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Chinese & East Asian Medicines

An Examination of a Therapeutic Alliance: How the Acupuncture Experience Facilitates Treatment of the Modern Self Through the Methods of Intake and Self-Cultivation

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Sharon Hennessey, DAOM, L.Ac.

Dr. Hennessey is Domain Chair of the Acupuncture Department at ACTCM @ CIIS with an interest in acupuncture research. She has published several articles in CJOM, and recently presented a poster at SAR’s Conference in 2015 and 2017. Her posters and articles can be viewed at sharonhennessey.com.

Abstract:

The concept of therapeutic alliance, i.e., the relationship between practitioner and patient, is identified as being historically rooted within the practice of traditional Chinese medicine. Within this context, this relationship is shown to serve the modern self — a recent construct favored in westernized industrial countries. While tracing the rise of the modern self, the value and limitations of this construct are evaluated.

In this essay both the acupuncture intake, comprised of ten questions, and the practice of the Chinese self-cultivation techniques are analyzed: the intake procedure as an effective therapy and practitioner self-cultivation as a source for patient inspiration. By re-appropriating archaic methods, Chinese medicine practitioners can guide patients in the formation of a valuable personal narrative to address a construct of modernity.

Key words:

acupuncture narrative, human potential, Yang Sheng self-cultivation.

An Archeological Discovery

Ancient Chinese culture may have eschewed the individual, but in the practice of Chinese medicine there has always been an emphasis on treating idiosyncratic pathologies, unique to each person. Elisabeth Hsu, in chapter 2 of Innovation of Chinese Medicine, describes twenty-five such medical case histories found in the biography of a Han doctor recorded in about 90 BC. Hsu asserts that illness was designated by the term bing rather than the term ji. Her investigation revealed that apart from other meanings, bing frequently referred to the emotional state of a distressed or aggrieved person, suggesting that bing referred to the mind-emotion-body complex.1 This concept of individualism, buried in Chinese medicine, functioned as a release valve for strictures in traditional Confucian culture, indicating a nod to the individual through pathology.

By using this strategy today, the modern acupuncture practitioner may covertly treat a wide range of disharmonies that effect the psychological or metaphysical through the medium of the physical body.

Evolution of the Modern Self

Once upon a time we were all part of a family, congregating within a community or tribe, bounded by rules and traditions that guided every aspect of our lives. But industrialization and other extraordinary successes of capitalism eventually managed to devastate these traditions and erode our connection with the past.

As now experienced, the concept of self is a unique and recent construct that has emerged in the past century, launching each individual on a quest for personal meaning that had been previously supplied by traditional communities. Add to that the Nietzschean demise of the creator, the startling new world of physics, and the material excess of capitalist production, there emerged from the divan of Sigmund Freud and other psychologists a new kind of self. In the BBC documentary, Century of the Self, Adam Curtis examines how we have moved from the ‘citizens with needs’ to ‘consumers with desire’. In this documentary, Curtis deconstructs how the Freudian concept of ‘unconscious’ desire was harnessed to the new business of marketing consumer goods, encouraging the emergence of a singular individual. This new self re-examined the constraints that had previously bound it to the precepts of religion and other dogma.

Jan Sloterdijk’s You Must Change Your Life describes our “withdrawal from this collective identity” as a directive demanding that all individuals must now stand beside themselves a priori, living their lives in front of the mirror, or function as actors of everyday life.2 He decrees that we were once part of a collective unity, bounded by religion, tradition, and family that functioned as additional immune system by guiding, signifying, and protecting us.2 Now, with only our self-created psyche to protect or direct us, humanity must face the numerous onslaughts of circumstance alone.

Christopher Macann states: “Ontological psychology ceases to be what Kant took it to be: a spurious deduction of the immortality of the soul from the principle of self-identity”3, and becomes instead what might be called a doctrine of self-actualization, a phrase made famous in Maslow’s Psychology of Being.”4 Maslow describes self-actualization as “….what a man can be, a man must be…It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”5

Authoring the Self or How to Live a Meaningful Life

The self has now become a center for experimentation and authorship. For a meaningful life, experiences must be accumulated and curated, and the personal narrative becomes a centerpiece for communication. Individual stories serve as guideposts for inspiration and transcendence in much the same way as The Confessions of Saint Augustine did 1700 years ago.2 Self-involvement is not new to western history, but it was traditionally used to serve as an example at the demand of some greater authority. Augustine’s Confessions are an early version of a transformational life story that permeates Hollywood dramas and soaps.

For the multitudes, the self-portrait, particularly illustrated by Rembrandt’s more than 90 painted images of himself, is now the “selfie”—a self that is not under the control of some special aegis. It is especially unsettling to many social critics, who claim it is a short jump from selfie to selfish. Great moral opprobrium is attached to this concept of self. Critics see self-involvement as shedding important shared traditions that have served to organize people or, in a spiritual context, preferring the self to the creator or the originator of that self. But this new self, while, yes, prideful and actively undermining tradition, still requires tending and guidance.

Jumping forward to our new, service-oriented economy, many kinds of practitioners are now engaged in mapping the ontology for this new individual self through the medium of the personal narrative. This new self has spawned a huge service industry that caters to its development, refinement, and care. This is important because other cultural institutions that once cultivated, sheltered, and groomed this aspect of our psyche are in retreat.

The Chinese Medicine Intake: The Practitioner Helps the Patient Write a Narrative

In my own specialty, acupuncture, the patient is encouraged to build their personnel narrative based on the ten intake questions, which provides an organizational template for their story. As the patient describes their digestion, sleep patterns, urination, breathing, and any other subjective sensations they may wish to include, these ten questions serve as a type of somatic confessional, whereby the patient is able to transpose their psychological and metaphysical anxiety into simple and comprehensible evaluation of autonomic vegetative functions. Rather than the soul or psyche, these functions then become the object of transformation. By the simple principle of adjusting the flow, intake, and expulsion of fluids, gases, and solids, the individual can be tuned to perform at a higher level.

In a secular world there is the obvious benefit to only adjudicating somatic function. Many pejorative moral and psychological implications can thus be averted, while such vegetative functions are modified or streamlined to a superior level of performance.

This strategy of using Chinese medicine to treat the somatic body by addressing the psyche is oddly akin6 to the James-Lange Theory of Emotion. This theory was put forth in 19th century initially by American psychologist and theosophist William James and later, separately, by Danish physician Carl Lange. In this theory, physiological changes actually precede emotions. The subjective emotion is experienced because of the underlying physiology: our autonomic nervous system generates the physiological events that we associate with an emotion such as heart rate, perspiration, dry mouth, muscular tension. This theory suggests that emotions are a result of physiology rather than the cause.6 The autonomic nervous system is primarily unconscious, associated with activating the flight or fight response. But new research also shows that the sympathetic nervous system is “part of a constant regulatory machinery that keeps body functions in a steady state equilibrium.”7

It has been recently demonstrated that the sympathetic nervous system and the hypo-pituitary axis are activated by antigenic activity. Local immune cells inform the central nervous system and vice versa; the door swings both ways. New research in bioelectronics suggests that inflammation can be suppressed by stimulating the vagus nerve with electrical impulses. The standard of care associated with inflammatory conditions, such as rheumatoid arthritis, Crohn’s disease, or other insidious autoimmune conditions, might very soon incorporate vagal stimulation. Increasing vagal tone can also be taught by using the biofeedback technique.8,9 Hence, research science is verifying that the underlying soma is an effective pathway to modulate the psyche and vice versa.

In a study (to be published) by Randy Gollub et al., a patient’s experience of pain relief was correlated to their perception of being cared for with empathetic understanding. Patients were asked to evaluate the level of interest shown by their practitioner. Results demonstrated that their pain relief was enhanced by practitioner empathy. 10

A trial designed by Ted Kaptchuk, presents the notion that the patient’s narrative about self is fundamental to their health. He discusses and demonstrates how a practitioner perceives a patient affects the outcome of their health.11 This study of patients with irritable bowel syndrome randomly divided them into three groups. Group one was put on a waiting list. Group two received placebo treatment from a disinterested clinician. The third group got the same placebo treatment from a clinician who asked them questions about symptoms, while describing the causes of irritable bowel and displaying optimism about them overcoming their condition. Not surprisingly, the health of those in the third group improved the most.

The Golub and Kaptchuk studies demonstrate the value of practitioner involvement. In recording the patient’s subjective narrative, practitioner empathy becomes part of substrate that influences the acupuncture patient’s outcome.

Acupuncturists stress which foods to eat, the temperature of the food to be consumed, how much to drink, what to drink, when to sleep, when to rise, how to dress, how often to have sexual intercourse, or how to massage internal organs. For patients who have never observed their bodily functions, discovering that the shape of a stool or the color of urine or nose phlegm can be a window into the interior can have profound effect on self-reflection. In a secular world, Chinese medicine provides support and instruction similar in some ways to the dietary and lifestyle guidelines once administered by other belief systems.

The acupuncture intake and diagnosis that generates this personal narrative with its pastiche of authentic Taoist and Confucian phrases represents an antique system of healing. This also can function successfully today as an intact nonreligious construct for evaluating the pilgrim/patient’s transcendent progress on their journey with their self, stressing behavior over belief.

Evolution of Self–Cultivation

For Maslow, levels of self-actualization are the peak levels achieved by an individual. Often an evolved individual can by example pull the rest of humanity upward toward a higher level of proficiency or consciousness.

In his essay, The Neurology of Self-Awareness, Ramachandran suggests that mirror neurons have played a critical role in learning through imitation rather than trial and error, along with our strong ability to empathize. He proposes that extraordinary human progress, in which self-awareness is fundamental, is the result of the interplay of these mirror neurons.12 He also posits that because of mirror neurons, humans have the uncanny ability to imitate each other and understand each other’s feelings, “setting the stage for a complex Lamarckian or cultural inheritance that characterizes our species.”12

Rizzolatti discovered back in 1996 that mirror neurons are the pre-motor neurons that fire when a primate performs some object-directed actions, such as grasping, tearing, manipulating, or holding but also when the animal watches someone else perform the same actions.13

Additionally, it is not just the repetition of one but repetition of many, imitating and competing, that drives us forward. Take the simple example of the marathon: in 1921, best time was 3 hours and 18 minutes; in 2014, best time was 2 hours, 2 minutes and 57 seconds.14 This has been achieved over the span of many years, through the accumulated effort of many runners, competing against each other, and shaving the time, second by second, year by year. Each competed to be the best, inspired by and imitating the competitor whom they followed, and tended and coached by those who made running a practice.

This sort of consciousness-raising effort that pervades human behavior is described by Jan Sloterdijk in You Must Change Your Life. He lauds the Nietzschean doctrine of combining practice with cumulative knowledge or education and designates practicing and training as an original and uniquely human path, especially in seeking to transcend the self.2 Through Sloterdijk‘s lens, training, peak experiences, and performance crystallize the human experience, while conscious measurement, observation, and skill refinement are reflected in learning and practice.

Sloterdijk comments that such training and practice systems formed the core of Platonism, Brahmanic training, and Taoist alchemy and martial arts, guiding adepts up ‘the vertical wall of achievement’ in superhuman spiritual and athletic extremes that have shaped the image of what human potential can be.2

Chinese Practice and Self-Cultivation

In ancient China, Taoism embraced the belief that through breath and meditation they could transform their lives, by reaching for immortality. Joseph Needham describes how in ancient China the physiological alchemists believed they could “master their neuro-muscular coordination, and sexual activity as part of the Tao.”15 He describes such activities, listing how this was accomplished by employing respiratory exercises, counting heartbeats, experiencing the movement of inner qi, and using a myriad of other special techniques, which were designed prolong longevity or restore youth by internally transforming the practitioner.15 These early Taoists exercises evolved into complicated styles of self-cultivation.

During the early Han period, around 200-100 BC, medical understanding of the inner body was changing. By the time the Huang de Nei Jing was compiled, there was a formal system of channels known as the jing luo, which allowed different types of qi to circulate.1

Medical technology was also changing. Fine filament needles became the preferred method of treatment.16 The practitioner was guided by the Su Wen and Ling Shu on how to perform this new inner practice. He was encouraged to gather his qi, employing techniques of self-cultivation that acupuncture students are still taught to imitate today. Metaphors in the Su Wen, such as “use the hand as if holding a tiger” or “pouring over a deep abyss,” coach the practitioner on how to proceed in treatment.

Technique was conflated with rectitude and moral character, instructing the practitioner to influence the spirit of the patient or proceed to a deeper metaphysical exchange, using the needle as an instrument of transmutation.16 These special skills represented the fruits of self-cultivation for the practitioner.

By focusing on self-manipulation of qi and self-improvement in technique, acupuncturists have become default practitioners of Yang Sheng self-cultivation

skills.1 Modern Chinese medicine has become an odd mix of the esoteric internal practice methods combined with modern physiology. By simply reading through a list of continuing education courses or the advanced curriculum at institute of traditional Chinese medicine, this obsession with obscure Taoist practices can easily be verified.

Pursuing a practice under the guidance of a Chinese master, whose particular lineage defines their curriculum vitae, is the equivalent to pursuing a board certification in another profession. Even if personally refraining from a deliberate practice of self-cultivation, acupuncture students are exposed to such practices through curriculum requirements. It is inculcated in the rhythm of learning in a professional school, where either qi gong or tai chi are combined with esoteric poetry about nature.

It is normal to find a student of acupuncture involved in a deep meditative performance exercise such as tai chi. Mastery of practice-related performance is expected of these students. In this profession, self-cultivation and skill development go hand in hand; other medical professionals are not expected to harmonize their qi, learn mystical movements such as tai chi, or root their being, before interacting with their patient. The skills of self-cultivation as both a healing art and a moral virtue are embedded in Chinese medicine. This imbues the practitioner with leadership qualities that occur in other training modes such as sports, arts, or religion. The modern patient, typically lacking in ritual signifiers for lifestyle direction, can thus benefit from this personal example of their practitioner.

Conclusion

Western treatments based on statistical patterns and board declarations that direct standards of care often negate or ignore an individual’s metaphysical sense of being. In the context of eastern and western cultural norms, western culture employs treatment standards that are ironically more aligned with the statistical whole, whereas traditional Chinese medicine, aligned with a rigid Confucian social structure, embraces the individual. In this example of cultural syncretism, acupuncture offers the modern self the care and understanding that it currently lacks in the territory of western evidence-based treatment.

Despite being anchored in traditional principles of Taoist and Confucian philosophy, Chinese medicine is able to address the modern concept of self by creating a distinct diagnostic template for the treatment of each patient. This narrative template teaches individuals to observe and measure their soma in a practical, effective way against an intact system that encompasses philosophical underpinnings that reflect every aspect of patient behavior. It is composed of understandable natural metaphors that generally resonate well with the patient and can be transposed into simple behavioral modification.

As part of traditional culture, both the narrative and techniques of self-cultivation are able to furnish individual guidance and performance-activated behavior that are often lacking in both western therapy and modern cultural norms. When scientists try to evaluate the efficacy of the acupuncture treatment, they often fail to comprehend the value of these methods: the intake, which varnishes the diagnosis with a veneer of empathy, and examples of self-cultivation, which represent internal strength achieved through moral refinement. Together, these two essential components of an acupuncture treatment may contribute monumentally to a therapeutic alliance that successfully enhances the patient’s outcome.

