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Drinking from a

deeper wellBy Charles Chace

THE IMPORTANCE OF STUDYING the pre-modern medical literature as a basis for fur-thering ones understanding of Chinese medi-cine has been a perennial topic of debate foreducators and students. As a long-time studentof Chinese medicine and its literary tradition,I found Liu Du-Zhous Thoughts Regarding theStudy of Chinese Medicinein the May 2005 issueof TheLanternto be among the most eloquentand articulate statements on the topic. My onlyreply could only be Ditto. What he said.

Lius essay has prompted me to ride on his coattails in making what I hope are some practicalsuggestions as to how we in the West might takehis words to heart. One of Liu Du-Zhous keypoints is that one cannot read the classics pas-sively, perusing them as one would a magazine.They must be engaged rigorously and in a sys-tematic manner. This is not simply a matter ofworking hard. It requires that the reader proceedboth intelligently and creatively.

The text itself is only half of the equation. Ourchallenge is to discover how to drink more deeply,as it were, from the well of insight that resides notso much in the texts themselves as in our relation-ship with them. Only when we have really inter-nalized this material, claimed it for our own, doesits value become apparent. As Liu points out, thisis not an easy task, and it is a particularly daunt-ing one for us in the West. In this essay, I present afew of the techniques that I found for more effec-

tively engaging pre-modern literature, and I hopeto frame the two translations that accompany itin the context of those techniques.

I must confess that contrary to Liu Du-Zhouscounsel, I rarely read a source text alone, even atthe beginning. Frankly, I need glosses and com-mentaries to be sure that I have a general idea ofwhat is being conveyed. The writing in pre-mod-ern medical texts is often sufficiently opaque as toengender a variety of interpretations, even amongauthoritative commentators. Bouncing back andforth between these commentaries and the sourcetext itself both deepens my understanding of thetext and helps to define the lines of inquiry I willpursue. Personally, I find it unproductive to sim-ply read and re-read a text over and over. Regard-less of what language I am reading in, it is easy forme think that Ive gotten the gist of passage onlyto discover later that I have failed to carefully ex-amine what has been said. In the absence of someform of analysis, repetitive readings only tend toreinforce my initial preconceptions. On the otherhand, once I have some clear context in whichto work, I will inevitably end up reading the textdozens, if not hundreds of times.

There are two methods that I have found help-ful to fully engage the classical. First, I try to dis-cover some way of picking the material apart,some handle that I can wrestle with. This handlecould be comparing what is said in one chapterwith what was said in another or it could be fol-lowing up on related commentaries. For especial-ly complex passages, I will often map out the flowof ideas, analysing them at each step. Then, Ill

! Charles Chace has been astudent of Chinese medicine andits literature for over 25 years.He graduated from the NewEngland School of Acupuncturein 1984. He is the author andtranslator of a variety of booksand articles on acupuncture andChinese medicine including AQin Bowei Anthology, transla-tions of the writings of one ofthe architects of modern Chinesemedicine, with Yang Shou-Zhong,a translation of the first textbookof acupuncture from 100 C.E.,The Yellow Emperors SystematicClassic of Acupuncture andMoxibustion(Huang Di Zhen JiuJia Yi Jing ), and with Miki Shima,Channel Divergences, DeeperPathways of the Web. Charlesmaintains a clinical practice inBoulder Colorado.

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Approaching Warm Disease through source literature

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critique my own assessment. One thing that thisprocess invariably does is to illustrate the scopeof my ignorance concerning the topic in questionand what sort of homework I have to do simplyto understand the larger context of the discussion.Rather than humiliating me, I am continually re-

minded that the earliest of the classical texts werewritten to be transmitted directly to students whowould copy the text, memorise it and then haveit explained to them by their teachers. Later textswritten for more public consumption still presup-posed a greater familiarity with the literary tradi-tion of Chinese medicine than I possess. I invari-ably assume that some background research onmy part is required if I hope to comprehend theimportance of the material. Curiously, this proc-ess also sustains my interest in a way that encour-ages me to stick with the task.

The other method that I use is to actually writeout a translation of the material I am study-

ing. I do this even if I read a book such as OnCold Damage that has already been beautifullyrendered into English. I have been involved in anumber of translation projects that have resultedin publication, yet the vast majority of my trans-lation efforts never see the light of day. Transla-tion is simply one way that I study. For myself, theprocess is far more important than the publica-tion. Somehow, the rigor imposed by committingmy interpretation to print helps to hone my un-derstanding, once again clarifying what it is thatI do not fully comprehend. I am compelled to ex-amine the text in a way that I never do when sim-ply sight-reading. I think more deeply about whatis being said, and the flow of ideas. Translation isits own form of textual analysis, particularly if thesource language is not your native tongue.

