Nurturing Life in Classical Chinese Medicine: Sun Simiao on Healing without Drugs, Transforming Bodies and Cultivating Life
What is the goal of Chinese medicine? One obvious answer is to heal suffering bodies, but what does that entail? How do we define ‘healing’ and ‘bodies’? What is the role of the practitioner and the patient in this process? What is ‘Chinese’ and what is ‘traditional’ about ‘traditional Chinese medicine’ and does that matter? These are the questions that we as teachers, practitioners, students and patients need to ask again and again. Answers will vary greatly, depending on financial status, level of education, personal life history, patients’ needs, institutional requirements, cultural background and daily mood. As a historian and translator of Chinese medicine texts, medical anthropologist, and farmer involved in sustainable agriculture, these are questions I have been asking myself continuously over the past few years. In the following pages, I offer one possible perspective by introducing you to the lofty ideals expressed by the seventh-century hermit Sun Simiao 孫思邈 in terms of ‘nurturing life’ (yang sheng 養生). I hope that the sentiments expressed below will inspire you to pursue a vision of Chinese medicine and of healing that at least acknowledges, and perhaps even aspires to, the depth, wisdom and healing potential reflected in the classical writings. Believing that it is best to let Sun Simiao speak for himself, I have selected a handful of examples from one of the most important classics in Chinese medicine, an enormous and comprehensive encyclopaedia titled Essential Prescriptions for Every Emergency worth a Thousand in Gold (Bei Ji Qian Jin Yao Fang 備急千金要方, abbreviated below as Essential Prescriptions), which was completed by Sun Simiao around 652 CE. After a historical introduction to Sun Simiao’s life and his perspective on ethics and the professional training of the ‘great physician’, I have selected three examples with brief representative quotations from the topics of physical cultivation, sexual cultivation and dietetics, in order to illustrate what Sun Simiao meant when he spoke of the ‘great physician’ (da yi 大醫) and of ‘nurturing life’ (yang sheng 養生).
Sun Simiao, early Chinese medicine, prescription/formulary literature, ethics, yangsheng/nurturing life, cosmology, dietetics, sexual cultivation, medical classics, medieval China, Confucianism, Daoism, physician
Background on Sun Simiao and the Essential Prescriptions
Before delving into the specifics of Sun Simiao’s practical advice on medicine, let us consider for a moment what he included under medical practice, as reflected in the content of the Essential Prescriptions. The overwhelming portion of the medical advice in this text consists of medicinal formulas, complemented by some instructions on acupuncture and moxibustion, exorcistic rituals, chants and other religious practices, simple household recipes, physical manipulations and what might be called ‘magical’ remedies. After one introductory scroll, the text includes (in this precise order): three scrolls on gynaecology; one on paediatrics; one on the ‘seven orifices’; one on ‘wind toxin and foot qi’; one on the ‘various wind [disorders]’; two scrolls on cold damage; one scroll each on the liver, gall bladder, heart, small intestine, spleen, stomach, lung, large intestine, kidney and urinary bladder; one on ‘dispersion thirst, urinary dribbling and block, haematuria and water swelling’; one on various abscesses; one on ‘haemorrhoids and fistulas’; one on ‘resolving toxins and miscellaneous treatments’; one on emergency treatments; one on dietetics; one on nurturing life; one on pulse diagnosis; and lastly two scrolls on acupuncture and moxibustion. Even just this content outline suggests a conception of medicine quite different from both earlier medical classics and contemporary TCM textbooks.
