Why Do Old People Get Shorter?

Introduction

Adults start losing height in their 30s, due to many factors that lead to the deterioration of bones, muscles and joints. By age 70, a person has lost approximately 4cm; after age 70, height decreases at a significantly faster rate (Harvard). The rate of decrease in height is greater in women than in men (see figure 1).

Height changes normally occur along the trunk and spine. As there are no significant changes in the long bones of the arms and legs, height loss is primarily caused by shortening of the trunk and spine (A.D.A.M.).

Bone Deterioration

Both compact bone and spongy bone continue to be replaced in a process called remodeling. “Normally bone remodeling involves a process whereby old bone resorption is balanced by new bone formation, with (at least theoretically) no net loss of bone tissue” (Kiebzak p.173). But as people grow old, the remodeling sequence becomes dis-aligned, which means that resorption continues at the same rate as before but the speed of formation slows down, causing bone turnover to decrease, so that by about age 40 there is proportional bone loss as osteoclastic activity exceeds osteoblastic activity (Christiansen & Grzyybowshi, p.58).

Mineral-associated proteins, which exist in the extracellular matrix of the bone tissue, decrease with age. “Circulating levels of calcitonin may decrease with age and the calcitonin reserve may be impaired in the elderly” (Kiebzak p.178), and if so this would contribute to the degeneration of bone mass.

Loss of bone mass can lead to vertebral fractures, causing kyphosis and resulting in the spine hunching over. This fracturing can occur in the thoracic region of the spine or within the whole vertebrae region (Harvard). This is caused by the over- mineralization of the bone, which in turn results in the “crystallinity of bone increase with age” (Kiebzak p.176). This change in turn leads to an accumulation of micro-fractures as “mineralized tissue develops tiny cracks as a consequence of critical mechanical stress” (Kiebzak p.175).

Muscle and Connective Tissue Atrophy

“Voluntary muscle strength declines significantly in older adults. One contributing factor to this strength loss is muscle atrophy developed in old age”. Yue, et al. found that “the ability to maximally activate the muscle decreases with age.” As inactivity is a known cause of muscle loss, this inability to fully utilise the muscles must contribute to their gradual loss in older people.

In the very old, many of the limbs often cannot be completely extended because of decreased ligamental flexibility. This lack of extension results in a permanent stooped appearance and accentuates short stature (Christiansen & Grzyybowshi, p.59). Foot arches also become less pronounced with aging, causing slight height loss (A.D.A.M).

Progressive loss of muscle depends on the specific muscle and how much it is used. This loss is manifested by a decrease in the number of muscle fibres and by their shrinkage (A.D.A.M). Muscle tissue is replaced more slowly, and the aging muscle fibres are replaced with fat and collagen. (Christiansen & Grzyybowshi p.80).

Joint Wear

The trunk gets shorter as the intervertebral disks lose fluids and bones get thinner. This leads to the compacting of the vertebrae, and shrinkage in stature. “Disc thinning occurs due to loss of fluid content, conversion of the nucleus tissues to a highly organized collagenous tissue, gradual ossification of the end plate and protrusion of disc tissue” (Aebi, Gunzburg & Szpalski p.18). This loss of fluids in the joints also contributes to the wearing out of the cartilages.

“Older adults experience some major changes in the articular system, particularly in the synovial joints. Elastin and collagen fibers in an joint become less flexible and tissue repair declines. The articular cartilage surfaces wear and decline because older adults are not able to replace cartilage as quickly as when they are younger” (Rizzo p.10).

This is all likely to lead to the knees and hips becoming more flexed as they begin to lose structure due to the degenerative changes (A.D.A.M).

Additional Factors

Activity: Mechanical loadings (i.e. high density physical activities) are considered perhaps the most important factors in shifting the remodeling balance in favour of bone formation in adults. It is found that weight-bearing exercises can increase bone mass in the elderly (Kiebzak, p 178). However, it is also found that participation in these activities significantly decreases with age. Research has also established that inactivity results in a shrinkage of bone and muscle density.

Diet: The diet of the elderly frequently lacks minerals and vitamins, especially calcium (Kiebzak, p.178). Malnutrition in the elderly is considered to be often under-diagnosed (Wells & Dumbrell p.1). Lack of nutrition preventing optimal body function, combined with a lack of energy and mobility, results in overall body deteriation and therefore height reduction.

Case Study

Laura, 73, has lost 57cm of her height in 45 years. She measured 172 cm at age 28 and now she measures 115cm. She had an hysterectomy at age 28 and noticed her height reducing at approximately age 35. Her shrinkage appeared to slow when she undertook Hormone Replacement Therapy at 50. However, in the past six years, there has been a large decrease in height and her posture has become stooped. Recently, she was found to have osteoarthritis in the cervical vertebra and underwent a spinal fusion. Her noticeable height loss after the hysterectomy and the slowing down of her height loss after starting H.R.T. indicate that in this case the height loss is likely to be related to hormone levels.

Conclusions

Aging is a complex and varied process. Most gerontologists feel that height loss with age is the cumulative effect of many factors, including genetic, environmental and cultural influences, nutrition, exercise and general lifestyle (A.D.A.M).

The decrease in height that people experience as they reach old age can be ultimately attributed to normal wear and tear on cartilage and spinal disks, which leads to the cartilage being worn away from joints (typically knee) and compression of the spinal disks. The resultant pain precipitates reduced muscle usage, beginning a deteriorative cycle of reduced muscle size, decrease in bone density, thinner bones, and pain and inactivity take hold, thus leading to the shrinkage most elderly people undergo. Women shrink more than men, however, due most likely to hormonal changes.

Regular exercise is one of the best ways to slow or prevent problems with bones, muscles and joints. Tai chi and yoga can help in maintaining or improving muscle control, body balance and posture.

References:

• Aebi M, Gunzburg R, & Szpalski M (eds). (2005). The Aging Spine. Springer – Verlag Berlin Heidelberg .
• Christiansen, J L & Grzybowski, J M. (1993) Biology of Aging. Mosby –Year Book, Inc.
• Cohen, Sandra W. (2006). Aging changes in the bones- muscles- joints. A.D.A.M Navigator, Online health information and services, URAC accredited Health website.
• Harvard Health Letter (2005). Standing Tall. Expanded Academic ASAP. Thomson Gale. RMIT University Library Online Database. Dec Issue 2.
• Kiebzak G M. (1991) Age-related Bone Change. Experimental Gerontology. Vol 26, pp171-187.
• Rizzo DC. (2006) Fundamental of Anatomy and Physiology, 2nd ed. Thomson Delmar Learning
• Sorkin J D, Muller D C & Andres R. (1999). Longitudinal Change In the Heights of Men and Women. Epidemiologic Reviews. Vol 21, No.2.
• Wells, Jennie L, & Dumbrell, Andrea C. (2006) Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clinical Interventions in Aging 1:1, 67
Yue, Guang H., Vinoth K. Ranganathan, Vlodek Siemionow, Jing Z. Liu, & Vinod Sahgal. (1999) Older adults exhibit a reduced ability to fully activate their biceps brachii muscle. The Journals of Gerontology, Series A 54.5, M249(5).”

