The Greatest Benefit to Mankind: A Medical History of Humanity

Written in Sanskrit, the earliest surviving Ayurveda texts date from the early centuries of the Christian era; traditional claims among practitioners that Ayurveda dates back thousands of years are pious. Of the various Sanskrit writings that expound the Ayurveda, the earliest are the Caraka Samhita [Caraka’s Compendium] and the Susruta Samhita [Susruta’s Compendium], supposedly the work of the sages Caraka and Susruta. Very substantial in bulk, they form the cornerstone of Ayurveda. A third early text, the Bhela Samhita, survives only in a single damaged manuscript.

The Caraka Samhita tradition is connected with north-western India, and in particular the ancient university of Taksasila; the Susruta Samhita was supposedly composed in Benares on the River Ganges. Their original composition date is a matter of speculation: earlier versions may derive from as far back as the time of the Buddha (early fourth century BC). Caraka may date to around AD 100; Susruta to the fourth century. The Sanskrit texts which became canonical represent the works in the form they had attained around AD 1000.

There are other subsequent prominent Brahminic texts. These include the Astangahrdaya Samhita of Vagbhata (AD C. 600), which includes midwifery, the Rugviniscaya of Madhavakara (AD C. 700), the Sarngadhara Samhita of Sarngadhara (c. fourteenth century AD), and the Bhavaprakasa of Bhavamisra (sixteenth century). Madhavakara’s work broke new ground through rearranging medical topics according to pathological categories, thereby establishing the model of thematic grouping followed by almost all later works. Sarngadhara was the first Sanskrit author to introduce new foreign elements, including opium and metallic compounds, into the materia medica, and the use of pulse lore in diagnosis and prognosis.

The Caraka Samhita and the Susruta Samhita stem from a common intellectual tradition. The Caraka Samhita is marked by long reflective and philosophical passages, including discussions of causality and so forth. The Susruta Samhita for its part contains extensive descriptions of sophisticated surgical techniques: eye operations, plastic surgery, etc., which do not appear in the Caraka Samhita at all or only in less detail. Both are huge compendia of medical teachings on subjects such as a balanced diet; the powers of plants and vegetables; the causes and symptoms of various maladies; epidemic diseases; the right techniques for examining patients; the parts of the body; conception, pregnancy and the way to take care of foetuses; diagnosis and prognosis; stimulants and aphrodisiacs; the nature and treatment of fever, heated blood, swellings, urinary and skin disorders, consumption, insanity, epilepsy, dropsy, piles, asthma, coughs and hiccups and scores of other conditions; cupping, blood-letting, the use of leeches, and many other treatments; the right use of alcohol; the properties of vegetables, nuts, and other materia medica; the use of enemas – and all alongside incantations, omens and fears of sorcery.

The medicines described in the Caraka Samhita and the Susruta Samhita comprise a rich menu of animal, vegetable, and mineral substances. For dealing with the 200 diseases and 150 other conditions mentioned, the Caraka Samhita refers to 177 materials of animal derivation, including snake dung, the milk, flesh, fat, blood, dung, or urine of such animals as the horse, goat, elephant, camel, cow and sheep, the eggs of the sparrow, pea-hen and crocodile, beeswax and honey, and various soups; 341 items of vegetable origin (seeds, flowers, fruit, tree-bark and leaves), and 64 substances of mineral origin (assorted gems, gold, silver, copper, salt, clay, tin, lead and sulphur). The use of dung and urine are standard; since the cow is a holy animal to orthodox Hindus, all its products are purifying. Cow dung was judged to possess disinfectant properties and was prescribed for external use, including fumigation; urine was to be applied externally in many recipes.

The Caraka Samhita praises the virtuous healer: ‘Everyone admires a twice-born [brahmin] physician who is courteous, wise, self-disciplined, and a master of his subject. He is like a guru, a master of life itself.’ Quacks, by contrast, are roundly condemned: ‘As soon as they hear someone is ill, they descend on him and in his hearing speak loudly of their medical expertise.’ In respect of the true physician, the Caraka Samhita tenders an Oath of Initiation, comparable to the Hippocratic Oath. A pupil in Ayurvedic medicine had to vow to be celibate, to speak the truth, to adhere to a vegetarian diet, to be free of envy, and never to carry weapons. He was to obey his master and pledge himself to the relief of his patients, never abandoning or taking sexual advantage of them. He was not to treat enemies of the king or wicked people, and had to desist from treating women unattended by their husbands or guardians. The student had to visit the patient’s home properly chaperoned, and respect the confidentiality of all privileged information pertaining to the patient and his or her household.

