Chinese Medical History

This dissertation attempts to explain how Chinese officials, physicians, and ordinary families construed and handled mad speech, crazy behavior, and insane people from roughly 1000 CE to the end of the Qing dynasty (1644-1911). I treat “madness” not as an entity, but as an ascribed characteristic of people, acts, and words.

Part 1 analyzes how physicians from Song (960-1279) to Qing explained and treated kuang or diankuang (“mania,” “insanity”), a chiefly behavioral illness. Far from splitting mind from body, most doctors assumed that psycho-behavioral pathology supervened upon organic imbalances; they thus treated mad patients with drugs designed to correct these imbalances. As I trace how doctors came to attribute insanity to the action of inner Fire and mucus (instead of invasion by Wind or demons), I explore several key issues in Chinese medical history: what doctrinal innovations Jin-Yuan physicians (1115-1368) proposed, why the most sophisticated Ming (1368-1644) medical writers were syncretists (zhezhong), why the “Danxi corpus”––a body of works attributed to Zhu Zhenheng (1282-1358)––dominated Ming medical thinking, and how profoundly intertextual the Chinese medical tradition was. I also study how doctors interpreted possession symptoms and postpartum insanity.

Part 2 examines Qing judicial and popular practices surrounding “madness.” Legal fengbing (“madness illness”) and medical kuang functioned differently because they emerged from (and were deployed within) fields of practices whose categories and concerns differed. The way legal officials handled mad acts was shaped by specific institutional concerns and procedures. In the 1660s, the new crime “killing because of madness” likened mad homicides to accidental killings. Because this crime was not punished physically, legislators soon ordered that mad people be preventively confined. Although the script by which Qing law understood mad killings hardly changed, mad homicides were sentenced increasingly severely starting in the 1750s, especially when victims were senior relatives. Yet few mad killers were executed. By contrast, ostensibly mad men whose written fantasies harnessed imperial symbols were often sentenced to death for subversion. This fear that “mad words” could threaten the symbolic fabric of the eighteenth-century Qing state sheds new light on the old topic of “literary trials” (wenziyu).

Neste texto, abordaremos alguns conceitos da medicina chinesa que relacionam o ser humano e a natureza utilizando como fonte principal o HUÁNG DÌ NÈI JĪNG 黃帝內經1 (Clássico de Medicina Interna do Imperador Amarelo), cujo primeiro registro remonta o século III a.C. A medicina chinesa concebe o ser humano como um todo indivisível e esta noção deriva de um princípio fundador, o DÀO 道 , que representa o aspecto não-dual do cosmo e é composto por YĪN/YÁNG 陰陽 norteando todos os seres: de sua harmonia depende a saúde do ser humano e de seu meio. Através destes princípios observamos, nesta racionalidade médica, um discurso sobre a natureza que concebe de maneira interdependente o microcosmos-homem e o macrocosmos-meio. A noção de QÌ 氣 é outro conceito importante que relaciona o ser humano e natureza. De difícil tradução, ele representa o aspecto não material (erroneamente traduzido como energético) de todos os seres vivos. Quando em circulação, garante a boa saúde. Várias práticas podem prevenir ou remediar sua estagnação e todas elas indicam a necessidade do ser humano em retomar a harmonia com a natureza interna e externa a ele: o uso de plantas, animais e vegetais na farmacopéia, acupuntura e moxabustão, atenção à dieta relacionada ao clima, às estações do ano e às características individuais e exercícios como o TÀI JÍ QUÁN 太極拳 (Taichi chuan), que imitam alguns movimentos de animais.

