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Chapter

CHINESE MEDICINE RESEARCH: THE RELEVANCE OF THE SOCIAL SCIENCES FOR

CLINICAL DECISION-MAKING

Mary Garvey, Ph.D.University of Technology, Sydney, Australia

ABSTRACT

The chapter focuses on the medical body as the site of medical theorising, research and practice. Twentieth century philosophers and historians have explained how, as the object of investigation, the body is also the effect or outcome of the investigators’ research questions, perspectives and methods. Researchers in the social sciences today recognise different ‘bodies’ according to different disciplinary epistemologies. The chapter explores the transferral of early Chinese conceptions to the medical body image and highlights the relevance of traditional perspectives for contemporary practice. The notions of a ‘Chinese medicine tradition’ are so pervasive in the English-language literature on Chinese medicine that the chapter begins with the question of what constitutes ‘the tradition’.

How medical practitioners and researchers perceive the body determines their methods and interpretations. From its infancy in the Han dynasty (206 BCE – 220 CE), Chinese medicine’s representations of the body favoured a systemic and dynamic perspective of process and change, rather than an anatomical–physicalist approach. Early perspectives were drawn from much older traditions, such as those derived from the Book of Changes (易经 Yì jīng) and ‘cultivating life’

( 养生 yǎng shēng) currents of philosophy–practice, where the body was seen as the shape or disposition of the human process. In clinical practice, Chinese medicine’s internal coherence relies on its traditional terms, concepts and relationships. These constructs guide the interpretation of presenting signs and symptoms, and diagnostic interpretations in turn provide the rationale for treatment decisions.

Because the orientation of the medical gaze guides clinical decision-making, the chapter argues for the continued relevance of traditional conceptions. Even though Chinese medicine’s epistemic methods are not anatomical or physicalist in nature, they have produced reliable data and repeatable interpretations. The study of Chinese medical history and its classic texts reveals detailed and pragmatic representations of health, disease and the medical body. Research publications by Chinese medicine historians, translators and anthropologists connect today’s clinicians with a raft of time-honoured clinical methods and techniques recorded in the textual archive. Chinese medicine’s traditional conceptions of the body–person recognise the interdependence of physical, psychological and social factors in health management, and its epistemic methods have explanatory insight and therapeutic potential for contemporary health care.

1. INTRODUCTION

The transmission of Chinese medicine into the contemporary world and Western languages presents a significant challenge for its preservation and evolution as a distinct medical discipline. The nature of the challenges are complex but broadly explained by the global dominance today of the biomedical culture. Biomedicine dominates our public institutions — educational, medical, research, political and professional — and the public mind. Today, the contrast between biomedicine and Chinese medicine places Chinese medicine either as inferior or as a resource that biomedicine can selectively incorporate. Both these options raise issues that will be the focus of this chapter.

Throughout the history of Chinese medicine its ‘tradition’ has been one of its most remarkable assets, producing a unique nexus of medical theory and practice. Yet this aspect of Chinese medicine seems most at risk today because of its cultural and historical distance, and the philosophical differences between biomedicine and Chinese medicine. Early Chinese medicine perspectives do not conform to contemporary scientific medicine perspectives and today there is a strong push for Chinese medicine to adapt its therapeutic

Chinese Medicine Research

techniques and medicinal substances to the biomedical paradigm. Conversely, and with no professional bias towards promoting its clinical efficacy or effectiveness, historians, sinologists and anthropologists agree that once divorced from its conceptual basis, Chinese medicine can no longer be a system of medicine, only an assortment of empirically applied remedies. [1-5]

A key issue for the transmission of Chinese medicine in the West today is how best to professionalise the discipline and negotiate its future as a health care profession. On the one hand, the present climate of medical pluralism in the West may actually contribute to the preservation of Chinese medicine, allowing the profession to maintain its characteristic features. However, in non-Chinese speaking countries today, the tenuous grasp of traditional perspectives and methods is easily displaced by biomedical perspectives and methods. So on the other hand, the Chinese medicine profession is likely to find it more expedient politically and educationally to biomedicalise Chinese medical content and methods, and to follow or create a path of integration with biomedicine. [6, 7]

In 2002 the integration of scientific medicine and traditional medicines became part of a global health strategy promoted by the World Health Organization, [8] and in 2007 the Beijing Declaration of Traditional Chinese Medicine (TCM) stated that, with its basis in molecular biology, TCM is a 'part of modern biomedicine'. [9] Since at least the middle of the twentieth century the efforts to modernise Chinese medicine have de-emphasised its incompatible onto–epistemics — the philosophical assumptions regarding the nature of reality, being and knowing. They have applied scientific research to correct and modernise Chinese medicine and to align its practices with biomedicine. Chinese medicine’s contemporary textbooks reflect many of these changes. [10, 11]

Today, the TCM orthodoxy subordinates traditional conceptions and methods to a disease-focussed biomedical perspective. To modernise traditional Chinese medical perspectives, TCM clinical textbooks are structured according to biomedical disease categories and authors translate traditional terms using contemporary nosologies. The structure of textbook content in turn shapes clinical perspectives and practices. In this way, modernisation fundamentally changes traditional methods of diagnosis and therapy.

To argue for the relevance of Chinese medicine’s traditional conceptions for contemporary clinical health care this chapter and the next section in particular draw primarily on notions of the ‘medical body’ as the site of medical theorising and practice. The ways in which Chinese medicine and

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biomedicine each view the medical body distil the differences that continue to disrupt the smooth integration of biomedical and Chinese medical practices. To explore the broad question of how the body is perceived in Chinese medicine the chapter will draw on research from the social sciences to focus on early medical perspectives of the body. The discussion will show how English speaking Chinese medicine researchers and professionals can engage with a more traditional field of study and practice, the reasons why they should be interested in doing so, and the relevance of traditional perspectives for health care practices today.

The notion of a Chinese medicine tradition is so pervasive in today’s English-language literature that the question of what constitutes the ‘tradition’ is addressed in Section 3. The formation of China’s medical tradition was set in train during the Han dynasty (206 BCE–220 CE) with the compilation of the early classics. Only three are extant: the Yellow Emperor’s Inner Canon (黄帝内经 Huáng dì nèi jīng c. 100 BCE), the Canon of Difficult Issues ( 难经 Nán jīng, c. 100 CE) and the Treatise on Cold Damage and Miscellaneous Disorders ( 伤寒杂病论 Shāng hán zá bìng lùn, c. 200 CE). Some of the Yellow Emperor’s Inner Canon (hereafter the Inner Canon)’s original contents are known to include materials from perhaps as early as 800 BCE. [12] Thus, the development of Chinese medicine’s onto-epistemics began well before the Han dynasty and the compilation of the Inner Canon. They underpin the content of its treatises and all areas of the textual tradition since.

