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Psychiatry in Chinese medicine

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 a
.
T HE SP Et-C I A L N
a rrE \'rA t!vf'U MB E R OF
tfr Eft vF nE E "COLLECTIONS OF
TI H
l. -=
ESSAYS ON CH E R A T U RE AND
SE LITERATURE AI HISTORY",
I N H O N O U R OF T H E E IGH T IE T H BIRTHDAY OF
DR J O S E P F I N E E D H A M, F R S , F BA

.
 TFIN,CONCE,PTUAL
HISTORYOFPSYCHIATRIC
TERVIS[N TRADITIONAL
CHINESE
MEDICINE
Hans Agren*
INTRODUCTION

There existsin Chinesephilosophy and sciencea conspicuous lack of dualistic thought

in the senseof parting things physiological from things psychological. This well-known
fact stands, of course, in sharp contrast to Indo-European thinking. For example, the
analytical prowess of the Greek language easily delineated soma from psyche, matter
frorn ideas, and, similar to animistic thought, the spirit from the body. The split,
however, was not very clearcut, and interactions were felt as natural. In Europe, bridging
this gap has been hailed as a sign of modernization.
Animistic thought was dualistic in the sensethat supernatural forces would interact
with the natural body in producing" say, disease. This dichotomy between a personal
body and an extrapersonal animus is commonplace in religious thought and has been
but little changed by modernization. On the other hand, the split between the body
and an intrapersonal animus, or soul, is what will interest us here. One traces a merge
between the two much earlier in East Asian history than in other parts of the world.
'
The early Chinesesourcesdemonstratecommon animistic modes of thinking - Devils
@ui H) and Spirits (ling ffi) are able to possess(zhu lft) the human body and soul and
thus produce disorders(somatic, behavioural, and social). At a slightly more sophisticated
level of reasoning, Evil Influences (xie {lJ) of diverse kinds more or less replace Devils
and Spirits. Supernatural factors are early parallelled by natural concepts like Cold,
Heat, wind, Drought, Humidity and so on, affecting the body in much the same way
as the supernatural ones. Chinese rationalism of various schools has ever since Con-
fucius opposed supernatural conceptualizations in general. Tough-minded Confucians
have created a highly metaphysical, however rational system of thought characterized by
correlative thinking and numerology. In so doing, supernatural terms may be used in
a borrowed and natural sense. Folk traditions continued to think soft-mindedly about
gods and devils and found their main channels of expression in Taoism and Buddhism.
Early Confucians disregardedany split between the body and supernatural extrapersonal
forces (there is no way of gaining knowledge about gods-thus they are of no interest.;
and constructed an array of external agents of a natural kind bringing disorder. In
the same sweep, they disregarded any gap between the body and some intrapersonal
non-body soul.
The literate medical tradition in China dominated by Confucian rationalism has by

* Dr. Hans Agren, (6X94,S), Professor in the Department of Fsychiatry,

University i{ospital,
Uppsala, Sweden.
 574 EXPLORATIONS IN TIIE HISTORY OF SCIENCE AND TECHNOLOGY IN CHINA

this way of thinking taken a decidedly "organic" point of view in dealing with psycho-
logical disorders. Somatic, behavioural, or emotional symptoms are not differentiated
in their incorporation into disorder entities, and treatrnent does not bother about the
origin of the symptoms to be treated. This organic outlook in explaining also psycho-
logical troubles appears to be deeply ingrained in the Chinese and other East Asians.
Of all evidence it also lies behind the virtual non-acceptanceby Chinese psychiatrists of
Western psycho-dynamic psychology and their ready acceptanceof organic psychiatry in
the West.

DIAGNOSES

Medical diagnostics is learnt labelling. Disorders do not "exist" as entities that

