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The Conception of Illness in Early Chinese Medicine, as Documented in Newly Discovered 3rd and 2nd Century B.C.
Manuscripts (Part I) Author(s): Donald Harper Source: Sudhoffs Archiv, Bd. 74, H. 2 (1990), pp. 210-235 Published by: Franz Steiner Verlag Stable URL: http://www.jstor.org/stable/20777300 . Accessed: 30/09/2013 05:35
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The Conception of Illness in Early Chinese Medicine, as Documented inNewly Discovered 3rd and 2nd Century (Part I)* Manuscripts
By Donald Harper
B.C.
placated with animal sacrifices; and there is evidence that Shang religion employed exorcistic rituals to expel demonic evil, including illness.1As in other ancient civilizations, one can delineate in the historical record of Chinese medicine the emergence of an increasingly rationalized understanding both of thehuman organism and of thenature of the illnesses that afflict it against the background of magico-religious ideas.2 The growth of Chinese natural philosophy during the Warring States period (mid-5th centuryB.C.-221 B.C.) spurred the in trend medicine rationalizing by providing new theoreticalparadigms, inparticular theYin Yang andWu Xing (Five Phase) cyclical theories and the concept of qiz "vital vapor". By the turnof the Han period (206 B. C.-A. D. 220), a body of theoryexisted millennium, during the which formed the core of medical knowledge for an elite group of physicians and their patrons. The severalworks that constitute the Huang di neijingh (Inner canon of theYellow ca. 1st century B.C. but much altered in the received text) are the Thearch; firstcompiled oldest Chinese medical texts in the received literature. The Huang di neijing has continually
The attempt to understand illness- to determine the nature of those things that harm the human organism and to control them- is in evidence in the earliestChinese written records, the Shang inscriptions on bone and turtle shell (ca. 14th-llth centuries B.C.). Often the inscriptions attribute an illness to the illwill of the Shang royal ancestorswho must then be
Research
for this article was Council of Learned
the American
supported Societies.
when
subject of concern in the inscriptions, which record the divinatory procedures employed by the Shang kings to probe the spirit world (chiefly their own ancestors) for information. a There are many unsolved problems in the study of Shang paleography, discipline whose beginnings date from the early years of the 20th century following the first discoveries of the inscribed bones and shells. See Paul U. Unschuld, in China: A History Medicine 1985), 19-21, for several of Ideas (Berkeley, examples of inscriptions related to illness. For a summary of Shang evidence for exorcism in a medical context see Shirakawa Shizuka, Kanji no sekaibm (Tokyo, 1976), vol. 2, 230-37. 2 One might characterize the difference between what I call a rationalized understanding of phenomena one in ancient a and a magico-religious thought by stating that the latter remained grounded in belief in deities and supernatural powers atwork in nature, while the former grew out of theories that attempted to in terms of regular and identifiable constants within the operation of nature itself. explain phenomena the boundary between rational explanation on the one hand and magico-religious and occult However, belief on the other is not easily defined. The use of the word science with reference to the branches of ancient natural philosophy is similarly problematic, especially when its use is intended to equate certain nature in ancient of with modern scientific knowledge. The nature of science in a insights knowledge a premodern context is subject of continuing debate, which lies beyond the scope of this article. I would that scholarship on the history of early science has put to rest the notion of a watershed note, nonetheless, scientific progress Brian Vickers, (Cambridge, brought about the definitive separation of science from magic. See, for example, in Occult and Scientific Mentalities in the Renaissance, ed. Brian Vickers "Introduction", 1984), 1-55; and G.E.R. 1979). Lloyd, Magic, Reason and Experience (Cambridge, Sudhoffs Archiv,Band 74,Heft 2 (1990) ? Franz Steiner Wiesbaden GmbH, Sitz Stuttgart Verlag
Institute for the History for research inMunich. 1 Illness is a regular
of Medicine,
Foundation and by grants from the Alexander von Humboldt I am grateful to Prof. Dr. Paul U. Unschuld, Director of the Munich University, for providing me with the ideal environment
The Conception
of Illness
in Early Chinese
Medicine
211
informedmedical speculation down the centuries, assuming a significance in Chinese West.3 civilization not unlike thatof theCorpus Hippocraticum in the While itscontent isnot homogeneous, reflectingthe fact that it incorporates the writings of the 2nd-lst centuries of the several distinct medical traditions B.C., Huang di nei jing is an essentially natural phenomenon arising frompathogenic conditions of the qi within the system of moc "vessels" and internalorgans in the human body (theworkings of which are explained by Yin Yang and Five Phase theories), and illness is cured by correcting the qi with acupuncture). At several points in the Huang di nei jing the question of the (principally existence of demonically rooted illnesses and of the efficacyofmagical treatmentsis raised, Huang ambiguities in the thoughtof the only to be dismissed.4There remain some interesting di nei jing,5 but overall the book is remarkable for its rationalistic and skeptical attitude discounted. demonology and magic have been effectively What has been missing from theChinese historical record ismedical literature predating or contemporary with theHuang di nei jing thatmight clarify the intellectual and cultural contextwithin which itsmedical theories and acupuncture therapywere formed; and that
3 Acta Asiatica 36 (1979), 67-89, on of theHuang-ti "The Formation See Yamada Keiji, Nei-cbing", di nei jing. Unschuld, the relationship between groups of Han physicians and the content of theHuang an interpretive and useful overview between of the relationship in China, Medicine 29-66, gives di and magical beliefs on the one hand and the theoretical medicine presented in theHuang demonological Issues Classic The nei jing on the other. Unschuld, 1-59, 1986), (Berkeley, of Nan-Ching: Difficult in the text in the received literature, the Nan that a second Han medical demonstrates jing (compiled was as influential as theHuang di nei jing in establishing the theoretical base for lst-2nd centuries A.D.), medicine. Unschuld's translation of theNanjing is the best guide to Chinese medical theory in its classical formulation. a chthonic deity who was euhemerized States period as an Thearch, during theWarring as ancestral patron of medical and various occult arts founder of civilization, was regarded content of theHuang di nei jing ismostly in the form of (including alchemy) by the 3rd century B.C. The to which his medical teachers (e.g. Qi a rhetorical dialogue asks questions inwhich the Yellow Thearch is shared Bor) respond. The rhetorical format of exchanges between this legendary pupil and his teachers The Yellow archaic consistently adheres to naturalistic theories in its explanations of illness and treatment. Illness
de Lao and occult literature of the period. Cf. Anna K. Seidel, La Divinisation with other philosophical Tseu dans le Taoisme des Han (Paris, 1969), 50 f. 4 di nei jing: Ling shuhn (Sihu heiyao), "Zei feng",bo 9.11a, is The following dialogue from theHuang said, "What theMaster has just now stated are all things a sick man himself would If, however, he has not encountered an evil qi and further has not experienced a horrific shock to his self-will, and yet suddenly is taken ill,what is the reason for it? Is it nothing other than that the cause lies in the activities of demons and spirits?" Qi Bo replied, "In this case there is also old evil that has remained and is not yet released. Because of it, if the self-will hates something or longs for something, the inside and the two qi strike one another. The origin of this blood and qi are thrown into disorder condition is subtle. Looking one doesn't see it and listening one doesn't hear it. Thus it resembles demons and spirits." di nei jing: Su wenhp (Sihu heiyao), "Wu zang bie lun",bq 3.14b, ismore trenchant in its The Huang of demonology: condemnation one must examine (the person) all the way down, determine the condition treating illness is enthralled (mo), and observe his self-will and thoughts as well as his illness. One who demons and spirits cannot be spoken with about culminant virtue. 5 For example, in the passage from "Zei feng" quoted in n. 4 there appears to be an admission that exists (otherwise how can something appear to resemble it), but that category of demonic phenomena irrelevant to the understanding of illness. The implications of the existence of a spirit world alongside Whenever his vessels natural world are examined further below. of by the it is the representative: The Yellow Thearch
know.
212
Donald
Harper
were current in might reveal a fuller spectrum of belief and practice in themedical arts that Han medical books listed and Of the society. Warring States,Qin (221-207 B.C.), thirty-six in the 1st century B.C. catalogue of the royal Han library (classified in four categories:
medical
Huang di nei jing has survived.6There is a reasonable amount of anecdotal material only the included in historical and philosphical texts as well as in belles lettres,but the only other Huang di nei jing are selectedwritings of the 2nd preceding the example ofmedical literature B.C. Yid century physician Chunyu preserved in the account of his life in the Sbijie by Sima 87 It is B.C.).7 impossible to estimate how much medical literatureactually Qianf (145-ca. existed and how widely it circulated. However, we do know that itwas usual formedical practitioners to transmittexts to theirdisciples as part of the transmissionof theirknowledge, and that elite patrons collected medical literature.This pattern of textual transmission and patronage was also characteristicof the other branches of natural philosophy and occult arts with which medicine was affiliated.8 The long lost technical literature of ancientChinese natural philosophy and occult arts has recent to been gradually coming light in archeological excavations. The manuscripts have all been found in tombs, apparently selected for burial from the libraryof the deceased. It is possible that some of the individuals buried in the tombswere practicing specialists, butmost
seem to have been elite patrons of discovered, it becomes increasingly As more and more specialists.9 evident that theoretical developments of this literature philoso is in natural
theory,
recipes,
sexual
cultivation,
and macrobiotics
for achieving
transcendence),
phy (e.g. of Yin Yang and Five Phase models, and their applications) were being made by physicians, astrologers, diviners, and the like. Further, there is a catholicity in this literature that reveals broad affinitiesbetween a rationalized understanding of nature and various magico-religious and occult views. This catholicity is due, inpart, to the applied nature of the specialist's knowledge. A specialist was expected to utilize his knowledge to accomplish specificends; andwhile natural theoryprovided a powerful explanatorymodel, acceptance of certain rationalized views of nature did not preclude thevalue ofmagic.10Natural philosophy
6 treatise of theHan The content of the catalogue is preserved in the bibliographic shuhk by Ban Gubr and the original titles of (32-92 A. D.). The medical division is called "Fang jiwbs (Recipes and techniques); are "Yi di nei jing), "Jing the four subcategories canons; the location of theHuang jing"bt (Physicians' and "Shen xian"bw (Divine transcendence). recipes), "Fang zhong"bv (Intra-chamber), fang,,bu (Canonical
doubtful). Yamada Keiji, "Hen Shaku densetsu", Toho gakuhdhy 60 (1988), 73-158, has shown that Sima from earlier anecdotal literature and tailored the account to reflect created the account of Bian Que Qian own time. It is an arts in Sima Qian's the image of Bian Que as a patron of certain medical important and not an example of medical literature. fascinating document, but is 8 is detailed in the Shiji accounts The custom of textual transmission as part of medical apprenticeship of Bian Que and Chunyu Yi. Medical literature comprised one segment of a technical literature that included, among many subjects, works on astrology, calendrics, divination, and incantation. The Han on the latter subjects "Shu shu,,bz bibliographic places works together in the division catalogue one none and of the medical division of in this the works ahead just arts) (with (Calculations exception, division survive). 9 For a general treatment of the new manuscripts and speculations on why manuscripts were placed in to Natural and the and Han Manuscripts Related tombs, see Harper, Philosophy "Warring States, Qin, Sources of Early China, ed. E. L. Shaughnessy. Occult", forthcoming in Paleographic 10 The emphasis on applied knowledge is evident in the names of the two divisions of the Han
See Han shu (Beijing, 1962), 30.1776-1780. 7 Most of the account consists of quotations from medical See Shi ji (Beijing, 1959), 105.2794-2817. case histories and other prose written by Chunyu Yi. The same chapter of the Shiji begins with an account States period is of the legendary physician Bian Quebx (whose historical existence during theWarring
The Conception
of Illness
in Early Chinese
Medicine
213
was not ignored by the "masters" zi% of pre-Qin philosophy, but they concerned themselves Warring States period theories of nature were principally with politics and ethics. By the inseparable from political and ethical issues, and argumentation on the Tao (Way) as an
ultimate nature
The humanistic orientation of thephilosophers undeniably contributed to the rationalizing of

