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Outward Form (xing 形) and Inward Qi 氣: The “Sentimental Body” in Early Chinese Medicine

Published online by Cambridge University Press:  08 August 2014

Translated by
Elisabeth Hsu 許小麗
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Abstract

What did the early Chinese medical body look like before it was inhabited by the five viscera and before canonical medical rationale was framed in terms of the five agents (wuxing 五行)? This article makes the case for a body with an outwardly visible ‘form’ (xing 形) that housed invisible qi 氣 internally. The qi contained in this body was not the universal qi and all-pervasive stuff that we encounter in later medical texts. Nor can it be limited to the ‘breath’ referred to in the context of meditation techniques, since the term referred also to a moral dimension, thoughts and feelings. In the body's upper spheres, qi took on yang 陽 qualities and was associated with feelings of grief or joy; in its lower ones, it took on yin 陰 qualities and was associated with anger. Since this body was primarily a function of emotional and moral aetiologies, it is in what follows called a ‘sentimental body’, and is contrasted with the canonical ‘body ecologic’ which was most importantly a function of the seasons.

The textual material presented in this article suggests that the ‘sentimental body’ with its two yinyang spheres was an early Chinese medical body conception. From an extensive computer search that systematically compared passages on xing and qi in the Yellow Emperor's Inner Canon with texts in the early medical manuscripts from Mawangdui and Zhangjiashan, it emerged as a distinctive body. While the canonical ‘body ecologic’, framed in a pentic numerology, became prominent in medical reasoning during to the Han dynasty (206 B.C.E.–220 C.E.), the ‘sentimental body’, which alludes to yinyang cosmologies, dates to the Warring States period (475–221 B.C.E.).

當五臟的觀念還沒有在中醫理論中盛行、五行還沒有成為經典性中 醫理論的架構基礎之時，中醫對身體的想象是怎樣的？本文希望論 證，當時的身體是在外在的可見之 “形” 中內含有不可見之 “氣”。 這 個氣并非後來中醫文獻所說的無所不在、充斥宇宙的 “氣”，而且也不 僅限於靜坐技巧所關涉的 “呼吸”，因為它還涉及到道德層面、思想以 及情感。在上半身，氣呈陽性，與悲、喜等情感有關；在下半身，氣 呈陰性，與憤怒有關。由於這樣的身體基本上被情感、道德、思維過 程以及感知所支配，它與經典理論中感應四季的 “生態體”不同，因此 我在下文中稱之為 “感知體”。

本文所使用的文獻材料表明，這樣的包含陰陽兩個部分的 “感知體” 是早期中國醫學中的身體概念。經過大規模的電腦檢索，把在《黄帝 內經》中講到 “形” 和 “氣” 的句字與馬王堆、張家山出土文獻進行系 统的對比，這個“感知体”明确地呈現出來：以五行定義的 “生態體” 觀 念在漢代 (公元前 206 年–公元 220 年) 的中醫思想中開始盛行，而暗 含陰陽宇宙觀的 “感知體” 則屬於戰國時期 (公元前 475 年–公元前 221 年)。

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Articles
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Early China , Volume 32 , 2009 , pp. 103 - 124
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Copyright © Society for the Study of Early China 2009

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References

Earlier versions of this article were presented at the workshop on the “Manifestation of Emotions and Dispositions in Chinese and East Asian Sources,” Napoli, 10–11 June, 2005; at the conference on “Daoist Cultivation in Theory and Practice,” Kloster Frauenwoerth im Chiemsee, 25–28 May, 2006; and in the panel on “Healing and Curing: Senses and Emotions in Medical Anthropology” at the 9th EASA conference, Bristol, 18–21 September, 2006. I thank the organisers and the respective audiences for their inspiration and Robin Yates and the two anonymous reviewers of Early China for valuable comments on an earlier draft. A more detailed but differently structured account of this material is in Elisabeth Hsu, Pulse Diagnosis in Early Chinese Medicine: The Telling Touch (Cambridge: Cambridge University Press, 2010), chapter 4.

1. There is, of course, no one canonical Chinese medical body. The body conception alluded to in this sentence is in the anonymous (Zhou to Han, 3rd century B.C.E. to 11th/12th century C.E.) Yellow Emperor's Inner Canon (Huangdi neijing 黃帝內經), the Basic Questions (Su wen 素問), pian 4 and 5. See Huangdi neijing zhangju suoyin 黃帝內 經章句索引, ed. Yingqiu, Ren 任應秋 (Beijing: Renmin weisheng, 1986), 17 and 20–21, and n. 8 belowGoogle Scholar. This body conception, which dates to the Han dynasty, provides the basis for the contemporary Traditional Chinese Medical body. See Sivin, Nathan, Traditional Medicine in Contemporary China: A Partial Translation of Revised Outline of Chinese Medicine (1972) with an Introductory Study on Change in Present-day and Early Medicine (Ann Arbor: Center for Chinese Studies, University of Michigan, 1987), 213–36CrossRefGoogle Scholar.