A few points are worth mentioning: First, one of the greatest innovations in Sun Simiao’s encyclopaedia was the eminent position accorded to gynaecology. Earlier texts like the Essentials from the Golden Coffer (Jin Gui Yao Lüe 金匱要略, composed in the Eastern Han period by Zhang Zhongjing 張仲景) or On the Origins and Symptoms of the Various Diseases (Zhu Bing Yuan Hou Lun 諸病源候論, composed in 610 by Chao Yuanfang 巢元方) contained brief sections on disorders and treatments specifically targeting the female body, but these were always placed, like an afterthought, at the very end of the text, to be followed only by paediatrics. Information on diagnosing or treating the female body in the other Han dynasty classics (Inner Classic of the Yellow Emperor [Huang Di Nei Jing], Classic of Difficult Issues [Nan Jing], Treatise on Cold Damage [Shang Han Lun]) was minimal and limited to fleeting comments. By contrast, Sun Simiao placed his section on ‘Prescriptions for Women’ at the very beginning, after the introductory scroll. Moreover, he began his gynaecological section with an essay that emphasised the need for any ‘gentleman engaged in the art of nurturing life’ to devote particular attention to this topic because ‘women are ten times more difficult to treat than men’, and yet are the mainstay of the family because of their pivotal role in reproduction. As a consequence, he devoted a full three scrolls, or roughly ten percent of his Essential Prescriptions to this topic and eloquently argued for the need for ‘separate prescriptions’ and special care for women’s bodies and minds. He thereby set the stage for the fully-fledged emergence of gynaecology as a respected medical speciality in the official, government-sponsored system of medical training, research and publications in the Song dynasty several centuries later.
Related to this, I would argue that Sun Simiao radically altered the meaning of a key term in Chinese medicine, namely ‘nurturing life’ (yang sheng 養生). In the early history of Chinese medicine, the notion of health and longevity, achieved and maintained by personal cultivation, was the overarching goal, the pivot around which elite medical authors contemplated and composed medical literature, especially in the context of materia medica and theoretical literature. This concept included such practices as dietetics, alchemy, a reclusive lifestyle, gymnastic and breathing exercises to stimulate the circulation of qi throughout the body, sexual cultivation (which, while emphasising the female orgasm as an essential component of complete intercourse, aimed at the male practitioner’s health benefits) and visualisation meditation. By reinterpreting the meaning of ‘life’ in a social, moral and cosmological context, Sun Simiao was, to my knowledge, the first author to widen this circumscribed set of individual practices, centred on improving the individual practitioner’s health and prolonging life. He included the female body in the larger perspective of life beyond just the individual body, as well as the survival of the family for generations to come, and ultimately the altruistic ideal of benefiting society and the macrocosm at large.
Befitting this new vision of ‘nurturing life’, Sun Simiao organised his encyclopaedia to cover first gynaecology, then paediatrics, then general medicine, and then what we might call ‘preventative care’ and dietetics, with a smattering of ‘geriatrics’ thrown in, appended by volumes on the pulse and acupuncture and moxibustion. The implications of this view of medicine are far-reaching, since the physician is no longer merely treating individual bodies in isolation but the entire family line, then by extension the state and society, and ultimately even the universe at large. This macrocosmic connection was certainly not a foreign sentiment to the early thinkers, steeped as they were in correlative thinking and its all-pervasive links between the macrocosm and a limitless number of microcosms, all on the basis of the transformation of qi in ceaseless cycles of the five phases and yin and yang. This view is expressed perhaps most explicitly in the Great Learning (Da Xue 大學), a text attributed to Confucius, but brought to great prominence in the Neo-Confucian movement of the Song period:
‘The Way of Great Learning lies in illuminating bright virtue, in holding dear the people, in stopping only at utmost goodness ... Wanting to illuminate bright virtue under heaven, the ancients first governed their states. Wanting to govern their states, they first put their families in order. Wanting to put their families in order, they first cultivated their body. Wanting to cultivate their body, they first rectified their heart. Wanting to rectify their heart, they first made their intentions sincere. Wanting to make their intentions sincere, they first extended their knowledge. The extension of knowledge lies in the investigation of things ... ‘
While the concepts of ‘extending knowledge’ and ‘investigating things’ are intellectual constructs that rose to centre-stage several centuries after Sun Simiao’s death in the new philosophy of Neo-Confucianism, the Great Learning as such predates the beginning of the Common Era and has always been considered a key text in the Confucian tradition. The progression of knowledge and engagement from the individual body to the family, to human society (‘under heaven’) and ultimately to the macrocosm was certainly as familiar to the authors of the Inner Classic of the Yellow Emperor as it was to political writers, historians, rulers, diviners or alchemists. The influence on Sun Simiao and on classical Chinese medicine in general of correlative thinking and the correspondences between the macrocosm and an infinite number of microcosms in terms of cycles of the five phases and the changes of yin and yang can hardly be overstated. By integrating this cosmology with the ethical ideals of Confucianism and Buddhism in terms of spiritual, personal and social cultivation, Sun Simiao convincingly argued for a radical extension of the role of the physician. Going far beyond the role of the craftsman in charge of alleviating suffering by addressing symptoms with instant fixes, Sun Simiao thereby opened up the path for the eventual rise of the ‘scholar-physicians’ (ru yi 儒醫), members of the literati class who chose medicine as a respected professional alternative to government service in the following centuries.
