Imagine the fourteenth century physician Zhu Danxi 朱丹溪 (1281-1358) beamed into the late 1960s by Scotty from Starship Enterprise. Landing in Los Angeles the first thing he does is attend a concert by The Doors because he has heard that Jim Morrison does a good song about fire and desire, two things that Zhu Danxi is intensely interested in. In fact, he immediately understands what Morrison means when he pleads for his baby to light his fire to get them both a little higher. However, being in the business of tempering rather than stoking fire and therefore not at all enamoured with either the lustfulness of Jimmy’s lyrics nor the sensuality of his performance he leaves rather disenchanted.
Back home Zhu Danxi belonged to a group of physicians working between the 12th and 17th centuries who fundamentally reshaped Chinese medicine’s understanding of the body/person. The details of this long drawn out process and its intersections with contemporaneous transformations at all levels of Chinese society and culture are beyond the scope of this discussion. It would not be entirely wrong, however, to claim that they decisively turned on re-imaginations of fire and desire within a newly constituted autonomous body/person.
To understand this process it is helpful to begin with the body/person as it was conceived before Zhu Danxi and his colleagues went to work on it. In this view the body/person was conceived as a microcosm of the wider cosmos around it, both animated by the same processes of change and transformation. These processes were grasped through yin/yang and five phases correspondences and wind/qi were imagined to be the dynamic forces that powered them. Indeed, the conceptualisation of qi as wind and vice versa was so close that the terms were often used more or less interchangeably as in the following passage from the Little Compendium of Drugs and Formulas (Xiao pin fang 小品方), a 5th century formulary that has been lost in China but became a compulsory text for medical students in 8th century Japan [1].
Wind is the qi of the four seasons and five phases. When it divides to spread throughout the eight directions [of the compass], when it accords with the twelve months and fills all three hundred and sixty days, when it comes in each season from its proper place, then it is called proper wind. In the universe it manifests as [the movement of] the five phases, in the human body as the qi of the five visceral systems [2].
There thus existed no distinct boundary between the body/person and the cosmos around it as both resonated with the same cosmic winds. And yet, this open body/person was never completely open either and health and disease not just a matter of aligning oneself with cosmic flows. For when the body became deficient thief-like winds could invade it and prove difficult to expel. [3] This led to the concept of the six potentially harmful seasonal qi against which the body had to be guarded, wind and cold especially. Historians have traced the notion of the body being invaded by pathogenic qi back to older demonological models of disease and argued that even in the classical period Chinese medicine was therefore already a potentially unstable synthesis of ideas with radically different cultural roots.
This classical notion of the body/person underwent an important reconfiguration from the 12th century onward when fire gradually began to replace wind as the most important imaginary through which physicians conceptualised the workings of qi. Several centuries later the influential textbook author Li Zhongzi 李中梓 (1588-1655) could therefore simply state:
Qi is fire, fire is qi. They are the same [kind of] thing and [merely] go by different names [4].
Exploring the multiple influences that informed this re-imagination of qi as fire is beyond the scope of this discussion. Suffice to say that they were closely tied to emergent conceptions of a more autonomous body/person animated by its own innate vitalities. A broader engagement among the Chinese elite with Daoist life cultivation techniques guiding attention towards one’s inner qi was one source of inspiration for this shift of perspective. The same period witnessed a new interest in human desire and the emotions as potentially creative forces in human life. Furthermore, as the country moved towards an increasingly monetised economy people began to engage in forms of exchange that detached both things and individual selves from relationships into which they had previously been embedded. Meanwhile, Neoconfucian thinkers, as the dominant intellectuals of their time, also began to accord individuals greater independence from externally imposed rules and mechanisms of social control. Human beings still belonged to a wider world of qi transformation but were now responsible themselves for cultivating their innate capacities for moral knowledge and action.
In the domain of medicine these selfsame forces created the more autonomous model of the body/person I alluded to above. The most important source of vitality in this reconfigured person were no longer cosmic winds but vitalities produced within the body itself. These included vitalities derived from food and drink but over time the focus shifted increasingly onto the fiery qi emitting from a place in the lower body known as the gate of vitality (mingmen 命門).
Unfortunately, physicians could neither agree on the precise location of this mysterious organ (suggestions included the kidneys, the right kidney, a place between the kidneys, the uterus), nor on how to designate the vitalities produced there (original qi, ministerial fire, yin fire, empty fire, dragon fire, yang qi, protective qi), or on how to integrate the newly emergent understandings of this physiological fire with existing notions of fire inherited from earlier authors. Furthermore, just like the life giving forces of the cosmic winds had been able to invade the body as evil qi, the physiological qi produced in the gate of vitality could as easily turn into pathological fire.