and to
organizing
structure
both
in nature
and
in human
society
became
quite
sophisticated. of
philosophical masters rarelyexhibit an interestinnature outside of itsutility as an explanatory model for theirparticularphilosophical program; and itoften appears that ideas about nature have been adapted and adopted from the technical literatureof natural philosophy and the For medical literature,the medical writings major discovery to date is the corpus of fifteen from tomb 3 atMawangdui*1 in elevenwritten on silk and fouron slips of bamboo or wood in 1973. is The excavated burial dated Hunan, precisely to 168 B.C., providing a Changsha,1 ante quern for the of the scriptplaces the redaction of firmterminus and analysis manuscripts;
some of the manuscripts in the late 3rd century B.C.12 nn. 6 and 8 above). The mutual bibliographic catalogue containing the writings of these specialists (see term is in the which denoted the technical books that them among identity crystallized fangca "recipe", and signified their ability to successfully apply this knowledge. contained their knowledge Chunyu Yi's to transmit to apprenticeship with the elderly physician Yang Qingcb began with the latter's decision recipe books". The term fang sht" "master of recipes" occurs for Chunyu Yi his jin fang shucc "tabooed the first time in the Shiji to identify specialists in natural philosophy and occult arts who were patronized occult.11
skepticism
of magico-religious
views.
However,
the extant
writings
the
di nei internal organs according to the theories of certain fang shi which differ from the standard Huang for further jing identification (Su wen, 3.13b). See Harper, "Warring States, Qin, and Han Manuscripts" discussion. 11 The Han the philosophers in a division called "Zhu zi"ce (The catalogue places bibliographic a Yin This which includes thewritings attributed to division has for masters). Yang specialists subcategory is reputed to have formulated Yin Yang and Five Zou Yan,cf the late 4th century B.C. philosopher who Phase theories (and whom many fang shi regarded as an ancestral father). One could list other pre-Qin in ancient in the "Zhu zi" division that are relevant to the development books of natural philosophy the influence of the ideas in these works on the and it is clear that one must acknowledge China; not the likes of Plato But there were and Aristotle the pre-Qin among practitioner-specialists. can be said to have one of the pre-Qin philosophers produced analyses of nature (in all philosophers. No in of itsmanifold aspects) for its own sake in such a way that they determined subsequent developments nan zi,c% a Han the various branches of natural philosophy. The Huai philosophical work compiled under includes chapters that treat of cosmological, the sponsorship of Liu Anch (179-122 B.C.), astrological, and physiological matters. Liu An was an active patron oifang shi and other specialists in geographical, that is distilled in his book. Wang ChongV1 and it is their knowledge 27-ca. natural philosophy, (A.D.
the reputation of the fang shi by the Qin and Han courts (and by other members of the elite). Although was primarily that of wonder-workers whose magical powers and knowledge of nature were equally was medical valued, even the most skeptical physician (the usual term for a self-acknowledged specialist an was based on the conception of fang. Considering the Yellow affinity with them that yicd) shared Thearch's additional role as patron of various occult arts (see n. 3 above), there is an interesting passage in the Su wen, "Wu zang bie lun", inwhich the Yellow Thearch asks Qi Bo to explain the identification of
He thepolitics and ethicsof thepre-Qin philosophers). Wang Chong found to be illogical(including
100) Lun hengCi (Assaying
of discourse)
is remarkable
for its skeptical
scrutiny of all manner
of ideas that
to him were own ideas concerning nature and the spirit world. His lambasted what superstitious for which he could not have had empirical arguments, however, were often based on assumptions it could be said that the development of knowledge evidence (see below, n. 76). As a general observation, to be, and continued the framework of natural philosophy was, within guided by the practitioner I would include practitioners of religious Taoism from ca. 3rd century A.D.). specialists (among whom 12 in and a transcription are published Han mu ho of the original manuscripts Mawangdui Photographs Vor an excellent overview of theMawangdui excavations shu,ck vol. 4 (Beijing, 1985); hereafter, HMBS.
214
Donald
Harper
The Mawangdui medical corpus representsprecisely thekind of technical medical literature thatbegan to flourish in the Warring States period and continued to proliferateduring the Qin andHan. There are five writings on the systemofmo "vessels" in the body and cauterization therapyassociated with it (acupuncture isnotmentioned anywhere in the Mawangdui medical
corpus), (two are seven whose recipe contents and manuals one are related to sexual mainly is an illustrated chart and macrobiotic practices of therapeutic exercises), hygiene one on
gestation andmatters related to childbirth,one which provides several recipes for love philters (and includes other charms), and a long recipemanual whose recipes are arranged according to fifty-twotypes of ailment. Originally untitled, Chinese scholars have assigned titles to the Other discoveries of medical manuscripts have been smaller than theMawangdui find. Tomb 247 at Zhangjiashan' in Jiangling,k Hubei, excavated in 1983, includedwritings on mo on exercises. and The tomb dates to no later than themid-2nd century theory therapeutic
B.C., and the medical texts are fifteen writings.13
Tomb 1 at Shuanggudui1 in Fuyang,m Anhui, excavated in 1977 and dated precisely to 165 B.C., included a writing that could be described as a drug list since its contentmostly names individual drugs and identifies the ailments that they cure. The material on drugs in Mawangdui recipes and the Fuyang text constitutes the earliest documentation of Chinese
pharmacy.15 Manuscripts have also been Hubei, that discovered. treat of arts and various and occult astrology, divinatory hemerology, Two such manuscripts in Yunmeng,0 from tomb 11 at Shuihudi11 to ca. 217 B.C., to in 1975 and dated contain material that is relevant
closely
related
to
Mawangdui
texts on
the same
subjects.14
excavated
medicine and the conception of illness.16 There is a demonography in one manuscript that
of the site of the three tombs) and summary of themedical corpus, see Unschuld, (including photographs "Die Bedeutung in der Ma-wang-tui-Funde fur die chinesische Medizinund Pharmaziegeschichte", zum 65. der Pharmaziegeschicbte: ed. P. Dilg Perspektiven Festschrift fiir Rudolf Schmitz Gehurtstag, were found in the tomb, including two editions of the (Graz, 1983), 389-417. Other manuscripts in Han mu ho shu, vol. 1 (Beijing, 1980), and a variety philosophical work Lao zi,cl published Mawangdui of calendro-astrological material as yet unpublished. 13 I adopt the titles assigned to them in HMBS. See the introduction toHMBS for a listing of the fifteen medical writings according to their occurrence on silk sheets (three separate sheets of silk contain eleven It has been estimated that accounting for lacunae there were approximately writings), bamboo, or wood. 30000 approximately corpus, of which (the script signs of the Chinese writing system) in the medical logographs 24000 are preserved. The longest text is the recipe manual Wushier hingfangu (Recipes for 10000 graphs (cf.Unschuld, fifty-two ailments), currently containing approximately "Bedeutung der Ma
related to mo theory and cauterization 400). For a survey of the writings (and wang-tui-Funde", see Yamada, of the antiquity of cauterization relative to acupuncture), "Formation discussion of the in China, 73-75 and 92-95. Harper, and Unschuld, Medicine "The Sexual Arts of Huang-ti Nei-ching"; Ancient China as Described in a Manuscript of the Second Century B.C.", Harvard Journal of Asiatic Studies 47 (1987), 545-60, surveys the writings related to sexual cultivation and macrobiotics. 14 A transcription of the writings on mo theory is published in Anonymous, "Jiangling Zhangjiashan Han 1989.7, 72-74. jian Mo shu shiwen", Wenwucm 15 The Fuyang text has been assigned the titleWan wucn (Myriad things). A transcription is published inAnonymous, 1988.4, 36-47. The language of Wan wu is similar jian Wan wu", Wenwuco "Fuyang Han to passages in the Shan hai jing** (Canon of mountains and seas), the early Chinese book of myth and drugs and the ailments they cure; and there ismention of legendary geography, that describe marvelous wu. The material on drugs antedates the drugs with magical properties inWan Fuyang and Mawangdui oldest extant materia medica, the Shen nong hen caocp (Materia medica of Shen Nong), by several centuries. 16 on Qin The tomb library is perhaps better known for its manuscripts and judicial governmental
The Conception identifies parallels types of to medicine have demonic are on
of Illness
in Early Chinese
Medicine to caused counteract them;
215
the Both
phenomena
manuscripts ailment and diagnosis manuscript
sometime before or slightlyafter theQin unification of China in 221 B.C.19 These manuscripts are invaluable sources for the study of theory and practice during the period when Chinese medicine was achievingwhat is considered to be its classical form. It should be emphasized that they are textsthathave only recentlycome out of the ground, fresh
(albeit timeworn) from the 3rd-2nd centuries B.C. The manuscripts contain lacunae due to
by including to determine the cause of an the use of hemerological techniques to medical to chart its course from onset to conclusion, with suggestive parallels an occult most has been discovered in Similar material and prognosis.18 recently to in 1986 and dated in Tianshui,q from tomb 1 at Fangmatanp excavated Gansu, sections
clear,
remedies and provides to ailments references
demons.17
rotted silk and bamboo; but they have experienced none of the vicissitudes of transmission that led to the loss of most ancient literature (especially of technical literature likemedical books), or that recast the original form and content of a book in a new edition. The manuscripts may both corroborate and correct the view of medicine that has been handed down in the received literature.20 The geographical distribution of themanuscripts is also content of those fromShuihudi in Hubei (south central); and the writings on mo theory from in Hunan in from share text parallels both Hubei and (south) Zhangjiashan Mawangdui between them andwith the Huang di neijing. It is reasonable to speak of an oikumene by the 3rd centuryB.C. within which natural philosophy and occult knowledge circulated.While it
appears that practitioners, matters. were rather the manuscripts owned than mostly by patrons specialist are the same writings that circulated the specialists.21 among essentially they noteworthy. The occult manuscripts from Fangmatan in Gansu (northwest) reflect the
a are in the Photographs (illegible) and transcription of all of the manuscripts published site report for the Shuihudi tombs: Anonymous, Yunmeng Shuihudi Qin mucq (Beijing, archeological are reproduced in plates 116-165. 1981). The two occult manuscripts 17 "A Chinese Demonography See Harper, of the Third Century B.C.", Harvard Journal of Asiatic Studies 45 (1985), 459-498, for a study of the demonography, which in the manuscript has the title "Jie"cr
(Spellbinding). 18
Cf. Marc Combattants," 19 Selected
di nei jing. portions of theHuang 21 on mo For example, the content of theMawangdui and Zhangjiashan writings theory parallels the of course, be quite important to discover manuscripts di nei jing. It would, that could be Huang to have belonged to a practicing physician or astrologer. As to the circulation of ideas and demonstrated books before the Qin unification there were the (221 B.C.), important cultural differences between in the 3rd century B.C. which continued to exist long after the ancient regions of the Chinese world some of the content in the reflects regional culture. For the most part, however, manuscripts period; and ideas seem to have spread widely. Manuscripts from the north and northeast have not yet been discovered, a significant gap in light of the fact that in Qin and Han times this region was regarded as the center of come from regions I have mentioned activity of the fang shi "masters of recipes". All of the manuscripts and the script can be thatwere already controlled by the feudal state of Qin during the 3rd century B.C., identified as the standardized medical 20, (September
Fangmatan of Li Xueqin, 1990.4, 45. jian zhong de zhi guai gushi", Wenwuct "Fangmatan 20 of the Huang-ti Cf. Yamada, "Formation 67-70, on the medieval Nei-ching," reshaping of the on mo theory for di neijing and the significance of theMawangdui Huang writings determining the older
a la Fin des Royaumes "Les Traites de Shuihudi et PHemerologie Chinoise content of the two manuscripts. 72 (1986), 175-228, on the hemerological "Tianshui passages from the Fangmatan occult material are transcribed inHe Shuangquan, 1989.2, 23-31. On the dating of the tomb, I follow the judgment Qin jian zong shu", Wenwucs Kalinowski, Voung Pao
Mawangdui
form adopted by the Qin government. There is occasional evidence in the corpus of the form of script used in the feudal state of Chu.cu In private conversation informed me that a still unpublished Mawangdui occult manuscript is 1990) Li Xueqin
216
The purpose of the present article
Donald is to use
Harper the new manuscripts to examine the conception
of illness in earlyChinese medicine. Previously thedocumentation of demonological beliefs in the received literature showed that such beliefs existed and that various rationalized explanations of illnesswere proposed to counter them, culminating in the theories of the Huang di nei jing. However, we have not had medical literaturethat could reveal themany elements of debate amongmedical specialists in the emergence of new views of illness, except
for the limiteddiversityof opionion reflected in the The manuscripts Huang di nei jing itself. new on not a rationalized in theoretical differences provide only insights, significant on of also illness but that The and occult ideas influenced medicine. understanding magical evidence indicates that therewas not a monolithic theory either of nature or of illness in medicine even by the 2nd centuryB.C, in spite of Chunyu Yi's statement mid-century thata "model of the vessels" devised by ancient sagesmade itpossible to successfullydiagnose and treatall illness.22 When in the Huang di nei jing, in a philosophical discourse on the workings
of nature preceding an explanation of acupuncture technique, Qi Bor states that, "the Way is
without demons and spirits- singly it comes and singly it goes," themanuscripts provide reasons towonder how widely this idea of a rationalized nature freeof demonic intrusion was believed and how rigorously itwas applied inmedicine.23 Examination of themanuscript evidence is divided as follows: etiology, in part I of this article; and nosology and diagnosis/ prognosis in part II (to appear in SudhoffsArchiv 75). Etiology
Demons and
the Shang bone and shell inscriptions to the current folk almanacs. Statedmore generally, an ailment is something located on or in the body thathas a cause which can be identifiedand treated. Demonic intrusion is the example par excellence of this view of illness, and the treatment is exorcism.Medicine often refines this concept by replacing demons with other with identifiableagents, and that treatmentfocuses on eliminating the cause of localized entity the ailment. Paul U. Unschuld identifies this view as the "ontological" approach to illness, which he contrastswith the "functional" approach representedby the theories of the Huang mo and pathogenic conditions of qi di nei jing. The objective of the theoreticalparadigm of the in theHuang di nei jing is in fact to establish a universal model that explains illness as a
fundamental disfunction of the human agents and pathogens of a more naturalistic origin. But the idea remains that an ailment is a
spirits
cause
illness
in the magico-religious
view,
documented
in China
from
In this model particular ailments are secondarymanifestations of thatdisfunction, and the goal of therapy is to re-establish the harmonious functioningof the organism.24
a of Chu and Qin script (from the errors it appears that Chu scribe had still not more are we to determine the effect As discovered be better able may Qin script). manuscripts that regional differences in script had on the circulation of books. 22 Shi ji, 105.2813. Chunyu Yi's argument on mo theory is translated under "nosology" in part II of this article. 23 Su wen, "Bao ming quan xing lun",cv 8.3b. 24 Some Historical and Epistemological "Traditional Chinese Medicine: Social Unschuld, Reflections", Science and Medicine 24 (1987), 1023-1029. Unschuld observes that the ontological approach in Chinese di nei jing, medicine, which continued to be accepted alongside the functional approach of theHuang shares certain ideas with Western medicine that undoubtedly of Western influenced the acceptance written mastered in China in the 19th-20th centuries. in a mixture
organism
within
the system
of mo
and
internal
organs.
medicine
The Conception
of Illness
in Early Chinese
Medicine
217
That the functional approach of theHuang di nei jing and acupuncture therapywere ultimately accepted inChinese medicine is obvious; so obvious that itsnewness in theHan period is often overlooked, as is the continued acceptance of the ontological approach in later Chinese medicine. To be sure, the idea that illnesshad something to do with qi was old. A well known anecdote in the chronicleZuo zhuan* under theyear 540 B.C., records the teachingof Physician He1 inwhich illness is classified according to six types of qi that are generated by
heaven. Illness occurs when abusive
qi in the body.25 But this notion of qi is related to the ontological approach to illness, the excessive qi being identifiedas the cause of a specific ailment rather than some other agent.26 As late as the 2nd-lst centuriesB.C. theproblem forChunyu Yi and like-mindedphysicians was to successfullydemonstrate that themultifarious ailments - the greatmajority ofwhich already had proper names in contemporary language did not exist as discrete phenomena, butwere in fact manifestations of a deeper disturbance in thehuman organism.27Based on the
content
activity
generates
an excess
of any one
of these heavenly
The prime document for speculative reconstruction of a contrastingview of illness is the ailments),whose recipes Mawangdui recipemanual Wushier bingfangu (Recipes for fifty-two are classified by category of ailment.28 The 282 recipes that survive afterrestorationof the silk sheet are remarkablydetailed, including at times a description of the symptoms of the ailment being treated,precise instructionsforpreparing drugs and performing therapy,and occasional notes on the identification of certain plants as well as on the storage of drugs and medicines. to attests the sophistication with which Warring States physicians identified Wushier bingfang specific ailments and developed appropriate treatments; there are not comparable recipe
manuals 25 in the received literature earlier than the 4th-6th centuries A.D.29
of the new manuscripts,
medical
opinion
was
not
in unanimous
agreement.
Zuo zhuany Zhao gongcw 1; see the Harvard-Yenching concordance, Chun qiu jing zhuan yin decx was in the second (Beijing, 1937), vol. 1, 344 f. There is general agreement that the Zuo zhuan composed half of the 4th century B.C. The six types of grare: Yin qi, Yang qiy the qi of wind, the qi of rain, the qi of since each type of darkness, and the qi of brightness. The classification is equally significant for nosology, qi is associated with a specific category of ailment. 26 to Physician He, the patient, who is the ruler of the feudal state of Jin,cy has engaged in According excessive nighttime sexual activity so that Yang qi and the qi of darkness have caused his illness. The cure is moderation. that the ailment is like gu31 (a diagnosis Physician He's begins with the observation see below p. 225) and that it is neither demonic nor related to ailment involving black magic, diet, all statements that are consistent with the ontological approach. 27 and diagnostic Chunyu Yi addresses this problem directly, and explicitly deals with the nosological in his argument on mo theory (see "nosology" in part II of this article). implications, 28 "The Wu Shih Erh Ping Fang: Translation and Prolegomena" (Ann Arbor, Harper, 1982), is a is the fifth and last writing transcription, translation, and study of Wushierb bingfang. The recipe manual on a sheet of silk that also contains four writings on mo theory and cauterization. The manuscript was demonic in the late 3rd century B.C. References toWushier bingfang below are both to the transcription I have also consulted two other annotated "The Wu Shih Erh Ping Fang". and to Harper, no editions of Wushier bingfang: Yamada Keiji, ed., Shin hakken Cbiigoku kenkyucx kagakushi shiryo et al., and Zhou Yimou shu kao zbudz 1985), vol. 1 (Yakuchu hen), 137-289; (Kyoto, yi Mawangdui (Tianjin, 1988), 49-227. 29 As mentioned listed in the Han bibliographic above, none of the recipe manuals catalogue survive, has been regarded as the creator of and in fact were lost long ago. Traditionally Zhang Jidb (142-220?) redacted inHMBS complex medicinal sophisticated and the several works attributed compounds, recipe literature. In the received literature the oldest for emergencies), first compiled by Ge to him regarded as the beginnings of that begins to compare recipe manual (283-343) and expanded by Tao
ofWushierbingfang is theZhou hou bei ji fangdc (Recipeskept behind the with the rangeof content
elbow in readiness
Hongjingde (456-536).
Hongdd
218
Donald
Harper
Given this generalwealth of detail, it is significantthat the content ofWushier bing fang is virtually unaffected by mo theory, even though it is preceded on the sheet of silk by four writings on mo theoryand cauterization. There is only one recipe that refersto specificvessels and recommends cauterizing them; theother cases of cauterization cannot be definitely linked tomo theory.30 Even more striking is the inclusion inWushier bing fang of several ailment are that demonic, and of a number of recipes thatdescribe theuse ofmagical rituals, categories
incantations, and other
provide magical recipes, often alongside recipes for the same ailment using drugs and other Quite apart from the significance of themagical recipes for studying the influence of with passages magico-religious and occult thought in earlymedicine, these recipes (together were evidently employed in daily life.The rituals, incantations, and relatedmagical acts that ultimate source for this magical material must have been the religious personnel, wuw
"shamans", periods.32 and The occult fang shiw "masters contemporary received of recipes" of the Warring States, literature almost without exception Qin, ignores and Han magic, that treat of magic in other new manuscripts) have restored to us a hitherto unknown record of therapies.31
symbolic
acts
to exorcise
illness.
Sixteen
of
the ailment
categories
specialists.Wushier bingfang suggests that the Huang di neijing condemnation was directed asmuch against thepractices of self-acknowledgedphysicians as it was against those of sundry in and that views are represented in the the whose arts; specialists demono-magical physicians were to assert di nei still the Huang jing actively attempting superior logic of their own
theories.34
