Journal of Chinese Medicine • Number 111 • June 2016


Huang Di Nei Jing Ling Shu: The Ancient Classic on Needle Therapy


13


having to explain such elementary matters to his listener. Demons and spirits can


therefore be completely


excluded as causes of illness. The alternatives introduced by the new medicine covered a broad spectrum. They stretched from the processes and changes of life, one’s innate constitution, hazardous climatic conditions, effects of social status and one’s regional life center to individual living conditions and emotional agitation. A passage in chapter 28 says:


“As for the very first origin of all diseases, they all originate from wind, rain, cold and summer heat, from yin and yang [qi], joy and anger, from beverages and food and from living conditions, from being severely scared and from sudden fear.”


Of course, one’s own responsibility for making life choices that maintain health is first and foremost. This was the foundation of existential responsibility, of living a life “adapted” to the laws of nature and not “violating” them. The individual is surrounded by natural phenomena


that apparently simply await their chance to gain entry and then cause illness. He must therefore refrain from exposing himself, i.e. granting them a breach from the outside through which “evil” could then enter his body. As we have seen above, it is the emotions that, when excessively developed, create the space or “void” that then invites the intruder to invade. In its normal state the skin is a closed barrier to prospective intruders. It must be overcome, for example through structures such as sweat pores that open up following great exertions, thereby providing an entry route. Especially the wind, originally perceived as a powerful spirit,12


has since ancient times


been identified as the first of the natural forces that have no place inside the human body, yet gain entry through inattentiveness and then, often together with cold or moisture, cause blockages in the flow of blood and qi, causing pains, swelling and many other symptoms. The observers of the time also recognized that sickness or health depended not only on the choices one makes in life. Evidently there were innate constitutions that gave some people long lives and others an early death. One person, we read in chapter 47 of the Ling shu, is born with a large heart, another with a small heart, one with a large kidney, the other with a small kidney, etc. It is completely clear, according to the author, that these innate constitutions lead to differing chances in life. As we learn in chapter 50, the innate constitution is


much more important than one’s mental composure when it comes to how well one endures pain. It makes no difference whether one is courageous or a coward; there are individuals of both types who can bear pain and some that cannot. It does not depend on a deliberate choice, but is already spelled out by one’s inborn constitution. Here we can also note an amusing detail that would come to


light when discussing, in today’s terminology, the loss of impulse control. Why, as we read in chapter 50 of the Ling shu, do some cowards sometimes nevertheless take on courageous men? Because they are drunk, according to the explanation then and now; because alcohol lowers one’s inhibitions.


The question of why one person lived long despite being exposed to the greatest dangers, while another died young who kept a quiet existence within his four walls and lived an “upstanding” life, is discussed from various angles, for example in chapter 54. In chapter 58 the question is explored of how someone can fall ill without any apparent external pathogenic influence. All this is largely comprehensible, yet some of the ideas at the time on the origins of illness remain limited to Chinese medicine. In the Ling shu this is especially the interpretation of certain seasons and days as especially hazardous to health. These concepts might reflect observations that had a certain empirical basis in China, as until recently, at least, the country had a continental climate in which seasonal climatic processes could be quite precisely dated and were therefore predictable. However, the systematization of such experiences and their association with the theoretical framework of the yin-yang and Five-Phases doctrine remain hardly understandable to present-day readers.


7. Diagnosis The Ling shu and Su wen document a highly significant advance in the evaluation of illness. They explicitly and repeatedly introduce a differentiation that apparently had not previously existed, namely distinguishing between the pathological condition that arises inside the organism and which can be ascertained using only theory on the one hand, and the pathological consequences of this condition, which in some respects manifested themselves to the patient as unpleasant changes but indicated deviations from normal conditions to the practitioner. The new medicine made use of a series of comparisons to draw attention to these deviations. The “root,” or ben 本, meaning “origin,” and its opposite, mo 末, meaning the “end” or “consequence,” was one of the conceptual pairs with which illnesses and symptoms were referred to. It is up to the healer, using diagnosis to identify the


“root” of an illness and draw necessary conclusions for therapy or, given an unfavorable prognosis, for the non-introduction of therapy. In ancient cultures this differentiation could decide between life and death for the healer. A physician who treated an incurable patient was either incompetent or intent on profiting from someone sure to die. Both of these were reprehensible and possibly criminal. Therefore the prognosis played an important role both in ancient China and Greece. There are no comparable ancient sources for Indian Ayurveda medicine, but there, too, until the arrival of modern Western medicine the Ayurveda doctor had to exercise extreme restraint toward


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