Huang Di Nei Jing Su Wen
Nature, Knowledge, Imagery In An Ancient Chinese Medical Text
By Paul U. Unschuld
University of California Press, Berkeley; 2003
520 pages, US: $75
Reviewed by Joseph M. Helms, MD
I had a difficult time coming to terms with Paul Unschuld's new book, Su Wen. As an acupuncture student in France in the 1970s, I sat in on countless discussions and head-butting sessions about whose classical source was most accurate when used to justify a theoretical construct or interpret a clinical case. Could we rely on Soulie de Morant or Chamfrault, Husson or Larre, my study group or your family tradition for the true truth? These were French pissing contests at their very best. The New World had nothing to offer as translations of the classics, only Ilsa Veith's partial attempt and Henry Loo's vulgarizations. So I adopted the American pragmatic approach of testing all theories and retaining those that both made sense and produced good clinical results. And I waited for Unschuld's book. I knew it would appear one day. The author assured me that he was starting on it as soon as he published his Nan Ching in 1986 (UC Press, Berkeley), and a decade later, I saw 2 meter-high stacks of paper in his Munich office, which he saluted as the Su Wen. Acupuncture folklore repeatedly confirmed that the Nei Jing Su Wen contained an even truer truth than the Nan Ching; we only had to wait for Unschuld.
I read the Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery In An Ancient Chinese Medical Text as preparation for a 5-day seminar with Unschuld. The overarching Unschuldian hypothesis that permeated his every statement at the seminar was that any significant change from one basic medical system of ideas to another, or fundamental theoretical changes occurring within established medical systems of ideas, depends on stimuli originating outside the realm of medicine. Changes are not based on insights gained through clinical observations or experimentation; rather, from notions of social order and crisis that find parallel expression in notions of bodily order and crisis. This thesis is also the underpinning that organizes his Su Wen.
At the seminar, he illustrated how the impact of Confucian natural law on society and politics in pre-Han and Han China had prefigured the endorsement of acupuncture and systematic correspondences as the dominant medical science in unified China. Except for intermittent skirmishes with the Daoists, this medical theory – codified between the 2nd century BC and the 1st century AD – remained intact until the arrival of Western missionaries and physicians in the 19th century. He articulated anew a core tenet of Medicine in China: A History of Ideas (UC Press, Berkeley:1988); the medicine of acupuncture is a mirror of Confucian/Legalist society, that both society and medicine depend on maintaining a complex interdependence and interaction of individual units – whether social duties or human organs – that are interconnected into a unified structure.
The Confucian philosophy of preventing chaos through following laws of natural order is embodied in the acupuncture philosophy of the Su Wen and Nan Ching: prevent disease through healthy lifestyle and prophylactic intervention when the organism shows signs of imbalance. The Daoist worldview saw no sense in adopting laws of systematic correspondence or acknowledging the channels that connect the organs. Such laws were manmade and constrictive. Daoists preferred to use substances taken from nature to relieve the body from its corporeal suffering and thereby developed Chinese herbal medicine. The difference between acupuncture and pharmaceutical medicine in China is the difference between Confucianism and Daoism. It was not until the Song Dynasty in the 12th century that pharmaceutical medicine and acupuncture coexisted and started to collaborate in theory and practice. The Chinese spirit, to this day, is one that is at ease with "as-well-as" rather than the European "either-or" position, which disallows coexisting contradictions. Chinese do not consider contradiction to be ugly or improper. One can be a Confucian during the day and a Daoist at night, as well as live in a communist society.
This was the crux of my difficult time with Unschuld's Su Wen. I privately hoped that Unschuld would deliver a collection of comforting Bible stories from the Chinese classics, stories that were simple and direct, that showed us the difference between right and wrong, and led us to answers and the truth. Stories that Emperor Constantine might have assembled in the 4th century to present a unified doctrine of religion, ethics, and politics as he conveniently embraced Christianity for his Roman Empire.
