Confucian values and the development of medicine in China

Confucian values and the development of medicine in China Chiu-kay TANG, University of Hong Kong, Hong Kong Abstract: It is generally recognized that Confucius moulded the Chinese culture. His teachings have exerted a vital influence on the Chinese way of life and thought for more than two thousand years. Confucius emphasis on social order and proper governance of the state prompted Chinese scholars in the past to think that the highest career in life was that of the high-ranking government official. However, only a tiny minority of the followers of Confucius could realize this goal. A large proportion of scholars who had failed to become high-ranking government officials turned to studying medicine because there was an old Chinese saying that if one failed to become a good prime minister, then one should try to become a good doctor. Therefore, in general, there was no lack of doctors in ancient China. However, the Confucian values of filial piety discouraged cutting open the bodies of the deceased to examine the internal organs and determine the causes of death. This greatly hampered the development of anatomy, the scientific basis of modern Western medicine. As a result, China lagged far behind the West in the employment of modern methods of treating diseases. Confucianism is the school of thought founded by Confucius in the Spring and Autumn Period ( 春秋時代, 770-476 BC). Ever since Emperor Wu of Han ( 漢武帝, 157 BC -87 BC) established Confucianism as official state doctrine, it has exerted a vital influence on the Chinese way of life for more than two thousand years. In fact, it is generally recognized that Confucius moulded the Chinese culture. All other intellectual disciplines in ancient China were more all less affected by Confucianism. Medicine was an important component of traditional Chinese culture, therefore, it should come as no surprise that the theories of Chinese medicine integrated with many important Confucian concepts in the course of its development since the Han Dynasty. Confucianism had both positive and negative effects on the development of medicine in China. Confucianism advocates active involvement in worldly affairs. The student, having

completed his studies, should enter into government service ( 學而優則仕 ). 1 This is a famous saying from The Analects of Confucius ( 論語 ). This teaching was the ideal for followers of Confucianism. By serving as government officials, Confucian scholars could govern and benefit the people. Confucius emphasis on social order and proper governance of the state prompted Chinese scholars in the past to think that the highest career in life was that of the high-ranking government official. However, only a tiny minority of the followers of Confucianism could realize this goal. A large proportion of scholars who had failed to become high-ranking government officials turned to studying medicine because there was an old Chinese saying that if one failed to become a good prime minister, then one should try to become a good doctor ( 不為良相, 願為良醫 ). 2 As a result, there was no lack of doctors in ancient China. Being disciples of Confucius, many of these doctors were learned scholars who had the ability to contribute to the development of the theoretical aspect of medicine and help enhance the standard of medical ethics. Many Confucian doctors regarded medicine as part of the Confucian system and used Confucian thoughts to explain the aetiology, diagnosis and treatment of diseases and health preservation. One of the Confucian values which had the most significant impact on the development of medicine in ancient China was filial piety ( 孝 ). In Confucian thought, filial piety is the responsibility of every person to respect, love, obey and take care of their parents during their lifetime and to perform ritual sacrifices after their death. It is considered the foremost value in Chinese culture and the root of ren ( 仁 ) or the virtues of humaneness, the main theme of Confucian teachings. Apart from being good to his parents and providing them with sufficient food and clothes, a filial son must pay attention to their states of health. The best way to achieve this was not to seek the help of practitioners of medicine but to learn medicine himself. A classic in Chinese medicine written by the famous Jin ( 金 ) doctor Zhang Congzheng ( 張從正 ) was entitled Rumen Shiqin 儒門事親 ( ), meaning Confucians duties to their parents. The editors of the Si Ku Quan Shu 四庫全書 ( ) or the Complete Library in the Four Branches of Literature, had the following comment on this book: The book was entitled Rumen Shiqin because only Confucian scholars were wise enough to understand the theories of medicine and anyone who was 1 論語 子張 : 子夏曰 : 仕而優則學, 學而優則仕 2 吳曾 能改齋漫錄 卷十三云 : 范文正公微時, 嘗詣靈祠求禱, 曰 : 他時得位相乎? 不許 復禱之曰 : 不然, 願為良醫 亦不許 既而嘆曰 : 夫不能利澤生民, 非大丈夫平生之志 ( 上海 : 上海古籍出版社,,1979 年, 頁 381 )

