Whatever Happened to Nèijīng (內經)?

There are MANY ways to study Chinese medicine. The practical desire to assure adequate training in China early in the Song (960-279) led to the standardization of the basic modern clinical doctrine. Many clinical differentiations had already been ‘worked out’ by that time, and they were organized into the familiar syndromes of the zàngfǔ (). This process of standardization certainly accelerated with the advent of mechanical printing about a thousand years ago, which allowed relatively wide distribution of the vast textbooks of the Ming (1368-1644) and even simpler handbooks of the Qing (1644-1911). We now have SO MUCH information to learn, and students of Chinese medicine are generally expected to memorize many disparate ‘facts.’ There is little appreciation for clinical thinking to discern the dynamic responsive nature of an individual’s pathology, because there is so much emphasis on accurately classifying its manifestations.

While the most recent round of modernization during the second half of the 20th century stressed consistent and coherent theory, it did not completely eliminate the inherently heterogeneous nature of Chinese medical theory. We all learn differential diagnosis, according to the zàngfǔ (), which has been standard for the past thousand years, yet many individuals continue to supplement that basic theory with other systems such as the ‘six stages’ of Shanghanlun. Indeed, throughout the history of Chinese medicine there have been MANY schools of thought that have accentuated various aspects of Chinese medical theory. While we have seen the effort to integrate ‘the best’ of many disparate historical ideas into the contemporary clinical doctrine (‘TCM’), that process has neither completely integrated those historical ideas nor always preserved them with perfect fidelity.

The process of modernization and standardization began MANY centuries before Chinese medicine was imported to the West, so a very large portion of ‘historical texts’ implement that program. Certainly, these included the The Best of Acupuncture and Moxibustion, by Gao Wu (1523) The Great Accomplishments of Acupuncture and Moxibustion, by Yang Jizhou (1601), many other texts of the Ming and Qing Dynasties (1368-1911), and the more recent Chinese Acupuncture, by George Soulie de Morant (translated into English by Grinnell, et. al.). Many scholarly practitioners dive into this nearly limitless sea of information, seeking specific options for treating patients who have not responded well to their initial treatments. While this is laudable research, as many historical texts provide more detailed information than the standard texts of “TCM,” these texts do not substantially broaden the modern doctrine’s clinical theory. Emphasis on information, including specific differentiations and treatment strategies, brings most focus to clearly discerning the expression of distress, rather than the complex process of ‘sorting out’ the individual’s dynamic process.

In response to being overwhelmed by information, many acupuncturists choose to learn ’empirical’ systems of evaluation and treatment, ranging from a wide variety of Japanese approaches to the lineage of Master Tung. While learning the craft of acupuncture can certainly make one a more effective practitioner, these teachings generally work around TCM acupuncture, rather than helping one understand how to resolve the contemporary doctrine’s shortcomings. Virtually all of the empirical teachings highlighted by various teachers have their theoretical foundations in Nèijīng (內經), though this broader theory is not clearly elucidated — neither in the texts of the classics themselves, nor by the teachers. Empirical schools are generally much more about ‘how to do it,’ rather than ‘how to think about it.’

All students and practitioners of acupuncture and Chinese herbal medicine learn these are ancient arts/sciences, based on a pair of fundamental classic texts — Sùwèn (素問) and Língshū (靈樞), which together are called Nèijīng (內經). This invocation is repeated so often; it has become a mantra and an article of faith. Often, it is one of the main reasons people — both within and outside the profession — are inclined to believe in our work. And, it is only partially true!

So, what is true about the relationship between modern TCM and Nèijīng (內經)? Well, most of the basic theory of contemporary Chinese medicine can be found in specific chapters of Nèijīng (內經). For instance:

  • Many of the Five Phase associations we all learn are delineated in Sùwèn (素問), chapter 5
  • Much of the basic theory of zàngfǔ () comes from Sùwèn (素問), chapter 8
  • The idea that we can treat a primary channel to effect the zàng (臧) or  (俯) for which it is named is implied by from Língshū (靈樞), chapter 2

Isn’t that enough? The ‘TCM’ we learn in acupuncture school comes from Nèijīng (內經). Well…it’s not that simple. Each of the two texts of Nèijīng (內經) consists of eighty-one (81) chapters, and almost all of them are relatively short snippets of dialogue between the Yellow Emperor and one of his advisers (medicine teachers). Each of these short dialogues centers around a few themes; the entire texts of Sùwèn (素問) and Língshū (靈樞) are each like tapestries of these dialogues. Each text exhibits MANY themes, and their information is NOT logically consistent. Indeed, they are both are riddled with discrepancies and apparent contradictions, and that creates their beauty and depth.

Sùwèn (素問) and Língshū (靈樞) are NOT textbooks or handbooks!

The classic texts of Nèijīng (內經) are filled with a wide variety of thought provoking conundrums. They are designed to stimulate inquiry — into the nature of life in general, and the subtle dynamics of each individual’s struggles with it. They focus a reader’s attention on many aspects of life,  some being rather obvious, and they lead to some startling conclusions, especially for people trained in the modern clinical doctrine of Chinese medicine. The suggest a profound transformation in our perception of life, including a framework for understanding the nature of transformational healing for people with chronic degenerative diseases.

How does one resolve the apparent contradictions and mysteries in the texts? Working with patients allows practitioners to delve into the subtle and responsive dynamics of the individually embodied spirit. Contemplation on one’s experience as a practitioner is the ultimate teacher, as it informs one’s ability to probe the depths of the text.

Why were the classics written in conundrums? Seems like a great topic for another blog posting