The School of TCM and the Schools of the TCM Health-Preserving Science

Since the Northern Song Dynasty, a malpractice of determining diagnosis only according to symptoms, not seeking the causes of diseases, had been prevalent. So many insightful physicians began paying attention to theoretical study advocating study and analysis of clinical pathological and pathogenic causes of diseases. As they had formed their different viewpoints due to living in different conditions, climate, time, and the differentiation of ethnic groups, ways of life, customs, occupations and experiences, various physicians in their medical practice created their different theories on medicine and health preservation and summed up their practical experiences and cases. As a result, a thriving academic atmosphere appeared in the medical circle at the time.

A commentary in the Medical Specialists of the Complete Library of Oianlong says: "Different schools of Confucianism came into being in the Song Dynasty; but different schools of medical science appeared in the Jin and Yuan dynasties." The "Four Large Schools of the Jin and Yuan" were those of Liu Wansu, Zhang Congzheng Li Guo and Zhu Zhenheng.

Liu Wansu proposed the theory of "pathogenic fire," holding that the Six Natural Factors originated in an internal fire. He proposed the therapeutic principle of "relieving fire from the heart, and tonifying the kidneys." This later became known as "the school of coldness."

Zhang Congzheng proposed the principles of "preserving health by supplementing nutrition from food, and treating disease by taking medicines." He held that the causes of diseases, whether they came from inside or outside the body, were all evil Qi. The primary task of treatment, therefore, was to dispel these evil Qi. His method of treating diseases was an attack on them, so this became known as the "school of attack."

The "theory of internal injury" was proposed by Li Guo. He advocated that "the vital essence of man is formed by the Qi of the stomach. Various kinds of diseases are all caused by internal injury to the stomach and spleen." His methods of treatment included tonifying ,these organs and invigorating the vital energy, hence this was called the "school of replenishment."

Zhu Zhenheng proposed the "theory of ministerial fire," believing that the hyperactivity of ministerial fire was sure to consume a person's Yin substance. If one wants to prevent the hyperactivity of ministerial fire, he should clear away heart fire, desire nothing and control sexual passion to save and nourish the Yin blood. In clinical practice, he emphasized the therapeutic approach of tonifying Yin and relieving fire, hence he was called the "school of nourishing Yin."

These four schools generated a lively academic atmosphere at the time and had a great influence on the medical circles at home and abroad.

The School of Tonification with "Warm" Medicines

Liu Wansu's "theory of pathogenic fire" and Zhu Zhenheng's theory of "excessive Yang and deficient Yin" had a profound influence on physicians of the Ming Dynasty and an excessive use of drugs of a cold nature by some physicians gradually surfaced. To stop the tendency, a school of tonification with "warm" medicines appeared in the second half of the dynasty This school, which included Xue Lizhai, Zhang Jiebin and Zhao Xianke, was initiated by Xue Kai and his son Xue Lizhai. They held that most wind-syndromes and rheumatic and miscellaneous diseases were caused by deficiency of the spleen and kidneys. They should therefore be treated with tonics and drugs, which were warm in nature.

Zhang Jiebin was the backbone of the school. He disagreed with Zhu Zhenheng and advocated the theory of "not excessive Yang but deficient Yin." Zhang developed the theory of notification with medicines whose nature was warm.

Zhao Xianke, a contemporary of Zhang, who inherited Xue Lizhai's academic theory, made his particular contribution to the theory of the "gate of life." The school of tonification with "warm" medicines was an important remedy in curbing the prevalent mistakes of the time.

The School of Epidemic Febrile Disease

At the end of the Ming Dynasty, Wu Youxing was making keen observations of the nature of epidemic diseases based on his clinical experience. His studies and observations led him to writ "the book Treatise on Pestilence. The book dealt with epidemic diseases such as the plague, smallpox, and diphtheria and laid the foundations of the school of epidemic febrile disease. The school reached maturity in the second half of the Qing Dynasty. Its adherents insisted that epidemic febrile disease was different from exogenous febrile disease. They produced books and established their theories, creating a complete system of differentiation and treatment of this class of disease. Ye Gui and Wu Tang were two representatives of the school.

Ye Gui was the founder of the school. His works include Treatise on Epidemic Febrile Disease and A Guide to Clinical Practice with Medical Records, based on extensive clinical experience.

Wu Tang proposed the theory of differentiation of syndromes according to the pathological changes of the Triple Energizer (the three visceral cavities housing the internal organs) and treatment. He wrote the Treatise on Differentiation and Treatment of Epidemic Febrile Disease, advocating the treatment principles of mild improvement, moderate nutrition and nourishing Yin.