References: 

  1. Ed. by Elisabeth Hsu, Innovation in Chinese Medicine, Needham Research Institute, Cambridge University Press, 2001; p. 16.
  2. Peter Sloterdijk, You Must change Your Life, Polity Press; 2013. pp. 211, 215, 322, 199.
  3. Referring to the Cartesian Objective
  4. Maccan, Being and Becoming: https://philosophy now.org/issues/61
  5. A.H.Maslow (1943); A Theory of Human Motivation, Originally published in Psychological Review, 50, p.370-396. http;//psychclassics.yorku.ca/Maslow/motivation.ht
  6. https:Wikipedia.org/wiki/James-Lange_theory
  7. http://medscape.com; Medscape: Arthritis Research & Therapy; Georg Pongratz; Rainer H Straub; The Sympathetic Nervous Response in Inflammation.
  8. http://www.newyorktimes.com: Michael Beharmay, Can the Nervous System Be Hacked?; Mar. 23, 2014.
  9. Torres-Rosas R, Yehia G, Peña G, Mishra P, del Rocio M,  Ulloa L, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nature Medicine. 20, 291–295 (204) doi:10.1038/nm.3479
  10. Mawla I, Gerber J, Delibero S, Oriz A, Protsenko E,  Gollub R. Oral Abstract, Therapeutic Alliance between Patient and Practitioner Is Associated with Acupuncture Analgesia in Chronic Low Back Pain, Society for Acupuncture Research, 2015 Conference program, Boston, MA, USA, 11/12-13, 2015 , #SAR2015.
  11. T J Kaptchuk; Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome; BMJ.April2008;336:999 doi:10.1136/bmj.39524.439618.25.
  12. Ramachandran V. [1.1.09]; Conversation: (title) Mind; Self Awareness: The Last Frontier; E. edge.org.
  13. Marco Iacoboni, Istvan Molnar-Szakacs, Vittorio Gallese, Giovanni Buccino, John C Mazziotta, and Giacomo Rizzolatti; Grasping the Intentions of Others with One’s Own Mirror Neuron System; Published: February 22, 2005; DOI:10.1371/journal.pbio.0030079
  14. https:/www.wikipedia.org/wiki/Marathon;_world_record_progression
  15. Joseph Needam, Volume V, Science and Civilisation in China: Chemistry and Chemical Technology, Part 5, Spagyrical Discovery and Invention: Physiological Alchemy, Science and Civilisation in China, Volume V:5; Cambridge University Press,1985; p. XXVIII, Introduction., p. 29
  16. Vivienne Lo, Spirit of Stone: Technical Considerations in the Treatment of the Jade Body; Bulletin of the School of Oriental and African Studies, University of London Vol. 65, No. 1 (2002), pp. 99-128, Published by: Cambridge University Press on behalf of School of Oriental and African Studies; Stable URL: http://www.jstor.org/stable/4145903

Chinese & East Asian Medicines

Classical Formula Powders: Dosage and Application

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Treatment periods are rarely discussed in classical Chinese medical literature.  While classics like the Shanghan Lun meticulously describe formula preparation and administration over the course of a day, the number of days a formula should be used for is never plainly described.  Due to this ambiguity, many physicians apply a saying that originates in the Huangdi Neijing to classical formula use, “after one dose one knows, after two doses there is resolution.”[i]

However, by examining powder and pill formula dosage, we can gain more specific insight into classical treatment timeframes.  Whereas with liquid decoctions the written herb weights compose a single day’s worth of formula, with powders the daily dose is fixed at a few grams and the herb weights define a formula’s projected treatment period.

This article is an exploration into the treatment periods and patterns for four foundational classical formula powders, accurate weights and measures based on Han period archeological evidence, and the drinks traditionally used to aid powder consumption. The goal is to provide insight into how and why classical clinicians used medical powders.

Classical Weights

A liang (兩) is the core unit of weight used in classical Han dynasty formulas.  Though there has been some debate as to the exact weight of a classical liang throughout Chinese history, and a great deal of inaccuracy in modern texts, recent archeological findings indicate that a liang weighed between 13.8 and 15.6 grams.  Contemporary doctors in mainland China generally simplify a classical liang’s weight to 15g.  A classical Liang can be subdivided into 24 zhu (銖) or four fen (分).  16 Liang combine to make one jin (斤)[iii].  The table below describes the weight of each measurement unit:

Table 1.  Han Period Weight Units

Measure Unit Approximate Weight Simplified Weight
Jin 斤 220.8g to 249.6g 240g
Liang 兩 13.8g to 15.6g 15g
Fen 分 3.45g to 3.9g 3.75g
Zhu 銖 0.575g to 0.65g 0.625g

Single doses of powdered formulas were most commonly dosed by heaping powder onto a fangcunbi (方寸匕, Square Inch Spoon) or a qianbi (錢匕, Coin Spoon).  The cun (寸), a classical unit of measurement, is 2.32cm long.[iv]  Therefore, a square cun measures 5.4 cm2 in area.  The Zhongyao Da Cidian (中藥大辭典, Great Encyclopedia of Chinese Medicine) states that a fangcunbi weighs 2g for metal and stone powders and 1g for plant powders.  However, the actual tested weights are somewhat heavier, causing researcher Li Yuhang (李宇航) to conclude that plant powders should be dosed at 1-2g and mineral powders at 3-4g[v].  A portion of his findings is translated on the following table:

Table 2. Actual Fangcunbi Powder Weights

Formula Actual Weight
Wu Ling San 五苓散 1.59g
Muli Zexie San 牡蠣澤瀉散 1.27g
Banxia San 半夏散 1.46g
Sini San using Baishao 四逆散（白芍） 1.66g
Sini San using Chishao 四逆散（赤芍） 1.68g
Chishizhi (in Taohua Tang) 赤石脂（桃花湯） 3.31g
Wenge San 文蛤散 3.33g

The qianbi dose was measured using the Han Dynasty wuzhuqian (五銖錢, five zhu coin).  The coin’s radius measures 2.5cm and it has an approximately 1 cm2 square hole in the center.  Assuming a finger is used to plug the square hole in the center of the coin when used as a scoop, the area measures 4.9 cm2, giving it roughly 10% less area than the fangcunbi.

For the purposes of this article, I simplified unknown formula powder weights to 1.66g per dose for a fangcunbi and 1.5g for a qianbi.  Given that most formulas suggest three daily doses this works out to 5g total per day for the fangcunbi and 4.5g per day for the qianbi.

Intake Methods

Classically, powders are stirred into a warm liquid and drank.  The choice of liquid gives additional insight into the formula’s purpose and should be considered an essential part of powdered formula construction.  The main liquids used for powder administration in the Shanghan Lun and Jingui Yaolue are baiyin (白飲, the water from boiled rice[vi], also called miyin 米飲), maizhou (麥粥, wheat porridge), jiangshui (漿水, fermented millet water), jiu (酒 rice wine, likely analogous to modern huangjiu 黃酒) and water.  In formulas that don’t specifically mention what drink to use, Ge Hong and Sun Simiao suggest that any of the above can be used[vii], presumably leaving the choice of liquid assistant to the practitioner.

Table 3. Liquid Assistants for Powder Administration

Liquid Function Formulas
Baiyin (白飲, boiled rice water) Sweet, balanced.  Strengthens earth harmonizes the middle qi, separates clear from turbid, generates fluids;stops thirst; promotes urination. Sini San, Wu Ling San, San Wu Xiao Bai San, Muli Zexie San.Rice is also used in Baihu Tang, Taohua Tang, and Zhuye Shigao Tang.
Maizhou (麥粥, wheat porridge) Sweet, slightly bitter, cool.  Eliminates heat, stops thirst and dry throat, promotes urination, nourishes liver qi. Zhishi Shaoyao San, Baizhu San (modification).Wheat is also used in Gan Mai Dazao Tang.
Jiangshui (漿水, fermented millet water) Sweet, sour, cool.  Regulates the stomach, dissolves food obstructions, stops thirst. Chixiaodou Danggui San, Shuqi San, Banxia Ganjiang San, Baizhu San (modification).Jiangshui is also used in Zhishi Zhizichi Tang.
Jiu (酒, rice wine) Bitter, acrid, warm.  Invigorates the channels, unblocks obstruction syndrome, warms the blood, scatters blood stasis. Danggui Shaoyao San, Danggui San, Baizhu San, Tianxiong San, Zishi Han Shi San, Tuguagen San.

A Selection of Powdered Formulas

According to Dr. Li Yuming,[viii] Zhang Zhongjing uses internal powdered formulas primarily to treat diseases of the lower jiao, especially recalcitrant conditions that involve blood deficiency and or fluid accumulation.  Below I have selected four representative formulas that each demonstrate a specific lower jiao pathology and can be considered foundational building blocks for individualized powdered formula construction.

Sini San 四逆散, Frigid Extremities Powder

SiniSan SHL Text Weight Gram Weight
Zhi Gancao 炙甘草 10 Fen分 37.5g
Zhishi 枳實 10 Fen分 37.5g
Chaihu 柴胡 10 Fen分 37.5g
Shaoyao 芍藥 10 Fen分 37.5g
Total Formula Weight 40 Fen分 150g (138g-156g)
Single Dose Weight 1 Fangcunbi 1.66g-1.68g
Daily Dose Weight 3 Fangcunbi 5g (4.98g-5.04g)
Treatment Period 30 Days (27.3-31.3days)
Administered With Baiyin白飲 (Boiled Rice Water)


Sini San treats Liver qi stagnation that manifests with cold hands and feet, possibly with cough, palpitations, inhibited urination, abdominal pain, or diarrhea with tenesmus, emotional distress, depression, chest and rib distention or pain, or breast distention pain, with a white tongue coat, and a thin wiry pulse.[ix]

According to the Shennong Bencao Jing (《神農本草經》The Divine Husbandman’s Classic of Materia Medica), Chaihu’s bitter, balanced nature has the ability to eliminate knotted qi and food accumulations from the GI tract.[x] Zhishi’s bitter, cool, slightly acrid and sour nature assists Chaihu by breaking up stagnant qi, reducing distention and pain from accumulation and directing the qi of the GI tract downwards.  Shaoyao’s bitter, sour and slightly cool nature nourishes the liver, preserves yin, and according to the Mingyi Bielu (《名醫別錄》Miscellaneous Records of Famous Physicians) eliminates blood stasis, expels water, and benefits the bladder and intestines.[xi] Zhi Gancao’s sweet, warm nature nourishes the middle qi.  Rice water’s bland, sweet and balanced nature is used to administer the formula to build thin fluids, regulate fluid metabolism, and benefit the spleen and stomach.

The Sini San pattern shows signs of dryness, blood deficiency, qi knotting, and food accumulations in the GI tract, and resultant lower jiao yang qi depression.  The formula is overall cool and bitter, with hints of acrid, sour, and sweet and should be considered a light purgative with elements of qi and blood building.  Sini San’s light dose and ability to enter the lower jiao is aimed at slowly purging the intestines without stressing the body’s upright qi.  Due to the purgative nature, caution should be used when exceeding the projected treatment period of 30 days.

Wu Ling San 五苓散, Five Poria Powder

Wu Ling San SHL Text Weight JGYL Text Weight Gram Weight
Zexie 澤瀉 1 Liang 兩 6 Zhu 銖 1Liang兩1Fen分 18.75g
Zhuling 豬苓 18 Zhu銖 3Fen分 11.25g
Fuling 茯苓 18 Zhu銖 3Fen分 11.25g
Baizhu 白術 18 Zhu銖 3Fen分 11.25g
Guizhi 桂枝 ½ Liang兩 2Fen分 7.5g
Total Formula Weight 4 Liang 60g (55.2g-62.4g)
Single Dose Weight 1 Fangcunbi 1.59g
Daily Dose Weight 3 Fangcunbi 4.77g
Treatment Period 12 days (11.6 – 13.1 days)
Administered With Baiyin白飲 (Boiled Rice Water)


Wu Ling San treats a number of symptom patterns, all of which revolve around dampness accumulation in the lower jiao resulting in some degree of yang qi depression and heat.  The primary acute pattern manifests with headache, low fever, irritability, aversion to cold, dry mouth and thirst, possibly with vomiting upon drinking, and urinary obstruction.  Other variants include diabetic thirst and edema patterns.

Zexie, Zhuling, and Fuling’s overall bland and cool natures act to leach out dampness, promote urination, and gently clear lower jiao heat.  Baizhu’s bitter warm nature strengthens the spleen by drying dampness and dissolving food and phlegm liquids[xii]. Guizhi’s acrid warm nature disperses yang and promotes the movement and ascent of yang out of the lower jiao.  Rice water’s bland, sweet and balanced nature is used to administer the formula to build thin fluids, regulate fluid metabolism, and benefit the spleen and stomach.

When taking the Wu Ling San the patient is advised to drink plenty of warm water and that the condition will resolve through gentle sweating which indicates that upright qi has regained control of the surface.  Presumably, the 12 day dose period is the expected term of resolution for the acute symptom pattern.

Danggui Shaoyao San 當歸芍藥散, Angelicae and Peony Powder

Danggui Shaoyao San JGYL Text Weight Gram Weight
Danggui 3 Liang 45g
Shaoyao 1 Jin 240g
Fuling 4 Liang 60g
Baizhu 4 Liang 60g
Zexie ½ Jin 120g
Chuanxiong ½ Jin (3 Liang*) 120g (45g*)
Total Formula Weight 43 Liang (38 Liang*) 645g (593.4g – 670.8g)

570g* (524.4g – 592.8g)
Single Dose Weight 1 Fangcunbi ~1.66g
Daily Dose Weight 3 Fangcunbi ~5g
Treatment Period 129days (118.7 days – 134.2 days)

114 days* (104.9 days – 118.6 days)
Administered With Jiu 酒 (Rice Wine)

*One Jingui Yaolue version states a 3 liang dose for Chuanxiong, all other versions state ½ jin.

Danggui Shaoyao San primarily treats blood deficiency with fluid accumulation in the lower jiao resulting in abdominal pain or cramping.  Though the pattern is more common among women, the formula can also be used for men.  Other possible symptoms include rib distention or pain, lack of appetite, dizziness, emotional constraint, and weakness of the limbs with a pale tongue, white tongue coating, and a deep, wiry pulse.[xiii]

The formula is composed of two main elements: Danggui, Chuanxiong and Shaoyao to nourish the blood and gently disperse blood stasis; and Fuling, Zexie, and Baizhu to regulate water metabolism, dry dampness, promote urination and fortify the spleen.  Together the two groups somewhat resemble a combination of Wu Ling San and Sini San but with a greater focus on blood level movement and nourishment.  To further promote blood movement, rice wine’s acrid, bitter and warm nature is used to administer the formula.  The Mingyi Bielu notes that Rice Wine has the specific ability to circulate a medicine’s strength[xiv] by unblocking the channels and invigorating the vessels.

While the formula is best known for treating acute stomach cramping during pregnancy, modern text books urge cautious use during pregnancy, “specifically because too high a dosage of Chuanxiong Rhizoma can affect the fetus, particularly in mothers who have deficient and weak Kidney qi”.[xv] The question of whether Danggui Shaoyao San’s daily dose of Chuanxiong at 0.93g is considered high must be left to the practitioner and further research. But clearly, it was classically thought of as a safe formula as it was dosed for around four months of use during pregnancy and is suited for long term blood and fluid regulation in the lower jiao.

Chixiaodou Danggui San 赤小豆當歸散, Adzuki and Angelicae Powder

Chixiaodou Danggui San JGYL Text Weight Gram Weight
Chixiaodou (adzuki bean, sprouted and dried) 3 Sheng* 510g
Danggui 10 Liang** 150g
Total Formula Weight 660g
Single Dose Weight 1 Fangcunbi ~1.66g
Daily Dose Weight 3 Fangcunbi ~5g
Treatment Period 132 days
Administered With Jiangshui 漿水 (Fermented Millet Water)

* A Sheng is a unit of volume that measures approximately 200ml.

** Some Jinggui Yaolue versions write 3 liang, others write 10 liang.

Chixiaodou Danggui San treats damp heat in the lower jiao which can lead to hemorrhoids, anal prolapse, excessive menstrual bleeding, ulceration, intestinal abscess, red eyes, rashes, irritability and other symptoms associated with damp head leading to blood toxicity presenting with a red tongue, yellow, greasy tongue coat, and rapid pulse.

Chixiaodou has a sweet/bland, slightly sour, and balanced nature, promotes urination, drains damp heat, stops bleeding and, as noted in the Shennong Bencao Jing, has the ability to expel the blood and pus from carbuncles and welling-abscess.[xvi]  Danggui’s sweet, acrid and warm nature nourishes the blood, disperses stasis, and promotes the healing of sores.  Fermented millet water is used to administer the powder and supports Chixiaodou by dissolving food accumulation and regulating the stomach with its sweet, sour, and cool nature.

Like Danggui Shaoyao San, Chixiaodou Danggui San has an intended dose period of around four months and aims to nourish blood in the lower jiao while simultaneously eliminating fluid accumulation.  Chixiaodou, a common food in China, is a particularly safe medicine for the slow, long term elimination of damp heat and blood toxicity.

