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By Charles W. Young, M.D., Professor of Bacteriology and Pathology, Union Medical College, Peking

Before considering the process and status of the westernizing of Chinese medical practice, it is well to be oriented as to what it is that is being changed. Briefly what is Chinese medical practice?

Let us approach this question with open mind. It is easy to ridicule what is not understood. Racial prejudice is not confined to the Chinese and if we take the trouble to study the original sources, not only much of interest will be found, but some information of real value. Often it is stated in strange terms and based on bizarre theories, but the experience of centuries is behind it and parts deserve investigation by modern methods of research.

In our glance at Chinese medicine it is to be remembered that Chinese civilization is in the stage occupied by the European nations in the middle ages. It has been in much the same condition of suspended animation for two milleniums. Thus if we get a view of Chinese medicine it will be one of that practiced by them in the times of the Greeks and Romans. More than that it is extremely interesting to note that the theories of cosmogony of the Chinese run parallel to those of the Greeks, and that the theories of pathology of each are based on those of cosmogony. To illustrate: The Greeks believed that the universe was composed of four elements, viz., earth, air, fire and water, and that consequently the human organism was composed of these primitive substances. Health was conditioned on the proper proportion or balance of these constituents; disease on the disproportion or loss of balance. These views of Empedocles (fifth century B.C.) in a modified form permeate not only the pathology of the Greeks and Romans, but of all writers up

to the eighteenth century. To this was added the so-called humoral theory, i.e., that the body fluids consist of blood, phlegm, yellow and black bile; and that to these correspond the four elements noted above, fire, air, water and earth, and the four conditions of matter, warm, cold, moist and dry. The predominence of one fluid over the others produce different temperaments, viz.; sanguine, phlegmatic, bilious or choleric and melancholic.

The Greeks, knew very little of human anatomy. They feared the dead and their religion enjoined immediate burial. Their knowledge of anatomy came from dissection of animals, including apes, and from observations during surgical operations.

The ancients did not differentiate between tendons, ligaments, and nerves. They believed that arteries contained air and conveyed it to the various organs.

While in Greece there was a well-defined medical cult, in Rome anyone who wished could declare himself a physician. There were no laws, which complied with, guaranteed the capacity of the practitioner, and medical responsibility was extremely limited.

I have taken time to enumerate these matters because of the striking similarity to Chinese theories and practices. As with the Greeks, the theory of cosmogony agreed on, pathology and treatment are perfectly rational. To the Chinese the universe is composed of five elements, metal, earth, fire, wood, water, each derived in turn from the succeeding. Corresponding to these are the five conditions cold, windy, hot, dry, moist. Health depends on the balance or correct proportion of these elements. Moreover there are added the great dual influences, the Yin and Yang, or female and male, negative and positive, dark and light. The Yin (elemental moisture) resides in the solid or semi-solid viscera, the liver, heart, lungs, spleen, and kidney. The Yang rules the contractile hollow organs, the large intestine, small intestine bladder, gall-bladder and stomach. The liver corresponds to wood, the heart to fire, the spleen to earth, the lungs to metal, and the kidneys to water. Each solid organ has a hollow viscus as its assistant or minister; thus the liver is

assisted by the gall-bladder, the heart by the small intestine, the spleen by the stomach, the lungs by the large intestine and the kidneys by the urinary bladder. The liver is the seat of the soul; the gall-bladder of strength and courage. The lungs regulate temperament, and so on.

Diagnosis rests mainly on the examination of the pulse and the inspection of the face and tongue. The pulse is palpated with greatest care and detail. The patients' wrists are felt in turn by the physician with the three fingers of the opposite hand, each finger revealing the condition of a different pair of organs. Light and heavy palpation differentiate respectively between the hollow viscera and their corresponding or governing solid organs. Fifty-one chief types of pulse are recognized. The face is minutely inspected. There are thirty-seven appearances of the tongue.

