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- the world as Hippocrates knew it

- China did not yet exist

- mapped around 500 B.C. by Hekataios, a Greek of Miletos named "the Father of Geography"

* Greeks did not think China truly existed but were developing medical techniques of their own 

- spiritual father of Taoism 

- lived during the court of Chou, 1030 to 221 B.C., a time known as The Warring States

- despite political turmoil time of great intellectual development

- Academy of the Gate of Chi founded in 318 B.C. in state of Chhi

* philosophy developed in China was parrelling that of Greek philosophy- think Alexandria meseum  

- also known as Khung the Master or more commonly Confucius 

- adviser to the Chou emperor

- contemporary of Buddha 

- Academy of the Gate of Chi founded in 318 B.C. in Chhi

* Chinese philosophy paralleling that of Greek philosohpy 

* Confucius wrote texts; many, such as Lun Yu or 'Conversations and Discourses' were medical based 

- a great Chinese medical classic

- compilation of earlier medical texts

- one topic this book dealt extensively with was acupuncture

- court library of court of Chou was probably as large as any one that Plato could compile in Athens

- this library likely contained all the books that would be compiled into the Huang Ti Nei Ching 

- contained many other types of books as well

* signifies that despite the lack of Greek knowledge of  China, the information being learned and amassed in China was equal to that of Greek knowledge in volume and depth

five-element theory

- beleived that everything was made of water, fire, wood, metal, and earth

- bound by an "order of mutual production" and "order of mutual conquest"

- complementary forces both necesary for proper balance in life 

- yang: bright, dry, masculine aspect

- yin: dark, moist, feminine aspect 

- common representation is ying yang 

- more traditional representation is with lines (p 233)

- yang lines were whole 

- yin lines broken

- combined to produce 8 trigrams or doubled to produce 64 hexagrams

* gave birth to I Ching

* common theme of balance, maintaining or restoring,  in Chinese medicine 

- "Book of Changes"

- oracle book- consulted throughout Chinese history until recent times

- known for 'giving the right answer'

- unlike other oracle books, attracted vast amount of comment and scholarly work 

- made it an oracle book with "high ethical overtones"

-consists of 64 short texts- one for each possible hexagram (see yin and yang) 

- written in a vague style 

- reader needing advice performs certain manipulations with 50 little sticks in order to form a hexagram to determine which passage to read 

- described as a way to explore the unconscious 

* this book is difficult for western readers to understand

* represents a separation between the western biomedical theory and the eastern medical techniques 

- a theme in the book is "prevention is better than repression"

- first came about as a political principle; reflecting the strains of feudal society 

- same concept applied to a bodily illness 

* Chinese view of world found everything correlated 

- a healthy state depended on a balance of individuals, health of individuals depended on world around and health of each organ dependent on all others

* nothing can change without changing the whole 

"resonance" 

- "Institutions of the Chou"

- compliation of information on the Chou state prepared during the Han Dynasty (2nd century BC) 

* portrays the ideal state as the Han Dynasty imagined it

- contains some medical information 

- outlined the specific duties of employees in the state 

* main duties of physicians of the state

-different levels of physicians: chief, food physician, simple diseases, ulcers 

- showed that:

- the status of surgery was low as it was limited to a lower class of physician

- practice of medicine was a tightly organized system

-graded acheivments, exams etc. for practicing physicians 

* showed that medicine no longer was in the hands of sorcerors and priests but rather a science

Duties of Chief Physician

- overall direction of all lower physicians 

- collects powerful drugs 

- dictates which physicians should treat which cases 

- examines all physicians at the end of the year 

- determines which diseases are treatable or not 

* examination of physicians did not reach western culture until 12th century -> directly reflects Chinese standards  

* Greece had no system for selecting public physicians 

- ulcer physicians 

- in charge of treating swollen ulcers, ulcers that drip, ulcers caused by metal, and ulcers of fractures

- apply drugs, clense and destroy them

- attack them with 5 poisonous substances

- fortify them with 5 emanations or with 5 kinds of grain 

- heal them with 5 medicinal substances 

- temper them by the 5 flavors 

- follow different principles to treat the ulcer and the person as a whole 

- p. 245 'The Yang I Approach to a Sore'