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21. For example, Han mu boshu zhengli xiaozu, Mawangdui, “Yinyang shiyi mai jiujing jiaben” 陰陽十一脈灸經甲本, 7–13Google Scholar, and Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), Mai shu, 238–42: “If this one is agitated, then it gives rise to disorders” 是動則病; Shiki kaichū kōshō 史記會注考證 ed. Kametarō, Takigawa 瀧川龜太郎 (Tokyo: Tōyō bunka gakuin, 1932–1934), 105.38–39Google Scholar: “An Agitation of the jueyin” 蹶陰之動; Huangdi neijing zhangju suoyin, Ling shu, 9.249Google Scholar; all quoted in Hsu, , The Telling Touch, 337, 327, 145Google Scholar.

22. See Zhangjiashan, Mai shu, cited on p. 113 belowGoogle Scholar; Shiki kaichū kōshō, 105.24Google Scholar, and the Su wen passages quoted in Hsu, , The Telling Touch, 138–39Google Scholar.

23. Guanzi 管子, ed. Xiang, Liu 劉向 (Xinbian zhuzi jicheng 新編諸子集成 ed., Beijing: Zhonghua, 2006), 16.937Google Scholar (“Nei ye”), translation based on Rickett, W. Allyn, Guanzi: Political, Economic, and Philosophical Essays from Early China (Princeton: Princeton University Press, 1998), 2.43Google Scholar, with minor modifications.

24. Sterckx, Roel, “Searching for Spirit: Shen and Sacrifice in Warring States and Han Philosophy and Ritual,” in De l'esprit aux esprits: enquête sur la notion de shen—Of Self and Spirits: Exploring shen in China—神, ed. Graziani, R. and Sterckx, R., Extrême-Orient— Extrême-Occident 29 (2007), 27Google Scholar.

25. Chong, Wang 王充, Lunheng zhushi 論衡注釋, ed. Beijing daxue lishi xi Lun Heng zhushi xiaozu 北京大學歷史系《論衡》注釋小組 (Beijing: Zhonghua, 1979) 4.1433Google Scholar (“Jie chu” 解除); Lun-hêng: Philosophical Essays of Wang Ch’ung, ed. and trans. Forke, Alfred (New York: Paragon Books, 1962 [1907]), 2.532Google Scholar.

26. Sterckx, “Searching for Spirit,” convincingly argues that in pre-Buddhist China people dealt with spirits through ritual practice, rather than through the social practice of writing “ontological definitions” about them. Spirits were called into existence through ritual performances. Establishing a spirit's presence was a difficult task and required sincerity and various purificatory forms of preparation. However, when Sterckx concludes by stating, first, that the spirit world was culturally constructed and, then, by attacking the notion of a “spiritual embodiment of pre-existing or preconceived powers in nature” (p. 40), his argument builds on a non-sequitur. Ritual performances and self-cultivation practices can culturally construct an ontology of spirits as an immanent aspect of place and things that are made present through ritual. It would appear that the above early 4th century B.C.E. Guanzi core text speaks of effecting spirit presence and alertness in the person practising self-cultivation precisely through bringing the immanent powers of the heart to the fore, and not by inviting subtle energies into the body.

27. Kuriyama, Shigehisa, “Visual Knowledge in Classical Chinese Medicine,” in Knowledge and the Scholarly Medical Traditions, ed. Bates, Don (Cambridge: Cambridge University Press, 1995), 205–34CrossRefGoogle Scholar. See also Kuriyama, , The Expressiveness of the Body, and the Divergence of Greek and Chinese Medicine (New York: Zone Books, 1999), 187Google Scholar.

28. Mai shu, in Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), 245, strips 63–64.

29. The graph in question is fraught with problems, not for Kuriyama, , Expressiveness of the Body, 48–50Google Scholar, but for Pfister, , Sexuelle körpertechniken, vol. I, chapters 2–4Google Scholar.