Here in the West we can use the fact that formany of us Chinese is not our native languageto approach a text in a fresh way. We inevitablyask questions that would never occur to a nativespeaker. It often has been my experience that myquestions are so alien to my Chinese teachers wayof thinking that they cannot even comprehendwhy I would ask such a thing. Yet such quer ies areclearly relevant to my own understanding and ap-plication of the medicine. Inquiry of this naturein not merely an option for us in the West, it isindispensable to making ourselves full partnersin the ongoing tradition of Chinese medicine. Ifwe hope to truly own our medicine, we cannotforever rely on the pronouncements of others toguide our thinking. That we develop our own re-lationship with the literary tradition is a centraltenet of Liu Du-Zhous message.

Liu Du-Zhou was undoubtedly writing for anAsian audience. Although his observations re-main valid for all students of Chinese medicine,the issue for us in the West is not simply whetheror not we should study the classics. The vast ma-

jority of this literature is unavailable in Westernlanguages, and even if the primary texts are someday translated, it is unlikely that their associatedcommentaries and case records will ever be pub-lished in English. We are inevitably faced with acorollary question of whether it is worthwhile or

necessary for students of Chinese medicine tohave direct access to Asian languages. I believethat if we are going to study the classics, we musthave at least some access to its source languages.

That said, it is by no means impossible to en-gage the pre-modern literature in English transla-tion. One is simply limited to the material that hasalready been translated, and it requires one to bea little more creative in ones study methods. Thetranslations that follow this article (on pages 8 and31) are directed toward those who do not have di-rect access to the literature. We have tried to framethem in a manner that facilitates their use as studytools for those working exclusively in English.

Once I have begun to immerse myself into atext, I find myself swimming in a sea of questionsand ideas that inevitably begin to percolate intomy clinical practice. It is not that I am anxious totry out a new herb combination or needle tech-nique, so much as I find myself thinking aboutwhat I already do in a slightly different way. Youwill likely be disappointed if you look to the pre-modern literature for highly specific informationon how to treat one of your patients. On the otherhand, it is a wonderful means of fostering con-nections that you would not ordinarily make,connections that subtly but meaningfully changethe way you practice. After a while, the questionsthat arise from my clinical ponderings then filterback into my textual studies forming of a feed-back loop that incorporates an aspect of practicalapplication to the process.

Finally, I often find collaborative efforts to be aparticularly fruitful means of penetrating a text.

Just as the process of written translation shakesme out of my own often unconscious preconcep-tions, another set of eyes, another understanding,rattles my cage and gets me thinking in direc-tions that would not have occurred to me had Iremained sequestered in my own library. The twotranslations that accompany this essay are theproduct of just this sort of collaboration and theyprovide concrete examples of some of the ideasI have been discussing. Zev Rosenberg and FredWongs essay on San Ren Tangin the last issue ofThe Lanternis the product of similar collabora-tive approach to research.

Both of the following translations concern warmdisease. They exemplify two very different stylesof Chinese medical writing. The first is a theoreti-cal discussion written in a literary form. The lat-ter is a case record written in the telegraphic stylecharacteristic of many case records from the Qingdynasty. It provides a concrete example of how the

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It often has been my

experience that my

questions are so alien to myChinese teachers way of

thinking that they cannot

even comprehend why I

would ask such a thing.

Yet such queries are clearly

relevant to my own

understanding and

application of the medicine.

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posturing. In these textbooks, lurking pathogenswere primarily a buzz-word with little relevanceto clinical practice. MS, AIDS or spinal meningitismight be modeled in terms of lurking pathogensbut their treatment had little to do with actually re-solving them. Indeed, the familiar organisation of

treatment strategies according to fixed zang-fu pat-terns effectively froze the fluidity of the prescribingespoused in the source literature. Disappointed, itoccurred to us that we might have once again fallenprey to our own preconceptions regarding a poorlyunderstood topic in the pre-modern literature.We took a step back and began looking into howwarm disease specialists during the Qing dynastyhad applied the concept of lurking pathogens. Inparticular, we reviewed the extensive case recordsleft by Ye Gui and Liu Bao-Yi.