The Health-Preservation School

In their clinical practice, Chinese physicians through the ages applied the useful health-preserving theories of Confucianism, Buddhism and Taoism to TCM and created the traditional science of health preservation on the basis of Chinese medicinal theories.

The development of this science can be divided into two stages. The first stage was from the Qin Dynasty to the Tang. During this stage, the main approaches were the use of elixir medicine, Daoyin method (of promoting health by regulated and controlled breathing) and sex guide. After the Song Dynasty, the application of drugs produced from animal and herbal extracts replaced the elixir medicines, and the health-preservation and medicare approaches for the elderly were established.

Having unified China under his rule, Emperor Qinshihuang wished to become immortal, and alchemists appeared to meet this demand. During the Han Dynasty, Emperor Wudi (r. 140-87 BC) issued an imperial edict to seek the elixir of life and recruited alchemists to produce such a drug. During the rule of Emperor Yuandi (r. 317-322 AD) of the Eastern Jin Dynasty, a Taoist and physician named Ge Hong studied alchemy for many years and wrote The Works of Master Bao Pu, persuading people to learn the skills of alchemy and eat "golden elixir." This influential book was responsible for an increase in the study of alchemy and eating golden elixir. During the Tang period, the practice gained in popularity. The Tang rulers regarded Li Er, the founder of Taoism, as their ancestor, and made great efforts to promote Taoism.

At the same time, mineral drugs were also popular. At first, this kind of drug was used to treat diseases, but their habitual use became very popular among the literati and officials. Since they also had harmful effects, they became gradually obsolete after the Tang.

The Daoyin method was also developed during this period. This method had already been practiced in society. During the Warring States Period, because of the rise of alchemists, the method was mixed with the Taoist thought of "discarding all desires and purifying the mind." By the Han Dynasty; the method's theory and practice had improved. The well-known physician Zhang Zhongjing explained the functions of the method in health preservation and disease prevention. Hua Tuo, the "master surgeon," further developed the Daoyin method with the Five-Animal Exercise, which was patterned upon the movements of the tiger, deer, bear, monkey and bird.

The theory, content and practice of the method further developed during the Wei, Jin and Southern and Northern Dynasties periods. Ge Hong emphasized in his theory the relations between man and Qi, pointing out that the function of Qigong was to "keep health inside and prevent evils from outside." He also advocated a combination of static and dynamic movements without a fixed form. Xu Xun, a Taoist of the Jin Dynasty, proposed a way to promote the smooth movement of tendons, bones and muscles, and blood circulation through Qigong exercise. This may be the first time that the term "Qigong" was used in a document. Tao Hongjing of the Southern and Northern Dynasties was the first to edit and compile Daoyin materials into a special collection that involves 12 kinds of regulated breathing, a six-character formula of breathing exercises and eight patterns of movements. They are still widely practiced today.

During the Sui and Tang dynasties, the imperial court officially recognized the Daoyin method as an approach to keep fit and treat diseases, and the method developed into its prime stage. The Daoyin Method of Health Preservation by Chao Yuanfang of the Sui, and the Essential Prescriptions Worth a Thousand Pieces of Gold and Prescriptions for Health Preservation by Sun Simiao of the Tang, record many Daoyin ways of health preservation. Sun himself was an active disseminator of the method. Based on the six-character formula, he described 12 practical ways of breathing regulation, and recommended that even people who were in good health should do them.

Early in the spring and Autumn Period, the effects of sex on the body were noticed. The development of sex guide as a branch of learning was closely linked to the rise of Taoist doctrine, being a part of Taoist self-cultivation. They knew it would be beneficial to good conditions of one's mind and body if one controlled one's sex life.

During the Tang Dynasty, sex guide developed into its acme, because of the worship of Taoism by Tang rulers. Moreover, social stability appeared in the first half of the Tang, when emperors, and princes, officials and wealthy people indulged in sensual pleasures. As a result, various kinds of diseases came close at heel. So correct sex knowledge was in demand objectively.

After the Song Dynasty; the emphasis on health preservation and medical care began to change, with tonics and health-promoting food becoming the mainstream. By the Ming and Qing dynasties, a unique health-preservation system for the elderly had essentially taken shape.

Reference to the use of tonics can be found in documents as early as The Book of Songs. According to Shen Nong's Canon of Materia Medica, "The best-quality medicines are used to nourish life, the better ones to nourish nature and the good ones to cure diseases." It is a summary of health promotion by tonics practiced before the period of the Western Han. Alchemy and the use of elixirs to promote health was widespread during the Wei, Jin, Sui and Tang dynasties. This proved to be a mistaken approach and by the time of the Song Dynasty, herbal materials were being used instead. In his Ming Dynasty book Compendium of Materia Medica, Li Shizhen sharply criticized the use of elixirs, advocating the use of tonics produced from animals and herbs.