Sun Simiao - medical thinker, philosopher, practitioner of ‘nurturing life’
For clues as to how Sun Simiao arrived at this revolutionary medical ethics, even a cursory look at his life offers insights, as long as we approach the wealth of information that is available on this famous Chinese sage with proper historical caution. From historically solid, transmitted sources like Sun Simiao’s biography in the dynastic histories, we find out surprisingly little about his life. As the official biographies emphasise, he was already famous at a young age for his penetrating understanding of philosophy, religion, literature and cosmology, had illustrious friends and followers among the high society of his times, and was repeatedly asked from the 580s onwards to join the court as advisor, but refused to serve under immoral rulers until the founding of the Tang dynasty in 618. After spending more than 56 years as advisor to the Tang emperors, he retired in 674 to live out the latter part of his life as an ascetic in the mountains in pursuit of longevity. Any other information that may circulate on the internet or in popular books on the subject, whether in Chinese or Western languages, stems from sources many many centuries removed from his life and can therefore not be considered trustworthy in a search for solid facts. Several points are worth making:
Surprisingly and highly significantly, the only reference to medicine in Sun Simiao’s early biographies is his response in the following paragraph, which I quote here in its entirety:
‘Zhaolin had a malignant illness that physicians were unable to cure, so he went and asked Simiao, “What principles do the famous physicians employ to cure illness?” Simiao answered, “I have heard that if one is skilled at talking about Heaven, one must substantiate it in the human realm; if one is skilled at talking about humans, one must also root it in Heaven. In Heaven, there are four seasons and five phases; winter cold and summer heat alternate with each other. When this cyclical revolution is harmonious, it forms rain; when it is angry, wind; when it congeals, frost and snow; when it stretches out, rainbows. These are the constancies of Heaven and Earth. Humans have four limbs and five internal organs. They alternate between being awake and sleeping. In exhaling and inhaling and spitting out and sucking in, essence and qi leave and come. In their flow, they constitute the constructive and protective [influences of the body], they manifest as facial color, and they erupt as sound. These are the constancies of humanity. Yang employs the form, yin employs the essence. This is where Heaven and humanity are identical.
When [the constancies] are lost, if [qi and essence] steam upward, they cause heat [in the body]; if they are blocked, they cause cold; if they are bound, tumors and excrescences; if they sink, abscesses; if they scatter wildly, panting and shortness of breath; and if they are exhausted, scorching and withering. Their symptoms arise on the face, and their transformations move around in the body.
When one extends this analogy to apply to Heaven and Earth, it is also likewise. Thus the waxing and waning of the Five Planets, the irregular motions of the constellations, the eclipses of the sun and moon, the flight of shooting stars, these are Heaven and Earth’s symptoms of danger. Unseasonable winter cold and summer heat are the ascent or blockage [of qi and essence] in Heaven and Earth. Uprighted boulders and thrust-up earth are the tumors and excrescences of Heaven and Earth. Collapsing mountains and caved-in ground are the abscesses of Heaven and Earth. Scattered winds and violent rain are the panting and shortness of breath of Heaven and Earth. Dried-up streams and parched marshes are the scorching and withering of Heaven and Earth.
An excellent physician guides [qi and essence] with medicinals and [lancing] stones and rescues with needles and prescriptions. A sage[ly ruler] harmonises [qi and essence] in order to perfect his power and uses them for support in order to manage the affairs of humanity. Thus, the human body has illnesses that can be cured, and Heaven and Earth have calamities that can be dispersed.”’
This quotation elegantly expresses Sun Simiao’s perspective that the role of the physician was closely related to that of the sagely ruler, since both had to be intimately connected to the macrocosm - or in his words ‘rooted in heaven’ - in order to be effective. Again, though, the most interesting part of these biographies is what we do not find: There is not a single word about a family tradition of medical practice, a medical lineage, discipleship, transmission of texts (as in other Chinese biographies of physicians), medical practice, or even one instance of Sun Simiao actually having cured anybody. What we do find evidence for in his biographies is his longevity, depth of learning and sagely insights into the workings of the cosmos, into philosophy, numerology and divination, and his high social standing.