- ask questions 

- take the pulse 

-may perform acupuncture or moxa 

moxa

- treating the skin with small lumps of smoldering material

- a treatment done to rekindle the fiery yang

- used by a yang i to draw the heat of an ulcer away from the site of sickness 

- applied when an excess of yin

- physician takes a piece of fuzz, places it on a certain point on the body and lights it on fire

- basically a cautery treatment 

- painful but represents Chinese approach to pain- essentially grin and bear it 

- a person who has had their external genitalia removed 

- single act of surgery in ancient China

- not unique to China however

- seen in Mesopotamia 

- illegal in Rome but still done

- because eunuchs could not pose a threat to found competitive dynasties, they were allowed open doors at court 

* played important roles in politics starting in the Han Dynasty 

- drug used in China

- actually fossilized mammoth teeth 

- represented expanding chinese pharmacy over time

- like Greek culture, used resins and balsams

- favorite balsam was an imported one India

- like the Arabs were to the Greeks, the Indians were to the Chinese

- middlemen to highly valued natural product 

- woman of the Han dynasty, passed away ca 180 B.C.

- buried in a coffin that was inside two other coffins 

- bathed in a pink fluid- mainly vinegar with mecurial compounds 

* showed that the Chinese had vinegar and knew how to use it 

* mercury was one of the 5 poisons used on wounds 

- more toxic than lead but also more batericidal 

* means the chinese had learned a great deal on decay 

- piercing of the skin with multiple small needles

- a technique to restore balance of forces in the body 

- "drainage" 

- meridians: set of imaginary, or spiritual, vessels containing chi

- chi is similar to the Greek idea of pneuma or energy 

- practicing acupuncture is a method of draining energy

- could let energy out or in, replenish or redirect

- multiple specific points; some would treat and some could make the situation worse

- wrongly applied acupuncture

* today viewed as a form of complementary medicine 

* meaning is accompanies traditional biomedical techniques 

1. Describe the principle that prevention is better than repression. What are some medical

examples of the application of this principle in ancient China?

- Primarily a political term

-represented struggles of feudal society where prevention was a means of survival

- same concept was then applied to bodily illness

- superior physicians were thought to help patients before they became sick

-prescribing good diet and daily exercise; general good      health practices

- similar to the political state in the sense that things should be fixed before they are driven to extremes such as rebellion

2. Compare the Nei Ching and the Greek Hippocratic treatise entitled Airs Waters Places.

How is disease conceptualized in these works; what does it “depend on”?

- Nei Ching- “The Yellow Emperor’s Classic on Internal Medicine” of “Manual of Physic” or manual of the inside

-written by Huang Ti who may have lived between 2629 and 2598 B.C.

- comparable in terms of impact on medicine to the Hippocratic treatise

- p 242

- disease depends on geography and the seasons

-diseases are treated differently dependent on the time of year and place 

3. Compare the surgical practice of the yang I with the types of surgeries in early Egypt, according to the Smith Papyrus. How important was surgery in China? Are there certain types of surgeries that had greater cultural significance?

Egypt:

            - surgery is covered extensively in the document

            - commonly used as a treatment of trauma

China:

-surgery was of low status, limited to a “third-rate    graduates”

- only surgery really noted in China was that of castration

- those that were castrated- eunuchs- were allowed open doors in court because they posed no risk of starting a rival dynasty

4. Compare Chinese and Greek medical treatments, including the cautery, bleeding, and dietary restrictions. How do treatments differ in these two cultures? Contextualize the

treatments of ancient China and explain how they relate to greater religious and cultural

principles.

- Greek: goal is balance of the four humors

- bleeding: cut spots on the body in order to cause bleeding to remove 'bad blood' 

- cautery: 

- dietary restrictions: used to restore balance when someone was too wet or dry or some other state

- may include purging, or consuming toxic things

-China: goal is balance of forces: internal, external, cosmic

- bleeding was not really supported; instead opted for acupuncture or moxa

- methods that restored balance in terms of energy

- cautery

- seen in moxa

- another method for restoring balance to the forces in the body

- literally the burning of a piece of fuzz while sitting on the flesh

- meant to draw yang to the site 

- dietary restriction

- healthy diet