dismisses it,or ishostile. Consider, for example, thepronouncement in the Huang di nei jing, "One who is enthralled by demons and spirits cannot be spoken with about culminant virtue".33 It is an ironyof archeological chance thatamedical manuscript should emerge from the ground to reveal that demonological magic had sophisticated followers among medical
30 The single reference to vessels is discussed below, p. 219. Many of the examples of cauterization in Wushier bing fang are related more generally to heating or burn therapy in early Chinese medicine. 31 I identify a recipe as magical when the ailment category is demonic or when the recipe uses one of the above mentioned strategies to expel an illness. I have not attempted to account for recipes in which treatment with drugs or other effect (such as the therapies might have been intended to have a magical exorcistic use of cinnabar or burning). For the most part my identification of magical recipes is in "Maotai Kanbo shutsudo isho san sokuw,df in Shin hakken Chiigoku agreement with the list inYamada, kagakushi, vol. 2 (Ronko hen), 256 (which counts a total of forty-nine magical recipes). 32 The religious personnel of the period included specialists in ritual, incantation, and divination. The chief attribute of the shaman was the ability to serve as a direct intermediary with the spirit world, which was often combined with the capabilities listed above. The fang shi undoubtedly popularized magical arts of the by treating them as skills that could be learned in the same way that one could gain knowledge world through the application of natural theories. There are numerous references in the received literature to the existence of these groups of if not to the details of their actual practices. people, 33 See the passage cited in n. 4 above. 34 The question of who practiced medicine in ancient China and with what qualifications needs further literature that began to circulate in the Warring States period can be associated study. The medical the yicd (which I translate as physician) and with the occultist fang shi (cf. the reference to in n. 10 above). Both of these groups competed formedical authority with the establishment and shamans. The represented by the religious personnel medicine practiced by each of these groups was, however, by no means mutually exclusive. Legend held that the profession of physician was created by shamans, and there is sufficient documentation in the received literature to show that drug lore was indeed a shamanic specialty (cf. Harper, "The Wu Shih Erh "Hen Shaku densetsu", 100-105, also identifies a fundamental division Ping Fang", 42-44). Yamada, fang shimedical knowledge traditional magico-religious primarily with
The Conception
of Illness
in Early Chinese
Medicine
219
The twenty-fourrecipes in the ailment category tuix "inguinal swellings" inWusbier bing fang exemplify the range of etiological conception in the recipemanual, fromdemono-magical to a case of the application ofmo theory.Tui means literally"drop down", and is attested first as aword for a fiery,descendingwind in the received literature; thenew manuscripts provide the earliest attestation of tui as a name for various kinds of swelling in the inguinal region, The treatmentsin severalof the Wusbier bingfang recipes indicate that the includinghernias.35 abnormal swellings in the inguinal region are probably associated with qi (although theword qi is not mentioned). The following recipe is notable for the referencesnot only to two forms
of cauterization, but also to the use of the biany "stone
One (recipe). Inguinal swellings. First raise the testicles and pull down the skin. Pierce the side of the navel37 with a stone probe . . . liquid and lard . . . stir inpure liquor.38 In addition, cauterize thewound. Do not allow thewind to reach it. To cure it easily, cauterize theGreat Yin and Great Yang . . ,39 Excellent. (Appendix 1:1) The first technique described in the recipe is rather complex, requiring both a lancing procedure and cauterization over thewound produced by the stone probe. In addition, the wound must be protected fromexposure towind (whichwas believed to transmitillness).The
recommendation equally effective to cauterize the Great Yin or Great treatment. My interpretation mo is offered Yang of the dual recommendation as a and simpler is that cauteriza
probe":36
between place
hou shuyidh(Taibei, 1971),225-229. ming 36
them; but the specialization must have existed before this time. At present we know too little about the actual practice of medicine by these various types of people to determine precisely the relationships among inHarper, "The Wu them or to judge their relative standing in the society at large (cf. the brief discussion Shih Erh Ping Fang", 22-67). 35 There are a number of references to tui as an ailment name inHan sources. Cf. Yu Yan, Gudai jibing I for 392 (recipe 134). See Appendix "The Wu Shih Erh Ping Fang", 52; Harper, HMBS, new manuscripts. transcription of all passages translated from the 37 I follow the suggestion of Zhao Youchen, "Wushier bing fang zhong duo zi de kao shi", Wenwudl literature of the 1981.3, 22, in identifying the word duod) as the navel. There is attestation in latermedical importance of the navel in connection with the treatment of inguinal swellings. The word duo is not
two kinds of physician: one a physician whose practice was hereditary and tied to the family's from a master and then of residence; and the other an itinerant physician who learned medicine sought clients in various regions, and who in this respect followed the pattern characteristic of the fang in the received literature before shi. Pharmacal specialists within themedical profession are not mentioned is first used to identify the term ben caodg (denoting materia medica) the late 1st century B.C., when
attested as the name of a body part in the received literature, and several other identifications have been 52, says that the graph stands for sbuidk "buttocks," which is unlikely (phonological proposed. HMBS, reconstruction of ancient Chinese does not support a phonetic identity between the two graphs). Yamada, scrotum (a speculation Shin hakken Chugoku kagakushi, vol. 1, 196, suggests that the word refers to the based on the common meaning "drop, hang" for duo, extended to refer to "that which hangs"), but there is already another word for scrotum inWushier bingfang and scrotum does not fit the context in all six of the occurrences of the word argument Mawangdui in favor of duo medical as navel duo as the name of a body part inWushier bingfang is that none of the known classical words
(navel does). A negative for navel occur in the
corpus. The
is a southern dialect word. not attested in received literature, and that in some cases may be dialect words. 38 to lance the flesh by the navel, and a medicine a stone is applied to Apparently probe has been used at the same spot. the wound. This is followed by cauterization 39 The reference is to the two vessels, the Great Yin mo and the Great Yang mo. Perhaps theword mo is one of the two lacunae in the text.
"mid-body hole" (HMBS, context where the meaning
recipe manual 2a liaofangdl designates the navel with the circumlocution 123). The word duo also occurs in the Zhangjiashan writings on mo theory in a could be navel ("Jiangling Zhangjiashan Han jian", 72). It is possible that duo in theMawangdui medical There are other examples of words corpus that are
220
Donald
Harper
tion inWushier bing fang ismostly an older form of the burn therapy (certainly already with mo theory.The above recipe dependent on the concept of qi) thatpreceded integration which was based on mo theory. In light records both theolder therapyand thenewer therapy mo writings precedingWushier bingfang identifiestui as of this, it is interesting thatone of the
an ailment whose Ceasing Yin mo.40 treatment is associated not with the above named vessels but rather with the
A second cauterization treatmentof tui inWushier bing fang is notable for its detailed account of how cauterizationwas performed, including the earliest description of the use of
artemisia:41
One (recipe). Take the hurds of hemp and wrap them in artemisia.Use this to cauterize the center of the crown of the head of the person with inguinal swellings. Let itblister and no more. (Appendix 1:2) mo theory,but none of the The center of the crown of thehead is an importantpoint in later Mawangdui writings on mo theorydescribe a vessel that extends to thispoint. It is probable that the crown of the head was important for other reasons in earlymedicine.42 Other recipes to treat tui include drinkingmedicine; for example, a chicken egg in a cup of with these recipes are However, interfiled vinegar, and powdered silkworm eggs in liquor.43
twelve
other exorcistic acts. The following recipe attributes tui to the intrusionof a fox demon, and provides the earliest documentation of fox possession inChina:44 One (recipe). On a xin siz day chant the incantationof expulsion saying, "P'wan.45 The day is xin si" three times.46Say, "Spirit ofHeaven send down the sickness-shield. Spirit
Maids according to sequence hear the spirit pronouncement.47 A certain fox has intruded
examples
of magical
treatment
that describe
complicated
rituals,
incantations,
and
It may be significant that the di neijing). (this is also in agreement with theHuang identifies the Great Yin mo as the vessel that "covers the belly" (HMBS, 11). Since the no reference to specific points along the path of a vessel where medical corpus makes Mawangdui cauterization is performed, the use of the Great Yin and Great Yang mo in Wushier bing fang may be ideas (e.g., to cauterize a vessel that is associated with the belly related to more generalized anatomical where tui occurs). region 41 379 (recipe 126). Lu Gwei-djen and Joseph "The Wu Sbib Erh Ping Fang", 50; Harper, HMBS, Celestial Lancets Needham, 1980), 175 f., note that while there are early text references to (Cambridge, the plant aidm (Artemisia argyi, Artemisia vulgaris), cauterization (and hence for the form of cauterization
40 HMBS, same writing
11-12
ludn (ca. 6th century). In theWushier bing fang and applied directly to the skin. 42 An earlier recipe to treat lizard bites (HMBS, 52)) recommends therapy. 43 HMBS, pressing
and use for the first description of its preparation is in theMing yi bie called, in English, moxibustion) a cigarette recipe, the artemisia wrapped hemp is lit like
"The Wu Shih Erh Ping Fang", 253 (recipe 37; Harper, thistles into the center of the crown of the head, an example of counter-irritant Shih Erh 370f. 121-22).
An utterance (hence the use of the ancient phonological that included an exorcistic reconstruction) spitting action. 46 Xin si is eighteenth in the sequence of the sexagenary cycle composed of binomial combinations of a system of use in the ten Stems and twelve Branches, counting sixty day cycles already in Shang to drive out the inscriptions. The recipe exploits the hemerological symbolism of the Stems and Branches fox demon. The new Shuihudi occult manuscripts explain many aspects ofWarring States hemerological symbolism, however the precise reason for selecting a xin si day in this recipe is not clear. 47 The Spirit of Heaven refers to the supreme god of heaven, who is summoned in the incantation to are intervene. The Spirit Maids the female spirits associated with the ten Stems known from undoubtedly
Harper, Ping Fang", (recipes 44 HMBS, 50; Harper, "TheWu ShihErh Ping Fang," 373 (recipe123). 45
50;
"The Wu
The Conception
of Illness
in Early Chinese
Medicine
221
where itdoes not belong.48Desist. Ifyou do not desist, Iwill hack you apartwith an ax." Then grasp a piece of hemp cloth and exorcistically beat the person twice seven times. (Appendix 1:3) Only one othermagical recipe for tui identifiesa fox as the cause (the only references to foxes in the Wusbier bingfang Mawangdui medical corpus). In addition, thereare examples in of things in nature that cause illness which are inseparable from the spiritof the thing, so that the recipes alternatebetween treatingthe ailmentwith medicine and treatingit with exorcism. A scorpion sting is magically treatedby exorcising the scorpion spirit in two recipes;49and the who is exorcised in three painful rash caused by lacquer resin is blamed on the lacquer spirit, recipes.50But themagical recipes for tuiprovide still another view of demonic illness. In the following recipe the inguinal swellings are identifiedas misbegotten "sons":51 moon first One (recipe).Urine retention.52 On the sixteenthday of the month when the
wanes, "The
mother is strong. Exactly like people they bore sons, but they just bore the inguinal Then exorcistically beat and hammer the person twice seven times with an ironmallet. Do it at sunrise.Have the person with inguinal swellings face east. (Appendix I: 4) The etiology of tui in this and in several other recipes hinges on the triad ofmother, father,
and son. The incantation indicates that the ailment occurred because mother overpowered swelling deformity. Perverseness desist. I grasp the hammering stone and strike mother."
the Pace of Yu perform sun is matched against
thrice.53
the moon"
Say,
"The moon times
ismatched And,
three
each.
against "Father
the sun"
and
is perverse,
fatherand gave birth to illnessmonsters (sons), manifested as swellings on the body of the patient. In contrast to the fox etiology (a clear cut case of demon intrusion) and the scorpion or lacquer spirits, the ailment itself is reified in the formof something that became demonic because of a freakishperversion of nature. The exorcism employs cosmology to destroy the ailment by timing the treatmentto coincide with the waning of themoon (feminineand Yin) was lost and the growth of solar power (masculine and Yang), thus restoring the balance that
when the ailment occurred.54
later occult and religious Taoist belief; they are summoned for assistance according to the sequence of the Stems in the sexagenary cycle. Thus the incantation specifically summons the Spirit Maids of sign xin. 48 50, identifies the words hu zhaodo (my "fox has intruded") as the name for a type of hernia HMBS, di nei jing as hu shandp (and therefore does not regard this recipe as a case of fox given in theHuang demon intrusion). However, theMawangdui 12) prove that hu shan in the writings on mo theory (HMBS, di nei jing is a text error iov pian shan,dq which thus invalidates the equation of hu shan with hu Huang zhao in this recipe for tui. Grammatically, zhao denotes the nails of the zhaodr should be a verb. While hands and feet, the graphically similar chads means "poke into, intrude" (the graph on the original silk sheet is only partially visible, and it is possible that it should have been transcribed as cha). 49 "The Wu Shih Erh Ping Fang", 245-247 HMBSy 36; Harper, (recipes 47-48). There are three other recipes that treat the scorpion sting with external medicine. 50 68 f; Harper, "The Wu Shih Erh Ping Fang*551-554 The four other HMBS, (recipes 232-234). are salve. recipes for lacquer rash extremely fragmentary, but all appear to treat the rash with a medicinal
Warring
States magico-religious and occult practice (the earliest attestation is in the Fangmatan occult cf. He, "Tianshui Fangmatan Qin "The Wu Shih Erh Ping Fang", jian", 25). See Harper, manuscript; 98-101, for discussion of the shamanistic origins of the Pace of Yu. 54 The additional use of exorcistic beating in all of the magical recipes for tui is undoubtedly based on the pun with the word formallet, chui.du
There is a separate category for urine retention (longdt) inWushier bing fang immediately preceding tui. The two ailments can occur simultaneously. 53 The Pace of Yu is amagical dance step used when entering into contact with spirits . Itwas commonly in the centuries after theHan period. The new manuscripts used in religious Taoism document its use in
51 HMBSy 49; Harper, "TheWu ShihErh Ping Fang", 367 (recipe119). 52
222
Donald
Harper
In assessing the naturalistic and demonic etiologies discussed so far, one might choose to
believe
Wushier bingfang magical recipes in determining the natural cause of all illness, and that the were perhaps randomly included because of the eclecticism of the individual who compiled the The in the manual. occult from Shuihudi leadsme to pursue recipe manuscript demonography another line of speculation: thatknowledge of demonic etiology continued to develop within the demonological studies of magico-religious and occult specialists, and that demonic was not only the medicine as an influential etiology remained in explanatorymodel. The result
transmission rationalized of old notions of demonic and intrusion, demonology. but One a cross-fertilization between theories a understanding of nature effect of naturalistic in
that by
the 3rd-2nd
centuries
B.C.
there were
recognized
criteria
in medicine
for
demonology was to enrich the schema of mechanisms throughwhich spirit powers were believed tomanifest themselves.55 The prevalence in Wushier bingfang of the general idea that
ailments are caused
illnessmight have impressed physicians.56 In either case, the ideas shared in common were fundamental to the respective fieldsof knowledge. Against thisbackground the emergence of the functional approach with its redefinitionof illness appears all themore remarkable. Points of similarity between Wushier bing fang and the Shuihudi demonography are obvious in themagical strategies employed to exorcise demons; both texts contain similar exorcistic rituals,maledictions, and the like. This alone is significantevidence of a common
store
by
agents
serves
to
indicate
how
demonological
arguments
concerning
aspects of the demonography indicate an even closer textual relationshipwith Wushier bing fang, and thus suggest similaritiesbetween demonology andmedicine as fieldsof knowledge. The Shuihudi demonography is a short textcontaining seventy separate entries, sixty-nineof which identifysome type of demonic phenomenon and provide remedies.57 It is probably a was edited for inclusion in a condensation of a largercorpus of demonographic literaturethat
of magico-religious
belief
and practice
upon
which
both
texts drew.
However,
several
manuscript whose content is primarily hemerological.58 But the formal organization of the Shuihudi demonography and the content are sufficientto show that it is also a kind of recipe
manual, religious and that it provides specialists a and occult rationale Thus the magico for demonic etiology. sophisticated on the that had their own genre of recipe manual supernatural ideas in medicine.59
was
circulated in the same milieu as medical literature.Certainly the prestige attached to books
a factor in the reception of demonological
The majority of entries in the demonography are composed of threeparts: description of the signs or symptoms of the demonic phenomenon, identification of the demon, and
exorcistic remedy. The same tripartite structure is inmany Wushier bingfang recipes. Cases of
55 The cause
hemerological illness on which
use of the ten Stems days is a good example
in the Shuihudi
of this phenomenon
occult manuscripts
(Shuihudi Qin mu,
to discern which-spirits plates 121 f and
in the contemporary received noting that in the anecdotes concerning medical diagnosis in spite of what other literature the argument is usually that the illness being diagnosed is not demonic nor do specialists may have already said. The accounts do not deny the existence of demons and spirits, are they explicitly argue that demons and spirits incapable of causing illness. 57 as The 1st entry is a prologue that describes the purpose of the demonography providing protection from demonic depredations. 58 are recorded in theHan "A The titles of several demonographies catalogue; cf. Harper, bibliographic Chinese Demonography460 f. 59 One should of course not overlook the certain influence of oral traditions, but there is no reliable way to gauge it.
157-159). 56 It isworth
The Conception demonic There harassment are numerous
of Illness
in Early Chinese
Medicine blamed
223
are various. anger,
were apparently classified as a subset of demonic phenomena. The 8th anxiety,or sorrow) that entry in the demonography illustrates the form of the entries and has the added interestof describing a demonic illness that resembles the "sons" in theWushier bing fang recipe for
tui:60
are and frequent, instances of illness,
the machinations as well
of the demons conditions
as of emotional
(inexplicable
Without cause the people of a household all become diseased. Some die, some are sick. The men and women have sheddingwhiskers, sparse hair, and yellow eyes. This is the fertilizedegg. The kernel of the eggwas born and became a demon. Pound one sheng**61 of selected kernels. In the samemortar, eat the egg kernels along with millet and meat. Then it will stop. (Appendix I: 5) Like the swellings of tui that resulted from a freakish birth, the disease described in the demonography is attributed to a similar aberration of fertilizedeggs. The magical pestling of the kernels (kernel refers to the embryo in the egg) resembles the hammering of the The act of eating theprepared kernels is identical to the ingestionofmedicine. It is swellings.62 not coincidental thatother demonography entriesdescribe the ingestionof ashen substances, medicine in Wushier bing fang.63 which is themost common formof taking of demons and thepossibility of things innature becoming demonic is a The transmutability regular theme in the demonography. And the problems that are treated range from the mundane. As examples of the hazards present in the everyday extraordinary to the seemingly entries the environment, provide a framework for understanding illness as part of a larger inter-connected set of phenomena inwhich a boundary between natural and demonic is not
drawn. The 22nd
demon. It identifiesthedemon as a chthonic demon who has taken on the guise of a rat and is either in thevinegar supply or in some other condiment. The remedy is to find the rat and get rid of it.64 The 59th entrydeals with theproblem of fireand lightningfromheaven thatcannot with white sand and be stopped from burning the home; it recommends stopping the fire a to the The 17th man-made fire entry states thatbugs magically oppose lightning.65 building which have been chopped apart can be prevented from rejoining the chopped parts of their bodies by sprinkling themwith ashes.66 Three entries reifyYin and Yang as demons, one of which (the 32nd) concerns female
madness:67
entry concerns
a person
who
continually
receives
a death
summons
from
60
HMBS, 49 f;Harper, "TheWu ShihErh Ping Fang", 361 (recipe117) and 376 (recipe124). For pestle:
4If. another use of the term kernel to refer to the embryo in a fertilized egg, see HMBS, 63 a to be See the entry on theYang Demon below. The magico-religious significance of taking drug has considered when evaluating the pharmacal component of early medicine. 64 Shuihudi Qin mu, plate 132.
Shuihudi Qin mu, plate 133. 61 200 cc. Approximately 62 The two other recipes for tui that refer to the swellings
as "sons"
employ magical
pounding
with
Shuihudi Qin mu, plate 135. The exorcistic use of sand and ashes by religious personnel is attested in the contemporary received literature; see, for example, Zhou /*dv (Shisan jing zhu shu, reproduction of customs. confirms the popular practice of such magico-religious 1815 ed.), 37.6a-7a. The demonography 67 Shuihudi Qin mu, plate 133. The 12th and 13th entries concern the involvement of the Yang Demon in other happenings is and the Yin Demon (Shuihudi Qin mu, plate 134). In the former the Yang Demon blamed for the stove not cooking food and the room must be fumigated with pig feces; in the latter the Yin
65Shuihudi Qin mu, plate 133.