never change, but are invented as hypotheses about the proper grouping together of
signs and symptoms that tend to be connected and change concurrently in time' Diag-
nostical hypotheses mirror the times in which they were set up. The primary aim for
diagnosesis to serveas targets for medical therapy that will become specifi.cand directed.
The medical historian often "translates" ancien terms of disorders into some modern
ones, exclaiming that this-or-that disease was "discovered" already by those ancient
peoples. This can certainly be argued for in exceptional instances, What we can do
better, however, is to analyze constellations of symptoms and probe our way into an
understanding of how they were analyzed at higher levels of reasoning. But only some
types of personal discomfort are considered by the patient to be worthy of medical
attention. Which symptoms to take "seriously" is a personal choice highly influenced
by social and cultural values. We have a situation of a choice between discomforts
on the hand of the patient (how to phrase a complaint and decision where to seek
help) and on the hand of the doctor (decision of r'vhich symptoms are really important
and how they relate to each other).
The rational High Tradition of Chinese medicine did not use the names of disorders
as targets of therapy as in the West. Instead, use was made of another kind of symptom
constellation expressedmainly in terms of supposedpneumatic imbalancesbetweeninternal
organs or by the name of the very rnateria medica prescription used in curing - the
".manifestationtype" of a disorder or zheng ffi (seeAgrenl'2). Widely different disorders
could be shown to have a similar type of manifestation and thus receive similar treat-
ment. It follows that a patient presenting emotional complaints is subjected to the
standard methods of diagnosis, labelled with some kind of manifestation type (that may
be the same as that of some purely somatic disorder), and given proper therapy - herbal
drugs, acupuncture, or whatever.
For obvious reasons, we fail to recognize "psychiatry" in traditional Chinese medi-
cine. But we will find concepts with a clearly psychiatric content dispersed widely in

1 Agren, H.: ,.A new approach to Chinese traditional medicine", American fournal of Chinese
Medicine, 3, 207-212, 1975.
2 Agren, H.:'.En1piricism and speculationin traditional East Asian Medicine", Journal of the Japan
societyfar the History of Metlicine (Nihon ishigakkaizasshi F4.EE,F+€+Efi),23:2,300-317' 1977.
 AGREN: PSYCHIATRIC TERMS IN CHINESE MEDICINE 575

many fields of medicine.

THE EARLIEST RECORDS

Medical terminology as depicted in the earliest Chinese literature has been studied
by Lu Gwei-Djen and Joseph Needhams some ten years ago. Among potentially psy-
chiatric characterson oracle-bonesone finds ga # that has resisted definite interpretation,
"three insects in a bowl". Lu and Needham suggestthat it refers to a particular
disease
and cite an opinion that it denotes schistosomiasis. ln Zuo zhuan
ftffi, the cornmen-
tary of the spring and Autumn Annals, 6th century B. c., Lu and Needham srategu
to have a meaning of physical exhaustion and melancholia. Gu du (..grzpoison")
#€
is common in the materia medica literature as a target for certain drug therapies, and
gui zhu ftft (Devil Possession), Apprehension (iing ffi), and the dian
ffi and kuang \a
disorders are frequently listed in conjunction to it. A probable solution would be that
gu mirrored the easily recognizedtrouble of intestinal worm infestations, and that worms
were thought to cause behavioural disorders much the same as devils and fright. Kuang
fi. is noted by Lu and Needham to appear as early as 555 B. c. denoting a mad dog,
possibly suffering from rabies.
Inthe Huangdi neiiing ffiffiruffi, the Inner Classic of the Yellow Emperor, psychiatric
terms appear mainly in the part named Lingshu ffiffi (Divine Pivot). Although the text
was substantially changed during editing in early Tang Dynasty, the terms for symptoms
must be regarded to be ancient and to depict common usage during the Former Han
Dynasty.
In the following, a few main lines of clearly psychiatric disorders and symptoms
will be followed longitudinally in classical texts from the 2nd century B. C. to the lgth
century A. D. Emphasis is laid on the core triad of behavioural disorders in China-
dian ffi, Retarded Madness Disorder, kuang fi, Agitated Madness Disorder, and xien
ffi Convulsive Madness Disorder. Anxious and depressivesyndromes will be described-
I will refrain from overly commenting the texts selectedand translated bv the author"
as I believe they speak well for themselves.

THE THREE MAIN MADNESSES

Dian ffi, xian ffi, and kuang ffi are mentioned as disorder entities in the oldest
medical rnanuscript recently excavatedin China, the so-cailedFifty-two Medical prescrip-
tions from late Qin-early Han time.a Dian appears as dianji
ffif4, Dian Disease, aird
various forms of xian ffi like Horse, Sheep, and snake xian appear. Dian and xian
are not coupled to one entity. Kuang fi: shows only in the phrase "kuang Dog Bites
Man", letting one to assume the dog was rabid.