The Inner Canon applied ‘natural law’ to the living body and its environment, and natural law took the form of numerically significant concepts and frameworks such as the yin–yang, five phase and six channel models. Early Chinese life sciences applied such models to observe, describe and analyse human life, health and illness. Numeric significances linked medical concepts to broader philosophical themes and gave its practice methods an organisational framework. Early perspectives and methods inform the surviving archive of China’s pre-scientific medicine and reveal its unique conceptions of the body. How traditional representations of the medical body focus the Chinese medical gaze, priviledge functional and processual information and guide clinical decision-making, is taken up in Sections 4 and 5.

This chapter’s argument for preserving Chinese medicine as a distinct medical field applies a practice-based focus and a synthetic approach to examine these early constructions of the living body. The synthetic approach connects the interests of scholarship, research and medical practice and draws on academic, bio-scientific, social and clinical research. The approach is a

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deliberate strategy that reflects the historical intersection between Chinese medicine philosophy / theory and its therapeutic methods. To re-instate Chinese medicine’s theory–practice nexus the discussion draws on materials from Chinese medicine’s own literature (classical, premodern and contemporary interpretations and clinical discussions), and borrows from research adjacent to the field (historical, philological and anthropological studies). [13]

In fact, bio-scientific and socio-historical research publications rarely assist Chinese medicine clinicians with issues of clinical practice. However the analysis of multidisciplinary sources can add context and depth of field to traditional perspectives, and Chinese medicine’s traditional philosophy–practice nexus will be shown to support the internal intelligibility of its premodern conceptual frameworks for clinical decision-making. The re-imagining of Chinese medicine’s traditional perspectives and methods re-connects contemporary Chinese medicine students and professionals to the complexity of this distinctive medical discipline.

2. MEDICAL BODIES

Chinese medicine does not have one single explanatory model for the body, and nor do Chinese conceptions of the medical body describe an objectively quantifiable body. Confucian and Daoist philosophers of the Warring States period (475–221 BCE) saw the body as the dynamic product of a person’s life experience, that was ‘continually shaped and reshaped’ by life experiences and habits. [14] Other representations saw the body–person as a microcosm of the state, or of the cosmos, or as a portion or allotment of the cosmos. When Chinese medicine’s classic texts applied early observations of ‘the laws of nature’ they developed a body image that was not a well-defined physical entity, but which was characterised by systems of process and transformation. In practice, Chinese medicine deals with ‘a complex and ever-changing combination of ideas, subjective experiences, and realities’. [15]

Philosophical and self-cultivation texts from the late Warring States period signal the beginnings of Chinese theorising about the body. Self-cultivation texts described the body as ‘the source of virtue and ritual order’, an idea that had been anticipated in the Confucian Analects (论语 Lúnyǔ, c. 500 BCE). [16] Even earlier, the Book of Changes (易经 Yì jīng, from c. 700 BCE) established an approach to philosophy and the life sciences that deeply influenced Daoism, Confucianism and the early development of Chinese medicine. When Han

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dynasty (206 BCE–220 CE) physicians applied the Book of Changes’ methods to the medical body, they found that the potentials and propensities of the body–person were the observable physical and non-physical features of human life processes and transformations, the life influences and substances known as 气 qì.

The 气 qì that formed every individual human being was the same qi that formed the cosmos. ‘Heavenly’ (more refined) qi intermingled with ‘earthly’ (more substantial) kinds of qi to produce life, and as a microcosmic portion of the cosmos the body functioned in accordance with it. After birth the body’s qi was derived from eating, drinking and breathing, and the processes of life were both spontaneous and ordered according to natural law, such as the daily and seasonal cycles. As a microcosm of the heaven–earth world the body–person combined, ‘cognitive ingredients, social ideals, physical data, and sensual self-awareness’. [17] As a microcosm of the state, the medical body was organised according to Chinese social ideals. Its contents were represented by the social order of the empire — its organs, processes and senses as institutions, goods and offices with particular areas of governance, responsibility and influence. [2, 18, 19] So, as well as documenting some of the structural properties of the body’s internal visceral systems, Han dynasty medical discourses articulated their functional duties and relationships of governance ( 主 zhǔ).

Chinese terms for ‘body’ include early notions regarding the person, their sense of self and their lived experience. Some of the terms we translate as body in English-language texts, such as 身 shēn, 体 tǐ, and 形 xíng, demonstrate these ideas: Nigel Wiseman and Feng Ye [20] have glossed them,

身 shēn — the person and body; 体 tǐ — the body as an organic whole; and 形 xíng — the shape or form of the visible body. So the term 形 xíng for instance does not refer to the anatomical body as such, but to its innate properties and propensities. Hence, while qi was considered life influences, movements, substances and transformations, xing referred to the form it assumed, to embodiment. From the Warring States period (475–221 BCE), xing-form was often paired with 势 shì-potentiality, the external shape of manifested process with its configuration of influences. It was a thing’s shi-propensities that mediated between formlessness and form, between the non-visible and visible; and shi-propensities were observable in ‘the disposition of things’. [21-25]

While there are passages in the early Chinese texts where the term 身 shēn does denote ‘body’, it was not only the body as a physical entity. It was one's ‘lived body seen from within’, and its meaning included one’s ‘person’, ‘self’, ‘life’, and ‘lifetime’. [24, 26] The Inner Canon’s use of 身 shēn frequently denoted the human body and the person as a whole including their life,

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abilities and mental state. In early Chinese language 身体 shēn tǐ referred to the whole body and in contemporary Chinese shen ti is used to denote ‘body’ or ‘bodily’. Yet, shen ti today also implies ‘a person or self with all the connotations of the physical, social, and mindful’. [5, 27] Therefore the Chinese medical body actually refers to the disposition and configuration of human life processes and qi influences, and the visible shape of becoming.

Self-cultivation ( 修身 xiū shēn) has been an important topic in China from very early times, and commentators suggest that self-cultivation practices are integral to Chinese conceptions of the body. [28-30] Although xiu shen-self cultivation literally means the ‘cultivation of the body’, the Book of Changes (c. 700 BCE) for example provided guidance for the cultivation of oneself ‘toward better moral development’. [31] Daoist and Confucian self-cultivation practices trained one’s attention upon the inner realm, the spirit/mind (神 shén), and the cultivation of spirit/mind brightness ( 神明 shén míng). Indeed, just as 身 shēn refers today to one’s person or self, the notion of self-cultivation and its practices still refers to the cultivation of morality, of one’s person, of the embodied self.

Even though the ability to read the state of a person’s qi-patterns and regulate disordered patterns was (and still is) a hallmark of Chinese diagnosis and therapy, Chinese medicine also observed and investigated the body’s physical structures from earliest times. The Han dynasty medical classics contain a number of structures that appear to have an easy correlation with anatomical equivalents — the heart, stomach, kidneys, bones, uterus and so on. We know the Chinese performed detailed anatomical dissections from very early on because the physical weights, capacities and measurements of the internal organs and other structures were recorded in the Inner Canon and in the Canon of Difficult Issues (c. 100 CE). The physical measurements recorded are so similar to those we observe today that they could only have been obtained through dissection. Alongside these records of the body contents and their physical measurements, the Han dynasty medical texts also documented non-anatomical information regarding the visceral systems such as their associations with the five dispositions / minds (the 五志 wǔ zhì). [21, 32].