Celebrated and deified in China as a Daoist immortal and the ‘King of Medicine’ (yao wang 藥王, or more literally ‘King of Medicinals’), Sun Simiao exemplifies the inclusive and open-minded syncretism of Daoism, Buddhism and Confucianism that is so typical of early medieval China. This same spirit of integration also pervades the selection of prescriptions in his medical encyclopedia. On the one hand, the Essential Prescriptions includes complex medicinal formulas with well over a dozen ingredients, many of which are still commonly used today and which reflect the sophisticated knowledge of educated literati practitioners with access to a large body of technical formulary literature. On the other hand, there is advice to treat stalled labour with ‘salt from three households’, the husband’s charred underpants or physical manipulation. And in the volumes on ‘nurturing the body’ and ‘dietetics’, as well as in the few essays interspersed throughout the Essential Prescriptions, we clearly see an understanding of medicine as a body of knowledge concerned with cultivating the microcosmic human body and bringing it back into harmony with the macrocosm. This is achieved by means of the system of correlative thinking, prolonging life by moving qi and blood, avoiding overtaxing the body and preventing disease from arising in the first place.
Sun Simiao on medical ethics and professional training
The most illuminating statements for teasing out what we might call the ‘macrocosmic’ or ‘life-nurturing’ dimension of Sun Simiao’s medicine, considered by many his most important contribution to Chinese medicine, are undoubtedly found in the very beginning of the Essential Prescriptions in the two chapters on ‘The Great Physician’s Professional Practice’ (Da yi xi ye 大醫習業) and ‘The Great Physician’s Absolute Sincerity’ (Da yi jing cheng 大醫精誠). Chapter One on the ‘Great Physician’s Professional Practice’ outlines the basic requirements in the training of a ‘great physician’. The first is familiarity with the major medical classics: theoretical treatises; books on acupuncture, moxibustion and pulse diagnosis; materia medica and formularies. The next might come as a surprise: mastery of the various techniques for predicting people’s fate such as calendrical and numerological techniques, astrology, physiognomy, plastromancy (i.e. turtle shell divination), the Classic of Changes (Yi Jing 易經) etc., to avoid being ‘like a traveller at night without eyesight, blindly stumbling to your death’. Next, you must study the prescriptions contained in the Essential Prescriptions, ‘fixing your mind on them, pinching them tightly as if with tweezers, and grinding them down like ink stones’. As if this programme weren’t enough for one lifetime, you must complete the following education:
‘Moreover, [you must] wade and hunt through the general literature. Why is that? If you have not studied the five [Confucian] classics, you do not know the way of humaneness and righteousness; if you have not studied the three [dynastic] histories, you do not know the affairs of the past and present; if you have not studied the masters of [Warring States] philosophy, you will be unable to observe matters and silently know them; if you have not studied the Inner Classics [of Buddhism], you do not know the virtues of compassion, sympathy, joy and abandonment; if you have not studied the Zhuangzi and Laozi, you are unable to allow perfection in the movements of the body. As a result, in good and bad fortune, you will cling to loathing and generate confusion wherever you go. Lastly, arriving at the waxing and waning of the five phases and the heavenly patterns in the seven luminaries, you must also explore their subtleties. If you are able to learn all these, there will be no obstacles in your way of medicine, and it will be characterised by the utmost in both skill and beauty.’
After having completed this programme, the second chapter on ‘The Great Physician’s Absolute Sincerity’ lays out the following ethical requirements for a professional physician: in one’s daily practice, one must have an attitude of self-possession and concentration; have a dignified appearance; treat all patients equally with no regard to wealth, gender, status, nature of ailment or potential rewards; and live a pure life of utmost devotion to easing the suffering of one’s fellow humans regardless of physical discomforts, while abstaining from luxuries and from criticising one’s fellow physicians. In Sun Simiao’s own words:
‘Nowadays, there are diseases that are identical on the inside but different on the outside, as well as diseases that are different on the inside but identical on the outside. Therefore, abundance or deficiency in the five viscera and six bowels and the free flow or blockage of blood in the vessels and of construction and defense is certainly not something that can be observed [merely] by eyes and ears. They must first be examined by diagnosing signs: at [the three positions of pulse diagnosis] cunkou (inch opening), guan (bar), and chi (cubit), for the presence of disorder in terms of a floating or sunken, stringlike or tight [pulse]; in the flow at the transport points, for differences in whether it is high or low, shallow or deep; and in the flesh, sinews, and bones, for differences in whether they are thick or thin, hard or soft. Only somebody who concentrates their mind with refinement and subtlety can even begin to talk about this. Nowadays, however, affairs of the utmost refinement and subtlety are being pursued with a coarse and shallow mind. Is this not dangerous indeed?
