Monday, August 22, 2011

2698-1000 B.C.:Asthma in ancient China

 Huang Ti about 1000 BC
(Edited 2/18/12)  While the Eber Papyri provides the oldest account of asthma remedies, it wasn't discovered by the modern world until the 19th century.

That left as the oldest known medical book through most of history as Nei Ching written by Huang Ti about 2,697 BCThe work basically consists of conversations between the emperor and his physician Ch'i Pai.  Parts of the dialog are recorded medical descriptions of asthma-like symptoms and possible remedies. 

Huang Ti Nei Ching Su Wen was known as the Yellow Emperor who reined over Ancient China from approximately 2697-2598 B.C.  He is known as the Father of Chinese Medicine. (1)

He is believed to have ruled China as the third of China's first five rulers from 2696-2598 B.C.  There is an ongoing debate as to whether he actually existed or was the work of legends. There's also an ongoing debate as to whether he actually wrote the Nei Ching Su Wen or whether it was actually written about 1000 B.C and antedated "as to enhance it's value," according to one historian.  Veith quotes one historian who questioned that Ti could possibly rule a nation and still have plenty of time for dialog with his physician ch'i Pai and also time to write it all down. (2)

Of significance in the Nei Ching is the relevance of Yang, Yin and Tao.  Ilza Veith, in her 2002 book, "The Yellow Emperor's Classic of Internal Medicine," described that in the beginning there was chaos between the three primary substances -- force, form and substance.  This ultimately results in a light substance rising to form heaven, and a heavy substance sinking to form the earth. 

The Nei Chung
These two substances were referred to as the Yang (heaven) and the yin (earth), or the "dueling" powers of the universe.  Veith describes Yang as the sunny side of a river and Yin as the shadowy side of a river.  She explains that "Yang stands for sun, heaven, day, fire, heat, dryness, light, and many other related subjects.  Yin stands for moon, earth, night, water, cold, dampness, and darkness; Yin tends to contract and to flow downwards.  As Heaven, Yang sends fertility in the form of sun (and rain) upon the earth; hence heaven's relation to earth is like that of man to wife -- the man being Yang and the wife being Yin."  Any imbalance of these essence's are the cause of any problems that might ensue.

This whole concept was similar to other civilizations, such as in the West the belief was that disease was the result of an imbalance of the four humours.  In China disease was believed to be caused by too much of the essence yang and/ or too little yin.

So in order to maintain health one would have to maintain a balance of Yang and Yin, which was ultimately accomplished by good behaviours towards Tao, which refers to "the way." Veith explains that man must completely adjust to the "flow" of the Universe, which was the responsibility of Tao.  For example, the earth was dependent on the heavens, such as rain was needed to end drought, sun was needed to melt snow, etc.  In this way the yearly cycle of life flowed smoothly and was completed in a year.  This was Tao, or the way.  Essentially, there was "the Tao of Heaven, the Tao of the Earth, and the Tao of Man, one fitting into the other as an indivisible entity."

The first paragraphs of the first chapter of the Nei Ching has the emperor asking his physician, Ch'i Po, why it is that ancient people used to live to be 100 years old and now people only live half that long.  The physician answered:

"In ancient times those people who understood Tao (the way of self cultivation) patterned themselves upon the Yin and the Yang (the two principles of nature) and they lived in harmony with the arts of divination.... There was temperance in eating and drinking.  Their hours of rising and retiring were regular and not disorderly and wild.  By these means the ancients kept their bodies united with their souls, so as to fulfill their allotted span completely, measuring unto a hundred years before they passed away.... nowadays people are not like this; they use wine as beverage and they adopt recklessness as usual behavior.  They enter the chamber (of love) in an intoxicated condition; their passions exhaust their vital forces; their cravings dissipate their true (essence); they do not know how to find contentment within themselves; they're not skilled in the control of their spirits. They devote all their attention to the amusement of their minds, thus cutting themselves off from the joys of long (life).  Their risings and retiring is without regularity.  For these reasons they reach only one half of the hundred years and then they degenerate." (3)

It is this "degeneration" then that causes diseases which plague a person in life, and many of which cause an early death.  People that lived to be 100 are "in harmony with Tao, the Right Way."  Health, or longevity, was completely dependent on a person's "behavior towards Tao, Veith explained. "Thus, man saw the universe endowed with a spirit that was indomitable in its strength and unforgiving toward disobedience."  Longevity, thus, was a "token of sainthood." (4) 

So asthma-like symptoms were believed to be caused by an imbalance of Yin and Yang.  The lungs were believed to be responsible for metabolism and flow of fluids through the body, and an imbalance of Yang and Yin in the lungs will cause too much phlegm, edema, sweat and cause diseases such as breathing disorders.  (5) 

This ultimately obstructs Qi (also referred to as Chi).  Imbalances of Yang and Yin are believed to be caused by obstruction of Qi, which may be described as the energy or life force that keeps the humors in balance and the body functioning properly.