But the compilers of the Su Wen from its heterogeneous and contradictory sources did not erase internal discrepancies and conceptual breaks. They did not have a Han Constantine when they most needed him. Unlike the Su Wen, its contemporary companion Nan Ching had a single author, a constant structure, and is without internal contradictions. The Su Wen is full of as-well-as contradictions; completely opposite notions coexisting even in the same chapter. Unschuld is too intellectually rigorous and innocent of scheming to rework history for our occidental convenience, and the Su Wen that he delivers is presented unadorned – birthmarks, deformities, and all. This wasn't what I was waiting for. I wanted to be reassured that Wood is Liver and Fire is red and instead, I was told that sometimes Metal is Liver and that Heart corresponds to sweet and the center.
I have recovered from my difficulties and now, while I find the Nan Ching more professionally satisfying when I'm looking for inspiration or clarification, I find the Su Wen more academically stimulating. I have accommodated to not receiving my Bible stories, and have accepted this volume as a modern commentary on the Chinese classic, just as its title announces. It is not the complete 350 sections of the Nei Jing Su Wen Ling Shu. (That is coming as Unschuld's next UC Press publication, in 3 thick volumes, prepared in collaboration with Hermann Tessenow.) It is 6 rationally-ordered sections in Unschuld's words using examples from the full translation to illustrate his message. The writing is clear, articulate, and mercilessly precise. His style is scholarly and intellectually compelling, yet it reads surprisingly easily. The short first 2 sections address the bibliographic history and meaning of the title. The second 2 sections review early Su Wen commentaries and the sources of the traditional material.
Of greatest interest to practitioners of acupuncture is Section V, the survey of the contents of the Su Wen. The divisions flow in comforting clinical familiarity: Yin-Yang, five-agents (another Unschuldian transmogrification), organs, production and circulation of blood and Qi, vessels, pathogenic agents, diseases, examination of the patient, and therapies. Each division contains the essence on its subject from the original text, and gives us enough material to be at ease that Unschuld's selections reflect the backbone of our acupuncture art. And, yes, it contains examples of the contradictions as well, enough to be reassured that the unresolved citations and questions from our training will remain unresolved.
So, is it worth it? Have we taken a step forward with this new book? My answer is emphatically yes. Unschuld's 21st-century commentary, Nature, Knowledge, Imagery In An Ancient Chinese Medical Text, not only parses digestible units of text and context of importance to our culture as acupuncturists, it recapitulates the author's prior theses and gives us an unexpurgated experience of Chinese culture and medical science. We are fortunate to have Paul Unschuld working with us in our era of exploration and integration, and I welcome this new synthesis of his monumental work as the historian of Chinese medicine.
Review previously published in Deutsche Zeitschrift fur Akupunktur, Vol 46, 2/2004. Reprinted with permission.
A Personal Acupuncture Handbook
By Jennifer Sobel, LAc
Acupuncture Books, Inc. (619-261-6165)
($44.95 + $5 shipping/handling)
Reviewed by Peter A. S. Johnstone, MD
I was fortunate enough to review A Personal Acupuncture Handbook. This spiral-bound book is appropriately sized for the desk or briefcase, but has plenty of white space that the acupuncturist may use to annotate his/her thoughts. Each acupoint is listed and diagrammed on the top half of its own page, and the bottom half is left blank. While this might seem wasteful, it creates a format that is easy to read and is very forgiving of our notes and comments in each case. Remember the "Gross Anatomy" texts where we tried to cram notes into the margins while working on the cadaver? This concept precludes such cramped and illegible results.
The book is not for the experienced practitioner who believes he/she knows all the points and their purposes all the time. But for the rest of us and especially for those learning our craft, it is a real find. (It is available from www.acupuncturebookstore.com.) This is an excellent gift for most active practitioners as well as for the acupuncturist who deals with some clinical scenarios infrequently.