Kidney Function According to Chinese Medical Theory

The main function of the kidney is to govern the growth and development of the body, via its vital roles in storing jing (essence) and dominating reproduction and development. The kidney is considered to be the congenital foundation of the body and its functions and, therefore, the kidney dominates growth and development (Cheng, et al. 1987, p. 32-33 & Dong, 2006, p. 34).

The primary function of the kidney is to store and control ‘essence’, or jing. Jing is the essence of qi and the basis for all body matter, such as the bones, the blood, etc., and much of the body’s operations. According to Chinese medical theory there are two types of jing that are required for the support and development of life; these are congenital jing and acquired jing, which are both stored in the kidney, and which together in the greater whole are known as kidney jing. Unlike qi, jing circulates in very long cycles (seven years for females and eight years for males) that govern the different stages of human development. The function of jing is to promote growth, development and reproduction, to provide the basis for kidney qi, to produce marrow, and to provide the basis for all of the body’s jing, qi and shen (mind). (Cheng, et al. 1987, p.32; Maciocia, 2005, p. 46 & Yin, & Shuai, 1992, p. 34).

Congenital jing comes from the parents and determines one’s basic constitution; it cannot be altered, although it can be positively influenced by acquired jing. Acquired jing is produced from food by the spleen and stomach and is then stored in the kidney and circulated throughout the body. Congenital and acquired jing have a promoting/ controlling relationship with each other and their interaction produces kidney jing; all three play a part in determining growth and development, sexual maturation and reproduction, and the aging process (Cheng, et al. 1987, p. 32 & Maciocia, 2005, p. 46).

Every new cycle of jing prompts a new cycle of human development. For example, congenital jing exists from conception, carrying on from the jings of the parents. Once the child is born, acquired jing is responsible for replenishing the congenital jing and starting the first independent jing cycle which, for the next seven years in girls and eight years in boys, will control the growth and development of the child. Then, when the child looses its baby teeth, its body begins a new cycle, that of pre-adolescence. The next jing cycle is then adolescence, when kidney jing matures and causes the ren meridian to open and flow. At this time, part of the kidney jing transforms into tian gui, which develops and maintains reproductive function; hence the kidney is considered to dominate reproduction. In the next stage the body finishes its physical growth, and eventually the decline of jing leads to the exhaustion of tian gui, thus extinguishing reproductive ability. Inevitably, the further decline of jing eventually leads to death. (Cheng, et al. 1987, p.32; Maciocia, 2005, p. 45-46 and Zhiya, Yanchi, Ruifu & Dong, 1995, p. 193-194).

All four of the kidney energy aspects are essential in the growth and development of the human body. The four aspects are kidney jing (essence), kidney yin (water), kidney yang (fire) and kidney qi. The ‘essence’ is cooked in the ‘water’ using the ‘fire’ to produce life-promoting ‘qi’. All of the body’s functions rely on the heat provided by kidney qi and the gate of life (the space between the left and right kidneys) (Maciocia, (2005), p. 49).

Kidney jing is the foundation of the yin and yang of all the body’s organs. Kidney yin and yang are the primordial yin and yang, and the root of yin and yang to all the zang organs. Kidney yin moistens and nourishes the whole body, while kidney yang provides warmth and promotes all of the body’s organs and tissue (Yin, & Shuai, 1992, p. 34-35). Kidney yang is the dynamic force necessary to start the body’s system of balancing water metabolism, which also employs the spleen, lung, liver and san jiao (Zhiya, et al.,, 1995, p. 194).

Of the five zang organs, the kidney is considered to be the water element. As it is the body’s water gate, it regulates the body’s water metabolism and the reception of qi. The foundation of yin fluid that nourishes and moistens the whole body is kidney yin. When the kidney receives fluid the qi of kidney yang divides it into to two types, clear and turbid. The clear fluid is sent upward through san jiao to moisten the lung and for the lung to distribute to the rest of the body, while the turbid fluid is sent downward for expulsion by the bladder. The water gate, as its name implies, is also responsible for regulating the opening and closing of the drainage ducts, namely the bladder and the anus, which rely on the activity of kidney qi. Also, while lung qi controls respiration in the body, kidney qi coordinates inhalation. (Cheng, et al. 1987, p.32, 34; Dong, 2006, p. 34 & Zhiya, et al., 1995, p. 194)

The yang (fu) organs transform food into pure, refined, vital substances that the yin (zang) organs then store. Being a zang organ, the kidney generates and stores qi. It is also responsible for the lustre of the hair, the production of bones and brain matter, the correct functioning of the ears, and the regulation of the opening and closing of the bladder and the anus. Mentally, the kidney is responsible for supporting memory, while emotionally it is linked to determination, or will power (zhi) (Dong, 2006, p. 29-30 & Maciocia, 2005, p. 93).

As stated in Giovanni Maciocia’s book, The Foundations Of Chinese Medicine: A Comprehensive Text For Acupuncturists And Herbalists, ‘At the basis of all is Qi: all the other vital substances are but manifestations of Qi in varying degrees of materiality, ranging from the completely material, such as Body Fluids, to the totally immaterial, such as the Mind (Shen)’. Congenital jing is the origin of the body’s qi. Qi is the energy that drives the body; it comes from primordial qi, which comes from kidney jing. Qi is replenished by the combined efforts of the stomach, spleen, kidney, and lung. This replenishment is achieved through the stomach’s and the spleen’s transformation and transportation of food and water, and also through clear qi taken into the lung from the air; both come together in the kidney and interact with the kidney jing to provide qi for the whole body. Essential qi is stored in the kidney and derives from the combination of both congenital and acquired jing. Essential qi, which comes from the parents, provides the body’s basic matter and is the basis for all growth and development of the body. During childhood, essential qi is in development, as is the child, and henceforth qi mirrors the development and decline for the entire human life cycle. For all these reasons, Chinese medicine considers the kidney to be the root of qi. (Maciocia, 2005, p. 49; Zhiya, et al., 1995, p. 193-194 & Yin, & Shuai, 1992, p. 34-35, 50-51, 53).

In Chinese medicine the kidney is the key to human growth and development because it is the root of all qi and jing, and is, therefore, the impetus for all of the body’s ability to grow and develop. As qi and jing develop and decline, so does the human body’s development and abilities, for qi and jing are the essential energies of life.


Bibliography

Cheng, X.-n., Deng, L., & Cheng, Y. (Eds.). (1987). Chinese Acupuncture And Moxibustion. Beijing: Foreign Languages Press.

Dong, Lin (2006). Lecture Notes For COTH2140 Chinese Medicine Theory 1 History Of Chinese Medicine Component. RMIT University: Bundoora West.

Maciocia, G. (2005). The Foundations Of Chinese Medicine: A Comprehensive Text For Acupuncturists And Herbalists. Philadelphia, MA: Elseverier Churchill Livingstone.

Zhiya, Z., Yanchi, L., Ruifu, Z. & Dong, L. (1995). Advanced Textbook On Traditional Chinese Medicine And Pharmacology (Vol. I) . Beijing: New World Press.

Yin, H.-h., & Shuai, H.-c. (1992). Fundamentals Of Traditional Chinese Medicine. Beijing, China: Foreign Languages Press.

