, this chart illustrates another approach from the same era. It was recovered from the Han dynasty number three tomb at Mawangdui.

  One of the main differences between philosophical and religious Daoism was in their attitude toward death. The philosophical school taught a spiritual path towards the loss of consciousness of self, and thereby a transcendence of death, while the religious approach was to banish death itself by reaching physical immortality. The former tried “by mystic insight to transcend man’s limitations,” while the latter tried “by magic and protoscience, not to change man’s understanding of what life is, but to perpetuate and ameliorate precisely the life he knows.”(111) Physical means of accomplishing this were prominent from the start, as Zhang Dao-ling, the founder of religious Daoism, was himself an alchemist.(112) In fact, the earliest alchemical treatise, The Kinship of the Three by Wei Po Yang was written in 142 A.D., during Zhang’s lifetime.(113) Alchemy, as a method of achieving immortality, was based on the ingestion of natural substances including animal, vegetable and mineral products, which makes the alchemical tradition intimately connected with that of herbal medicine.

  Several primitive works on herbal medicine dating from the Han dynasty have been discovered in recent years. The Fifty-two Prescriptions from Ma wang dui and the wooden tablets from Wu Wei in Gansu province both provide empirical formulae for prescribing herbs without discussing their theoretical basis.(114)

  Traditionally, the origin of herbal medicine is attributed to the legendary Emperor Shen Nong, and while several ancient texts had mentioned individual herbs(115), the first book solely about herbs and their use which provided a theoretical underpinning was written by an unknown Han dynasty author who honorarily attributed it to Shen Nong. It was Shen Nong’s Materia Medica, a work which listed 365 herbs in three classes, with a theory of prescriptive formulation and 170 diseases susceptible to herbal treatment. The original text was lost during the Tang dynasty.(116)

  Figure 69: ZHANG DAO-LING.

  The originator of one sect of religious Daoism, Zhang was considered the Daoist Pope, and was famous for the use of charms and incantations to cure disease.

  Figure 70: DAO HONG-JING (452-536 A.D.),

  was a religious Daoist who salvaged and expanded the original herbal text kno
wn as Shen Nong’s Materia Medica.

  What we know of the original Material Medica is based on the work of a later Daoist alchemist, Dao Hong-jing (452-536 A.D.) who added 365 new herbs to the previous work and expanded the system of herbal classification (117) (Fig.70). The link I’ve proposed between herbalism and religious Daoism is supported by the inclusion of his work and other herbal texts in the Dao Zang, or Daoist Bible.(118) An earlier alchemist, Ge Hong (281-341 A.D.) whose works were also included in the Dao Zang under the pseudonym Bao Pu Zi,(119) explained the meaning of the three classes of herbs as being: Upper class: those which give immortality, middle class: those which prolong life and lower class: those which cure sickness (Fig.71). Ge Hong wrote prolifically, his works being even more extensive than those of the great historian Si Ma Qian. However he never undertook any alchemical experiments himself, due to the expense of the materials involved! (120) While this revelation brings into question the value of his teachings, it may have allowed him to live out a normal life-span, in contrast to some of the royal recipients of alchemical elixirs who died of heavy metal poisoning. (121)

  Figure 71: GE HONG (281-341 A.D.),

  was a prolific writer on Daoist alchemy, more commo nly known by his pseudonym Bao Pu Zi.