The diagnostic and therapeutic aspects of Ayurveda depended on knowledge of the canonical Sanskrit texts. The good physician (vaidya) memorized material consisting largely of verses which specified the correlations between the three humours (wind, bile and phlegm), and the various symptoms, complaints and treatments. He conducted an examination of his patient which took into account the symptoms, in the process recalling verses applicable to the patient’s condition. These would trigger remembrance of further verses containing the same combinations of humoral references, all of which would lead to a prognosis and a proposed therapy.

The Ayurvedic schemes of substances, qualities and actions offered the vaidya an effective combination of solid learned structure and freedom to act. The practice of Ayurveda depended heavily upon oral traditions, passed down from master to pupil, in which a huge magazine of memorized textual material was recreated to fit particular circumstances, while remaining faithful to the fundamental meaning of the text. (The role of precedent within English Common Law offers a parallel.)

The Susruta Samhita is distinctive for its wide-ranging section on surgery, which describes how a surgeon should be trained and the various operations he should perform. There are, among other things, descriptions of cutting for stone, couching for cataract, the way to extract arrowheads and splinters, suturing, and the examination of human corpses as part of the study of anatomy. The text maintains that surgery is the oldest and most useful of the eight branches of medical knowledge, and elaborate surgical techniques are described. However, there is little evidence to confirm that these practices persisted. A description of the couching operation for cataract exists in the ninth-century Kalyanakaraka by Ugraditya, and texts based on the Susruta Samhita copy out the sections on surgery with other material. But medical texts give no evidence of any continuous development of surgical thinking; no ancient or even medieval surgical instruments survive; nor is surgery described in literary or other sources. A parallel may be found in the apparent fate of surgery within the Islamic tradition.

One possible explanation for this apparent waning of surgery is that, as the caste system grew more rigid, taboos concerning physical contact became stronger and, a little like Hippocratic doctors, vaidyas may have shunned therapies which involved applying the knife to the body, transferring their attention to less intrusive approaches, including examination of the pulse and the tongue. Whatever the reasons, the early sophistication of surgical knowledge seems to have been an isolated phenomenon in the development of the Indian medical tradition.

There is, however, one well-documented historical event which suggests that surgery akin to the Susruta Samhita remained widely known. In March 1793, an operation was undertaken in Poona of significance for the later course of plastic surgery. A Maratha named Cowasjee, a bullock driver with the English army, having been captured by Tipu Sultan’s forces, had his nose and one hand cut off – a customary punishment for adultery. He turned to a man of the brickmakers’ caste to have his face repaired. Thomas Cruso (d. 1802) and James Trindlay, surgeons in the Bombay Presidency, witnessed this operation, publishing in 1794 an account of what they had seen, with an engraving of the patient and diagrams of the skin-graft procedure. The obscure brick-maker, reported the English surgeons, had performed a superb skin-graft and nose reconstruction using a technique superior to anything they had ever seen. It was taken up in Europe and became known as the ‘Hindu method’.

This may seem to be proof of the persistence of Susruta’s surgery during the course of well over a thousand years, but there are puzzling elements to the tale – notably the fact that rhinoplasty of this kind is not delineated in any detail in the Susruta Samhita. Furthermore, as a member of the brickmakers’ caste, the surgeon who performed the Poona operation was not himself a vaidya. He probably knew no Sanskrit: his skill lay in his hands, not in his head. It is conceivable that this represents a survival of a procedure from Susruta’s time, but if so it seems to have been passed down independently of the practice of educated physicians. There is no evidence from other written sources of the practice of such operations in the intervening period.

A similar puzzle is posed by smallpox. Before the nineteenth century, inoculation was popular knowledge and widely used for protection against the disease, with the expectation that a mild episode would follow. After the graft the patient was kept quarantined in a controlled environment. A detailed account by an English surgeon, dating from 1767, describes the practice and states that it was widespread in Bengal. No trace of inoculation appears, however, in any Sanskrit medical text. The disease was undeniably identified in Ayurvedic writings, where it is called the ‘lentil’ disease, but again the link between theory and practice is tenuous. It seems that techniques recorded in texts, though still related in the learned tradition, fell into disuse, while new developments were widely practised without being inscribed in approved medical learning.

