In modern acupuncture, meridians are often thought of as metaphysical structures. A new research study of an ancient Chinese text found in a Mawangdui tomb suggests they were actually based on physical anatomical pathways discovered through dissection.
Below are excerpts from the recently published article/study.
© 2020 The Authors. The Anatomical Record published by Wiley Periodicals LLC on behalf of American Association for Anatomy
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
For thousands of years, scientists have studied human anatomy by dissecting bodies. Our knowledge of their findings is limited, however, both by the subsequent loss of many of the oldest texts, and by a tendency toward a Eurocentric perspective in medicine. As a discipline, anatomy tends to be much more familiar with ancient Greek texts than with those from India, China, or Persia. Here, we show that the Mawangdui medical texts, entombed in the Mawangdui burial site in Changsha, China 168 BCE, are the oldest surviving anatomical atlas in the world. These medical texts both predate and inform the later acupuncture texts which have been the foundation for acupuncture practice in the subsequent two millennia. The skills necessary to interpret them are diverse, requiring the researcher firstly to read the original Chinese, and secondly to perform the anatomical investigations that allow a re‐viewing of the structures that the texts refer to. Acupuncture meridians are considered to be esoteric in nature, but these texts are clearly descriptions of the physical body. As such, they represent a previously hidden chapter in the history of anatomy, and a new perspective on acupuncture.
Studying anatomy via direct dissection of the human body has been the “gold standard” in Western medicine since the Renaissance (1300–1600 CE) (Porter, 2017). There are records of even earlier anatomical dissections and physiological experiments by Herophilus (335–280 BCE) and Erasistratus (304‐c.250 BCE), but their original works were lost in the fire of the library at Alexandria (von Staden, 1992). Galen (129‐c.210 CE) followed in their footsteps, and his surviving animal‐based works, which formed the basis of Western anatomy for the subsequent thousand years, indicate that he was familiar with theirs. Our histories of anatomy are highly Eurocentric. Great emphasis is placed on anatomical discoveries made in Europe (especially Greece), but there is usually very little mention of China (Shaw & McLennan, 2016), Persia (Alghamdi, Ziermann, & Diogo, 2017), or India (Wujastyk, 2009). This pattern persists even though these cultures have long and proud medical traditions. The first records of cataract surgery come from India in the fifth century BCE (Davis, 2016; Grzybowski & Ascaso, 2014) well before Herophilus. Prior to the flourishing of anatomy in Renaissance Europe, Chinese anatomical studies led to the creation of the Anatomical Atlas of Truth (Cun Zhen Tu) (Yang, 1106), and Ou XiFan’s Anatomical Illustrations (Ou Xifan Wuy Zang Tu) (Chiang, 2015) in the Song dynasty (960–1279 CE) (The Song Dynasty (960–1279), n.d.). In Persia, Ibn Sina (980–1037 CE) wrote the Canon of Medicine in 1025 CE (Koh, 2009), whereas in Europe Vesalius’ famous De Humani Corporis Fabrica (On the Fabric of the Human Body) was only published in 1543 (Vesalius, 1543), (Vesalius, n.d.).
Here we argue that the ancient Chinese “Mawangdui texts” (dating to the second‐third century BCE) (Yimou et al., 1988) constitute one of the very earliest anatomical atlases based on systematic human anatomical study comparable to that found in ancient Greece. Crucially, where the early Greek texts perished, the Chinese ones survived. The study of the Mawangdui medical texts thus offers us both a unique window into ancient Chinese anatomical knowledge, and a chance to rediscover this way of seeing and mapping the human body.
The establishment of these texts as an atlas also informs some of the most basic assumptions about the anatomical basis for acupuncture meridians and points. This has major implications for current scientific research into the mechanism(s) of acupuncture. It challenges the widespread belief that there is no scientific foundation for the “anatomy of acupuncture,” by showing that the earliest physicians writing about acupuncture were in fact writing about the physical body.
2 THE MAWANGDUI MEDICAL TEXTS
The Mawangdui medical manuscripts were entombed at the Mawangdui burial site in Changsha, Hunan Province, China in 168 BCE. This site comprises three separate tombs closed at different times, containing the bodies of the Marquis Dai, his wife Lady Dai, and their son (Harper, 1998). Many artifacts were found in the tombs including treatises on medicine, war, personal cultivation, materia medica, and recipes for foods that would be considered healthy or medicinal. There are three anatomical manuscripts which differ in their details but generally contain similar material (Changsha Mawangdui Han Dynasty Tombs Exhibition Hunan Provincial Museum, n.d.). They were written around 300–200 BCE (Yimou et al., 1988), broadly contemporaneously with the now‐lost dissection‐based texts of Herophilus and Erisastratus (Lloyd & Sivin, 2002).
