Huang Di Nei Jing Su Wen: Nature, Knowledge and Imagery in an Ancient Chinese Medical Text

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HUANG DI NEI JING SU WEN: NATURE, KNOWLEDGE, IMAGERY IN AN ANCIENT CHINESE MEDICAL TEXT. By Paul U. Unschuld. Berkeley: University of California Press, 2003. Pp. xii + 519; illustrations; appendix; index. Cloth, $75.00, ISBN 0-520-23322-0.

Continuing his detailed and sustained research into the history of Chinese medicine, here Paul Unschuld (Institute for the History of Medicine; Munich University) provides a systematic discussion of the history and contents of the Huangdi neijing suwen (Yellow Thearch’s Inner Classic: Basic Questions; abbr. Suwen), the most well-known and influential classic of Chinese medicine. The present book is the first installment of a proposed seven-volume series on the Suwen, which is planned to include three volumes on the historical and structural layers of the Suwen and a three-volume English translation, all of which are being prepared in collaboration with Hermann Tessenow (Institute for the History of Medicine) (x). One also hopes that the “Suwen Project,” of which Unschuld is the senior director, will result in the publication of a concordance to the Suwen.

The Suwen is part of a group of classical Chinese medical works entitled Huangdi neijing (Yellow Thearch’s Inner Classics), which also include the Huangdi neijing lingshu (Yellow Thearch’s Inner Classic: Numinous Pivot) and Huangdi neijing taisu (Yellow Thearch’s Inner Classic: Great Foundations). The Huangdi neijing texts are the earliest medical classics employing and advocating “correlative” and “naturalistic” medicine (yin-yang and Five Phase correspondences and climatic influences [wind, cold, heat, etc.] as the cause of disease); this therapeutic approach became standardized during the Han dynasty (Early: 202 B.C.E.-9 C.E.; Later: 25-221 C.E.) and elevated to the status of “medical orthodoxy” from that historical period to the present-day (see Unschuld’s Medicine in China: A History of Ideas [University of California Press, 1985]). In Nature, Knowledge, Imagery in an Ancient Chinese Medical Text, Unschuld traces the history of early editions and commentaries through the eventual establishment of the “textus receptus” of the extant Suwen, for which Wang Bing (fl. 760) bears primary responsibility. In terms of the various historical and textual layers, the Suwen is a compilation of fragmentary texts written, collected, and edited by an unknown number of individuals in a period lasting from about the second century B.C.E. to the second century C.E. The received text also contains philosophical strata, such as the yin-yang and Five Phase doctrine of systematic correspondence, whose beginnings are at least as early as the fourth and third centuries B.C.E. In addition, as the text has been edited throughout Chinese history, it also contains material from probably as late as the eighth century C.E. (see 22-75). With regard to the latter, it seems that Wang Bing is responsible for the addition of the seven “comprehensive discourses” (dalun), namely, chapters 66 through 74 (excluding the two apocryphal chapters 72 and 73) (46-48; 393).