To add to what is already full or to decrease what is already deficient, to penetrate further into what is already flowing freely or to congest what is already blocked, to cool what is already cold or to warm what is already hot, this is only doubling the disorder, and where there was still hope for the patient’s life, I now see their death.
Therefore, the difficulty and sophistication of the technical skills required for medicinal prescriptions and divination by means of tortoise shell or yarrow stalks is not something that is acquired from the spirits. So how does one obtain their secrets and subtlety?
The fools of the world study formulas for three years and yet it is said [of them] that there is not a single disease under heaven that they are able to treat. After treating disease for three years, they finally become aware that no formula under heaven exists that they are able to use. For this reason, students must absolutely acquaint themselves to the greatest extent with the origins of medicine, studying tirelessly with absolute diligence. They may not recklessly repeat rumors and then claim that this is all there is to the Way of Medicine! Deep indeed is their self-delusion.
Whenever a physician treats an illness, he must quiet his spirit and settle his will, he must be free of wants and desires, and he must first develop a heart full of great compassion and empathy. He must pledge to devote himself completely to relieving the suffering of all sentient beings. If patients suffering from disease come to him seeking help, he may not inquire whether they are nobility or low class or poor or wealthy, [or consider their] old age or youth, beauty or ugliness, or whether he detests or likes them or whether they are his friend, whether they are Chinese or barbarian, a fool or a sage. He must treat all of them exactly the same as if they were his closest relative. Neither must he “look to the front while turning around to cover his back,” worry about his personal fortune or misfortune, and guard and cherish his own life. When seeing the suffering and grief of others, he must act as if it were his own and open his heart deeply to their misery. He must not avoid dangerous mountains with rugged cliffs, any time of day or night, the cold of winter or heat of summer, hunger or thirst, fatigue and exhaustion. He must singlemindedly attend to their rescue without thinking of efforts or appearances. Acting like this, he can serve as great physician for the masses; acting against this, he is a gigantic thief to all sentient beings.’
In these two chapters, Sun Simiao masterfully outlined the lofty ideals that a practitioner of Chinese medicine should aspire to; ideals that, I believe, can still serve well as guideposts in today’s medicine. As much as Sun Simiao is being celebrated these days, the true extent of his ideals is often woefully overlooked by contemporary practitioners, students and educators in their rush to provide a satisfactory and sorely needed alternative and complement to biomedical care. As a result, the full potential of Chinese medicine, the art behind the craft, the true essence of this ancient treasure-trove of knowledge about the human body and its interactions with the natural, social and macrocosmic environments in the ever-changing transformations of qi often remains unexplored and neglected. As we can see from the quotes above, Sun Simiao already warned of the detrimental effects of intellectual laziness, ignorance, lack of moral standards and greed on medical practice. How much more difficult it is today when 99.99 per cent of Chinese medical texts are only available to those readers fortunate enough to understand classical Chinese medical literature. Throughout the history of Chinese medicine, medical practitioners and authors have bemoaned the chronic shortage of true sages and ‘great physicians’ in the flesh, at whose feet they could learn by example. As a response, they have always turned to the ancient writings and have compiled and composed medical literature based on their understanding of the classics, through the filter of their personal experiences. And this is precisely the reason why the classics are still so significant in our modern times.