Face Recognition Developmental Trends in 6-, 10- and 18-year-olds

Abstract
The aim of this study is to show an overall increase in face recognition developmental trends, and determine if there is a significant difference in the ways children and adults encode and recall face recognition information. It is hypothesised that 10-year-olds will correctly recognise a greater proportion of upright faces than will six- year-olds, and that 18-year-olds will correctly recognise a greater proportion of upright faces than 10-year-olds. It is also hypothesised that 10-year-olds will not correctly recognise a greater proportion of inverted faces than will six-year-olds, and that 18-year-olds will not correctly recognise a greater proportion of inverted faces than 10-year-olds. It was also predicted that 10- and 18-year-olds will recognise a greater proportion of upright compared to inverted faces, and six year olds will not correctly recognise more upright than inverted faces. All three hypotheses are supported; however, there is an unexpected over-all increase in the proportion of correctly recognised inverted faces between the ages of six and 18 which suggests that, although previous studies have found no increase in inverted face recognition across such an age-range, perhaps it does exist.
The aim of this study is to show an overall increase in face recognition developmental trends, and determine if there is a significant difference in the ways children and adults encode and recall face recognition information. The results will enhance our understanding of this seemingly specialised aspect of memory encoding and recall.

Although infantile amnesia is a common phenomenon, there is abundant proof that from the moment of birth there exists implicit memory, as well as the beginnings of explicit memory (Westen, Burton & Kowalski 2006, pp. 478). Turati, Cassia, Simion and Leo (2006) report that newborns have face recognition abilities. One’s ability to process and store memories seems to increase during the growth and development period. (Westen, et al. 2006, pp. 478).

There is little difference in the ability of children aged under 10 between recognising photographs of unfamiliar faces, whether inverted or not; unlike people aged 10 or over, who exhibit difficulty in recognising inverted faces (Carey & Diamond, 1977). Carey and Diamond (1977) offer direct evidence that 10-year-olds do not use isolated facial features in attempts to recognise faces, whereas six-year-olds rely heavily on this form of encoding. They suggest that the reason for this is because children under 10 have not developed ‘the ability to encode orientation-specific configurational aspects of a face’ yet, which forces them to focus on specific aspects of a face in remembering it, and therefore they have difficulty recalling a face if a feature they remember, such as bushy eyebrows, has been disguised (Carey & Diamond, 1977). Carey and Diamond (1977) also found that people aged 10 and over encode spatial relationships among facial features. As an effect of this learned ability, between the ages of six and 10 recognition performance of upright faces improves dramatically, as apposed to recognition performance of inverted faces, which remains constant and is comparable to adult ability.

From age six there is a decline in the ability to recognise inverted faces, while the ability to recognise upright faces increases. Indeed, it has been shown that normal adults are able to recognise the faces of 90% of their classmates 35 years after graduation. This all seems to imply a loss of encoding ability. (Carey, et al. 1980)

Blaney and Winograd (1978) suggest that in the case of face recognition “… older children encode more features than younger children and that at both ages additional features are sampled when judgments of niceness are demanded.” Investigation of facial judgement with regards to likeability indicates support for the assertion that children lack the capacity, rather than the ability, to encode upright faces as efficiently as adults (Carey et al. 1980). Carey, Diamond and Woods’ (1980) study suggests that only a five second viewing is required for an adult to encode a face, whereas it takes a 6-year-old several minutes of exposure to different facial variants, such as angle and expression.

Given these previous studies it is hypothesised for this study that 10-year-olds will correctly recognise a greater proportion of upright faces than will six-year-olds, and that 18-year-olds will correctly recognise a greater proportion of upright faces than will 10-year-olds.

It is also hypothesised that 10-year-olds will not correctly recognise a greater proportion of inverted faces than will six-year-olds, and that 18-year-olds will not correctly recognise a greater proportion of inverted faces than 10-year-olds.

It was also predicted that 10- and 18-year-olds will recognise a greater proportion of upright compared to inverted faces, and six-year-olds will not correctly recognise more upright than inverted faces.


Method

Participants
A total of 75 participants were recruited by experimenters at La Trobe University, Melbourne, of which 25 were six-year-old children, 25, 10-year-old children and 25, 18-year-old adults. The sex of the participants was uncontrolled, for this variable has been found to not influence performance in face recognition.

Apparatus
Apparatus included a set of 40 black-and-white photographs of faces, half each of either sex, cropped beneath the chin and taken against a uniform background with all distinctive cues eliminated to ensure uniformity. There were 20 target faces and 20 distracter faces, half each of either sex per grouping. These were divided equally into two sets, one upright and one inverted set. A slide projector and screen was used to present the faces.

Procedure
Two tests were administered to each participant, both the upright and inverted faces tests, with each test consisting of a familiarization phase and a recognition phase. Participants were told which orientation of the pictures they were to be presented and tested in. During the familiarization phase, 10 faces (five female; five male) were randomly presented for five seconds each. During the recognition phase, the 10 target faces were presented along with the 10 distracter faces (5 female: 5 male), all in a different, random order. There was no time limit imposed here; rather, the participants were required to note whether the face shown in each recognition phase was familiar or novel. The number of faces correctly identified from the target set for each condition (maximum 10) was recorded for each participant. The order of testing was counterbalanced across groups.


Results

Figure 1 shows that there is an increased ability to recognise upright faces across age groups, as there was found to be an overlap of less than half the margin of error between the age groups of 10 and 18, and no overlap in the margin of error between the age groups of six and 10.

Figure 1. Percentage of correctly recognised upright faces for each age group (with bars showing standard error of means)

Figure 2 shows an overlap of more than half the margin of error between the age groups of six and 10, and of 10 and 18, which indicates that there are no significant differences in the ability to recognise inverted faces between these age groups. However, there is slight overlap in the margin of error between the age group of six and 18, thus indicating an overall increased ability to recognise inverted faces between these two ages.

Figure 2. Percentage of correctly recognised inverted faces for each age group (with bars showing standard error of means)

Figure 3 shows that there was no difference in six-year-olds’ ability to correctly recognise upright and inverted faces, for the margin of error crossed 0. Conversely, the graph shows a significant difference in ability between the 10- and 18-year-olds.

Figure 3. Difference in the percentage of correctly recognised upright and inverted faces for each age group (with bars showing standard error of means)


Discussion

All three hypotheses are supported, although an unexpected over-all increase in the proportion of correctly recognised inverted faces between the ages of six and 18 is indicated. Previous studies found no increase in inverted face recognition across such an age-range; however, this study suggests that it may, in fact, exist, developing at an initially rapid rate in early childhood and then continuing development throughout life, only at a slower rate, thereby assuming a secondary role to the more reliable method of encoding that is spatial relationship encoding.

One limitation of this study is that a photograph can only represent a single view of a subject, which, as discussed earlier in relation to Carey, Diamond and Woods’ (1980) conclusions, may limit a child’s ability to encode a face. Another limitation is that imposed by the shifts in perception as people mature. To an 18-year-old, distinct facial features like a ‘stoned’ look provide a sense of familiarity, but a six-year-old’s interpretation of a purely superficial feature, like a big nose, provides little. Diamond and Carey (1977) found that “young children were not fooled by simple disguises if the photographs showed persons already highly familiar to them;” if the distinct features recognisable to an 18-year-old were absent would they do any better than a six-year-old, or would they, too, revert to encoding piecemeal, causing inverted faces to have little bearing on their recall accuracy? This absence of distinguishing features is, I believe, a contributing factor in the phenomenon of own-race face recognition bias.

