A few days ago, The New York Times had an article about the Munich academic and expert in Chinese medicine, Dr. Paul Unschuld, whose name translates as “innocence”. What struck me was that this expert apparently doesn’t believe all that much in the pharmacological effectiveness of traditional Chinese medicines, but sees the classic writings of the Yellow Emperor as an instrument that brought a certain enlightenment and pragmatism into Chinese medicine and culture.
Dr. Unschuld indicates that he believes traditional Chinese medicine can be effective in certain situations, but that it is also an expression of the Chinese way of thinking. The article states:
“For Dr. Unschuld, Chinese medicine is far more interesting as an allegory for China’s mental state. His most famous book is a history of Chinese medical ideas, in which he sees classic figures, such as the Yellow Emperor, as a reflection of the Chinese people’s deep-seated pragmatism. At a time when demons and ghosts were blamed for illness, these Chinese works from 2,000 years ago ascribed it to behavior or disease that could be corrected or cured.
“It is a metaphor for enlightenment,” he says.
Especially striking, Dr. Unschuld says, is that the Chinese approach puts responsibility on the individual, as reflected in the statement “wo ming zai wo, bu zai tian” — “my fate lies with me, not with heaven.” This mentality was reflected on a national level in the 19th and 20th centuries, when China was being attacked by outsiders. The Chinese largely blamed themselves and sought concrete answers by studying foreign ideas, industrializing and building a modern economy.”
I often think about how our perceptions about disease are culturally rooted and how physicians not just deliver treatments but are in a position to nudge our patients’ views of how health and disease come about.
It seems to me we are now in the middle of a big transition that echoes the Yellow Emperor. In his era, demons and ghosts were blamed for causing disease, and he pointed out how much our own lifestyle lies at the root of illness. In the last hundred years, our culture, with its tremendous scientific and technological advances, embraced the notion that our diseases come from invading bacteria, random gene mutations and other causes completely beyond our control. The promise of modern medicine has been that we can understand and counteract these forces through science, with more and more counteractive interventions. But as our treatments get more and more powerful, we have seen many of them cause ripple effects that cause other types of discomfort or disease. Now, we are instead seeing serious research into the relationships between illness and our psychological state, our harmony with our own gut bacteria, our low level exposure to dust and dirt we thought were harmful, our dietary choices and our physical activity level. We are beginning to see ourselves as no longer the hapless victims of outside forces, but products of our own day to day living choices.
I have written about the Yellow Emperor before in a 2013 piece that was also published on The Health Care Blog:
Every now and then the title of a book influences your thinking even before you read the first page.
That was the case for me with Thomas Moore’s “Care of the Soul” and with “Shadow Syndromes” by Ratley and Johnson. The titles of those two books jolted my mind into thinking about the human condition in ways I hadn’t done before and the contents of the books only echoed the thoughts the titles had provoked the instant I saw them.
This time, it wasn’t the title, “Cultivating Chi”, but the subtitle, “A Samurai Physician’s Teachings on the Way of Health“. The book was written by Kaibara Ekiken (1630-1714) in the last year of his life, and is a new translation and review by William Scott Wilson. The original version of the book was called the Yojokun.
The images of a samurai – a self-disciplined warrior, somehow both noble master and devoted servant – juxtaposed with the idea of “physician” were a novel constellation to me. I can’t say I was able to predict exactly what the book contained, but I had an idea, and found the book in many ways inspiring.
The translator, in his foreword, points out the ancient sources of Ekiken’s inspiration during his long life as a physician. Perhaps the most notable of them was “The Yellow Emperor’s Classic on Medicine”, from around 2500 B.C., which Ekiken himself lamented people weren’t reading in the original Chinese in the early 1700’s, but in Japanese translation. One of his favorite quotes was:
“Listen, treating a disease that has already developed, or trying to bring order to disruptions that have already begun, is like digging a well after you’ve become thirsty, or making weapons after the battle is over. Wouldn’t it already be too late?”
Ekiken’s own words, in 1714, really describe Disease Prevention the way we now see it:
“The first principle of the Way of Nurturing Life is avoiding overexposure to things that can damage your body. These can be divided into two categories: inner desires and negative external influences.
Inner desires encompass the desires for food, drink, sex, sleep, and excessive talking as well as the desires of the seven emotions – joy, anger, anxiety, yearning, sorrow, fear and astonishment. (I see in this a reference to archetypal or somatic medicine.)
The negative external influences comprise the four dispositions of Nature: wind, cold, heat and humidity.
If you restrain the inner desires, they will diminish.
If you are aware of the negative external influences and their effects, you can keep them at bay.
Following both of these rules of thumb, you will avoid damaging your health, be free from disease, and be able to maintain and even increase your natural life span.”
On the topic of Restraint, the Yellow Emperor text states:
“In the remote past, those who understood the Way followed the patterns of yin and yang, harmonized these with nurturing practices, put limits on their eating and drinking, and did not recklessly overexert themselves. Thus, body and spirit interacted well, they lived out their naturally given years, and only left this world after a hundred years or more.
People these days are not like his. They drink wine as though it were berry juice, make arbitrary what should be constant, get drunk and indulge in sex, deplete their pure essence because of desire, and thus suffer a loss of their fundamental health….Thus they fizzle out after fifty years or so.”
During the Ming dynasty, a prominent physician wrote:
“Premature death due to the hundred diseases is mostly connected to eating and drinking.”
That quote still carries relevance today.
Interestingly, Ekiken sees medications, herbs, acupuncture and all the available treatments of his time as a last resort because they are unbalanced interventions to counter the imbalance of the body. Almost a hundred years later, Samuel Hahnemann coined the word allopathy for this type of treatment.
Ekiken wrote at length about what distinguishes a mediocre physician from a good one. For example, he describes the good physician as less in a hurry to prescribe medications. One of his many aphorisms seems uncannily relevant to today’s emphasis of guidelines over individualized treatment:
“A good doctor gives medicine in response to the condition of the situation…This is not a matter of adhering to one absolute method. It is rather like a good general who fights his battles well by observing his enemies closely and responding to their changes. His methods are not determined beforehand. He observes the moment and is in accord with what is right.”
Quoting Confucius, he ends his description of a good doctor:
“A good doctor warms up the old and understands the new”.
May all of us remember and respect the wisdom of the 2500 B.C. text, now almost 5000 years old, as it speaks of “avoiding overexposure to things that can damage your body”. It reminds me of all the lectures I have attended on diabetes and heart disease where the speaker devotes exactly one sentence to this topic, and then spends the rest of the time talking about all the interesting drugs we have to counteract the effects of our exposure to harmful or excessive foodstuffs.
A little samurai discipline and restraint could help most of us…