66
224
A woman Demon who is not crazy or takes pleasure
Donald
Harper in a voice.68 seeds is the Yang This from a north-facing
. . . and incinerate them.69 (Put) the ashes into food and feed it to her. The demon will leave. (Appendix 1:6)
to the Huang di neijing, extreme fluctuations and excessive concentrations of Yang
incoherent, in following
yet sings her. Take
shang*h twice seven
was qi cause kuang*0 "craziness".70 The Shuihudi demonography indicates that this etiology framework. into known the natural/demonic and fitted already The parallel between Yang qi and a Yang Demon raises a question concerning thenature of The Shuihudi demonography refers several times to the actions of a demonic qi, as qi itself. when theqi of the Whirling Wind causeswild beasts and domestic animals to speak piao feng*d in the 11th entry.71 Thus qi makes itpossible for an externaldemon or spirit to impingeon an of individual, either because it conducts the demonic manifestation or because qi is the stuff of things that exist in the naturalworld. The Huang di nei jing demons just as it is the stuff would deny the existence of this type of demonic qi, offering in itsplace a rationalized idea of With respect to the human organism, its theories of qi, pathogenic qi in the environment.72 deal purelywith the relationshipbetween the indwelling spiritual and mental elements of the individual and the physiological substrate; the external spiritworld is not relevant to the However, the view reflected in the demonography is functioningof the human organism.73 backed up in Warring States literaturethatdiscusses the role of qi, jing, and shen in interaction with the spiritworld, both with respect to demonic intrusion as well as to physical and Jing Qin andHan times.74 spiritualcultivation techniques; and these ideas remained current in
alone had the sense jingae "essence" (a refined concentrate of qi, one form of which is semen), and sben*{ "spirit"
According
to the transmutabilityof demons and things in the natural world was often attributed to it is know and difficult of Given bivalence the and of shen, qi, jing, qi properties jing.75
Demon is responsible for the death of the domestic animals. Yin and Yang were reified as cosmological in the state cult observed by Qin and Han monarchs; see, for example, Shiji, 28.1367, concerning theworship of the "eight spirit generals". But it is curious to see Yin and Yang appear as noisome demons at the popular level. 68 name of one of the notes in the pentatonic scale, and is associated with clear, piercing Shang is the sounds. 69 The name of the plant is lost in the lacuna, but it is probably a type of gourd since the word for seed specifically denotes gourd seeds. 70 kodai ni okeru seishin shippei kan", Nihon Chugoku Cf. Ishida Hidemi, gakkai bdd 33 "Chugoku 71 staff and throw a Shuihudi qin mu, plate 134. The remedy is to strike the animal with a peach wood shoe at it. The 43rd entry (plate 135) and 70th entry (plate 134) also concern theWhirling Wind demon. 72 di nei in China, 67-68, on the concept of xie qidx "evil qi" in theHuang Cf. Unschuld, Medicine kodai ni okeru seishin", provides "Chugoku di nei jing. of qi, jing, and shen in theHuang interpretation Ishida, 12-24, examines the question of the relationship spirit world from both standpoints. between 73 an excellent overview of the rationalistic
of "genie"
or
"spectre"
and was
used
to refer to something
demonic.
The
deities
(1981), 32f.
74Shibata ni okeru shin to do", Nihon Chugoku gakkai hddy36 (1984), Kiyotsugu, "Kansbi shihen
an individual's indwelling spirit and the external
It "The jing of an aged entity"; Shuo wen jie zi zhueb (reproduction of 1872 ed.), 9A.41a. Shenea (58-147): was believed that things - birds, beasts, plants, objects, etc. became refined with age until they were able to transform and take on new forms at will (a human guise was common). The idea is discussed by Wang in Lun heng (Sibu heiyao), "Ding gui"ec, 22.11b. Chong
75 Shuowen jie zihhbyXu ofmeidz (a kindof goblin) in theetymological Cf. thedefinition dictionary
The Conception
of Illness
in Early Chinese
Medicine
225
where a given individual's beliefswould have fallenon a scale from rationalized understanding tomagico-religious belief.76 This bivalencemay also explain thedual view of the ailment tui in Wusbier bingfang; qi as an agent is not alien to the demonic agents identified in themagical The possibility of an overlap between demonic agents and natural agents is documented evenmore concretely in the Shuihudi demonography entries and Wusbier bing fang recipes
that treat of various recipes.
exorcised from the environment.The Shang inscriptionsprovide the firstattestation of gu*1 pictographically a representation of bugs sealed in a vessel. If later definitions of gu are applicable to Shang usage, theword refersto a demonic potion prepared from bugs that can sicken selectvictims. By extension, gu refersto demonic evil and black magic in general.79By Warring States times gu was also applied to ailments involving infestationsof bugs in the body.80 It has been hypothesized that gu denoted ailments like schistosomiasis, yet the underlying conception of the ailment cannot be separated from the magico-religious
significance of a demonic bug-attack.81
minimum, insects and reptiles as well as all of the demonic variations on these creatures in early Chinese belief. The breadth of the category is indicated in the earliest etymological definition of hui*% defined as a name for the viper and then explained as a general term for anything small that crawls or flies, is hairy or naked, or has shell-like plates or scales.77 Chong*h denotes bugs with legs, but also connotes an infestationof bugs.78 In the ancient magico-religious traditionbugs were noxious pests, demonic powers thathad to be regularly
types of bugs.
I use
the word
"bug"
to refer to a category
that includes,
at
Wusbier bingfang could be classified as bug ailments on Eight of the ailment categories in the basis of theirnames: li^ "scorpion", zhi shi*k "leech eating", yuan31 "lizard", mingAm eating", and "gu." The presence of bugs is noted in other ailment categories, likepin zhi*q
"ming-bug", . . . quan zhean "... quan-bug", she chi*? "snake bite", chong sbi*p "bug
a theory that allowed him to accept the "natural" Chong validity of marvels, developed and incantation while rejecting the notion of a discrete spirit world that intruded on human maintained that all apparent demonic or spiritual phenomena were the result of momentary of Yang qi. Such phenomena concentrations lacked real existence (hence the demons of popular belief were incapable of causing injury), but had an effective power that derived from the nature of Yang qi itself. Incantations were effective because of an equation of speech, fire, and Yang qi; and the incantations of people specially endowed with Yang qi were more effective. Wang Chong also argued that the mad their songs of boys who were believed to have the gift of prophecy were genuinely prophetic because prophecy, affairs. He young male bodies were rich in Yang qi and were natural conduits for the qi of the "fire star" (Mars), which was a particularly (Lun heng, "Ding gui", significant planet in Chinese astrological omenology In light of the Shuihudi demonography 22.14a). entry on the singing of a woman possessed by the Yang it is certain that some of Wang would have regarded the same demon, Chong's contemporaries as ideas concerning incantation, see phenomenon supernatural. For further details on Wang Chong's
76 Wang
Poem", Harvard Journal of Asiatic Studies 47 (1987), 279f. Harper, "Wang Yen-shou's Nightmare 77 Shuo wen jie zi zhu, 13A.40b-41a. 78 Shuo wen jie zi zbu, 13B.4b. The connotation of bug infestation derives from the tripling of the earlier graph. The graph usually read hui can also be used for the word chong. 79 Cf. Shirakawa, Kanji no sekai, vol. 2, 250 f, on the meaning of gu and its significance in the Shang of gu in Shuo wen jie zi zhu, 13B.5b-6b is "when a second definition of gu as a type of demon. bugs". This is followed by 81 Cf. Lu Gwei-djen in Ancient and Joseph Needham, "Records of Diseases (Springfield, 1967), 225. Antiquity, ed. Broth well and Sandison inscriptions. 80 Thus the first definition the belly China", is attacked by in Diseases in
226
Donald
Harper
afeminine-hemorrhoid,,and jia*r "scabies", and justifies a bug etiology for some of these
ailments.82
recipes for scorpions and lizards; and anotherMawangdui recipe manual includes magical recipes to treat all manner of bug bites.85The difficulty in other ailments involving bugs is knowing how much theperception of the bugs was influencedby magico-religious ideas and how much by a more rationalized view. After all, the Huang di nei jing regards bugs as a from conditions of and wind, and at timespasses over the secondary phenomenon arising qi role of bugs altogether.86 In diagnosing a case of intestinalparasites, Chunyu Yi already of cold and damp qi.87 The same worms are associated with hemorrhoids inWushier bing fag** A good argument fordemonic conceptions in Wushier bingfang can be made on thebasis of the examples of bug-caused illness and the general fearof bugs in the Shuihudi demonogra mundane phy. As with the other entries, those that concern bugs range from the seemingly (e. g., sprinklingashes on chopped bugs) to thebizarre and horrific. In the 26th entrya demon thatpesters boys and girls and vanishes when other people approach is identifiedas the shen
argued that the rao ."round worms" (Enterobius vermicularis) were a natural transformation
Given the absence of specific etiological accounts inWushier bing fang, the perception of bugs in the recipes isnot readily apparent.The gu category is clearly demono-magical. Four of the recipes prescribe the ingestionofmedicine, ranging fromdrinking the ashes of amenstrual cloth in liquid to drinking a beveragemixed with the ashes of a black rooster and a snake that have been charred in a pottery kettle on an east-facing stove.83The fifthrecipe describes There aremagical bathing thepatientwith a broth containing the ashes of amagical talisman.84
hu?x Spirit Bug in human disguise.89 The 69th entry attributes blood and stench in the household well to the di cbong*u EJarth Bug, who must be forced from the well and concerns discarded.90The 28th entry explicitly illness:91 Everyone in a household has contractingmuscles.92 This is the hut hui** Conjunction
Bug who occupies the west wall of the house. Clear away the southwest corner to a depth Cf. Harper, "The Wu Shih Erh Ping Fang", 408, for details on hemorrhoids and bugs; and I.e., 502, on scabies. Later medical a literature corroborates bug etiology for both ailments. 83 "The Wu Shih Erh Ping Fang", 604 (recipe 271) and 607 (recipe 273). The latter 73; Harper, HMBS, to counteract gu. recipe imitates the gu production technique to make a medicine 84 "The Wu Shih Erh Ping Fang," 605 (recipe 272). This is the earliest reference to 73; Harper, HMBS, use of "talisman water," which was widely used in religious Taoism the magico-religious from the 2nd 82
century A. D. 85 are 127-129. The recipes in the latter text, Za liao HMBS, primarily to counteract the poison fang,dl of the deadly yu,ed a legendary and lethal southern creature. But several recipes are also good for snakes, bees, and leeches. 86 Such is the case in discussions of li,^ an ailment name that is principally related to leprosy, in the einMenschheits di neijing. Cf. Unschuld, Huang "Lepra in China", Aussatz, Lepra, Hansen-Krankheit: ed. J. H. Wolf problem imWandel, (Wiirzburg, 1986), 164?165. The bug ailment inWushier hingfang with /z/leprosy is discussed below. 87 105.2809. Shiji, plate 90Shuihudi mu, plate 134. Qin 91 92 Shuihudi Qin mu, 132. The remedy is to stab itwith a possible identification of the ming
88 HMBS, 55; Harper, "TheWu ShihErh Ping Fang", 425 (recipe148). 89