As well as an occasional and selective focus on physical structures, Chinese medicine did have its anatomy advocates. Wang Qingren (王清任 , 1768–1831) for example, deplored classical Chinese medicine’s representations of the internal body. In his Correcting the Errors In the Forest of Medicine (医林改错 Yī lín gǎi cuò, 1830) Wang famously rejected non-visible medical entities such as the channels and criticised the early classics for their unreliable accounts of the body interior. [33-35] Bridie Andrews [36]

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finds some evidence of indirect Western influence in the Correcting the Errors In the Forest of Medicine, and she judges that Wang’s work reflected the move towards 'evidential research' (考证 kǎo zhèng) that was current at the time. His scepticism matched the late Ming (1368–1644) and early Qing dynasty (1644–1911) trend that was critical of classical metaphysics and their systems of numeric correspondences. Wang Qingren and his adherents began an ongoing debate that started with anatomy and touched on all the issues of modernisation that confronted medicine in China at the end of the Qing.

So why didn’t Chinese physicians in any dynasty more actively persue their anatomical investigations or apply anatomical information to their medical practices? Western writers have frequently approached and refined these questions. It has been suggested for example that China’s sociopolitical structures stymied technological and scientific innovation to some extent, that traditions respecting one’s ancestors and parents meant that one’s body should not be dismembered or dissected, and that anatomy itself is an anomaly in the histories of medical sciences. [37-39] As far as the Chinese medicine tradition was concerned, the problem with anatomical research was that it provided knowledge of physical structures without life phenomena. The structural understanding of dead bodies simply could not contribute to the investigation of qi movements and transformations and human life processes. The inner organs of dissected cadavers have lost the manifestations and changes of their qi-functions because physiological life activities have ceased. This makes corpses and their contents essentially irrelevant for a medical system concerned with the dynamic states of human life. [40]

The ancient Chinese interest in the dynamic states of life has meant that traditional Chinese medicine favours the complexities of transformation and change over the investigation of physical structures and mechanisms. Nevertheless, qi-based conceptions and physical structures are not mutually exclusive views in Chinese medicine. Wu Yili [41] has shown how Ming and Qing dynasty physicians most certainly negotiated their way through the possibilities defined by each, just as ‘a feng shui master's reading of qi in a given landscape depends on the form and relative position of the objects that occupy it’ (p. 116). Late imperial doctors assumed that the body’s qi-movements and transformations were patterned according to the layout of its physical structures. However, the re-interpretations of the Chinese medical body that had been ongoing since the Han did not fundamentally alter early conceptions so much as contribute to the organic continuity of the tradition.

With the collapse of the Imperial era in the early twentieth century things began to change for Chinese medicine. Yet, even the early twentieth century

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advocates for integrating Chinese and Western medicine such as Yun Tieqiao (恽铁樵 1878–1935) have observed that ‘the physiology of Western medicine is based on anatomy ... and the physiology of Chinese medicine originated from the inner Classics is based on transformation of qi’. [5] So despite the ideological overhaul last century, today’s TCM textbooks still do not include anatomical or physical descriptions of the body or its contents and the TCM body image is not anatomical. Instead, TCM’s visceral systems imagery systematises the functional and dysfunctional manifestations of health and illness.

Because early Chinese life sciences generally investigated functional, relational and processual patterns and manifestations, early medical scholars applied the same epistemic to the living body. For the time, the Inner Canon’s explanations of the body are remarkable for their nature-based models and the absence of magico–religious thinking. In fact, the Han classics document a major conceptual shift away from what we know of ancient China’s magico–demonological medicine and introduce concepts of illness that are linked to natural phenomena such as worms, wind, cold and dampness, and to environmental cycles of change such as the seasonal and diurnal cycles. [42, 43]

The body image that was elaborated in the Inner Canon and the Canon of Difficult Issues was derived from the much older traditions of self-cultivation ( 修身 xiū shēn) and cultivating life ( 养生 yǎng shēng). Cultivating life practice regimes for breathing, physical training and dietetics were thought to maintain youthful vitality and protect the body from illness causing influences. [44, 45] According to early cultivating life discourses, the disruptive influence of external factors relied mainly or to some extent on the state of the body’s internal environment. Early medical texts used both explanations (external factors and internal harmony) independently, and more frequently they linked them to explain how internal imbalances, especially depleted qi-substances and influences, allowed external and other illness causing factors to injure the body. [14, 46]

When reading social sciences research and scholarship it is easy to see the impact of early history and culture on China’s methods of investigating the world, and how these early onto-epistemics guided conceptions of the body in the early medical classics. The Inner Canon’s descriptions of bodily structures and functional areas applied models of association and governance to categorise bodily entities and life processes. For example, when the number five is applied to the internal visceral systems, their associations with five phase qi qualities linked them with specific spirit/mind resources,

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physiological substances, tissues and structures. (Chinese medicine’s application of numerically significant sets to describe categories of qi and to analyse its processes and manifestations will be explained in the next section.) The Inner Canon’s various descriptions of the body all share the notion that it is formed by the correct disposition of material and immaterial structures and influences, and all these were closely integrated so that the body itself was unified by early notions of interrelatedness and ‘the one 气 qi’ flowing through heaven and earth.

Macrocosmically, qi was a broad unifying force; microcosmically, qi unified the physical body, its mental activities, emotional responses, physiological influences, processes and transformations. After conception, the one qi, the source of life, begins to differentiate according to yin–yang and five phase ‘natural law’. The medical analysis of postnatal life categorises Chinese medicine’s channels and organs according to their yin–yang and five phase qualities and relationships. The Inner Canon explained the movement and circulation of qi by means of a network of channels and collaterals (经络 jīng luò) whose pathways and branches reached every part of the body, and for a long time the channel system was seen ‘to constitute the essential physiological structure around which the other constituents of the body were organized’. [47]

The channel network enabled physiological integration and exchange by circulating qi substances: they connected the visceral systems (脏腑 zàng fǔ) with one another and with specific functional areas, structures, tissues and senses, integrating the whole body. The five yin viscera (脏 zàng — the heart, spleen, lungs, kidneys and liver), and the six yang bowels (腑 fǔ — the stomach, small intestine, large intestine, bladder, gall bladder and triple burner), were paired in relationships of association. For example, the yin and yang of the water phase are the kidney and bladder, the yin and yang of the wood phase are the liver and gall bladder. Their combined influences ensure harmonious movement and transformation between body systems, their qi activities and areas of influence. The correlative and symbolic models that applied to the dynamic balance of the body’s qi physiology also applied to its behaviours, practices, senses, mental activities and emotional responses. The free and orderly movement of qi therefore maintained not only one’s physical health, but the clarity of sensory perceptions and the balance of one’s inner life.

