On the Relationship Between Medicine and Philosophy1
Zhang Xichun
Translated and introduced by Heiner Fruehauf
Zhang Xichun (1860-1933) is one of China's great scholar-physicians. He is primarily remembered for his prominent role in spearheading the early movement of Chinese-Western medicine integration during the first three decades of this century. The depth of his knowledge and the broad range of his activities, moreover, distinguish him as one of the last of the classical cast of renaissance physicians. He was a clinician who specialized in the treatment of puzzling disorders; an educator who founded several colleges of traditional Chinese medicine; and a writer who produced passionate essays covering a wide range of topics, including new-yet-old interpretations of fundamental medical concepts and idiosyncratic insights into the materia medica (such as a systematic assessment of the energetic properties of Western drugs). In 1933, the last year of his productive career, Zhang's publications were collected under the programmatic title, Chinese at Heart but Western Where Appropriate: Essays Investigating an Integrated Form of Medicine.
This influential volume reflects the primary intellectual struggle characterizing Zhang's era, namely the question of whether to resist or to embrace the unstoppable transition from a traditional Chinese environment to a modernizing society ticking to the modi operandi of the West. Zhang's position was clearly traditional ("Chinese at heart") in that he advocated to keep the holistic principles of Chinese philosophy--yin/yang, the five phases, the bagua--as the basic tool set for all medical investigation. However, it was modern in the sense that he vowed to actively examine, with this traditional tool set, Western medical theories and achievements, as well as to encourage his fellow physicians to learn from the efficient procedures of the new medical culture, such as the practice of accurate chart keeping.
Today, traditional Chinese medicine is again in a state of transition. In the now reversed situation where Oriental medicine is introduced to the West in an increasingly broad fashion, Zhang's reflections may prove to be more seasonable than ever. His writings remind us that we have a choice in how to approach the integration of these two fundamentally different medical systems. Rather than using Western medicine to evaluate the scientific character of Oriental medicine, Zhang argued, the acquisitions of Western medicine could be integrated into a traditional framework. While the ti-yong slogan ("Holding on to Chinese customs but using Western machines") of the 19th century political reformer Feng Guifen had failed in the political arena, Zhang was able to successfully demonstrate the efficacy of his principles in clinical practice. A prominent feature among these efforts was the creation of traditional style remedies which utilize modern substances, such as Aspirin and Gypsum Decoction (Asipilin Jia Shigao Tang).
Most of Zhang Xichun's essays, the following one included, are thus dedicated to the message that Chinese medicine is first and foremost a way of thinking, a philosophical culture rather than a reservoir of formulaic treatment procedures that
resist change at any price. By fully embracing this culture and thus "remaining Chinese at heart," he asserted, the paraphernalia of the modern world could be put to use within this system without compromising the foundations of the system itself. According to Zhang, Chinese medicine is a science in its own right--fit to inspire a more holistic use of Western medicines, but not dependent on any type of vindication that the parameters of Western medicine may promise to provide. The following article, written in the last year of his life, is a fervent testimonial to the irreplaceable theoretical foundations of traditional medicine, with particular emphasis on the Taoist origins of Chinese medicine.
Most recent medical reports seem to publicize the opinion that our ancient philosophy obstructs the progress of medicine. The authors, evidently, do not understand the functional power associated with philosophical knowledge. Moreover, they do not understand that philosophy is really the source of all medical information. The Book of Songs (Shijing) contains the following line: "If you grasp the wisdom that is contained in the workings of the universe and expressed in the realm of philosophy, you will be able to safeguard your physical health." If we mind what is written here, the classic tells us that we must first possess a natural disposition to apprehend the timeless wisdom of philosophy; secondly, that we must fathom the practical details embedded in this philosophy; and finally, that this will open the one and only way for the preservation of our physical body. It was precisely this sequence of philosophical disposition, philosophical knowledge, and the consequent implementation of concrete health practices that the hermit ancestors of Chinese medicine regarded as the Tao of Nourishing Life. The term philosophy, therefore, describes the entirety of intuitive insight, intellectual knowledge, and all concrete activities associated with the art of nourishing life that the ancient master practitioners engaged in.
Especially the more benevolently dispositioned practitioners hoped that their own ability of nourishing the life force could be duplicated by their fellow human beings. However, since not everybody understood how the ancient philosophical wisdom could help in safeguarding their health, the way of nourishing life was most often insufficient, and naturally many people did get sick. The establishment of medicine and herbology, therefore, was originally designed as a measure to bring the principles of philosophy to those who were unable to nourish their own life force.