For the treatment of disease the Chinese have a very extensive materia medica. Many of their drugs are also used in the West, as calomel and other forms of mercury, arsenic, copper sulphate, iron, sulphur, sodium sulphate, alum, ammonium chloride, rhubarb, pomegranate root, camphor, aconite, cannabis indica, musk, ginger, licorice, anise, cinnamon, gentian, cardamons, peppermint, aloes, orange peel, castor oil, and digitalis. In addition there are many inert or disgusting substances, e.g., insects, snakes' skins, recent and fossil bones of animals, and faeces of men and animals. But the Chinese are not peculiar in this. The London Pharmacopoea, the first in England, was compiled by the Royal College of Physicians in 1618. It contained crabs' eyes, pearls, oyster shells, and coral, each supposed to have different qualities. It also recommended formulae containing faeces of men, dogs, mice, geese and other animals, calculi, human skull and the moss growing on it, blind puppies and earthworms. Not until 1721 were important changes made and even that edition retained dogs' excrement, earthworms, and the moss from human skulls.

Chinese prescriptions contain many ingredients, usually nine or ten, often fifty. The same was true in the West one or two hundred years ago. The ingredients of the prescrip

tion are divided into the ruler, minister and subordinate corresponding to our basis, adjuvant and corrective.

Organotherapy is popular among the Chinese. Liver, lung and kidney of animals are given for human disease of those organs. Gall, especially of tigers, bears and notorious bandits is eaten to secure courage. Tigers' bones are considered the supreme tonic. tonic. Even human flesh is used occasionally, a son or daughter sacrificing a bit to cure a wasting disease of a parent. The ignorant have explained the strength of foreign medicines by supposing that these remedies were refined from the organs of kidnapped victims. The Tientsin massacre of 1870 grew out of the spread of such reports. It has been common rumor that foreign doctors pluck out the eyes of their patients. Personally I have known of an American physician who felt it necessary to guard the reputation of himself and his hospital by requiring the presence of a responsible friend at the operation of enucleation of an eye to receive the organ and so guard against senseless rumors.

At least since the eleventh century the Chinese have practiced inoculation against smallpox. The directions were very minute. The season and condition of the subject were taken into account. A wad of cotton moistened with the contents of a pustule from a mild case of smallpox was introduced into the nostril, or a dried pustule was powdered and rubbed into the nares.

The Chinese have never been surgeons, not from lack of handicraft but from lack of knowledge of anatomy and of methods of stopping the flow of blood. Almost their only procedures are acupuncture and counterirritation by heat variously applied, or by scraping. Acupuncture is very common. The safe spots 388 in number, are indicated on two figures prepared by imperial order in 1027 A.D. These mannikins are still in use in the T'ai I Yüan (Imperial Medical College) in Peking. The locations into which needles may be introduced include the joints, abdomen, and eye. An ancient surgeon is said to have rendered his patients anaesthetic by giving them medicine internally. The name of this drug is not given but it is supposed to have been

Indian hemp or hyocyamus. The Chinese do use the latter to induce sleep.

China has officials corresponding to our coroners. Their training is based on an official codex published in 1248 A.D.

a time at which Europe possessed nothing of the kind. Although it contains many absurd tests such as abounded in Europe a few centuries ago, it also has some shrewd methods of determining the cause or manner of death. Only the exterior of the body is examined.

Medical practice is ranked low among the callings in China. Physicians are considered a little above priests but below diviners and school teachers. After gaining a familiarity with the medical classics, an apprenticeship with an experienced practitioner is considered necessary. If the novitiate can point back to several generations of successful physicians, his reputation will probably be greater from the start. Professional visits are made only on specific invitation and several physicians are likely to be called in rapid succession, and discarded with their treatment unless immediately successful. The bearing of this on cases that require time and careful observation and supervision can be appreciated. Fees are small and the cost of treatment is likely to be the subject of bargaining. Medical ethics it must be confessed are not very high. Probably it is this that causes physicians to be held in comparatively low esteem. A work on medical ethics published during the Ming dynasty says:

When a patient is severely ill, treat him as thou wouldest wish to be treated thyself. If thou art called to a consultation, go at once and do not delay. If he ask thee for medicine, give it to him at once and do not ask if he be rich or poor. Use thy heart always to save life and to please all; so will thine own happiness be exalted. In the midst of the darkness of the world be sure there is someone who is protecting thee. When thou art called to an acute illness and thinkest with all thy might of nothing but making money out of the patient, if thy heart be nor filled with love of thy neighbor, be sure that in the world there is someone who will punish thee.

This is good, but with it contrast the Hippocratic oath:

I swear by Apollo the physician, and Esculapius and Hygiea and Panacea and all the gods and goddesses, that according to my ability and judgment, I will keep this oath and this stipulation


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