Nature, Knowledge, Imagery in an Ancient Chinese Medical Text consists of six chapters and an appendix. The first chapter covers the bibliographic history of the Suwen.Chapter two discusses the meaning of the text’s title, with Unschuld commenting on Huangdi (Yellow Thearch), nei (inner/esoteric), jing (classic/scripture), and suwen (basic/fundamental questions) in turn. Here Unschuld, citing the work of Hermann Tessenow, provides the following insight: “Most of the dialogues…were the work of compilers who constructed them as a device to link originally separate texts. The questions and answers put in the mouths of Huang Di and his partners allowed them [the compilers] to provide introductions and transitions from one theme to another. Only in a few instances, as for example in the first part of Su wen 19, should the dialogue be considered a structural characteristic of the primary text” (8-9). Chapter three, “Early Su Wen Texts and Commentaries before the Eleventh Century,” and chapter four, “Origin and Tradition of the Textus Receptus of the Su Wen,” are highly detailed and technical discussions of the textual history and commentarial traditions of the received Suwen. In chapter five, Unschuld provides a comprehensive survey of the contents of the Suwen. Here he discusses the literary setting, yin-yang doctrine, five-agents doctrine, the human body and its organs, blood and qi, the vessels, pathogenic agents, diseases, examination, invasive therapies, substance therapies, and heat therapies. Chapter six is an epilogue entitled “Toward a Comparative Historical Anthropology of Medical Thought,” in which Unschuld engages in more speculative, philosophical, and comparative analysis. For Unschuld, the Suwen marks a deliberate break with an older medical tradition (documented in texts such as the Mawangdui manuscripts) and the genesis of an “innovative style of thought” that proved to be the seed for a long-lasting new tradition. The new medical tradition that developed from the Suwen refused to recognize numinous agents, ancestors, and “bugs” as causes of disease. “It focused on environmental conditions, climatic agents, and behavior as causal in the emergence of disease; on the importance of laws, structures, and morale in the explanation of illness; and, in addition to dietetics, on a new technique, acupuncture, in the prevention and treatment of ailments” (319). Perhaps most importantly, the texts collected in the Suwen and other Han-dynasty compilations mark the “beginning of medicine in China” (ibid.). The events that led up to the emergence of such a radically new perspective leads to a conclusion directly related to the title of Unschuld’s book: “The emergence of the new perspective outlined in the Su wen…was a production of knowledge and values by humans acting in what could be hypothesized as an inescapable response to far-reaching changes in their environment” (320; see 325-37; 348-49). The book concludes with a highly technical appendix, complete with various diagrams, on the climatological theories of the “five periods and six climatic influences” (wuyun liuqi).

For those interested in the connection between Daoism and Chinese medical traditions, the present work provides few specific comments. On the most general level, Unschuld identifies the Suwen as expressing a type of “Confucianized medicine” (emphasizing regulation, harmony, and so forth) that has little connection with the Daoist tradition. “[The] authors who contributed to the corpus leaned more to Confucian or late Zhou, early Han Huang-Lao notions than to anything else….Daoist concepts are absent almost entirely from the Su wen” (339-40; also 329, 345). By “Daoist concepts,” it appears that Unschuld at least partially means “demonological” conceptions of and “exoricistic” responses to illness (see, for example, 41). This type of categorization deserves further research and debate in two respects. First, is it an accurate depiction of “classical Daoism” and of the Suwen? Second, is Unschuld’s repeated emphasis on “new modes of thought” and “new styles of thinking” the most accurate and applicable interpretative framework? It seems, instead, that the Suwen in particular and Chinese medical traditions in general are more focused on existential and pragmatic concerns (practice and embodied understanding) than epistemological ones (much to the chagrin of Western researchers). On a different note, one wonders about the appearance of “Tianshi” (Celestial Master) in the first chapter of the received Suwen. We also know that Wang Bing’s commentary exhibits a certain degree of Daoistic orientation (41, 46, 48-51). Although a distinction must also be made concerning the “original context of composition” and subsequent influence of the Suwen, from the perspective of Daoist Studies the view of classical Chinese medicine as expressed in the Suwen eventually came to occupy an important place in the Daoist tradition. As scholars of Daoism such as Livia Kohn (Boston University), Fabrizio Pregadio (Stanford University), and the late Isabelle Robinet (1932-2000) have shown, views of the body-self and the understanding of disease and wellness expressed in texts such as the Suwen played a prominent role in later Daoism, especially in self-cultivation and internal alchemy (neidan) lineages. This connection deserves further research. As a final minor point, one would have preferred a different title, as the present book is not the Huangdi neijing suwen; the Suwen is, in fact, the title of a classical Chinese medical text.

These comments, of course, point more to the present reviewer’s concerns than those of Unschuld. Nature, Knowledge, Imagery in an Ancient Chinese Medical Text is a major scholarly achievement. Unschuld’s meticulous study will be of particular interest to historians of medicine and scholars of Chinese medicine. Unschuld’s text-critical method may also be applied to dating Daoist texts. In addition, as the author has a certain awareness of the question concerning the relationship between classical Chinese medicine and contemporary Traditional Chinese Medicine (TCM) (323), dedicated and self-critical practitioners of Chinese medicine may benefit from careful reading of Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. Researchers and research libraries, especially those with collections on the history of medicine, will want to acquire this book.

Louis Komjathy
Boston University
September 21, 2004