Pre-modern Chinese medical and philosophical understandings of mental health

Molly Anderson

When we think of ancient medical understanding, we are influenced by the Eurocentric history we were taught at school and particularly remember the Ancient Greek ideas of the Four Humours.

Perhaps we are also aware that the ancient Greeks believed the Gods could cause mental illness. In a similar way, the ancient Chinese also believed that mental illness could have been caused by external forces like spirits who were punishing them for their misbehaviour, or even for their ancestors’ misconduct. However, there were many other pre-modern Chinese ideas about the causes of mental illness. These were based on traditional Chinese medicinal teachings which treated the mind and body as one. These holistic beliefs meant they treated mental illness as if it was a physical illness and focused on balancing the fluids and health of organs in the body in order to cure the mind. At a basic level, this seems familiar to our knowledge of ancient and medieval western ideas of health. In Ancient China, doctors believed if there was a homeostatic imbalance in the body then this would cause mental illness. Qi (pronounced ‘chi’) was very important to keep in balance since in traditional Chinese medicine it was seen as vital energy. In the important Chinese medical text of the Yellow Emperor’s Inner Canon of Medicine (China's earliest written record on medicine, codified during the Han Dynasty (206 BCE - 220 CE.)) mental illnesses are described as being caused by abnormal states of Qi. Historian Hsiu-fen Chen states the belief that emotions could also affect the movement of Qi. The amount or flow of this vital energy could, for example, rise in anger or stagnate in grief, also demonstrated in the Inner Canon. As well as Qi being kept in balance, blood circulation was also important as well as other liquids like phlegm and semen. Sound familiar? But the emotions not only affected Qi, but the health of organs as well. For example, it was believed that anger would injure the liver, and too much joy would injure the heart. The heart was a crucial organ to keep healthy as the Ancient Chinese believed the heart governed the body as the heart-mind or Xin (pronounced ‘shin’). Fabien Simonis shows that many physicians recognised insanity as being caused by dysfunctions of the heart.
Pre-modern Chinese medical and philosophical understandings of mental health
Image from Yellow Emperor’s Inner Canon of Medicine

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Pre-modern Chinese medical and philosophical understandings of mental health
Ying and Yang symbol

There was also a need to keep the Yin and Yang in balance

There was also a need to keep the Yin and Yang in balance, the two natural forces which created all things in the universe, and also the five universal elements or Wu Xing (pronounced ‘woo shing’) which made all things and creatures. Pre-modern Chinese physicians believed it was essential that there was harmony between nature and the person, internally and externally, to achieve good mental health and general physical health. But how would a Chinese practitioner actually help their patient to balance all these contributors to the health of the body? Well, your Ancient Chinese doctor would find what was imbalanced in the body and would restore that balance. If a patient came with symptoms of madness the typical practitioner would detect the imbalances in the body by taking the pulse, which Simonis notes would show things like excessive inner Fire, or depletion of Cardiac Qi. Physicians then thought this specific imbalance could be cured by purgative medicines which would cool the body down. These theories and practices continued into more modern times, as this was what one practitioner in the nineteenth century, Wu Tang, prescribed to patient Mr Bao to cure his inner Fire, or essentially make him have a big fiery poo. But, if they thought there was a blockage of the channels through which energy flows in the body, or Jing Luo, then they used bleeding or purging techniques, similar to ideas of how to balance the Four Humours in pre-modern Western medicine. In this case study however, it wasn’t the purgative medicines that cured Mr Bao, but rather more of a psychotherapeutic treatment. Simonis shows that Wu Tang cured Mr Bao by his ‘chatty three-inch tongue’ as he called it, by talking to Mr Bao to reveal his hidden emotions which detected his anger behind not achieving his ambitions. This helped Mr Bao to see his problem and eliminate his illness by realising he did not need to be defined by his failure. This could be seen as similar to modern ideas of how to cure mental health issues. But Simonis argues it was not a ‘talking cure’ because Mr Bao remained voiceless as he was cured using therapeutic manipulation. Additionally, ‘talk therapy’ was not widely accepted in pre-modern Chinese medicine. It remained the dominant belief that mental illness needed to be cured by physical ingredients like herbal remedies or more invasive treatments, since mental illness was treated the same as physical bodily illnesses.It isn’t too far a stretch to see that our understanding today of hormones are perhaps a legacy of these views of fluid or energy. A hormonal imbalance is often treated by doctors today with medication – so the treatments of mental illness in the past are not useful, but the underlying theory and believed causation potentially is. This we can see in the holistic nature of western medical care today as is highlighted by many historians of medicine. Pre-modern mind-body ideas continue to inform our understanding today, although the overall usefulness of treatment of mental health issues based on these theories are not relevant to us in the 21st century. This is clear from the modern-day reliance on medicine to treat mental illness, which was less common in pre-modern times. Obviously, we don’t believe that a hot bath, warm food, or an enema to help exorcise fiery poop will cure your depression! But working on how we deal with external factors, managing our stresses and fears have always been and continue to be important in how we deal with mental health issues.
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Pre-modern Chinese medical and philosophical understandings of mental health

Molly Anderson

My name is Molly Anderson and I graduated from Lancaster University with a First-Class BA Honours degree in History in 2022. I am now a writer for a history holiday travel company and am looking forward to starting a Masters degree in Heritage Management at Queen Mary University of London in September 2023. You can follow me on Instagram, for regular posts about places I visit and my research.
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