In this light it is easy to fall into the trap of assuming that the Ayurvedic tradition was static and ‘timeless’ – that later texts did no more than to elaborate a coherent and comprehensive set of teachings set out, once and for all, in the Caraka Samhita and the Susruta Samhita. This supposition is given some support by the fact that these two texts do present themselves as unchanging bodies of knowledge; moreover, it is in line with native and foreign stereotypes of India as the fountain-head of eternal truths. But while the canonical texts present the appearance of homogeneity, research into the development of Sanskrit Ayurvedic literature has revealed that numerous authors dissented from orthodox viewpoints. In the course of time new diseases were reported and identified. From the sixteenth century syphilis (known as ‘foreigners’ disease’ in Sanskrit) was described in texts (mercury, brought to India by Islamic physicians, was used to treat it); and from the eighteenth century writings embraced disease descriptions evidently borrowed from western medicine.

There were also innovations in diagnostics. Close attention to urine, and techniques for its inspection, stem from the eleventh century. Before the thirteenth century there is no mention of pulse examination in Sanskrit texts, but it subsequently developed into a key diagnostic method. A technique called ‘examination of the eight bases’ (astasthanapariksa) – the routine diagnostic method for examining the patient’s pulse, urine, faeces, tongue, eyes, general appearance, voice and skin – emerged in the sixteenth century. Novel prognostic techniques also came into use. For example, from about the same time, a procedure was taught whereby a bead of oil was dropped on the surface of a patient’s urine. The remaining span of his life was read from the way the oil spread.

In therapy, a discernible shift lay in the rise of standardized compound medicines (yoga). Consisting of a large number of ingredients, yoga is regularly described in terms of its specific effectiveness against a particular ailment; this brings into question the conventional western view that Ayurvedic medicine was invariably holistic.

Though Ayurveda is the most familiar tradition of indigenous Indian medicine, others have flourished in the subcontinent, notably the Siddha system of the Tamils and the Yunani medicine of Islam. Other assorted therapies are also visible, from folk medicine and shamanism to faith-healing and astrology.

In south India, the form of medicine evolved in the Tamil-speaking areas was dissimilar in certain aspects to Ayurveda. Known as Siddha medicine (Tamil: cittar), this was basically an esoteric magical and alchemical system, presumably heavily influenced by tantric ideas. It was characterized by a greater use of metals, in particular mercury, than in Ayurveda, and prized a substance called muppu, credited with possessing great powers for physical and spiritual transformation. Pulse taking was highly valued for diagnosis. The semi-legendary founders of Siddha medicine include Bogar, who is said to have journeyed to China, teaching and learning alchemical lore, and Ramadevar, who supposedly travelled to Mecca, teaching the Arabs the arts of alchemy.

From earliest times, Ayurvedic medicine handled and treated a range of children’s maladies, blaming them on the evil influence of celestial demons (graha, seizer), believed to attack children. The Sanskrit term graha was subsequently used to mean ‘planet’, and although grahas are clearly described as celestial beings in the Susruta Samhita, later rites for planetary propitiation are targeted at the same types of influence. Indian astrology and religious ordinances contain texts for placating heavenly bodies, as well as astrological prognostications regarding such matters as pregnancy and the sex of unborn children, dream interpretation, sickness and death. According to an early and significant legal work, ‘one desirous of prosperity, of removing evil or calamities, of rainfall [for farming], long life, bodily health and one desirous of performing magic rites against enemies and others should perform sacrifice to planets.’

A work exemplifying the close relationship between medicine and astrology as therapeutic systems is the Virasimhavaloka by Virasimpa, written in AD 1383, probably in Gwalior. It deals with diseases from three points of view: astrology, religion, and medicine. The body parts are matched to the constellations and planets in an intricate scheme of influences and associations, and it is the astrologer’s task to read this pattern of symbols to understand the patient’s problem before advising remedies such as charms, expiations, prayers and herbs.

The Bower manuscript, one of the oldest surviving Indian works, contains a text on divination by dice. It reveals the outlook of a fifth-century healer interested in the therapeutic powers of garlic, in elixirs for eternal life, in the treatment of eye diseases, herbal medicines, butter decoctions, aphrodisiacs, oils, the care of children, and spells against snake-bites, as well as divination.

NEW ARRIVALS

Islam brought new medical practices to India, having a major impact after the eleventh-century Turco-Afghan invasions of Gujarat, and becoming entrenched especially around Lahore, Agra, Lucknow and Delhi. These were known as Yunani Tibb – Yunani (or unani) being an Indian representation of the word ‘Ionian’. Yunani medicine derives in large part from Galenic medicine as interpreted in Ibn Sina’s Al-Qanun fi’l-tibb [Canon], and continues to flourish in India today. It is practised by hakims (physicians) in rural areas especially and is advocated among those who wish to embrace a distinctively Islamic medicine.

