Heaven-and-the-Human-as-One and the Culture of Chinese Medicine (2012-07-22)
Heaven-and-the-Human-as-One and the Culture of Chinese Medicine
Fan Zhenglun
22 July 2012
Heaven-and-the-human-as-one (tian-ren heyi) is the essence of Chinese traditional culture. By extant historical record, five thousand years of Chinese civilization is acknowledged in the field. Of the four ancient civilizations — Rome, India, Egypt, Babylon, China — the only one without cultural rupture in those five millennia is the Chinese. To speak of today's culture, we must begin with our history.
The most fundamental thought in our history, I would say, is people-as-root: from of old the Chinese place the human first. We all know the Three Sovereigns — Fuxi, Shennong, and the Yellow Emperor — ancestors and political-economic-cultural founders of the Chinese nation, and also fine physicians: Fuxi made the nine needles, Shennong tasted the hundred herbs, the Yellow Emperor wrote the Neijing. So in highest antiquity our ancestors already put the human first. With people (ren) there is literacy/culture (wen); with wen, there is transformation (hua) — culture. That China has flourished for five thousand years is inseparable from this primacy of the human. Is it man, or god, who rules the world? Humanism, or theism? — this is the deepest distinction between Chinese culture and Western culture, and the premise of Heaven-and-the-human-as-one.
"Do not do to others what you would not have done to yourself" and "Lay down life for benevolence, give up self for righteousness"
Both Daoism and Confucianism speak of Heaven-and-the-human-as-one, but with different meanings. Daoism speaks of the unity of human and Nature; Confucianism, of the unity of human and Heaven-Mandate. How did these two views arise?
The human is, first of all, in closest relation to Nature. From the beginning humans worshiped the heavens, earth, mountains, and rivers, and were drawn to study the human-nature relation. From that came the Daoist union of Nature and human. Laozi's thought did not fall from the sky. The Dao De Jing says "the highest goodness is like water; the soft overcomes the hard" — never violence. Why? Historically, Laozi's thought is the high crystallization of long matrilineal-clan thought. In the natural world, mother is most great, most fair: she does not love this one over that for being prettier. In nature and in human society, motherly love is most encompassing — so Laozi's thought, too, is encompassing.
Confucianism speaks of ancestor-veneration. We Chinese hold that being human-not-other-creature comes from ancestors having given us life. Though gone, the ancestors' spirit still comforts us. This veneration evolved into a union of human and Heaven-Mandate. Confucius's thought, too, did not fall from the sky — it embodies patrilineal-clan thought. The patrilineal clan, outside, speaks ruler-ruler, minister-minister; inside, father-father, son-son — a hierarchy that arose with the patrilineal clan.
To resolve the conflicts of this hierarchy, Confucius proposed one character: ren, benevolence. Two persons make ren — exactly Laozi's do not do to others what you would not have done to yourself. Each act considered from the other's side; one's kindly heart, one's benevolent heart, comes out. In the strict patrilineal hierarchy, the superior should think of his subordinate, the subordinate of his superior. This kindly, benevolent heart is the great means of softening social conflict; that Confucian thought has held our society together for millennia is for this reason.
But benevolence without measure becomes what Confucius calls womanly benevolence — kindness without right and wrong. On Confucius's premise of ren, Mencius advanced something more: yi, righteousness. The traditional character has sheep above and me below. The sheep in old China is the symbol of all that is beautiful. So yi reads: for the sake of the beautiful, I am willing to give myself. Hence the Confucian-Mencian doctrine of lay down life for benevolence, give up self for righteousness.
Confucianism and Daoism are the two great pillars on which our native culture is built. What does Chinese medicine inherit? Chinese medicine resolves the question of the human; it resolves how a human, in nature, completes the whole arc of birth-growth-strength-aging-end. So TCM's Heaven-and-the-human-as-one is of one lineage with Laozi's human-and-Nature in accord; the two combine wholly. The Neijing, under Wang Bing's annotations, draws many lines from Laozi's Dao De Jing. To one who knows Laozi well, the Neijing reads no longer strange.
"Way begets one, one begets two, two begets three, three begets the ten thousand things"
The Daoist view begins by holding the human a product of Heaven-and-Earth.