O HUÁNG DÌ NÈI JĪNG 黃帝內經 é considerado até hoje um dos livros mais importantes e valiosos sobre medicina chinesa. Evidências sugerem que sua base foi formada por um conjunto de textos escritos durante o período dos Estados Combatentes (475-221 AEC), passando pela dinastia Qin (221-206 AEC) e pela dinastia Han (206 AEC-221 DEC), embora as versões mais antigas que chegaram até nós, remontem da dinastia Song (970-1279). Compartilhando visões de mundo com várias outras escolas filosóficas chinesas antigas, o HUÁNG DÌ NÈI JĪNG compreende o ser humano e a natureza como entidades inseparáveis e em constante mutação, impermanência, interdependência e relação. Esta cosmologia foi explicada, especialmente, por meio de duas teorias de correspondências sistemáticas: Cinco Movimentos WǓ XÍNG五行 e YĪN YÁNG 陰陽. Segundo esta última, todos os aspectos do universo, incluindo o próprio corpo humano, poderiam ser compreendidos por meio de uma polaridade chamada de YĪN YÁNG: a realidade como a união dinâmica dos opostos. Essa teoria, além de estar presente em diversos aspectos da cultura chinesa antiga como política, astrologia, história e filosofia, a partir da compilação do HUÁNG DÌ NÈI JĪNG também se tornou uma das principais ferramentas de sistematização, interpretação e compreensão da medicina chinesa em geral e do ser humano em particular.

Atopic dermatitis (AD), a chronic, relapsing dermatitis, is characterized by dry and pruritus skin in patients with a personal or family history of atopy. It affects up to 20% of children and 1-3% of adults in most countries worldwide, and leads to significant treatment costs and morbidity. These guidelines are developed in accordance with evidence-based publications and expert opinions. Following simple algorithms, the guidelines aim to assist adult and pediatric physicians in the better care of patients with AD. As with other diseases, there have been several diagnosis criteria proposed over time. Nonetheless, the classical Hanifin and Rajka criterion with no pathognomonic laboratory biomarkers is still the most widely used worldwide for the diagnosis of AD. The management of AD must be considered case by case to provide suitable care for each patient. Basic therapy is focused on avoiding specific/unspecific provoking factors and hydrating skin. Topical anti-inflammatory treatment...

In 1759, Zhao Xuemin 趙學敏, a scholar and physician from Qiantang County (present-day Hangzhou), compiled his Chuanya 串雅. Based on certain editions of this work, modern scholars have assumed that this text is composed of recipes collected from itinerant healers, and that it was its author’s intention to transmit folk healing practices through the printed word. The original manuscript that Zhao Xuemin compiled probably never reached print, however, whereas the extant editions of this text found numerous new editions and re-printings. Focusing on several manuscripts and printed editions of the Chuanya which emerged between the late Qing and Republican period, this article traces the processes through which various different agents created and recreated the Chuanya. In contrast to past studies where the connection between the Chuanya and popular healing is taken for granted, I argue that any conclusion should primarily take into account the various editions of this work. By the case study of this text, I hope to clarify a broader dimension around the authorship of printed medical books in late imperial China and challenge the assumption that we can understand them outside the context of their edition and publication.

The act of prescribing pharmaceutical drugs to patients is normally the site of judgements about the drug’s efficacy and safety. The success of treatments and the licences for commodities depend on the biochemical identity of the drugs and of their path and transformations inside the body. However, the ‘supply chain’ outside the body is eschewed by such discourse, and its importance for both pharmaceutical brands and physician-centred historiographies is ignored. As this ethnographic fieldwork on Tibetan and Chinese medicines in Sichuan shows, overlooked social actors ensure reliable knowledge about medicinal things and materials long before patients take their medicine. This paper takes a step back from the final products—clearly defined as ‘Tibetan’ or ‘Chinese’—and introduces those who produce and distribute them. Via observations of particular regimes of circulation and processing, the actions of collecting, manufacturing, transporting, and educating appear as the first and foremost acts of efficacy and safety.

The essay compares the historical, philosophical and linguistics-metaphorical underpinings of TCM vs Galenic-Modern Medicine, and how these metaphysical structures influences their respective conceptualisations of etiology and therapy. It argues further that a proper grasp of these underlying issues is necessary before a proper and respectful dialogue between the two medical traditions can take place.

This is the handout for the paper delivered at the International CHinese Philosophy Conference at NTU, Jul 2017. Unfortunately, I have yet to work out the final form of the paper. Hopefully soon!