good
sword.
Shuihudi Qin mu, plate 133. Suo jinec is not attested as an ailment in the received literature. Perhaps the contracting muscles are similar to the convulsive spasms associated with ailments like xiane{ (see Harper, "The Wu Shih Erh Ping an occurrence of xian inWushier Fang", 209, for hingfang).
The Conception
of Illness
in Early Chinese
Medicine
227
environment of the home and represented safety and health hazards. Any doubt about the substantialityof the Conjunction Bug should be resolved by the 27th entry concerning a zhuang shenzy Morphic Spirit that looks like "a red pig with a horse tail and dog head." Once meal.95 caught, it can be cooked and makes a fine A word that is used inWarring States, Qin, and Han textswith reference to helmin thophobia and illness occurs in two entries in the demonography. According to theFeng su A. D.), yanghh is "a bug that eats people, and likes best tongyi*z by Ying Shaoba (2nd century to eat a person's heart." The definitionof yang ("anthropophagous bug") is given as part of a meant to definition of the idiomwu yanghc "let therebe no yang", which was an old greeting wish a person good health.96 Other definitions of yang indicate that the word had a generalized meaning of something that causes anxiety or calamity, probably by extension from a rootmeaning of bugs as the source of calamity.97 Both senses of the word are used in the demonography. The 41st entry concerns the demonic bug itself:98 Without cause a person's hair lifts up like bugs and chin or cheekwhiskers. This is theqi of theAnthropophagous Bug inhabiting it.Then boil grass shoes and use them to paper will stop. (Appendix I: 8) (the hair), and then it
of five cbiaw9ibelow ground level. Strike it with an ironmallet. You must hit the bug's head. Dig itup and get rid of it. Ifyou do not get ridof it, within threeyears everyone in the household will have contracting muscles. (Appendix I: 7) All of the bug demons mentioned above are only attested in the demonography. But they appear to reflectpopular belief, and probably a belief in bug demons that extended well The Shan haijing** describes many exotic terata beyond the locality of the Shuihudi tomb.94 and often provides details on how a particular zoomorph should be dealt with ifcaught (they can be effective drugs). The Shuihudi demonography shows that these creatureswere clearly real in the popular mind - not only did they exist, they often existed in the immediate
The remedy is significantfor thehistory of technology because ithas the.earliestoccurrence of the word for paper (zhi,hd used verbally in the text) and even provides a rudimentary description of the papermaking process.99 The 70th entry concerns the consequences of an object stolen from the home by the Whirling Wind. The firstaction is to throw a shoe at the demon. If the item is recovered, it must be ritually discarded in the roadway; and ifnot, the shoe is substituted for it. This procedure insures that "therewill be no calamity" (wu yang), although the entry concludes
with the statement that "within one
Wushier bingfang reveals a parallel case of thenotion Analysis of the ailment "ming-bug" in of an anthropophagous bug associated with omens ofmisfortune. The word ming^ is attested
year
the family will
invariably
have
calamity".100
84.
93 1.15 m. Approximately 94 See the comments on the dissemination of books and ideas above, p. 215. 95 Shuihudi Qin mu, plates 132-133. The name Morphic Spirit may refer to its ability to change 96 See Le Fong sou t'ong yi (Centre franco-chinois d'etudes index series: Beijing, sinologiques 97 98 Shuo wen Shuihudi jie zi zhu, 10B.46b, glosses yang as youeg "anxiety". vol. 5:1 (Cambridge, 1985), 35^42,
shape. 1943),
Qin mu, plates 134-135. 99 in China, Cf. T. H. Tsien, Science and Civilisation for paper and archeological discoveries of paper. 100 Shuihudi Qin mu, plate 134.
on the word
228
as the name But of a crop pest an ailment
Donald
Harper
it is neither
in early literature, its modern scientific identification uncertain.101 name to this in the received literature, nor is there any reference
bug in connection with the human body:102 Recipe forming-bug ailment.Ming