Within the human body-person that which is wild, defensive, and rushes harmoniously without ceasing is called qi. That which creates disorder by changing movement and reckless rushing is called fire. [5]
Still, the following account by Xiong Qinghu , a nineteenth century author who equated the gate of vitality to the Kidneys and referred to the fire produced there as protective qi (weiqi 衛氣), provides a vivid description of these ideas including a very materialist account of how physiological fire could be imagined to be produced from bodily essence.
The protective qi has an essence and a function. What is called its essence, refers to the root of the protective qi. This root is in the Kidneys. The Inner Canon of Huangdi says that the protective qi emits from the lower jiao [because] it is close to and therefore begins its movement from the foot lesser yin. The lower jiao is the place [in the body] that has the most fat and the protective yang is located within the centre of this fat. Hence, when it is said that the protective qi emits from the lower jiao, the [analogy] is like a lamp that as long as it is attached to the oil will shine steadily and incessantly. Hence, later generations also called it the fire within the water. This is so not only for humans. The fat of all things can fuel fire. Therefore, amongst all living things there is none where the yang qi is not contained within the fat.[6]
Xiong Qinghu also outlined the many bodily functions he considered as being underpinned by the protective qi. These extended from providing the energies for the transformation of food and drink, the warming of the body and the defence against external pathogens to the regulation of sleep/wake cycles, the generation of dreams, the coordination of left/right balance in the body, as well as being the foundation of human emotionality and intelligence.
Here Xiong went further than most previous authors, including Zhu Danxi, who had tied the fire produced in the lower jiao to the generative but also potentially destabilising forces of human desire but ascribed intelligence and volition to the Heart’s governance of spirit illumination (shenming 神明).
In fact, by avoiding references to the gate of vitality and labelling the vitalities produced in the lower jiao protective qi Xiong consciously eluded debates about the role of the two different fires in the human body that had dominated medical discourse over preceding centuries. These two fires were the newly important fire of the gate of vitality and the fire traditionally associated with the Heart by way of five phases doctrine. Based on a line in chapter 66 of the Simple Questions, the former was widely referred to as ‘ministerial fire’ (xianghuo 相火) and the latter as ‘sovereign fire’ (junhuo 君火). Debates about the precise function and interrelationship of these two fires were further complicated by the recognition of fire as both productive and destructive. These debates were fierce, often highly personal, and viewed by many physicians, including Ye Tianshi 葉天士 (1665-1746), as ultimately unproductive. Yet, even as he ostensibly despaired of them, Ye’s critique was effectively his own contribution to these selfsame debates:
Yang qi is qi without form. It can generate things and acts unceasingly. Fire is fire with form. It can harm things. Hence, one cannot say that yang qi equates to fire. [All types of] fire are at base one single thing. Sovereign and ministerial fire are both able to generate things when they are tranquil and do not move. Once they move they turn into human desires, become pathogenic qi and harm things. Hence, [this kind of fire] is referred to as a thief. Why is it necessary to argue noisily about the different doctrines that have only misled people throughout the ages?[7]
Others, like the eighteenth century scholar physician Xu Dachun 徐大春 (1693-1771), advocated a return to the past (fugu 復古) shorn of post-Song innovations as the solution. But once again, while he criticised others for sowing confusion Xu could not help himself from adding his own ideas about the nature of ministerial and sovereign fire to the mix. The only difference was that he dressed them up as ancient wisdom.[8]
To the extent that these debates were never satisfactory resolved the medical historian Paul Unschuld has described medicine in late imperial China as undergoing incessant decline when
thinkers seeking solutions to medical questions wandered aimlessly in all directions, lacking any orientation, and unable to find a feasible way out.[9]
Pace Unschuld, I think one arrives at a more charitable reading of those times when one relocates the debates in the field of medicine once more in the context of the larger questions of which they constituted but one expression. Namely, how to conceive of individual agency without surrendering a view of the cosmos as a larger whole to which we all belong? How to align autonomous individuals organically with society and the world beyond without relying on the suppression of desire? How to live without being destroyed by the world beyond or, vice versa, destroying ourselves and the world in the process of expressing ourselves?