Book Review: Shuji Cao, Yushang Li, The Plague: War and Peace: Environmental and Social Changes in China, 1230-1960. Jinan: Shandong Pictorial Publishing House, 2006. 466 p.
It is the impact of the New Cultural History, which rose at 1980s, drives historians to reconsider the limitation of previous historical research and seek breakouts. As two important branches of the New Cultural History, medical history (including the history of human disease) and environmental history appeared under this circumstance and become popular nowadays. Shuji Cao and Yushang Li’s new work, The Plague, is a good case study of applying New Cultural History Methodology to academic research in History. Shuji Cao, a professor of Shanghai Jiao Tong University and once worked in the Center for Historical Geography Studies at Fudan University, is adept at demographic transition research. The brilliant new work The Plague is based on his discussion of mortality rate in The Population History of China (vol.4-6). Although the mortality rate estimates are sometimes questionable, it is a common predicament in medical history and human disease study, since the primary sources are not only scarce but also vague, and could be interpreted in different ways.
The first part of the book is about the conception and methodology of research. The authors try to break out the framework of “History of Epidemic” and make a clear direction to “History of Human Disease” study. This makes the research become more in-depth. It is so difficult to match the ancient names of diseases to modern ones; because same disease names between ancient and modern could turn out to be different diseases, while different disease names could actually be the same disease. “E’he,” “Geda wen,” “Yangmao wen” can be recognized as plague, but “Shanghan rezheng” might be too complex to be recognized. By now, there is a large unknowable field in the study of human disease, especially when it comes into social history discussions. Jared M. Diamond (1999) and William H. McNeill (1998) endeavor to combine the research of human disease and medical treatment to the process of social transition, in order to restore the more complex historical truth. This book to some extent draws a picture and provides details of the relationship between disease and social transition.
The second and third parts of the book are the core sections of the book: the propagation of plague in War and Peace. Based on the records of primary sources, the authors try to describe the propagation of disease in both normal and abnormal periods. From their perspectives, the plague that was popular during Jin-Yuan War, could be taken by the Mongolian army from west Yunnan (source of the plague) to Sichuan and Hubei. Another suspicious source was among east Guangdong, south Jiangxi and Fujian. They believe that the plague was a combination of pneumonic plague and bubonic plague, according to the clinical symptom records in Nan’an Fu (p. 82). However, "the disease was plague" is still not a valid statement: the evidences that 3 of the 611 preserved tombstones which showed the owners died in plague also cannot demonstrate the situation that “abnormally high mortality rate once appeared.” (PP. 96-7); and it’s hard to judge if “Datou wen” and “Dare zhi zheng” in Daliang county were plague (p. 112). However, the argumentation in the “legends and facts in Yuan dynasty” section is brilliant: the authors mimicked how plague spreads in Europe and used the same logic to connect the fragmented Chinese plague records into a reasonable plague propagation story in Yuan Dynasty China. The shortages of the book are that the authors do not touch down to the in-depth transition of local society, and some other analysis, such as the defective of the Jin-Yuan records and epidemic affection of Qing army, need to be strengthened. Chapter six narrates the prevalent plague after the rebellion of Du Wenxiu, the Muslim leader, in Xianfeng period. They use the more accurate and complete local records and investigations to estimate the mortality rate and try to construct an evaluation model. The conclusion is “61% of the population who died in War actually died in plague.” (p. 156)
The epidemic transmissions in Peaceful period are modeled in four large regions: Yunnan, Fujian and Guangdong, Northeast and Northwest China. Chapter seven focuses on Yunnan. Based on the detailed and clear records, the time-series and cross-regional descriptions about plague propagation are concrete and persuasive. Several models of epidemic transmission are constructed: “town-village,” “town-town,” “county-county.” The trading route transmission model is denied. Chapter eight reveals the continuity and volatility of plague in Fujian and Guangdong, but lack of a solid case study. However, the authors find that analysis based on the data collection of the number of people who died in plague in rural area is effective in this region. Chapter nine shows the epidemic transmission in the region where modern traffic such as railway was widely applied. Chapter ten and eleven narrate what happen after the 1930s. They rely on the modern medical science reports and investigations, and the abundant Qing Dynasty records to study the cities and temple sites in railway line. In this regard, daily lives in both war and peace ages are revealed.
Narratives in the fourth part are under a framework of disaster relieves and modern public medical treatments and hygiene. The Shanghai case reflects the relationship between immunization and the transformation of a modern nation. The authors also discuss the ideas, measures and results of disinfection in South China, Shanxi and Inner Mongolia. They indicate that the traditional Chinese medicine treats plague by testing the older medicaments and adding or cutting the dose, not by searching new medicaments. Meanwhile, people’s traditional views also blocked the impetus of modern medical treatment and hygiene. Local government, central government and popular organizations’ attitude towards immunization was also fickle (e.g. Charity House). The authors express their ideas of meaning of space and their philosophies of environment in the last part.
The subtitle of the book, “Environmental and Social Changes in China,” tells us it is a work of social environmental history. The authors use a lot of archives, investigations and reports of local archives and health and epidemic prevention stations, the special and previous materials successfully reveal part of the history. In the discussion of history of human disease, though the authors may falsely apply or interpret some Chinese medical texts (e.g. “Datou tianxing,” “Geda,”), their analysis and research on the names of diseases are valuable. Moreover, the regional geography, the authors also dedicate to describe the epidemic transmission process from animals to human based on their major field of research on regional geography, encouraging the readers to investigate epidemic history, environmental history and social history, to figure out the correspondence of pathology and symptom, the support of diseases, and the relations of environment and social changing. These are all what the book could leave us for thinking.