Yunani medicine and Ayurveda have interacted to some degree, especially in materia medica. Though the primary languages of Yunani medicine are Persian and Arabic, there are also certain Sanskrit texts. Yunani postulates four basic humours, as distinct from Ayurveda’s three, and it has more of an orientation towards treatments in hospitals. The major difference between them is their clientèle. Broadly, Yunani physicians treat Muslim patients, and Ayurvedic physicians treat Hindus.

In the first half of the sixteenth century Portuguese settlers came to Goa. The first medical book printed in India was the Coloquios dos Simples, e Drogas he Cousas Mediçinais da India (1563) [Colloquies on the Medical Simples and Drugs of India] by Garcia d’Orta (1490–1570). D’Orta had gathered his material from local physicians, and the signs are that there was a free exchange of medical ideas at that time between the Portuguese and the Indians. Relationships however declined, and after 1600 the Portuguese introduced restrictions which in effect banned Hindu physicians in Goa.

Dutch East India Company officials showed great interest in the natural history and medicines of the Malabar coast where they traded and settled. Heinrich van Rheede (1637–91), the Dutch governor, published between 1686 and 1703 a work containing nearly 800 plates of Indian plants. Paul Herman’s (1646–95) herbarium and Museum Zeylanicum provided major sources for Linnaeus’s Flora Zeylanica (1747).

The British arrived around 1600. Facing unfamiliar and severe health problems, East India Company traders were keen to learn from the local vaidyas and hakims, and Indian doctors were curious about British surgery, since the art had lapsed among vaidyas. It was observed by Sir William Sleeman (1788–1856) that ‘the educated class, as indeed all classes, say that they do not want our physicians, but stand much in need of our surgeons.’

British physicians were initially prompted to adopt Indian methods by the problems involved in shipping medical stores from Europe. In time, however, they grew increasingly critical of the crudeness of indigenous drugs and contemptuous of what they saw as the shortcomings of Indian medicine. With characteristic ethnocentricity, East India Company attitudes towards Indian medicine hardened. When medical colleges had been founded in Bengal and elsewhere under the British Raj, the study of Ayurveda was given a semblance of support alongside British medicine; but with changes in educational policy after 1835 and the suppression of Ayurvedic teaching in state-funded medical colleges, British support for Ayurvedic training ceased. Ayurvedic physicians continued to practise, although their training was reduced to the traditional family apprenticeship system.

In the twentieth century, with the rise of the Indian independence movement, indigenous traditions received active encouragement from nationalists. In recent decades there have been divided loyalties: since independence in 1947, the Indian government has oscillated between commitment to western medicine in the name of progress, and acceptance of the fact that Ayurvedic medicine is widely practised, especially in the countryside, and commands sturdy loyalties. Many Indian physicians have a strong incentive to devote themselves to western medicine – it is a passport to practise throughout the world.

In 1970, the Indian Parliament passed the Indian Medicine Central Council Act, setting up a central council for Ayurveda. Since then government-accredited colleges and universities have provided professional training and qualifications. This training, however, includes some basic education in western methods, family planning and public health. In 1983, there were approximately one hundred officially approved Ayurvedic training colleges, many attached to universities. But although the number of Ayurvedic and Yunani colleges and dispensaries has multiplied since independence, government funding has been minimal. Popular perception is said to be that the students in the indigenous medical schools failed to gain admission to modern western medical or professional universities.

The traditions combine and are rarely exclusive. Private Ayurvedic practitioners make use of modern western treatments, often on the wishes of their patients: western-style injections are widely regarded as a powerful, almost magical cure. In a small 1970s study of fifty-nine indigenous practitioners in Punjab and Mysore, researchers found that the vast majority of drugs being used were antibiotics and similar western medicines. The idea that Ayurvedic physicians deal purely in herbs, roots, and therapeutic massage is a nostalgic myth. Today in India, the patient may take any of many available paths towards greater health. There exist side by side physicians of cosmopolitan medicine, Ayurveda, and Yunani, as well as others such as homoeopaths, naturopaths, traditional bone-setters, yoga teachers and faith-healers.

The trend, however, is towards the greater assimilation of western medicine, especially among the wealthy and cosmopolitan. It is noteworthy that Ayurvedic medicine has not yet achieved the vogue in the West acquired by Indian philosophy and (thanks to fascination with acupuncture and the yin-yang system) by Chinese medicine.