Although the Chinese never shared the West’s reliance on anatomical investigations, it is easy to overdraw the distinctions between their perspectives of the body and to reduce those distinctions to a function versus

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structure dichotomy. A more balanced view however acknowledges Chinese medicine’s detailed and accurate understanding of many aspects of the physical body. [41] Even though premodern Chinese medical texts most certainly noted the body’s physical structures, their investigations favoured the systematic observation of human life manifestations. It is not that premodern Chinese thinkers were not able to understand the world structurally, only that priority was given to qi-based influences, movements and transformations. [5, 48]

3. MEDICAL TRADITIONS

The Chinese medicine tradition is usually linked to the origins of its early concepts and terms and their development over the two millennia that coincided with China’s Imperial era (221 BCE –1912 CE). The twentieth century version of Chinese medicine is known in the West as ‘Traditional Chinese Medicine’ (TCM) because it includes conceptual models from the Inner Canon (c. 100 BCE) and from many important texts and currents since. The main distinction between TCM and the Chinese medicine tradition is that TCM is a twentieth century distillation and consensus of ancient concepts and premodern discourses, whereas the tradition in a broad sense is the large and diverse body of Chinese medical theory–practice starting with the Inner Canon. However, many historical–philosophical currents that have been influential for Chinese medicine’s traditional practices are not readily accessible via the transmission of TCM in English-language texts.

For the Chinese medicine tradition, premodern and contemporary scholars rely on the extant written legacy of the last two thousand years. Premodern Chinese medicine also included illiterate pedlars and small family businesses with closely guarded medicinal recipes and little else by way of written materials. With passing reference to these forms of practice, historians and scholars tend to concentrate on its famous textual tradition, a tradition influenced by sociopolitical changes and steeped in philosophical meaning. (There are some notable exceptions to this. For information about Chinese family, itererant and other non-literate medical practices see for example 49, 50-52)

The opposition of dogmatic tradition and progressive modernity is one factor that tends to cast an unfavourable light on Chinese medicine in the contemporary West. Theo van Leeuwen [53] has argued that this is because the kind of authority that is grounded in traditional customs, beliefs, habits and

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practices is generally thought to produce a static, monolithic edifice. However, historians have shown that the Chinese medicine tradition is dynamic, innovative and open to change. Its history in fact describes an evolving, living tradition that is comprised of many diverse currents and capable of assimilating modern scientific theories and technologies. Researchers in the social sciences depict Chinese medicine as a thriving and flexible medical tradition, one that has formed an organic continuity over time. [54, 55]

If the Chinese medicine tradition is not a single or fixed tradition, then what is the nature of its organic continuity? Social scientists have suggested that a tradition is formed in a culture’s historical infancy, or at least that the ‘personality’ of the tradition is established then. [24] So to identify the Chinese medicine tradition the discussion here highlights some of the classic texts, content and features that reveal the culture, continuity, perspectives and personality of the Chinese medicine tradition.

In the Introduction to his translation of the Confucian Analects (originally c. 500 BCE), Simon Leys [56] characterises a classic text as ‘open-ended in the sense that it lends itself constantly to new developments [and] different interpretations’ that accrue over time. It can be deformed and enriched, but it keeps growing and somehow ‘retains its core identity, even if its original shape cannot be fully retrieved anymore’. In the case of Chinese medicine, the Han dynasty classic texts are the first of the living threads that weave through the many centuries of practice, theorising, development and evolution that comprise the Chinese medical tradition. Chinese medicine’s textual archive was thoroughly revised during the Song (960–1278), systematised during the Ming (1368–1644), and then reconstructed during the twentieth century. Even so, right up to the end of the Qing dynasty (1644–1912 CE), Chinese medicine’s theoretical developments did not discard the ideas and frameworks contained in the Han medical classics so much as expand and accumulate around them.

Even before the Analects, the Chinese interest in ‘continuity through changes’ can be seen in the Book of Changes (from c. 700 BCE), the oldest and most famous of China’s ancient classics. Chinese medical texts often point to the importance of the Book of Changes for medicine. Historically, Sun Simiao ( 孫思邈 581–682) and Zhang Jiebin ( 張介賓 1560–1639) emphasised the close relationship between medicine ( 医 yī) and The Changes (易 yì) and claimed it was impossible to practice medicine without understanding them. [40] The Book of Changes is the earliest record of China’s most enduring onto-epistemics, which were based on the manifestations and images arising from the dao and its potentials. Its methods of knowing the world guided

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China’s early medical investigations and help explain their focus on the dynamic states of human life. In the Book of Changes, yin and yang encompassed and connected all phenomena because they were thought to contain the dao. In other words, yin and yang represented natural law: the dao’s potentials unfolded according to yin–yang principles and patterns of manifestation. So, as qi flows from the dao, it undergoes a process of yin–yang differentiation and emerges as the myriad beings and their patterns of qi.

The authors of the Inner Canon’s 162 treatises are unknown, and the various currents of medical theorising that we find in them were not always in agreement. Diverse as they are, many of the early medical classics espouse some enduring features that characterise early medcial conceptions and representations of the body. The first is the application of systems of correlative thinking: from the Inner Canon and Canon of Difficult Issues in particular came a persistent set of conceptual models, 气 qì, 阴阳 yīn yáng, 五

行 wǔ xíng (five phases) and 六经 liù jīng (six channels). Qi, yin–yang and five phases all appear in non-medical texts before and since, and deeply influenced Chinese medical theorising throughout the Imperial era.

Paul Unschuld [2] has dealt with China’s early correlative systems in detail. He calls these ways of knowing the world ‘systematic correspondence’, and shows how they are based on the idea that all phenomena can be categorised as manifestations of certain underlying principles. The main ones follow China’s early twofold (yin–yang) and fivefold (five phase) models. Systematic correspondences were used to categorise phenomena and to describe the relationships between them including the dynamics of their changes and transformations. The empirical observation of patterns of correspondence set up the earliest versions of relational categories, and the idea of resonance ( 應 yīng) supported the correspondences and the organising principles (natural laws) connecting macrocosmic and microcosmic phenomena.