This article analyses the place and value of occult arts in the healthcare market of Republican China (1912-1949). Medical historiography has long neglected the resilience of such occult arts as talismans, astrology and divination in the context of China's search for modernity. Focusing on the production, trade, and consumption of goods and services related to talismanic healing, I give voice to Chinese occultists by investigating the formation of a 'market of the occult' in the Republican era. I adopt a global perspective to clarify the changes that occult healing underwent following the popularisation of new printing technologies, mass media and transnational spiritualism in early twentieth-century China. Erstwhile embraced in secrecy, the occult was now being made public. Cheap manuals, wide-circulation newspapers and book catalogues reveal that in contrast to past studies that herald the disenchantment of the world as the hallmark of Chinese modernity, occult healing did not simply survive but thrived in the face of modern science and technology.

Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis (AS). The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS. Fifty-nine AS patients and 40 healthy controls were enrolled. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) at posterior-anterior (PA) lumbar, lateral lumbar and hip regions. Thoracic and lumbar X-rays were obtained for morphometric measurements. Clinical, biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiology Index-total (BASRI-t), erythrocyte sedimentation rate (ESR) and the C-reactive protein levels. Osteoporosis was present in 32% of patients and 5% of controls according to lateral vertebral BMD...

Previous studies have shown evidence of health-related risk behaviors among women who have sex with women (WSW), such as sex with men, multiple bisexual partners, and drug use. Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians, which can affect their ability to receive an accurate diagnosis and treatment. No previous research has targeted women who have sex with women in China. We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections (RTI)/sexually transmitted infections (STI). Participants were recruited through outreach in venues and online for a cross-sectional study. Data were collected using interviews and laboratory tests. We recruited 224 women who have sex with women. In the year preceding their participation in the study, 92% (206/224) of women reported sexual relations with women. The RTI rates were: gonorrhea (15.8...

Much is known about the cytogenetic lesions that characterize multiple myeloma (MM) patients from the USA, Europe, and East Asia. However, little has been published about the disease among Southeast Asians. The aim of this study was to determine the chromosomal abnormalities of MM patients in our Singapore population. Forty-five newly-diagnosed, morphologically confirmed patients comprising 18 males and 27 females, aged 46 - 84 years (median 65 years) were investigated by karyotyping and fluorescence in situ hybridization (FISH). FISH employing standard panel probes and 1p36/1q21 and 6q21/15q22 probes was performed on diagnostic bone marrow samples. Thirty-four cases (75.6%) had karyotypic abnormalities. Including FISH, a total detection rate of 91.1% was attained. Numerical and complex structural aberrations were common to both hyperdiploid and non-hyperdiploid patients. Numerical gains of several recurring chromosomes were frequent among hyperdiploid patients while structural rear...

To review evidence-based management of nephropathy in patients with type 2 diabetes. A literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed. Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected. Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients. Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic...

