Imagine a student at a Chinese medicine college giving the following answer when questioned during their final year oral exam as to what the various bodily viscera store: “The heart stores the spirits,” she replies, “the kidneys store the essences, the spleen stores the hun, and the gallbladder the po souls.”
Our examiners are a bit perplexed. This is a good student, and the question was rather simple. So they give her another chance and ask her to outline the contribution of different organs to bodily physiology. The answer the student gives to this question is even more baffling.
Life is produced by the interaction of the [four] essential aspects [of heaven and earth]. Hence, when yang and firmness interact, heart and lungs are generated. When yang and softness interact, liver and gallbladder are generated. When softness and yin interact, the kidneys and urinary bladder are generated. When firmness and yin interact, spleen and stomach are generated. The heart generates the eyes, the gallbladder generates the ears, the spleen generates the nose, the kidneys generate the mouth, the lungs generate the bones, the liver generates the flesh, the stomach generates the marrow, and the urinary bladder generates the blood. [1]
Te examiners scratch their heads, ask themselves what substance our student has consumed, and reluctantly fail her.
Shao Yong’s challenge to conventional Chinese medicine
Our student, who happens to have more than a passing interest in Chinese philosophy, does not take this lying down, however. She informs her examiners that she was quoting, verbatim, a passage from the work of Shao Yong 邵雍 (1012-1077). In case they did not know, Shao Yong was one of the most famous cosmologists in the history of Chinese thought. His ordering of the sixty-four hexagrams of the Yijing in a binary sequence is widely, but mistakenly, said to have influenced Gottfried Leibniz (1646–1716), and thereby, indirectly, the development of the binary number system that underlies modern computation. [2] Historians and philosophers of science have compared Shao Yong’s breadth of vision to that of the theoretical physicist Stephen Hawking (1942–2018).[3]
That is not, however, why our student cited Shao Yong. She knows him as one of the foremost interpreters of the Book of Changes (Yijing 易經), as someone who developed his philosophy in conversation with medicine and the body, and who, in doing so, greatly influenced the development of medicine, too. No less a physician than the famous Zhu Danxi had, on the word of his closest disciple, considered Shao Yong the most important influence on his own thinking.[4] Shao Yong’s cosmological speculations provided some of the philosophical underpinnings for the development of the warming supplementation (wenbu 溫補) current in the course of the Ming dynasty. One could also make a good argument that Chinese medicine’s interest in the mingmen 命门 as the source of individual human life started with Shao Yong.[5] As for me personally, reading Jin-Yuan medical masters like Li Dongyuan and Zhu Danxi through Shao Yong has made their ideas much more intelligible.
Returning to our student, she notes to her examiners that her teachers had told her again and again in the course of her studies that Chinese medicine was, at heart, a philosophical medicine, grounded in texts like the Book of Changes. If that was so, did the examiners now wish to claim that they had a deeper knowledge of the Changes than Shao Yong? Or that their understanding of yin/yang cosmology transcended that of a philosopher they had probably never read? If modern TCM textbooks and Shao Yong’s ideas did not match, could they explain to her why the textbooks were correct and Shao Yong was wrong?
Our examiners are baffled. It is true, they never heard of Shao Yong, but they are sufficiently inquisitive to tell our student that they will read up on him, consider her challenge, and come back to her in due course. When they begin to read Shao Yong, they quickly discover that while he talked about all the things Chinese philosophers of a certain type talked about - dao, qi, yin/yang, principle (li 理), nature (xing 性) - his ideas were unconventional in many respects. In particular, he worked with four and not five elements, and he considered the cosmos itself as subject to the same process of birth, growth, decline and death as all the ten thousand things within it.
Shao Yong’s four elements were fire, earth, water and stone. He described wood to be an outgrowth of earth, and metal and outgrowth of stone. The central position of the number four in his cosmology is apparent in the quotes cited above. He considered the heart, kidneys, spleen and gallbladder the most important organs of the body, and the eyes, mouth, nose and ears to be their corresponding sense organs. These associations were rooted in his division of yin/yang into taiyang, shaoyang, taiyin and shaoyin, which for anyone with a knowledge of Chinese medicine are not difficult to associate with the heart, gallbladder, spleen, and kidneys respectively.
Reading Shao Yong thus leads our very open-minded examiners to ask themselves some broader questions: Who decides what gets remembered and what forgotten in Chinese medicine? What would be the criteria for adjudicating between Shao Yong’s numerological system based on the number four, and that of more conventional five phases thinking they were familiar with. Does asking this question indicate that Chinese medicine is, as many modern critics would contend, just fantasy?
Our examiners find it difficult to answer these questions. But what they can do, they decide, is to try and draw up a typology of how Chinese medicine as a community of practitioners tends to deal with these questions. So let us try to help them in their efforts.
Strategies of remembering and forgetting
The easiest strategy for dealing with a challenge such as that faced by our examiners has been to simply ignore it. This is why Shao Yong ideas do not commonly feature in Chinese medicine textbooks. It is a strategy that helps maintain the myth of Chinese medicine as a single coherent tradition, anchored in the ancient wisdom of the Chinese people. The problem with this strategy is that sooner or later someone like Shao Yong or our student comes along and challenges that myth. If we have the power, we can try to keep a lid on such challenges through sanctions and punishment (making them fail their exams, for instance, or preventing publication through peer review processes). That does not make the problem go away, however. Sooner or later someone we cannot silence (a historian perhaps) may come along an expose our myth making; or someone with even more power (bioscience) may employ the same strategies to silence us.