does ... not emerge at a regular spot.1 It causes a nose Sometimes
It is a bug. The places where it chews holes . . ,103

it is located and his at the nose, sometimes off. To at the out to break treat it,
side of themouth, sometimes at the teeth and gums, sometimes at the hands and fingers
person's to be gouged fingers
take fresh raw fish, . . . and blend a sufficientamount of saltwith it.105 Spread (the ... it. When the ailment subsides, stop. medicine) where the bug has chewed Thoroughly tested.There are no prohibitions. Excellent. (Appendix 1:9) Based on the symptoms ithas been suggested that the ailment is leprosy, even though two names for an ailment that is definitely associated with leprosy are attested inQin and Han texts: lihe (also a word for pestilence) and e jihi "foul sickness" (also applied to disabling afflictions like blindness or deafness).106And li is attested in the sense of leprosy in the Shuihudi manuscripts and in theZhangjiashan writings on mo theory.107 Ming-bug is not the name in in is ailment Wushier that unattested the received literature, and only bing fang unattested ailment names in the Zhangjiashan writings on mo theory lengthen the list considerably.However, given the currencyof li as thename for the leprosy-relatedailment in the 3rd-2nd centuriesB.C., one wonders why thename ming-bug should have been adopted in Wushier bing fang. Inmy judgment the identification with leprosy isplausible, and the explanation traceable to the conception of demonic bugs. Ming is one of two crop pests that are regularlypaired in early literature, the second being te.hgm It cannot be coincidental that under the ailment Wushier bingfang includes two recipes for treatingdamage caused category "bug eating" the one the for when the te-bug chews at the mouth and nose, and theother for when it ?e-bug: by Thus Wushier bing fang has adopted a classical pairing of bugs and chews at the teeth.109 of the applied it to illness, theming-bug ailment clearly themore major and life-threatening
101 One has been the insects that infest millet and sorghum, Diatraea shariinensis or D. proposal "The Wu Shih Erh Ping Fang", 306. cf. Harper, venosata; 102 "The Wu Shih Erh Ping Fang", 305 (recipe 77). HMBS, 43; Harper, 103 a a meaning Judging from the description of symptoms that follows, the lacuna may be word with
China", Journal of the American Oriental Society 102.1 (1982), 9-14; S. Yates, "Forms of Ch'in Law: An Annotated Translation of the Feng chen Shih", Harvard Journal of Asiatic Studies 41 (1981), 152-153. For li in the Zhangjiashan mo writings, see Han jian," 72. "Jiangling Zhangjiashan 108 to pre-Han and Han The ?e-bug has been identified with the locust, but this is clearly inapplicable usage inwhich it is paired with the wmg-bug (the locust constituted a category of pest unto itself). 109 "The Wu Shih Erh Ping Fang", 567 (recipe 243) and 571 (recipe 247). The te 70; Harper, HMBS, "Forensic Medicine and K. C. D. McLeod in Pre-Imperial and R. D. occurs bug also
like "rot". 104 I. e., the ming-bug can be anywhere in the body; other bugs are restricted to specific areas, like the teeth, mouth, or nose (see below). 105 The lacuna at the beginning of the phrase should be the verb for how the raw fish is prepared in a mortar, etc.). There are examples of using a kind of fish paste to treat skin rash (chopped, pounded 308. "The Wu Shih Erh Ping Fang", and sores caused by bugs in later medicine. Cf. Harper, 106 163-165. Cf. Unschuld, "Lepra in China", 107 Remnants See A. F. P. Hulsewe, 1985), 154 f and 197, for the several (Leiden, of Ch'in Law and judicial manuscripts. See also, Derk Bodde, references to ///leprosy in the Shuihudi governmental
on mo in the Zhangjiashan it is identified as a nose ailment; cf. writings theory, where literature attributes tooth decay as well as damage to jian", 72. Later medical "Jiangling Zhangjiashan Han skin and flesh to unseen bugs under the category nieh (hidden bugs).
The Conception
of Illness
in Early Chinese
Medicine
229
two. This difference is reflected in the earliest definition of the twowords, which appear in sequence in the Shuo wen jie zi:hhming is the bug that eats the heart of the stalk, te the bug that eats the blades of the grain plant.110 The Shuo wen jie zi definition thenprovides etymologies forming and te that relate these bugs to omenology. The right-hand side ofming is also pronounced ming and means "dark,
hidden, omens: covert";
The name of each bug is linked to formsof human activity that cause nature to respondwith When officials areming minghl "hidden and covert" and offend the laws, then theming When officials have qi teh) "qi that is inconstant", then the ?e-bug is generated. The etymologies are directly related to state-sponsored omenology as recorded in the treatise on theFive Phases (i. e. on cosmology and natural phenomena) in the Han shu.hk The treatise identifies the ming and te bugs as representing the "naked bug" subclass of prodigies associated with things in nature; and the treatiseprovides details on how nefarious human
conduct disturbs the harmonious balance bug is generated.
the right-hand
side of
te, pronounced
te, means
"changeable,
inconstant".
The Shuo wen jie zi andHan shu indicate that officialHan omenology incorporated the ming and tebugs into theprevailing ideology according towhich human misconduct unsettles nature's harmony, giving rise to aberrant qi which in turnproduces ominous prodigies like plagues of bugs.112 The examples of the yang-bug in the Shuihudi demonography are was associated with indicative of the older and more purely demonological conception that In with this demonic, anthropophagous bugs.113 view, a demonic bug bugs specifically
attack was not
of qi
in nature.111
whether his actionsmight cause offense to demons and spirits,or person could not be certain whether he might fall victim to a chance demonic encounter (hence he armed himselfwith literaturelike the Shuihudi demonography). The extension of thenames of known crop pests to designate ailments caused by bugs seems to represent a combination of naturalistic and demonological concerns. The ailments are attributed to thingsknown to exist elsewhere in nature. At the same time, and especially in the case of the disfigurementcaused by theming bug ailment, the horror of the depredations of demonic bugs ismade concrete.114
Thus we have several more pieces of evidence in addition to the symptoms described in
necessarily
a direct
and
natural
response
to an
individual's
morality.
Yet
of theming-bug ailmentwith lil Wushier bingfang on which to base a possible identification