CHAPTER VII TRADITIONAL CHINESE MEDICINE (#ulink_5a167f72-891e-57d6-af0c-f68ac7dd087c)

Rather like the Ayurvedic medicine just discussed, traditional Chinese medicine has often been presented as an authentic incarnation of timeless wisdom. Chinese medicine, assert its champions (and occasionally its detractors) has been passed down essentially unchanged since the dawn of civilization. This characterization, along with claims that, unlike western biomedicine, it is holistic and draws only upon mild ‘natural’ substances, is to some extent a propaganda exercise. Even so, the impressive antiquity of Chinese medicine, and its distinctive attitudes towards knowledge of the human body, provide some justification for the contrast. Traditional values and canonical texts were, indeed, highly valued and, unlike the West, novelity has never been prized in the Chinese medical tradition, or for that matter in Chinese thought and culture at large.

While distinctive, Chinese medicine is not totally unlike other medical traditions, and that is partly because it is not wholly indigenous. Over the centuries it has absorbed many outside influences, from India, Tibet, central and south-east Asia, while for the last hundred and fifty years it has been forced to adjust to western medicine. Certain of the key drugs in the Chinese pharmacopoeia were introduced from abroad – ginseng from Korea, musk from Tibet, camphor, cardamom and cloves from south-east Asia, frankincense and myrrh from the Middle East. The needling techniques behind acupuncture may have originated in central Asian shamanic healing. Indian Buddhism brought teachings concerning the soul and salvation which prescribed care for the ill and infirm. Buddhist charms were incorporated into classical Chinese therapy, while, in medieval times at least, cataract surgery was performed which probably derived from India (such operations later lapsed). Indian medical theories are not wholly compatible with Chinese models, however; and though some have held that Ayurvedic or even Greek influences are present in the use of such categories as ‘hot’ and ‘cold’ in Chinese medicine, these are better seen not as borrowings but as transcultural.

While Chinese medicine thus assimilated beliefs and practices from elsewhere, the reverse was happening as well. As the Chinese tongue, Confucianism and Chinese Buddhism were embraced by elites through south east Asia, so too was Chinese medicine. Along with Buddhism, it had been introduced to Korea by the sixth century AD, and Buddhist priests relayed it from there to Japan. (In modern Korea, Chinese medicine is known as hanui: and in Japan as kanpo.) From the sixteenth century, Chinese medicine arrived with migrants to Taiwan, the Philippines and elsewhere – all regions where Chinese medicine flourishes today alongside the western variety.

Alongside herbs such as ginseng and Chinese rhubarb, distinctive features of Chinese medicine, notably moxibustion and acupuncture, became reasonably familiar to Westerners from the seventeenth century onwards: from Japan, the Dutchmen Wilhem Ten Rhyne (1647–1700) and Engelbert Kaempfer (1651–1716) sent home accounts of acupuncture, including maps of the acupuncture channels. Yet this had no noticeable impact upon European medicine, even though after 1800 acupuncture enjoyed a certain vogue, especially in France.

CHINESE HEALING

Peasants traditionally went to folk or religious healers, for in popular thinking the supernatural was seen as a major cause of illness – sickness was believed to be created by demons or to be punishment for violating or neglecting one’s ancestors, who might then need to be propitiated with sacrifices. Learned medicine, by contrast, was wholly an elite matter, taught and practised by educated men, who treated clients from the middle and higher strata of society and from the state bureaucracy. This learned medicine was grounded on a corpus of texts: works on medical theory; on the classification, diagnosis and treatment of diseases (including collections of case histories); and on drugs and prescriptions.

The earliest surviving texts (over ten thousand specialized medical writings have come down) date back about twenty-two centuries, and incorporate even earlier materials. Dynastic circumstances account for this timing. The Chinese Empire became politically unified in 221 BC, and the emperors of the Han dynasty (206 BC – AD 220) established a body of political, philosophical and religious teachings. This period brought about the formation of the medical canon which constitutes the theoretical basis for the ‘high classical’ medical tradition and which was to set the mould for subsequent medical doctrines and developments. An integrated empire promoted the idea of a unified body, while policy-making for a flourishing state encouraged thinking about health. Thereafter the human body was envisaged, by analogy, to the state, as a series of operations which built up, allocated and processed precious and scarce resources, through communications networks. Good medicine was like good government.