The texts describe the organization of the human body in the form of divisions or pathways, each of which has associated disease patterns. These 11 pathways carry the same names as the acupuncture meridians described in the later Huangdi Neijing or Yellow Emperor’s/Yellow Thearch’s Classic of Internal Medicine (henceforth “the Neijing”) (Huangdi Neijing, 2010). The Neijing is the canonical text of ancient Chinese medicine and has great status in Chinese history and culture. It is recognized as the repository of medical thought at the time of the Han dynasty (206 BCE–220 CE), and contains the earliest exposition of acupuncture theory, points and clinical practice, and we have discussed the anatomical content found in it in other papers (Shaw, 2014; Shaw & Aland, 2014; Shaw & McLennan, 2016). Unlike the entombed Mawangdui texts, the Neijing was copied and recopied over time, has volumes of commentary associated with it, and remained current throughout Chinese history to the present. There are sections from the Mawangdui texts copied verbatim into the Neijing, suggesting that the older texts became subsumed into the bigger, more detailed compendium. The key difference in content between the two is the addition of an extra meridian (arm jue yin) to the Neijing that is not found in Mawangdui (Unschuld, 1985, p. 81). There is also no mention of either acupuncture, or acupuncture points found in Mawangdui. This information is all contained in the later Neijing text, which clearly indicates that mapping the body was an area of active anatomical research in the Han era, with a progression of ideas over time.
Both the Neijing and Mawangdui describe a system of meridians or pathways through the body in which Qi (vital energy) circulates. How this description was arrived at, however, is the subject of considerable debate. In ancient China, the development of anatomy is generally considered not to have involved dissection (Harper, 1998; Lloyd & Sivin, 2002), in contrast to what was broadly contemporaneous in the West. This is because Han‐era China was governed by Confucian law. Under Confucian law, each person had their place and the stability of the state and social order was maintained through a rigid social structure. One of the laws underpinning that structure was that of “filial piety” (Confucianism, 1996), under which it was a child’s duty to respect and worship their parents and ancestors. The human body was considered sacred, and dissection was seen as a mutilation of one’s ancestor, and therefore forbidden (Lloyd & Sivin, 2002). For this reason, it is widely assumed that the anatomy described in Mawangdui and the Neijing was arrived at through some means that did not involve direct examination of the body (Lloyd & Sivin, 2002; Unschuld, 1985).
However, the Han Shu (Book of Han) records the dissection of the criminal Wang Sun‐Qing in CE16 (Schnorrenberger, 2008). The Han Shu is a complete history of the Han Dynasty from 206 BCE‐23 CE, and this record of dissection forming part of Wang Sun‐Qing’s punishment shows that in the case of criminals, the law of filial piety did not apply. The penal system at the time included the “5 Punishments”: tattooing of the face, cutting off the nose, chopping off the feet, castration, and the death penalty(Yang, 2015). The death penalty could be carried out by strangling, decapitation, or slicing. Decapitation was a more serious penalty than strangulation because it mutilated the body, thereby humiliating the person and denying them a fate for their mortal remains that was in compliance with the law of filial piety. Death by slicing was more severe still, as the offender was tied to a post and cut whilst still alive, until they died. The record of dissection would fit with a punishment system that considered mutilation of the body the most severe form of the death penalty (Kim & LeBlang, 1977). We argue here that the Mawangdui texts record anatomy arrived at via dissection (as does the succeeding Neijing). If this assessment is correct, they are not only the oldest Chinese anatomy texts, but also the oldest surviving anatomical atlases in the world, predating Galen by a thousand years.
4.1 The Mawangdui meridians in the flesh
The Mawangdui arm meridians are much simpler than those of the leg, so we treat them first. Arm and leg meridians are each split into yin and yang. The patterns each set displays are themselves useful illustrations of the naming conventions and paradigms of ancient Chinese anatomical studies, as represented in the Mawangdui.
In what follows, we are dealing with three discrete but inter‐related sets of information: the original Chinese texts (characters), direct translations of those texts that are as literal as possible (in English), and the anatomical descriptions that we believe align most closely with the pathways described.
The Table of Translations (found in the Supplementary Information) gives the original Chinese texts and our translations of them. As there are usually three texts per meridian, we also provide a collated translation which is a summary of the combined texts for each meridian.
In the main body of our results section, we take these detailed documents as the basis for our interpretation. Tables 1–11, and Figures 2–12–2–12, therefore act to unify and integrate the text, translation and anatomical structure. We name the physical structures that we have identified through dissection and anatomical examination as the most likely structures being described in the Mawangdui. These sections summarize our evaluation of the physical actuality of the meridians described. In the main text, we alternate between modern anatomical terminology and references to the translations. For clarity, the original Chinese terminology is given in italics and our translations of the texts are referred to in quotation marks. The translations are included where they are relevant to understanding the reasons for our interpretations.
The full article/paper then goes through a whole series of meridians with translations, descriptions and corresponding dissection photos. The first Arm tai yang meridian is reproduced below.