30. Maoshi zhengyi 毛詩正義, in Shisanjing zhushu 十三經注疏, ed. Yuan, Ruan 阮元 (Beijing: Zhonghua, 1980), 1.363Google Scholar.

31. See, for example, Zhou Yi 周易, in Shisanjing zhushu, “Qian” 乾, 1.13.

32. For example, for positive connotations of hua 滑, see Huangdi neijing zhangju suoyin, Su wen, 28.86Google Scholar: “Hence if the five viscera, the bones and flesh are shiny and agreeable, one is able to live long” 故五藏骨肉滑利, 可以長久也; Huangdi neijing zhangju suoyin, Ling shu, 18.325Google Scholar: “Qi and mai of a person in his prime are abundant, his muscles and flesh are shining” 壯者之氣血盛, 其肌肉滑; sheng is in medical texts often synonymous with “replete” (shi 實), generally with negative connotations.

33. Huangdi neijing zhangju suoyin, Su wen 18.55Google Scholar. See also Huangdi neijing zhangju suoyin, Ling shu 8.292Google Scholar: “Lung qi … if it is replete, one wheezes. The chest feels full and one breathes while lying on one's back, facing upward [gasping for air]”肺氣 … 實 則喘喝胸盈仰息.

34. Huangdi neijing zhangju suoyin, Su wen 18.57Google Scholar.

35. Gu 固 (“solid, firm”) is here interpreted as a stative verb that refers to a healthy state. For more detail on this, see Hsu, , The Telling Touch, 30Google Scholar.

36. Mai shu, in Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), 245, strip 65.

37. Another possible translation is: “As to the mai that with certainty has agitations, it is the shin's minor yin.” Compare and contrast with Mawangdui gu yishu kaoshi 馬 王堆古醫書考釋, ed. Jixing, Ma 馬繼興 (Changsha: Hunan kexue jishu, 1992), 170Google Scholar; Zhangjiashan Han jian Mai shu jiaoshi 張家山漢簡《脈書》校釋, ed. Dalun, Gao 高大 倫 (Chengdu: Chengdu, 1992), 104–7Google Scholar.

38. Stones and jade were highly valued in antiquity. See, for example, Rawson, Jessica, Chinese Jade from the Neolithic to the Qing (London: British Museum, 1995)Google Scholar, and Lo, Vivienne, “Lithic Therapy in Early Chinese Body Practices,” in Practitioners, Practices and Patients: New Approaches to Medical Archaeology and Anthropology, ed. Baker, P.A. and Carr, G. (Oxford: Oxbow Books, 2002), 195–220Google Scholar. Neither of these authors mentions gu as a valued lithic quality, however.

39. Mawangdui Han mu boshu zhengli xiaozu, “Shi wen” 十問, 152, strip 101; translation modified from Harper, , Early Chinese Medical Literature, 411Google Scholar.

40. Huangdi neijing zhangju suoyin, Su wen 3.14Google Scholar. See also Huangdi neijing zhangju suoyin, Su wen, 3.12Google Scholar: “If one follows it [heaven], one's yang qi is solid” 順之則陽氣固, and 15: “If the yang is dense, then it is solid” 陽密乃固. In Huangdi neijing zhangju suoyin, Su wen, 5.20Google Scholar, an unhealthy state is marked by “not being solid” bugu 不固.

41. Huangdi neijing zhangju suoyin, Su wen, 46.129Google Scholar. For more detail in support of this argument, see Hsu, , The Telling Touch, 282Google Scholar.

42. Huangdi neijing zhangju suoyin, Su wen, 39.113Google Scholar.

43. Translated in Hsu, , The Telling Touch, 86Google Scholar. Compare and contrast with Harper, , “Iatromancy,” 118Google Scholar, who translates gu 固 in case 21 of Chunyu Yi's Memoir in Shi ji 105, as “to make it certain.” No doubt, in Yi's case 4 gu means “certainly” in the phrase “The kidneys certainly govern water” (shen gu zhushui 腎固主水), but gu meaning “certainly” would be ungrammatical in the phrase guse bian ye 固色變也, translated here as “the solid complexion is altered.” See Shiki kaichū kōshō, 31 and 48.

44. Han mu boshu zhengli xiaozu, Mawangdui, “Shi wen,” 152, strip 99Google Scholar. See also Hsu, The Telling Touch, case 6, line 36, 233, which suggests that a healthy liver was “hard” (gang 剛).