Laozi puts it clearly in the Dao De Jing: "The Way begets one; one begets two; two begets three; three begets the ten thousand things. The ten thousand things carry yin on their backs and embrace yang; the surging qi achieves harmony." What does this mean? The Way is a chaotic substance; in unceasing motion it produces one. Ancient China had no zero; one is a point. Extended, it becomes a line. Strictly, one is taiji, the perfect unity of yin and yang. So Way begets one. One begets two: the taiji in motion — clear yang ascends, turbid yin descends; clear-yang is Heaven, turbid-yin is Earth. With Heaven and Earth, are the ten thousand things present? Laozi says no — only when three enters do the ten thousand things arise. Earth's qi rises as cloud, Heaven's qi descends as rain; the middle, the three, is the moving qi. We often say a person has yunqi (luck/qi-of-movement) — the word in fact comes from Laozi's three. Mars has Heaven and Earth, but no humans — because it lacks three, lacks the moving qi, the Earth-qi rising and Heaven-qi descending, the Heaven-Earth-intercourse state. Three begets the ten thousand things: all life on Earth was begotten by moving qi; the human, like every other creature, is a product of Heaven-and-Earth's motion. Surging qi — in old Chinese the meeting of yin-qi and yang-qi; only by such meeting are all Earth's creatures born. In this sense, the human and other creatures are the same — both products of qi's motion.
What is qi? Standing on a mountain, we see formed substances rise unceasingly — qi shows itself. In Daoist halls one often finds the character built of 無 (without) above and four dots below. The without does not mean nothing — it means invisible. The four dots below were in old script fire, signifying motion. The whole: an invisible thing in unceasing motion — that is the old Chinese sense of qi. Whether one, two, or three, all is qi monism: every substance is the transformation of qi. A very important idea in Chinese tradition. Zhuangzi said: "Qi gathers and life arises; qi disperses and life ends." When qi gathers in some form, the thing appears; when it disperses, the thing is not to be found. So with the human: alive is qi-gathered; dead, qi-dispersed, and the formed life-individual vanishes.
Western culture is now turning to Heaven-Earth-Life. Laozi long ago said three begets the ten thousand things — already stressing the Heaven-Earth-Life triad.
Birth, growth, strength, aging, end — the law of all Earth's life. The human, dwelling on Earth, follows Earth's motion, which follows Heaven's motion: "The human follows Earth; Earth follows Heaven." Then: "Heaven follows Way; Way follows Nature." When the Way is spoken of, it can seem ungraspable; Laozi tells us simply: Way follows Nature. What is Nature? After spring, summer; after summer, autumn; after autumn, winter. The cycle of the four seasons reflects the Way's natural law.
The Neijing says: "The human is begotten by Heaven-and-Earth's qi and completed by the four seasons' law." How to understand? Take renzhong — the philtrum, "human-center." A name only? No — it carries deep meaning. The human is a product of Heaven-and-Earth, a high concentration of their forms. Why? The human has nine orifices. In the mother's womb, nine closed, one open: the navel connects to mother, mother's barrier guards the child. At birth, one closed, nine open: with the cord cut, the independent body sets up a relation with Nature. The orifices: two eyes, two nostrils, two ears above; mouth, anus, urethra below. Renzhong is between mouth and nose. In Chinese culture, the three even numbers above stand for kun — Earth; the three odd numbers below stand for qian — Heaven. The human's nine-orifice arrangement embodies Earth-qi must rise, Heaven-qi must descend: Earth has come up to Heaven, Heaven has come down to Earth — the Heaven-Earth-intercourse state of an independent life. When a person faints, we pinch renzhong — why? Because it is the point where Heaven and Earth meet. In faint, Earth-qi has stopped rising, Heaven-qi has stopped descending; pinch renzhong, Earth-qi rises and Heaven-qi descends, and the person wakes. So the human is begotten by Heaven-and-Earth is not an empty phrase.
"Heaven covers, Earth bears; the ten thousand things complete in between; none surpasses the human"
Chinese medicine stresses the human's reliance on Nature. The Neijing says: "The human is born of Earth, his life suspended on Heaven; Heaven-and-Earth's qi together — this is called human." And: "Heaven feeds the human by the five qi; Earth feeds the human by the five flavors." That is, the human as a life-individual must combine with Nature's qi and food-grain qi. The human's life-qi has three parts: pre-Heaven, breath, food.
