[This is a draft of a paper that I am in the midst of writing]
Medicine in the Zhou Dynasty is particularly interesting in the history of Chinese medicine as it was the period where the first attempts were made to describe the phenomena of illness and disease in naturalistic terms, primarily, in terms of the flow of qi (氣 vapour). At its infancy, Zhou medical theory was still simple and was not complicated by the incorporation of Yin-Yang and Five Phases Theory – concepts that we strongly associate with Chinese medicine today. During the Shang Dynasty (just before the Zhou Dynasty), the phenomenon of illnesses and diseases was understood in terms of punishments met out by ancestral spirits (or evil spirits) who were offended or upset by the inflicted person. Diagnosis, therefore, consisted of determining which ancestor (or evil spirit) had been offended, and the reason for the offence. Similarly, treatment was done and understood in terms of appeasing the offended ancestral spirit or exorcising an evil spirit.
Nonetheless, the medical worldview in the Zhou dynasty was still in its primitive form and had not developed into the familiar complex medical theories that we find in the Huangdi Neijing Suwen. [The Huangdi Neijing Suwen is a medical text compiled during the early part of the Han dynasty. Some scholars have claimed that parts of the text were written during the late Zhou period. This may be true, but it does not change the fact that much of the Zhou dynasty’s worldview of medicine was still in its primitive form.] Moreover, the medical worldview during the Zhou was still very much influenced by the medical worldview of the Shang. Much of the Zhou’s medical ideas and practice, therefore, involved magico-religious elements, including the use of spells, incantations, and magical/tantric arts for treatment: a far cry from the traditional Chinese medical treatments found from the Han period till our contemporary times.
In this post, I will reconstruct the philosophical concept of harmony underlying the Zhou Dynasty medical worldview. To do this, I will first outline the historical understanding of how medical harmony is achieved, based primarily on the Neiye (The Inner Traning), but supported by content from excavated medical texts from the Mawangdui tomb and minor medical prescriptions by Mozi. I have intentionally refrained from making references to the Huangdi Neijing Suwen as I wish to avoid imposing later Han (and post-Han) Dynasty categories and ideas on what is essentially a Zhou medical worldview.
Before I begin, I would like to draw a distinction between the state of harmony, and the process of harmonising. Often, harmony is understood more as a state that one arrives at. However, due to the unique nature of classical Chinese where the same word can be used both as a noun or as a verb, harmony as it appears in the form of 和 he in classical texts, is used both as a state (noun) as well as a process (verb).
The Neiye defines medical harmony as the harmony between qi (氣 vital essence) and xing (形 body/bodily form) (Neiye21). When a state of harmony is achieved, such a person will have vitality (生 sheng, or life). But how is this harmony achieved? The Neiye tells us that if we try to “examine the Way of harmonising” qi and xing, the “essentials are not visible, its signs are not numerous.” (Neiye 21)
Why are there no clear indicators for harmony? I argue that harmony, as a state, is a moving target that varies from individual to individual. It is not an independent, objective state that can be clearly defined. To further complicate matters, it is not easy to pick out clear signs as the process itself involves an interaction between qi and xing, both of which mutually interact and mutually affect each other.
The medical texts excavated from the Mawangdui tomb tells us that bodily health is dependent upon the flow and direction of qi. Qi “should flow in a downward direction,” and it is most beneficial to the lower part of the body. Since qi“follows warmth and departs from coolness,” the sage, as a “model of good hygiene,” thus keeps his head cold and his feet warm to ensure that qi flows in the right direction. However, this also means that the rate qi flow and its direction/movement is sensitive to changes in the weather and the seasons. If one is not cautious, one may fall ill as a result of the irregular flow of qi within the body, either in the form of a surplus flow or a deficient flow of qi, or qi flowing in the wrong direction.
To help regulate the influence of the external environment on the body, just as how the sage makes the effort to keep his head cold and his feet warm, philosophers such as Mozi, have prescribed having adequate shelter and wearing seasonal-appropriate clothes to alter the effects of the external environment to be in harmony with the body. [Mozi Chapter 1] But should such preventive methods fail, medical treatment acts so as to regulate the flow and direction of qi within to body, by redistributing qi using “therapies designed to remove surplus and correct insufficiency.” (Harper, 1998)
The body too has the ability to control the flow of qi within it. What we do with our bodies – in eating, acting, and even with our mental states – will have an effect on qi and its flow within the body. “Over-filling yourself with food will impair your vital energy and cause your body to deteriorate,” while “over-restricting your consumption causes the bones to wither and the blood to congeal.” (Neiye 23)
Fortunately, one can do something with one’s body (both the physical body and the heart-mind) to correct this imbalance:
“When full, move quickly; when hungry, neglect your thoughts; when old, forget worry. If when full you don’t move quickly, vital energy will not circulate to your limbs. If when hungry you don’t neglect your thoughts of food, when you finally eat you will not stop. If when old you don’t forget your worries, the fount of your vital energy will rapidly drain out.” (Neiye 23)
The Neiye places a great emphasis on the role of the xin (heart-mind) in regulating qi in the body. The xin (心 heart-mind),when disturbed or disrupted by strong emotions or desires, such as “sorrow, happiness, joy, anger, desire, and profit-seeking” (Neiye 3), can ruin the delicate harmony between the body and qi. It is for this reason that the Neiye strongly prescribes the use of breathing exercises (or meditation) to help maintain calmness and keep one’s desires and emotions in check. It is in such a state of calm and serenity that “harmony will naturally develop.” (Neiye 3) [Personally, I prefer to translate the phrase “和乃自成” as: harmony will come to its completion by its own accord.]