45. Huangdi neijing zhangju suoyin, Ling shu, 6.285Google Scholar.

46. See, for example, Huangdi neijing zhangju suoyin, Su wen, 41.118Google Scholar: “Inspect whether they are abundant” 視其盛者; Huangdi neijing zhangju suoyin, Ling shu, 23.341Google Scholar: “Inspect whether there is abundance above the ankle” 視跗上盛者; Huangdi neijing zhangju suoyin, Su wen, 31.93Google Scholar: “Inspect whether they are depleted” 視其虛; Huangdi neijing zhangju suoyin, Su wen, 62.168Google Scholar: “Inspect whether their links are depleted” 視其虛絡; Huangdi neijing zhangju suoyin, Su wen, 60.163Google Scholar: “Inspect whether his channels are exuberant in the yang sphere” 視其經之過於陽者; Huangdi neijing zhangju suoyin, Su wen, 5.23Google Scholar: “Use the outside for knowing the inside, and observe the patterns of exuberance and insufficiency” 以表知裡, 以觀過與不及之理; and Huangdi neijing zhangju suoyin, Ling shu, 5.280Google Scholar: “Inspect whether there is bounty or dearth” 視有餘不足.

47. Huangdi neijing zhangju suoyin, Su wen 62.168–69Google Scholar, concerns, indiscriminately, bounty and dearth of spirit (shen 神), qi, blood (xue 血), the visible form (xing 形), and will (zhi 志).

48. See, for example, Huangdi neijing zhangju suoyin, Su wen 80.253Google Scholar: “Hence while examining [a patient] some, while inspecting the breathing, inspect the intention” 故 診之或視息視意; and Huangdi neijing zhangju suoyin, Ling shu 72.450Google Scholar: “Inspect whether they are noxious or normal” 視其邪正.

49. Kuriyama, , Expressiveness of the Body, 174Google Scholar.

50. Harper, , Early Chinese Medical Literature, 333 and 357–58Google Scholar, translates se as “complexion” in the Mawangdui Han mu boshu zhengli xiaozu, “Yangsheng fang” 養生方, 102 and 117, strip 36 and strips 205, 208. See also Mawangdui Han mu boshu zhengli xiaozu, “Zaliao fang” 雜療方, 126, strip 42, and “Shi wen,” 145, strip 8.

51. Mawangdui Han mu boshu zhengli xiaozu, “Yinyang shiyi mai jiujing jiaben,” 12, strip 64.

52. Mawangdui Han mu boshu zhengli xiaozu, “Shi wen,” 152, strip 101, and 145, strip 10.

53. Mawangdui Han mu boshu zhengli xiaozu, “Tianxia zhi dao tan” 天下至道談, 165, strip 40; translated by Harper, , Early Chinese Medical Literature, 432Google Scholar.

54. For example, Huangdi neijing zhangju suoyin, Su wen, 19.63Google Scholar.

55. Huangdi neijing zhangju suoyin, Ling shu, 49.401Google Scholar, where it also takes on qualities typically attributed to mai, such as floating (fu 浮) and sunken (chen 沉), dispersed (san 散) and united (tuan 摶). Diagnosis of mai and se had much in common; often the same verbs assessed their qualities. See Hsu, , The Telling Touch, 23, 33, 45, 83, 87, 115, 119, 283–84, 291Google Scholar.

56. For example, Huangdi neijing zhangju suoyin, Ling shu, 71.447Google Scholar: “The five colours of the eyes” 目之五色; Huangdi neijing zhangju suoyin, Ling shu, 64.432Google Scholar: “The colour of the ears” 耳色; Huangdi neijing zhangju suoyin, Ling shu, 57.414Google Scholar: “The colour of the abdomen” 腹色; Shi ji, chapter 105, case 12 (translated in Hsu, , The Telling Touch, 80Google Scholar): “The colour of body and head hair is lustrous” 毛髮而色澤; and also Huangdi neijing zhangju suoyin, Ling shu, 10.305Google Scholar: “The colour of the body hair is not lustrous” maose buze 毛色不澤.

57. Huangdi neijing zhangju suoyin, Ling shu, 10.306Google Scholar. Consider also Huangdi neijing zhangju suoyin, Ling shu, 74.454Google Scholar: “When there are blue-green blood vessels, there is a coldness inside the stomach” 有青血脈者, 胃中有寒.

58. For example, Huangdi neijing zhangju suoyin, Ling shu, 20.332Google Scholar: “The blue-green vessels between the ears” 耳間青脈, and Huangdi neijing zhangju suoyin, Su wen, 18.56Google Scholar: “When on the arm there are increasingly more blue-green vessels …” 臂多青脈.

59. For example, Huangdi neijing zhangju suoyin, Ling shu, 70.444Google Scholar; an exception is Huangdi neijing zhangju suoyin, Su wen, 10.36Google Scholar.