He also criticized previous malpractice in the use of herbal tonics. Such tonics, he said, should be non-toxic and fully edible, and a differentiation of syndromes was needed. This brought the practice of using tonics onto a healthy course and laid the foundations of its future development.

The Classic of Internal Medicine contains a discussion about the use of food for health preservation. Wang Chong, materialist philosopher of the Eastern Han Dynasty wrote one of the earliest monographs in ancient China on health preservation, called On Nature Cultivation, involving 16 essays. In his book Essential Prescriptions worth a Thousand Pieces of Gold, Sun Simiao of the Tang period devoted the 26th volume to nourishment and treatment with food. As the earliest monograph in this field, it records many principles and methods in food nourishment, laying the foundations of Chinese medicinal nourishment and therapy with food. Based on a wide collection of food prescriptions prevalent in society and on his own practice, Sun compiled and edited the book 7bnifiing Prescriptions, which was later revised by his disciples to become Dietetic Prescriptions of Materia Medica. The book gives a detailed description of ways of food processing, cooking, and the value of nutrition. This was the first of its kind in the country.

In the Song Dynasty, special importance was attached to medical care. In the voluminous works Peaceful, Holy and Benevolent Prescriptions and General Collection for Holy Relief, a number of ways for food therapy are recorded. Chen Dasou wrote a book Benxinzai Menu of Vegetables, which relates the preparations for 20 courses of vegetables. In his work Fresh Food of a Mountain Dweller, Lin Hong lists 102 kinds of food. Based on the achievements made in health preservation for the elderly since the Tang and Song dynasties, Chen Zhi produced the book Health Preservation for the Aged. In its first volume, he gives a special scientific and practical discussion on food therapy, complete with a profound study of its mechanisms.

Principles of a Proper Diet by Hu Sihui, a Yuan Dynasty court physician responsible for diet, is a monograph of high academic value. It inherits the age-long tradition of combining food nourishing and food therapy, introducing the nutritive functions, therapeutic effect and methods of cooking of various varieties of food. The book also introduces the preventive food therapy for people in good health, breaking from past practices which concentrated on therapeutic methods.

The voluminous Compendium of Materia Medica" of the Ming Dynas9" also discusses food nourishing and provides a great deal of materials for its development. Many literati and scholars were also well versed in food nourishing approaches and wrote about their personal experiences.

Works on health preservation and medical care for the elderly did not appear until the publishing of Sun Simiao's Essential Prescriptions worth a Thousand Pieces of Gold. Chen Zhi's Health Preservation [or the Aged is the earliest Chinese work on medical care for the elderly. Zou Xuan of the Yuan Dynasty revised the book and compiled three more volumes to supplement it, renaming it A New Book on Longevity and Health Preservation for the Aged. The book became a household "necessity" in China and later spread to Korea and Japan.

Eight Discourses on Health Preservation by Tu Longwei of the Ming period was a monograph on health care for the aged, based on the teachings of Taoism. It gives extensive and detailed discourses on factors that can influence health, such as changes of the seasons, diet, living conditions, drugs and tonics. It was very popular among the people.

During the Jiajing period of the Ming Dynasty (1522-1566), Xu Chuanfu wrote the two-volume Attending the Aged. The book linked health preservation with the ideas of loyalty and filial piety, promoting a further development of study on the subject. Gong Yanxian, imperial physician of the Ming period, in his book Longevity and Health Preservation introduces many principles and methods of health preservation and collects a great number of secret prescriptions for maintaining longevity. In another book On Senility, he discusses the causes of ageing in depth. Gong Juzhong, another imperial physician of the Ming, produced A Guide to Five Blessings and Longevity and Snow Melted in a Hot Furnace, in which he gives discourses on living environment, functional regulation, shape-keeping, control of desires, massage, exercise and drugs for the elderly. And a dozen of Daoyin approaches are also introduced.

During the reign of Emperor Qianlong of the Qing Dynasty (1736-1795), Cao Tingdong, a well-known health-preservation specialist, wrote Common Sayings Serving the Aged, in which he advocates health preservation through control of diet, regulation of spirit, taking care of one's daily life, and Daoyin exercises.

During the Ming and Qing dynasties, many non-medical publications also dealt with questions of health preservation and longevity for the aged, presenting a unique character in practices in this regard.

Cultural Features of Chinese Medicine

The School of TCM and the Schools of the TCM Health-Preserving Science

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