In any tradition there exist two different routes by which we can connect past and present, history and mythology. Both narrate the past to us but do so in very different ways and towards very different ends.
Mythology creatively selects elements from the past, adorns and retouches them in order to place who we imagine ourselves to be in the present on firmer historical foundations. Almost all of the history written or narrated by Chinese medicine practitioners is of this kind: Zhang Zhongjing’s biography in the Song dynasty edition on the Treatise on Cold Damage (Shanghan lun 傷寒論) that turned Zhang Zhongjing the magician into Zhang Zhongjing the scholar physician so as to provide this then new type of doctor with historical cachet (1); Yu Chang’s account of Zhang Zhongjing working hand in hand with the early Buddhists in China because in his view Buddhist medicine was superior to the Neoconfucian scholarly type (2); claims by modernist medical reformers in Republican China that classical formula or jingfang medical practice rooted in the Treatise on Cold Damage represented a native Chinese empiricism that was modern before its time and equal or even superior to that of western medicine (3); and the very opposite claim made by some present day jingfang practitioners that their medicine, unlike TCM, is “pure” classical thinking unpolluted by the modern transformations that characterise TCM (4).
History, unlike mythology, seeks to understand what happened in the past and how that past made the present through an archeology of facts. This does not mean, of course, that historians do not have biases in how they interpret these facts. When I first came to the study of Chinese medicine in the 1980s, for instance, it was taken for granted by Western historians that the theories laid out in the Inner Canon of Huangdi (Huangdi neijing 黃帝內經) - what Paul Unschuld calls the “medicine of systematic correspondence” - furnished the blueprint for Chinese medicine throughout the ages. The single exception at the time was the work of the Swedish historian Hans Agren. In a series of very interesting papers published in the 1970s and 80s, Agren claimed that the history of Chinese medicine was essentially the history of the interplay between two fundamentally different currents, one based on the Inner Canon and a second one based on the Treatise on Cold Damage (5).
As far as I can tell, what accounts for the difference between Agren’s position and that of his contemporaries are the lenses through which they viewed their subject. Needham, Sivin, Porkert, and Unschuld approached Chinese medicine predominantly with the help of Chinese commentaries. Agren, on the other hand, cited mainly Japanese secondary sources. I learned later that one of the most important forces in the appropriation of Chinese medicine in Japan, whose influence endures into the present day and produced what we now know as Kampo medicine, was the so called “ancient formula current” (J. kohoha, C. gufangpai 古方派). Physicians associated with this current like Tōdō Yoshimasu (1702- 1772) rejected the Neijing tradition and concepts like the five phases or yin/yang as irredeemably metaphysical. In their own mythological writings the kohoha writers fashioned the Treatise on Cold Damage instead as channeling a much older entirely empirical medical tradition as yet unpolluted by Neijing metaphysics. This never happened in China where (at least until Chinese physicians encountered Japanese Kampo in the early twentieth century) even the most ardent advocates of jingfang medicine also read the Inner Canon. Clearly, the mythology of the ancient formula current had seeped through into Agren’s historical writings just as Chinese mythologies had influenced the work of his contemporaries.
The next time I heard a similar argument being made in the context of Chinese medical history was over thirty years later when I attended the lecture of a jingfang teacher in London. In her talk the lecturer claimed that jingfang practice was utterly different from Neijing-type Chinese medicine because the Inner Canon and the Treatise on Cold Damage constituted two entirely different strands of the Chinese medical tradition. Because this sounded suspiciously Japanese to me I asked the presenter whether her style of jingfang practice (that of the modern Chinese physician Hu Xishu 胡希恕 (1898—1984) drew on Japanese sources. It was a question she could not answer.
