India and China Medicine
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China and India

      We include here some notes on Indian and Chinese medicine more for completeness than for any other reason. What Indian medicine may have contributed to Western practice is obscure with the singular exception of lens couching. That there was intercourse between the Mediterranean littoral and the Indian sub-continent beyond that of Alexander's occupation in 326 BCE -- he was apparently looking for the headwaters of the Nile -- is not in dispute. Nor is the fact that such interfacing was two-way. The connection, if any, with China is more abstruse due to distance and the presence of natural as well as man-made obstacles. One feature of Chinese medicine that did gradually make its way to the Islamic world and thence into Europe was the practice of systematized grading and testing of physicians. Other evidence of intercourse exists in the form of jade axes discovered during the excavation of Troy and Hippocrates' use of cinnamon. Such evidence as exists is scanty and it's entirely possible that the origin of the jade was never known to the Trojans nor the spice to Hippocrates.

      India

      While little is known of the medicine of Mesopotamia and Egypt, still less of the early medicine and ophthalmology of the Hindu culture in the valley of the Indus has come to our knowledge; moreover, how much of it derived from Greek sources is obscure. However, Indian culture was already ancient by the time of Alexander. 2200 years before, they had developed their own writing and built large cities. Around 1500 BCE they were overrun by a lighter-skinned people who called themselves Arryans after the country of their origin -- Iran.[15] The language of these new-comers derived from the same stem as Greek and Latin evolving over time into Sanskrit. These new people also brought with them a large body of literature, particularly the Vedas -- divine works of inspiration.

      Medicine evolved into a system called the Ayurveda (knowledge of life) exemplified by two treatises -- the Charaka Samhita mainly dealing with medicine and the Sushruta Samhita pertaining to surgery -- the two disciplines were not mixed. These works were typically transmitted by mouth, taking about 12 years to memorize just one. The physician was called the vaidya (he who knows or the learned one) which word has the same root as veda (source of wisdom). He too was forced to learn his text by chanting it over and over in apprenticeship to an established vaidya.

      Sushruta is said to have been the son of a royal sage and the favorite pupil of Dhanwantari -- the "Father of Hindu Medicine". The exact period in which he lived is debated -- but it was probably some time before the advent of Alexander. Sushruta's writings in the form of verse are most comprehensive; he taught that the foundation of surgery was anatomy and made his students perform dissections.* He classified ocular diseases systematically on a topographical basis and enumerated them in 76 varieties. He espoused a wise system of therapeutics; and his surgical skill was of no mean order, including operations on the lids, the outer eye, and couching for cataract. The breadth of his methods of therapeusis and the choice of his surgical techniques indicate a discipline evolved over a considerable period of time. Sushruta's writings are the first record which has survived of a science of ocular anatomy in India. The chapter on eye diseases is at least 4 times as long as its correlate in De Medicina and the description of lens couching is more precise.[16]

      Not so the medical aspects of Hindu medicine. As in Egyptian society, religion played a large role in Indian medicine. Charaka stated that medicines are of three kinds:

       

      • First -- Mantras and religious acts
      • Second -- dieting and drugs
      • Third -- subjugation of the mind by withdrawing it from every kind of injurious or harmful act.[15]

      After medicine would then come the fourth treatment -- surgery (Sushruta would put that first). The actual practice of medicine is closely reminiscent of the Pythagorean four humors with its three doshas (principles): vayu (wind), pitta (bile), kapha (phlegm). A disturbance in any of these could affect the rakta (blood). Nonetheless it was probably more efficacious than its Greek counterpart by being more pragmatic.

      The Charaka in medicine and Sushruta in surgery, edited and re-edited and amplified in commentaries and propagated by the practice of Buddhism -- formed the basis of Hindu medicine for centuries. But with the appearance of the Portuguese in the 16th century, followed by the French and the British, the further development of the Ayurveda system was stifled and although even today some of the medical lore still flourishes, the anatomy and the surgical practice gave way to the teaching of the western nations.

      China

      Civilized society arose in China -- as it did in Mesopotamia, Egypt and India -- as a bronze-age culture in a river-valley, the earliest known phase of which flourished under the Shang Dynasty on the Yellow River, about 1500 BCE Before this era it was the stuff of legends, being said to date from the Emperor Fu Hsi (2900 BCE). Classical Chinese medicine was based primarily upon the works ascribed to three legendary emperors of which Fu Hsi was the first. He is said to have originated the pa kua, a symbol composed of eight separate trigrams which represent all yang-yin states.