Related to the correlative frameworks, and a second key feature of Han dynasty classical medicine, is its use of numeric significances. Early conceptual models often incorporated numeric sets that categorised macrocosmic (heaven–earth) and microcosmic (human) phenomena into meaningful groups. Phenomena so categorised were related by similar qualities — the ying-resonance idea. Some of the main numeric categories for medicine are ‘one’ (signifying the 道 dào, the ‘way’, and 气 qì), ‘two’ (for yin–yang), ‘three’ (for the 三宝 sān bǎo, the ‘three treasures’, meaning the essence–qi–spirit/mind), and so on. Their numerical ‘meanings’ linked these conceptual models to broader philosophical themes, and supported the

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correspondences and relationships between phenomena, their potentials, transformations and cycles of change. [57]

Regarding the first of Chinese philosophy–medicine’s numeric significances, the number ‘one’, Chinese thinkers saw reality as continuously produced out of the unitary state of qi that was called the ‘way’ of nature (the

道 dào). According to this worldview, the human body was inseparable from the dao and the cosmos because they shared the flowing course of nature through the ‘one qi’. [58, 59] Qi is often untranslated in English publications because we have no word for a concept that bridges the usually quite distinct notions of matter and energy. Moreover, it is a very broad term with a variety of interpretations that depend on its textual, historical and philosophical contexts. In addition, the yin–yang and five phase conceptual models were applied to the permutations and qualities of qi, and medically the notion of qi was multifaceted. The correct and free movement of qi influences and substances enlivened and integrated the body–person. The notion of qi organised human life phenomena into qualitative and directional influences and substances that were linked to therapies; and it established a model that explained illness as dysfunction. [60, 61]

The most important concept associated with the number ‘two’ is 阴阳 yīn–yáng. The ancient Chinese conceived of reality as continually evolving from the interactions and transformations of yin and yang. Yin–yang natural law was thought to orient the process of reality and its unfolding, and the principles of their interaction were thought to guide the actualisation and materialisation of qi-influences. The Inner Canon explains for example that the density of the body interior is maintained by the inward movement of yin qi, while the interior’s functional activities contribute to the outward movement of yang qi to the body surface. The clear yang qi effuses outward to permeate and fill the spaces in the skin and muscles and strengthen the four limbs, while unclear yin qi returns to the internal visceral systems. The yin’s inward movement brings about a convergence of essential qi that creates substance and structure. [62]

A third feature of the early classics is the variety of schools or currents of theory–practice and, despite sometimes conflicting perspectives, the tendency to accept the value of each of them. The yin–yang and five phase currents, for example, arose from competing perspectives of reality and were originally incompatible models. Early Chinese thinking tended to build upon earlier achievements rather than discard them in favour of new ideas: rather than replacing the old with the new, Chinese ways of knowing were marked by an ‘expansion’ of knowledge. [12, 63]

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A fourth feature of premodern Chinese medicine is its focus on clusters of illness manifestations or ‘manifestation types’ (证 zhèng), rather than singular symptoms (症 zhèng) or illnesses (病 bìng). [64] Zheng-manifestation patterns are clinically meaningful collections of observable signs and reported symptoms — their grouping is a result of the medical gaze that organises clinical information. It was Zhang Zhongjing ( 张仲景 150–219 CE) who first grouped illness manifestations and changes (the signs and symptoms of illness) in clinically logical sets and matched them with representative herbal formulas in his Treatise on Cold Damage and Miscellaneous Disorders (originally c. 200 CE). [65]

Originally 证 zhèng (manifestation types) meant the ‘manifestations on the outside’ and is nowadays translated as ‘pattern’ or ‘syndrome’. Zhang Zhongjing scholars point to his use of manifestation clusters as the origin of Chinese medicine’s ‘patterns of manifestation’ perspective. However, Zhang Zhongjing’s methods, and indeed herbal practices up to and including the Song dynasty (960–1279), were mostly pragmatic and based on illnesses and symptoms. [66] Nathan Sivin [67] traces the origins of the Chinese medicine’s patterns of manifestation doctrine to the Northern Song (960–1127), and its deployment in medical practice really only emerged during that time. In fact, classical Chinese medicine as we recognize it today actually took shape during the Song dynasty when imperial medical bureaucrats systematised the surviving canonical medical texts into standard printed editions. Scholar physicians of the Northern Song (960–1127) articulated a more integrated and coherent image of the medical body by combining the Inner Canon’s six or twelve main channels and the Treatise on Cold Damage’s six stage models, and linking both to the Inner Canon’s visceral systems.

In the Inner Canon (c. 100 BCE) the six channels (六经 liù jīng) are the pathways transporting qi around the body; in the Treatise on Cold Damage (originally c. 200 CE) they are ‘levels’ from the surface to the interior of the body and correspond to the depth and location of disorder, or more correctly, the stages in the transformations of externally contracted illness. The six ‘channels’, ‘levels’ or ‘stages’ are on a continuum from the most yang exterior level to the most yin interior. The Treatise on Cold Damage analysis differentiates ‘degrees of internality of a disease process without reference to a measurable depth inside the body’. [68] It includes many variations in presentation that consider the person’s constitution, the possible worsening or resolution scenarios, and complications associated with treatments and mis-treatments.

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Subsequently, Chinese herbal medicine was also systematised. The yin–yang and five phase models were gradually applied to the analysis of medicinal substances creating a more formal rationale for herbal practice. From that time, a well-crafted herbal prescription was ‘tailored to a specific client's constitution, environment, and symptoms, with a theoretical basis couched in terms of natural patterns of yin / yang action and Five Phase sequence’. [69] Finally, the Qing dynasty (1644–1912)’s ‘qi-based’ worldview valued an evidential perspective that de-emphasised metaphysical speculations in favour of a more concrete, common-sense realism. For the remaining several centuries of the Imperial era, the concrete, visible, immediate and dynamic experiences of human life, including subjective experiences, perceptions and feelings, provided the evidence for Chinese life sciences. The Chinese medical gaze observed a synthesis of qi-functions that included human life processes, bodily substances and structures, cognitive activities and sensory perceptions, desires and emotions.

4. THE MEDICAL GAZE

The orientation of the medical gaze guides diagnostic and therapeutic decision making. Though investigating the same human body, the onto-epistemics that underpin the differences in Chinese medicine’s and biomedicine’s interpretations and methods arise from their readings of the body. The impact of China’s early historical, social and cultural influences on its medical conceptions is well documented, and just like traditional Chinese representations of the medical body, modern European representations were constructed according to their favoured notions of reality and methods of knowing. [70-72]

The West’s scientific perspective first appeared in Europe with the Age of Enlightenment in the eighteenth century, when rationality dispelled superstition and dogma. From that time science gathered observable, measurable evidence, and medical science employed objective methods to investigate the physical body. This is the onto-epistemic that has guided the evolution of the biomedical body image: it favoured the more physical realm of anatomical dissection and focussed the Western medical gaze on material structures and phenomena. Today, bio-scientific methods and evidence act as the organising structures for medical knowledge and importantly, as a mechanism to exclude some types of knowledge. [73, 74]

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When China’s early medical scholars and physicians investigated the living body, they identified its fundamental components as the basic physiological substances (qi, blood, fluids and essence), the channels that circulated them, and the internal visceral systems that transformed and protected them. The Inner Canon’s analysis of the body interior describes the visceral systems in terms of their qi activities and associations, and their governance of certain structures and functional areas. The qi of each system travels throughout the body via their channels and the channels connect the organ systems, the upper and lower body, its interior and exterior, unifying and integrating the substances, structures, processes and transformations of human life.