Throughout the ages, philosophy thus represented a vast field, including the works of the master medical scholars of each era, such as the Jin Dynasty's Ge Xichuan [Ge Hong, 283-343], the Northern/Southern Dynasties' Tao Huayang [Tao Hongjing, 456-536], and the Tang Dynasty's Sun Simiao [fl. 581-682]. These famous physicians were really philosophers who wrote extremely valuable philosophical works. During the Ming Dynasty, furthermore, we come to Li Binhu [Li Shizhen, fl.1518-1593] and his Outline of the Materia Medica (Bencao Gangmu) where the eight extraordinary channels are exclusively discussed from the perspective of Zhang Ziyang's theory on this matter; Ziyang, of course, is also a philosopher. If these examples do not suffice to support my argument, we can go a step further and seek proof in the Neijing itself.
The Neijing, by definition, is a medical textbook attributed to the Yellow Emperor. The opening chapter of this work, entitled "On Safeguarding Prenatal Energy in Most Ancient Times" (Shang Gu Tian Zhen Lun), contains the following programmatic
statement: "In the most ancient of times there were masters who had accomplished the highest level of human self-realization. They marshaled the secret of heaven and earth's transformative processes, they mastered the pattern of change that manifests in the waxing and waning of yin and yang, they absorbed the essence of the universe through breathing practices, and they kept their shen concealed in internal meditation in an extraordinarily disciplined fashion, thus never separating their awareness from the flesh of their physical bodies--therefore, they were able to live long lives in harmony with the neverending cycles of the universe."
Essentially, this passage states that these self-realized masters understood and thus controlled the quintessential forces of the universe; that they were able to hold on to it without leaking it, just as if they were carrying a substance; that they could continually breathe in more universal essence, in order to supplement this fundamental force and keep it strong; that they mobilized extraordinary internal focus to congeal it; and finally, that due to all these skills, they were able to change the qualitative make-up of their bodies, returning their flesh and muscles to a youthful state and thus live forever. Going far beyond his own example, therefore, it was clearly the Yellow Emperor's pedagogic intent to promote this type of ancient master as the prototypical model of the great philosopher. In sum, although the Neijing is a book about medicine, it starts out with a philosophical discussion. Medicine, from the perspective of the Neijing, is the science of how to safeguard one's body through the wisdom of the ages--philosophy.
We can only teach our fellow human beings about how to protect their bodies if we are first capable of protecting our own. The base science for the protection of our own body and the safeguarding of our own health is philosophy, i.e. the age-old knowledge of the movement patterns of the universe which are at the root of our body's transformative processes. The base science for the safeguarding of other people's health is medicine, again a process wherein the physician first thoroughly understands the workings of his/her own body transformations, and then naturally becomes a teacher who is capable of instructing others how to regulate their bodies' qi metabolism. Once again, therefore, we see that philosophy is really the wellspring of medicine, or, if contemplated from the other end, that medicine is the natural offspring of philosophy. And thus the Neijing, medicine's definitive source text, has to start out the way it does, namely in the realm of philosophy. So, why is it then that philosophy obstructs medicine? Please mark that my argument consists of more than just empty words that lack the backing of facts. There are many more examples that I could cite to prove my point, including some that pertain to my own life experience.
I have been blessed with a strong and robust constitution, and my heart fire is quite abundant. However, my ministerial [kidney] fire has a tendency to become deficient. Because of this situation, I can generally handle cold food and drink without problems, but I easily suffer when sitting in cold places. When I was younger I did not pay much attention to this particular weakness of mine, but once passed the age of forty this deficiency was growing more severe, and I got diarrhea every time I sat in a cold place. Over time, this condition weakened me. Since I had made it my mission in life to promote the teachings of medicine and was still far from completing my written work, I feared that I was wasting my life and vowed to reverse the condition. From then on, I religiously took a small dose of unprocessed sulphur before each meal to tonify my weak ministerial fire, a measure which turned out to be extremely successful. However, if I would not take the powder for more than ten days, the cold sensation would creep back in just as before. Finally I came across a Taoist text in which I found the following passage: "Sitting in silence, move the heart fire downwards to warm and tonify the lower burner." I committed to give these instructions a try. I must say that in the beginning my qi did not move very smoothly. Then I tried to focus more on the breath, specifically on the moment between inhale and exhale. Every time I had completed exhaling, I bade the kidney qi to rise and the heart qi to descend. Then I followed the impetus of the descending motion to let the qi of heart and kidney mate. I continued this simple exercise for several days, and finally experienced a faint stirring of warmth in my lower dantian. Henceforth, it was not necessary anymore to continue my habitual sulphur consumption.
