Abstract
Chinese classics of medicine and medical records abound in reference to epidemic febrile diseases. Along with famine due to crop failures, droughts, floods and wars, they exerted a heavy burden on Chinese populations throughout the ages. The early classics of medicine (e.g. Huang Di Nei Jing, Nan Jing, Shang Han Lun, about 200 B.C.–220 A.D.) credited epidemic diseases to the invasion of the body by pathogenic cold and wind, classing them into the category of “cold damage disorders”. With the creation of the “School of Warm Diseases” (Qing Dynasty, 1644–1911), a new conception of epidemic diseases emerged: distinction between “warm diseases” and “cold damage disorders”, role of a warm “epidemic (or pestilential) qi” or “epidemic toxin” in their occurrence, body invasion through the mouth and nose, high contagiousness, specificity of the epidemic qi according to the species (human or animal) and the nature of the epidemic disease, favouring role of severe climatic and environmental conditions in their emergence, etc. This paper reviews the evolution of medical perceptions on epidemic diseases through Chinese classics of medicine. It stresses the importance of the growing awareness of variations in local and regional environments (with their climatic, epidemiological and medical specificities) in the refashioning of discourses and practices relative to epidemic diseases in Chinese medicine.
This paper was written when I was a member of the research unit UMR_D 190 “Emergence des Pathologies virales”, Aix Marseille University, French Institute of Research for Development (IRD) and French School of Public Health (EHESP) (13005, Marseille, France) and located at the Center of Excellence for Vectors and Vector-Borne Diseases (CVVD), Faculty of Sciences, Mahidol University at Salaya, Thailand.
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Notes
- 1.
A first apprehension of the concept of warm diseases in Chinese medicine has been published in French in 2010 (see Buchillet 2010).
- 2.
- 3.
Qi has been translated in English as “vital energy”, “energy”, “vapour”, etc. However, none of these translations are able to capture the different meanings of qi according to the Chinese thought. It is why I keep the original word in Chinese.
- 4.
In English, wu xing 五行 is often translated as “five elements” by analogy with the notion of “element” as a basic constituent of nature in the ancient Greek philosophy (Maciocia 1989). As xing literally means “movement” or “process” and as the theory of wu xing emphasizes movement and change, its translation as “five movements” appears more adequate.
- 5.
The san jiao 三焦 (triple burner or three burners) refers to three areas (or burners) of the body cavity which include the different organs with their functional activities: one distinguishes the upper (e.g. heart/pericardium and lungs), middle (e.g. stomach and spleen) and lower (e.g. liver, kidneys, bladders, small and large intestines, and the womb in women) burners. It is the way of circulation of the qi within the organism which stimulates the physiological activities of body organs and fluids.
- 6.
The terms “fire” (huo) and “heat” (re) are often used interchangeably in works about Chinese medicine. They refer however to different realities. Firstly, there is a difference of degree between them (e.g. heat is lesser than fire). Secondly, fire as a pathogenic climatic factor refers either to summer heat (shu), to an extreme heat that may occur at any season or to the transformation into fire of another climatic perversity within the organism (e.g. cold contracted in winter may transform into heat and extreme heat may give way to fire). Finally, one distinguishes the “lesser fire” (shao huo 少火), which is essential to the physiological activity, from the “vigorous fire” (zhuang huo 壮火) or pathogenic fire which may injure the qi. It becomes an internal cause of disease (Marié 1997).
- 7.
Late summer is a period of ten days around the summer solstice.
- 8.
Warmth is an attenuated form of heat. In works devoted to Chinese medicine, the denomination “warm diseases” (wen bing) refers interchangeably to warm and heat diseases.
- 9.
The Huang Di Nei Jing (“Classic of Internal Medicine of the Yellow Emperor”) or, in short, Nei Jing (“Classic of Internal Medicine”), which is ascribed to the legendary emperor Huang Di, was probably compiled by unknown authors at different periods from the Warring States Period (475–221 B.C.) to the Eastern Han Dynasty (25–220 A.D.). It is a synthesis of the different currents of thought and clinical observations and experiences of these periods. It consists of two parts: Su Wen 素问 (“Plain Questions”) which establishes the theoretical foundations of Chinese medicine and gives the descriptions of numerous diseases and Ling Shu 灵枢 (“Spiritual Pivot”) which is more devoted to acupuncture and moxibustion. References to the Huang Di Nei Jing – Su Wen were borrowed from Van Nghi (1973/1991), Liu (2001), Unschuld (2003) and Kong (2010).
- 10.