Before the Han dynasty illness-causing agents exterior to the body were ghosts and ancestors. The Han medical texts reconceived external illness-causing agents with their analysis of environmental factors (such as wind, cold, dampness, heat, worms, and so on), and this indicates a fifth feature of the early classic texts — their analyses of external (non-body) illness causing agents. They observed the characteristics and changes of environmental phenomena and how they caused disorder by obstructing the qi at the body surface. The resulting cluster of manifestations, acute onset, fever and chills, muscle aches and headaches, neck stiffness, a sore throat and floating pulse, indicate the patho-mechanisms and illness pattern. Today, the experience of catching a cold or ‘flu is the very same as the early classics’ descriptions of the initial stage of an illness due to external damage. As the pathogenic qi affecting the body surface changes and worsens the disturbance was observed to move more deeply into the body through a sequence of stages or levels. After the Song synthesis, Jin–Yuan (1115–1368) scholar physicians began a second wave of medical innovation in which the early analyses of external (environmental) illness-causing factors were complemented by a stronger emphasis on internal (constitutional and emotional) factors.

Han dynasty discussions of the body surface and internal environment signal a sixth feature of early medical theorising. Early perspectives included some detailed conceptions of the body’s interior and exterior environments and of the interface between them, the body surface. In some parts of the Inner Canon the body surface functioned as ‘a permeable, indefinite boundary’ between the person and their circumstances and environment, giving ‘an impression of the human body as virtually indistinguishable from nature’. [27] In other sections of the Inner Canon the body surface is more clearly distinguished as a kind of border that defended the person against external pathogenic qi. In both cases premodern texts saw the body surface as an

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interface of exchange. It was permeable and extendable: qi-influences from the environment and body surface moved in to the body interior, and interior influences and substances moved out to the body surface. The body surface thereby offered signs that could be read diagnostically and a site for external therapies such as acupuncture. The premodern Chinese medical gaze understood that observable manifestations indicated interior processes. ‘Governing viscera and governed parts, the vital inner core and the expressive surface — all these are related in the same way that roots and stem are related to the leaves and blossoms’. [37]

By observing visceral manifestations at the body surface Chinese medicine’s model of organ–channel systems incorporated relationships of governance ( 主 zhǔ) that connected organs, senses, emotions, tissues, structures, regions, substances and process events. Consequently, kidney depletion can manifest in lumbar pain or hair loss, and liver disorder can manifest in blurring vision or thickening of the nails. Zhu-governance linked the liver yin visceral system with its yang organ partner, the gall bladder, and with the eyes, nails and sinews, the inner aspect of the legs; with the free movement of qi, blood and fluids; with planning, insight and decision making; and with the ease and clarity of mental–emotional activities and responses. In its traditional context the concept of zhu-governance binds together particular substances, process events, organs and tissues in a way not discernable by anatomical investigations. As a mnemonic device the notion of zhu-governance helps the student of medicine envisage a qi-based view of the body that attends to the influences and qualities of movement, time, transformation and relationship. Even though these associations are not discernable by dissection they have been confirmed over time by clinical observation and therapeutic intervention.

The visceral manifestations doctrine became a systematic articulation of the body–person’s qi-influences, substances and activities especially from the Song (960–1279) onwards. The inward–outward movements of qi are an example of yin–yang transformations between the body interior and exterior. The inward–outward movement of qi accounts for the dispersed nature of internal visceral activities and responsibilities, and the appearance of functional (and dysfunctional) manifestations externally. John Hay [21] and Manfred Porkert [75] use the idea of ‘unfolding’ in relation to the influence of interior visceral influences. ‘Unfolding’ is their translation of zhu-governance — Chinese medicine’s observed relationships of governance or unfoldment account for its visceral associations, influences and manifestations. The notion

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of unfoldments represents the body core as relatively dense and its peripheries as more dispersed, a body image ‘that is very suggestive for medicine’. [68]

TCM’s visceral manifestation theory (藏象学 záng xiàng xué) is an empirical method whereby the activities of the internal organ systems are inferred from observable external signs. In the twentieth century, the Song’s ‘patterns of manifestation’ doctine was reconceived to encompass the variety of diagnostic models that had arisen over the centuries since. When the national textbooks were compiled in the 1960s, TCM’s ‘identify pattern to determine treatment’ (辩证论治 biànzhèng lùnzhì) approach was adopted as the official clinical methodology. It was distilled from early notions of clusters or patterns of illness manifestations and established a common starting point that was relevant for many of the premodern currents of practice. Its greatest success though was to allow ‘the incorporation of Western disease categories into Chinese medical practice’ [76]: the method actually linked biomedical disease categories with Chinese pattern analysis, treatment strategies and methods.

Today, TCM clinicians begin with ‘identifying the disease’ ( 辩病 biànbìng), and within disease categories, they apply a standardised approach to ‘identifying patterns’ (辩证 biànzhèng). Since the 1960s ‘identify pattern to determine treatment’ has become the core method of TCM diagnosis and allowed Chinese doctors to apply traditional methods to biomedical diagnoses. [1, 68] So as well as the characteristic features of premodern medical theorising identified so far, TCM’s visceral manifestations theory is a seventh defining feature of the contemporary tradition.

How medical practitioners perceive the body shapes their interactions with it in the clinical setting. From the Han, medical theorising shifted away from magical and ancestor–spirit influences in favour of the observation of natural phenomena, their relationships and transformations. As a result, classical Chinese medicine was based on ‘the laws of nature’, and natural law was described in relational and functional terms. Even today, early conceptions of yin–yang and five phase ‘natural law’ guide the Chinese medical gaze in terms of its qi-based analysis of associations and manifestations. Chinese medicine’s epistemic methods produced reliable data and repeatable interpretations even though they were not anatomical or physicalist methods.

The Chinese medical gaze systematically observes the emergent manifestations of human life. It applies to the body–person’s living organ systems, to their associated sensory organs and other body structures and tissues, to their influences and substances, perceptions and consciousness, movements and transformations. In other words, it applies to the living body

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and whole person. The practice of medicine, the clinician’s perceptions, reasoning and decision making, are guided by learned perceptions of the body, the site of therapeutic interventions.

5. MEDICAL METHODS

Chinese medical methods accept the validity of subjective feelings and sensory perceptions for diagnostic information gathering (the patient’s experience of their illness) and decision-making (the physician’s observations and interpretations of their illness manifestations). To observe clinical manifestations (signs and symptoms) medical diagnosis relies on the four examinations (四诊 sì zhěn): to gather information about their patient’s condition the practitioner applies learned methods of looking, smelling and listening, asking and feeling. The four examinations, though only established as a systematic approach to diagnosis towards the end of the Qing dynasty (1616–1911), were based on the investigative approach first formulated in Chinese medicine’s early classics.

Social science researchers have linked the Chinese interest in subjectivity with the early appearance and development of the concept of qi. During the Western Han (206 BCE–65 CE) self-cultivation and nurturing life traditions documented exercise techniques, dietetics and qi cultivation practices that were incorporated into the early medical texts. The self-cultivation literature developed a richly sensuous language around the subjective experiences of one’s inner world, and historians of Chinese medicine have found direct links between this literature and the Inner Canon treatises [76]. In particular Vivienne Lo, [44, 77] a researcher in the early history of Asian medicine, has found that the language of self-cultivation texts describe the body and the subjective experiences of qi in great detail. Her work shows how these discourses and practices informed the Inner Canon’s representations of the body–person.