      With the rise of the philosophy of Taoism the universe and the body of man were considered as being controlled by two principles -- the Yin, a passive, wet, shadowy female force, and the Yang, an active, dry, light male force. All anatomical features of the body and the diseases to which it was subject were dominated by either one or other of these and treatment was directed towards correction of the appropriate excess. Acupuncture is said to have been developed by the Yellow Emperor and was devised to drain off excess yang and yin and thus establish proper balance. The same method could be used to infuse the body with excess energy.

      Figure 1. Hang Ti

      Physiological functions were constructed into a humoral system similar to that of the Greek concepts of the 6th century BCE except there were 5 rather than 4 essential humors. And remedies there were in plenty: one of the greatest Chinese medical works, Pen Ts'ao (the Herbal), compiled from ancient sources by Li Shih-Chen (although ascribed to Shen Nung, the Red Emperor (Hang Ti) -- about 2737 BCE) who completed his task in 1578 after 28 years' labor, lists 1892 of them -- animal, vegetable and mineral.

      The Nei Ching (The Yellow Emperor's Manual on Physic) -- a textbook equivalent to the Hippocratic Corpus -- was supposedly written in that time (2600 BCE).** About 1000 BCE the Chou Dynasty (1050-255 BCE) arose which considerably extended the venue of Chinese civilization. During this epoch most medical works appeared and the Nei Ching expanded. Mo Ti (479-381 BCE), discussed many problems of physics and optics in those fragments of his "Canons" which are still available. The eye was a "locked treasure-room" and the inversion of the image created therein was correctly explained. The reflection of light from plane, convex and concave mirrors was studied and empirical rules deduced for the forms of the varying images thus obtained.

      The Period of the Wars followed in which the Han dynasty (202 BCE to AD 220) was notable for its technical innovations; a time in which the Nei Ching probably reached its current form. In it anatomy and physiology are based on the analogy between Man on the one hand, and the State and the Universe on the other; the heavens are round and the earth flat, hence the head is round and the feet flat. The heart is the prince of the body, the lungs his ministers, the liver the military commander, the spleen and stomach the granaries, and so on. During this period, Ko Hung, an alchemist, wrote treatises describing beriberi, hepatitis, and plague, and gave one of the earliest descriptions of smallpox. Unfortunately, the vigorously creative thought characteristic of this period was never to be repeated in the disturbed and checkered history of that country, and in medieval times such optical works as Than Chhiao's "Book of Transformations" (940 AD) contained little new.

      Of the early ophthalmological lore of the Chinese civilization we know little. The earliest Chinese treatise on the eye was an encyclopedic work written by Sun Szu Mo of the T'ang Dynasty (602-907) -- the Yin Hai Ching Wei (the Comprehensive Manual of the Silver Sea -- the name for the eye in the Buddhist classics); it described 81 diseases and prescribes treatment in a spirit of unobjective superstition.[8] Chinese thought dominated ancient Japan medical texts and it is from these writings that further insight into Chinese medicine can be obtained. Fukuyoshi Omura (834-847) wrote Chisoki, a book on surgery, which was a report on Chinese techniques. In it he describes incising of the cataract with a needle -- intriguing. Did the Chinese make this discovery themselves or was it borrowed -- like spectacles?

      The premise that Europeans learned of spectacles from the Chinese is not tenable even though they are supposed to have been mentioned in the memoirs of Marco Polo. Polo's ventures lasted from 1271 to 1295 but the "Travels" were not dictated until 3 years later and were revised 9 years after that; by that time spectacles had been in use in Europe for several years. In any case, nowhere in Polo's original writings are spectacles mentioned.

      Anatomical study seems not to have been entertained within Chinese medicine (violation of the body was forbidden by the doctrines of Confucius) nor is evidence of critical observation persuasive. While western civilization owes much to our brethren from across the "headache mountains"*** -- the invention of gunpowder, paper and possibly printing -- that debt does not extend to medicine. Ophthalmology in the land of the Chinn had to wait until western influence began to permeate the country in the 19th century before it became rationalized.

 

      * However, it was forbidden a Hindu to touch a dead body. Thus the cadaver was left to rot under water and the parts slowly swept away and their position observed. Thus Hindu anatomy was almost nonexistent -- not much can be learned from a pudding. They made up for this lack by employing empiricism.

      ** It seems more likely that it was written later (around 400 BCE) and ascribed to legendary times much as the Egyptians did with their medical papyri. Hence the word Ching -- which can be translated as "classic".

      *** So called because of the dizziness and headache (symptoms of mountain sickness) experienced while crossing them to the west.

      Gutenberg invented printing with movable type.