Conclusion

From the above formulas, we can clearly see that Zhang Zhongjing favored using powders for the long-term treatment of recalcitrant lower jiao and gastrointestinal diseases that present with mixed excess and deficiency patterns.  According to the Jingfang Xiaopin （《經方小品》A Small Collection of Classical Formulas), powders and pills were used after a decoction formula had eliminated the primary pathogenic factors, presumably as a long term regulatory treatment, which could then be periodically assisted with decoction formulas.[xvii]  Sun Simiao believed powders were appropriate for slowly driving out pathogens, particularly wind and damp obstructions with symptoms that come and go without a static location,[xviii] as is characteristic with many gastrointestinal disorders.

Unfortunately, formula powders are rarely used in the modern clinic.  When used, they are often decocted as liquid formulas with little concern for difference in administration form or dose.  I hypothesize that powdered formulas may offer a better, cheaper, safer, and more convenient treatment method for the long-term resolution of many gastrointestinal and other lower jiao associated disorders, especially when used in conjunction with periodic decoction formula treatments.  As renewed interest in classical formula theory and application continues to grow in China and around the world I hope that modern practitioners will also renew research into formula powders for modern clinical use.

Endnotes

[i]《黄帝内经素问·腹中论篇第四十》云，“一剂知二剂已”。

[ii] 王付.经方用量秘旨. 人民军医出版社, 2015.62-64，98-100

[iii]《汉书·律历志·权衡》云，“权者，铢、两、斤、钧、石也……一龠容千二百黍，重十二铢，两之为两，二十四铢为两，十六两为斤”。

[iv] 李宇航.《伤寒论》方药剂量与配伍比例研究. 人民卫生出版社, 2015. 64

[v] 李宇航.《伤寒论》方药剂量与配伍比例研究. 人民卫生出版社, 2015. 68

[vi] 朱西杰、晋学仁、樊恒茂. “《伤寒论》“白饮”新解”，来源：《国医论坛》2000年第02期

[vii]《千金要方·论服饵第八》云，“凡服丸散，不云酒水饮者，本方如此，是可通用也”。《肘後備急方·華陽隱居《補闕肘後百一方》序》云，“凡下丸散，不雲酒水飲者，本方如此，而別說用酒水飲，則是可通用三物服也”。

[viii] 李宇铭.伤寒治内方证原意. 中国中医药出版社, 2014.

[ix] 王付《历代经方方论》.人民军医出版社, 2013. 515

[x]《神农本草经》云，“柴胡味苦平，主心腹，去肠胃中结气，饮食积聚，寒热邪气，推陈致新”。

[xi]《名医别录》云，“芍药味酸微寒有小毒，主通顺血脉，缓中，散恶血，逐贼血，去水气，利膀胱、大小肠，消痈肿，时行寒热，中恶，腹痛，腰痛”。

[xii]《神农本草经》云，“消食”。《名医别录》云，“消痰水……消谷嗜食”。

[xiii] 王付《历代经方方论》.人民军医出版社, 2013. 574

[xiv]《名医别录》云，“酒，味苦甘辛大热有毒，主行药势，杀邪恶气”。

[xv] Bensky Chinese Herbal Medicine – Formulas & Strategies, 2nd Ed. page 588

[xvi] 《神农本草经》云， “ 味甘、酸，平。主下水肿，排痈肿脓血。生平泽”。

[xvii]《小品方·述看方及逆合备急药决》云，“病源宜服利药治取除者服汤之后宜将丸散也时时服汤助丸散耳”

[xviii]《千金要方·论诊候第四》云，“散能逐邪风气湿痹表里移走居无常处者散当平之”

Chinese & East Asian Medicines, Religion & Medicine

Daoist Contemplation and Chinese Medicine, Part 1: History and definition of contemplation in Daoist texts

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Different forms of contemplative practices have been one of the key elements in Daoist tradition. This essay will appear in four parts dealing with:

1. History and definition of contemplation in Daoist texts

2. Contemplative practices and concept of body-mind

3. Contemplation and dietary practices

4. Contemplation and art of medicine

In these short essays I define contemplative practices, look historical relevance and how has it affected the development Chinese medicine and what does it has to do with ideals of art of medicine. Some concepts presented might no longer fit to current understanding of Chinese medicine, but they have played consequential role in formulation of ideas and have been influential cultural context for ancient doctors who wrote some of the foremost classics of Chinese medicine. While reading these essays please keep in mind, that heart and mind are same word (xīn 心) in Chinese.

Defining Daoist contemplation

To be able to track down history of contemplative practices we first need to be able to define what we mean by contemplation. Modern practitioners usually prefer to use trendy terms like mindfulness often defined as conscious awareness and non-judgmental acceptance. While this might work well for some forms of practices, for more historical study we have to to rely on Daoist and Chinese Buddhist terms, definitions and context.

Mindfulness research literature often takes terms sati (Pāli) and smṛti (Sanskrit), which directly translates to Chinese niàn 念, to mean contemplation and mindfulness. Niàn means memory or recollection; to think on or to reflect upon something; to read or study. In Daoist context this term can be used for studying scriptures and contemplating or holding an object or idea in mind. Sometimes this is done by concentrating on a deity.

However, most of the Daoist texts use term guān 觀 in Chinese literature. It translates to looking and observing. Very often it is used in connection with word nèi 內 which means inner or internal to denote the nature and direction of observation. Therefore nèiguān 內觀 could be translated as inner observation. Nèiguān also serves as literal translation of Buddhist concepts of vipassanā (Pāli or vipaśyanā in Sanskrit). Inner contemplation or nèiguān is set of practices where one directs his awareness within himself. In different types and stages of the practice object of awareness can be body as whole or some part like an organ. Object can be an emotion and how it is experienced within body-mind in level qì or energy. Many of these techniques concentrate on breathing. Some of the breathing meditations are similar to what is described in Buddhist Ānāpānasati Sutta (Pāli) or Ānāpānasmṛti Sūtra (Sanskrit). However Daoist practitioners often start their practice by concentrating on subtleties of breathing felt on lower abdomen instead the mindfulness of breathing itself.

The aim of contemplation has usually been, especially in Daoist practice, to be able to slowly shift ones attention to mind itself. This is usually seen as the key element of the practice in Daoist context as the “real” contemplation is apophatic in nature, striving to attain total emptiness and complete negation or detachment from desires, concepts and contents of the mind. This emptiness is obtained by silencing the mind with sustained non-interfering observation or Nèiguān. The famous Qīngjìngjīng 清靜經 explains:

能遣之者,内觀於心,心無其心;外觀於形,形無其形;遠觀於物,物無其物。三者既悟,唯見於空。觀 空以空,空無所空。所空既無,無無亦無。無無既無,湛然常寂。寂無所寂,慾豈能生?慾既不生, 即是真靜。

“These [desires] can be removed by internally contemplating the heart (mind). The heart is not this heart. Externally contemplating form. The form is not this forms. From distance contemplating things. These things are not these things. After these three have been realized and [you are] just seeing these as emptiness, contemplate this emptiness with emptiness. Emptiness does not exists in emptiness. In [this] emptiness there is still [further] non-existence. Non-existence of non-existence is also non-existing. [When] non-existence of non-existence is non-existing, there is deepest and eternal stillness. In stillness [where even] stillness does not exists, how could desires arise? When desires cannot arise, it is true peace.”

Despite the epilogue by Gě Xuán 葛玄 (164–244) who attributed the text to goddess Xīwángmǔ 西王母, in reality the text is probably written during early Tang-dynasty (618 – 907)[1]. The wording is clearly influenced by Buddhism but it gives the essential idea about contemplative practice and its apophatic nature. Following this nature we can start tracing contemplative practices through history. This nature is crucial for understanding continuation of the practice, its ideals and importance to Chinese medical and philosophical culture.

Early views and history of contemplative practices in China

Nèiguān practices that flourished in China during Tang-dynasty (618 – 907) are usually thought to have their origin in Buddhism. Buddhism started spreading to China during the 2nd century CE and one of the most well known Buddhist missionaries during the time was Ān Shìgāo 安世高 (c. 148 – 180) who translated Buddhist texts to Chinese language[2]. Among these texts there was also Ānāpānasati Sutta containing outlines of same idea used in practice of nèiguān. But even before that the practice was already well known in China. One of the oldest and synonymous expression to nèiguān is kǎonèishēn 考內身 which can be found from scripture titled Báixīn 白心 or Purifying the mind. In Báixīn there is a passage which says:

欲愛吾身,先知吾情君親六合,以考內身。以此知象,乃知行情既知行情,乃知養生。

“Desires and affections [arise from] our own body. First we understand our emotions, ruling sentiments and six harmonies by looking inside the body. Then we’ll know images after which we understand movement of emotions. By knowing movement of emotions we then understand cultivation of life (yǎngshēng).”

I translate kǎonèishēn here as looking inside the body. It might have been more easily understood by Western readers of spiritual practices, if I had translated it to inspecting inner bodies but that might be a bit stretching for context of early Daoist texts. Therefore the word body (shēn 身) needs bit clarification. The view of body in many archaic Chinese texts was much more broad than our modern use of the word. It was not just torso with four limbs but more a vessel composed of and containing different energies, spiritual influences and essence (jīng 精). It was seen intimately connected to time and world around us. I’ll come back to nature of body-mind in next part but the important thing here is that Báixīn gives advice to turn our attention into our body-minds to become aware of emotions and mental images. Báixīn also belongs to the earliest texts using term yǎngshēng or cultivating life which later formed a central concept in many medical and religious practices.

Báixīn dates back to 285 – 235 B.C. being from last period of Jìxià Academy (Jìxià xuégōng 稷下學宮)[3]. It is included in collection of political and philosophical texts named Guǎnzǐ 管子. The collection contains three other meditative texts namely Xīnshù shàng 心術上, Xīnshù xià 心術下 and Nèiyè 內業. Both Xīnshù texts speak of emptiness of the heart or mind. “Empty it (mind) from desires and Shén (Spirit) enters its domain. Clean from impure and Shén will remain in its place.” (《心術上》：虛其欲,神將入舍。掃除不潔,神乃留處。)

Xīnshù texts expand the ideas presented in older text called Nèiyè and transform individual meditation practice to fit the fields of economics and politics. They advocate importance of contemplative mindfulness practice to rulers and bureaucrats. The ideal ruler must remain detached from confusion of emotions and doubts. Their mind must remain clear in order to rule efficiently. Xīnshù xià states that:

心安,是國安也。心治,是國治也。… 治心在於中,治言出於口,治事加於民;故功作而民從,則 百姓治矣。

“When mind is peaceful nation is at peace. When mind is governed nation is [under] governance…When governed mind stays at its center and controlled words come out of mouth then governed actions are guiding the subjects. Thus good results are achieved and people will follow. In this way the common people are governed.”

Many texts from Huáng-Lǎo School promote contemplation to gain understanding of laws of governing people and contemplation was seen as a mean to understand universal way or law which also controlled the society. This discourse is highly interesting when we compare it to modern mindfulness movement and especially mindful leadership where we see similar claims and uses. Meditative texts of Guǎnzǐ do not demand worship, divination or other ritualistic techniques. They are plain and simple self cultivation practices written by the literati to other members of ruling class of their time. The fact that these texts were included in highly political text collection gives us an impression that these practices were wide spread and not known only in religious circles. This is especially evident as many of the texts in Guǎnzǐ belong to strict Legalist school that saw tradition and softer values as weakness to be cut down[4].

The Guǎnzǐ collection also includes scripture called Nèiyè 內業 or Internal practice, which is probably the oldest of surviving Chinese meditation manuals and dates back to circa 325 B.C. The poetic style of Nèiyè suggests oral tradition and therefore even older origin.[3] Nèiyè presents very clear and plain description of meditation. Its themes are similar to many Tang-dynasty meditation texts and Nèiyè defines connection of man to universe, reason for contemplation, different attitudes and key elements for practice. The text begins with idea how human being is connected to cosmos:

凡物之精,比則為生下生五穀,上為列星。流於天地之間,謂之鬼神,藏於胸中,謂之聖人。

“From the essence of every being comes their life. Below it gives birth to five grains, above forms the constellations. Its flow between heaven and earth we call as spirits and gods. When it is stored within center of chest we call him a sage.”

During writing of Nèiyè the idea of essence (jīng 精) was still developing. The essence was seen as something having nature of divinity or spirit. Later it became described more substantial and bit liquid like as in texts like Huángdì Nèijīng Sùwèn 黃帝內經素問. The concept of Jīng-Shén 精神, which is usually translated as life-force or vigor it still retained its early intangibility. Some of the early texts see essence as one of the “bodily spirits” or shén.

The text proceeds defining how all the sorrows arise from the heart and they are ended with the heart. The heart was seen to effect everyone around us, bringing with it our fortunes or misfortunes. Only cultivation of the heart was seen as means for real moral development and thus Nèiyè states that:

賞不足以勸善,刑不足以懲過。氣意得而天下服。心意定而天下聽。

“Rewards are not sufficient to encourage virtue, nor punishments enough for disciplining. [Only] when qi-mind is obtained, that what is under the heaven will be subjugated. Only when heart-mind is stopped that what is under the heaven will obey.”

Same idea of shedding false morals, ethical values and empty rituals and replacing them by true nature was recurring theme in even earlier Zhuāngzǐ 莊子.

Author(s) of Nèiyè also pondered how or what in the mind can observe itself:

何謂解之,在於心安。我心治,官乃治。我心安,官乃安。治之者心也,安之者心也;心以藏心,心之中又有心焉。彼心之心,音以先言,音然後形,形然後言。言然後使,使然後治。不治必亂,亂乃死。

“How to explain that which is in peaceful heart? [When] I (ego) and heart are regulated, officials (organs) are regulated. [When] I and heart are at peace, officials are in peace. One regulating them is heart. One pacifying them is heart. There is heart hidden within heart. In the center of the heart there is another heart! This heart within heart is the voice before the words. From the voice follow forms, from the form follow the words. From the words follow actions and from the actions follow governing. [From that which] is not governed follows chaos and from the chaos follows death.”

As non-controlled mind was seen as main reason for chaos and destruction the often emphasized benefit from cultivation was freedom from internal conflict and outer catastrophes. In Nèiyè this freedom is describes thus:

中無惑意,外無邪菑,心全於中,形全於外。不逢天菑,不遇人害,謂之聖人。

“Without confusing thoughts within, one is externally without evil and disasters. Heart maintained in the center and form is maintained externally. [Thus one does] not encounter heavenly calamities nor face human troubles [therefore] we call him a sage.”

Freedom from human suffering later became exaggerated more and more until it became immortality and total untouchability during Han-dynasty and was still aim of contemplative practitioners during Tang-dynasty. See for example text called Preserving Shén and refining Qì.
The themes of freedom, emptiness and cultivation of heart were also present in many other writings of the time, but were often less instructive and more ambiguous in their poetic or prosaic expression. Of these texts Dàodéjīng 道德經 and Zhuāngzǐ are famous examples. Zhuāngzǐ for example describes fasting of the heart in following quote:

回曰:「敢問心齋。」仲尼曰:「若一志,无聽之以耳而聽之以心,无聽之以心而聽之以氣。聽止於耳,心止於符。氣也者,虛而待物者也。唯道集虛。虛者,心齋也。」

“[Yán] Huí said: Could I ask about fasting of mind?
Zhòng Ní answered: When having singular will, you’ll not hear with ears but you hear them with heart. When not hearing with heart you’ll hear them with qì. Hearing stops to listening with ears. Heart stops to symbols. The Qì is emptiness that receives things. Only Dào gathers in emptiness. Emptiness is fasting of the heart.”

Dàodéjīng as the best known Daoist text has collected many different translations around it. The text describes contemplation in its 16th chapter:

致虛極,守靜篤。萬物並作,吾以觀復。夫物芸芸,各復歸其根。歸根曰靜,是謂復命。復命曰常,知常曰明。不知常,妄作凶。知常容,容乃公,公乃天,天乃道,道乃久,沒身不殆。

“Reaching the utmost emptiness and guarding stillness and honesty, 10 000 things are working in union. Contemplating this, I’ll return. Countless humans and beings all return to their root. Returning to the root is called stillness. It is also described as returning to life (fù mìng is literally returning the destiny). Returning to life is called eternity. Knowing eternity is called enlightenment. Not knowing eternity [you just] arrogantly cause disasters. By knowing eternal you’ll accept. From accepting follows fairness. From fairness follows completion. From completion follows heavenly and from heavenly follows Dào. From Dào follows continuation and [then even] disappearance of body is not fatal.”