So, there seems to be at least two factors involved in face recognition – the encoding of specific features, and the encoding of spatial relationships. This does not, however, explain the own-race face recognition bias, which, as Anderson (1999) points out, “… has been reliably demonstrated by innumerable experiments” and seems to indicate that there is more involved in the encoding of faces than the two aforementioned factors. It is my opinion that own-face recognition bias occurs because most people find the interpretation of emotion and character difficult in, what is to them, an unusual facial configuration, thus causing categorisation conflict in the encoding of the face. This encoding conflict probably has something to do with six-year-old children’s inability to recognise new faces from a photograph, where they do not possess enough information to categorise it except in a very superficial, piecemeal fashion. This is in accordance with Blaney and Winograd’s (1978) study, where they showed that the accuracy of memory recall increased across all age groups when faces were judged in terms of ‘niceness’.

It would be interesting to undertake a study on face recognition of upright and inverted faces using photographs of different race faces, to ascertain how the encoding would then work.


References

Anderson, Justin Lee. (1999). Determinants of accuracy in cross-racial identification [Electronic version]. Ann Arbor, MI: UMI Company.

Blaney, R.L., & Winograd, E. (1978). Developmental differences in children’s recognition memory for faces [Electronic version]. Developmental Psychology, 14, 441-442.

Carey, S., & Diamond, R. (1977). From piecemeal to configurational representation of faces [Electronic version]. Science, 195, 312-314.

Carey, S., Diamond, R., & Woods, B. (1980). Development of face recognition – A maturational component [Electronic version]? Developmental Psychology, 16, 257- 269.

Chiara Turati, Viola Macchi Cassia, Francesca Simion, & Irene Leo. (2006). Newborns' Face Recognition: Role of Inner and Outer Facial Features [Electronic version]. Child Development, 77 (2), 297.

Graham, Reiko & Cabeza, Robert. (2001). Dissociating the Neural Correlates of Item and Context Memory: An ERP Study of Face Recognition [Electronic version]. Canadian Journal of Experimental Psychology, 55 (2), 154-161.

Westen, D., Burton, L., and Kowalski, R. (2006). Psychology: Australian and New Zealand Edition. Milton, Qld: Wiley

Old World Disease in the New World

Final word count: 1,550 of 1,500 limit

• Why did the New World peoples succumb to Old World disease and what was distinctive about their own diseases ecologies? Discuss in reference to the Americas.
• How different might history have been had human beings suffered from the same diseases the world over?


In Plagues and People, William H. McNeill states that the ‘…Amerindian population on the eve of the conquest [was] at about one hundred million…’ Evidence of this large population derives from the great structures that required a large human workforce, such as the Mounds of North America and the monuments left by the Aztecs of Central America and the Incas of South America; there are also firsthand accounts from explorers like de Soto and Columbus, and a broad scattering of archaeological evidence across the Americas. However, 50 years after Cortez’s arrival at Mexico the population had shrunk to one tenth of its former size. (McNeill 213; Crosby 210, 211, 212 and Cook 19)

Old World endemic diseases played the starring role in the destruction of the Amerindians, as these peoples had no acquired resistances to Old World diseases. This, observes William H. McNeill, ‘… acted to tip the world balance sharply in favour of the civilized communities of Eurasia.’ (McNeill 215, 218, 225)

The modern disease regime, and hence modern civilisation, derives from the fact that disease experienced peoples flourished while disease inexperienced communities were destroyed. Limits on food supply and on any given community’s ability to adapt to its environment were also important factors. (McNeill 233)

Because Europe ‘grew up’ with disease there had been time to adjust socially and epidemiologically to each disease as it appeared; William H. McNeill states that ‘…the more diseased a community, the less destructive its epidemics become.’ (McNeill 231) Yet, as the Amerindians had no experience with most of Eurasia’s diseases, and the bombardment they underwent was, as David Stannard writes, ‘…synergistic, not merely additive,’ the synergistic effect was devastating, for it not only wiped out masses of the population but also demoralised the Amerindian society. (Stannard 319; McNeill 215)

Amerindians had no diseases to share with the Old World that had any comparable depopulating impact with diseases that the Old World would share with them, even if yellow fever and syphilis did originate from the Americas, which, with no conclusive evidence on either side, is debatable. (McNeill, pp. 208, 227)

Once introduced to virgin soil, the ability of many diseases to quickly reproduce allows them to spread a chain of infection quickly across large geographical areas despite the lack of large enough populations to maintain them for long durations. (Crosby 196 and McNeill 219) As Alfred Crosby points out, people in the prime of life are most susceptible to foreign disease, for the vital nature of their bodies is to ‘…overreact and smother normal body functions with inflammation and edema.’ (Crosby 199)

The diseases of the Amerindians included encephalitis, hepatitis, pinta, polio and yaws; however, they were without amebic dysentery, bubonic plague, chicken pox, cholera, dengue fever, diphtheria, influenza, malaria, measles, scarlet fever, smallpox, typhoid fever, trachoma, whooping cough and a number of helminthic infestations. (Crosby 197-198)

Smallpox was the first Old World disease to arrive and thus spread destruction throughout the New World. Its affects on the Amerindian populations was particularly severe, for not only did it produce a death rate of from 25% to over 50%, but its transmission by breath made it highly contagious, and its 10-14 day incubation period allowed seemingly healthy victims time to flee and carry it to new communities. (Crosby 200, 201)

Measles was the second to arrive and second only to smallpox in the devastation it caused the Amerindian populations. (Stannard 314) Next, in 1546 there came a new disease that was probably typhus, followed in 1558-1559 by influenza, which killed many in both the Old and New World. In Europe the death rate was 20% and, although there are no statistics for the Americas, it can be assumed that because it was a virgin land the death rate would have been at least as severe. (McNeill 216-218)

Along with the immediate distraction smallpox causes, it also has a lasting affect on populations because it kills pregnant women in unusually high numbers and the surviving pregnant women suffer an infant mortality rate of at least 50%. Also, as David Stannard delineates, ‘…the single most important cause of male sterility – obstructive azoospermia – is cased by smallpox.’(Stannard 315)

The introduction of malaria affected the whole tropical zone of the Americas. It affected settlement patterns and, along with yellow fever, reduced the numbers of Europeans and completed the eradication of the Amerindian peoples, especially those of the Caribbean. Surviving European entrepreneurs then found a lack of slave labour and felt compelled to start importing slaves from Africa, who seemed to have, as William H. McNeil states, an ‘…epidemiological advantage in resisting malaria…’ (McNeill 219, 221, 223)

As David Stannard suggests in his article Disease and Infertility, the introduction of diseases from the Old World to the New not only killed many people but, also, its adverse affect on reproduction sent populations of indigenous people spiralling down unrecoverably. The subject of David Stannard’s article is Hawaii’ s experience with disease invasion but he argues that it is reasonable to assume that Amerindians would have suffered a similar reproductive experience. The alarming birth to death ratio, even in the non-epidemic years where the median crude death rate was 4.73% to a birth rate of 1.93% of the population, shows a total population decrease of 2.8% which left the population in 1860 at half the size it had been a mere 30 years earlier. The main contributors to this severe population decrease were: high infant and child mortality rates due to epidemic disease and congenital syphilis, where two thirds of children thus born, died; high rates of ectopic pregnancy, spontaneous abortion and sterilisation due to infection from gonorrhoea and sexual transmitted syphilis (which although in debate, is highly unlikely to have effected Amerindians pre-invasion); the STD (sexually transmitted disease) related side-effect of pelvic inflammatory disease, which would have caused 60+% of female sufferers to become sterile; epididymitis in men would have left 50-80% of sufferers sterile; and there would have been less incidence of sexual intercourse due to extreme coital pain in those with gonorrhoea. (Stannard 305-312)