60. Huangdi neijing zhangju suoyin, Su wen, 66.182Google Scholar.

61. On these pian, see Yingqiu, Ren 任應秋, “Huangdi neijing yanjiu shijiang” 黃帝 內經 研究十講, in Nei jing yanjiu luncong 內經研究論叢, ed. Yingqiu, Ren 任應秋 and Zhanglin, Liu 劉長林 (Wuhan: Hubei renmin, 1982), 1–99Google Scholar; Unschuld, Paul U., Zheng, J.S. and Tessenow, H., “The Doctrine of the Five Periods and Six Qi in the Huang Di nei jing Su wen,” appendix to Unschuld, Paul U., Huang Di Nei Jing Su Wen, 385–488Google Scholar; Congde, Feng 封從德, Les cinq cycles et les six souffles: la cosmologie de la médecine chinoise selon les sept grands traités du Suwen, Thèse de doctorat en sciences religieuses (Paris: École Pratique des Hautes Études, Sorbonne, 2003)Google Scholar.

62. The six body constituents are bone (gu 骨), sinew (jin 筋), blood (xue 血), vessels (mai 脈), flesh (rou 肉) and qi. See Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), Mai shu, 244, strips 49–52. The implications of the notion qi invoked here are difficult to derive from the context; they may or may not relate to the distinction between xing and qi discussed here.

63. Huangdi neijing zhangju suoyin, Su wen, 6.25Google Scholar.

64. Huangdi neijing zhangju suoyin, Su wen, 13.41Google Scholar.

65. Huangdi neijing zhangju suoyin, Su wen, 1.9Google Scholar.

66. Huangdi neijing zhangju suoyin, Su wen, 9.31Google Scholar, and 20.65; Dunhuang P3287, text 1, col. 2 and P 3477, text 1, col. 6–13. See Dunhuang yiyao wenxian jijiao 敦煌醫藥文獻輯 校, ed. Jixing, Ma 馬繼興 et al. (Nanjing: Jiangsu guji, 1998), 9 and 153Google Scholar.

67. For more details, see Hsu, , The Telling Touch, 13–14, 109–12, 357–60Google Scholar.

68. Csikszentmihalyi, , Material Virtue, 102, 147, 152, 156Google Scholar.

69. Harper, , Early Medical Literature, 81Google Scholar, when commenting on the Zhangjiashan Mai shu, says: “To paraphrase, health depends on the condition of vapour [qi] in the vessels [mai].” However, the Mai shu does not contain any explicit mention of there being qi in the mai.

70. ”When able to defecate and pass vapour [qi, i.e., intestinal gas] there is welcome relief” 得後與氣則怢然衰 and “ailing from hunger; insufficiency of vapour; a tendency to become angry”病飢, 氣【不足】, 善怒. See Harper, , Early Medical Literature, 208, and 210Google Scholar, and Han mu boshu zhengli xiaozu, Mawangdui, “Yinyang shiyi mai jiujing,” 11 and 12Google Scholar. In self-cultivation texts, by contrast, qi plays a more important role; there are techniques for augmenting and strengthening qi and for effecting qi expansion and the arrival of qi, see Lo, “Influence of Nurturing Life Culture.” Having said this, notions of “heavenly qi” (tianqi 天氣) and “earthly qi” (diqi 地氣) that probably were thought to permeate the universe occur in Mawangdui, “Yinyang mai sihou” 陰陽脈死候, 21Google Scholar.

71. This is the main argument of Hsu, , The Telling Touch, 45–46Google Scholar.

72. Huangdi neijing zhangju suoyin, Ling shu, 6.284Google Scholar.

73. Huangdi neijing zhangju suoyin, Su wen, 39.113Google Scholar.

74. Huangdi neijing zhangju suoyin, Ling shu, 66.439Google Scholar.

75. Huangdi neijing zhangju suoyin, Su wen, 47.133Google Scholar.

76. Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), Mai shu, 144, strips 56–57 (please note that the citation of this passage in Hsu, , Mai 脈, 151Google ScholarPubMed, contains embarrassing typographical errors).

77. Interestingly, parallel passages to these two parts of the Zhangjiashan Mai shu quotation occur in entirely different contexts in the Huangdi neijing. Accordingly, this brief Zhangjiashan Mai shu passage may represent a mini-compilation, which juxtaposes textual excerpts from two different traditions of medical learning.

78. Zhangjiashan 247 hao Han mu zhujian zhengli xiaozu, Zhangjiashan Han mu zhujian (247-hao mu), Mai shu, 144, strips 54–55.