Four core works make up the ‘high classical’ tradition, all of unknown authorship. They are the Yellow Emperor’s Inner Canon of Medicine (Huangdi Neijing), so called because it includes a dialogue between the ‘yellow emperor’ Huang-ti and his chief minister, Ch’i Po; the Divine Husbandman’s Materia Medica; the Canon of Problems; and the Treatise on Cold-Damage Disorders. The former two enjoy scriptural status, being considered as preserving the wisdom of legendary sages; every learned physician would be expected to be word-perfect with those. The latter two, for their part, were also classics which physicians would also be expected to know inside out; but they were thought to originate not in divine revelation but in experience, which was open to being queried, revised and even contradicted.

The Inner Canon contains teachings on core subjects: the physiological make-up of the body, including the circulation of qi (roughly: energy); health and the onset and prognosis of diseases; and therapy through needling (bloodletting or acupuncture). It depicts the human body like a kingdom, with organs like the heart and liver regarded as functions, or functionaries, working in harmony through communications and transport systems – the vessels and channels of the body (analogous to China’s great rivers), through which qi would flow.

The Canon of Problems addresses eighty-one ‘difficult issues’ which arise from the Inner Canon, relating mostly to diagnosis and needling treatment. Its significance alongside the Inner Canon was unquestioned until the Song dynasty (960–1279), but thereafter, where discrepancies were noted between the two works, it was assumed that the writer of the Canon of Problems had failed to grasp the authoritative teachings of the Inner Canon.

The Treatise on Cold Damage Disorders, for its part, deals with the identification and treatment of diseases caused by external cold factors (shanghan bing): approximately what western medicine would designate acute infectious fevers. Diagnosis follows what is known as the Six Warps theory, and therapy is not by needling but by drugs. Formulae are given for more than a hundred prescriptions – for countering fever, diarrhoea, and so forth – and many such items from the pharmacopoeia are still in use.

In the twelfth century Chinese physicians began to refine shanghan (cold factor) theory, developing the notion of heat-factor disorders (wenre bing), and thereby distinguishing between disorders in terms of their separate aetiologies. This tendency became more pronounced during the seventeenth century, when China was buffeted by waves of serious epidemics. Criticism of cold-damage theory then led to a succession of works on heat-factor disorders, especially the Wenre lun of Ye Tianshi (c. 1740), which elaborated the ‘triple burners’ (san jiao) system of disease classification.

Lastly, the Divine Husbandman’s Materia Medica includes descriptions of the properties and uses of over three hundred vegetable, animal and mineral drugs, arranged into three classes: upper, middle and lower. Viewed as gentle and cumulative in action, drugs of the upper class were meant to promote health and longevity; the more potent lower class of drugs was to be employed once the patient had actually fallen sick. This longevity-oriented pharmacy was abandoned in later materia medica, giving way to systems based on curative qualities, with items being categorized according to a scheme of correspondences between yin yang and wu xing (the ‘five phases’ or ‘five processes’). Thousands of materia medica listings were written down over the centuries, the principal one being the late sixteenth-century Bencao gangmu.

THE TRADITION

How have these ancient texts have been able to retain such uninterrupted authority? Was it because Chinese medicine was, at bottom, hidebound or metaphysically oriented, its physicians being concerned first and foremost with dogma and only secondarily with hard evidence and the cutting-edge of experience? Some have seen it that way, and there have been critics who have dismissed Chinese medicine as nothing more than an elaborate verbal tapestry. Sinophiles, by contrast, argue that the story of Chinese medicine is one of the progressive winnowing of the grains of science from the chaff of ignorance and superstition. Along such (seemingly Whiggish) lines it has been claimed that Chinese physicians evolved theories (such as the model of the heart as a pump) which match or even surpass the evolution of western scientific medicine.

Facing these problems of interpretation, it is crucial to remember that the Chinese medical tradition presents an example of a classical model of knowledge. The role of basic concepts such as yin yang, for instance, remains definitive, even though their meanings were capable of modification. Canonical works were regarded as the sure guides to understanding the human body (microcosm) and its relations to the macrocosm. As in the other text-based learning, there has been a scholarly predisposition in the Chinese tradition towards ironing out doctrinal conflicts by means of an attempted reconciliation in higher synthesis.

Like Greek medicine, Chinese teachings were built upon the conviction that the body represents a microcosm of Nature and society. Corporeal processes follow rhythms comparable to those governing the workings of the universe. ‘A human body is the counterpart of a state’, observed in Inner Canon: