[Dissertation] Phlegm (tan 痰): Toward a History of Humors in Early Chinese Medicine

Author:
Koehle, Natalie Caroline

School:
Harvard University

Year:
2016

Advisory Committee: 
Kuijp, Leonard W. van der; Kuriyama, Shigehisa; Gyatso, Janet

Abstract:

This dissertation examines the Chinese conception of phlegm and related body fluids phlegm from the first occurrence of phlegm in Zhang Zhongjing’s 張仲景 (fl. 150-219) Jingui yaolue 金匱要略 through the first extended discussion Wang Gui’s 王桂 (1264-1354) Taiding yangsheng zhulun 泰定養生主論 (1338). Following the conceptual development of phlegm and fluids, the study illustrates one of the most important shifts in postclassical Chinese medicine. That is the transformation of the experience of phlegm from an insignificant water pathology that causes indigestion, to a major pathogen in Chinese medicine that is associated with an astonishing range of symptoms, and external and internal etiologies. The history of phlegm also intersects with another major shift in the history of Chinese medicine that is rise of fire, and the link of fire and emotions that was forged during the early Song dynasty.

In contrast to the current over-emphasis on pneumatic or energetic aspects of the Chinese imagination of the body, this dissertation focuses on the humoral aspects of Chinese medicine. This focus brings into view distinct parallels in the conception, experience, and treatment of fluids in the Chinese, Greek and Indian medical traditions, such as the concern with maintaining flow, and the fear of blockage, stagnation, and misguided flows. For instance, all of these traditions view phlegm as the result of a disturbance in the flow. These parallels in the Chinese, Greek, and Indian conception of humors, therefore, help us to better understand the history of phlegm not only in the history of Chinese medicine, but also in the Indo-European traditions.

The dissertation further sheds light on the history of Sino-Indian and Sino-Persian knowledge transfer, and the influence of Indic and Greek conceptions into Chinese medicine, as it puts forward evidence, which suggests that the similarities between Chinese and Indo-European conceptions of phlegm were due, in part, to historical influences from the Indic and Islamic medical traditions. Āyurvedic conceptions of phlegm reached China through the intermediary of Buddhist translations, where phlegm played an important role in physiology. Islamic medicine was present in the Yuan dynasty, and its concepts show clearly in Wang Gui’s Yuan period treatise.

The dissertation’s focus on fluids also brings into view differences in the conception of matter and the experience of fluid in the Chinese and the Greco-Roman medical traditions. In early Chinese medicine, phlegm and stagnant fluids were associated with lumps and tumorous growth, but not with decay. In the Greco-Roman tradition phlegm and stagnations were feared because of their immediate connection with putrefaction and decay. In early Chinese medicine, phlegm and fluids were diagnosed by signs from within the body, such as the sounds of water, but also the subjective feeling of fullness reported by the patients. In the Greco-Roman tradition, as in Wang Gui’s Yuan period treatise, phlegm was diagnosed through the examination of the patients’ outflows.