Classical Chinese Concepts Of Anatomy

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One aspect of Chinese medicine that is likely to seem especially strange to the modern reader is the classical approach to human anatomy. However, if classical Chinese anatomy is properly thought of in terms of function rather than structure, distinctions between anatomy and physiology become irrelevant. Anatomy, in the Western sense, did not form the basis of classical Chinese medical theory or practice. Western anatomists study the body as if dealing with an assemblage of bits and pieces belonging to a machine. In contrast, classical Chinese anatomy is concerned with the dynamic interplay of functional systems rather than specific organs. Within classical Chinese medical concepts, the term "liver" does not mean the material substance used to create pate, but the functional sphere within the body that corresponds to wood, spring, morning, quickening, and germination. Because of its emphasis on function rather than structure, Chinese anatomy can incorporate organs that have no physical substrate, such as the remarkable triple-warmer. Rather like id, ego, and superego in psychology, the triple-warmer has functions, but no specific location.

Other intriguing entities that have no direct counterpart in Western anatomy and physiology have been called the "life gate'' and the "potential fire.'' Some scholars believe that classical Chinese theories about the ''life gate'' and the "potential fire'' might be related to modern endocrinology. Joseph Needham called such classical theories ''physiological alchemy.'' Classic Chinese medical texts refer to the ''life gate'' as the repository of the primary life energy (ch'i or qi), which originated from the kidneys. In the male, this repository stores the essence and in the female it sustains the uterus. The theory of ''potential fire'' was ascribed to a physician who lived during the Yuan Dynasty (1271-1368), which indicates that new entities and forces continued to appear in Chinese medical thought. The ''potential fire'', which originated in the abdomen, was controlled by body fluids, like the blood. Another form of ''fire'' was associated with the heart and was related to mental activities. Normally, these two kinds of ''fires'' kept each other in balance, but an excess of ''potential fire'' could lead to loss of control over the emotions. Followers of this school of thought tried to maintain health by focusing on physical and spiritual harmony, and the management of food and environment. They also claimed that they could cure diseases that could not be healed by ordinary means.

In the Inner Canon, the yin and yang, and the five phases, are closely related to the five ''firm organs'' (heart, spleen, lungs, liver, kidneys) and the five ''hollow organs'' (gall bladder, bladder, stomach, large intestines, small intestines). Residing deep within the body, the five firm organs, or viscera, are classified as yin and function as storage facilities, reservoirs, or depots. Located relatively close to the exterior of the body, the five hollow organs, or bowels, are classified as yang, and assumed the functions of elimination. Interactions among the various organs were made possible by linking them through a system of conduits rather like irrigation channels.

Because of the vital importance of irrigation to agriculture in China, the functions of the conduits in the body were often compared to the hydraulic works maintained by the government. For example, the triple-warmer was analogous to officials who were charged with planning the construction of ditches and sluices. For the body to work properly, the organs, like the officials of the state, must dutifully assist one another. Thus, when the system functioned harmoniously, the heart acted with insight and understanding like the king's minister, while the liver acted like the military leader responsible for strategic planning.

The system of fivefold correspondences could have created an embarrassing discrepancy between medical philosophy and medical practice, because acupuncture and moxibustion techniques had become standardized around a system of six pairs of conduits or acupuncture tracts. The problem was resolved by adding the pericardium or heart-enclosing network and the triple-warmer to the list of firm and hollow organs, respectively.

Despite considerable debate about various details, there is little argument about the fact that Chinese scholars accepted the relationship between the heart and the circulation of the blood long before these concepts were incorporated into Western science and medicine by William Harvey (1578-1657) in the seventeenth century. Westerners generally coped with the challenge to Harveian originality by dismissing Chinese concepts of the circulation as obscure mysticism "improved" by loose translations. Philosophical arguments, rather than dissection, presumably led Chinese physicians to the concept of the ceaseless circulation of some vital substance—which might be translated as blood, or breath, or energy—within the body's network of channels.

Although the Nei Ching assumes that the movement of blood is controlled by the heart and the movement of energy by the lungs, scholars disagree as to the meaning and the implications of the terms that are variously translated as blood, breath, or energy. Chinese physicians believed that because blood was a vital substance that nourished the body, the loss of blood was debilitating. In contrast to Western doctors, Chinese physicians rejected the practice of bloodletting, which was an important therapeutic component of Western medicine up to the twentieth century.

According to Chinese medical philosophy, disease was basically caused by an imbalance of yin and yang, resulting in a disorder of one of the five phases, expressed as a dysfunction of the corresponding organ and the organs controlled by the injured organ. Therefore, all therapies were directed toward restoration of a state of harmony. In accordance with the fivefold system, the Nei Ching described five methods of treatment: curing the spirit by living in harmony with the universe, dietary management, acupuncture, drugs, and treatment of the bowels and viscera, blood, and breath. In prescribing any preventive or therapeutic regimen, the physician had to carefully consider the influence of geography, climate, and local customs.

With a sense of sorrow and disappointment, the Yellow Emperor and his Minister recalled that, in a previous golden age, human beings practiced temperance and lived in harmony with nature for over one hundred vigorous years. Later, people disregarded the ways of nature and became feeble, short-lived, and subject to many diseases. For example, the people of the East ate fish and craved salt; this diet injured the blood and caused ulcers. Winds, or ''noxious airs,'' caused much illness because they penetrated the body, disturbed the harmony of yin and yang, and diminished vital energy. Generally, winds caused chills and fevers, but specific winds associated with the changing seasons were linked to particular dangers. Disturbances of the harmonious relationship between mind and body could also cause illness.

For diagnosis and prognosis, the Chinese physician relied on sphygmology, a very complicated examination of the pulse. Because of the intimate connection between the tracts and vessels through which yang and yin flowed, the study of yin in the blood could reveal problems of yang in the tracts. Thus, by listening to the waves of blood generated by the heartbeat, the physician could detect disease in various parts of the body. The physician was expected to study fifty pulses, recognize more than two hundred variations, and know those that indicated the imminence of death. Pulses could be weak, strong, rough, smooth, sharp as a hook, fine as a hair, dead as a rock, deep as a well, or soft as a feather. The volume, strength, weakness, regularity, or irregularity of the pulse revealed the nature of the disease, whether it was chronic or acute, its cause and duration, and the prospects for death or recovery.

Sphygmology revealed incipient illness and allowed the physician to prescribe preventive measures or manage the course of therapy. Other kinds of diagnostic clues might be necessary, especially when dealing with children. Through close inspection, the physician could find diagnostic clues in the sounds made by the patient when talking, moaning, laughing, or weeping, and in the colors of various parts of the body. For example, inspection of the tongue could reveal 30 different shades of color that provided evidence of disease or the possibility of death. Physicians also had to recognize various types of difficult and skeptical patients, such as those who were arrogant, miserly, or addicted to overeating and dissipations, and those who had more faith in magicians and quacks than physicians.

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