  This brief synopsis of the origin of herbal medicine serves to introduce the works of the most influential physician of the Han dynasty, and possibly in the entire history of Chinese medicine, Zhang Zhong-jing. (c. 150-210 A.D.)(122) (Fig.72). While Zhang occasionally used acupuncture as an adjunctive therapy, he was principally an herbalist, but more than that, he elaborated the systematics of the clinical practice of herbal medicine in a manner that is still followed to this day. His books Treatise on Cold-Induced Disorders and Essential Prescriptions of the Golden Chest(123) along with the Nei Jing and Nan Jing are considered the canons of Oriental medicine.(124) Originally, his two works were published as one, Treatise on Cold-Induced and Miscellaneous Diseases, but as with the Nei Jing, no copies of the original work have survived. Although Zhang was familiar with the Nei Jing and Nan Jing, his work is a radical departure from them. He presents a schema for classifying cold-induced diseases in six stages, which borrows its terminology, but little else, from the Nei Jing. It is based on classifying symptoms and signs according to Yin/Yang theory, and uses a rudimentary form of the Eight Principles which form the basis of Traditional Chinese Medicine, or TCM.(125) Zhang introduced the etiological classification of illnesses as being due to endogenous, exogenous or miscellaneous causes, which is the root of the contemporary traditional theory of etiology developed approximately 1,000 years later in the Song dynasty.(126) The common theme throughout all of Zhang’s work is the organization of his approach to illnesses around classifying them by the “differentiation of symptom-sign complexes,” which allowed his work to be presented in the form of a clinical manual, the first of its kind, and earning it the sobriquet, “Father of Prescriptions.”(127)

  Figure 72: ZHANG ZHONG-JING (c. 150-210 A.D.),

  author of the Shong Han Lun (Treatise on Cold-Induced Disorders) which was the first clinical guide to the practice of Chinese herbal medicine, and is still revered today as the “Father of Prescriptions.”

  From what I have said, it is clear that Zhang took traditional Oriental medicine off in a new direction, and that the split in traditional acupuncture between the schools emphasizing the Five Elements (primarily outside the Peoples’ Republic of China) and those emphasizing the Eight Principles (primarily within the PRC itself), which has become most pronounced in the twentieth century, cannot be reconciled without an understanding of the relationship of Zhang’s work to the earlier works of traditional medicine. Zhang himself claimed to have studied books on herbs and the pulse in addition to the Nei Jing and Nan Jing.(128) In the Han dynasty, there were several dozens of medical treatises extant which were later lost(129) and I have already mentioned the nascent alchemical literature, all of which could have influenced Zhang’s thinking. Many theories have been proposed to account for Zhang’s tradition, but I think we are on the safest ground by sticking to that mentioned by Huang Fu Mi in the preface to his own book of 282 A.D., because it is the oldest medical text that has come down to us in its original form. In it, Huang states that the Treatise on Cold-Induced Disorders was based on the Theory of Herbal Decoctions attributed to Yi Yin, the prime minister of the ancient Yin (Shang) dynasty.(130) This theory has been the consensus belief of the Japanese who have tried to practice Zhang’s herbology in its unadulterated form, and it links Zhang to an ancient branch of traditional Oriental medicine parallel to that of the Nei Jing.

  This interpretation still leaves us with two unreconciled approaches to Oriental medicine, however the Japanese scholarship includes evidence that Zhang’s work via Yi Yin was in turn ultimately based on the Yi Jing.(131) The implicit integration of Yin/Yang and 5 Element energetics, in the Yi Jing which was probably written shortly after the fall of the Shang dynasty, could thereby have served as the common source for later elaborations in both the Nei Jing and the Treatise on Cold-Induced Disorders (by way of the intermediary Theory of Herbal Decoctions). I have previously published a monograph which develops this hypothesis, showing that the six stages model of Zhang’s Treatise on Cold-Induced Disorders is implicit in the Fu Xi circular order of the trigrams (which also appears in the Nei Jing) and that the Five Element model, more emphasized in the acupuncture tradition, is implicit in the Wen Wang order of the trigrams.(132) I believe this to be a credible solution to the dilemma of two competing traditions which ultimately only emphasized different aspects of the coherent energetic theories embodied in the Yi Jing.