Physical cultivation: advice on ‘nurturing one’s nature’ (yang xing 養性 )
Having introduced Sun Simiao’s ideas concerning medical training and professional practice, it is now time to turn to the actual content of the Essential Prescriptions, to see how he intended to apply these ideals in daily practice. Given the importance placed by Sun Simiao on ‘nurturing life,’ in other words on the physician’s personal practice of cultivating health in body, mind and spirit as a necessary precondition for becoming an effective healer, the most obvious place to start is the chapter on yang xing (lit. ‘nurturing one’s nature’). As he explains in the foreword to this chapter, ‘to be skilled at nurturing one’s nature is to treat disease before it arises’. It is not limited to ingesting alchemical preparations but must be combined with ethical behaviour: ‘If a person’s virtue in actions is not abundant, even if they constantly take elixirs of jade and pills of gold, they will be unable to extend their longevity.’ The rewards of nurturing one’s nature are numerous: ‘A person who is skilled at preserving life will not encounter ferocious tigers. This is heaven’s reward for having morality (dao de 道德).’ He also quotes Qi Bo, the Yellow Emperor's advisor, who explains why people in antiquity did not become weak in their actions even after living for a hundred years while people nowadays weaken already after living half as long: ‘The ancients, in their knowledge of the Dao, followed the pattern of yin and yang, harmonised [their actions] with skills and calculations, were moderate in their food and drink and regular in their living habits, and did not recklessly overexert themselves. Therefore they were able to keep their body and spirit complete and live out their heavenly years to the fullest, only leaving after a hundred years had passed.’ In the remainder of this chapter, Sun Simiao emphasises the need for moderation and regularity in lifestyle and diet, for living in harmony with the seasons, and for avoiding physical overexertion and emotional excess, along the lines of the Inner Classic of the Yellow Emperor.
The second section covers advice on ascetic living and begins as follows:
‘The Perfected Person said: “Even if you constantly ingest alchemical preparations but do not know the art of nurturing life, it will still be difficult to extend your lifespan. The way of nurturing life is to constantly strive for minor exertion but never become greatly fatigued and force what you cannot endure. Moreover, running water does not grow stale, the pivot of the door does not get bug-infested. The reason for this is that they move.
The Way of nurturing life consists of never moving nor standing for a long time, never sitting nor lying for a long time, never looking nor hearing for a long time. Extended looking damages the blood, extended lying down damages the qi, extended standing damages the bones, extended sitting damages the flesh, and extended moving damages the sinews. Avoid overeating, overdrinking, and heavy lifting. Avoid anxiety and worrying, great anger, sorrow and grief, great fear, jumping about, too many words and great laughter. Avoid eagerly jumping at your desires and avoid holding on to hatred. All of these are harmful to longevity. If you are able not to go against these [warnings], then you will be able to extend your life.
Therefore, a person who is good at preserving life constantly reduces thoughts, ideas, desires, business affairs, speaking, laughter, worrying, joy, happiness, anger, likes and dislikes. If you can observe these twelve reductions, this is the essence of nurturing life. Excessive thought imperils the spirit, excessive thought scatters the will, excessive desires muddle the will, excessive business affairs exhaust the physical body, excessive speech wears out the qi, excessive laughter damages the viscera, excessive worry intimidates the heart, excessive joy makes the intentions spill over, excessive happiness makes you forget mistakes and become muddled and confused, excessive anger makes the hundred vessels unsettled, excessive likes make you lose your concentration, and excessive dislikes make you haggard and dismal. If you fail to eliminate these twelve excesses, construction and defense will lose their measure, and qi and blood will flow frenetically. This is the root to losing your life. Only a person who has neither too much nor too little [of these] is able to approximate the Way ...’
The section continues in a similar vein, emphasising the importance of moderation in all activities, of cultivating a calm and balanced mind and of avoiding excess in all emotions and activities. It also contains miscellaneous advice, such as: ‘Eat mallow once every ten days because it is disinhibiting and therefore unblocks the five viscera and supports qi,’ or ‘when drinking alcohol, do not desire too much, but if you do drink too much, quickly vomiting it is best.’
The remainder of this chapter gives advice on healthy living to promote longevity, covering information on: ideal living arrangements; physical gymnastic-like exercises and self-massage; ‘regulating qi’ by cultivating and circulating qi and the breath; transforming the body by means of longevity-promoting foods (including everything from growing dihuang [Rehmanniae radix], collecting pine nuts, and preparing pine resin, to consuming a variety of minerals and stalactites and brewing gouqi [Lycii radix] wine); ‘the Yellow Emperor’s taboos and prohibitions’ (behavioural guidelines including rules of common politeness, not to sit with the feet facing the fire or the stove; not to sit, walk, or stand facing the sun etc.); and lastly a lengthy chapter on ‘supplementing and boosting in the bedroom’.