3 I-u, G. D' and Needham, J.: "R.ecordsof diseasesin ancient China", Chapter 17 in Diseases
in Antiquity, Ed.: Brothweli and Sandison,Charles C. Thomas publ., 1967.
4 Zhong Y. Y. f6ftDf and Ling x. i4*: "woguo xianyi faxiande zuigu yifang-bo shu 52
bingfang" ?iHIEEt{TXf!&HBtrHeqfrt=ffi}i,, (The oldest medical book on prescriprions yet
ciscoveredin China-the silk manuscript "Fifty-two prescriptions")
, wen lvu XM,t, 9, 49-56. lg:s.
 576 EXPLOR.ATIONS IN l'HE HISTORY OF SCIENCE AND TECFINOLOGY IN CHINA

To illustrate the early history of dian and xian the following excerpt ftom Zhengzhi
zhunshengffiFyefffi,u shows sound histori cal sensein the medical writer Wang Kentang
$.*gH by 1602:
"The Suwen ;5Fi (part of the Yellow Fmperor's Inner Classic) speaksof dian ffi and
stops there; xian ffi is not mentioned. The Lingshu ffifE on the other hand, also has xian
ffi, xianqi ffip and xianque ffiffi. Both books have diankuang ffi[I, fengdian ,E\ffi and
jingxian ffiffi as well. The parting of dian arrdxian into two headingsh ad not been settled.
Researchinto details shows that dian beTongsto the original Suwen,a nd that dianxian and
xiankuang belongs to the original Lingshu."
The Ltngsha Chapter 22 is entitled "On dian and kuang Madness Disorders".
It says:
"... Dian MadnessDisorder: At the onset the patient loseshis gaietyfift, his head
feels heavy and painful and his gaze is directed upward. The eyes become red, sornetimes
extremely red. He then developsIrritability in his Heart/Mind (fanxin ffi'},). Syn-rptoms
are all seenin the face... ... When an attack of dian starts the mouth becomestwisted,
the patient screams,breathinggetsdifficult and the pulse palpitates... ... The patient also
falls backward (fanjiang ft,ffi) and for this reason he will feel pain along his spine."
Half a millenium later, convulsive features is the most prominent part of diqn de-
scribed in the Chao-shi pingyuan hou lun Hft)trilfl,fft;'ft by Chao Yuanfang Hti/t in
610 A. D.6 Chao writes about five forms of dian, (l), yang dian ("During aL attack
the patient looks like a dead man and will pass urine; after giving him food there will
be recovery"). (2), yin dian ("The disorder comes now and then from birth or inlancy
on; at the navel there is a sore that will not heal"). (3), Wind dian ("Daring an attack
the eyes will squint, (the muscles) will contract and relax, and there will be a sound
like that of a sheep. After giving some food there will be recovery"). (4), Humid
dian 1flffi ("There will be a headache over the eyebrows and the body feels heavy. When
sitting down in a hot bath humid airs lft will collect in the brain"). (5), Hotse dian
("Attacks come intermittently; the eyes look backward and there is no sound from
the mouth. Hands and feet will clench, then the whole body follows suite").
By the end of the 16th century, as stated in the Jingyue quanshu FgfrA$ by Zhang
Jiebin ffiy'fff,? convulsions as a major criterium for dian was still problematical:
"Every case of dian entails xlan, convulsions. Looking into the Neiiing one seesdian
discoursed in great detail, but xian is not determined to the same degree- this was left
to later generations. The existence of terms like dianxian, fengxian, and fengdian would
point to their not being the same. This has led to an unnecessarychaos. In other texts
the Five convulsions (wuxian 1!,ffi), that is Horse, cow, Pig, Sheep,and chicken convul-
sion (xlan) would be what we today call Sheep and Pig dian. This is nothing but a
resemblance to the soundemitted (from the sick during an attack). All thesenamescould