Europeans noted that Amerindians living on the west coast of North America in the late 18th century suffered under the weight of much sexually transmitted disease, which shows that STDs had become endemic among Amerindians since the European invasion. (Stannard 317)

As David Stannard states, ‘…stress – in the terrifying face of apparent ongoing genocide – was greater among native peoples than most modern American or Europeans can even imagine’; and as stress is a major disruption to neurohormonal transmittion, which is critical in reproductive ability, it would have only served to accelerate the genocide. (Stannard 318-19)

From both the Europeans’ and Amerindians’ points of view the evidence was conclusive: God was punishing the Amerindians. It seemed to both sides that the Europeans had, as William H. McNeill puts it, ‘… divine approval for all they did.’ After all, when disease struck it decimated Amerindian populations while leaving the Europeans virtually untouched. (McNeill 216-217) Perhaps the most damaging consequence of these entrenched religious beliefs was the willingness of the Amerindians to accept the authority of anyone ‘…who spoke with a loud voice and had white skin…’, which reinforced social hierarchies and oppression to the advantage of the Europeans. (McNeill 217)

The staple Amerindian diet of maize and potatoes produces a large amount of calories per acre, so by the 15th Century South and Central American populations had surpassed the population requirements to sustain ‘civilised’ diseases. However, because the population was so dense in most areas that hunting was not possible, they were basically an agricultural people. The lack of domesticated animals meant that environmental famine would hit hard; therefore, as archaeological evidence suggests, the periodic disease and epidemic deaths Amerindians suffered was related to famine, not ‘civilised’ disease. The most likely reason for the absence of ‘civilised’ disease in South and Central America is the lack of wild animals necessary to infect and carry animal diseases between domesticated herds, and thus the spread of disease was greatly reduced, allowing significantly less opportunity for cross-species contamination. (McNeill, pp 209-212) In North America there were simply no domesticated animals and, therefore, no opportunity for cross-species contamination. (Crosby 210)

I propose that Europeans would not have been able to expand and, therefore, dominate the world so easily without the help of alien diseases. A worldview of co-existence probably would have been dominant earlier in history, for genocide would have been virtually impossible without this help. Technology would have probably been a much more highly valued commodity because it would have been the only commodity apart from wide food availability, and hence a population surplus, that gave one people the edge over another. The Amerindians had greater food availability than the Europeans and were it not for disease they would have easily beaten Cortez and gained the means of travel in the form of ships and horses, which in turn would have at least lead to trade and thus the acquirement of knowledge. Lack of transport seems to have been the only thing holding the Aztec and Incan Empires back; had not disease devastated them we could have the Aztec or Incan Empire where today the United States Of America’s Empire holds. How different would U.S. history be if disease hadn’t swept through Massachusetts Bay in 1616-1617, killing a good deal of the Amerindians there, and undoubtedly demoralising the rest, just three years before the Pilgrims landed at Plymouth Rock? After all, it was the Amerindians’ kindness and charity that allowed the Pilgrims to survive and prosper, thus encouraging more foreign settlers. (McNeill 219)

Bibliography

Cook, Noble David, Born to die: disease and New World conquest. 1492—1650, Cambridge University Press, Cambridge 1998.

Crosby, Alfred W., Ecological Imperialism: the biological expansion of Europe, 900-1900, Cambridge University Press, Cambridge 1986.

McNeill, William H., Plagues and Peoples, revised (ed), Anchor Books, New York 1998.

Stannard, David E., ‘Disease and infertility: a new look at the demographic collapse of native populations in the wake of western contact’, in Kenneth F. Kiple and Stephen V. Beck eds, Biological Consequences of European Expansion, 1450-1800, Ashgate/Variorum, Aldershot and Brookfield, 1997.

Ecological History of Humankind - Confluence of the Disease Pools

Final word count: 1,600 of 1,500 limit

• What does McNeill mean by the confluence of the disease pools of Eurasia?
• How did this place other parts of the world at risk and from what diseases?
• Trace the trade routes and human travel that could have spread disease?
• Describe Mongol society during the great Mongol empire. What were the secrets of its military success?


In 500B.C. there were four disease pools - China, India, the Mediterranean and the Middle East - each distinct, due to climate differences and the separateness caused by their limited mobility. Populations outside or on the fringes of these civilisations were too sparse, small and immobile for disease to spread from pool to pool. (McNeill, 1998, p. 94-160)

At the beginning of the Christian era the four disease pools started gradually converging, through cross-cultural exchange via ships and the Silk Road. (McNeill, 1998, pp. 94-160) This latter, traders had begun forging in the Chinese province of Xinjiang, and it grew to run along the south edges of the Takla Makan and Transoxiana deserts from oasis town to oasis town, then forking off to the west Roman Empire and across the Hindu Kush to the Indus plains. (Curtin 1984, p. 94, 101) So, it were the trade routes that facilitated the convergence of the four pools by about A.D.1200. (McNeill, 1998, pp. 94-160)

Of the four disease pools, the Middle East was the oldest and most stable; epidemic diseases date back to 2000B.C. according to Biblical references, and both microparasites and human parasites (i.e.: the ruling classes) had stabilised by 500B.C. From Persian philosopher/ physician, al-Razi (ninth century A.D.), we encounter the first unambiguous description of infectious diseases like measles and smallpox. (McNeill, 1998, p. 94-160)

The next most well-adapted region to disease was India. Despite the unreliability of contemporary medical records, it can be logically determined that because of its warm, wet climate India’s ecosystem offered rich opportunities for the proliferation of communicable diseases. This indicates that people living on the sub-continent experienced a heavy load of infestation and infection from non-human parasites. Diseases such as smallpox, bubonic plague and cholera may have come from India through cross-species contamination; for example, black rats, carriers of bubonic plague, are native to India. Although India is not as biologically hazardous as Africa (there is no evidence of the sleeping sickness or waterborne infections of the alimentary track that kept Africa’s population too sparse to become a disease pool), classical Indian civilisation took form under climatic and disease conditions that were too much for the early Chinese to bear. (McNeill, 1998, p. 94-160)

Due to China’s cool, dry, northern climate it was less disease experienced than India but its warm wet southern climate gave it more disease experience than the Mediterranean. Because of the climatic differences there was a sharp rise in the disease gradient from north to south, the result of which was prevalent southern diseases such as malaria, bilharzia, dengue fever and schistosomiasis, and hence it took 1000 years longer for Chinese civilisation to establish in the south than in the north. Northern China’s cold climate was unfavourable to microparasites and waterborne diseases, and because the staple diet of rice is an high calorie food the diseases that did exist did not prevent population growth. Jared Diamond suggests that, because pigs were domesticated early in China, it is likely that influenza actually came from China. (Diamond, 1999, p. 330). Evidence suggests that in the north stability between disease and human population was reached by 500B.C., and because Confucian culture strenuously restrained arbitrary or innovative use of power a stable balance between the parasitic ruling classes and peasants was achieved in 300B.C. and lasted until A.D.1900. (McNeill, 1998, p. 94-160)