The Shang Han Lun is part of Zhang Ji’s original text entitled Shang Han Za Bing Lun 伤寒杂病论 (“Treatise on Cold Damage Disorders and Miscellaneous Diseases”) that was lost during the numerous wars of the late Eastern Han Dynasty. Fragments of the original treatise have been found some decades later. The section devoted to cold damage disorders was arranged and edited by Wang Xi (Wang Shu-He, 210–285), a palace physician of the Western Jin Dynasty (220–265), into the book we know now as Shang Han Lun (“Treatise on Cold Damage Disorders”). The sections of the original manuscript devoted to the study of different types of diseases (including digestive, gynaecological and paediatric disorders) were rearranged later into the book entitled Jin Kui Yao Lue 金匮要略 (“Synopsis of Prescriptions of the Golden Chamber”). The citations in this article are borrowed from the translation of the Shang Han Lun by Mitchell et al. (see Shāng Hán Lùn 1999).
- 11.
119 disasters including epidemic diseases have been reported during the late Eastern Han Dynasty (see Qu et al. 1994).
- 12.
It should be noted that tai yang, yang ming, shao yang, tai yin, shao yin and jue yin are the names of the six pairs of major channels to which one refers to in acupuncture and moxibustion. In the Shang Han Lun, they are referring to different stages of penetration of the exogenous pathogens within the organism and not to the channels.
- 13.
Such as ma huang (Herba ephedrae) ou gui zhi (Ramulus cinnamon cassiae). Acrid substances have the property to “clear the surface [of the body]”. In warm diseases, however, they may damage body fluids and favour the progression of the disease within the organism (Liu 2001).
- 14.
Differences in climates, environments, bodily constitutions and nature of diseases, foods and therapies were first alluded to in Su Wen 12 which divided China into five directions (wu fang 五方, e.g. east, west, north, south and centre). On the theory of wu fang and the resulting regionalist perspective in medicine, see Hanson (2011).
- 15.
According to Dunstan (1975) and Benedict (1986), the aetiology of bubonic plague is improbable given the absence in contemporary local gazetteers and medical works of any clear mention of buboes (the most characteristic symptom of the disease) and of widespread death of rats prior to the outbreak of the disease in humans. Actually, rat epizootics and buboes or enlarged lymph glands are the criteria used by medical historians to establish a retrospective diagnosis of bubonic plague through historical sources.
- 16.
- 17.
- 18.
The “membrane source” (mo yuan 膜原) is located between the stomach and the muscle layer at mid-distance from the inner and outer parts of the body. Wu You-Xing elaborated a special formula (the decoction da yuan yin) to reach this area, diminish the heat, dry the dampness and favour the circulation of the qi within the organism in order to expel the pestilential qi (Liu 2001; Hanson 2011).
- 19.
- 20.
- 21.
See note 5 above.
- 22.
The concept of “toxin” (du 毒) in Chinese medicine differs from that of western medicine where it is related to a toxic protein released by some bacteria. In Chinese medicine, “toxin” refers to three different realities: toxic nature of herbs, particular patterns in dermatology (e.g. herpes zoster) and toxic warm heat which may manifest within the body with localized symptoms (e.g. local redness, swelling and pain, sometimes also local eruptions or open ulcerations). Three main diseases in Chinese medicine are understood in reference to the concept of warm toxin: “big head fever” (da tou wen 大头温), “putrefying throat eruption” (lan hou sha 烂喉沙) and “throat-entwining wind” (chan hou feng 缠喉风). These diseases somehow overlap certain diseases of western medicine, respectively erysipelas or mumps, scarlet fever and diphtheria (Dunstan 1975; Hoizey 1988; Warm Disease Theory – Wēn Bìng Xué 2000; Liu 2001).
- 23.
In Chinese medicine, the term nue 疟 refers to diseases which manifest with regular alternation of chills and fevers and sweating (Liu 2001). Of course, it is impossible to assert with any degree of certainty that diseases described in the past with these symptoms are really malaria.
- 24.
The modern term for cholera is huo luan 霍乱. In the past, in China as in Europe, the term “cholera” was used to refer to the seasonal or sporadic diarrhoea. In 1841, e.g. during the third pandemic of cholera, John Snow first demonstrated the aquatic nature of the disease. However, its causal agent was only discovered in 1883 in Calcutta and Alexandria by the German bacteriologist Robert Koch. Since that time, the term “cholera” refers only to this affection. On Wang Meng-Ming’s perception of cholera, see Hanson (2011).
- 25.
- 26.
On the impact of the regional perspective in medicine on the formation of the School of Warm Diseases, see Hanson (2011).
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Buchillet, D. (2015). Climate, Environment and Epidemic Febrile Diseases: A View from Chinese Medicine. In: Morand, S., Dujardin, JP., Lefait-Robin, R., Apiwathnasorn, C. (eds) Socio-Ecological Dimensions of Infectious Diseases in Southeast Asia. Springer, Singapore. https://doi.org/10.1007/978-981-287-527-3_2
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