5 Zhengzhi zhunsheng#i64xffi (The Medical Plummet and Level) by wang Kentang f€H, 1602.
Reprint by Cheng Yongpei f9zltl$ in 1791.Vol. 5, p.45.
6 Chao-shipingyuan hou lun HR,ffiWlRffi (Mr. Chao's Treatise on the Origins and Symptoms of
Diseases),by Chao Yuanfang Hmfi, 610. 1886 edition. Iuan 2 p- 72.
7 Jingyue quanshuFEA+ (collected works of Zhang Jiebin) by Zhang Jiebin &tH, 1624.
Facsimile edition, Kexue Jishu Shanghai.Juan 34, p. 575.
 icnnN: psycHIATRIc rERMs IN cHrNEsEMEDIcINE
s77
be looked upon as dianxian, not dividing it into two. There is not sufficient proof that
(only) xian would carry with it (muscular) contractions and relaxations."
Nevertheless, dian certainiy has more to it than features from an epileptic sphere.
The Zhengzhi zhunshengffiffi#fffi from 1602 states:
"The dian patient may run about madly (kuang trJ), appear stupid (7a ff.), laugh, look
sad, weep and act drunken much like an idiot. Words have neither head nor tail. He
does not know whether he is dirty or clean. For many months and years he will not
get better. In common parlance it is called Heart/Mind Wind (xinfeng ,d..6J."'
"The dian disorder is commonly called Loss of Heart/Mind Wind (shi j1 xinfeng).
It has many causes(yrn [l). The sick act depressed(yiyu {FED and do not comply with
others. They are frustrated in their lives (.f{,ffr) and helpless (ffi4ql), develop mental absent-
mindedness(huanghu 'p[,f,@.), become erratic and they may also be prone to outbursts of
anger ($fii). Infrequently they can be called kuang [a. They do not share the explosive
character of severekuang, but are more chronic (h).',"

The picture here is that of a chronic cognitive deterioration, a view supported in

the Yizang jinjian Wi,r-#W from 1742, stating simply that dian '.... begins with a loss
of gaiety and progressestoward silliness in spirit and inconsistenciesin talking."ro
The xian disorder has a more consistentmeaning throughout history, and the majority
of patients described in medical texts as xian or some xian variety would suffer from
epileptic fits' There are some hints Ihat xian was mainly used for children, and the
equivalent in adults would be dian (Qian jin yao fang Zhengzhi zhunsheng
t#Efr,tt
ffi iA#fflE).t2 In the Jingyue quanshu FEAgtt an old tradition of dividing xian into
three is cited: Wind xian thought to be due to sweatingin warm clothes, Apprehension
xian ffiffi due to fright, and Food xian @ffi due to inadequatebreastfeeding. A succinct
description of a grand mal-epileptic attack is carried over in the yizong jinjian
WF^#W
of 1742:
" .,. Xian ConvulsiveDisorderstartswith spittingof salivaand progresses
with confusion,
unability to speak, and falling to the ground @. There will be seizures(chouchu
{fuffi),
but when they have subsidedthe affiictedwill appearlike a normal persop."u
The rabid dog indeed mimics the violent and unsocial behaviour of some mad people,
and the word kuang fi has been used for a vast array of antisocial activities. Linsshu
h a s:
"...Kuang MadnessDisorder:Attheonsetthepatientgivesanappearance of sadness.
He then may show happiness,forgetfulness,bitterness,angerand fear. Grief and starvation
can be behind the condition. When an attack starts the patient sleepslittle and is not

8 Zhengzhi zhunsheng,see above. Vol. 5, p. 45.

9 Idem, Vol. 5, p. 54.
10 Yizong jinjian Ef;+g (Golden Mirror of the Schools of Medicine), 1742. Greater China
Library edition, 1971.Juan 4, p. 1,09.
1l Qianjinvaofong +#wfi (prescriptionsworthaThousand), by sun simiao trfr,B,is,652. Edo
Gakkei print, facsimile edition Renmin Weisheng chubanshe.Juan 74, p. 253.
12 Zhengzhi zhunsheng,see above. Vol. 5, p. 4.5.
13 lingyue quanshu,see above. Juan 34, p. 576,
14 Yizongjinjian, see above. Juan 4, p. 709.
 578 EXPLCRATIOhIS IN THE HISTORY OF SCIENCE AND TECHNOLOG

hungry. He believes himself to be of lofty virtue, disputes in matters of wisdom, tells