The Mediterranean disease pool was the least experienced due to its temperate climate and sparseness of population and therefore diseases required sea travel to get from one area to another, so needing a longer gestation period to be widely communicable. Also unlike the other pools, here the main crops (wine and olive oil) caused little land disturbance, and grain farming seems to have had little biological impact as it was confined mainly to regions where the grain was native. During A.D.5-11 the Mediterranean disease pool engulfed all of Europe, and as the climate in the rest of Europe was cooler the disease gradient diminished, thus facilitating population growth and colonisation. (McNeill, 1998, p. 94-160)

Between 460-377B.C. Hippocrates recorded mumps, malaria, tuberculosis and/or influenza and possibly diphtheria; he makes no mention of smallpox, measles or the bubonic plague, however. Records show that in A.D.165-180 a new plague (possibly smallpox or something ancestral thereto) in which a quarter to a third of the population died, in some places. A.D.100-300 seems the most likely period in which smallpox and measles established themselves in the Mediterranean. From Byzantine historian Procopius’ writings about the plague of Justinian in A.D.542-543, the bubonic plague can be confidently identified as that which killed tens of thousands in Constantinople; in the 16th Century medical scholars had identified measles and smallpox as distinct diseases. (McNeill, 1998, p. 94-160)

The macro-parasites (ruling classes) were so endemic here that they reached plague proportions in the form of Roman Imperialism. (McNeill, 1998, p. 94-160)

The Middle East seems to have been effectively the trade crossroads, as the most important east-west trade route in Eurasia ran from the Roman centre of Palmyra in Syria, then east to Babylonia and across northern Iran to Merv, then branching off south to the Indus Valley and further east along the Silk Road to China. The Middle East also linked India and Africa to the Mediterranean via the Red Sea or Persian Gulf. (Curtin 1984, p. 96) Sea trade from the Red Sea and the Persian Gulf to India, and from India to Southeast Asia, was established from the second century B.C. (McNeill, 1998, p. 94-160).

The west Indian Ocean’s winds were favourable for trade between southern India and the Middle East; during the warm season winds blow from the southwest and during the cool season, from the northeast. The trade-winds for sailing to and from India to Indonesia, China and Japan were equally advantageous. (Curtin 1984, p. 99, 101) By 200B.C. Asoka, ruler of India, had unified most of South Asia and was trading, and spreading Hinduism, throughout via sea and land. By the Christian Era Indian traders were taking advantage of the Indian Ocean trade-winds, the Silk Road and the route from northeast India across the mountains of eastern Bengal to Burma and on to China’s Yunnan Province. (Curtin 1984, p. 90, 101-102)

McNeill states that the bubonic plague penetrated the Mediterranean either from Central Africa or northeast India via the sea trade of the Indian Ocean and the Red Sea. (McNeill, 1998, p. 94-160)

By the second century B.C., China had begun forging the Silk Road and trading with the surrounding barbarians. Its land and sea trade routes gradually developed a cross-cultural trade that continued into the 18th century. By the first century A.D, China’s trade with India was extensive and trade between China and Rome was well established. (Curtin 1984, p. 91-93)

China and the Mediterranean were at the far most, opposite ends of the trade routes. Trade with and within the Mediterranean was extensive as the Mediterranean was dependent upon transport and barbarian society for food and slaves. War was profitable; when losses occurred they were relatively easy to overcome and winning expanded the empire to encompass new populations of workers, slaves and supplies. (McNeill, 1998, p. 94-160)

Contemporary accounts confirm that smallpox and measles arrived in China overland from the North-West in A.D.653 They also cite the arrival of bubonic plague via sea in A.D.610 and A.D.640. There are also accounts of the plague claiming half the population of both Shantung province in A.D.762 and Chekiang province in A.D.806. (McNeill, 1998, p. 94-160) As trade between the disease pools increased, so too did cross-contamination between them, but the final event that sealed the confluence of the four pools into one was the forming of the Mongol empire.

The Mongol empire was founded by Genghis Khan (1162-1227) in 1206 and became the largest continuous empire in world history (see figure III). Historian R. J. Rummel estimates that 30 million people were killed during the Mongol empire and that the population of China fell by half in merely fifty years of Mongol rule (Rummel, 1997, p. 64). Besides the fact that the Mongols were ruthless warriors, part of the reason for this mass loss of life was that this empire not only opened trade routes through the Eurasian steppes where, as David Christian states, ‘…the plague bacillus had long been endemic…’ (Christian, 1998, p.426), but also because the Mongol empire made overland travel fast and predatorily safe throughout, thus encouraging unprecedented traffic from one side of Eurasia to the other.

Being nomadic horse-herders, the Mongols had a mobile advantage over the sedentary 12th century Eurasian civilisations and they were able, therefore, to quickly conquer most of Eurasia. The military success of the Mongols was in fact dependent on them being great horsemen and tacticians. Horses not only provided speed but the Mongol’s diet largely comprised horses’ milk, meat and blood, thus providing them with protein-rich staples. The Mongols also ate any kind of meat from mouse to, in desperation, human. (Christine, 1998, p. 419-421) However, while horses were key to the Mongol empire they also rigidly bound it through a lack of suitable grazing land beyond empirical limits.

Mongol government ensured ruling class loyalty from hostage taking, army numbers, income revenue taxes, excellent communication via the yam (post-horse system) and easy travel with safe, clear roads. (Christine, 1998, p. 417)

Although Mongol society was patriarchal, women were valued as important members in both work and decision-making. The Mongols had a very tolerant religious outlook; as Mongke Kahn once said, “…God gave different fingers to the hand so has He given different ways [religious paths] to men.” (Christine, 1998, p. 425) They were also absorbtive learners who took ideas and technology from every contact and spread them throughout Eurasia. (Christine, 1998, p. 426)

Ultimately, the Mongol empire proved a violent explosion of cross-cultural interaction that facilitated world knowledge and ensured the confluence of the disease pools.


Bibliography

Christian, David, A History of Russia, Central Asia and Mongolia, Blackwell, London 1998.

Curtin, Philip, Cross-cultural trade in world history, Cambridge 1984.

Diamond, Jared, Guns, Germs and Steel, W. W. Norton, New York 1999.

McNeill, Plagues and Peoples, revised (ed), Anchor Books, New York 1998.

Rummel, R. J., Death by Government, Transaction Publishers, Somerset 1997.

Central Ideas of Samkhya

Topic: Explain and critically evaluate the central ideas of Samkhya.

The Hindu Orthodox school of Samkhya’s main concern is the operation and physical nature of the cosmos and, therefore, the nature of cause and effect. Samkhya is a dualist philosophy because it divides the nature of the cosmos into two separate cosmic categories, which are both forms of ultimate reality, namely purusha and prakriti. According to Samkhya, purusha is pure consciousness and prakriti is the physical matter of existence from which everything is made; this necessitates that both realities must co-exist and be eternal. Samkhya believes that variants in forms of matter are the result of eternal interaction of the three aspects, or gunas, of prakriti: sattva, rajas and tamas.