The link between the notions of qi and a person’s inner life experiences, their subjectivity, introduces an eighth feature of Chinese medicine’s epistemic methods. Although subjectivity is not unique to the Chinese medicine tradition, its continuing relevance for Chinese medicine practice does contrast sharply with the objective methods and standards of bio-science. Chinese diagnostic methods do not disregard symptoms (the person’s subjective experience of their illness) in favour of signs (observable and objective data): they give equal value to both. [72] Ancient and premodern notions of the

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body–person began with the cultivating life literature, which encompassed ethical behaviour and the effects of a person’s conduct and intentions on their human form, and this perspective took account of the lived body as seen from within.

In Chinese cultivating life and medical discourses the channels and the qi circulating in them accounted for the human being’s experience of their body from within. The notion of qi was related to one’s sensory experiences and subjective bodily feelings, and a person’s experience of their qi is felt, for example, as bodily warmth, activity, flexibility, strength; or the experience of depleted qi is felt as a lack of warmth, weakness, lethargy and so on. The person’s experience of their qi also included the dynamics of disorder and their manifestations such as pain, fever, bloating, ringing in the ears, stiffness or numbness.

In Chinese medicine, physicians observed how in good health the person experiences a subjective sense of ease, ‘that is embodied through visceral experience and manifested in [their] social interactions [and] ordinary experience’. [5] Conversely, a person’s experience of unhappiness and sadness was accompanied by feelings of stagnation and blockage, such as muscle tension, bloating, chest discomfort and lack of appetite. A person’s experience of unhappiness and stagnation were observed to extend beyond their internal body–mind sensations (their physical and visceral discomforts, anxieties, phobias, depression) to their social–emotional interactions and relationships (their neediness, distrust, inappropriate responses, emotional lability, erratic behaviour). [78] This is the person’s lived experience and existential world.

Consequently, from earliest times the Chinese medicine physician attended to their patients’ subjective experiences and relevant diagnostic information included the person’s inner experience of disorder. Diagnostically the physician relied on their own sensory perceptions to observe their patient’s form and manifestations. The physician ascertained the movements and qualities of their patient’s qi by visual observation, by asking and listening, and by palpating the channels, the abdomen, the pulse, the tone and texture of the skin and flesh. Medical observations took note of qualities and changes that were impossible to detect using anatomical dissection and objective methods.

The internal coherence of Chinese medical methods begins with its qi-based terms, concepts and relationships, which guide the interpretation of clinical manifestations; diagnostic interpretations then supply the rationale for prescription writing. The traditional Chinese diagnostic focus identified clusters or patterns of illness manifestations. The application of yin–yang to

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the analysis of illness patterns identified for example the location (internal–external) and the character (depletion–repletion) of the disorder. These two pairs of terms, and many other yin–yang pairs, still feature in TCM’s diagnostic language. The application of the five phase associations link each of the body’s visceral systems with specific senses, substances, tissues, mental–emotional abilities and responses. Consequently, a disturbance affecting a visceral system can be detected from changes in their associated functional areas.

Chinese medicine’s analysis of qi movements and transformations is summarised by the qi dynamic (the orderly ascending–descending and floating–sinking qi movements) and the smooth flow of qi through the channel system (the main channels and their network branches). The channel pathways and acupoints mapped qi-based concepts and relationships on the body surface. When using palpation to gather diagnostic information, the clinician feels the tone of the tissue structures and the junctions, clefts and spaces between them. Tactile examination can detect areas of warmth / cold, weakness / tension, dampness / dryness, accumulations / depletions that reflect the nature of dysfunction. If the person feels discomfort or pain in certain body areas, channels or points, dysfunction in the relevant systems are indicated. The channels and points are qi-based structures that explain how external treatments such as acupuncture are applied to regulate and adjust qi-influences and substances and their orderly movements.

From the Song onwards, these notions of qi movements and transformations became central to the discipline: they unified Chinese medicine’s channel and organ systems and linked its diagnostic categories to its treatment strategies. Before the Song, lineage and itinerant doctors for the most part applied treatments and formulas symptomatically. It was the Song scholar physicians who developed the notion of tailoring treatments to each person’s specific manifestations and circumstances. They sought to match the known qi-patterns of medicinal substances and formula recipes with the specific qi-patterns of individual patients. [66, 76] With the classification of medicinal substances according to their qi qualities, prescription writing could construct very specific formulas to re-establish health, that is, to resolve pathogenic influences and supplement insufficiencies, and to mimic and restore orderly qi-influences and movements.

Successful treatment depends on correctly identifying the location and the nature of disorder, and Chinese medicine’s treatment strategies and methods directly guide specific instances of therapy. Whether disorders are physical, mental, emotional, hormonal or neurological, traditional methods adjust the

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affected visceral and channel systems, their qi-influences and substances. They harmonise disorderly qi patterns and movements and restore the dynamic balance of yin and yang, they expel pathogenic factors, clear obstructions and replenish depletions that disrupt orderly qi influences. In cases of external damage, disruption at the body surface must be resolved: relevant strategies and prescriptions take into account the nature of the disruption (wind, cold, dampness, dryness or heat). In cases of internal disorder the clinician must resolve pathogenic qi and harmonise correct qi-functions. The variety and flexibility of traditional methods allows contemporary clinicians to apply ancient and premodern strategies in clinical practice today.

Accurate interpretations of clinical manifestations allow the clinician to respond to specific instances of illness, and understanding Chinese medicine’s historical perspectives and developments enables more accurate and nuanced clinical interpretations. Traditional medical methods are concerned with the person’s overall dys/functional body state and a diagnostic pattern is like a summary of their specific qi-functional patterns at the time of consultation. Chinese medical methods discern the mechanisms of disorder, diagnosis organises manifestations of disorder into medically meaningful information, and therapy responds to the specific qi-patterns of each person. Even today’s TCM treatment strategies and methods are designed to match and respond to the zheng-pattern/s identified ( 辩证论治 biàn zhèng lùn zhì). Although the therapeutic adjustments Chinese medicine aims for are as yet poorly understood using bio-scientific parameters, research does show that its interventions can instigate a cascade of changes that result in the normalising of physiological processes and human life functions. [13]

In the early classics, an understanding of the movements and inter-transformations of yin and yang was sufficient to explain the body–person’s structures and life functions. The ‘one qi running through all of creation’ assumed the interrelatedness of all phenomena, not only between the emotions and physicality of an individual person, but also between the person and their sociopolitical and cosmological environment. As a result, the separation of mind and body created by philosophical traditions in the West never arose in China. Chinese diagnostic methods observed and interpreted the functional disturbances caused by illness; its clinical methods were designed to adjust qi movements and transformations. This is the case whether its medical interventions are applied to physical or mental illnesses.