The force of Qi was the essential force of keeping the body healthy, and it was inhaled with each breath after birth.  Once inhaled it was up to each healthy organ to transfer both Qi and nutrients throughout the body.

In order for the organs of the body to function properly, Qi must continue to flow properly throughout the body.  So dysfunction of the lung will result in failure of respiration, "leading to failure of fresh air to be inhaled and the turbid Qi of the body to be exhaled, with the resultant inadequate formation of Qi." (6)

Likewise, the lungs were associated with mucus.  Yang was heat and Yin was cold.  Cold was believed to diminish Yin in the lungs, and this resulted in an imbalance of Qi in the lungs, which resulted in an increase in mucus, which ultimately resulted in difficulty in breathing, or asthma-like symptoms. 

It should be noted here that unlike Western medical doctrines such as the Hippocratic Corpus, the Nei Ching failed to specifically define any diseases.  So terms equivalent to asthma and dyspnea were not used.  Instead, diseases were referred to as "'injuries of the heart,' 'injuries of the lungs,' etc." (7)

The Nei Ching basically called for diagnosing diseases by measuring the pulse, and treating diseases by remedies that reset Yang and Yin, which mainly involved mental balance, herbal medicine, diet, massage, acupuncture (inserting needle into certain regions of the body) or moxibustion (placing cones of powdered leaves on various regions of the body and burning them until blisters form).  Since diseases of the lungs were caused by an imbalance of Yin caused by cold, asthma remedies were believed to warm the lungs, balance Yin, decrease mucus, and make breathing easier. 

Another neat similarity between the Nei Ching and the later written document the Hippocratic Corpus (such as the Hippocratic Oath) is that both writings mention the use of careful technique and responsibility by the physician. 

The Nei Ching notes that "The most important requirement of the art of healing is that no mistake or neglect occur... poor medical workmanship is neglectful and careless and must therefore be combated, because a disease that is not completely cured can easily breed new disease or there can be a recurrence of the old disease... illness is comparable to the root; good medical work is comparable to the topmost branch; if the root is not reached, the evil influences cannot be subjugated... The superior physician helps before the early budding of the disease.  The inferior physician begins to help when the disease has already developed; he helps when destruction has already set in.  And since his help comes when the disease has already developed, it is said of him that he is ignorant. " (8)

While Nei Ching is the oldest known recorded Chinese medical treaties, Shen Nung, who lived from 2838-2698 is often considered as the founder of Chinese Medicine as well as the "Fire Emporor."  (9) 

Shen Nung (2838-2698)
Shen Nung created the Pen Ts'ao, or "Divine Husbandman's Materia Medica."  It's basically a pharmacopoeia describing how to create remedies from drugs and plants to treat various diseases. He was the first to mention using the plant Ma Huang (Now referred to as ephedra) for treating respiratory disorders.

The leaves and/ or stems of the Ma Huang plant were dried prepared in such a way that it was served as a drink, often as a bitter tasting tea.  Nung believed Ma Huang worked by reversing the flow of Qi.

One of the truly interesting things about ancient Chinese asthma treatment is the use of Ma Huang to treat asthma-like symptoms.  The modern world refers to this plant as ephedra, and from it was derived the bronchodilator ephedrine in 1901

Leaves of the plant were crushed and served in a bitter tasting yellow tea. This may actually have provided relief from an asthma attack. While Veith describes that Western medicine reached China early in the 17th century, (10) it would be another 300 years before ephedrine would play a significant role in the treatment of asthma in the U.S. and Europe, as I describe in this post.

So while Ancient Chinese asthmatics may have been able to obtain asthma relief by using ephedra, the rest of the world (except for maybe Japan and Korea) would have to wait. 

Click here for more asthma history.

  1. Saunders, M, J.B. Dec, "Huang Ti Nei Ching Su Wen -- The Yellow Emperor's Classic of Internal Mediciner,"  Calif Med1967 July; 107(1): 125–126
  2. Veith, Ilza, author /translator, "The Yellow emperor's Classic of Internal Medicine," 2002, Los Angeles, pages 4-6
  3. Ibid, page 97-8
  4. Ibid, pages pages 98 and 10-14
  5. "Qi Theory,,
  6. Ibid,
  7. Veith, op cit, pages 49 and 50
  8. Veith, op cit, pages 57-8, also see chapter 26 beginning on page 217
  9. Navara, Tova, "The Encyclopedia of Asthma and Respiratory Disorders," 2003, New York, page 177
  10. Veith, op cit, page 1

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