how noble he is, likes to abuse and curse and day or night never rests... ...In Mad
talking (kuangyan df:F) the patient shows Apprehension (jine W) and is apt to laugh, likes
to siitg and be merry, recklessly walking about without rest. A state of great fear lies
behind. In this Madness the eye may look at and the ear listen to absurdities (wangqian
ftfl, wangv'en Effi) and the patient will often shout. A diminished amount of qi has
generated it, The mad patient wiil have an increased appetite. He is bound to see devils
and gods and to laugh inwardly. A state of great joy lies betrrind. Hunger gives distress
but food will soon bring about a sense of well-being."ts
This description brings to mind a present-day agitated psychotic disorder with afferi
tive disturbance and visual as well as auditory hallucinations. It is impossible to differen-
tiate between mania and a schizophrenic disorder from the Chinese sources.
Walking about in the nude, shouting and singing from high places, restlessness,
fighting and neglecting duties are the symptoms associated most often with kuang. The
text Yishuoffiffi from 1189written by Zhang Gao ffift argues:
"How does one differ dian from kuang Madness? The answer is that kuang at the
start has diminished need for rest and food, the patient believeshe is wise and noble,
he laughsat absurditiesand likes to have fun. Dian is mentally inattendant(Z<*), speaks
erratically and may even climb high placesto shout cursesat others, or he may run about
madly ('like a rabid dog', kuang zou {Aft.)."ra
Indeed, the boundaries betweenthe three disorders dian, kuang, and xian are blurred.
It would be an impossible task to find unambiguous English words for these entities.
Nevertheless, I suggest that judging from the nature of the principal symptoms, dian
would be Retarded Madness Disorder, kuang Agitated Madness Disorder, afid xian
Convulsive Madness Disorder. These non-committing words would prevent us from
reading modern nosological ideas into the Chinese medical tradition.

ANXIOIJS MOODS

Fear, apprehension and anxiety are common ingredients in descriptron of disorders

in Chinesetraditional medicine. Only seldom, however, are conceptsof this kind elevated
to the status of a disorder per se. Jing ffi or Apprehensionis one of the most common
words, and a description of a disorder with this name is found in the mid part of
Chapter 50 in Lingshu ffiffi-, "On Bravery":
"... The Yellow Emperor said: There are those who can endurepain and those who
cannot. It is not a question of mere bravery (yong B\ and cowardice(qie 1*). Some
brave soldiers cannot stand pain, and in the face of peril they anticipatepain and halt.
Some cowardly soldiers do stand pain but get afraid in periloussituations;however,if
feeling pain they do not get moved by it. The braves who can stand pain do not get
afraid and if they feel pain are not moved by it. The cowardswho cannot stand pain
experienceit in any dangeroussituation. Their eyeswill turn around, the face looks per-
plexed, fear makes them unable to speak, and in losing their breath/qi (shi qi f1f;) they
developApprehensionDisorder(jine W). The colour of the facechanges;they may die all

15 Huangdi neijing lingshu trtrfrf$ffiiffi, Chapter 22.

16 Yi shuo 5t7tr (N{edicalDiscourses),by Zhang Gao g&R (Qiming +EE), 1189.Juan 5, p. 4.
 AGREN: PSYCHIATRIC TERMS IN CHINESE MEDICINE 579

of a suddenbut may as abruptlycometo life again..."

The Chqo-shibingyuanhou lun HE)fiiJH,{Ro=,ft
from 610 states:
"Small children develop Apprehension (jinq W) when Blood and qi are not in har-
monious control of the body and a state of Fullness (shi ffi) within (has been built up1.
Mind (xinshen ,1.1t$)becomesunsettled and Apprehension develops. When severe,the process
rnay become xian ffi Convulsive Madness Disorder..."1?
'fhe Zhengzhi zhunsheng from 1602 reads:
#ifi€fflE
"How do Apprehension(jine H), Palpitation (qi 'W), Hearr Anxiety (zhengchong ,f|fg)
and Fear (kongbu *{fi) ditrer from each other? It is said that when there is Palpitation
there will be Heart Anxiety. Those with Heart Anxiety are at bottom not apprehended;
the heart throbs but they are not always apprehensive. Zhang Zihe dftF.i,n (dead 1228,
one of, the famousFour Doctors of the Yuan Dynasty) said: The personwith Apprehen-
sion does not himself know the reason(behind his feelings). The personwith Fear does
know it. The apprehensive will becomefrightenedby sounds,and will believeothers will
catch hira. The affiictedcannot sit or lie down alone but will need a comoanion in order
not to be afraicl. At night he may need the lights to be on."ro

Further, the Yizong jinjian %#hW from 1742 says:

"If, inside,the heart throbs without therebeingany fear, we have PalpitationDisorder
(Si 't+). If Apprehensionis part as well, the disorderis called Heart Anxiety (zhengchong
'lTt+.t). If one is apt to forget what was said before, we speak about Forgetfulness(7iar-
tuang I[CE). For someonewho appearsconfusedbut otherwisehas a good appearance,the
term is Absentmindedness(huanghu,gl,l,p,)..."rs
An illuminating case history in Gujin y|an an fr+Wftt* from 1778 states:
"Hua Boren i€,{H,f- (physician and commentatoron the Nanjing Wffi, fl. 1361; treated
a man suffering from Heart Anxiety. The patient was apt to forget, the mouth was pale,
the tonguedry and he sweatedprofusely. His limbs were exhaustedand weak. He became
feverish, and the urine was white and turbid. A crowd of doctors held that there was
some internal damageand insufficiency...The good doctor said: Grief (you @), Sadness
(chou f*), and lToo-Much; Thinking (sild ,S,ffi) has damagedhis Heart/Mind! This man
is of common birth but his ambition is high... A state of depression(yiyu tl[ED has
been built up since a long time. This is what lead to internal damage!"2O
In the Shanghanlun (SS;ft tradition, two other words are prominent in describing
emotions: "fan,E and zao,fft. In Chapter 61 of the original text (Otsuka's edition)
w e re a d :
"In the Damage due to Cold Factors (shanghenEi19 the pulse will be faint and the
peripheryof the body wiii be cold. On the seventhand eighth days the skin will be cool
and the patient filled with anger (zao ffi). If he does not calm down within a short time,
the peripheralcold will be due to tape-worms. The patient can be orderedto calm down,
but when relapsing he will be irritable (fan 'lE\. After a moment this will stop. If he

17 Chao-shi bingyuan hou lun, see above. Juan 45, p. 241.

18 Zhengzhi zhunsheng,see above. Vol. 5, p. 82.
19 Yizong jinjian, see above. Juan 4, p. 108.
20 Gujin yi'an an E+WF.+X (Collection of Old and New Medical Case Histories), by Yu Zhen
frffi, L778. Old print. Juan 6. p. 3.
 580 EXPLORATIONS IN THE HISTORY OF SCIENCE AND TECHNOLOGY TN CHINA

tries to eat he will vomit and once more become irritable ..."21
The Song Dynasty emendator of the Shanghan lun IE*--rfu, Cheng Wuji fiffif, (in
1144) explained fan ffi as disruption (raohnn tEffiL) and zao fg as resentmett (fbnii
{filff)." One could try irritability and anger, modern words with a better psychiatric
ring.

DEPR.ESSIVE MOODS

Depressed mood was certainly observed by the ancient Chinese physicians,but it

seldom was thought of as anything but a symptom of some other disorder, or as a
natural emotion. Common terms for depressedmood was bei /ft, you E, and men !}5,.
Chapter 69 in Lingshu ffitE is entitled "On Grief, Rage and Loss of SpeechtrtffiF"
and reads: "People who suddenly develop both Grief and Rage and lose their speech;
which tract (jin7 W) has been obstructed?" An anatomical discourse of the airways is
given and how external factors may be causally involved is explained, but nothing more
is said about Grief. The character yu l1g that came to be used for depressivemood
is used in the old texts just to denote a "depressed" content of pneuma/qi in the various
internal organs.
Mood is a subject in the Waitai biyao |l@f.fi$ by Wang Tao 31ffi in 752:
"'The Profound Teacher's Five Evils Pill' i466441j1 cures Apprehension and Fear
in the Heart/Mind, (bad) dreams,Sadness(chou fo,!.)and Grief (you B) on awakening,
as well as mental deterioration ("mental chaos" ffiffi|). Evil Influences(xie f,13)fly along
the tracts entering the Five Internal Organs (zang ffi), producing irritability, Iistlessness
(fanmen ffiflg!), and depression,wailing (beiai #,&) and crying (t,4i rfff&) that comes and
goes. Frequently attacks of sorrow (ku E) and fear (bu ,tfr) go with rapid inhalations.
There is Absentmindednessand a tendency to lie down. The heart leaps. Suddenly the
sick person becomes angry (yu nu '&#) and may develop a dian ffi Madness Disorder
and fall to the ground. Hands and feet are cold and lucid. Gui fil Devils and xie f,[3
Evil Influencesare within (the body), having passedthrough to the internal organs (zangfu
mHff)...""
In another passage,mention is apparently made of the circadian rhythm in mood
seen in certain depressivestates:
"...In worse cases,there is damagefrom Grief (you B), Sadness(chou ffi), depres-
sion (bei lS), and the patient is not happy (bule fift). He may suddenly becomefor-
getful. Either he may be better in the mornings and have more trouble in the evenings
(chaocha mu ju $f;ffiElJ; cha ff is a technicalterm for variation, as in richa El*, diurnal
variation), or he is better in the eveningwith attacks coming in the morning (mu cha chao
fa H*9A - ) . . . " *
The Song wark Shanghan ming li lun IEB.FEIE;ft bv Cheng Wuji fiffif, (shortly