Should Christians use TCM? This question is commonly debated between Christians, particularly those living in Asia. Some object to TCM because they regard it as not 'medically proven'. Others reject it because of its supposed non-Christian roots. For many Chinese, however, TCM is based on the key pillars of Chinese philosophy. This, along with its usage over 2,000 years, means that TCM is often revered as an important cultural heritage. What is at stake is not only an alternative source of medicine, but how Christians should relate to their cultural traditions. The book and workshop will examine the theological and inter-disciplinary principles involved in evaluating Chinese medicine. Through the workshop, we hope that participants will not only develop a deeper appreciation of TCM, but also acquire the skills needed for engaging Chinese culture in general.

Calcifying tendinopathy is a tendon disorder with calcium deposits in the mid-substance presented with chronic activity-related pain, tenderness, local edema and various degrees of incapacitation. Most of current treatments are neither effective nor evidence-based because its underlying pathogenesis is poorly understood and treatment is usually symptomatic. Understanding the pathogenesis of calcifying tendinopathy is essential for its effective evidence-based management. One of the key histopathological features of calcifying tendinopathy is the presence of chondrocyte phenotype which surrounds the calcific deposits, suggesting that the formation of calcific deposits was cell-mediated. Although the origin of cells participating in the formation of chondrocyte phenotype and ossification is still unknown, many evidences have suggested that erroneous tendon cell differentiation is involved in the process. Recent studies have shown the presence of stem cells with self-renewal and multi-...

The exaggerated surge in morning blood pressure (BP) that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications. However, no previous studies have evaluated the rate of this surge independently of the evening period. It remains unclear whether the rate of increase experienced during the surge is a significant or independent determinant of cardiovascular events. We randomly selected 340 ambulatory BP monitoring (ABPM) patients. All subjects without type 2 diabetes mellitus were divided into two groups: hypertensive group (n = 170) and normotensive group (n = 170). We analyzed ambulatory blood pressure recordings using a double logistic curve-fitting procedure to determine whether the magnitude of the surge in BP and heart rate (HR) in the morning is related to the level of BP in hypertensive individuals. We evaluated the association between the rate of the morning surge in systolic BP (SBP) and the...

Childhood leukemia bottleneck phenomenon is the most mysterious corollary of the prenatal origin discovery of leukemogenic chromosome translocations. The bottleneck is evidence that leukemia initiation, by in utero acquired chromosome translocations that generate functional fusion genes, is far more common than the incidence rate of corresponding leukemia. For childhood TEL-AML1(+) acute lymphoblastic leukemia (ALL) this equates to approximately 100 times. Practically this means that among a hundred children born with TEL-AML1 fusion gene, only one child will later in its life develop ALL. The key data necessary for unraveling of this mystery were discovered in 2002. It was the level of TEL-AML1(+) cells’ frequency. The bottleneck is caused by the very low body TEL-AML1(+) cell count. Only one out of a thousand B cells carries TEL-AML1 fusion gene. TEL-AML1(+) body cell count is low because TEL-AML1 fusion is generated at cell level of 10(-3) to 10(-4) just during the late fetal lym...

During the blood stage of malaria infection, parasites internalize in the host red blood cells and degrade massive amounts of hemoglobin for their development. Although the morphology of the parasite's hemoglobin uptake pathway has been clearly observed, little has been known about its molecular mechanisms. The recombinant proteins from Plasmodium falciparum, dynamin like protein 1 (PfDYN1) and 2 (PfDYN2) GTPase domain, were expressed in E.coli and showed GTPase activity. By using a dynamin inhibitor, dynasore, we demonstrated the involvement of PfDYN1 in the hemoglobin uptake pathway. The GTPase activity of the two recombinant proteins was inhibited by dynasore in vitro. Treatment of parasite cultures with 80 micromol/L dynasore at the ring and early trophozoite stage resulted in substantial inhibition of parasite growth and in an obvious decline of hemoglobin quantum. Furthermore, reduced intracellular hemozoin accumulation and decreased uptake of the FITC-dextran were also ob...

... Fahmi Yousef Khan, A Haleem EL-Hiday and Nader A Morad ... Laboratory results were total white cell count 5000/µl, hemoglobin 4.8 gm/dl, hematocrit 19.7%, mean corpuscular volume (MCV) 53.2 fl, mean corpuscular hemoglobin (MCH) 15.2 pg, mean cell hemoglobin ...