It is not known exactly when the first charts were produced, although there is reason to believe they date back to the Han dynasty.(145) We do know that Sun Si-Miao (590-682 A.D.) in the Tang dynasty (618-906 A.D.) drew charts of the anterior, posterior and lateral views of the body, the same format in use today, and showed the Principal Meridians in five colors with the Extraordinary Meridians in a sixth color (Fig.76). Sun is also credited with the introduction of the system of proportional measurement, the “Chinese inch,” which allows for accurate localization in spite of individual differences in size and shape.(146) The pinnacle of this development was the casting of two life-size bronze manikins by Wang Wei-i (Fig.77) in 1027 A.D., in the Song dynasty (960-1279 A.D.). These models had holes at the locations of the acupuncture Points, and were constructed in such a way that they could be covered with a thin layer of wax and then filled with water (Fig.78). Students were required to pierce the wax in the correct places, so as to allow the water to flow out.(147) In my visits to acupuncture schools in both the Orient and Occident, I have never seen such a device in use, but it appeals to my esthetic sense, and I hope it will someday be resurrected. I should point out however, that an influential Japanese tradition teaches that the Points are living phenomena which can actually change location with varying states of health, and thus must be individually located by using refined palpatory skills in each separate patient.
Figure 75: CHAO YUAN-FANG (550—630 A.D.)
author of Zhu Bing Yuan Hou Zhong Lun (Chaos Etiology), the first comprehensive work on etiology and pathology in Chinese medicine.
Figure 76: SUN SI-MIAO (590-682 A.D.)
the most esteemed physician of the Tang dynasty, who contributed to nearly every branch of TOM including ethics, acupuncture, moxibustion, herbal medicine and demonology.
I have previously mentioned Sun Si-Miao in several contexts: ethics, self-treatment, charts and proportional measurement. In this I have only scratched the surface of his many contributions to Oriental medicine. Thus, it is curious that Sun was not at all favorable to acupuncture in his early years, but concentrated his attention on herbal medicine and nutrition. His cautious attitude towards acupuncture reflected the recognition that it could do as much harm as good, a dilemma that has colored physicians’ attitudes towards acupuncture down to the present day. In Sun’s case, his caution caused him to adopt a critically observant approach and from this foundation, when he finally endorsed acupuncture, he was able to introduce and systematize many new concepts including the categories of “Forbidden Points,” “Ah Shi” or “Ouch” Points, “Extraordinary Points,” and Points for preventative scarring moxibustion, in addition to his charts and system of proportional measurement.(148)
Figure 77: WANG WEI-I,
a Song dynasty acupuncturist who supervised the casting of two life-size bronze manikins under imperial patronage.
Not all of the prominent physicians of the Tang dynasty were convinced, however, that acupuncture could be practiced with safety and efficacy. In particular, Wang Tao (675-755 A.D.), the most prolific medical writer of his day,(149) dealt with herbal medicine and moxibustion but not acupuncture, feeling that the latter was likely to injure a patient instead of saving him(150) (Fig.79). Wang did, however, institute a new tradition in Oriental medicine, by stating the sources for all of the prescription formulae he collected, a fashion which has regrettably not been universally followed.(151)
The confusion over the correct path for Oriental medicine was only exacerbated by the behavior of the Tang emperor, Yi Zong, who was furious when his daughter died of a febrile illness in spite of the best medical care available. In his bitterness, Yi Zong ordered the beheading of twenty of the leading Chinese physicians.(152)
Although Oriental medicine was beset with many challenges during the Tang dynasty, one of its greatest achievements was the publication of the revised edition of the Nei Jing by Wang Bing-ci in 762. As I have mentioned, Wang (c. 710-804 A.D.) is thought to have added at least seven chapters of his own (Chapters 66-71 and 74) to replace those already lost by his time,(153) and it is the nature of his innovative replacements that I would like to consider next. His “new” chapters deal with what Porkert has called “phase energetics,” which literally translates from the Chinese as “five phases and six energies.”(154) Because traditional acupuncture is based on the notion of the controlled manipulation of energy, the systematization of phase energetics was an important advance.(155) The origin of the concept of phase energetics is controversial, some authorities tracing this idea back to the Han dynasty while others place it as late as the Tang.(156) In either case, it is clear that it is not until after the Tang that the commentatory literature began to discuss phase energetics, and to describe concretely how to give acupuncture treatment with respect to the hour, day, month and season. Particular applications of phase energetics in acupuncture include the Law of Midday/Midnight, the Four-Needle Technique, and treatment by the Stems and Branches, all of which depend on a knowledge of the 66 Command Points on the 12 Principal Meridians. (More information on these technical terms can be found in the Appendix, but they can safely be skipped over by the lay reader without loosing the thread of this story.) The point I would like to emphasize is that the “five phases and six energies” involve a thorough integration of the twin theoretical bases of Five Elements and Yin/Yang doctrines and is fully in keeping with the prior developments in traditional acupuncture.
Figure 78: THE BRONZE MANIKIN.
This copy is in the National Museum in Tokyo, where it may be seen by special arrangement.
Figure 79: WANG TAO (675-755 A.D.)
dissapproved of acupuncture as being too dangerous. He favored moxibustion and herbal medicine instead.
The interest in phase energetics developed side by side with a comprehensive re-evaluation of traditional metaphysical teachings in the Song dynasty, a movement known as Neo-Confucianism. This development was essentially an attempt to account for manifest reality on the basis of a more systematic description of the workings of the Dao. In Neo-Confucian terms, the Supreme Ultimate or Tai Ji is the state of unmanifest reality which (through the workings of the Dao) gives rise to all manifest phenomena through the interaction of primal substrate (Qi) and the principle (Li) which organizes it. The following Song philosophers were important in developing this theory: Zhou Dunyi (1071-1073), Zhang Zai (1020-1077), Cheng Hao (1032-1085), Cheng Yi (1033-1107) and Zhu Xi (1130-1200). The familiar symbol for the interaction of Yin and Yang, known as the Tai Ji image (Fig.80) is a product of this era, and has now become the universally recognized emblem of traditional Oriental thought.
During this same period, a Bureau for Re-editing Medical Books was established in 1057, which had the effect of consolidating an “orthodox” tradition. The earliest extant text on the history of Chinese medicine, Yishou was written somewhat thereafter by Zang Gao, in 1189, so much of what we know of the early history of Chinese medicine most likely has a Neo-Confucian bias. In any case, the introduction of phase energetics together with the other Neo-Confucian metaphysical speculations, seems to have sparked a renewed interest in theorization in Oriental medicine in general, which led to major developments in herbal medicine as well, especially starting in the Jin (1115-1234 A.D.) and Yuan (1260-1368 A.D.) dynasties. The other springboard for these new theories was the clarification of traditional etiology by Chen Yen in 1174 A.D., when he elaborated on the classification of etiological factors into the three categories of exogenous, endogenous and miscellaneous.(157) These developments led to the “Four Great Schools” of the Jin and Yuan dynasties, whose teachings became the most powerful orthodox tradition in China, becoming incorporated into TCM, but were not as universally accepted in Japan, which, after a preliminary trial of Jin-Yuan style medicine, subsequently harkened back to the Treatise on Cold-Induced Disorders for its style of Oriental herbal medicine and to the Nei Jing and especially the Nan Jing for its style of traditional acupuncture.
Figure 80: T
HE TAI JI IMAGE
univerally recognized as a symbol of Yin and Yang, first became popular in the Song Dynasty.
The “cooling” school of Liu Wan-su(158) (1120-1200 A.D.) was the first of the “Four Great Schools”(159) (Fig.81). Based on a discussion of phase energetics, Liu developed the idea that exogenous pathogens (the “six energies”) universally provoked heat and inflammation in the body. Therefore, he recommended treatment of all such conditions with cold and cool drugs, but he also recommended acupuncture and incantations as adjunctive treatment. His herbal teachings are widely known, whereas his thoughts about acupuncture are not, and although he wrote three books on the Su Wen his methods of acupuncture are said to have been maintained only by a few expatriates who continued his oral tradition on China’s offshore islands.(160)
Figure 81: LIU WAN-SU (1120-1200 A.D.),
founder of the “cooling” school of thought.
In contrast, Li Dong-yuan (1180-1251 A.D., also known variously as Li Gao or “the old gentleman of the Eastern wall”)(161) focused his attention on the endogenous and miscellaneous causes of disease, and concluded that these all act to disrupt the functioning of the Stomach and Spleen in their nutritional role of supporting the body’s “original energy”(162) (Fig.82). His publication of these ideas in 1249 A.D. lead to the “strengthening the Earth” school which recommended strengthening the Stomach and Spleen with tonics as the basic approach to all treatment.(163) Like Liu Wan-su, some of his work is much less well known (perhaps because it is outside the usual domain of TCM), and includes the use of psychosomatic treatments for dealing with cases of excessive joy, anger, sadness, grief, fear and apprehension.(164)
Zhang Cong-zheng(165) (1156 -1228 A.D.) was a military physician who disagreed with the theories of both Liu and Li, and instead proposed that all illnesses were basically due to excessive pathogenic factors in the climate or diet which needed to be expelled from the body (Fig.83). Thus, he developed the “purgative” school which favored diaphoretics, emetics and purgatives over tonics, and his style of acupuncture emphasized the use of the bleeding needle.(166)
Figure 82: LI DONG-YUAN (1180-1251 A.D.),
founder of the “strengthening the Earth” school of thought.
Finally, Zhu Zhen-heng (1281 -1358 A.D., also known as Master Danxi)(167) developed a fourth universal explanation for disease: that internal deficiency resulting from overindulgence was the root cause, and he taught that all illnesses must therefore be treated with tonics (Fig.84). He focussed on the difference between “princely” and “ministerial” types of fire,(168) and explained that excessive activity of the latter has the effect of weakening Yin. Based on this pathological model, in 1347 A.D. he published the doctrine that it was always Yin which became Deficient, while Yang tended to Excess, and his recommendations led to the “nourishing the Yin” school.(169) He also contributed to the development of the doctrine initiated by Zhang Yuan-su (c. 1186) that herbs work by “entering” different Meridians in the body,(170) thereby trying to re-establish a connection between acupuncture and herbal medicine, which had become weakened by the new herbalist theories of the Four Schools. Earlier authors had proposed conflicting schemes for which herbs entered which Meridians, but Zhu added the notion that because individual herbs can have several different flavors in combination, each one could enter several different Meridians, a resolution which has continued to this day to be the dominant interpretation. Zhu is also associated with another method or school called the “living noose” which referred to a type of “word therapy” wherein the practitioner embodied different emotions in an attempt to induce different affective reactions in patients(171)–a technique that today is allocated at least as much clinical practice time as is pulse diagnosis in the Leamington Acupuncture schools, while being virtually unknown in those of TCM or other traditions.
Figure 83: ZHANG CONG-ZHENG (1156-1228 A.D.)
founder of the “purgative” school of thought.
While these four schools were primarily concerned with herbal medicine, they have broader implications for all of Oriental medicine, which they have influenced. Each school took some aspect of etiology and tried to formulate a system of therapeutics appropriate to deal with the chosen causative factor. The danger of such approaches is that they necessarily ignore essential parts of Oriental medicine by seeing all illness from the viewpoint of a specific etiological category. The strength of Oriental medicine, on the other hand, has always rested on its holistic conceptualization and willingness to treat each individual without any preconceptions as to why they might be sick. We can see this same tendency towards ideological (and etiological) narrowing in the surviving contemporary styles of traditional acupuncture, all of which suffer to the degree that they exclude parts of the totality of TOM, including, but not limited to: the relative importance of Yin/Yang versus Five Element doctrines, endogenous (psychological) versus exogenous (somatic) etiological factors, and even the role of the Spirit and the possibility of demonic possession.