110 Shuo wen jie zi zhu, 13A.43b. 111 27B-2.1406. Hanshu, 112 An entire essay in the Lun heng, "Shang chong",ei is devoted to disproving the idea that there is a link between human affairs and bugs. The main basis of the argument (after first stating thatman is simply the foremost among the "300 bugs") is an attack on the illogicality of finding only the activities of certain crop pests significant while entirely ignoring other bugs like mosquitoes. Apart from the attack on what as the is for essay Wang Chong superstition, significant being the earliest text to refer to the regarded belief in the "three bugs" that inhabit the bowels of the human body, a belief thatWang Chong accepts as valid
bite and as the name
"A Chinese Demonography", organs; cf. Harper, 114 ailment (HMBS, 43; Harper, The quan-bug to be based on similar ideas. Shuo wen jie zi zhu, for a bug (a bug found
(Lun heng, "Shang chong", 16.9a). The destructive presence of these bugs was widely accepted in later medicine, in religious Taoism. and much elaborated 113 eats the heart of It is significant that the yang-bug likes best to eat the heart, and that the ming-bug the stalk. There are other anthropophagous belief that favor the vital demons in early magico-religious 482. "The Wu Shih Erh Ping Fang", 309 (recipe 78)) appears 13A.43b, defines quane] both as a word for a poisonous to other glosses). inmelons according
230
Donald
Harper
medical literature,and part leprosy. Bugs are considered to be a factor in the ailment li in later of pestilence and is not explicitly etymologized as a bug in connection with the ailment leprosy, this is not a decisive factor in identifying ming-bug as simply another kind of "bug" name for the same ailment; but neither is it insignificant. More persuasive is the conception of theming-bug ailment as a mark of something demonic or ominous, an affliction with its source in the spirit world. A speculative etymology of li as a word forpestilencemight focus on the same conception,116and the other termused as a synonym for ///leprosy reinforces it. An e ji "foul sickness"was as an afflictionthat marked a person as offensive to the spiritsand to normal humankind, including and crippled legs.117 mutism, deafness, blindness, ///leprosy,
The term of the graph itself represents the graph for "scorpion".115 Since li is attested earlier in the sense
was heaven sent; that is, sent from the spirit world.118Whoever signified that the affliction first used ming-bug as an ailmentname may have been guided by the same etiological thinking that led to the inclusion of ///leprosy in the class of "heavenly" and "foul" afflictions.119 Surveying the Mawangdui medical corpus as a whole, and including the other new medical manuscripts, one finds a highly refined classification of ailments coupled with definite ideas about their etiology. The ontological approach is clearly predominant, and is represented in ways that reveal the sympathy between magico-religious thinking and a more rationalized understanding of nature. At the same time, the Mawangdui and Zhangjiashan writings on mo demonstrate that the of the theory conception body and illness is being reshaped to conform to a contrastingview that equates illness with somatic disharmony. The mo writings already begin to classify ailments according to the system of vessels, although the classification is rudimentary in comparison with the Huang di nei jing. Significantly,a long listof technical names of ailments arranged according to thepart of thebody where each ailment occurs (from the top of the head to the bottom of the heel) comes firstin theZhangjiashan writings on the
mo.
tian jihl
"heavenly
sickness"
was
synonymous
with
"foul
sickness"
and must
have
The success of the functional approach inmedicine that emerged in its classical form in the Huang di nei jing was related to a problem inherent in the ontological approach. A model of illness that is based on identifyingdiscrete phenomena becomes unwieldy unless some unifying theory gives it coherence. In Chinese natural philosophy theYin Yang and Five
Phase theories
Apparently
the classification
of ailments
according
to mo
can not yet
stand
on
its own.
inmedicine itwas ultimatelymo theory that made possible the broad application of nature
theory to the human organism.
provided
the basis
for arriving
at a coherent
understanding
of phenomena;
and
shutsudo isho", Shin hakken Chiigoku kagakushi, vol. 2, 239 f, argues against the identification of the a ailment with ///leprosy. However, his suggestion that the ailment may be framboesia, ming-bug characteristic tropical skin ailment, is unconvincing.
165. "Lepra in China", Kotei densetsu: kodai Chiigoku shinwa no kenkyilek (Kyoto, 1970), 100, offers interesting evidence for such an interpretation of li. 117 as references to Occurrences of e ji in early sources are conventionally interpreted leprosy. one occurrence is clearly to a case of having crippled legs. See the Gong yang zhu shuel (Shisan However, jing zbu shu), 23.14a, where the "foul sickness" that prevented an elder son from being made ruler of the feudal state ofWeiem is crippled legs. The commentary by He Xiuen (129-182) lists seven afflictions that are all "foul sickness". 118 See the parallel to the Gong yang passage in Gu liang zbu shu*0 (Shisan jing zbu shu), 18.5a. 119 In the final analysis it cannot be positively proven that the ming-bug ailment is ///leprosy (of course, neither is li precisely identical to leprosy; cf. Unschuld, "Maotai Kanbo Yamada, "Lepra in China").
115 Cf. Unschuld, 116 Mori Yasataro,
The Conception Although the "new" medicine was
of Illness
in Early Chinese neat,
Medicine
231
side of an ontological
approach was hardly discarded. From the accounts ofmedicine provided by Chunyu Yi and the much of the debate focused on which approach was Huang di nei jing it is evident that
better able to
theoretically
the pragmatic
(nosology and diagnosis/prognosis formPart II of this article).
systematize
ailments,
thereby
guaranteeing
proper
diagnosis
and
treatment
Zusammenfassung
Das Huang di nei jing aus dem 1. Jh. v. Chr. ist der altestemedizinische Text aus der klassischen Epoche der Chinesischen Medizin, der durch die Jahrhunderte hinweg bis in die worden ist. Erst in jiingsterZeit wurden bei Grabungen in China Gegenwart iiberliefert v. Chr. gefunden mit Hinweisen auf medizinische Manuskripte aus dem 3. und 2. Jahrhundert heilkundliche Theorien und Praktiken, die friiherals die Inhalte des Huang di nei jing zu datieren sind und sich von diesen auch unterscheiden. Von besonderem Interesse ist die Bandbreite der Vorstellungen vomWesen der Krankheiten; diese reichen von der Annahme damonischer Besessenheit bis hin zu der Postulierung natiirlicher Ursachen.
Anschrift des Verfassers:
Dr. Donald
Harper Professor
of East Asian Studies Department The University of Arizona Tucson, Arizona 85721
USA
232
APPENDIX KEY: I
Donald TRANSCRIPTION
Harper
ARE NOT EITHER ATTESTED IN THE
C )
INDICATES THE ATTESTED GRAPH FOR MANUSCRIPT GRAPHS THAT

