THE EXPRESSIVENESS OF THE BODY AND THE DIVERGENCE OF GREEK AND CHINESE MEDICINE

Shigehisa Kuriyama

Until quite recently, books on traditional Chinese medicine invariably contained depictions of the body that were, to Western eyes, almost comically at variance with those found in European medical texts. The Chinese diagrams typically portray a noticeably corpulent individual, over whose rather shapeless frame meander the lines of the so-called meridians. This is the starting point of Kuriyama's absorbing study of the differences, and also the resemblances, between Western and Eastern conceptions of the body in antiquity.

His book is full of startling insights. Before reading it, for example, I hadn't realized that, until they were influenced by Western notions of anatomy in the twentieth century, Chinese physicians simply didn't register the existence of muscles. But this is less surprising than may at first appear, for the muscles are not really all that obvious. Even in the West, it takes exposure to art before we think of the body in this way. The perception of the body as, ideally, a system of well-defined musculature is learned, not innate. Go to the beach or the swimming pool and you will see few bodies that demonstrate the "ideal" delineation of the musculature that is supposed to exist. In most of us, the muscles are concealed by subcutaneous fat.

These divergent views of the body became apparent, in China and Europe respectively, as far back as the turn of the second and third centuries CE. They must surely reflect an important difference in outlook, but perhaps not exactly what most people tend to assume. Today we are often told that the differences between West and East depend on an opposition between holism and dualism, organicism and reductionism, nearly always with the implication that holism and organicism are good and their opposites bad. But Kuriyama shows that these are superficial judgements that miss the real essence of the matter. The differences were not merely intellectual or conceptual but were intimately related to Eastern and Western ways of knowing the body, and hence the self; and these in turn depended on ways of seeing and of touching and feeling the body.

Kuriyama repeatedly demonstrates that our modern views of ancient Chinese medicine are seriously over-simplified and in need of revision in the light of recent discoveries. Books on the ancient system written for Westerners often still start by stating that the earliest descriptions of the acupuncture channels, the jingmo, begin with the Neijing (The Yellow Emperor's Classic of Internal Medicine). (The grossly misleading term "meridians" isn't even dignified with an entry in the index here.) In 1973, however, some remarkable manuscripts were discovered in the Mawangdui tombs. These were composed before 168 BCE and therefore predate the Neijing, and they require us to rethink our understanding of how classical Chinese medicine developed.

The mo described in these ancient texts are clearly the close forerunners of the jingmo of acupuncture, yet the astonishing thing is that the texts say nothing at all about acupuncture "points" nor, indeed, about acupuncture; the treatment they describe is moxibustion. This casts doubt on the hitherto plausible suggestion that the points were described first and the channels later postulated to link them up. More probably the sequence of events was the reverse, or perhaps the channels and the points were arrived at separately and only united in description at a later stage.

So how did the idea of acupuncture points arise? Kuriyama makes the very interesting suggestion that it may have been as a result of bloodletting, which was practised in China as well as in Europe; indeed, he goes even further, and considers the possibility that there may have been cross-cultural connections between East and West at this time that would have led to the diffusion of such practices. Today we generally regard bloodletting as an inexplicable aberration that was persisted in for centuries. However, what is not usually realized is that in much of antiquity, in both East and West, the site from which blood was taken was thought to make a difference. Blood might be taken from the leg or the arm to relieve pain in particular sites, say the head or the liver. There are close similarities between Hippocratic treatments using venesection and acupuncture.

Whatever the origins of acupuncture may have been, the treatment didn't depend on knowledge of anatomy, for dissection was hardly carried out at all in China, and, even when it was, the focus of attention wasn't on anatomy in the modern sense. The puzzling question isn't why the Chinese didn't study anatomy; other major medical traditions (Ayurvedic, Egyptian, even Hippocratic) also managed without it for thousands of years. The real puzzle is how and why it arose in the West when it did. Kuriyama suggests that interest in the muscles and how they work may be associated with the development of a preoccupation with the sense of an autonomous will, and hence with the Western concept of what it is to be an individual.

This is not to say that the idea of the person as an individual was lacking in ancient China, but it took a different course. In China, the individual was conceived of as a microcosm, a mini-world within the larger frame of the cosmos. And health and disease were thought of in the same terms as health and disease in society at large. Society was always menaced by chaos, which could only be counteracted by orderly government. In the individual, likewise, health depended on order, on resistance to disorder and chaos. And the essential threat to the integrity of the individual came to be identified with wind. Wind as such was not necessarily harmful; indeed, it could be beneficial, but disordered wind was the great danger; wind that arose in the wrong season, at the wrong time. Correct timing of things was held to be of enormous importance. "Empty" winds were those that blew at the wrong time; these were the dangerous winds, in contrast to the proper "full" winds that blew at the correct time. "Full" winds would, at most, cause only minor illnesses that people would recover from spontaneously; "empty" winds were the real evil, which could cause serious or fatal illnesses.

The importance of wind in classical Chinese medicine can hardly be exaggerated, although this was a gradual development, A physician in the sixth century BCE named six causes for disease (yin, yang, wind, rain, darkness, and brightness), but in the Neijing we find wind identified as "the beginning of the hundred diseases". Modern commentators on Chinese medicine, Kuriyama believes, tend to play down the importance of wind in the classical scheme, preferring to concentrate on yin and yang and the five phases; but, although these are certainly essential components of the classical system, the influence of wind is crucial. Wind in this context is much more than an atmospheric phenomenon. It is thought of as a cosmic influence that is capable of inducing chaos, disrupting the orderly function of society and, also, of the internal economy of the individual, by exciting imbalances. Thus, it isn't so much a cause of disease as disease itself, an alien invader.

Yet although Chinese medicine conceived of a resonance between macrocosm and microcosm, it also recognized the independence of the individual, and this brings it closer to the Greek ideal. We can resist the attacks of evil empty wind by maintaining our own inner fullness, by standing up against these incursions from outside. Wind can only enter the body and wreak havoc when it encounters emptiness. This helps to explain the corpulence of the figures depicted in the Chinese medical texts; they are fleshy because this is a sign of health, of fullness. Chinese and Western traditions, Kuriyama concludes, express two different yet parallel ways in which people have tried to come to terms with an essential mystery: the mystery of what constitutes a person, and what separates the living from the dead. "Say that a living person possesses a soul, or spirit, or vital breath, and we have only invented names for ignorance."

I find this a truly illuminating book that has done more to shape my understanding of the subject than almost anything else I have read. No one who wants to write about acupuncture in the future can afford to ignore it.