CLASSICAL CHINESE CONCEPTS OF ANATOMY

11 May

One aspect of Chinese medicine that is likely to seem especially strange to the modern reader is the classical approach to human anatomy.  However, if classical Chinese anatomy  is properly  thought  of in terms of function rather   than   structure,   distinctions   between  anatomy   and   physiology become irrelevant.  Anatomy,  in the Western sense, did not form the basis of classical Chinese medical theory or practice. Western anatomists study the body as if dealing with an assemblage of bits and pieces belonging to a machine.  In  contrast, classical Chinese  anatomy  is concerned  with  the dynamic  interplay   of  functional   systems  rather   than   specific  organs. Within classical Chinese medical concepts, the term ‘‘liver’’ does not mean the  material  substance  used  to  create  paˆ te´,  but  the  functional   sphere within the body that  corresponds  to wood, spring, morning,  quickening, and  germination. Because of its emphasis  on function rather  than  struc- ture,  Chinese  anatomy   can  incorporate organs  that  have  no  physical substrate,  such  as  the  remarkable  triple-warmer. Rather   like  id,  ego, and  superego  in  psychology,  the  triple-warmer   has  functions,   but  no specific location.

Other intriguing entities that have no direct counterpart in Western anatomy   and  physiology  have  been  called  the  ‘‘life gate’’  and  the ‘‘potential fire.’’ Some scholars believe that classical Chinese theories about the  ‘‘life gate’’ and the ‘‘potential fire’’ might be related to modern endo- crinology. Joseph Needham  called such classical theories ‘‘physiological alchemy.’’ Classic Chinese medical texts refer to the ‘‘life gate’’ as the repository  of the primary  life energy (ch’i or qi), which originated  from the kidneys.  In the male, this repository  stores the essence and  in the female it sustains the uterus. The theory of ‘‘potential fire’’ was ascribed to a physician who lived during  the Yu¨ an Dynasty  (1271–1368), which indicates  that  new entities  and  forces continued  to  appear  in Chinese medical thought. The ‘‘potential fire’’, which originated  in the abdomen, was controlled  by body  fluids, like the blood.  Another  form  of ‘‘fire’’ was  associated  with  the  heart  and  was  related  to  mental  activities. Normally,  these two  kinds  of ‘‘fires’’ kept  each other  in balance,  but an  excess of  ‘‘potential  fire’’ could  lead  to  loss  of  control  over  the emotions.  Followers  of this school of thought tried to maintain  health by focusing  on  physical  and  spiritual  harmony,  and  the management of  food  and  environment.  They  also  claimed  that   they  could  cure diseases that  could not be healed by ordinary  means.

the  triple-warmer  was analogous   to  officials  who  were charged  with planning  the construction of ditches and sluices. For  the body to work properly,  the organs,  like the officials of the state, must dutifully assist one another.  Thus, when the system functioned  harmoniously, the heart acted with insight and understanding like the king’s minister, while the liver acted like the military leader responsible  for strategic  planning.

The  system  of  fivefold  correspondences  could  have  created  an embarrassing discrepancy between medical philosophy  and medical practice, because acupuncture and moxibustion  techniques  had become standardized around a system of six pairs  of conduits  or acupuncture tracts.  The problem  was resolved by adding  the pericardium  or heart- enclosing network  and the triple-warmer  to the list of firm and hollow organs,  respectively.

Despite  considerable  debate  about  various  details,  there  is little argument  about  the fact that Chinese scholars accepted the relationship between the heart and the circulation of the blood long before these con- cepts were incorporated into Western science and medicine by William Harvey  (1578–1657) in the  seventeenth  century.  Westerners  generally coped with the challenge to Harveian  originality  by dismissing Chinese concepts  of the circulation  as obscure  mysticism ‘‘improved’’ by loose translations. Philosophical arguments,  rather  than  dissection,  presum- ably led Chinese physicians to the concept  of the ceaseless circulation of some vital substance—which  might be translated as blood, or breath, or energy—within  the body’s network  of channels.

Although   the  Nei  Ching  assumes  that  the  movement  of  blood is controlled  by the heart  and  the movement  of energy by the lungs, scholars  disagree as to the meaning  and  the implications  of the terms that are variously translated as blood, breath,  or energy. Chinese physi- cians believed that  because blood  was a vital substance  that  nourished the  body,  the  loss of blood  was debilitating.  In  contrast  to  Western doctors,  Chinese physicians rejected the practice of bloodletting, which was an important therapeutic component of Western medicine up to the twentieth  century.

According  to  Chinese  medical  philosophy,  disease  was basically caused  by  an  imbalance  of  yin  and  yang,  resulting  in  a  disorder  of one of the five phases, expressed as a dysfunction  of the corresponding organ  and  the  organs  controlled  by the  injured  organ.  Therefore,  all therapies  were directed  toward  restoration of a state  of harmony. In accordance   with  the  fivefold  system,  the  Nei  Ching  described   five methods  of treatment: curing the spirit by living in harmony  with the universe,  dietary  management, acupuncture, drugs,  and  treatment of the bowels and viscera, blood, and breath. In prescribing any preventive or  therapeutic regimen,  the  physician  had  to  carefully  consider  the influence of geography,  climate, and local customs.