Considering this particular chapter we have to take into account that Dàodéjīng, as we now read it, was edited by Wáng Bì during early third century. The chapter found from the Mǎwángduī excavation, dating to second century B.C.[5] is very similar but a century older Guōdiàn[6] version does not mention contemplation at all. The importance of observing with empty mind is prominent in many other chapters as well.

Taking into account textual evidence about these contemplative practices and the idea of using them for returning to original state or to finding true nature had clearly been already developed before end of Warring States period. The Chinese still remained isolated from India centuries after writing the meditative texts of Guǎnzǐ or Dàodéjīng and Zhuāngzì. It was only at the first and second centuries during which trading of goods and thoughts between China and India really begun. If we consider the possible dating of historical Buddha to be somewhere around the commonly agreed 566–486 B.C.[7], it is hardly likely that Buddhist influence at the time could have induced such a wide spread of contemplative ideology in China. Buddhist tradition speaks of teachers Ārāḍa Kālāmalta ja Uddaka Rāmaputta as well reputed teachers, so we can say that these practices were also more wide spread in India during that time. But with lack of active trade routes, cultural exchange and having textual sources showing more wide spread cultural use of the contemplative ideas in China, we may conclude that it is highly likely that contemplative practices were developed independently in China and the Buddhist influences merged to Chinese contemplative ideologies and practices only later.

Rise of Buddhism in China however sparked new interest in contemplative practices. Old texts were edited, new texts were written and older classics were interpreted from viewpoint more fitting to contemplative practices. Zuòwàng lùn 坐忘論, which quotes heavily on Dàodéjīng and Zhuāngzǐ, is good example of reinterpreting older scriptures. The spread of Buddhism also influenced other areas of practices like dietary taboos and ethical codes. What remained the same was apophatic nature of contemplative practice. To quote a Tang-dynasty text called Nèiguānjīng 內觀經 – Classic of inner contemplation:

道也者,不可言傳口授而得之。常虛心靜神,道自來居。

“Dào cannot be put to words. By mouth it cannot be given or obtained. [By having] constantly empty heart and tranquil spirit, Dào naturally returns to its residence.”

 

References

  1. Verellen Franciscus and Schipper Kristofer. The Taoist Canon: A Historical Companion to the Daozang. University Of Chicago Press, 2005.
  2. Greene Eric M. Healing breaths and rotting bones: On the relationship between buddhist and chinese meditation practices during the eastern han and three kingdoms period. Journal of Chinese Religions, 4(2):145–184, 3 2014. (www)
  3. Roth Harold D. Daoism in the guanzi. In book Liu Xiaogan (editor), Dao Companion to Daoist Philosophy, pages 265–280. Springer, 2015.
  4. Rickett Allyn W. Guanzi: Political, Economic, and Philosophical Essays from Early China. Princeton University Press, 1998.
  5. Harper Donald. Early Chinese Medical Literature. Routledge, 1997.
  6. Meyer Dirk. Meaning-Construction in Warring States Philosophical Discourse: A Discussion of the Palaeographic Materials from Tomb Guōdiàn One. Doctoral thesis, Leiden University, 2008. (www)
  7. Heinz Bechert, editor. The Dating o fthe Historical Buddha. Die Datierung des Historischen Buddha. Symposien zur Buddhismusforschung, IV, 1, 1991. (www)
Chinese & East Asian Medicines, Religion & Medicine

An Excerpt from Fascicle Twenty-Nine of Huilin’s Yiqie jing yinyi 一切經音義, Pronunciations and Meanings for All [Buddhist] Scriptures

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An Excerpt from Fascicle Twenty-Nine of Huilin’s Yiqie jing yinyi 一切經音義, Pronunciations and Meanings for All [Buddhist] Scriptures[1]

Translated and introduced by Robban Toleno

The following lexical entries come from the Yiqie jing yinyi, a hundred-fascicle guide to the language of Buddhist scriptures that was compiled in 807 by the Buddhist monk Huilin 慧琳 (737-820). Huilin’s philological work builds upon the earlier efforts of the monk Xuanying 玄應 (d.u.). The organization of this reading aid follows the chapters of whatever scripture is under scrutiny. In the excerpt below, Huilin has listed words from the ninth fascicle of the Jin’guangming zuishengwang jing 金光明最勝王經, Sutra of the Most Excellent King of Golden Light[2], which was translated to Chinese in 703 by Yijing (635-713). Much of Huilin’s notation concerns the proper forms and pronunciations of characters. Because the meanings of Chinese words often depended on pronunciation rather than inherent semantic values of characters[3], and because Chinese Buddhists often chanted their scriptures, guidance on the pronunciation of obscure vocabulary had a practical significance. Philological study helped keep chanting in unison, reduced scribal errors in the copying of sutras, and aided readers in interpreting scriptures. Huilin relies on a number of lexical works that predate the arrival of Buddhist writings, effectively grounding the philological study of Buddhist scriptures in a classical vein of Chinese knowledge production stretching back to ancient writings. These lexical notes contain a wealth of information for linguists working to reconstruct the pronunciations of Middle Chinese, which differed considerably from those of modern Mandarin.[4] They also demonstrate that Chinese Buddhist scholar-monks such as Huilin were well versed in practical forms of knowledge including natural history and medicine.

 

Ninth Fascicle of the Jinguangming zuishengwang jing, Sutra of the Most Excellent King of Golden Light

金光明最勝王經卷第九

 

匱乏[5] The first [character’s pronunciation] combines gwijH 逵 and hwijH 位. The Shuowen [jiezi says that] 匱 [means] a box. Derived from 匚, the pronunciation of which is pjang 方, and kjw+jH 貴 for the tone. The latter [character’s pronunciation] combines bjom 凡 and pjop 法. The Shuowen cites the Chunqiu zhuan, saying that [匱乏] is properly interpreted [to mean] lacking (乏). Fa 乏 means paucity.

匱乏(上逵位反。說文匱匣也。從匚，匚音方，貴聲。下凡法反。說文引春秋傳曰:反正為乏。乏少也)。

 

金翅[6] [The second character] combines the sounds syij 尸 and tsyijH 至. Also known as “kae-lju-la” (transliteration of Skt. garuḍa) or ‘dragon-window’, this is the Gold-Winged King of Birds[7], the eater of dragons. Ancient writings render [the character 翅] as 翄 or [羽+氏].

金翅(尸至反，一名加婁羅，一名龍䆫，即金翅鳥王也，食龍者。古文作翄亦作[羽*氏]也)。

 

滋繁[8] The first [character’s] pronunciation is tsij 諮 and its proper form comes from 水 and 並, with two 玄. When today it is rendered 茲, this is a vernacular form of the character. The latter [character] is pronounced byon 煩, with the tone of khawX 考; [its form] derives from 敏, with hejH 系 for the tone.[9]

滋繁(上音諮，正體從水並二玄，今作茲時俗字也。下音煩，考聲也，從敏，系聲也)。

 

老耄[10] The latter [character’s pronunciation] combines maw 毛 and pawH 報. The Liji annotated by Zheng reads, “Mao [means] senile and forgetful.” In ancient writings it derives from 蒿 and is rendered [蒿 over 老]. The Gujin zhengzi derives it from 老 with maw 毛 for the tone. The Zishu‘s having it [老 over 鬼] is a vernacular form of the character.[11]

老耄(下毛報反，鄭注禮記云:耄惛忘也。古文從蒿作[蒿/老] ，古今正字從老，毛聲，字書有作[老/鬼]俗字也)。

 

痰癊[12] The first [character’s] pronunciation is dam 談; the second is a combination of ‘im 陰 and kimH 禁. Note that the characters for 痰癊 do not have a definitive form. An illness of the breath located in the diaphragm. Bodily fluid that congeals and does not disperse due to a shortness of breath, and which like tendon glue (a collagen/gelatin product) does not sever when stretched. Its name is dam ‘imH 痰癊 and among the root [causes] of the four [types of] illness, this one can cause a hundred illnesses, all of which are ailments of the diaphragm.

痰癊(上音談，下陰禁反。案痰癊字無定體。[凶/月]鬲中氣病也。津液因氣疑結不散，如筋膠引挽不斷。名為痰癊，四病根本之中此一能生百病，皆上焦之疾也)。

 

鹹醋[13] The first [character’s] pronunciation is heam 咸. The “Hongfan” [chapter of the Shangshu] says of water that it trickles downward and becomes salty (鹹). The Erya says saltiness is bitter. Annotation [of the Erya] by Guo says bitter is great saltiness. The Shuowen [says] 鹹 [is pronounced] haem 銜 and is the flavor of the northern regions. [The character] derives from 鹵 with heam 咸 for the tone and luX 鹵 for the sound. The Lujing‘s use of 酉 to make 醎 is erroneous, as this is not a proper form [of the character]. The latter [character in the headword] combines tshang 倉 and kuH 固, [having the same] tone as khawX 考, and refers to vinegar. The Jixun [gives] swan 酸 [for 鹹酸, salty and sour].[14] This character (酸) is not proper, and according to the customary meanings and pronunciations [given] in scriptures, the character tshuH 醋 [associated with] fermented bean sauces is [to be] used. The wordbooks of the various philologists of recent generations are in agreement on the above pronunciation.[15] The Shuowen and [other] ancient wordbooks have since former times held that the construction 醋 is pronounced the same as dzak 昨. Where the [Jixun] says, “A guest pours (tsyak 酌) wine with the host,” this corresponds with the [second] character in dzyuw tsak 酬酢 (to toast with wine), the pronunciation of which combines dzang 藏 and lak 洛 and means to toast reciprocally with wine. If we rely on [information in] the Shuowen, the seven wordbooks Yupian, Gujin zhengzi, Wenzi dianshuo, Guangya, Qieyun, Zitong, and Zilin have both tsjangH 醬 (fermented bean sauces) and 醋 as derived from dzraeH 乍 to form tsak 酢 (the return toast of a guest to a host). Orthodox physicians [have] the character 酢 deriving from 乍. The Shuowen says it is verified. The Cangjiepian [has] 酸. The custom today is to revert to using the pronunciation dzak 昨. [I] still do not know which of the two forms is right, in the past or today, so for now I am writing both [solutions] together here.

鹹醋(上音咸。洪範云水曰:潤下潤下作鹹。尒雅云鹹苦也。郭注云苦即大鹹也。說文鹹銜也北方味也。從鹵，咸聲,鹵音。魯經從酉作醎誤也，非正體。下倉固反，考聲，云醋䤈也。集訓酸也。此字非正，且依經義音之俗用醬醋字也。近代切韻諸家字書並同上音。說文及古字書從昔作醋者並音為昨。訓云客酌主人酒也，是相酬酢字也，音藏洛反，獻酬也。若依說文，玉篇、古今正字、文字典說、廣雅、切韻、字統、字林七本字書醬醋字並從乍作酢。音倉固反。正醫酢字從乍也。說文云驗也。蒼頡篇酸也。今俗用却音為昨。未知二體今古孰是，今並書之也)。

 

甛膩[16] The first [character’s pronunciation] is a combination of drip[17] 䐑 (M. zhé) and yem 閻. The Guangya [says it means] sweet. The Shuowen [says it means] tasty 美, deriving from a sweet (甘) tongue (舌), which if formed into 甜 also means the same. The latter [character] is a combination of nrij 尼 and trjeH 智. The Chuci annotated by Wang Yi says that 膩 means oily. The Shuowen [gives] [月+㔾] (perhaps a variant of chì [月+匕], meaning an oily/slick appearance), [saying] it is derived from 肉 (meat) with nyijH 貳 for the tone, and is not derived from 月 (moon).

甛膩(上䐑閻反，廣雅甛甘也。說文美也，從甘舌，或作甜亦通。下尼智反，王逸注楚辭云膩滑也。說文[夗-夕+月]也，從肉，貳聲，從月非也)。

 

鍼刺[18] The first [character’s pronunciation] combines tsyip 執 and nyimH 任. The Guangya [says] 鍼 also [means] to prick (刺). The Liji says married women wear on the right side of the waist a needle tube and silk thread. The Shuowen accordingly [refers to] sewing. The Yupian [gives] the patching of clothes. Vernacular usage makes 針 based on 十, which not only accords with the times but is moreover in [common] use. The proper [form] derives from 金 (metal) and 箴 (needle), with simplification of the phonetic [element of the character, i.e., 箴 becoming 咸]. Pronunciation of the latter [character] 刺 [in the headword] is a combination of tsheng 青 and yek 亦, and also of tshjeX 此 and sijH 四. The two pronunciations are both acceptable for the proper form of the character. The Shuowen [says that 刺 means] to meet with injury. Gu Yewang[19] writes that [it means] needle-sharp and piercing into human flesh,[20] and says that the Gujin zhengzi [has it] derived from 刀 with tshjeH 朿 for the tone, 朿 being pronounced tshijH 次.[21] Deriving it from 朿 is not correct. Where scriptures have it derived from 夹 to make 刾, this is a vernacular character form.

鍼刺(上執任反。廣雅鍼亦刺也。禮記婦右佩鍼管線纊，說文所以縫也。玉篇綴衣也。俗用從十作針，亦順時，且用也。正從金從箴，省聲。下刺音青亦反，又此四反，二音並通正體字也。說文直傷也。顧野王云銳鑱人(=入)人肉中曰古今正字從刀，朿聲，朿音次，從朿者非也。經從夹作刾俗字也)。

 

鼻梁㩻[22] The last [character’s] pronunciation is khi 欺. Gu Yewang writes that 㩻 [means] slanted and not straight. The Shuowen [says it means] 陋 (provincial, inferior),[23] and that it derives from ngjwe 危, with tsye 支 for the tone. Others have it derived from 山 to make 崎; still others have it derived from 器 to make [器+支]. These are all ancient characters. Where scriptural writings derives it from 奇 to make 攲, this is not right. Sun Qingzi (the philosopher Xunzi) wrote that the ancestral shrine of Duke Huan had in it a ’tilting vessel’ (㩻器), which slanted when empty, overturned when full, and [remained] level when filled to the middle, in conformity with [the way] people [are].

鼻梁㩻(下音欺顧野王云㩻傾側不正也。說文陋也，從危，支聲。或從山作崎，或從器作[器+支] ，皆古字也。經文從奇作攲非也。孫卿子曰桓公廟有㩻器焉，虛則㩻，滿則覆，中則平，以誡於人也)。

 

餌藥[24] Combining nyi 而 and tsyiH 志, [餌] is a falling-tone character (去聲字).[25] The Cangjiepian says that 餌 is food. Gu Yewang says that in general everything that is eaten is called 餌. The Gujin zhengzi [says it refers to] cakes. The Shuowen derives it from [弓+畐+弓] to make [耳 over 弓+畐+弓], [defining it as] pastries.[26] Deriving it from [弓+畐+弓] with nyiX 耳 for the tone is an ancient character. Today it is derived from 食 to make 餌. The Zhouli annotated by Zheng Xuan (127-200) writes that what is steamed together is called pjengX 餅 (cakes and other products made from flour). The Zishu says it is 餻 (cakes or pastry).[27] The Shuowen derives it from 食 (food) with nyiX 耳 for the tone.

餌藥(而志反，去聲字也。蒼頡篇云餌食也。顧野王云凡所食皆曰餌。古今正字餅也。說文從[弼-百+(幅-巾)]作[耳/(弼-百+(幅-巾))]粉餅也，從[弼-百+(幅-巾)]耳聲古字也。今從食作餌。鄭玄注周禮云合蒸曰餅。字書云糕也。說文從食耳聲也)。

 

豺狼[28] The first [character] is pronounced dzrea 柴 [and] is the name of a rural animal. The Kuodi zhi says that the shape of dholes is like that of dogs but smaller, that they like to move in groups, and that they are a social animal. There is a [status] difference between the high and the low. Slave (i.e., low status) dholes will often move on ahead [of the group] and hunt down a bird or deer, and, not daring to start eating first, will keep guard, waiting for the leading dhole. The leading dhole arrives later but eats first, and only when it is satiated and abandons the remaining meat will the slave dholes commence eating together. The “Yueling” chapter of the Liji says that in the moon of the autumn season (the ninth month of the lunar calendar), dholes make sacrificial offerings of animals. The latter [character of the headword] is pronounced lang 郎. It is a wild animal. The deserts of the northern lands abound with this animal. They often live in dens [near] rivers and marshes. The Shuowen says wolves resemble dogs, with a pointed head and white forehead that is protruding in the front and wide in the back, the ears rising up vertically, the mouth square, the tail usually hanging downward, [and the fur] a bluish yellow or white color. They are exceedingly strong––donkeys, horses, people, and domestic animals all suffer harm. The Erya says of wolves that the males are called xwan 貛 (“badgers”), the females[29] lang 狼, and their young 獥 (M. jiào[30]), and that they are incomparably strong and fast. [狼] is a phono-semantic character (i.e., with one part providing a sound and another indicating something about the meaning). The pronunciation of 貛 is xwan 歡.