As I have shown above, both qi and the body mutally affect and mutually influence each other. The point where both qiand the body are said to be in the state of harmony, is therefore constantly moving depending on the external conditions affecting the body, and what one does with the body. In the context of life, health and vitality, it is simply not enough to just acquire the state of harmony once, as this state can easily be lost through changes in the weather, or changes in one’s mood or activity. A true state of medical harmony, in this case, would involve a constant process of harmonising these two variables. The sage would be one who has cultivated himself/herself in such a way whereby this process is almost self-maintained. But this process of harmonising is a delicate one. Doing something to (and/or with) the body will affect the flow of qi within the body, and doing something externally to manipulate the internal flow of qi will also affect the body. Monitoring the changes and trying to balance these two constantly changing variables is not easy.
Thankfully, there are some signs that help to indicate that a harmony between qi flow and the body has been attained: “their skin will be ample and smooth, their eyes and ears will be acute and clear, their muscles will be supple and their bones will be strong”, they will “perceive things with great clarity,” (Neiye 16) and their minds and senses will be calmed and well-ordered (Neiye 14), and thus will well-ordered words issue forth from their mouths (Neiye 10).
I will now attempt to reconstruct the philosophical concept of harmony in the Zhou Dynasty medical context.
This concept of harmony can be likened to a game of tug-of-war, where the two variables, qi flow and the body, are like two players standing at each end of the rope. As both players pull, they will inevitably move each other. But there will be a point where both are pulling each other with the same amount of force that there is no resultant movement between the two. This state would be the state of harmony as it was understood in the Zhou medical context: where the total (resultant) sum of the two vector forces (i.e. the variables, qi flow and the body) is zero. It is important to highlight here that the two variables are still active, just like how the two players playing tug-of-war are still pulling each other. The person performing the act of harmonising is still at work, monitoring and regulating both the external conditions that affect qi flow and the body. Conceivably, this model of harmony could accommodate more than two variables/forces, as long as the point of harmony is that point where the total (resultant) force is zero.
However, this model of harmony is very delicate and fragile. A slight change in (or to) just one variable is enough to destroy the entire state of harmony. The total (resultant) sum of the forces will cease to be zero, and one must attempt to re-harmonise the variables at play. In which case, a long-term state of harmony is, in fact, a continual process of harmonising: it is a continual process of monitoring and regulating the variables involves to ensure that the opposing forces are made to result in a zero-sum sitaution.
As a final note, I should point out that, I have deliberately refrained from describing concept of harmony as an “equilibrium,” even though it is very tempting to refer to it as such. The problem with the term, “equilibrium,” is that it is ambiguous and vague as the term, “harmony.” We think we know what it means, and in some ways we do have a general sense of it, however, just like the term, “harmony,” the term “equilibrium” can be construed and understood in many ways. For example, equilibrium can be construed to refer to a zero-sum state where the two variables/forces cease to exert a force/influence/reaction on each other (e.g. chemical equilibrium in titration). The concept of medical harmony, which I have explained above, does not fit this type of equilibrium. Another example of equilibrium is one that refers to a zero-sum state where the two variables/forces are still continually exerting a force/influence on each other (e.g. equilibrium of forces in physics). This type of equilibrium, on the surface, seems to be a good match with the concept of medical harmony, as the variables (qi and the body), are still continually acting and influencing each other.
References
- The Nei-Yeh (Inner Training), trans. Harold Roth (New York: Columbia University Press, 1999)
- Motse: The Neglected Rival of Confucius, trans. Yi-pao Mei (London: Probsthain, 1934)
- Paul Unschuld, Medicine in China: A History of Ideas (Berkeley: University of California Press, 2010)
- Donald Harper, Early Chinese Medical Literature: The Mawangdui Medical Manuscripts (London: Kegan Paul International, 1998)
Jonathan Y. H. Sim 