Later I came across the following passage in the [winter section of the] Neijing's "Treatise on Regulating the Shen in Accordance With the Climatic Atmospheres of the Four Seasons" (Siqi Tiaoshen Lun): "Keep your aspirations concealed and stored away, as if entertaining private thoughts that have already been fulfilled." The wisdom contained in these sparse words hit me like a lightening bolt, and I finally understood the essence of my quest. "Concealed and stored away" refers to the process of enticing the heart fire to move downwards; "as if entertaining private thoughts" refers to the process of enticing the heart fire downwards to mate with the kidney, which produces a sensation of pleasure and fulfillment. It is by this sentence that the Taoist practice of systematically playing with infants and joining with beautiful women must have been inspired. The words "already fulfilled" refer to the process of prolonged accumulation of true yang in the [lower] dantian, causing the original qi to become strong and exuberant, while at the same time staying for good in the region behind the belly button. Isn't this indeed self-fulfillment, and one, for once, that lasts and won't evaporate? Thus enlightened by the true meaning of this Neijing passage, I redoubled my efforts regarding this type of meditation, and although I am already seventy-three years old, both my physical strength and my mental vigor remain unrelenting. Even in the middle of winter, I can consume cold and uncooked food, and sit freely in cold places without fear of repercussions. I therefore experienced with my own body how the wisdom of philosophy can make up for the shortcomings of medicine and herbology. So again, how is it that philosophy supposedly obstructs medicine?
And there is more. Every physician can and should get in touch with the deepest layer of this philosophical wisdom [which lays beyond the realm of the intellect]. If this is achieved, the moment of diagnostic insight is like drinking water from a mountain lake: with absolute clarity, one can see the source of the disease revealed. It is for this reason that I have specifically included a detailed piece on quiet meditation in my Chinese-Western Essays (Zhong Zhong Can Xi Lu), hoping that this practice would cause physicians to become enlightened to the ageless wisdom of philosophy. If I have still left you doubtful as to the merit of my argument, then please go on to read another example illustrating this last point of mine.
The art of hypnosis has been acknowledged in both Eastern and Western traditions, and one day it will surely become a subject of scientific scrutiny. The key to the hypnotic procedure is to shut out the patient's postnatal awareness and key into his prenatal spirit. If the patient gets interrogated in this state, one can know what otherwise can't be known and see what otherwise can't be seen. Likewise, for a person who has reached the deepest layer of philosophical insight, his/her postnatal thoughts will disappear and his/her prenatal spirit will become brighter and brighter every day. To such a person, anything can be revealed without actually seeing it. While working with the prenatal awareness of another person is a technique, the pursuit of one's own prenatal spirit awareness is called Tao. And is it not much more preferable to cultivate the Tao than to work with tricky techniques? Indeed!
The President of the Shanxi Institute for the Reform of Traditional Chinese Medicine once said: "Chinese medicine originates in Taoist philosophy. In the beginning, the primary medical focus of our ancestors was on the art of nourishing life. Once their internal alchemy skills had reached a certain level, they were able to perceive the organs in their own bodies and feel the circulation of qi and blood within." This, for once, is truly a vital statement. And it is precisely the reason why I have chosen to highlight the discussion of philosophical and cosmological themes in my own work--not to sound off exalted tunes, but because I truly believe that physicians ought to immerse themselves in the philosophical wisdom of the ages in order to develop their medical knowledge to the fullest potential.
Right now, Westerners have a distinct predilection for [modern] science. There are, however, a few bright minds among them who understand philosophy, and who are very clear about the fact that science cannot stand alone, but needs to be assisted by philosophy to reach its highest potential. That is why one of our former presidents once said: "Everybody knows that Germany is reputably the scientifically most knowledgeable country in the world. It is most interesting, therefore, to find several German scientists who are studying Chinese philosophy with the declared goal of rectifying some of the shortcomings and imbalances that accompany the undertaking of science." These are the words of a former president, should they not carry enough weight to be trusted? They convey an inkling that the philosophical culture of China will move across the oceans in a few generations and inspire other civilizations. The best way to celebrate humankind's common universal origins, therefore, is already spreading far and wide!
1 From Zhang Xichun, Yixue zhong zhong can xi lu (Chinese at Heart but Western Where Appropriate: Essays Investigating an Integrated Form of Medicine, 1933). This article first appeared in The Empty Vessel, Winter, 1999.