In  the  Inner  Canon,  the  yin and  yang,  and  the  five phases,  are closely related to the five ‘‘firm organs’’ (heart, spleen, lungs, liver, kid- neys) and  the  five ‘‘hollow organs’’  (gall bladder,  bladder,  stomach, large intestines, small intestines). Residing deep within the body, the five firm  organs,  or  viscera,  are  classified as  yin and  function  as  storage facilities, reservoirs,  or depots.  Located  relatively close to the exterior of the body,  the five hollow organs,  or bowels, are classified as yang, and  assumed   the  functions   of  elimination.   Interactions  among   the various  organs  were made  possible by linking them  through  a system of conduits  rather  like irrigation  channels.

Because  of  the  vital  importance of  irrigation   to  agriculture   in China,  the functions  of the conduits  in the body were often compared to  the  hydraulic  works  maintained by the  government.  For  example, the  triple-warmer  was analogous   to  officials  who  were charged  with planning  the construction of ditches and sluices. For  the body to work properly,  the organs,  like the officials of the state, must dutifully assist one another.  Thus, when the system functioned  harmoniously, the heart acted with insight and understanding like the king’s minister, while the liver acted like the military leader responsible  for strategic  planning.

The  system  of  fivefold  correspondences  could  have  created  an embarrassing discrepancy between medical philosophy  and medical practice, because acupuncture and moxibustion  techniques  had become standardized around a system of six pairs  of conduits  or acupuncture tracts.  The problem  was resolved by adding  the pericardium  or heart- enclosing network  and the triple-warmer  to the list of firm and hollow organs,  respectively.

Despite  considerable  debate  about  various  details,  there  is little argument  about  the fact that Chinese scholars accepted the relationship between the heart and the circulation of the blood long before these con- cepts were incorporated into Western science and medicine by William Harvey  (1578–1657) in the  seventeenth  century.  Westerners  generally coped with the challenge to Harveian  originality  by dismissing Chinese concepts  of the circulation  as obscure  mysticism ‘‘improved’’ by loose translations. Philosophical arguments,  rather  than  dissection,  presum- ably led Chinese physicians to the concept  of the ceaseless circulation of some vital substance—which  might be translated as blood, or breath, or energy—within  the body’s network  of channels.

Although   the  Nei  Ching  assumes  that  the  movement  of  blood is controlled  by the heart  and  the movement  of energy by the lungs, scholars  disagree as to the meaning  and  the implications  of the terms that are variously translated as blood, breath,  or energy. Chinese physi- cians believed that  because blood  was a vital substance  that  nourished the  body,  the  loss of blood  was debilitating.  In  contrast  to  Western doctors,  Chinese physicians rejected the practice of bloodletting, which was an important therapeutic component of Western medicine up to the twentieth  century.

According  to  Chinese  medical  philosophy,  disease  was basically caused  by  an  imbalance  of  yin  and  yang,  resulting  in  a  disorder  of one of the five phases, expressed as a dysfunction  of the corresponding organ  and  the  organs  controlled  by the  injured  organ.  Therefore,  all therapies  were directed  toward  restoration of a state  of harmony. In accordance   with  the  fivefold  system,  the  Nei  Ching  described   five methods  of treatment: curing the spirit by living in harmony  with the universe,  dietary  management, acupuncture, drugs,  and  treatment of the bowels and viscera, blood, and breath. In prescribing any preventive or  therapeutic regimen,  the  physician  had  to  carefully  consider  the influence of geography,  climate, and local customs.

With a sense of sorrow and disappointment, the Yellow Emperor and his Minister  recalled that,  in a previous golden age, human  beings practiced  temperance  and  lived in harmony  with  nature  for  over one hundred  vigorous  years. Later,  people disregarded  the ways of nature and  became  feeble,  short-lived,   and  subject  to  many  diseases.  For example, the people of the East ate fish and craved salt; this diet injured the blood and caused ulcers. Winds, or ‘‘noxious airs,’’ caused much ill- ness because  they penetrated the body,  disturbed  the harmony  of yin and  yang, and  diminished  vital energy. Generally,  winds caused chills and fevers, but specific winds associated with the changing seasons were linked to particular dangers.  Disturbances of the harmonious relation- ship between mind and body could also cause illness.

For   diagnosis  and  prognosis,   the  Chinese  physician  relied  on sphygmology,  a very complicated  examination  of the pulse. Because of the intimate  connection  between the tracts  and  vessels through  which yang and yin flowed, the study of yin in the blood could reveal problems of yang in the tracts. Thus, by listening to the waves of blood generated by the heartbeat, the physician could detect disease in various  parts  of the body.  The physician  was expected  to  study  fifty pulses, recognize more  than  two  hundred   variations,   and  know  those  that   indicated the imminence of death.  Pulses could be weak, strong,  rough,  smooth, sharp  as a hook,  fine as a hair,  dead as a rock, deep as a well, or soft as a feather.  The volume, strength,  weakness, regularity,  or irregularity of the pulse revealed the nature  of the disease, whether  it was chronic or  acute,   its  cause  and  duration,  and   the  prospects   for  death   or recovery.

Sphygmology  revealed incipient illness and  allowed the physician to prescribe preventive measures or manage the course of therapy. Other kinds  of diagnostic  clues might  be necessary,  especially when dealing with children.  Through  close inspection,  the physician could find diag- nostic clues in the sounds made by the patient  when talking,  moaning, laughing, or weeping, and in the colors of various parts of the body. For example,  inspection  of the tongue  could  reveal 30 different  shades  of color that provided evidence of disease or the possibility of death. Physi- cians  also  had  to  recognize  various  types  of  difficult  and  skeptical patients,  such as those who were arrogant, miserly, or addicted to over- eating and dissipations,  and those who had more faith in magicians and quacks than  physicians.

Random Posts

Comments are closed.