Reflections on Studying Huang Di Nei Jing in the West

Abstract

Huang Di Nei Jing (《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author’s two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.

1 Personal experiences studying Chinese medicine

At the beginning of my medical career, I became interested to a question that changed the trajectory of my professional life. The question is quite simple: why do some patients get better while others do not?

At first, this question appears deceptively easy: patients who fail to recover must do so because current therapies do not adequately address their needs. Yet, I began to wonder whether there might be something more; perhaps these limitations arose not only from a lack of treatment options but also from a failure to ask the right questions or tell the right stories about the patient’s illness. Perhaps these shortcomings arise from fundamental errors in the way we perceive the world, rather than technical limitations alone. In a search for answers, I began to explore different medical traditions and focused on the medical traditions of China.

My first exposure to Chinese medicine came from introductory physician-training courses. After completing this training, I began to use my skills. Patients were receptive, and despite my limited skills, there were definite successes. Yet, I also noted a significant issue.

My physician training was comprehensive. As a trained physician, I was skilled at handling complex medical situations. Yet, my understanding of Chinese medicine was something altogether different. I achieved positive outcomes, yet lacked the ability to adjust my approach when things were not as expected. I treated with unfamiliar protocols without comprehending their rationale. Essentially, in the realm of Chinese medicine, I practiced as an ancillary healthcare provider rather than a true physician (Note 1).

Thus, a second question began to form: in the context of Chinese medicine, regardless of licensure, what defines physician-level practice and how is this best achieved?

I studied under the guidance of Dr. Anita Cignolini, an Italian anesthesiologist with a dedicated Chinese medicine practice in Milan. Dr. Cignolini received training in China during the later years of the Cultural Revolution, studying at the Harbin Acupuncture Research Center and Nanjing Medical College. She was a fervent advocate for acupuncture practice and research in Europe and possessed strong skills as both a practitioner and a teacher. From her, I learned how to practice at a more advanced level and was taught the importance of the medical classics.

I then returned to university to study Chinese languages, completed formal training in traditional Chinese medicine (TCM) and made further studies in China. During this period, I was fortunate to study with skilled and knowledgeable teachers, yet comprehensive discussions on the medical classics were sparse, and my deeper questions remained.

2 Development of Classical-Text Archaeology

At this time, in the late 1990s, a revolution in classical text research was quietly taking place. Many early Chinese texts had been digitized and became available in databases: this led the way for new approaches to text research based on the comparative evaluations of characters and text passages.

Traditionally, physicians have studied the medical classics through memorization and by learning in apprenticeship relationships, working closely with experienced teachers to perceive their deeper meanings. This approach has considerable merit. By committing texts to memory, the student develops a deep relationship with the texts, while the guidance of an experienced teacher ensures the preservation and transmission of knowledge that is difficult to attain by individual study alone (Note 2).

Yet, there are also limitations. Knowledge passed down through lineage systems may tend to emphasize the preservation of individual viewpoints and may limit the exploration of alternative perspectives. Students may accept a teacher’s viewpoints in ways which can hinder critical thinking and independent exploration. Cultural perspectives can simultaneously reinforce the conservation of precious knowledge while restricting new ways of thinking.

Classical text research has also lacked a formal research methodology that can be used in a shared way, using distinct approaches and verifications among diverse professional colleagues. Rather, understanding has more often come from knowledgeable physicians, studying deeply, working on their own, and coming to their own analysis. While this has yielded treasured knowledge, this approach lacks basic features shared by other academic fields, such as a common approach to methodology and terminology and formal methods of verification and evaluation.

As I began my translation work, it became increasingly clear that a formal methodology was needed to organize and interpret the large amount of information being discovered.

One of the first passages I encountered was Tian Yuan Ji Da Lun (《天元纪大论》The Great Treatise on the Original Patterns of the Heavens), the 66th Chapter of Su Wen (《素问》Basic Questions). This passage begins a lengthy section on the meaning of the complex interactions between heaven and earth that occur as they progress through their sixty-year annual cycles.

The opening passages discuss the meaning of the character Shen (神 Spirit):

“SW66. 阴阳不测谓之神

English Translation: [Aspects of] yin [and] yang [that] cannot [be] measured (Bu Ce), call them Shen.