responsible for taking care of his parents should study medicine. 其曰儒門事親者, 以為惟儒者能明其理, 而事親者當知醫也 ( 紀昀等編 : 四庫全書 儒門事親 提要 ) In ancient China, there was no lack of scholars who took up the study of medicine and became famous doctors because their parents were ill. The following are some typical examples: 1. Xu Daoyou ( 許道幼 ) lived in the Sui Dynasty ( 隋朝 ). He studied medicine because his mother fell ill. As a result of his hard work, he became a famous doctor. Once he said to his sons, A son should taste his parents food and examine the drugs offered to them. If he knows nothing about the art of healing, how could he be called a filial son? Hence, the art of healing was handed down from generation to generation. 許智藏, 高陽人也 祖道幼, 嘗以母疾, 遂覽醫方, 因而究極, 世號名醫 誡其諸子曰 : 為人子者, 嘗膳視藥, 不知方術, 豈謂孝乎? 由是世相傳授 ( 隋書 許智藏傳 ) 2. Two Tang scholars, Zhen Quan ( 甄權 ) and his brother Zhen Liyan ( 甄立言 ) paid special attention to books on medicine and studied them thoroughly after their mother had become ill. 甄權 嘗以母病, 與弟立言專醫方, 得其旨趣 ( 舊唐書 甄權立言傳 ) 3. Wang Tao ( 王燾 ), an official of the Tang Dynasty, was a filial son who attended to his mother s illness all year round. He even prepared his mother s medicine himself. He learned from several famous doctors and acquired all their skills in treating patients. He recorded his medical knowledge in a book that was highly regarded. 燾, 性至孝, 為徐州司馬 母有疾, 彌年不廢帶, 視絮湯劑 數從高醫遊, 遂窮其術, 因以所學作書, 號 外台秘要, 討繹精明, 世寶焉 ( 新唐書 王燾傳 ) 4. Zhu Zhenheng ( 朱震亨 ) was one of the four most famous doctors of the Jin and

Yua n Dynasties ( 金元四大家 ). One day, when he asked a doctor to treat his sick mother, he realized that if a son did not have any medical knowledge or sought advice from a mediocre doctor, it was his parents who suffered. Therefore he started to study medicine and search widely for renowned teachers of medicine. Finally, he learned the art of healing from Luo Zhiti and became a very successful doctor. 一日, 母病延醫, 因自悟曰 : 人子不知醫, 或委之庸人, 寧無有失 於是研究醫理, 博求名師, 得羅知悌之傳, 治症多奇效 ( 新元史 朱震亨傳 ) 5. Miao Zunyi ( 繆遵義 ) was a scholar and official of the Qing Dynasty. He studied medicine because he mother fell ill. After he grasped the art of healing, he resigned from the post of county magistrate and became a full-time doctor. He was innovative in the use of drugs. ( 繆 ) 遵義, 亦吴人 乾隆二年進士, 官知縣 因母病, 通方書, 棄官為醫, 用藥每岀創意 ( 清史稿 葉桂薛雪吴瑭章楠王士雄傳 ) Although filial piety played a significant role in the growth of medicine in ancient China, it did have some negative impacts on its development. The following passage from Xiao Jing (or The Classic of Filial Piety, 孝經 ) serves to illustrate this negative influence : (Once), when Zhong Ni was unoccupied, and his disciple Zeng was sitting nearby in attendance on him, the Master said, "The ancient kings had a perfect virtue and all-embracing rule of conduct, through which they were in accord with all under heaven. By the practice of it the people were brought to live in peace and harmony, and there was no ill-will between superiors and inferiors. Do you know what it was?" Zeng rose from his mat and said, "How should I, Shen, who am so devoid of intelligence, be able to know this?" The Master said, "(It was filial piety.) Now filial piety is the root of (all) virtue, and (the stem) out of which grows (all moral) teaching. Sit down again, and I will explain the subject to you. Our bodies - to every hair and bit of skin - are received by us from our parents, and we must not presume to injure or wound them. This is the beginning of filial piety. When we have