Sexual cultivation: ‘supplementing and boosting in the bedroom’ (fang zhong bu yi 房中補益)
This last chapter in scroll 27 of the Essential Prescriptions contains advice on sexual intercourse for the purpose of cultivating qi and therefore longevity, by avoiding seminal emissions and practising moderation (generally, twice a month is permissible, but elsewhere this is graduated by age and should be avoided completely by men past the age of 60), by carefully selecting a partner with the ideal external characteristics, by gaining the maximum health benefits through correct breathing and body postures, by avoiding astrologically and spiritually inauspicious times and positions, etc. As the introduction explains, ‘To cure a person by means of another person, this is true perfection indeed. As for the art of the bedchamber, its Way is extremely close by and yet people are unable to practice it. There is nothing more to technique than mounting ten women in one night while blocking and securing (bi gu 閉固 i.e., without ejaculation).’ The following statement can serve as an example for the sort of advice offered here:
‘If you are able to change women with great frequency, the benefits you will gain are numerous. When a person constantly mounts a single woman, [her] yin qi will turn weak and the [health] benefits [for the man] will also be reduced. The way of yang is modeled after fire and the house of yin is modeled after water. Water is able to control fire, and yin likewise disperses yang. If used for a long time without stopping, yin qi will surpass yang and yang will then be diminished instead. What you obtain does not supplement what you lose. Nevertheless, if you are able to mount 12 women and not ejaculate repeatedly, this causes the person to not grow old and to have a beautiful complexion. If a person can mount 93 women and keep himself secured [i.e. without ejaculating], he will live for 10,000 years.’
Sun Simiao’s advice on sexual cultivation reflects an attitude towards sexual intercourse that can be quite foreign to the modern reader and therefore requires some explanation: While it might not be obvious when first reading the advice above on mounting 93 women, moderation, self-control and regulation are the key to nurturing life by means of sexual cultivation as well. Similar to his advice on alcohol, food, emotions or physical taxation, it is not that sexual intercourse is harmful and should be avoided per se. On the contrary, movement means life and promotes health. It is only when we practise it in excess or without proper self-control that we drain the limited resources available to the body, to the point where the harmful effects outweigh the benefits. In the context of sexual intercourse, this means that the benefits that a man obtains from absorbing the yin qi and essence of his female partner during her orgasm must outweigh the loss of the man’s own qi and male essence that invariably occurs during the man’s orgasm. As a result, female orgasms are highly desirable, but male orgasms should be either avoided completely or strictly limited, depending on the man’s age and state of health. And as in all human activities, we must take into consideration the body’s natural cycles of growth and decline, of maturing and aging, as well as the larger changes occurring in the macrocosm, such as the cycle of the seasons and the revolutions of the heavenly bodies, and carefully align the individual body to these. In this way, we are able to allow the body to live out its maximum natural lifespan without aging prematurely, or even to reverse the process of aging and join the ranks of the immortals.
Dietetics: Sun Simiao on ‘healing with food’ (shi zhi 食治)
Reflecting similar sentiments, another dimension to the art of ‘nurturing life’ is so important that it is treated in a separate chapter: dietetics (shi zhi 食治, lit. ‘treating with food’). It lucidly expresses Sun Simiao’s attitude towards food and its significance from a medical perspective:
‘When a person’s body is balanced and harmonious, you must merely nurture it well. Do not recklessly ingest medicinals because the power of medicinals assists only partially and causes the person’s visceral qi to become imbalanced, so that they easily contract external trouble. All substances that contain qi provide food and thereby preserve life. And yet, eating them unawares can mean success or failure. The common people today use them daily without awareness, and so they hardly recognise when water and fire draw near ...
What people depend on is the physical body; what disorders harmonious qi is disease; what regulates vexing poisons is medicinals; what rescues life and provides support in crises is the physician. To secure the body at the root, you must provide it with food. To rescue from the speed of disease, you must rely on medicinals. A person who does not know the appropriateness of food is unable to preserve life. A person who does not understand the avoidances of medicinals is unable to use them to eliminate disease ...
Food is able to expel evil and stabilise the viscera and bowels, and to please the spirit and clear the will, thereby protecting blood and qi. If you are able to use food to balance out chronic disorders, release emotions, and chase away disease, you can call yourself an outstanding craftsperson. This is the special method of lengthening the years and “eating for old age” and the utmost art of nurturing life ...