The Neijing says: "True qi is what is received from Heaven, combined with grain-qi to fill spirit." That parents give a human child, not a puppy, is because the child receives the parents' true qi. So China has the saying "a strong mother, a fat child" — good parental constitution makes good child-constitution; pre-Heaven endowment is full. Heaven feeds the human by five qi; Earth feeds the human by five flavors. After birth, without breath qi, the human lives at most half an hour; without food-grain qi, seven days. So the human is born of Earth, his life suspended on Heaven; Heaven-and-Earth's qi together — this is called human. Only by drawing Heaven-and-Earth's qi can life-individual maintain itself. On this, Chinese medicine and Laozi's Heaven-and-the-human-as-one fully agree.
Another point Chinese medicine stresses: "Heaven covers, Earth bears; the ten thousand things complete in between; none surpasses the human." Also from the Neijing. Heaven above, Earth below, all creatures between — and most precious is the human. Chinese medicine holds: "The human receives Heaven-and-Earth's whole qi; things receive only part." Only the human has the capacity to turn back and know Heaven and Earth — hence spirit of the ten thousand things; he receives the finest substance Heaven-Earth has to give. Western medicine experiments mostly with mice, lower life forms, at most monkeys, taking them as near-human. Chimps, baboons, monkeys may be near the human — but they are not human. Only the human, on Earth, can know Heaven and Earth — that capacity no other creature has. This is the root distinction between animal and human. Chinese tradition stresses Heaven, Earth, Human — for in Chinese culture, the human is the spirit of the ten thousand things.
An example: TCM holds men are yang-dominant and women yin-dominant. In men the yang-dominance is not very visible; in women, yin-dominance is clearly seen. The menses in Chinese culture is called yuexin — moon-trust. Trust (xin): trustworthiness. The woman's life follows the moon: it arrives punctually each month, the cycle around 28 days, tied to the moon's full and waning. Yuexin is very important in a woman's life. Before its arrival she feels much vexation — blood descending, qi ascending, qi-blood out of balance — like the moon at month-end and month-start, the world is dark and one is easily irritated. Mid-cycle, qi-blood is at fullness — like the full moon, the world is fine. From this life-process we see how TCM's "the human pairs with Heaven-and-Earth, accords with the sun and moon" has reason. The decisive role of the human in Heaven-and-Earth determines that the human as a life-individual is in correspondence with Heaven-and-Earth — the theoretical base of Daoist Heaven-and-the-human-as-one.
"Correct the body's bias with the bias of the herb's nature"
When we fall ill — say, a cold — Western medicine asks what virus or bacterium infected us; TCM asks whether the wind is wind-cold, wind-heat, or wind-dryness. Why? Wind, cold, summer-heat, damp, dryness, fire — these are Nature's normal climatic changes; spring should be warm, summer hot, autumn cool, winter cold. Nature's six qi and the body's six qi are connected; when the body's changes are in sync with Nature's, no illness. Conversely, in summer when Nature is hot, but we sit all day in an air-conditioned room making a cold environment, illness arises.
So TCM says clearly: "The hundred diseases all arise from wind, cold, summer-heat, damp, dryness, fire, in their transformations and aberrations." During SARS, everyone thought SARS terrifying — Western medicine, faced with such a problem, first looks for the pathogen, then a weapon to kill it. With SARS not understood, with deaths unpredictable, and with mass infection of medical staff, panic was rooted. From TCM's angle: from March to May 2003, when Beijing SARS raged, Beijing's weather was anomalous. Beijing is normally a windy city, but in that period there was not a single dust storm — instead, an anomalous co-presence of cold-damp-heat. That climatic combination was the very Nature-condition in which SARS arose. In earlier flu seasons, taxi drivers had the highest infection rate — worst protective conditions. With SARS, however, taxi-driver infections were near zero. Why? Because in March–May taxi windows were always open. Wind is the best dispeller of damp; when wind removed damp, SARS lost its natural ground. Conversely, hospital staff in protective gear, scouring the floors with disinfectant — the medical environment had all three conditions: cold-damp-heat together. The best protective gear could not block the conditions the SARS virus needed. Cold-damp-heat are normal climatic changes; when they go too far or not far enough in anomalous combination, that is what the Neijing names the transformations and aberrations.