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CONCLUSION

The chapter argues for the preservation of Chinese medicine as a distinct medical discipline. In recent times, modernisation and integration have applied biomedical criteria to investigate, evaluate and correct Chinese medicine: these are one-sided, value-laden processes that essentially change the discipline and the traditional perspectives that guide Chinese medical reasoning and therapeutic decision-making. Even though Chinese medicine’s qi-based systems are not anatomical, nor are they abstract or idealised constructs. [79] The clinical reality of the Chinese medical body–person lies in detectable patterns of manifestations and process events, and the subjective experience of (dis)comfort and (dis)ease. The chapter argues that the correct understanding of the terms and concepts used to analyse human health and illness reveals the pragmatic nature of Chinese medicine’s traditional diagnostic frameworks and therapeutic methods.

To preserve Chinese medicine as a distinct medical discipline the connections between early conceptions and clinical practice need to be explicit for two main reasons. First, the practice of medicine, the clinician’s reasoning and decision making are guided by learned perceptions of the body, the site of therapeutic interventions. Second, historical accounts consistently link the correct understanding of Chinese medical conceptions with the effectiveness of its therapies. Chinese medicine’s conceptions of the body–person have explanatory insight and therapeutic potential for contemporary health care because clients and professionals today also recognise the interdependence of physical, psychological and social factors in health management. Chinese medicine’s textual archive documents its history of therapeutic success and frequently emphasises the importance of deep study and familiarity with its classical literature. By studying Chinese medical history and its classic texts, researchers and clinicians are able to expand our understanding of how health, disease and the medical body can be conceptualised. This connects us with the tradition and a textual archive that allows us to incorporate a raft of time-honoured clinical methods and techniques.

Even though early and premodern medical doctrines rarely attempted to generate a single, coherent image of the body, the Han dynasty’s classic texts gave rise to a medical perspective that produced reliable frameworks, explanations and interventions. Their application of qi-based analyses using the yin–yang and five phase concepts, and the yin–yang and six channel models, produced a nature-based and relational view of the body in health and illness. Although it is not possible to find a detailed image of the Chinese

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medical body in any one text or in any one area of research, the growth of interest in Chinese medicine in the West and the multidisciplinary research applied to it reveal a great deal about the continuity and diversity of traditional conceptions. English-language research and scholarship within and outside the Traditional Chinese Medicine (TCM) orthodoxy can highlight the relevance of non TCM research for clinical practice and restore some of the intelligibility and relevance of Chinese medicine’s theory–practice nexus.

Its grounding in China’s premodern philosophies and life sciences is what gives Chinese medicine its sense of continuity and tradition. Early observations of the laws of nature were applied to the living body — its qi movements and transformations, life patterns and habits, constitution and environment. By the end of the Han dynasty the Chinese medicine tradition had absorbed the dynamic perspective of China’s ancient philosophical investigations and cultivating life practices. Even though the history and development of Chinese medicine over the next two thousand years produced many currents of philosophy–practice and an enormously diverse textual archive, its tradition can be identified with certain enduring conceptual models and features. From the Han onwards the Chinese medicine tradition displayed more than a simple, if extra-long, continuity with the historic past.

Early Chinese philosophical and medical investigations were guided by the observations and analysis in the Book of Changes (from c. 700 BCE). China’s early onto-epistemics emphasised relationship, change and process, and oriented their investigations of reality towards context and environment. Rather than measurable data or items of knowledge, early Chinese philosophy–practice prefered patterns of manifestation, influence and change, and its more functional and processual ontology focused on the living body–person. The Inner Canon’s (c. 100 BCE) qi-based features and models described dynamic systems of transformation that encompassed macrocosmic (for example, seasonal and environmental qi) and microcosmic (for example, the process events of human physiology) phenomena and their changes over time. From the Han until the end of the nineteenth century China’s premodern medical texts expanded upon classical models and methods by incorporating new information and insights.

Thus, instead of a Kuhnian dialectic of scientific progress and obsolescence, a tradition emerged. It was a relatively holistic tradition, incorporating diet, lifestyle, mental, emotional and physical patterns and responses, and the appropriateness of them for leading a life that harmoniously suited the macrocosmic influences of human life, such as the cycles of nature and other environmental and social circumstances. The character of early

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Chinese medicine emphasised nature-based explanations and its strength lay in its sophisticated analysis of functional and relational data incorporating physical, emotional, environmental and social influences.

The discussion of how the body is conceived in Chinese medicine demonstrates the continued relevance of traditional conceptions for contemporary practice. While it is not difficult to find accounts of anatomical investigations in the premodern Chinese literature, many of the principal entities of the Chinese medical body were not observable using these methods. Some of the Inner Canon treatises documented the anatomical contents and measurements of the body’s physical structures, while others characterised healthy human life in terms of orderly qi movement, stable visceral functions, unimpeded blood and the essential qi of food and drink that produced and maintained life. Overall, the ancient and premodern Chinese body image was indistinguishable from the person as a whole, and the person was essentially interdependent with others. [80] Chinese medicine’s premodern discourses incorporated local, social, political, religious and philosophical conceptions, including various self-cultivation practices. Self-cultivation practices train the body and mind by attending to the movement and patency of qi-influences. Traditional conceptions connect self-cultivation discourses with other important Chinese medicine topics — the maintenance of health, the cultivation of one’s abilities, strength, relationships, awareness and intelligence.

Chinese medicine’s premodern representations formulated ideas about the whole person and living body that emphasised relational systems of movement and transformation. In this way Chinese medicine’s concepts of qi connect a person’s mental–emotional life with the physiological processes and structures that produce and maintain the body form and sense of self. Moreover, Chinese medicine’s notions of qi connect human life generally, and one’s person or self specifically, with the qi movements and transformations of our social, cultural and natural environments. Chinese medicine’s processual and relational view applies to systemic influences and transformations, body regions, organs, tissues, structures and substances, sensory perceptions, mental–emotional responses and conscious awareness.

The understanding of traditional representations of the Chinese medical body is both logical and expedient in terms of the effective utilization of Chinese medical practice methods. The living body’s qi patterns, transformations and process events, and its visceral and channel systems organise the traditional body image and the Chinese medical gaze. Traditional terms for qi systems and patterns correspond directly to Chinese medicine’s

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therapeutic archive and methods. In this way illness and therapy are ‘knitted together by [Chinese medicine’s] conceptual apparatus’. [81] Its functional language is the link between the clinician’s interpretation of illness manifestations and their therapeutic responses. Diagnostic terms encapsulate in one direction the disordered qi patterns of the affected areas or systems and in the other direction the language of therapeutic strategies. Therapeutic strategies in turn guide clinical methods and the selection of appropriate acupoints and medicinals.

It is because Chinese medicine’s notions of qi are not abstract constructs that its traditional medical methods are so practical and empirical. To harmonise living body systems, traditional Chinese acupuncture and herbal interventions replenish qi substances, and re-establish their harmonious functions and orderly movement. When the movement and interaction of qi and blood is harmonious, the body form and spirit/mind are unified, the essence–qi–spirit/mind are strong and well integrated, the yin–yang and five phase relationships are orderly, and human life unfolds.

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