Viewed from this perspective, post-Song ideas regarding the importance of internally produced fire can be viewed as attempts to ground human agency in a physiology driven by its own internal processes, to work out the role of desire and the emotions within this physiology, and to understand how all of this might be managed in health and disease. Beyond all of the bickering, I think it is also possible to detect an emergent consensus about how the fire that underpinned this physiology should be treated in the clinic: by nourishing it’s foundation, by facilitating its smooth expression and, in case physiological qi did turn into pathological fire, by not considering it a dangerous enemy but a child that had momentarily become rebellious and needed calming down and support.[10]
Unlike the gate of vitality in the lower body, which was conceived of as the the physiological foundation of individual autonomy, the Heart, as the second major organ associated with fire, continued to be conceptualised as simultaneously inward and outward facing. Through its control of the sensory orifices it was responsible for mediating exposure to the external stimuli that could arouse desire and cause the ministerial fire to blaze uncontrollably. That, in turn, required a moral intelligence that in the terminology of dominant Neoconfucian discourses was cultivated by guiding the human Heart/mind (renxin 人心) to grasp and reflect the cosmic Heart/mind (tianxin 天心) or Dao.
The illuminating power of such moral intelligence within the body/person was constituted by the Heart’s sovereign fire. Hence, while the emotional dimensions of pathologies of the fire of the gate of vitality invariably centred on the frustrated or excessive expression of innate desires, pathologies of the Heart were associated with the clouding of spirit illumination imagined as an obstruction of the sensory orifices and hence a loss of connection between the Heart/mind and the Dao.
The moral intelligence provided by the Heart/mind was rooted in coherence (li 理), a term referring to the always emergent patterns of connectivity that constitute the universe and that can be grasped by the human Heart/mind. In order to store coherence the Heart/mind had to be empty, both as a concrete anatomical structure and as the residence of the intangible spirit:
The heart has a shape which is round on the outside and hollow on the inside. You can describe it as a tangible object. As for that which encompasses all coherence and is intelligent and unpredictable, it is the coherence of mind and is not to be spoken of as a tangible object. But it is because the heart has this shape that it can contain all these coherence.[11]
This inward/outward facing role of the Heart as a mediator between the individual self and the world beyond continued to be conceptualised through the relationship between the Heart and fire as one of the five phases, a fire that is simultaneously without and within. Hence, it was the Heart and not the gate of vitality that was perceived as resonating with summer, heat and the sun - the powers that constitute the very possibility for our existence. For without the sun and the heat it radiates there would be no life on earth and, therefore, no ministerial fire either.
An awareness of these relationships was clearly articulated already in the Inner Canon, specifically in the Heart's connection with the Small Intestine as the official in charge of receiving and filling from whence the transformation of external objects emanates. It was restated by Zhu Danxi's designation of sovereign fire as "human fire" (renhuo 人火), a reference to its postnatal provenance. And what holds true for food equally applied to the mind as articulated in the work of Xunzi 荀子, a philosopher from the third century BCE
Transforming the body is the ultimate goal of learning. Only by inserting the Heart/mind between the gates to and from the outside world can learning transform the body. Otherwise it exits even as it enters, leaving the body unchanged.[12]
However, to the best of my knowledge, the precise nature of the interface between the outward and inward orientations of the Heart, the link between the digestive and cognitive functions of the Heart/mind and their articulation with the ministerial fire remained questions yet to be resolved. Was Heart fire merely the transformative power of the ministerial fire as brought to bear on things by the Heart/mind or did the Heart/mind possess independent powers of illumination? If so, where did these originate? Was the Heart's sovereign fire internalised fire assimilated from without or, if not, where did that fire go once it entered the body? Was sovereign fire a manifestation of spirit and as such a refinement of internal essences, in which case how did this relate to the Heart's function as a depository of coherence derived from the investigation of things?
At the same time, behind all the verbal mud-slinging regarding theory there was considerable agreement on actual clinical practice. Fire entering from the outside was considered to possess the propensity of a thief. If it could not be transformed, then it was best to get rid of it. Hence, an emphasis on bitter cooling medicinals, on purging and other forms of elimination, on detoxification, but also on keeping the Heart orifices open and the blood that nourishes the Heart ample.
I would also argue that Qing dynasty physicians like Xiong Qinghu were beginning to open up exciting new avenues for thinking about the many questions conjoining physiology, metaphysics, and human psychology that earlier thinkers like Zhu Danxi, Li Zhongzi, Ye Tianshi and Zhang Jiebin had opened up. They did this by abandoning the discourse on ministerial and sovereign fire that had by then become unproductive, shifting attention instead to understanding how different types of qi interacted with other types of physiological stuff within variously structured bodily spaces.[13]
We may further note that far from providing clear answers to any of these problems contemporary biomedicine is only gradually realising the connection between them. Once treated as distinct physiological systems, neuro-hormonal immunity is now viewed as constituting a single functional network. Human intelligence is no longer located merely in the brain but also in the gut. We are beginning to understand how gut health affects our moods and vice versa, how inflammation (as a manifestation of fire) is a mediator for untold diseases, and the role that biorhythms play in aligning all of these functions. If we allow biomedicine to only slowly unravel these connections, why should we measure Chinese medicine by a different yardstick and expect of it to provide us with fully worked out solutions?