ATTESTED APPROPRIATE IN THE RECEIVED MEANING. LITERATURE OR ARE NOT
INDICATES A LACUNA, C] BASIS OF FRAGMENTS OF THE THE MANUSCRIPTS. SYMBOL USED IN THE
WHICH MAY ON OCCASION BE ORIGINAL GRAPH OR TEXTUAL
FILLED ON THE PARALLELS IN
PRECEDING GRAPH IS TO BE REPEATED

SYMBOL PHRASE-MARKER. SYMBOL OF THE USED IN THE ORIGINAL
ORIGINAL
MANUSCRIPTS
IS
TO
INDICATE
^
AS AN
) .
THAT
THE
MANUSCRIPTS
OCCASIONAL
UNITS
USED TEXT.
IN
THE
ORIGINAL
MANUSCRIPTS
TO
FORMALLY
MARK
THE TRANSCRIPTION GRAPHS.
USES
STANDARD
MODERN
ORTHOGRAPHY
FOR
THE
% *
ft) u! ?v & #A 4 ft e. ^ a -10 jt *f"
The Conception
of Illness
in Early Chinese
Medicine
t &
1 *t^ A 4& &
a - #
? ^ &
?c7s
f cif)$.^
c3 A /*r 7sla n # If
^1? & ftg u ch3 n n t] i^jfc
jt$ i?
234 Donald APPENDIX II CHINESE AND
Harper FINDING LIST
JAPANESE
a|i h%$fii&
d;tfi,
e?k, f^%C
g^
ac^? adf )H a<ii af# a*? ah^, ai|| a^

at4f$ au^4,av4^ aw^ ax^ >^ay
ak$^i
Mi? & bajk?h bbt bc^,l bdi^ *>e;j| bj^' biIl bg3$bhlt^^t bk>ti b1^ (53 9-&?r bn?tfk j|. b*?fc?lf^ brij?i bsjs^l bt|i4 bu>lt bv^f b* ^ %.^7 %^ a. | ? fjjL b4f bxA^fe %^
The Conception
of Illness
in Early Chinese
Medicine
235
- %%. to
db
dc fl-t Mi%L%
dk ^
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dn 4
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The Conception of Illness in Early Chinese Medicine, as Documented in Newly Discovered 3rd and 2nd Century B.C.

for this article was Council of Learned

Institute for the History for research inMunich. 1 Illness is a regular

The humanistic orientation of thephilosophers undeniably contributed to the rationalizing of

He thepolitics and ethicsof thepre-Qin philosophers). Wang Chong found to be illogical(including

100) Lun hengCi (Assaying

for its skeptical

scrutiny of all manner

The Conception identifies parallels types of to medicine have demonic are on

Medicine to caused counteract them;

manuscripts ailment and diagnosis manuscript

remedies and provides to ailments references

Harper the new manuscripts to examine the conception

of the new manuscripts,

hou shuyidh(Taibei, 1971),225-229. ming 36

(navel does). A negative for navel occur in the

"mid-body hole" (HMBS, context where the meaning

40 HMBS, same writing

the Pace of Yu perform sun is matched against

"The moon times

51 HMBSy 49; Harper, "TheWu ShihErh Ping Fang", 367 (recipe119). 52

hemerological illness on which

use of the ten Stems days is a good example

(Shuihudi Qin mu,

to discern which-spirits plates 121 f and

The Conception demonic There harassment are numerous

are and frequent, instances of illness,

the machinations as well

of the demons conditions

65Shuihudi Qin mu, plate 133.

Harper in a voice.68 seeds is the Yang This from a north-facing

yet sings her. Take

shang*h twice seven

88 HMBS, 55; Harper, "TheWu ShihErh Ping Fang", 425 (recipe148). 89

the family will

bug in connection with the human body:102 Recipe forming-bug ailment.Ming

It is a bug. The places where it chews holes . . ,103

of theming-bug ailmentwith lil Wushier bingfang on which to base a possible identification

bite and as the name

can not yet

115 Cf. Unschuld, 116 Mori Yasataro,

The Conception Although the "new" medicine was

in Early Chinese neat,

(nosology and diagnosis/prognosis formPart II of this article).

ARE NOT EITHER ATTESTED IN THE

INDICATES THE ATTESTED GRAPH FOR MANUSCRIPT GRAPHS THAT

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FILLED ON THE PARALLELS IN

PRECEDING GRAPH IS TO BE REPEATED

THE TRANSCRIPTION GRAPHS.

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234 Donald APPENDIX II CHINESE AND

Harper FINDING LIST

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