I am not the first author to comment on the fragmentation of Oriental medicine into opposing schools of herbalism and acupuncture. Cheng et. al.(172) noted this separation as occurring in the Yuan dynasty and attributed it to a conflict between theoreticians (the herbalists) on the one hand and practitioners (the acupuncturists) on the other. Needham takes the opposite view, that the establishment of phase energetics in acupuncture represented the unfortunate triumph of abstract theory over clinical practice.(173) Being neither a practitioner, nor even a proponent of traditional acupuncture, his value judgments in this regard should be taken weighed accordingly. It was, in fact, Dou Han-qing’s (1195-1280)(174) systematic application of phase energetics to acupuncture around 1241 A.D.(175) that allowed for the development of more reliable protocols for specific energetic interventions in acupuncture therapy. These included the use of the Command or Crossing Points of the Eight Extraordinary Meridians, which he was the first to describe.(176) His book, Zhenjing Zhinan was reprinted with several others including He Ruoya’s Ziwuliuzhu Zhenjing in a 1331 compendium by his son Dou Guifang (also known as Tu Shih-ching) that established the role of the five Shu Points (also known as Five Element or Antique Points) in phase energetic therapy. Dou Han-qing was also the originator of many of the poetic names for the more complex needle techniques such as, “Setting the Mountain on Fire” for simultaneous tonification and heating, and “Making Cool like a Clear Sky” for simultaneous dispersion and cooling. (177) Another development of phase energetics, the notion of open and closed times for acupuncture Points and Meridians, was due to the Yuan dynasty physician Hua Shou (1304-1386) who was also the first author to classify the Governing and Conception Vessels with the twelve Principal Meridians, to make up the fourteen Meridians that have their own Points.(178)
Figure 84: ZHU ZHEN-HENG (1281-1358 A.D.), foun
der of the “nourishing the Yin” school of thought.
Moving on to the Ming dynasty (1368-1644) Gao Wu,(179) adapting ideas proposed by Xu Feng (180) (Zhen Jiu Da Quan, 1439), published Zhen Jiu Ju Ying in 1529, introducing the concept of Tonification and Sedation Points as special cases of the 66 Command Points, thus allowing for more systematic and practical use of Five Element theory in acupuncture treatment.(181) He also systematized the needle techniques for tonification and dispersion by both twisting and rotating and by lifting and thrusting.(182) Li Yan, also known as Li Zhai-jian, further developed the rules for tonification and dispersion in Yi Xue Ru Men or The Basics of Medical Studies (1575) which specified the needle methods according to male-female, left-right, Yang-Yin and inhale-exhale. This work had a marked influence on the development of traditional acupuncture in the West as we will see in Chapter Five.(183) In 1624 A.D., Zhang Jie-bin(184) wrote the Classic of Categories which systematized the disparate information in the ancient classics, and also introduced the idea of differentiating the “six changes,” a primitive form of what later developed into the differentiation by the Eight Principles, wh
ich is the diagnostic rubric of TCM(185) (Fig.85). Zhang also introduced the original song of ten questions which embodies the standard form of interrogative investigation in TCM. Finally, he is also remembered as the founder of the school of Yang tonification.(186) Perhaps the height of acupunctural scholarship was reached by Yang Ji-zhou (1522-1620 A.D.)(Fig.86), whose Great Compendium of Acupuncture and Moxibustion, published in 1601 A.D., summarized all the prior discoveries and teachings.(187)
In the Footsteps of the Yellow Emperor Page 9