Cause and effect are, by definition, interrelated. The Samkhya school does not debate this but is concerned with which came first, the chicken (the cause) or the egg (the effect). Samkhya believes the egg did and that hence the effect of a cause comes first. Its supposition that cause exists derives from the idea that the effect of the existence of the world could not have been produced without the pre-existence of its cause. It argues that causality is simply a shifting of the existing eternal material of the prakriti into different forms. Therefore, Samkhya argues that causes and effects are essentially the same, differing only in the forms they take, concluding that effect necessarily pre-exists within cause. Furthermore, as John M. Koller states, ‘… that which is absolutely nonexistent cannot have a cause.’ (Koller 55, 57)

I disagree with this Samkhya theory. It seems logical to me that cause comes before effect because the effect of life is observably death, and that the cause of life is life itself, so in order for death to exist, life has to exist first. Applying this same reasoning it may also be assumed that both cause and effect have always existed – hence samsara. However, the relationship of cause and effect raises an obvious philosophical question: can something come from nothing? – can there be effect without cause? In the sensual world the answer seems to be no, but if it is no how did cause and effect come into being? Perhaps cause and effect do not, in fact, exist; after all, they have no structure but are just perceptual concepts of the human mind. I believe that cause and effect do exist because events occur around me and to me, some of which I can control through the manipulation of what I perceive as causes. I can even make chain reactions of cause and effect predictably occur. For example, staying up all night causes me to become too tired to go to university, so I miss lectures and generate failure. I can, however, alter the chain of events to produce a different effect by changing the effect’s cause; I can go to bed early, awaken in time for university, attend lectures and pass my subjects. In summary, I agree that cause and effect do exist but that cause comes before effect.

As Samkhya is dualist the most basic philosophical question is: what is the relationship between Samkhya’s cosmic categories, purusha and prakriti, and how do they interact? According to John M. Koller, Samkhya believe that there is no relation between prakriti and purusha except that created by ignorance. (Koller 59) Yet, before we explore this relationship it is necessary to know Samkhya’s definition of prakriti and purusha.

Parkriti and purusha are opposing forms of ultimate, independent and separate reality. Parkriti is the primordial material cause – observable, bound, constantly active. Due to the imbalance of its gunas, its nature is to transform cause into effect therefore facilitating evolution of the sensual world. The gunas of Parkriti are: sattva – maintains prakriti (produces pleasure); rajas – invigorates prakriti (produces pain); and tamas – stability and permanence of prakriti (produces indifference). Conversely, purusha is pure consciousness; responsible, by its mere presence, for destabilising the primary balance of the gunas and therefore setting in motion the evolutionary process of prakriti. It is isolated, free, indifferent, inactive, calm, a spectator; the ultimate Self of the individual; the ultimate purposer.

If purusha causes the imbalance of parakriti’s gunas which facilitates evolution there must be a connection between the two, even though they are opposites. I propose that this connection is like that of the fiery sun in its opposition to the aqueous earth. The sun, like purusha, is responsible by it mere presence for setting in motion the evolutionary process on Earth. It is stationary in its relation to Earth, free of the orbit that binds Earth to it, indifferent to Earth, like a cosmic spectator, and so far as the evolution of biological life is concerned the sun is relatively inactive. Earth, however, like Parkriti, provided the primordial material for life there-on and is bound by its orbit to a cycle of constant motion whilst abounding with the activity of life. The relationship between purusha and prakriti is like that of gravity which holds the Earth in orbit around the sun; by the sun’s presence gravity affects the elements of Earth so as to evolve life. It seems reasonable to surmise that, similarly, without some force connecting purusha and prakriti the gunas would never have been disturbed and hence the evolution of the sensual world would not have occurred.

Samkhya philosophers take into account the changing world and explain it with a theory of evolution, beginning with the presence of purusha, which caused the imbalance of the gunas (or threads) of prakriti: sattva, rajas and tamas. They believe that at the beginning of everything was a single primordial material cause; they conclude that this cause, prakriti, has the same nature as everything of the world of experience, and vice-versa, because obviously everything comes from prakriti. (Koller 57)

This seems reasonable to me, for western science even had eventually come up with a similar theory, ‘The Big Bang’, and so, although pre-existent of scientific study, the theory has scientific merit. Yet still they are all merely philosophical theories. A major problem I have with this theory is that, if prakriti and purusha are eternal and the mere presence of purusha disturbs the gunas so as to bring evolutionary prakriti into action, it seems contradictory. It seems to me that there must always have been a disturbance in the gunas and that, therefore, evolution must be an eternal process. Samkhya, however, discounts this idea, holding instead that there was a time when the gunas were in balance. I believe that this is a religious justification rather than a well-considered theory, for it seems that if evolution is eternal there can be no escape from it except through death, and yet if death is the escape then that negates the teachings of the Dharma Shastras and the Gita, and also inspires the question of why we don’t just suicide and prevent the hassle of life and the suffering which brings into question the point and meaning of life.

My current theory is that evolution is eternal and death is the ‘way out’ of suffering, and that if all the elements that create life come together by chance, the existence of life is perhaps the universal equivalent of winning the lottery. All the planets with numbers that come up win the ‘lottery’ for life; indeed, just look at the night sky to see evidence of the many ‘lotto tickets’ that the ‘Big Bang’ generated. What happens afterwards is simply a matter of course and, this being a somewhat egocentric view, the point of life becomes pleasure; although not narcissistically so, for we are endowed with an awareness of others and their egocentricities and I believe we must take this into consideration as much for our own enjoyment as for others’.

I doubt that all things share elements of one another because each so-called base element (e.g. potassium) seems to be a substance unto itself. However, this is ambiguous, for perhaps we human animals don’t possess the scientific or perceptual ability to recognise the ultimate proof that there are only three elements making up everything and that all things are, therefore, related to each other. With the ‘Big Bang’ theory science currently concedes that Samkhya has the ‘everything comes from one source’ theory correct, but I still find it unlikely that one small group of thinkers would arrive at the correct answer in this.

In Asian Philosophies, John M. Koller states that the Samkhya view holds that the ‘… evolution of prakriti regards the first transformation as an illumination of prakriti by purusha…’, and that the result is the illumination of intelligence. This intelligence becomes self-aware which results in the evolution of ‘… distinct individual beings …’; then the organs and senses come into being and lastly objects. (Koller 58)

Intelligence ordering the universe and regulating its cycles? I’m unsure about that. It seems to me simply the nature of the universe. Planets revolve around suns. Moons revolve around planets. The gravity of bigger cosmic bodies affecting that of smaller ones seems to have created the natural rhythms which require no intelligence; and were there an intelligence ordering everything, I theorise that it would be so far removed from we, as microbes living on a speck of dust, that we would be unable to perceive it.

Bibliography:

Koller, John M., Asian Philosophies, 4th ed, Sydney: Pearson Education Australia PTY. Limited, 2002.

A Concise Overview of the Development of Chinese Acupuncture

The history of Chinese Medicine begins in remote antiquity, with the Xia Dynasty (2220 – 1700BC) (Dong p. 8). At this time China entered into a slave society and the power of this new slave labour allowed social development and progress to forge ahead much faster than it was previously able to. Some of the advancements were that people started using fire domestically and also for the relief of pain, that they were making clothes to protect themselves from the climate, and that they began living in small, secure, sheltered communities (Zhiya, Yanchi, Ruifu and Lianrong p. 15-19). These peoples also developed skills in using ‘stone knives and scrapers to incise an abscess, drain pus and let blood out for therapeutic purposes’, and they discovered that symptoms of injury were relieved by specific positioning of sharp stones on the body which lead to the invention of the bian stone, the first acupuncture tool (Cheng p. 1; Dong p. 13). Around 2000BC, due to technical improvements in stone tool manufacturing, the bian stone became a specialised medical instrument for uses such as qi regulation (Cheng p. 1-2). Thus, one of the key developments in this era was the birth of the field of Chinese medicine.

