Artigo. Traditional Chinese Medical Beliefs And Their

KEH-MING LIN

6. TRADITIONAL CHINESE MEDICAL BELIEFS AND THEIR RELEV ANCE FOR MENTAL ILLNESS AND PSYCHIATRY

After more than one hundred years of contact with the West and importation of Western medicine into China, traditional Chinese health beliefs and practices continue to exert important effects on the symptom manifestations and healthrelated behaviors of Chinese patients (Kleinman et al. 1975, 1978; Topley 1976; Chan and Chang 1976). This is particularly true when the problems they experience are psychiatric or psychosocial in nature (Kleinman 1979). In this paper, I will review some key traditional Chinese health concepts, especially as they relate to mental illness, and discuss their implications for contemporary psychiatric practice among Chinese populations. As will be seen in the sections that follow, Chinese medical concepts generally reflect the central theme of Chinese culture, which can best be characterized by a dialectic interaction between the idea of Tao and a strong pragmatic material orientation. The concept of Tao connotes a continuous search for the proper way of conducting one's social and personal life. Compared to Western civilization, Chinese culture has been less concerned with ontological issues such as the existence of God or the ultimate fate of the human race. Its two dominant philosophical traditions, Confucianism and Taoism, both focused their efforts in delineating Tao in different spheres: Confucianists have been mostly concerned with the proper way of conducting a person's social life; while Taoists have persistently devoted attention to searching for the optimal way for an individual to live a harmonious personal life in relation to cosmological and natural spheres (Hsu 1934). This concentrated interest in the well-being of the individual as an integrated organism within the context of his cosmological, natural and social environments has shaped and permeated Chinese thoughts all through the centuries. The pragmatic aspect of the concept of Tao leads Chinese to be less concerned about the absolute, supposedly "objective truth" of events than their Western counterparts, and also more willing to try apparently contradictory approaches as long as they work. The coexistence of scholarly traditional Chinese medicine ("the great tradition") and various folk healing practices ("the little tradition") demonstrates well their pragmatic and pluralistic tendency (Li mimeographed report). Both of them were largely fostered by the Taoist tradition, yet developed along divergent lines. In this chapter I will review the two traditions separately. TRADITIONAL CHINESE MEDICINE

Although not formally scientific in the modern sense, the Chinese medical system, as revealed in its classics (Huang-ti nei-ching Su-wen, Ling-shu; Shang-han 95 A. Kleinman et al. (eds.), Normal and Abnormal Behavior in Chinese Culture © Springer Science+Business Media Dordrecht 1981

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lun; Chil')-kuei yao-lueh), presents a rational, empirical and systematically synthesized healing tradition largely devoid of supernatural components. Scholars have shown that it went through a critical, ongoing developmental process involving observation and speculation as well as conceptual elaboration, and was often surprisingly objective and therapeutically effective (Agren 1975; Porkert 1974; Tseng 1973), although in later years it suffered from an overgrowth of theory and too literal and rigid interpretation of the originally dynamic, allegorical principles formulated in earlier phases (Wong and Wu 1936; Chen 1937). Microcosm-macrocosm correspondences (tien-jen-hsiang-ying) and dynamic balancing or harmony (t'iao-ho) appear to be the two most central concepts of Chinese medicine (Nan-Tung City Chinese Medical School 1959; Agren 1977; Bennett 1978). As noted above, the early Taoists were devoted naturalists. They saw human "beings" (the terms "body" and "psyche" should be avoided, as they represent a Western dichotomy)1 as part of the natural world, and believed that what was observed in the macrocosm should have its counterparts in the microcosm. Thus, whatever happened in the larger natural and social environments should also have its effect on the smaller human sphere of the individual. An elaborate system was developed to describe the correspondences between astronomical systems, seasons, weather, and time on the one hand, and the internal organs, functions, sensations, and emotions on the other hand. From this framework three main themes of fundamental importance evolved: the yinyang system, the Five Evolutive Phases, and the ching-lo (meridian) system. The concept of balance and harmony is the fundamental principle governing both macrocosm and microcosm. Since changes are regarded as not only unavoidable but a basic rule of the universe, balance (harmony) is not static but constantly dynamic. However, as there is always a certain degree of regularity involving both macrocosm and microcosm, "cyclicity" and "circulation" are prominent considerations in maintaining this balance (harmony). The etiology of diseases is classified into two categories: those operating internally and those originating externally. Internal etiology includes 7 kinds of excesses of emotions. External etiology is further classified into 6 categories: "wind" (feng), "coldness" (han), "hotness" (shu), "dampness" (shih), "dryness" (tsao), and "fire" (huo). While the middle four are closely related to the weather and are reminiscent of Galen's humoral system, the concepts of "wind" and "fire" are more abstract and generic, and consequently have even wider applications. Besides its literal meaning, "wind" also refers to any pathogenic force acting swiftly and therefore potentially more damaging. Symbolically, ''wind'' is thus implied in many diseases with acute onset or with an unpredictable nature. In combination with cold/hot/damp/dry conditions, ''wind'' provides the qualities of their being "actively invading" and rapid, and hence makes them even more dangerous. "Fire" as used here, is apparently different from the "fire" in the Five Evolutive Phases which will be described later, and denotes a more passive, complementary factor aggravating any conditions caused by the first five factors.