豺狼(上音柴。山獸名也。括地志云豺形似狗而小，好羣行，義獸也。有良賤之異。豺奴常先行獵得禽鹿等物，不敢前食，守待豺郎。豺郎後至先食，飽棄餘肉，豺奴方始共食。禮記月令云季秋之月豺乃祭獸。下音郎。野獸也。北地沙漠多饒此獸。常居川澤穴處。說文狼似犬，銳頭白額高前廣後，耳聳竪，口方，尾常垂下，青黃色或白色。甚有力，驢馬人皆遭害。爾雅曰狼，牡貛，牡狼，其子獥，絕有力迅。形聲字。 貛音歡也)。

 

狐玃[31] The first [character’s] pronunciation is hu 胡. Above, I already explained 野狐 (wild foxes). The latter [character’s pronunciation] is a combination of kju 俱 and ngjak[32] 籰 (M. yuè). The Erya annotated by Guo says that the jue 玃 is like the macaque only larger, bluish-black in color, and that it is able to seize and carry off humans, from which it gets its name.[33] Looking back [over the written record], this type of category is exceedingly common. Each has a different name. The Shuowen says it is a female monkey. Another name [for it] is naw 獶, a character with the form (a semantic indicator) on the left and the sound on the right. The pronunciation of 獶 is a combination of nu 奴 and taw 刀.

狐玃(上音胡。前已釋野狐也。下俱籰反。郭注爾雅云玃似獼猴而大，倉黑色，能[玃-(目*目)+賏]持人，故以為名。好顧眄此等種類甚多。各別異名。說文母猴也。一名獶，左形右聲字也。獶音奴刀反)。

 

鵰鷲[34] The first [character’s] pronunciation is tew 彫. The latter [character’s pronunciation] is dzjuwH 就. Because the third fascicle of the [Yiqie] yinyi on the Da bore jing (Skt. Mahāprajñāpāramitā-sūtra) already has an explanation [on this], I will not reiterate.[35]

鵰鷲(上音彫也。下音就。前大般若經音義第三卷已具釋文，繁不述)。

 

宛轉[36] The first [character’s pronunciation] is a combination of ‘jwon 冤 and hjwonX 遠. The Shuowen says 宛轉 [means] wo 臥 (resting, reposed). [The first character] deriving from xi 夕 (evening), [it means] resting (臥), temperate (有節). It derives from 夕 and 卪(= jié 節). Scriptures also have it derived from 女 (woman) to make ‘jwonX 婉 (gentle), [but that] is not this usage.

宛轉(上冤遠反。說文宛轉臥也。從夕，臥，有節也。從夕從卪。經又從女作婉，非此用也)。

 

欲涸[37] A combination of ha 何 and kak 各 [constitutes the second character’s pronunciation]. The Guangya says that 涸 [means] to be exhausted. The Guoyu annotated by Jia says that 涸 [means] to be used up. The Shuowen says that water dries up (涸). It derives from water 水, with kuH 固 for the tone.

欲涸(何各反。廣雅涸盡也。賈注國語云涸竭也。說文水涸也。從水固聲也)。

 

象廄[38] The first is the proper form of the character 象. The latter [character’s pronunciation] is a combination of kjuw 鳩 and hjuwH 又. The Shuowen [says these are] lodgings for elephants and horses. The Zhouli says 214 horses make up one jiu 厩 (stable).[39] Derived from 广 and 段. The pronunciation of 广 is ngjaemX 儼. The pronunciation of kjwieX 𣪘 is the same as [what was given] above.

象廄(上正體象字也。下鳩又反。說文象馬舍也。周禮曰馬二百一十四匹為一厩。從广段，广音儼。𣪘音同上也)。

 

皮囊[40] [The second character is] a combination of nak 諾 and lang 郎. Explanatory notes in the [Qieyun[41]] say that it is a bag with a base. It derives from [襄-〦], which derives from hwonH 㯻 (to tie up), simplified to [襄-〦] and pronounced nreang[42] 儜 (M. níng). 㯻 is pronounced hwonH 溷.

皮囊(諾郎反。韻詮云有底袋也。從[襄-〦]從㯻省[襄-〦] ，音儜。㯻音溷)。

 

循岸[43] The pronunciation of 循 is zwin 巡. Zwin 循 (“to follow the course of”) developed from 行 (walking).

循岸(循音巡，循由行也)。

 

睡寤[44] The first [character’s pronunciation] combines dzywe 垂 and lwijH 淚 and means sleep. The latter [character’s] pronunciation is mjuH 悟 and means to fall asleep. [It] derives from mjuwngH 㝱, economizing by deriving from [only] 爿.

睡寤(上垂淚反，眠也。下音悟，睡覺也。從㝱省從爿也)。

 

References

Baxter, William H. and Laurent Sagart. Old Chinese: A New Reconstruction. New York: Oxford, 2014.

Dictionary of Chinese Character Variants => Taiwan Ministry of Education. Yitizi zidian 異體字字典, http://dict2.variants.moe.edu.tw/variants/rbt/home.do; accessed November 2016.

Kroll, Paul W. A Student’s Dictionary of Classical and Medieval Chinese. Leiden / Boston: Brill, 2015.

Kwan, Tze-wan. “Abstract Concept Formation in Archaic Chinese Script Forms: Some Humboldtian Perspectives.” Philosophy East and West 61, no. 3 (2011): 409–52.

McDonald, Edward. “Getting Over the Walls of Discourse: “Character Fetishization” in Chinese Studies.” The Journal of Asian Studies 68, no. 4 (2009): 1189–213.

Muller, A. Charles, ed. Digital Dictionary of Buddhism. http://buddhism–dict.net/ddb. Edition of 2016-08-28.

SAT => SAT Daizōkyō Text Database 大正新脩藏經テキストデータベース , http://21dzk.l.u-tokyo.ac.jp/SAT/satdb2015.php; accessed November 2016.

T. => Taishō shinshū daizōkyō 大正新脩大藏經, Taishō-Era Newly Revised Tripitaka, the digitized text of which can be accessed through CBETA or SAT.

Notes

[1]           T. 2128, v.54, 502c07-503a16.

[2]           Skt. Suvarṇa-prabhāsôttama-sūtra. Yijing’s translation is T. 665, v.16, beginning on 403a04. For detailed notes regarding this sutra and its various editions, see Michael Radich, “Jinguangming jing 金光明經,” in Muller, Digital Dictionary of Buddhism, http://www.buddhism-dict.net.ezproxy.cul.columbia.edu/cgi-bin/xpr-ddb.pl?91.xml+id(‘b91d1-5149-660e-7d93’).

[3]           The compound qīqū is a good example of a word that can be represented with different character sets (崎嶇, 陭䧢, and 㩻䧢) and still mean the same thing. On the ideograph/logograph debate over what constitutes a word in premodern Chinese, see McDonald, “Getting over the Walls of Discourse” and Kwan, “Abstract Concept Formation in Archaic Chinese Script Forms.”

[4]           For an example of how Huilin’s work has been useful to linguists, see Baxter and Sagart, Old Chinese, 114.

[5]           MC gwijH bjop / M. guìfá; Skt. vaikalya; poverty. Huilin’s lexical notes include pronunciation glosses based on Middle Chinese (MC), which differs from modern Mandarin Chinese (M.) pronunciations. Where pronunciation is mentioned, I provide first Middle Chinese and then Mandarin readings, giving the Mandarin tone only for the headword and for instances where the body text discusses tonal values. The Middle Chinese readings are from Kroll, A Student’s Dictionary of Classical and Medieval Chinese, 53, which are based on Baxter and Sagart’s reconstructions. In some cases I have inferred Middle Chinese readings from the fanqie 反切 explanations provided by Huilin, if I cannot otherwise find a reconstruction. Because the logic of some of his explanations does not work there is a good likelihood of errors, whether entering from Huilin’s judgment or dialect, from problems with our modern-day reconstructions, or from my own carelessness. The traditional tonal system of Middle Chinese is indicated as follows: an unmarked (no X, H, or k) final position indicates a píng 平 tone; -X in the final position indicates a shǎng 上 tone, -H a qù 去 tone, and -p, -t, or -k in the final position a rù 入 tone. I find this notation cumbersome, but follow it because it is in use. See Baxter and Sagart, Old Chinese, 14.

[6]           MC kim syeH / M. jīnchì; Skt. garuḍa; a kind of mythical super bird like a roc.

[7]           An alternative reading has 王 as 正. The statement would then read that, of the different names for this bird type, jinchiniao 金翅鳥, or Gold Winged Birds, is the proper one.

[8]           MC tsi bjon / M. zīfán; proliferate.

[9]           Even after comparing Middle Chinese reconstructions, the logic of this statement is not clear.

[10]         MC khawX mawH / M. lǎomào; an elderly person; senile.

[11]         This text is probably the Ganlu zishu 干祿字書, by Yan Yuansun 顔元孫 (jinshi ca. 685-688).

[12]         MC dam ‘imH / M. tányìn; phlegm.

[13]         MC hen tshuH / M. xiáncù; salty and sour.

[14]         The identity of this work is not clear, as “jixun,” which appears to mean an anthology for training purposes, is likely an abbreviation of a longer title.

[15]         Wordbooks 字書 are semantically organized word lists, such as the Erya.

[16]         MC dem nrijH / M. tiánnì; sweet, sweet and fatty. A character variant is used which cannot be represented digitally: 肉*(武-止+(二/貝)). Having confirmed this variant (see A03366) in the Dictionary of Chinese Character Variants (異體字字典) maintained by the Taiwan Ministry of Education (http://dict2.variants.moe.edu.tw/variants/rbt/home.do), I use the standard form.

[17]         Inferring the reconstruction from 直葉切, as given in the Shuowen jiezi, accessed through the Dictionary of Chinese Character Variants.

[18]         MC tsyim tshjeH / M. zhēncì; pricking with needles; acupuncture.

[19]         Author of the Yupian and other works. He lived 518-581 CE.

[20]         Reading the first 人 as 入, since this appears to be a transcription error.

[21]         Discrepancies like this show the tentative nature of our knowledge of Middle Chinese reconstructions.

[22]         MC bjij ljang khje / M. bíliáng qī; “the bridge of the nose is slanting.”

[23]         Although this is the character appearing in the print and digital editions of the Taishō Buddhist canon, it appears to be an error, whether by Huilin or by a later scribe. The Shuowen gives khju / qū 䧢, meaning slanted. This character occurs in the compound qīqū, meaning steep (as in a road or hillside), and variously represented as 崎嶇, 陭䧢, and 㩻䧢.

[24]         MC nyiX yak / M. ěryào; to take medicine. Despite Huilin’s discussion here about cakes and pastries, historical sources use this compound as verb+object, meaning to eat medicine.

[25]         Huilin would have it pronounced nyiH.

[26]         “Powder cakes.” These are a type of small pastry made from powdered ingredients lightly bound together.

[27]         Following the Taishō print edition. The digitized canon shows 糕.

[28]         MC dzreaj lang / M. cháiláng; dholes (Asian wild dog) and wolves.

[29]         The Taishō print edition and corresponding digital text is in error here. The second 牡 should read pin 牝, a female animal.

[30]         The Middle Chinese is not clear for this character, which seems to have had multiple phonetic readings through its history.

[31]         MC hu kyak / M. hújué; foxes and apes.

[32]         Inferring the reconstruction from 玉縛切, as given in the Shuowen jiezi.

[33]         Reading 倉黑 as 蒼黑 and [玃-(目*目)+賏] as kjak / jue 攫, which appears to be the implied meaning.

[34]         MC tew dzjuwH / M. diāojiù; eagles and vultures.

[35]         Huilin provides explanations in several places, e.g. T54 n2128, 334b20-21.

[36]         MC ‘jwonX trjwenX / M. wǎnzhuǎn; resting, reposed; in some contexts it has the nuance of being supple, accommodating.

[37]         MC yowk hak / M. yùhé; desires dry up.

[38]         MC zjangX kjuwH / M. xiàngjiù; elephant stables.

[39]         Three characters have entered modern usage as acceptable variants for the word kjuwH / jiù, “stable”: 廄, 厩, and 廐.

[40]         MC bje nang / M. pínáng; leather bag.

[41]         Or perhaps this refers to another rime dictionary.

[42]         Inferring from 女耕切, as given in the Yupian and Guangyun.

[43]         MC zwin nganH / M. xún’àn; to follow the course of a riverbank.

[44]         MC dzyweH nguH / M. shuìwù; to sleep and wake.

Chinese & East Asian Medicines

Nestorian Christianity in the Tang Dynasty

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This is a syndicated post that first appeared at: http://huayanzang.blogspot.com/2016/10/nestorian-christianity-in-tang-dynasty.html

Nestorian Christianity in the Tang Dynasty

As of late I’ve been reading about the Nestorian Christian (Jingjiao 景教) community that thrived in China from the early seventh to mid-ninth century. Their church was, it seems, largely responsible for transmitting Hellenistic astrology and even some Near Eastern occult practices into China, hence my present interest. Their active influence in Chinese religious history during this period is not always recognized, especially in Buddhist Studies. There are several documents from their movement preserved in Chinese, in addition to two steles that were unearthed in Chang’an and Luoyang, thus we know a fair amount about their church.

Nestorianism as a Christian movement initially developed in the fifth century starting from Nestorios (c.381–c.451), who was bishop of Constantinople between 428–431. The primary doctrine of Nestorianism is that Christ was comprised of two separate persons, one human and one divine. This was rejected as heretical by their opponents. The Nestorian bishops were condemned at the Council of Ephesus in 431. The result was an eastward spread of the Nestorian movement. It eventually spread all across the Near East and Central Asia before reaching China in the year 635 when a mission led by Aluoben 阿羅夲 (also rendered as 阿羅本) arrived in the capital Chang’an 長安. His name in Chinese might have been a transliteration of ‘Abraham’. This mission occurred towards the final years of the Sassanian dynasty (224–650), and was shortly after the first Arab invasions of Iran starting in 633.1 This leads me to wonder if these early Christians in China might have been refugees.

By the late eighth century the Nestorian Christian community was thriving in China. We know this from a famous stele that was erected in the year 781, often called the ‘Nestorian Stele’ 大秦景教流行中國碑. The stele inscription describes the first Christian mission to China, some basic Christian doctrines and the names of clergymen in Chinese with parallel Syriac and Persian names written in Syriac script. It interestingly also provides dates according to the Chinese, Greek and Persian calendars. The text is composed in very elegant literary Chinese and was clearly written with elites in mind judging from its grammar and use of refined vocabulary.

The inscription on the stele was composed by a certain cleric named Adam 景淨 from Daqin-si 大秦寺. In one Buddhist source, to which we will return shortly, Adam is also identified as a ‘Persian monk’ 波斯僧.2 ‘Daqin-si’ referred to a Nestorian Christian church, but in this case refers to the one in Chang’an. Normally, Buddhist monasteries are indicated by the suffix –si 寺 (temple), but throughout the Tang dynasty (618–907), Nestorian churches were also designated with this suffix. There were such churches in both capitals (Chang’an and Luoyang). They were originally called ‘Persian temples’ 波斯寺 due to the original missionaries in 635 having come from Persia, though in 745 an imperial edict had them renamed to Daqin-si. The following edict records this.