By and large, we found that in addition tospring-warm patterns, respiratory tract infectionsthat began with few or no exterior symptoms as

a consequence of some earlier contraction or anyproblem that lasted a long time might be consid-ered a lurking pathogen. Nevertheless, in its criti-cal development during the late Ming and Qingdynasties, the concept of lurking pathogens wasrarely applied to degenerative diseases as we un-derstand them today.

Many of the cases we looked at contained onlyone or two entries, hardly the complex clini-cal presentations we were associating with lurk-ing pathogens in our own practice. A few of hiscase records concerning lurking pathogens werelengthy and quite convoluted. We began analysingthese in some detail, looking for clues as to howLiu, an influential theorist on lurking pathogens,actually treated deep-lying problems.

Case records from the Qing dynasty are noteasily absorbed. They assume that the reader issufficiently conversant with the medical theoriesat play that he can follow the flow of ideas withlittle or no explanation as to what is transpiring.Consequently, the only data included in thesecase records is the information that most directlypertains to the point the author is trying to make.Almost nothing is spelled out for the reader andit is up to him or her to make sense of the case.Readers unaccustomed to this style of writing caneasily gloss over a case record, assimilating onlyits superficial aspects. It immediately became ap-parent that it would not be enough to simply readover these cases. We would have to carefully pickthem apart.

At the time we began our research, we had no ac-cess to Lius own case records. Anthologies of Liuscases are much less readily available than his anno-tated collections of cases written by others.

We finally settled on a single case record from Liusanthology of the cases of Wng X-Go ( ).In our initial review of this record, we were confi-dent that we had clearly understood both Wangs

methodology and Lius critique. This providedus with not one, but two perspectives on thetreatment of a lurking pathogen. As our analysisprogressed, however, this case repeatedly causedus to question many of our assumptions con-cerning the application of warm disease theory,

particularly with regard to the timing of treat-ment strategies. Jason, in particular, spent longhours mapping out the treatment strategy andits progression, trying to understand the subtlechanges in each prescription. We would thenget together and deconstruct our own analysis,looking for inconsistencies in our logic and re-fining our interpretation.

In the end, the message was clear. For LiuBao-Yi, the effective treatment of lurking path-ogens meant nothing more or less than the skil-

ful and timely execution of basic warm diseasetheory,the very same principles outlined by YeGui. Our translation and analysis of that case is

the second of the essays that follow.These translations and ideas they containhave been gestating for some time. My purposein presenting them now is threefold. Obviously,I hope that they are a worthwhile contributionto the Chinese medical l iterature now availablein English. More importantly, I want to illus-trate how my colleagues and I have effectivelyengaged the pre-modern literature using trans-lation as a tool for analysis. Our understandingof this material is far greater than had we con-tented ourselves with sight-reading it over andover in either Chinese or English. For those en-deavoring to access the warm disease literaturein English translation, I hope that these essayswill provide some useful tools beyond the con-tent of the translations themselves. In summar y,I hope that this material will help us all drinkfrom a little deeper well.

I have a knack for picking projects of an awk-ward size. They tend to be too long to fit intoa single journal article and too short to meritindependent publication. That may be anotherreason they often languish on my hard drive.My collaborators and I thank Steve Clavey atThe Lantern for consenting to publish thesemonographs in a serialised form. Readers mayfind Liu Bao-Yis case record, in particular,something of a cliffhanger in the first issue:does the patient survive? Thanks to my clinicstaffers Kacey Wardle and Kate Nott for lendingtheir considerable editorial skills to the project.Finally, most importantly, special thanks to ourfriend and mentor, Liu Guo-Hui, who was gen-erous enough to review both translations, offer-ing many valuable suggestions and corrections.Of course, any errors are entirely our own.

1. This account was recorded in the The Collected Papers

of Wu Physicians( W YHu Jing).

For Liu Bao-Yi, the

effective treatment oflurking pathogens meant

nothing more or less than

the skillful and timely

execution of basic warm

disease theory, the very

same principles outlined

by Ye Gui.

! Daniela Van Wart trained inChina, Europe and the U.S. Shestudied in Beijing and at theTianjin College of TraditionalChinese Medicine from 1992 to1995, and received a Masters ofArt in Chinese Studies from theLudwig-Maximilians-University inMunich in 1998. Daniela receivedher U.S. diploma in TraditionalChinese Medicine from theColorado School of TraditionalChinese Medicine documentingher three years of TCM InternalMedicine and Acupuncture train-ing in May 2001. She is a licensedacupuncturist in Colorado.