21 Shdkanronkaisetsu l$Xflfffiffi, (Explanation of Shanghanlun, Treatise on Disorders Attributable

to Cold Damages),by Otsuka Keisetsu J'15l6hffi. 6saka: Sdgensha€tlzuif (4th edition), 1974.
22 Mentioned in Zhengzlti zhunsheng,see above. Vol. 5, p. 63.
23 Waitai biyao tF€fl'$ (Secret and Essential lPrescriptionsl from a Provincial Governor), by
Wang Tao 1ffi,'152. Juan 15, p. 405.
24 Waitai biyao, see above. Juan 15, p. 402.
 AGREN: PSYCHIATRIC TER.MS IN CHINESE MEDICINE 581

aftet ll44) mentions aonong 'Kj* as most likely denoting a state of hostile depression:
"Ao 'w means angry and nong ,ffi gives the appearanceof depression(ynmez
fr[fg!).
trn the Mind there are qfeelingsof; angriness,@'@,vexation {H,I.ffi,irritability
ffif{, melan-
choly ,ffiffi and depression6[6tr. Mind is in bad spirits frg]ffi and very angry ,Et,${.,'2s

CONCI,USION

The excerpts given from Chinese medical texts ranging from early Han Dynasty,
two centuries B. C., to the l8th century demonstrate a great many terms of decided
psychiatric interest interwoven in the great fabric of observations and rational metaphysics
that is Chinese traditional medicine. We find disorders of thinking and mood as well
as convulsions analyzed in such fair detail that it is sometimes possible to associateto
a modern diseaseentity. The demarcation lines betweenthe disorders are indeed blurred
as we would expect-a comment that an ancient Chinese doctor would have been as
likely to make were he to have seen our present-day systems of psychiatric classification.
Mental disorder of all evidencewas well-known in ancient China, and serious attempts
to treat the insane were made. Hypotheses about the nature and cause of mental de-
viations lvere never separated from holistic somatic/organic concepts, ubiquitous in the
Confucian High Tradition medicine. To find non-organic views we would have to look
into popular shamanism and Taoist daemonology for extrapersonal causative concepts,
or into Buddhism, where the intrapersonal soul had its ups and downs analyzed in purely
psychological terms.

Summary
Fsychiatry rn Chinese Traditional MeCicine

Flans Agren

The hypothesis that a dichotomy between the human body and an intrapersonal
soul be useful when thinking about man was discarded much earlier in East Asia than
in Europe. The traditional Chinese medicine of the literate classeshas disregardedthis
split ever since ideas of supernatural events were transformed into naturally understood
processesin early Han time. Mental signs and symptoms were analyzed using the same
frarne of referenceas bodily cues. Though we fail to recognize "psychiatry" as a special
branch of traditional medicine in China, concepts with a decidedly psychiatric interest
vrill be found in many fields of medicine. The names of "psychiatric" disorder entities
must be carefully analyzed in their context, and any extraction of modern rneaninss
of the old terms rnust be done with suspendedjudgment.

25 Skanghanming li lun tr&E]eifr (Elucidation of the Principles in the Shanghan lun), by Cheng
wuji t{ftd. ,Around 1150. Chapter 21. Part 5 of the collectivevolume Jinggui yaolue
fais tun &
H486tr;,fi (Discourseon the Prescriptionsin the Excerptsfrorn the Golden Casket). Reprint, Tailian
guofengPubl., 1968.p. 244.

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