I believe one of the reasons is a defensiveness that stems from a modern desire to demarcate Chinese medicine as a tradition separate from and different to biomedicine. Such desire presumes and then creates imaginary closures or, alternatively, despairs of their absence. Revealing these narratives for what they are - conjectures of our own desires - allows us to view the messy debates about the nature and function of ministerial and sovereign fire in a different light. Far from being lost in a maze of their own making Chinese physicians were slowly working their way towards an understanding of complex problems. In that they were and are no different to their biomedical colleagues in the present.
In fact, in the same way that Jim Morrison and Zhu Danxi would be able to communicate about human desire via the shared imaginary of fire, a productive dialogue between Chinese medicine and biomedical science might be enabled by exploring shared interests in the same bodily processes. The goal of such dialogue would not be to translate one closed system into another (asserting, for instance, that Chinese medicine discovered the immune system long before biomedicine did, or vice versa that biomedicine illuminates primitive Chinese medicine) but to help both in moving incrementally closer to an understanding of the world whose complexities may ultimately always be out of reach. Even better, we might invite historians and other humanities scholars along for an even more productive multi-logue.
As for Zhu Danxi's budding interest in Californian rock music, the next time he has the chance to time travel I suggest he might want to listen to Jefferson Starship playing Sketches of China. I don't know what he would make of their performance but I do think he would like the refrain:
And it ain't what you want it's what you need. No it ain't what you want it's what you need. And I'd rather be here than yesterday.
Endnotes
Triplett, Katja. Buddhism and Medicine in Japan: A Topical Survey (500-1600 CE) of a Complex Relationship. Berlin: De Gruyter, 2019, p. 90 note 72.
Chen Yanzhi 陳彥志. Xiaopin fang jilu jianzhu 小品方輯錄箋注. Hefei: Anhui kexue jishu chubanshe, 1990. [Author unkown, prob. 5th c. CE.], p. 72. Fabien Simonis' PhD Dissertation “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” Princeton University, 2010, provides a good overview of these developments.
Lingshu 靈樞, chapter 75.
Li Zhong-zi李中梓. Yizong bidu 醫宗必讀,” Beijing: Renmin weisheng chubanshe, 1995 [1637], p.21
Zhang Jiebin 張介賓. Zhi yi lu 質疑錄 . Nanjing: Jiangsu kexue jishu chubanshe, 1981 [1687], p. 324.
Qiong Qinghu 熊慶笏. “Zhongfeng lun 中風論,” In San San Yishu 三三醫書, Vol. 2, edited by Qiu Qingyuan 裘慶元, 725–47. Beijing: Zhongguo zhongyiyao chubanshe, 1998, p. 737.
Ye Tianshi 叶天士. Jingyue quanshu fahui 景岳全書發揮,” In Yetianshi yixue quanshu 叶天士醫學全書, edited by Huang Yingzhi 黃英志, Beijing: Zhongguo zhongyiyao chubanshe, 1999, p. 740.
Unschuld, Paul U. Forgotten Traditions in Ancient Chinese Medicine. Brookline, Mass.: Paradigm, 1991, pp. 81-2.
Unschuld, Paul U. Medicine in China: A History of Ideas. Berkeley: University of California Press, 1985, pp. 329-31.
This analogy as well as the one between excess fire and thieves was elaborated by Cheng Guopeng 程國彭. Yixue xinwu 醫學心語. Hefei: Anhui kexue jishu chubanshe, 1998 [1732], pp. 8-9.
Zhu Xi 朱熹. Xuexuan dushu lu 薛選讀書錄 cited in Zhang, Qiong. “Hybridizing Scholastic Psychology With Chinese Medicine: A Seventeenth-Century Chinese Catholic’s Conceptions of “xin” (Mind and Heart).” Early Science and Medicine 13, no. 4 (2008): 313–60, p. 344.
Xunzi 荀子 cited in Lewis, Mark Edward. The Construction of Space in Early China. Albany, N.Y.: State University of New York Press, 2005, p. 41.
Besides Qiong Qinghu I am thinking here especially of Zhou Xuehai 周學海.