天寶四載九月詔曰：波斯經教，出自大秦，傳習而來，久行中國。爰初建寺，因以為名，將欲示人。必修其本。其兩京波斯寺，宜改為大秦寺。天下諸府郡置者，亦準此。

In lunar month nine of year four [745] in reign era Tianbao the following edict was issued. The scriptural teachings of Persia came from Daqin, and long have they been transmitted in China. They were named [as Persian temples] when they were first built so as to show people [their origin]. It is necessary to revise their origin. The Persian temples in the two capitals should be renamed to ‘Daqin temples’. All prefectures and counties in which [such temples] are present will also follow suit.3

The ‘Daqin’ 大秦 (‘Great Qin’) in the name of the church is interesting as this term originally referred to the Roman empire in the early centuries CE, or more specifically its eastern territories, in particular Alexandria. In the eighth century, however, it does not appear to refer to the Byzantine empire, but rather to the Levant in general. The evidence to support this assertion is actually found in the stele from 781 as it provides the following hint:

神天宣慶，室女誕聖於大秦；㬌宿告祥，波斯覩耀以来貢。

The angel [Gabriel] proclaimed good tidings. The Virgin gave birth to the Sage in Daqin. The luminous asterism indicated a portent. The Persians witnessed the brilliance and came to pay tribute.

This of course is referring to the birth of Jesus Christ in Bethlehem. In light of this and the otherwise nebulous understanding of Daqin as being “west of the Western sea ​(i.e., the Caspian Sea),” I am convinced that ‘Daqin’ refers to the general geographic region of the Levant. It seems that Nestorians arriving in China all identified as either from Persia or Daqin, which is instructive since these territories were under the rule of the caliphates. They did not, so far as I know, identify as coming from Arabia. The word for Arabia in Chinese in this period was Dashi 大食, its Middle Chinese pronunciation reconstructed as dâiᶜ dźjək(Schuessler IPA). This is most certainly derived from Middle Persian word tāzīk / tāzīg, ‘Arab’.4 One might imagine Nestorian Christians in China identifying their ethnicity as Syrian, Persian or Sogdian, but never Arab even when they had been born under a caliphate.

Incidentally, later on ‘Daqin’ was changed to ‘Fulin’ 拂菻. In Middle Chinese this is reconstructed as pʰjuət *ljəmᴮ (Schuessler IPA). This appears to be a transliteration of an Iranian pronunciation of ‘Rome’, such Sogdian frwn and brwn, or Middle Persian hrōm. How do we know that this refers to Byzantium specifically? The New History of the Tang 新唐書, the revised history of the Tang dynasty compiled in 1060, states the following.

拂菻，古大秦也，居西海上，一曰海西國。去京師四萬里，在苫西，北直突厥可薩部，西瀕海，有遲散城，東南接波斯。

Fulin in former times was Daqin. It is located on the western sea. One [account] calls it the ‘Country on the Western Sea’. It is forty-thousand li from the capital [of Chang’an]. It is west of *Shan. To the north it meets the Turkish Khanate. To the west it approaches the sea, where there is *Alexandria.5 To the southeast it meets Persia.

The name Shan 苫 here most likely refers to Damascus. Its Middle-Chinese pronunciation is reconstructed as syem (Baxter-Sagart 2011). This seems to correspond to al-Shām, the Arabic name for Syria. A Chinese writer named Du Huan 杜環 travelled to the Abbasid Caliphate and returned to China in 762. His travelogue, the Jingxing ji 經行記, states that “the country of *Shan is on the western frontier of the Arab [state]” (苫國在大食西界).

The Byzantine Empire c. 867

This change in name from Daqin to Fulin appears to reflect the ongoing loss of territory of the Byzantium empire. The Levant in the ninth century was no longer under the control of Byzantium state. Chinese scholars only possessed an approximate conception of the Near East’s political and physical geography, which helps to explain why Alexandria is erroneously placed at its western side. Nevertheless, it is quite clear that Fulin is a transliteration of an Iranian pronunciation of ‘Rome’. Nestorians initially identified themselves as having come from Persia. Later they identified as hailing from ‘Daqin’, a general term for the Levant, likely as a result of the demise of the Sassanian state by the mid-seventh century. Finally, at some point in the ninth century it seems that ‘Daqin’ was understood to be the former territories of ‘Rome’ occupied by the Arabs.

Returning back to Nestorianism in China, I want to discuss its interaction with Buddhism. There is an account of the aforementioned clergyman Adam translating a Buddhist text with the Buddhist monk Prajñā 般若.

請譯佛經。乃與大秦寺波斯僧景淨，依胡本六波羅蜜經譯成七卷。時為般若不閑胡語，復未解唐言，景淨不識梵文，復未明釋教。雖稱傳譯未獲半珠。… 察其所譯理昧詞疎。且夫，釋氏伽藍，大秦僧寺，居止既別，行法全乖。景淨應傳彌尸訶教，沙門釋子弘闡佛經，欲使教法區分，人無濫涉。

They requested he [Prajñā] translate Buddhist scriptures. Together with the Persian monk Adam of Daqin-si, he translated the *[Mahāyāna-naya-]ṣaṭ-pāramitā-sūtra in seven fascicles based on a Sogdian edition. At the time Prajñā did not understand Sogdian or Chinese, while Adam understood neither Sanskrit nor Buddhism. Although they were said to have translated it, they had yet to obtain the half-pearls [i.e., ascertain the meaning]. … Upon investigating what had been translated, the reasoning was found to be unclear and the vocabulary off. The Buddhist monastery and Daqin church were to keep their residences separate and their practices entirely apart. Adam should transmit the teachings of the Messiah, while Buddhists shall propagate Buddhist scriptures, so as to keep the doctrines separate, and the peoples from excessive intermingling.6

This accounts suggests to me that while the state authorities respected both religions, they desired to keep them separate. In light of the elegant Chinese that Adam composed for the stele of 781, we can infer that he was quite learned in the Chinese classics, and therefore likely mingled with aristocrats in the capital. In such circles eminent Buddhist monks and Daoist priests were also active, thus there were many opportunities for elite religious thinkers to interact.

Another interesting fact about Nestorianism in China is that their clerics are on record as having practiced medicine in China. As to the type of medicine they practiced, I have reason to believe that it was actually Greek. Returning to the travelogue by Du Huan, he gives the following interesting account.

其大秦善醫眼及痢，或未病先見，或開腦出蟲。

The Daqin are adept in treating eyes and dysentery. Some can foresee illness before symptoms emerge. Some can perform trephinations and remove parasites.

The New History of the Tang also mentions such medical practices in Byzantium.

有善醫能開腦出蟲以愈目眚。

There are skilled physicians capable of performing trephinations and removing parasites to heal eye diseases.

Cranial surgery of this type was well known in ancient Greek medicine. As Arani and others note, “Cranial trepanation was first recorded by Hippocrates (460–355 BC).”7 This surgery was apparently performed in China as early as the late years of Emperor Gaozong 高宗 (r. 649 – 27 December 683). There is a story recorded in the Old Book of Tang 舊唐書, compiled in 945, and elsewhere that a cranial operation was performed on Gaozong.

上苦頭重不可忍，侍醫秦鳴鶴曰：「刺頭微出血，可愈。」天后帷中言曰：「此可斬，欲刺血於人主首耶！」上曰：「吾苦頭重，出血未必不佳。」即刺百會，上曰：「吾眼明矣。」

The Emperor was suffering intolerable headaches. His retainer physician Qin Minghe said, “It could be healed by piercing the head and drawing a bit of blood.” The Empress [Wu Zetian] behind a screen said, “He should be beheaded, wanting to draw blood from the leader of men!” The Emperor said, “My headaches are severe. Drawing blood is not necessarily bad.” The crown of the skull was pierced. The Emperor said, “My eyes has cleared up!”

The name Qin Minghe 秦鳴鶴 here possibly indicates a foreigner. The surname Qin could be derived from Daqin and in light of the surgery he performed he was likely from abroad. Huang (2002) and others attempt to identify him as an immigrant Nestorian clergyman.8 Although this is not certain, there are still other accounts that confirms the presence of Nestorian physicians in Tang China. In year 28 of reign era Kaiyuan 開元 (740), the clergyman Chongyi 僧崇一healed the younger brother of Emperor Xuanzong 玄宗 (r. 712–756).9 A report by Li Deyu 李德裕 (787–849) states that a certain Daqin cleric proficient in optometry (醫眼大秦僧一人) was present in Chengdu 成都 at one point.10

It is therefore clear that Nestorian clergyman did in fact practice medicine in China during the Tang dynasty, and moreover they most likely brought with them Greek medical techniques. They also introduced other foreign sciences and arts, such as astronomy and astrology. In 1980 in Xi’an the tombstone of a court astronomer was discovered. His name was Li Su 李素 (743–817) and he is identified as a Persian. It seems that he was a Christian clergyman from the community of Persians resident in Guangzhou. Sometime between 766–779 he was summoned to the court to work in the bureau of astronomy. Later his ‘courtesy name’ 字 of Wen Zhen 文貞 alongside the corresponding name ‘Luka’ in Syriac appears on the list of Christian clergymen on the stele of 781.11 Although not immediately clear from his biographical information, he likely practiced Hellenistic astronomy in light of his ethnic and religious backgrounds. Earlier ‘foreign’ court astronomers, such as Gautama Siddhārtha, employed and even translated Indian astronomy. Li Su as a replacement for Gautama Siddhārtha was likely functioning as a ‘second opinion’ at court in matters related to astronomy and calendrical science, providing a perspective based on foreign methods.

Nestorian clergymen clearly played important roles throughout the Tang dynasty. They were eliminated in China as an institution and religion in 845 when Emperor Wuzong 武宗 (840–846), a Daoist zealot, initiated a purge of foreign religions. Buddhism, Manichaeism and Christianity were, at least in the capital region, rapidly dismantled and their assets liquidated. Buddhist sangha members were defrocked, while Manichean priests were put to death.12 Christianity was to a large part eliminated as a major religion in China until several centuries later under the Mongols.

2《大唐貞元續開元釋教錄》卷1：「大秦寺波斯僧景淨」(CBETA, T55, no. 2156, p. 756, a20-21)

3 This is reported in fasc. 49 of the Tang huiyao 唐會要.
4 There were many ethnically Iranian persons in Tang China, including those identifying themselves as Persians, but also Sogdians and Bukharans.
5 Chisan 遲散 here refers to Alexandria. This is geographically problematic, but the Chinese understanding of the Near East was pieced together from multiple, often chronologically disparate, sources. See Yu Taishan, “China and the Ancient Mediterranean World: A Survey of Ancient Chinese Sources,” Sino-Platonic Papers 242 (2013): 34. http://sino-platonic.org/complete/spp242_china_mediterranean.pdf
6《貞元新定釋教目錄》卷17 . CBETA, T55, no. 2157, p. 892, a7-15.
8 Huang Lanlan 黃蘭蘭, “Tangdai Qin Minghe wei jingyi kao” 唐代秦鳴鶴為景醫考, Zhongshan Daxue xuebao 中山大學學報 42, no. 5 (2002): 61–67.
9 Jiu Tang shu 舊唐書 (fasc. 95).
10 See fasc. 703 of the Quan Tang wen 全唐文.
11 Rong Xinjiang 榮新江, “Yi ge shi Tangchao de Bosi Jingjiao jiazu” 一個仕唐朝的波斯景教家族, in Zhonggu Zhongguo yu wailai wenming 中古中國與外來文明 (Beijing: Sanlian Shudian, 2001), 255–257.
12 This is recorded in the journal of Japanese monk Ennin 圓仁 (794-864):【四月】中旬 敕下，令殺天下摩尼師。剃髮，令着袈裟，作沙門形而殺之。摩尼師即迴鶻所崇重也。
Chinese & East Asian Medicines, Research & Teaching

New Digital Tools for the History of Medicine and Religion in China

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This is a syndicated post that first appeared at www.cpianalysis.org.

When we do textual research on China, we rely on canons that were made with paper. The gold standard for a digital corpus is that it is paired with images of a citeable physical text produced in known historical conditions: at a specific time and place, by a known author or community, or as close to that as possible. Even more, the basic organisation of our wonderful modern databases is structured according to the catalogue and chapter headings of the original collections, which are essentially finding tools for paper archives. While these categories organised the literature and made it easier to find, they also profoundly influence how we, in turn, organise our own research, and how we write history.

The problem is that the categories of researchers change with time. As we analyse our sources in new ways, we give priority to certain texts or features over others, effectively re-indexing them to suit our purposes. Usually, textual scholars will privilege a few texts as case-studies for close study, because we lack the tools for large-scale analysis of textual corpuses to make summative statements about a field of knowledge, or to track changing patterns of a field over time. We can perform thorough and extensive searches for single or a few terms across wide sets of literature, but the long lists of results that are returned are unreadable by humans.

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Figure 1: Search result for a single term, gancao 甘草 (liquorice) in a major text collection

We have a problem of too much information, and too few ways of making sense of it.

In my digital work in the combined histories of Chinese medicine and of Chinese religions, I wish to make a critical intersection into how we theoretically interpret, and digitally analyse our sources. The history of Chinese religions has recently taken on some new directions in the theory of practice. In order to better understand the ways in which historical actors creatively combine aspects of “different” religions, such as Buddhism and Daoism, some scholars have started modelling religions as “repertoires of practice.”  This has a very productive overlap with actor-network theory in Science and Technology Studies (STS), which also sees knowledge as produced by “clots” or “assemblages” of people and things, practices, thoughts and institutions and many more.  Furthermore, the concept of “situated knowing” that came out of STS argues that different actors organise knowledge differently; there is no single, authoritative perspective on a particular field of knowledge.

This theoretical conjunction raises an important methodological question: How can we identify, sort through and organise a history of “repertoires of practice,” as they are enacted by historical actors of different stripes? Especially when these practices are disparate and escape the cataloguer’s eye?  How can we tell when and which practices are being combined and deployed, in concert or separately, and whether concentrations of practices remain constant across different sectarian affiliations, or whether they change in significant ways?  Can we identify patterns of change or stability?

In the Drugs Across Asia project, Chen Shih-pei and I are developing a pilot platform to test how to do exactly this. With generous support from Department III of the Max Planck Institute for the History of Science (MPIWG), in collaboration with the Research Center for Digital Humanities at National Taiwan University (NTU), and with Dharma Drum Institute of Liberal Arts (DILA), we are undertaking a pilot study to analyse all Daoist and Buddhist Canon and most medical sources up through the Six Dynasties (to 589 CE) for the presence of drug terms.

In stage one, I use a statistical tool developed by NTU to analyse the texts to identify where drug knowledge is located among the set of sources. NTU have uploaded all the texts for analysis as separate juan in the form of *.txt files. I have selected a combination of open source texts from various sources, primarily drawing from Kanripo. I then upload a large list of known drug terms (11,000!), which the tool uses to analyse which drugs appear in which juanaccording to frequency, and produces a list like this one.

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Figure 2: Chapters from Buddhist and Daoist Canons, according to Drug Term Frequency

From this list, I select the juan for further analysis. It is somewhat self-selecting, as I sort according to how many terms appear per juan. After this, I analyse whether or not the found terms are homonyms for other things, such as relics, deities, or other terms. In this method, more hits is a good thing, because a high concentration of terms per juan is an indicator that drugs are an important topic in that text.

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Figure 3: Drug terms in Buddhist monastic codes

From this data set, I can already begin to compare drug repertoires of different communities. For example, the graph above shows clusters of drug terms from five different Buddhist monastic codes. The terms that appear between the clusters are shared between two or more texts. When compared to an early Chinese materia medica, as in the graph below, it is visibly clear how different the drug lore from China and from India was.  There are only a very few common terms between the Chinese text and the five Indian texts. These terms need to be more thoroughly analysed to explain these differences and correlations, but the foundations of a research paper are already here.

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Figure 4: Buddhist Codes compared to Chinese Materia Medica

In the second stage, we mark up individual juan. It is exciting how easy MARKUS makes it to do this work. Using Keyword Search, I can paste my entire list of drug terms into MARKUS, and with one click identify which of those 11,000 terms appears in the text and where. This lets me quickly and easily see where the “action” is, where the drug knowledge is concentrated, without having to read through the entire juan first.  I can then go and review how drug knowledge is framed and organised in that text in particular.

This way of organising reveals the “ontology” of the drug knowledge in the juan. Does it mention other important data like disease terms, drug properties, anatomical terms, or material practices like decocting, chopping, or roasting? Geographic terms? Famous people or locations? These are all important for how drug knowledge is figured. I scan through the text to pick out a representative section, and use Manual markup to highlight these salient features. Having been captured by MARKUS, they can be produced as a data table. Through this process of reading and marking up terms, MARKUS enables the ontology of each text to emerge as a data structure directly from the organisation of the text itself.