A somewhat better strategy, therefore, would be to find a way of establishing facts by deciding who is right and who is wrong. Modern science is built on this model, but it does not really work for Chinese medicine. How can we truly know that it is the Lung, which stores the po soul, and not the gallbladder? Does Shao Yong’s argument that metal is a product of stone really destroy the utility of the concept of the metal element? Come to think of it, why should we not work with three elements, as in Ayurveda. Or, perhaps, seven, or nine?
To avoid such awkward choices, Chinese medicine has historically employed another strategy that, following the French anthropologist Levi-Strauss, we can refer to as bricolage. Bricolage is the creative assembling of whatever resources one has at hand to create tools that get a particular job done. There is no need for consistency (or truth), because one job is different from the next, and the tools available at this moment here may not be available at that moment over there. Such bricolage has been historically very useful and probably been a major factor supporting the vitality of Chinese medicine over time. It does, however, come with its own problems.
The first problem is that of relativism. Are all ways of assembling solutions equally acceptable, or do we want to allow some but not others? If so, on what basis? Let us look at some concrete examples.
When I was first taught acupuncture in the UK, we were encouraged to intuit the function of acupuncture points based on their English names. Even then it was clear to most of us that these names were in many cases the product of very dubious translations. It is therefore easy to criticise this practice. But what if one were able to read Chinese? Is it acceptable then to base one’s point selection on intuitive interpretation? What level of Chinese would one have to possess? Given that so much of the original sources of the Chinese medical tradition have been lost, how can we get by without some degree of intuition?
Another example is the attempt to understand formula functions and indications in the Treatise on Cold Damage (Shanghan lun) through concepts like ministerial or sovereign fire. These concepts do not occur in the text itself, and they only began to be used more widely by Chinese medicine physicians a thousand years after the original text was compiled. If it is acceptable to telescope Ming dynasty thinking back into a Han dynasty text, is it not equally acceptable to read the Treatise through modern biochemistry?
This question points to another problem with the bricolage approach tied to but different from that of relativism. If all methods of assembling solutions to clinical problems are potentially equally valid, then how are we supposed to make choices between competing claims? In practice, this meant that charisma and mythology, rather than facts, have always been important factors in establishing authority in the field of Chinese medicine. The teachers at my acupuncture college, for instance, never tired of telling us that our style of acupuncture was the only one truly able to penetrate to the root cause of illness in a person. That claim was based on nothing else than the charisma of the college’s founder. In a lecture I recently listened to, another charismatic teacher informed his audience that he belongs to the same Daoist lineage as Sun Simiao. As far as I can tell, there is no historical foundation for that claim, but it worked well as a tool to give credibility to his teachings. And what of the claims of various exponents of jingfang style herbal medicine that they, unlike practitioners of TCM, represent authentic Chinese medicine? Are such claims any different from those of Shao Yong, who tried to convince his readers to jettison the five phases not merely through the power of his theories, but also by presenting himself as a scholar, whose access to the dao transcended that of ordinary men?
Rethinking the teaching of Chinese medicine
Having milled these questions over for considerable time, our hypothetical examiners feel they are left with an existential dilemma. Having come to accept that they cannot compete with Shao Yong on the territory of Chinese philosophy, they know that failing their student would be based entirely on their institutional power. Passing her, on the other hand, would leave them open to similar claims from other students who could point to this or that charismatic teacher, or even their own intuitions, as the source of their knowledge. Moreover, our examiners a experienced enough to know that in clinical practice, all of their students will eventually come to do whatever they want anyway. So all they can do is direct them towards taking a certain path rather than another. But what should that path be? And what, if any, could be the role of exams in this process? After much further consideration, they conclude with reference to a recent British prime minster that a rejection of cakeism (the assertion that it is possible to have your cake and eat it) is probably a good enough criterium. For look where cakeism got the UK.
In practical terms, that means that it is acceptable to intuit point actions from their names, as long as one acknowledges that the translations may be wrong, and accepts the consequences thereof. There is nothing wrong, either, with seeking to understand the Treatise with the help of concepts like ministerial and sovereign fire, as long as one does not claim to be speaking directly for Zhang Zhongjing. Alternatively, if one wants to make such a claim, one cannot do so by working with ideas that Zhang Zhongjing could not have had himself. If one wishes to claim to be a direct descendant (of sorts) of Sun Simiao, one either needs to accept that all of us can make the same claim, or produce the evidence why most of us are not.
Put another way, our examiners have come to the conclusion that rather than viewing Chinese medicine as a system composed of distinctive ideas, believes and practices, they will henceforth consider it to be a field of contestation, on which a hundred schools of thought contend. The criteria they will use to pass or fail their students will be the capacity of a student to insert themselves into these debates in a productive manner.
In the next blogpost I will therefore present an example from their newly revised final exam.
Notes
1 Shao Yong 邵雍, Shaoyong ji 邵雍集, Guo Huoxiao 郭或校, Beijing: Zhonghua shuju: 116.
2 Maitre, MJ. “The Development of Binary Arithmetic By Leibniz: Influence or Independence Regarding the Xiantiantu of Shao Yong.” Journal of East-West Thought 12 (2022).
3. Sophia Katz, Structure and numbers: Shao Yong on the order of reality, Studies in History and Philosophy of Science Part A, Volume 81, 2020: 16-23.
4. Wu, Yiyi. “A Medical Line of Many Masters: A Prosopographical Study of Liu Wansu and His Disciples From the Jin to the Early Ming.” Chinese Science 11 (1993): 49
5. Shao Yong 邵雍, Shaoyong ji 邵雍集: 131, 135