established our character by the practice of the (filial) course, so as to make our name famous in future ages and thereby glorify our parents, this is the destination of filial piety. It commences with the service of parents; it proceeds to the service of the ruler; it is completed by the establishment of character. It is said in the Major Odes of the Kingdom: Never forget what your ancestors did for mankind; cultivate your virtue to carry forward the good tradition." 仲尼居, 曾子侍 子曰 : 先王有至德要道, 以順天下, 民用和睦, 上下無怨 汝知之乎? 曾子避席曰 : 參不敏, 何足以知之? 子曰 : 夫孝, 德之本也, 教之所由生也 復坐, 吾語汝 身體髮膚, 受之父母, 不敢毀傷, 孝之始也 立身行道, 揚名於後世, 以顯父母, 孝之終也 夫孝, 始於事親, 中於事君, 終於立身 大雅 云: 無念爾祖, 聿修厥德 ( 孝經 第一章) Under the influence of the Confucian teaching of filial piety that our bodies, to every hair and bit of skin, were received by us from our parents, and we must not presume to injure or wound them, most doctors and students of medicine in ancient China did not dare to cut open the bodies of patients or even cadavers. The following passage from Song Shu ( 宋書 ) fully demonstrates the powerful influence of the Confucian notion of filial piety on the preservation of the human body even after one s death. A person named Tang Ci fell ill after drinking with friends in a neighbouring village. He vomited out ten plus worms. When he was terminally ill, he ask Zhang, his wife, to cut open his abdomen to remove the cause of his illness. After Tang Ci died, Zhang cut open his abdomen and found that his five internal organs were all rotten. The county magistrate thought that Zhang was too merciless to cut open her husband s abdomen and Tang s son should have stopped his mother from doing so. The county magistrate found it difficult to reach a court decision. According to the law, anybody causing injury to a corpse should serve a four-year sentence; a wife injuring her husband should serve a five-year sentence; a son not showing filial piety should be executed. 時沛郡相縣唐賜往比村朱起母彭家飲酒還, 因得病, 吐蠱蟲十餘枚 臨死語妻張, 死後刳腹出病 後張手自破視, 五藏悉糜碎 郡縣以張忍行刳剖, 賜子副又不禁駐, 事起赦前, 法不能決 律傷死人, 四歲刑 ; 妻

傷夫, 五歲刑 ; 子不孝父母, 棄市 ( 宋書 顧覬之傳 ) The word dissect ( 解剖 ) first appeared more than two thousand years ago in Lingshu (or Spiritual Pivot, 靈樞 ), the second text of Huangdi Neijing (or The Inner Canon of Huangdi, 黃帝內經 ): An eight-foot tall body has skin and muscles. For a living man, we can get useful information by observation and palpation; for a dead man, we can do likewise by dissecting and examining him. 若夫八尺之士, 皮肉在此, 外可度量切循而得之, 其死可解剖而視之 ( 靈樞 經水第十二 ) This piece of information clearly shows that our ancestors acquired at least some preliminary knowledge of the structure of the human body more than two thousand years ago. However, there was little advancement in anatomy, the foundation stone of modern medicine, in the years that followed. Although there were records of dissecting human cadavers in ancient China, these were indeed very isolated incidences. Perhaps one of the most well-known of these incidences occurred in the Xin Dynasty ( 新朝, 8-23) when emperor Wang Mang ( 王莽 ) dissected the dead body of his political enemy Wang Sunqing ( 王孫慶 ) in order to determine the sizes of his five internal organs. We should note that in this particular case, the dissection of the human body was performed as a sort of punishment. Generally speaking, performing autopsies was forbidden in ancient China and this greatly hampered the development of anatomy. It was not until the Qing Dynasty that a breakthrough in the scientific study of structure of the human body occurred. This was solely attributed to Wang Qingren ( 王清任 ), a doctor practising in the Qian Long ( 乾隆 ) and Dao Guang ( 道光 ) periods. While studying and practicing medicine, he discovered certain errors in the existing records of the anatomical structure of the human body. He decided to set them right. He did a lot of open-air autopsies of unclaimed bodies exposed in burial grounds for the destitute, corpses of children who died in an epidemic and dismembered bodies of executed criminals. He also dissected animals in order to verify his anatomical findings in human bodies. He recorded the results of his fortytwo years of laborious work in a book called Yi Lin Gai Cuo (or Correcting the Errors in the Forest of Medicine, 醫林改錯 ). This book consists of two main parts, the first part being Wang s discussion of anatomical errors in the classical literature and his suggested corrections, which regretfully leave much to be desired.

Western science aims for precision and Western medicine tends to explain everything in terms of structure. Chinese medicine is completely different. As mentioned above, anatomy was severely underdeveloped in ancient China because of the Confucian concept of filial piety. As a result, little emphasis is placed on anatomical structure in Chinese medicine. Instead, it emphasizes function. This has more or less contributed to the development of principles in Chinese medicine which are sometimes akin to philosophical concepts, being flexible and open to a wide range of interpretation. Therefore, from the standpoint of Western medicine, Chinese medicine appeared unscientific and China lagged far behind the West in the employment of scientific methods of diagnosing and treating diseases.