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Figure 5: Ontology marked up in MARKUS

I then work closely with DILA to mark up the texts. DILA are responsible for producing CBETA, one of the foremost digital humanities projects in East Asia, and thus have extensive experience with marking Buddhist texts. I forward them the file, and they clean up the automatic marking, and use the sample ontology I’ve provided to continue to manually identify corresponding features throughout the rest of the text.  I check over the results, and forward the marked file to NTU to upload into the analysis platform.

NTU are currently developing a platform called DocuSky , based on the engine behind the Taiwan History Digital Library. This platform will enable detailed analysis of the resulting markups.  It will incorporate detailed meta-data for each text – telling when and by whom a text was compiled or written, in what literary genre, with what sectarian identity, and if available, in which geographic location. By analysing this detailed meta-data along with the markups, I will be able to analyse through which communities what drug knowledge travelled, and, given enough meta-data, at which times and places. The platform will also be capable of visualising the data on a GIS map and dynamic timeline, as in the existing MPIWG platform, PLATIN.

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Figure 6: PLATIN Place and Time Navigator

With this tool, I should be able to quickly identify identical and similar drug recipes at scale, as well as when, where and with whom they travelled, and how they were interpreted. This will provide a much broader and more complex picture of who knew what about which drugs than can currently be known from studying materia medica (bencao 本草) literature. I should be able to track changes in properties of drugs and recipes as they circulated through historical communities, and to do so at scale. It is a mainstay of medical history to compare different community interpretations of a single drug or recipe, but no one has compared large-scale patterns of change and transfer before. By identifying which communities possessed and transmitted which drug knowledge, this platform will facilitate a large-scale picture of one important feature of the relationship between medicine and religion in the Six Dynasties.

While this model is custom-tailored to do research on drugs, it is highly adaptable. In the future, researchers should be able to change their categories and term sets to search for any “repertoire” or “assemblage” of terms. This could include medical data such as anatomical locations or disease names.  But it could also be used to capture divinatory arts, health cultivation exercises, pantheons of gods, philosophical terms – anything you can develop a good term list for. I hope this set of tools will enable the fields of religious studies and medical history to come to much more nuanced descriptions of the histories of material (and immaterial) practice.

 

Chinese & East Asian Medicines

HOLISM, CHINESE MEDICINE AND SYSTEMS IDEOLOGIES: REWRITING THE PAST TO IMAGINE THE FUTURE

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This chapter explores the articulations that have emerged over the last half- century between various types of holism, Chinese medicine and systems biol- ogy. Given the discipline’s historical attachments to a definition of ‘medicine’ that rather narrowly refers to biomedicine as developed in Europe and the US from the eighteenth century onwards, the medical humanities are not the most obvious starting point for such an inquiry. At the same time, they do offer one advantage over neighbouring disciplines like medical history, anthropology or science and technol- ogy studies for someone like myself, a clinician as well as a historian and anthropologist: their strong commitment to the objective of facilitating better medical practice. This promise furthermore links to the wider project of critique, which, in Max Horkheimer’s definition of the term, aims at change and emancipation in order ‘to liberate human beings from the circumstances that enslave them’. If we take the critical medical humanities as explicitly affirming this shared objective and respon- sibility, extending the discipline’s traditional gaze is not a burden but becomes, in fact, an obligation.

With that in mind, this chapter seeks to accomplish three inter-related goals. It is first an inquiry into the historical processes whereby Chinese medicine, holism and systems biology have come to be entangled with each other in the present. The term holism is not originally Chinese and was only applied to Chinese medicine from the 1950s onward. Whether or not systems biology, the computational and mathematical modelling of complex biological systems, is holistic, as some of its proponents claim, also remains a contested issue. Holism clearly means different things to different people. Yet, in the early twenty-first century, those engaged in constructing an interface between Chinese medicine and systems biology widely agree that their project not only honours the holistic foundations of their respective traditions, but also is, in fact, driven by this shared commitment to holism and the development of a scientifically based personalised medicine. This raises the question of how this consensus was achieved and what it denotes.

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Chinese & East Asian Medicines

The Treatment of Otitis Media with TCM

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This is a syndicated post that original appeared at http://www.sixfishes.com

Cara O. Frank, L.OM.

The following is an excerpt and re-working from the chapter on the treatment of Non-suppurative otitis media from my book TCM Case Studies, Eye, Ear, Nose and Throat Disorders, from Peoples Medical Publishing House. The book also contains chapters on acute suppurative otitis, chronic suppurative otitis. If you find this information helpful, I encourage you to study the entire chapter, as it contains case studies and other helpful information.

Non-suppurative otitis media refers to the first phase of a middle ear infection. Many cases occur after a common cold and are part of the sequelae of an upper respiratory infection. 1 Most cases are viral in nature. Symptoms include mild pain that is worse at night along with a sensation of popping in the ears and deafness. Treatment consists of pain management with non-steroidal anti-inflammatory drugs (NSAIDS). Since most cases are viral, antibiotics generally don’t improve outcomes and are associated with side effects. Tympanostomy tubes may also be placed in the eardrum if there are more than three episodes in six months. 2

In TCM, otitis media falls into the category of ěr zhàn (耳胀, ear distention) or ěr bì (耳闭, ear block), an otolaryngological condition caused by external pathogenic invasion or retention of pathological toxins. It is characterized by symptoms of distention, fullness and a sensation of blockage inside the ear, accompanied by tinnitus with a deterioration of hearing. Classical texts define it as wind-type hearing loss, sudden hearing loss or hearing loss due to qi blockage. It is equivalent to non-purulent otitis media in Western medicine.

This is an extremely common complaint in clinical practice. the condition is very responsive to treatment with Chinese medicine.

There is close relationship between ear distention and ear block. Ear distention is seen in the initial onset of the infection and exhibits excessive-type symptoms. Usually caused by external pathogenic invasion and obstruction of channel qi, it is characterized by a feeling of distention in the ear with pain specific to the auricular region. In comparison, ear block is a chronic condition, often caused by retention of pathogenic toxins. It is related to spleen and kidney deficiency, and exhibits symptoms of deficiency-excess complex patterns. It is characterized by a sensation of blockage inside the ear, with impaired hearing. If treatment of ear distention is delayed, it can develop into ear block.

COMMON CLINICAL PATTERNS AND FORMULAS

The following are the main patterns of the differential diagnosis and treatment, however there are more choices in the pattern descriptions.

External pathogenic wind invasion with channel qi obstruction: ModifiedYín Qiào Săn (Lonicera and Forsythia Powder) or Sān Ào Tāng (Rough and Ready Three Decoction)

Liver-gallbladder damp-heat steaming the auricular orifice: Modified Lóng Dăn Xiè Gān Tāng (Gentian Liver-Draining Decoction)

Spleen deficiency and damp congestion with damp turbidity encumbering the ear: Modified Shēn Líng Bái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder)

Accumulation of toxins with qi and blood stagnation: Modified Tōng Qiào Huó Xuè Tāng (Orifice-Freeing Blood-Quickening Decoction)

1.External pathogenic wind invasion with channel qi obstruction resulting in impaired diffusion and downbearing of the lung and obstruction of the ear orifice:

The middle ear belongs to the lung system. Wind-cold or wind-heat attacks the exterior and hides in the lungs, leading to impaired diffusion and downbearing of the lung and pathogenic qi congestion in the clear orifice. The wind-cold type can be accompanied by a stuffy nose, clear nasal discharge, sneezing and headache or whole body soreness. The tongue coating will be thin and white with a floating, tight pulse. The treatment principle is to course wind, dissipate coldness, diffuse congestion and open the orifices. The formula should be Sān Ào Tāng (Rough and Ready Three Decoction) modified with jīng jiè (Herba Schizonepetae), fáng fēng (Radix Saposhnikoviae) and shí chāng pú (Rhizoma Acori Tatarinowii).

The wind-heat type includes symptoms of a stuffy nose, thick nasal discharge, headache and a sore throat. The tongue coating will be thin and yellow. The pulse is floating and rapid. The treatment principle is to course wind, dissipate heat, diffuse the lungs and open the orifices. The formula is modified Liù Wèi Tāng (Six-Ingredient Decoction) or Yín Qiào Săn (Lonicera and Forsythia Powder). If the patient’s tympanic cavity also has fluid, it is often due to impaired diffusion and downbearing of the lung from fluid stagnation. The treatment principle should focus on coursing wind and diffusing the lungs. Add medicinals for further lung diffusion, water dispersal and resolution of dampness such as tíng lì zǐ (Semen Lepidii; Semen Descurainiae), ché qián zǐ (Semen Plantaginis) and zé xiè (Rhizoma Alismatis).

2.Pathogens blocking the shaoyang channels with ear orifice obstruction:

The three yang channels of hand and foot plus the hand jueyin pericardium channel all cross the ear. The hand and foot shaoyang channels have the closest relationship with the ear. This condition is often caused by the external contraction of the six excesses, with pathogens entering shaoyang channel, leading to channel qi stagnation and pathogen blockage of the ear. It mainly manifests as auricular swelling and obstruction accompanied by a bitter taste in the mouth and a dry throat. The tongue coating is thin and yellow, and the pulse is wiry. The treatment principle should be to clear and diffuse shaoyang, open the orifices and nourish the ear. The formula selection for this pattern is Xiăo Chái Hú Tāng (Minor Bupleurum Decoction) or modified Tōng Qì Săn (Qi-Freeing Powder) from the Correction of Errors in Medical Works (Yī Lín Găi Cuò, 医林改错). In this condition, patients will not present with the typical symptoms of lung dysfunction such as cough, nasal discharge or a floating pulse.

3.Phlegm turbidity stagnation and ear orifice obstruction:

This pattern is mainly characterized by fluid accumulation in the tympanic cavity. It can reoccur often and last for long periods without typical symptoms of exterior patterns. Usually due to impairment of splenic movement and transformation, it results in disorders of fluid metabolism, leading to water-dampness retention in the ear. The treatment principle should focus on percolating water and resolving dampness by using modified Zhū Líng Tāng (Polyporus Decoction) or Zé Xiè Tāng (Alisma Decoction). Choose modified Shēn Líng Bái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder) if spleen deficient patterns are more prominent. If the patient has sticky accumulative fluid or thick fluids glued to the ear, then qi-moving, dampness-drying, phlegm-dissolving and nodule-dissipating medicinals should be added. Examples of such medicinals are bàn xià (Rhizoma Pinelliae), xuán shēn (Radix Scrophulariae), mŭ lì (Concha Ostreae) and zhè bèi mŭ (Bulbus Fritillariae Thunbergii).

With an accumulation of heat caused by phlegm turbidity, huāng qín (Radix Scutellariae), jīn yín huā (Flos Lonicerae Japonicae) and mŭ dān pí (Cortex Moutan) should be added to clear heat and eliminate pathogens, or clear heat and dissolve toxins. This type of pattern may be diagnosed in Western medicine as a low-grade infection of the middle ear cavity. Western medical theory attributes this condition to allergic response or endocrine dysfunction. Therefore, in the case of recurrent fluid accumulation without resolution, high doses of huáng qí (Radix Astragali), dăng shēn (Radix Codonopsis) and bái zhú (Rhizoma Atractylodis Macrocephalae) should be added to fortify the spleen and drain dampness. Alternately, add fù zĭ(Radix Aconiti Lateralis Praeparata), bā jǐ tiān (Radix Morindae Officinalis) and suŏ yáng (Herba Cynomorii) to warm the kidney and spleen. These medicinals may play an important role in regulating the endocrine system and ameliorating the allergic response.

4.Congealing of phlegm and stagnant blood congestion, and blockage in the ear orifice:

Due to the tendency of this condition to become chronic, the patient will often present with signs of stagnation, such as a tongue body with stagnant spots and a dusky, purplish color. There may also be obvious sticky discharge glued to the ear from the tympanum, thickening and becoming more turbid in the tympanic membrane, with decreased mobility. Treatment should focus on invigorating blood, transforming stasis, eliminating phlegm and dissipating nodules. Select modified Èr Chén Tāng (Two Matured Substances Decoction) and Bŭ Yáng Huán Wŭ Tāng (Yang-Supplementing and Five-Returning Decoction).

5.Qi deficiency resulting in dysfunction of the ear orifice

In this category, the patient presents with exudative type otitis media along with typical symptoms seen in spleen qi deficiency patterns. This is mostly seen in chronic cases and characterized by cloudy and sunken eardrums without any obvious fluid accumulation. The formula selection is modified Shēn Líng Bái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder) or Bŭ Zhōng Yì Qì Tāng (Center-Supplementing and Qi-Boosting Decoction), with added shí chāng pú (Rhizoma Acori Tatarinowii) to open the orifice. For patients with qi deficiency along with externally contracted cold symptoms, pathogen-eliminating medicinals such as chái hú (Radix Bupleuri), chuān xiōng (Rhizoma Chuanxiong), jīng jiè (Herba Schizonepetae) and bái zhĭ (Radix Angelicae Dahuricae) should be added. For patients presenting with kidney deficiency, medicinals such as bā jǐ tiān (Radix Morindae Officinalis), tù sī zĭ (Semen Cuscutae) and bŭ gŭ zhī (Fructus Psoraleae) should be added.

MODIFY LIKE A BOSS

For all patterns, in addition to the primary formula, be sure to include chái hú, which acts as an envoy to direct the formula to the shaoyang channels that surround the ear.

  • Because the disease usually involves pain, include medicinals that regulate the qi, such as chái hú, xiāng fù (Rhizoma Cyperi) and chuān xiōng.
  • To open obstruction in the channels, consider medicinals that unblock the channels and quicken the collaterals, such as shí chāng pú, dì lóng, lù lù tōng andbái jiāng cán(Bombyx Batryticatus).
  • Because the infection and inflammation is in the upper body, consider medicinals that clear fire toxin that are also light and diffusing in nature, such as jīn yín huā, lián qiào, jīng jiè and bò he. The first two are especially important as they expel pus and clear wei-level fevers.
  • When there is fire toxin or damp heat from liver and gallbladder, use bitter cold medicinals that downbear fire, such as huáng qín (Radix Scutellariae) and lóng dăn căo (Radix et Rhizoma Gentianae). Huáng qín is especially important because of its relationship with chái hú, which, as discussed above, guides medicinals to the ear via its shaoyang channel relationship.
  • Damp-obstruction is a major disharmony that must be resolved. This can be treated with many of the medicinals detailed in the above. However, three stand out as being especially effective: Huáng qí (Radix Astragali) not only boosts the qi and stabilizes the exterior, it also expels pus. Yì yĭ rén drains dampness and expels pus. Shí chāng pú is effective for opening the orifices to improve hearing.
  • The final key: if the otitis media is chronic with persistent discomfort, consider the possibility that there is blood stasis. This diagnosis is made not because there is ear trauma, but rather it reflects the chronicity of the case. Medicinals such as dāng guī (Radix Angelicae Sinensis), chuān xiōng and chì sháo (Radix Paeoniae Rubra) are important in this situation. The former medicinal has a relationship with huáng qí in the formula Dāng Guī Bŭ Xuè Tāng (Chinese Angelica Blood-Supplementing Decoction). The actions of the formula are to expel pus and resolve abscesses. Another formula to consider is Bŭ Yáng Huán Wŭ Tāng (Yang-Supplementing and Five-Returning Decoction) that includes all the medicinals listed above. Its action is to boost the qi and promote the circulation of blood in channels. Furthermore, the more chronic the otitis media, the more the practitioner should consider medicinals that reduce nodulation by resolving phlegm and invigorating the blood.

Tan Jing-shu’s approach: 

Modern TCM has accumulated extensive clinical experience in treating this condition. Professor Gan Zu-wang of the Nanjing University of Chinese Medicine especially emphasized treating the lungs by using a modified Sān Ào Tāng (Rough and Ready Three Decoction). The late, famous integrative otolaryngopharyngeal expert Tan Jing-shu advocated the practice of integrating TCM and Western medicine etiology and pathology. The pathological characteristics of this condition are infection and allergic reactions in the middle ear in terms of Western medicine, and qi stagnation and blood stasis in terms of TCM. Based on this theory he developed a formula known as the “Anti-Exudates Ear Formula” which yielded good clinical results. For patients with cumulative fluids in the middle ear, the theory focused on promoting urination and orifice opening.