  The two prominent physicians of the subsequent Jin dynasty (265-420 A.D.) were each linked to Zhang Zhong-jing. Wang Shu-he salvaged Zhang’s original one volume text and divided it into the two that are now extant (Fig.73). He is much more famous, however, for his own book, the Classic of Pulses, written in 280 A.D., which was the first comprehensive work on the subject. On the one hand, it clarifies the correspondences of Meridians and viscera to the 12 radial pulse positions as they were presented in the Nan Jing, and on the other hand it systematizes the different pulse qualities and divides them into 24 types giving in addition their diagnostic significance. Wang was thus clearly an expert in both the Nei Jing and Treatise on Cold-Induced Disorders traditions, and made no mention of any fundamental discrepancy between them, thus reassuring us in the hypothesis of a unitary conception. The Classic of Pulses was widely disseminated throughout the world, and even influenced Arabic medicine, showing up as the 24 pulses in Avicenna’s Medical Dictionary in the eleventh century.(133)

  The other famous Jin physician, Huang Fu Mi has already been mentioned in regard to his contribution to the discussion of the origins of the Treatise on Cold-Induced Disorders (Fig.74). He is also much more famous for his own book, the Systematic Classic of Acupuncture and Moxibustion written in 282 A.D. This was the first book solely about acupuncture and moxibustion, and filled in many of the gaps in the earlier literature. It lists 349 acupuncture Points by Meridian and region, giving their names, locations, properties, indications and methods of treatment in terms of needle depth, duration of needling, and number of moxa cones to be applied.(134) In addition it introduces a new method, treating physiologically defined Points, the Xi or Accumulation Points,(135) for acute symptoms, something which had not been described in the Nei Jing or Nan Jing. This work became the basic text in the field not only in China but also in Japan and Korea,(136) and to reiterate, it is the oldest traditional medical text to have survived intact into the present. It is of interest to note that when Huang was about 40 years old which was near the beginning of his professional life, he suffered from a serious illness that has been variously reported as either a stroke(137) or a severe attack of rheumatism.(138) In any case, his subsequent career belies the frequently stated, but erroneous belief that an acupuncturist must be in excellent health in order to practice effectively. The opposite view is
also supported by the career of Sun Si-Miao, the most famous physician of the Tang dynasty, who was likewise in poor health, but who successfully treated himself(139) thereby violating yet another dogmatic proscription.(140) It is my own belief that actually, rather than subtracting from one’s powers, the experience of illness in the physician himself and his attempts to grapple with it, strengthens him in his bond with his patients. After all, Oriental medicine is not so much based on intellectual knowing as it is on experiential being.

  Figure 73: WANG SHU-HE (210-285 A.D.),

  author of the Mai Jing (Classic of Pulses), a work whose influence extended even into Arabic medicine.

  Figure 74: HUANG-FU MI (215—286 A.D.),

  author of Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion), the first book to provide a reasonably comprehensive presentation of the classical acupuncture Points.

  Returning to our history, we have covered developments through the Jin dynasty, i.e. 420 A.D. The next 700 years or so were mostly devoted to the elaboration of all the aspects of traditional Oriental medicine presented so far, particularly from the pedagogical point of view. Beginning with the Northern Wei dynasty, in 493 A.D. there was an Imperial Medical College under the Imperial Medical Service(141) devoted to the promulgation of Oriental medicine and divided into four departments which illustrates the components of traditional medicine at that time–inter nal and external medicine, acupuncture and moxibustion, massage, and demonology (i.e., shamanism).(142) About 495 A.D. the oldest extant book on external medicine appeared,(143) discussing surgery, trauma, skin diseases and antiseptic technique. Then in 610 A.D., in the Sui dynasty (581-618 A.D.) Chao’s Etiology(144) provided the first comprehensive exposition of etiology and pathology, presenting over 1700 articles on disease symptomatology and its treatment, primarily by acupuncture (Fig.75). Chao Yuan-fang, the Taiyi or physician to the Emperor was in a unique position to achieve such a compilation. However, the most important advance in the field of acupuncture at this time was the appearance of teaching tools not based on discursive methodology–i.e., the development of meridian charts and statues.