How does TCM resolve it? Not by finding what it is and killing it, but by changing environment and condition. If outside is cold-damp-heat and inside the body is cold-damp-heat, the person is susceptible. SARS struck few elderly and few children, few of the weak — most of the strong and vigorous. Why? Because in their life-rhythm, cold-damp-heat co-existed most easily inside them. TCM prevention: dispel cold, clear heat, drain damp. The outer environment we cannot fix, but if internal cold-damp-heat cannot co-exist, what can SARS do? Two doses of Yinqiao Jiedu Wan with Huoxiang Zhengqi, and it is settled. Why? Yinqiao Jiedu handles cold-evil; Huoxiang Zhengqi handles damp-heat. Adjust those three, and SARS has no ground. Heaven-and-the-human-as-one takes a major place in TCM's view of disease.
Grounded in Heaven-and-the-human-as-one, TCM in treatment stresses treating the human. From the modern medical view, disease has a cause — that cause objectively exists. But Nature has given humans the right to live, and has given bacteria and viruses the same. We cannot live in a pure-of-pure environment; we breathe natural air, drink natural water; no one can guarantee that no pathogen will reach us. And does a pathogen's existence necessarily produce disease? No. Borrowing a Buddhist phrase, cause-condition-effect — cause and condition together produce effect. The cause objectively exists; disease is the effect. If modern medicine enters from cause, TCM enters from condition; cut the condition the pathogen needs, and the cause does not become effect.
So in TCM, why suit-the-person, suit-the-time, suit-the-place? One soil grows one kind of people, one soil grows one kind of thing. Heaven-Earth-Human, in different climates, geographies, and human states, produce different diseases — so TCM does not use one method for all. This too embodies Heaven-and-the-human-as-one.
On the same grounds, TCM holds that pulse in health varies with the four seasons: string-like, surging, floating, sinking. Spring's normal pulse is string-like; summer's, surging; autumn's, floating; winter's, sinking. Why? In spring everything moves from inside out — plants sprout. A string-like pulse, under the finger, feels like a stretched lute string — straight, long, tight. Why is tightness normal in spring? The human is connected to nature. Spring qi-blood moves from inside out, but the surface pores have not fully opened — hence the tight, string-like pulse. In summer, qi-blood is fully outside, plants are leafy, body qi-blood is at surface — the pulse is surging, easily found under a light touch, like flood-water. If only deep pressure finds it, then yang-qi is weak — what should rise in summer does not rise. The TCM pulse-theory and the four seasons clearly shows what born according to the four seasons means. When all of the human's states accord with Nature's climate, no illness — or only minor illness.
Since the human is the spirit of the ten thousand things, having received Heaven-and-Earth's whole qi while things receive only part, TCM's whole treatment is correcting the body's bias with the bias of the herb's nature. The human starts in full harmony of yin-yang and five-phase qi — balanced, healthy. In illness, that balance is broken. TCM says yin level, yang dense — essence-and-spirit ruled. When that balance is broken, TCM uses roots and barks not to treat the illness but to treat the human — using the herb's bias to restore the broken human balance. So TCM's pharmacopoeia has minerals, plants, anything — everything to hand can be medicine. Take beans: yellow, green, red, black. All called bean, but TCM treats them differently. Cabbage and tofu keep you safe — tofu is made of yellow beans. Yellow color tonifies spleen-stomach. Black-bean color enters kidney; green-bean color enters liver; red-bean color enters heart. Same bean, different nature given by Nature, different uses.
Likewise with herbs proper. From the 365 herbs of the Shennong Bencao to the 1,892 of Bencao Gangmu, the Chinese people did not take the road of pharmaceutical chemistry — they used TCM concepts. Both food and herbs have bias; TCM uses one bias to correct another. So everything to hand can be medicine. The biased, properly used, can restore broken human balance. Take duck — long in water, so cold by nature. In Nanjing one eats young duck salted — salted-water duck; in Beijing, roast duck; in Guangdong, old-duck soup. Why old duck? Because the old bird is no longer on the water, has long been on land — its cold-nature is moderated and can be used in soup. Boil young duck for soup, drink it, and you get diarrhea. Roasting or salting moderates the cold, returning the meat toward neutral. Food and medicine, same source: the principle is the same as Heaven-and-the-human-as-one.
"Assist the naturalness of the ten thousand things, daring not to act"
Laozi in the Dao De Jing proposes non-acting yet leaving nothing undone. Non-acting is by no means doing nothing. Doing nothing brings no pies from the sky. The Way of the Dao De Jing is the law of Nature's change. If in acting one follows the thing's own law, seemingly non-acting, in fact acting; if not, seemingly acting, in fact non-acting.