SW66. 神用无方谓之圣

English Translation: Manifestations [of] Shen [that] lack directionality (Wu Fang), call them sacred (Sheng)…

SW66. 神在天为风在地为木

English Translation: In [the terrestrial] heavens, Shen creates wind (Feng), on earth, [it] creates wood (Mu);

SW66. 在天为热在地为火

English Translation: in [the terrestrial] heavens, [it] creates heat (Re), on earth [it] creates fire (Huo);

SW66. 在天为湿在地为土

English Translation: in [the terrestrial] heavens, [it] creates dampness (Shi), on earth [it] creates soil (Tu);

SW66. 在天为燥在地为金

English Translation: in [the terrestrial] heavens, [it] creates dryness (Zao), on earth [it] creates metal (Jin);

SW66. 在天为寒在地为水

English Translation: in [the terrestrial] heavens, [it] creates cold (Han), on earth [it] creates water (Shui);

SW66. 故在天为气在地成形

English Translation: thus, [the celestial] heavens create [intangible patterns of] qi, [while the] earth [governs the] maturation (Cheng) [of tangible] forms (Xing).”¹

As I read these lines, it became clear that the terms and concepts I had studied in my Chinese medicine training were being used in new and unfamiliar ways. They describe a very different world and vision of Chinese medicine practice. But how to understand them?

In Chinese medicine, the term Shen typically describes an intrinsic essence of the human spirit—an indispensable force for maintaining overall health and vitality. Yet, these passages portray this term as a basic force of the universe, something intimately involved in the creation of the patterns of the natural world. What could this mean? How does an aspect of the human spirit create patterns of weather and trees? What does it mean that there is a dimension of yin (阴) and yang (阳) that cannot be measured? What defines the sacred and how does it differ from the concept of spirit? How do the celestial heavens produce intangible patterns that shape the physical world? And, importantly, how, in an epistemological sense, can we best research these issues in a formal way?

It became clear that a new approach to text research was needed to navigate the vast amount of information being discovered. In this regard, the placement of early Chinese texts in databases played a pivotal role.

Over the past twenty years of Nei Jing (《内经》The Inner Classic) research, using text databases, a new approach to text research has been developed to address these issues: the name given to this practice is “Classical-Text Archaeology”. In this research method, characters, text passages, and basic concepts are viewed as the unearthed artifacts of an ancient civilization whose true nature is not yet fully known. Like the initial discovery of pottery shards and other findings at an archaeological site, individual text findings may offer crucial hints but do not yet provide a comprehensive description of the civilization being discovered. Only through prolonged investigation does a more accurate understanding begin to emerge over time (Fig. 1).

Figure 1.

An excavation cite (source from: the author).

In the practice of Classical-Text Archaeology, each text research fragment undergoes a series of formal analyses. For example, in Nei Jing, the character Shen is a key text artifact that appears in 233 text passages. The practice of Classical-Text Archaeology begins by identifying each of these text passages and translating them in their entirety according to established criteria for research translation (Note 3).

Next, each passage is placed in different categories and sub-groupings for further analysis. For example, the character Shen is found in diverse passages that describe basic patterns of cosmology, nature, issues of human health and disease, clinical treatment, and so forth. This creates a natural hierarchy and grouping for studied text fragments.

After that, each passage and sub-grouping is evaluated to identify interwoven themes that might run through them. In Classical-Text Archaeology, themes of meaning common to all text passages being studied are called holographic translation viewpoints. These are defined as translation perspectives that hold true for each instance of the studied material.

Once a holographic translation viewpoint is tentatively established, it next undergoes a series of secondary validation challenges by posing a series of specific queries:

1. Is the proposed definition consistent with all instances of the source text?

2. Does the proposed definition accord with observable patterns of nature?

3. Is the proposed definition congruent with current knowledge of the culture and history of early China?

4. Does the proposed research definition lead to enhanced clinical outcomes?

5. Does the proposed research definition accord with understandings of contemporary scientific research?

If a new definition passes these steps, it then undergoes a third level of validation through professional feedback, teaching, and clinical practice over time. Once a new research definition has been tentatively established, it is then used as a basis to retranslate the original text and further our understanding of the perspectives and practices of the original authors of the text.²

For example, following this method to analyze the meaning of the character Shen in Nei Jing text yields the following research definition:

In Huang Di Nei Jing (《黄帝内经》The Yellow Emperor’s Inner Classic), the character Shen defines a basic aspect of space-time that transcends the observable cyclical patterns of yin and yang and that cannot be perceived directly. In certain balanced states of yin and yang motion, Shen emerges as a special form of transcendent illumination known as Shen Ming (神明 Shen Illumination). Shen Ming organizes patterns of yin and yang motion into coherent patterns of dynamic expression; and thus serves as a basis for organized patterns of motion within the cosmos, natural world, and human body. In human beings, Shen Ming arises spontaneously within the heart and circulates throughout the body via the three-dimensional vascular system. In this way, Shen Ming bestows biological coherence, and serves as the basis for human life and vitality.