Anti-Exudates Formula (empirical formula from Tan Jing-shu)

Formula: Kàng Shèn Ěr Fāng (Anti-Exudates Formula)

[抗渗耳方]

柴胡 chái hú 10g Radix Bupleuri
香附 xiāng fù 10g Rhizoma Cyperi
川芎 chuān xiōng 15g Rhizoma Chuanxiong
石菖蒲 shí chāng pú 15g Rhizoma Acori Tatarinowii
白术 bái zhú 15g Rhizoma Atractylodis Macrocephalae
茯苓 fú líng 15g Poria
金银花 jīn yín huā 15g Flos Lonicerae Japonicae
黄芪 huáng qí 30g Radix Astragali
当归 dāng guī 12g Radix Angelicae Sinensis
黄芩 huáng qín 12g Radix Scutellariae
水蛭 shuĭ zhì 5g Hirudo
炮山甲 páo shān jiă 5g Squama Manitis
泽泻 zé xiè 20g Rhizoma Alismatis

The actions of this formula are to fortify the spleen, disinhibit water, transform stasis, unblock the collaterals, clear heat, dissolve toxins, move qi and open the orifices to treat difficult and chronic cases of exudative otitis media.

[Formula Analysis]

Bái zhú, zé xiè, fú líng and huáng qí fortify the spleen and resolve dampness to treat the root of accumulating fluid exudates from the middle ear.

Tōng Qì Săn from the Correction of Errors in Medical Works plus shí chāng pú, shuĭ zhì and páo shān jiă move qi, transform stasis and open the orifices to benefit the opening of the tympanic cavity.

Jīn yín huā and huáng qín clear heat, dissolve toxins and have anti-bacterial and anti-toxic effects.

Huáng qí, bái zhú and dāng guī benefit qi, nourish blood, support the upright qi and secure the root to regulate the immunity.

Formula analysis

Tan Jing-shu’s Anti-Exudates Formula is like a hybrid of all the formulas that we have discussed in the chapter. The formula opens with Tōng Qì Tāng. Huáng qín and chái hú act as envoys to the ear, and from there, the formula incorporates bái zhú, huáng qí and fú líng to supplement the spleen qi. Fú líng also pairs with zé xiè to percolate dampness. Jīn yín huā clears fire toxin and expels pus. Dāng guī and huáng qí invigorate the qi and blood and expel pus. Going even further with this pair: if we add chuān xiōng and páo shān jiă (Squama Manitis), we then create the formula Tòu Nóng Săn (Pus-Expelling Powder). Summarizing the characteristics of Dr. Tang’s formula: its primary actions are to regulate the qi and blood, and expel pus using predominantly acrid flavors. In comparison to the primary case, both formulas include Tōng Qì Tāng; however, in the chapter’s primary case history it was combined withYín Qiào Săn to release exterior wind heat. In contrast, Anti-Exudates Formula is strictly a formula for internal patterns. 3

END NOTES

1.Ear Infections in Children. National Institute on Deafness and Other Communication Disorders,National Institute of Health, NIH Publication No. 13-4799, Updated February 2013. from:http://www.nidcd.nih.gov/health/hearing/earinfections

2.Otitis Media. National Institute of Health, NIH Publication 97-4216, Updated October 2000. from:http://www.nidcd.nih.gov/StaticResources/health/healthyhearing/tools/pdf/otitismedia.pdf

3.Li Fan-cheng, Xu Shao-qin. A Hundred TCM Clinical Masters in Modern China: Tan Jing-shu. Beijing: China Press of Traditional Chinese Medicine, 2007: 148-169

Chinese & East Asian Medicines

HUMAN MILK AS MEDICINE IN IMPERIAL CHINA: PRACTICE OR FANTASY?

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What does milk have in common with blood? According to Kou Zongshi (fl. 1110-1117), author of Bencao yanyi (Extended Interpretations on Materia Medica), they are basically the same vital fluid produced by the female body at two critical moments in a woman’s life. While the first menstrual period signifies the maturation of reproductive power, motherhood is the consummation of that power–miraculously causing the vital fluid to flow upward as milk. After nursing ends, the flow of milk again reverses back to blood, as evident from the return of the menses.

“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.

For centuries, Kou’s comment was repeatedly quoted as the dominant theory over lactation in the realm of learned medicine. It also coincides with parallel attempts to speculate on the metaphysical foundation of sex differences in women, and the consolidation of women’s medicine (fuke) and pediatrics (erke) as medical specialties.[1]

However, Kou’s original aim was to make sense of medical recipes. In particular, he was trying to figure out why do so many recipes for eye medicine use human milk to mix up powdered mineral drugs: a practice that has parallels in different cultural contexts. Since blood is essential for the five senses to function and human milk is essentially blood, Kou reasoned, this makes it an excellent medicine for eye diseases. Another recipe that may have been on his mind is the recommendation to drink “three portions of human milk” to help with obstructed menses. It makes sense if they were considered of the same origin. Like cures like.

Let’s pause here to consider what this means. Working with Chinese materia medica texts often means untangling different strands of thought, modes of compilation and miscellaneous quotations. The entry on each substance (e.g. human milk, renru or ruzhi) often begins with a learned survey of previous literature, including passages from classical literature and histories, and ends with a large (and often unwieldy) body of recipes. The problem is that the prescribed uses of the substances in the first part do not always sit well with the recipes, which are messy, opaque, and often outright strange.

In fact, Kou Zongshi’s work could be understood as a scholar-physician’s attempt to impose order and coherence on the unruly recipes, which were becoming increasingly available in print. [2] The incongruities and tension between theory and recipes, however, allows us to follow the intricate dance between empiricism and rationalism in such texts: when did authors equate recipes with real-life experiences, and when did they treat them as exemplars of theory and formulaic principles? When did book culture begin to shape the ways in which medicines were prepared, consumed, and invented?

Back to Kou Zongshi’s ingenious, if somewhat contrived, speculation over the nature of lactation. It did not seem to have caught much attention immediately. The twelfth and thirteenth centuries witnessed a growing suspicion among medical experts to discipline and curb wet nurses’ sway over childcare, and pediatric treatises abound with warnings against drunken, naughty wet nurses whose milk turns unwholesome to the infant.[3] Again, the female body’s power to nourish but also intoxicate with her transformed milk resonates with similar discourses discussed elsewhere on this blog; notably, alcoholic drinks were seen to be a bad thing that excites her passions, in contrast to ancient Roman recommendations.

In addition, the conquest of Mongols brought about increased consumption of cow and goat’s milk.[4] A leading physician active in the fourteenth century advised consuming those over human milk, which is easily “tainted with poisonous passions.” It looks like the arrival of more abundant dairy products would transform the existing pharmacopeia once and for all.

But not so simple. By the sixteenth century in China, human milk had become a “super food” of sorts, especially among elite families. Kou Zongshi’s dusty theory became a dominant trope, fanning the imagination of the female body as a machine of alchemical wonders, and her milk a sort of elixir that revitalizes the frail and depleted bodies. In the sixteenth-century encyclopedia Systematic Materia Medica(Bencao gangmu), Li Shizhen, the erudite naturalist and capable physician, criticized the excessive fetishizing of human milk. The prudent Li nevertheless included twelve “new recipes” that involve human milk as medicine. Li’s encyclopedia was first printed in 1596; soon after the turn of the century, dietary manuals began to teach people how to prepare dried milk powder at home, after collecting fresh milk from “strong women who just gave birth to boys”. Presumably, women sold their milk not as wet nurses, but directly to pharmacists (as depicted in the picture above).

So did people in imperial China consume human milk as medicine? Quite likely. But was it ubiquitous? Probably not. Recipes can be practical and fantastic, and theorists can explain and inspire. What matters is that human milk as medicine gradually came to be taken out of the context of nursing and acquired a more abstract quality as commodity.

[1] Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History: 960–1665 (Berkeley, CA: University of California Press, 1999).

[2] Asaf Goldschmidt, The Evolution of Chinese Medicine: Song Dynasty, 960-1200 (London ; New York: Routledge, 2009).

[3] Ping-Chen Hsiung, “To Nurse the Young: Breastfeeding and Infant Feeding in Late Imperial China,” Journal of Family History, 20, 3 (1995), pp. 217-38.

[4] Paul D. Buell, E.N. Anderson, and Charles Perry, A Soup for the Qan : Chinese Dietary Medicine of the Mongol Era as Seen in Hu Sihui’s Yinshan Zhengyao, 2nd Rev. and Expanded ed. (Leiden, The Netherlands: Brill, 2010).

Chinese & East Asian Medicines

Memorizing Formulae

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Memorizing formulae is something no herbalist can avoid. One sometimes hears people say that memorization is unnecessary, you can just look up a formula in a book when you need it. This is somewhat like saying that memorizing vocabulary isn’t necessary when learning a foreign language, you can just look it up in a dictionary when you need it. An effective herbalist must speak the language of herbs fluently and be able to construct new sentences (formulae) on the fly to adapt to changing circumstances.

In my own studies recently I’ve been reviewing formulae that I use so infrequently it’s hard to remember their ingredients. I thought it might be interesting to share some of the methods I’ve used to memorize formulas. None of these are new by any means, but I’ve found them very helpful over the years.

IMG_2350

This one, Xianfang huoming yin (仙方活命飲, Immortal-Formula Life-Saving Beverage), is the representative formula for the dispersing method (xiaofa 消法) used in treating the early stages of welling abscesses (yong 癰). Historically it’s been highly respected, but I haven’t had call to use it myself (though I do get to use Wuwei xiaodu yin 五味消毒飲, Five Flavor Toxin-Dispersing Beverage, on occasion).

The notes hand-written in the text is my mnemonic. This is one of my favorite ways to remember longer formulas that don’t break down into neatly analyzable divisions. I make a rhymed verse from the names of the herbs. I thought I’d share this one for fun.

In pinyin it goes (I’ve made one change since this photo was taken):

Yin, zao, hua, fang, zhi, gan, bei./Chen, mo, ru, jia, chi, guiwei.

Which means:

Jinyinhua, zaojiaoci, tianhuafen, fangfeng, baizhi, gancao, beimu./Chenpi, moxiang, ruxiang, chuanshanjia, chishao, dangguiwei.

Part of how I make this work for me is by grouping the herbs roughly by function (when the rhyme allows it). So the first three (jinyinhua, zaojiaoci, tianhuafen) are all herbs that address the toxic swelling rather directly (I could have put chuanshanjia in this group too, but it didn’t fit). The second four (fangfeng, baizhi, gancao, beimu) are a more loose group that assists with that function. The second line is all movers, starting with one qi mover (chenpi) and finishing with a whole mess of blood movers (moxiang, ruxiang, chuanshanjia, chishao, dangguiwei).

I’m very oral-aural–and I’ve always loved poetry–so that’s probably partially why this works well for me. But I’ve been shocked at how well it works. I’ve remembered some of these rhymes for years without using the formula or reviewing the rhyme.

IMG_2386

I find that some formulae, however, can be easily divided into parts based on the function of the herbs. So in the example above I’ve broken down Hao-qin qingdan tang (蒿芩清膽湯, Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction) into four pairs of herbs:

Qinghao and huangqin: The  lords of the formula that clear gallbladder damp-heat. Qinghao is the source for the artemisinin malaria medicines that earned Tu Youyou the nobel prize recently. From a Chinese medicine point of view it has the useful ability to clear heat that is hidden inside dampness in the same way the ashes of a fire can look cold but still hide glowing-hot embers.

Banxia and zhuru: These two herbs resolve phlegm and stop vomiting–a common symptom in this formula’s pattern.

Chenpi and zhike: This pair move the qi, which is often obstructed by dampness leading to problems like glomus in the epigastrium.

Fuling and Biyu san: This pair is a bit of a cheat since the second member is actually a small formula containing huashi, sheng gancao, and qingdai. Nevertheless, that’s how the formula is usually written. Both these ingredients disinhibit the urine, draining dampness downward and out of the body.

Finally, there are formulae that belong to formula families. These are best understood by understanding the family’s basic structure and how each formula is a modification of that structure. Generally speaking, there are four basic ways in which the basic structure of a formula family can be modified: adding ingredients, removing ingredients, replacing ingredients, and adjusting the dosage of ingredients.

The Guizhi tang 桂枝湯 family provides good examples of all three of these methods. The basic structure of the this family is the formula Guizhi tang itself (guizhi, shaoyao, zhi gancao, shengjiang, dazao), which is built from three formula elements (small formulae of one to four ingredients that act as the building blocs of larger formulae):

guizhi + zhi gan cao: This combo supplements the yang–particularly of the heart and spleen–and the defense (wei 衛). On its own, it is a formula called Guizhi gancao tang 桂枝甘草汤 used to warm and supplement the heart yang. It embodies the principle “acrid and sweet produce yang (xin-gan hua yang 辛甘化陽).”

shaoyao + zhi gancao: These two herbs together nourish the yin-blood–especially of the liver–and construction (ying 營). As a formula it is called Shaoyao gancao tang 芍藥甘草湯. It emobides the principle “sour and sweet produce yin (suan-gan hua yin 酸甘化陰).”

zhi gancao + shengjiang + dazao: This combination is frequently used by Zhang Zhongjing 張仲景 and serves to protect and nourish the stomach. It is particularly important in Guizhi tang because this formula acts primarily through the spleen and stomach–hence the saying that it “releases the flesh (jieji 解肌).”

The first Guizhi tang modification seen in the Shanghan lun (傷寒論, Treatise on Cold Damage) is an example of adding ingredients: Guizhi jia fuzi tang (桂枝加附子湯, Cinnamon Twig Decoction with Aconite Accessory Root Added). In this formula, fuzi is added to more strongly supplement the defense yang. It is used when a patient’s defense yang is weak or damaged by improper promotion of sweating.

The second modification of Guizhi tang in the Shanghan lun is a classic example of removing an ingredient: Guizhi qu shaoyao tang (桂枝去芍藥湯, Cinnamon Twig Decoction with Peony Root Removed). In this formula, the removal of shaoyao removes the second, yin-nourishing, formula element. This results in a formula that more strongly emphasizes warming and supplementing the heart yang. In the Shanghan lun it is used when incorrect purging damages the heart yang, allowing a cold evil to fall into the heart, but the Guizhi tang pattern persists.

The third modification of Guizhi tang is an example of replacement (or removal and addition, same difference in this case): Guizhi qu shaoyao jia fuzi tang (桂枝去芍藥加附子湯, Cinnamon Twig Decoction with Peony Root Removed and Aconite Accessory Root Added). Here fuzi is added to the previous formula, increasing yet further its ability to warm and supplement the heart yang. It is used in the same patterns as the previous formula, but when stronger cold is present.

Not all examples of replacement can also be described as removal and addition. The Ma-Xing family is an excellent example. This family has three representatives in the works of Zhang Zhongjing: Mahuang tang (麻黄汤, Ephedra Decoction), Mahuang xingren gancao shigao tang (麻黄杏仁甘草石膏汤, Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), and Mahuang xingren yiyiren gancao tang (麻黄杏仁薏苡甘草汤, Ephedra, Apricot Kernel, Job’s Tears, and Licorice Decoction). All three formulas contain the core two ingredients of the family–mahuang and xingren–as well as gancao, but by replacing the third ingredient and adjusting the doses of the remaining ingredients very different formulae are produced.

To return to Guizhi tang, one of its most famous modifications is an excellent example of how altering dosage can produce new formulae: Guizhi jia shaoyao tang (桂枝加芍药汤, Cinnamon Twig Decoction with Additional Peony Root). In this formula the dosage of shaoyao is doubled. This greatly increases the strength of the shaoyao + zhi gancao formula element, allowing the formula to more effectively soothe the liver and the sinews, treating the cramping pain that often accompanies diarrhea (in this case a taiyin-spleen vacuity diarrhea).

Understanding how the formulae of a family are related to one another–how they are constructed and modified–makes remembering their ingredients far simpler. Many such formula families exist in Chinese medicine, and understanding them is a key method of formula memorization.

All herbalists, whether just starting to learn or with many years of experience, have to keep memorizing and reviewing formulae. It’s just part of the process of being a good herbalist. Many people find memorization difficult, but everyone is capable of tremendous feats of memory–it’s part of our human skill set. We just have to learn how to use that capacity. These three methods have been very useful for me, and I hope that others may find them useful as well.