After spring must come summer; only then autumn. To try to do autumn's harvest in spring is pulling up sprouts to help them grow — the opposite of what one wants. So Laozi: assist the naturalness of the ten thousand things, daring not to act. There are inner laws to Nature; one only assists, follows Nature's law in acting, not changes it — else punishment by law.
Many today cannot do well, cannot succeed, because they disrespect the laws of motion. In summer, the human should be hot, because the weather is hot, body qi-blood should be hot. Qi-blood goes from inside out; in hot weather one must sweat — sweat is the means of clearing internal metabolic waste, a natural function. The ancients held the best summer thing is the fan — small or large as you wish: when too hot, fan; when not, set it down. Ancients knew how to build storied buildings but mostly built one-story — for the one-story dwelling catches Earth-qi. In a north-facing-south room of a flat roof, no matter how hot, there is a cool air; not stifling. We live well now; air conditioning at home, in cars, at the office. When pores should be open, we force them shut — surely against the law. Hence we see in the clinic: many people in summer with winter-cold colds. Don't blame the heavens. The ancients: Heaven's doing one can survive; self's doing one cannot. Defy the law — for comfort? — but oppose Nature's spring-arise, summer-grow, autumn-gather, winter-store; Nature will punish.
In illness, the body produces an answering force. Caught cold, the body mobilizes qi-blood outward to sweat — the natural function. So Chinese ancients gave great attention to following Nature; TCM's core method is guide-along-the-momentum. In treating wind-cold, why pungent-hot, pungent-warm herbs? Because the body is itself trying to sweat but cannot — we give it a little help. Drenched by rain, mother says drink some ginger soup — guide-along-the-momentum. Small things one handles oneself; when one cannot, you find a TCM doctor — a bit of mahuang and guizhi, sweat, illness gone. Guide-along-the-momentum assists the body's own resistance. "The body like burning coal — sweat out, and dispersion" — TCM's basic law. Fail to guide it, oppose the trend — punishment follows. Sweat should be sweated; if not sweated and instead purged, the road is run backwards. This matches Laozi's assist the natural and dare not act. TCM health-preservation expresses Heaven-and-the-human-as-one further. The Neijing chapter Great Discourse on Regulating Spirit by the Four Qi tells us how to preserve in spring, summer, autumn, winter, concluding: "Follow the four seasons and live; defy them and perish." The four qi are spring-summer-autumn-winter; preserve by spring-arise, summer-grow, autumn-gather, winter-store, spring-warm, summer-hot, autumn-cool, winter-cold — long life follows. Defy this, and punishment follows.
Our destruction of Nature is not one or two days. Western culture differs from Eastern. China speaks of harmony. Historically our ancestors discovered oil and coal in the Song — but did not use them. Why? Because we deeply respect all life on Earth — a Chinese trait. The West speaks of struggle, of weak as prey to strong; so its method is oppositional. Disease: vast manpower, materials, money on antibiotics — over 7,000 now, but only dozens usable. Why? You want to kill it; Nature will not let it die. The more you try to kill, the faster it mutates — modern medicine into a vicious cycle. So with our destruction of Nature: to an extent beyond saying. If technology's price is the killing of our mother Earth, we are criminals to ten thousand generations.
In sum: Heaven-and-the-human-as-one in TCM is no empty phrase — it has theoretical grounds. Because TCM holds the human a product of Nature, intimately tied to Nature, its reference frame in treatment is Heaven-Earth-Human. A vast frame. The Neijing: "Not knowing what the year holds, the qi's flourishing and waning, the rise of vacuity and excess, one cannot be a doctor." That is: not knowing what year it is, what qi flourishes and what wanes, where vacuity and excess arise — one cannot be a good doctor. A doctor who does not know above the heavens, below the earth, between human affairs, who does not know the dialectical Heaven-and-the-human-as-one, cannot be a doctor. A core TCM thought. The Neijing: "He who speaks well of Heaven must verify in the human." Sun Simiao: "He who speaks well of Heaven must treat well the human; he who speaks well of the human must base on Heaven." Chinese medicine is the discipline that, guided by ancient Daoist Heaven-and-the-human-as-one and Heaven-and-the-human-same-build, uses the image-number theory of yin-yang and five-phase from the Yijing to study the laws of human life-motion. That is my definition of Chinese medicine.