TABLE 1. Arm tai yang
|Arm tai yang (ear vessel)||Greater yang meridian of the arm, ear vessel—“it rises up from the little finger/back of hand, goes along the space on the outside of the two bones. It goes up the bone to the lower corner to the Centre of the elbow. It passes along the soft muscle ridge up to the shoulder, and passes along the back of the neck to join into the eye and the ear.”|
|Anatomical pathway||A. This is the most medial of the three yang meridians, and starts on the little finger. It passes along the arm on the extensor surface of the forearm as the basilic vein. B. It joins with the cephalic vein as the median cubital vein in the elbow, and continues along the edge of biceps brachii to the shoulder as the cephalic vein. C. It progresses up along the neck as the external jugular and branches to the eye and ear as the auriculotemporal vein.|
In the text above (and the Supplementary Information), we have shown how the text of the Mawangdui medical manuscripts maps onto the structures visible in a human cadaver. We propose, based on the close alignment we find between body and text, that the pathways the Mawangdui describes are not esoteric. Instead, they represent the earliest surviving anatomical atlas, designed to provide a concise description of the human body for students and practitioners of medicine in ancient China.
In keeping with the philosophical and social structures in which they were created, these pathways do not describe the body the way we would today. Instead of being viewed as a series of systems linked by functional relationships, the Mawangdui meridians divide the body into yin and yang, and within that, into greater and lesser and sometimes other categories (jue or “hidden,” and ming or “bright”). In many cases, the difference in perspective and priorities leads to clear distinctions between how we would interpret structures today and how they were understood in ancient China. As just one example, for the writers of the Mawangdui a pathway could transition from one “type” of structure to another provided it remained yin or yang as appropriate, while for a modern anatomist, linking (say) vein and muscle or fascial tract and artery as part of the same structure would be incomprehensible.
The yin/yang distinction seems to be the primary component of the Mawangdui divisions. Modern medicine has a systematic means of naming bodily structures which was codified in the Nomina Anatomica (Subcommittees of the International Anatomical Nomenclature Committee, 1989), but prior to this there was much more variation in Western naming conventions too. A modern anatomist reading Galen, Herophilus or Erasistratus would need a new paradigmatic lens, albeit perhaps a more familiar one, just as one does for reading the Mawangdui. Nevertheless, we can clearly see specific pieces of anatomy reflected in the Mawangdui manuscripts, and this greatly strengthens our interpretation of these texts as anatomical atlases. The multiple connections in foot tai yin are clearly the perforating veins, which are consistently present but sufficiently well‐hidden and specialized that many major anatomical atlases (Abrahams, Marks, & Hutchings, 2003; Drake, Vogl, & Mitchell, 2010) we use today do not give their names. Likewise, the descriptions of the branch of the latissimus dorsi to the humerus, or of arm shao yang running in the deltopectoral groove, are too closely aligned to anatomical reality to plausibly reflect the work of physicians who have never seen the dissected human body.
That said, there remain places in the Mawangdui where multiple interpretations are possible for a single pathway. The process of identifying the most likely anatomical structures to fit the texts was often confusing, and the subject of considerable debate between the authors. The meridians described in Mawangdui are in some cases very similar to the modern acupuncture meridian pathways (e.g., yang ming), but in other cases they are distinct from their modern counterparts (e.g., the arm vessels named tooth, shoulder and ear). Knowledge of the modern meridian pathways therefore sometimes aided the process of identification, but also created an unconscious bias of expectation of similarity and congruence. In order to maintain objectivity, we avoided giving the meridians their commonly used and more familiar names which are associated with organs, for example, bladder, kidney, stomach etc. Instead, we only referred to them by their Chinese name, as we have in this article. New translations or interpretations may yet change our understanding, and we welcome the prospect of future developments. We propose that the multiple texts in the Mawangdui compendium, and remaining discrepancies between them, most likely reflect the fact that the authors were engaged in ongoing conversation about the body and its function. This would further suggest that there was a progression in efforts to map the body that was supported by the Han Imperial Court, as scientists would require access to executed criminals to do this work.
We have already highlighted the many ways in which the Mawangdui manuscripts appear similar in form to the more familiar texts by contemporary ancient Greek anatomists. Disagreement between authors in print, the existence of multiple versions of a text, wholesale copying, extensive commentary, and distinctive world‐views all appear in both, and support our drawing analogies between them. Interpreting these features as indicating the existence of ongoing scientific discussion and debate, in a social context where bodies were rare commodities and socio‐political support was required to make anatomy respectable, would make sense of the fact that both seem to reflect similar working contexts. The Mawangdui manuscripts later became subsumed into the Neijing, which also describes acupuncture points. We have argued elsewhere that these also have anatomical correlates (Shaw & McLennan, 2016) and reflect an intimate knowledge of the interior of the human body.
To conclude, in this article, we have demonstrated that the 300–200 BCE Mawangdui medical texts represent the oldest surviving anatomical atlas in the world, predating Galen by about a thousand years. Reading these texts as anatomy rather than esoterica allows us exciting new insights into the history of acupuncture and medicine, as well as access to a view of science and the world that has been largely hidden since they were sealed away. This new knowledge will also have a major impact on the design of scientific research investigating the mechanisms for acupuncture by demonstrating that acupuncture was originally an anatomical science.
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