The Japanese influence on modern and contemporary Chinese medicine has always intrigued me but it is not something I have been able to follow up in a systematic manner. Sometimes, though, things come to you without looking for them. During the current Covid-19 lockdown I have spent considerable time reading Chinese medicine texts on epidemics. In one of these texts I stumbled upon a lecture given by a physician named Chen Xunzhai 陳遜齋 (1888-1948) at the Institute of National Medicine 國醫館 in Nanjing in 1935. It begins like this:
“The six warps (liujing 六經) in the Treatise for Cold Damage are synonyms for yin, yang, cold, heat, deficiency and excess. Greater yang, yang brightness and lesser yang are yang disorders. Greater yin, lesser yin and terminal yin are yin disorders. Greater yang, yang brightness and lesser yang are heat disorders. Greater yin, lesser yin and terminal yin are cold disorders. Greater yang, yang brightness and lesser yang are excess disorders. Greater yin, lesser yin and terminal yin are deficiency disorders. Besides yin, yang, cold, heat, deficiency and excess the location of the disorder in the exterior, interior or half-exterior/half-interior is also different.
The greater yang and the lesser yin both constitute the exterior. Greater yang designates heat and excess in the exterior, lesser yin designates cold and deficiency in the exterior. The yang brightness and the greater yin both constitute the interior. Yang brightness designates heat and excess in the interior, greater yin designates cold and deficiency in the interior. The lesser yang and the terminal yin both constitute the half-exterior/half-interior. Lesser yang designates heat and excess in the half-exterior/half-interior, terminal yin designates cold and deficiency in the half-exterior/half-interior.” (6)
Anyone who has ever come across Hu Xishu’s interpretation of the six warps in the Treatise on Cold Damage will immediately note that it is essentially the same as that proposed by Chen Xunzhai in his 1935 lecture. However, while Hu Xishu’s thinking, at least in the way it is disseminated by his contemporary acolytes, claims to connect directly to “pure classical thinking”, that of Chen Xunzhai can easily be traced to a very specific moment in Chinese medicine’s modern history.
The Institute of National Medicine in Nanjing was established by the Nationalist government in 1931 with the clear agenda of modernising Chinese medicine (7). On of its leading figures was Lu Yuanlei 陸淵雷 (1894-1955), a prominent physician and teacher from Shanghai who viewed Japanese Kampo as a model to be followed not only in reforming Chinese medicine but also in understanding the Treatise. Thus, in his A Modern Interpretation of the Treatise on Cold Damage (Shanghan lun jinshe 傷寒論今釋) he cited from forty-five different Japanese sources compared to only thirty-four Chinese ones. The book was one of the most popular publications of the cold damage literature during the Republican period and was reprinted seven times between 1931 and 1956.
Lu Yuanlei was a student of the famous scholar, revolutionary and physician Zhang Taiyan 章太炎 (1869-1936), who had lived in Japanese exile for a number of years, where he encountered and learned to admire the ancient formula current of Kampo medicine. So much so, in fact, that he later described Japan as the true centre of the East Asian medical tradition in the modern era:
“With the spread of the Treatise on Cold Damage to Japan, there have also been dozens of commentators. Their commentaries follow the text closely and are considerably more circumspect than ours. Their treatments demonstrate an ability to modify formulas with virtuosity, unimpeded by past orthodoxies, and moreover with frequent clinical success. In terms of making Zhang Zhongjing [come to life in the] present, we must state: our Way has gone to the East.” (8)
Given Chen Xunzhai’s work for the Institute of National Medicine there can be little doubt that his interpretation of the Treatise on Cold Damage was influenced by Japanese sources. In fact, to the best of my knowledge, it was the Japanese scholar physician Kitamurana Ohira 喜多村直寬 (1804－1876) who first proposed to classify the six warps in the Treatise solely with reference to the six qualifiers yin/yang, heat/cold, deficiency/excess.(9) Kitamurana’s work had been introduced to Chinese students of the Treatise in 1923 by Yun Tieqiao 惲鉄樵 (1878-1935), when he made it a cornerstone of his own Research into the Treatise on Cold Damage (Shanghan lun yanjiu 傷寒論研究).(10) Yun Tieqiao was the family physician of Zhang Taiyan, the teacher of Lu Yuanlei as well as of more than one thousand other physicians from all over China, and one of the most influential Chinese medical writers of the 1920s and 30s.(11)
One of the most difficult things for a historian is to find a smoking gun and I have neither the time nor incentive to go looking for one. I can therefore present no hard evidence that links Hu Xishu to Chen Xunzhai and further back to Yun Tieqiao, Kitamurana Ohira and the kohoha current of Kampo medicine. I am also not claiming that Hu Xishu copied or plagiarised Chen Xunzhai’s ideas. At the same time, given his scholarly background, the status of the Academy and the intellectual politics of Chinese medicine in Republican China, it is difficult to imagine that Japanese ideas about how to read the Treatise, heavily promoted and easily accessible at the time, would not have found their way into Hu Shixu’s thinking, too.