People who practice medicine must first thoroughly understand the source of the disorder and know what has been violated. Then, use food to treat it, and if food will not cure it, afterwards apply drugs.’
Like the sections on nurturing life discussed above, this chapter again advocates the common notion of classical Chinese medicine to ‘treat disease before it arises’ and to first use the least invasive tools at the practitioner’s disposal - namely food and what we might call lifestyle advice - before considering the more drastic measures of medicinal formulas and acupuncture or moxibustion as the physician’s last resort. This same sentiment is also reflected in the categorisation of medicinal substances in the Divine Farmer’s Classic of Materia Medica (Shen Nong Ben Cao Jing 神農本草經) into three classes: The highest-ranking drugs, the so-called ‘sovereigns’, nurture life, are associated with Heaven, contain no medicinal efficacy, and ‘should be taken over a long period of time to lighten the body, boost qi, and prolong life’. By contrast, the lowest category are the ‘assistants’ and ‘couriers’ who ‘treat disease’, are associated with earth, have medicinal efficacy, and ‘must not be taken over a long period of time. They are used to eliminate evil qi of cold or heat, break up accumulations and cure disease.’
What emerges as an underlying common thread in Sun Simiao’s writing is not a concern with offering treatments for specific diseases in the sense of aetiologically distinct syndromes and disorders that can be consistently addressed with a set of proven remedies, regardless of the particularities of the afflicted body and accompanying circumstances. Rather, where he ultimately found the true ‘art’ in medicine was in the great physician’s ability to understand the complex relationship - in the ever-changing transformations of qi - between the macrocosm and the microcosm of the human body. Having attained that stage of enlightened insight, the ‘great physician’ is then able to diagnose and realign any potential disharmony, first by means of subtle qi cultivation (including things like a quiet reclusive lifestyle, morality, breathing and other forms of physical exercise, spiritual practice, meditation and sexual intercourse), then by means of diet (including not only a regulated intake of balanced foods and drinks but also alchemical and herbal preparations, elimination of grains, consumption of pine resin, stalactites and pulverised minerals), and only as a last resort by means of medical intervention with acupuncture, moxibustion and medicinal prescriptions. The ideals and instructions described in the Essential Prescriptions, especially the warning against excessive engagement in worldly affairs, might be impossible to implement for most ordinary people caught in the web of modern life, but any student, practitioner or patient of Chinese medicine should be conscious of these roots and never stop trying to inch closer to the ideals explained and illustrated so vividly by Sun Simiao. In the end, this is what I see as the meaning of ‘nurturing life’ in Sun Simiao’s work: cultivating qi in balance with the macrocosm for the benefit of the individual body, the body of the family (most notably its women, children and the aged), the body politic and the ‘body’ of the cosmos. And given the current popularity and urgency of discussions on ‘sustainability’, I cannot think of a more appropriate time for Sun Simiao’s pearls of wisdom.
Dr. Sabine Wilms has been studying medieval Chinese medicine and the treatment of the female body in Chinese medical texts for well over a dozen years, since her days as a doctoral student in Asian Studies and medical Anthropology at the University of Arizona. She currently divides her time between producing books on Chinese medicine, researching and lecturing on Chinese medical history, gynaecology, and “cultivating life”, and living the good life in pursuit of the perfect goat cheese on her small farm in the mountains of Northern New Mexico.
Her publications include Bei Ji Qian Jin Yao Fang, Essential Prescriptions worth a Thousand in Gold for Every Emergency: Volumes 2-4 on Gynecology (The Chinese Medicine Database, 2007); the translation of Pathomechanisms of the Five Viscera by Yan Shilin (separate books on the Heart, Liver, Lung, Spleen, and Kidney, 2005-2007, Paradigm Publications); Jin gui yao lue: Essential Prescriptions of the Golden Coffer and Concise Introduction to Chinese Medicine (both with Nigel Wiseman, forthcoming by Paradigm Publications); Chinese Medicine in Infertility (co-edited with Andreas Noll, Thieme Publications in 2009); and The Great Compendium of Acupuncture and Moxibustion, Zhen Jiu Da Cheng, Volume 1 (The Chinese Medicine Database, forthcoming).
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