It is important to note that this constitutes a research definition. For example, it is unlikely that one were able to speak with the authors of the Nei Jing directly that they would describe Shen exactly in this way, but as a constructed research definition that remains true among different text instances, it becomes a powerful tool to uncover the original perspectives of the source text. Further, this definition leads to new understandings that may have practical implications for current global healthcare challenges. For example, this definition has led to the development of a new model of tumor formation and cancer treatment based on a model of the restoration of vascular flow, new approaches to the understanding of resistant infectious illnesses based on the concept of the ecological restoration of tissue planes, a new understanding of the original practices of acupuncture, now seen as a form of traditional surgery, whose primary aim was the restoration of normal flow within the vascular rivers of the body, and a new model of human illness based on a model of three-dimensional tissue coherence.

Because this is a formal research methodology, its conclusions can be studied, questioned, shared, analyzed, and progressed collaboratively by different groups of researchers working in diverse specialties, something that has been previously difficult to accomplish in lineage systems alone.

3 Discussion

Early Chinese medical texts provide the fundamental terms and principles upon which the tradition has been based for over two thousand years. As such, classical text research constitutes a critical basic science of Chinese medicine, comparable to the role that genomics research plays in modern cancer care. While the study of these texts has traditionally occurred in hidden lineage teachings and through the writings of individual physicians, the digitization of these texts allows for new approaches to classical text research and creates new opportunities for study in collaborative settings.

Requirements for meaningful scholarship include a clear understanding of where knowledge arises, and what this knowledge includes, as well as formal research methodologies that can be used among diverse colleagues and specialties; these systems should include valid means of validation, questioning, and refinement. Particularly in the West, these criteria have often been lacking regarding classical text research. While many practitioners recognize the significance of ancient texts in shaping clinical practice, fewer have a meaningful understanding of their contents and there are few opportunities to study more deeply. In China, the situation is much better, yet reductions in classical text education and an emphasis on biomedical approaches have led to a not entirely dissimilar situation.

Cultural differences play an important role in classical text research. Western researchers do not possess the same nuanced understandings of language, history, and culture that a researcher from the original culture may have. Yet, because they are not bound by established cultural perspectives, they may also see new viewpoints that lead to innovative ways of thinking. Moving forward, the best research model will likely be collaborative, including researchers from both within and outside the originating culture and from a variety of disciplines. Established research methodologies will facilitate these collaborations.

4 Summary

The digitization of early Chinese medical texts has led to new approaches in classical text research that have the potential to change our understanding of the basic principles of Chinese medicine in meaningful ways. Using these new research methodologies, Chinese medicine may be poised to enter one of its most transformative chapters. These approaches augment traditional forms of learning and allow researchers from diverse cultures and specialties access to the critical knowledge contained within these ancient texts with important implications for Chinese medicine, Western biomedicine, and many current global health challenges.

Notes

1. For the purposes of this discussion, physician-level care is defined as the capacity to manage complex medical situations from a deep understanding of basic theory and principles. In contrast, ancillary care refers to the ability to manage less complicated conditions following established protocols.

2. As noted in Li Ji (《礼记》Book of Rites), “If a physician does not come from a family that has practiced medicine for at three generations, their medicine should not be taken (医不三世不服其药).”

3. Basic criteria for research translations include the following: a) translations should be as literal as possible and not idiomatic or explanatory; b) original word order should be retained as much as possible; c) all words required by the translator for grammar and sentence structure in the target language should be indicated in square brackets and; d) words in the target language that have multiple character options should be clarified by Pinyin terms in parentheses.

Acknowledgements

Edward Neal, MD, MSOM, is trained in both Western and Chinese medicine. He has been involved in the study and teaching of Chinese medicine for over thirty years. As part of this work, he has consulted with the World Health Organization on matters of traditional East Asian medicine and has served as a visiting scholar at the University of San Diego Medical School. He is the medical director for the Apricot Grove Project and director for the Xinglin Institute NGO. These organizations study traditional forms of medical knowledge to find innovative solutions to current global challenges. Further information about these projects and training opportunities can be found at www.neijingstudies.com.

Funding

None.

Ethical approval

This study does not contain any studies with human or animal subjects performed by the author.

Author contributions

Edward Neal drafted and reviewed the article.

Conflict of interest

The author declares no financial or other conflicts of interest.