Which brings me back to the difference between history and mythology. The idea of Chinese medicine fertilising the development of traditional medicines throughout East Asia but not, simultaneously, being fertilised itself by the re-import of these ideas clearly is a myth owing more to contemporary nationalist ideologies than historical facts. So is the myth promoted by some modern jingfang practitioners that they have somehow managed to gain unmitigated access to pure classical thinking.
Because the real world is invariably messy purity of any kind only ever exists in mythical thought. I know why such myths come into being, but as both historian and practitioner of East Asian medicines I find the real stories about how ideas and practices get mixed up as they travel across space and time, taking on different lives as they do so, far more interesting, inspiring and practically useful.
Endnotes
1. Brown, Miranda. The Art of Medicine in Early China: The Ancient and Medieval Origins of a Modern Archive. Cambridge: Cambridge University Press, 2015, pp. 201-39.
2. Scheid, Volker. “The Neglected Role of Buddhism in the Development of Medicine in Late Imperial China Viewed Through the Life and Work of Yu Chang 喻昌 (1585-1664).” Bulletin of the History of Medicine 94, no. 1 (2020): 1–28.
3. Karchmer, Eric. “Ancient Formulas to Strengthen the Nation: Healing the Modern Chinese Body With the Treatise on Cold Damage.” Asian Medicine: Tradition and Modernity 8, no. 2 (2013): 394–422.
4. https://chinesemedicinetraveller.com/?article=six-syndrome-systen-of-the-shang-han-lun
5. Agren, Hans. “Chinese Traditional Medicine,” In Time, Science, and Society in China and the West, edited by J.T. Fraser, N. Lawrence, and F.C. Haber, 211–18. New York: Springer, 1972.
6. Tongsu Shanghan lun 通俗傷寒論 (Popular Guide to the Treatise on Cold Damage), Chapter 1, Section 2. accessible at: https://ctext.org/wiki.pl?if=gb&chapter=265152
7. For a brief overview of this period see Scheid, Volker and Eric Karchmer. “History of Chinese Medicine, 1890 - 2010,” In Modern Chinese Religion Ii: 1850-2015, Vol. 1, edited by Vincent Goosaert, Jan Kiely, and John Lagerwey, 141–96. Leiden: Brill, 2016.
8. Lu, Yuanlei 陆渊雷 (2008 [1931]). Shanghan lun jinshuo 伤寒论今释 (A Modern Interpretation of the Treatise on Cold Damage). Edited by Boo, Yanju 鲍艳举, Hua Baojin 花宝金, and Hou Wei 侯炜. Beijing: Academy Press, p.1.
9. Kitamurana Ohira 喜多村直寬. Shōkanron sogi 傷寒論疏義. (Point by Point Explanations of the Treatise on Cold Damage). Gakkundō 学訓堂, 1852.
10. Yun Tieqiao 惲鐵樵. Shanghan lun yanjiu 傷寒論研究 (Research on the Treatise of Cold Damage). Beijing: Xueyuan chubanshe, 2007 [1923], pp. 14-17.
11. Scheid, Volker. Currents of Tradition in Chinese Medicine, 1626 - 2006. Seattle: Eastland Press, 2007, pp. 213-218.