By the Shang Dynasty (1700 – 1100BC) people had developed the theory of Yin-Yang based on observations that disharmony in the environment affects the body and can cause disease (Dong p. 13). The earliest evidence that acupuncture was practiced in China comes from remote antiquity, specifically the Shang Dynasty, from which written evidence of acupuncture has been found on bone and tortoise shell (Cheng p. 2). Archaeologists have also revealed evidence of the importance that the people of the Shang Dynasty placed on public health, with the discovery of sewage pipes, communal wells, and hieroglyphs depicting the importance of personal hygiene (Zhiya et al. p. 15-19).

A book called The Rites of the Zhou Dynasty contains evidence of the earliest medical system in China existing during the Zhou Dynasties 1100 – 2221BC (Zhiya et al. p. 15-19), in which physicians were sub-categorised as chief physicians, food physicians, internal disease physicians and veterinarians (Dong p. 14).

Around 541BC, in investigating the cause of disease, Yi He, a famous Shang physician, developed the idea of the six types of Qi that could cause disease: Yin, Yang, Wind, Rain, Darkness and Brightness (Dong p. 13).

During the Warring States Period (476 – 221BC) China underwent a social transition from a slave society to a feudal society (Cheng p. 2). According to the Advanced Textbook on Traditional Chinese Medicine and Pharmacology Vol. 1, the social upheaval that took place in this time created ‘an intellectual stratum’ that allowed the upper-class time and freedom enough to pursue philosophical and scientific questions (p. 21).

In acupuncture during the Warring States Period, as iron became more widely used, metal needles gradually replaced the bian stone (Cheng p. 2).

During the 3rd Century BC the most influential Chinese medical text was produced; it was called Huang Di Nei Jing or Inner Canon of the Yellow Emperor, and it provided the theoretical basis on which all traditional Chinese medicine was to be built (Dong p. 17). It was a summation of all of China’s medical knowledge, theory and practice to that date, and advocated moxibustion and acupuncture as essential therapeutic techniques. (Cheng p. 2). It was a book of philosophy, anatomy and physiology, pathology, diagnostic methods, and prevention and treatments (Xue p. 45-49). It applied Yin-Yang to explain physiological functions, it summed up the five Zang and six Fu organs using the Five Elements theory, it emphasised treating the body as a whole being, and it theorised on the twelve regular meridians and eight extra meridians (Dong p. 18-20).

At the beginning of the Christian era the four distinct civilisations of China, India, the Middle East and the Mediterranean, which represented four distinct disease pools, started gradually converging, through cross-cultural exchange via ships and the Silk Road. So, it was the trade routes that facilitated the convergence of the four pools by about AD1200 (McNeill p. 94-160).

The medical milestone of the Han Dynasty (206BC – AD220) was Zhang Zhong Jing’s book, Treaties of Cold Injury and Miscellaneous Diseases (196 – 204BC) (Xue p. 45-49). This book stressed the importance of combining acupuncture with medicinal herbs (Cheng p. 3). Zhang Ji saw that many doctors were irresponsible or poorly skilled and so he wrote his book to provide theory, methodology, formulas and pharmacy, and ultimately his text ended up providing the basis for clinical medicine. Treaties of Cold Injury and Miscellaneous Diseases sets out the principles for diagnosing disease based on an holistic approach to signs and symptoms presented by a patient, which is still used today (Xue p. 45-49; Dong p. 22).

From 265 to 581 war, chaos and turmoil prevailed, thus encouraging the Chinese people to practice acupuncture because of its effectiveness and convenience. To help promote general medical knowledge in this tumultuous period, Ge Hong wrote Prescriptions of Emergencies (Cheng p. 4).

In the period of the Jin, Sui and Tang Dynasties (265 – 959), China’s feudal society was at its zenith, bringing about rapid advancement in the area of medicine. Historic medical texts were revised and annotated. The establishment of different branches of medicine occurred during the Sui Dynasty, separating acupuncture into a field of its own (Dong p. 26; Cheng p. 4). The landmark book A-B Classic of Acupuncture and Moxibustion by Huang Fu Mi was written during the Jin Dynasty (265 – 420). Compiled from the classic texts, Inner Canon of the Yellow Emperor and Canon of Acupuncture and Essential of Points, it is an extensive work comprising 12 volumes and including 349 acupuncture points, and proved very influential in furthering the development of acupuncture (Dong p. 31).

Written in the Tang Dynasty (618 – 907) by famous physician Sun Si Miao, Essentially Treasured Prescriptions was the first medical-practice encyclopedia. It features a summarisation of historic clinical experience from 200BC to AD640 (and includes prescriptions still used today), as well as an extensive study of meridians from which he designed a coloured chart that illustrated their distribution, and it established medical ethics for practitioners (Dong p. 30; Zhiya et al. p. 38).

In 624 the Office of Imperial Physicians was established. It was a government-funded formal medical institute with four departments: medicine, acupuncture, massage, and pharmacy (Dong p. 32). Its acupuncture students were instructed in meridians, acupoints, sphygmology, and needling manipulation (Cheng p. 5).

During 907 – 1368, thanks to advancements in printing technology, medical literature became more widely available than ever before, which in turn prompted great advancements in the field of Chinese medicine (Cheng p. 5).

Wang Wei Yi, having reviewed the ancient texts and also having revised acupuncture points and their related meridians, wrote Illustrated Classic of Acupuncture and Moxibustion: Bronze Statue with Acupoint, which in 1026 he had carved into stone to prevent copying mistakes. He was also responsible for creating two life-size human figures of bronze that included internal organs for examination as well as engraved meridians and acupuncture points. These two achievements allowed acupuncture to be unified and standardised throughout China (Cheng p. 5; Zhiya et al. p. 56-57).

From 1041 to 1048 Yang Jie carried out autopsies on executed criminals and made illustrations with explanations of his findings. His drawings were quite accurate and reprinted in many later works (Zhiya et al. p. 41-42). He advocated the importance of anatomical knowledge in selecting acupuncture points (Cheng p. 6).

In 1341, after researching prior texts on acupuncture and previously recorded acupuncture sites that were located away from the fourteen meridians, Hua Shou wrote Exposition of the Fourteen Meridians. It provided detailed descriptions on the course of the meridians and made a new acupuncture category of extra points. (Cheng p. 5-6; Zhiya et al. p. 56-57).

The Mongol empire was founded by Genghis Khan (b.1162 – d.1227) in 1206 and became the largest continuous empire in world history. Historian R. J. Rummel estimates that 30 million people were killed during the Mongol empire and that the population of China fell by half in merely fifty years of Mongol rule, also known in China as the Yuan Dynasty (Rummel p. 64).

Besides the fact that the Mongols were ruthless warriors, part of the reason for this mass loss of life was that this empire not only opened trade routes through the Eurasian steppes where, as David Christian states, ‘…the plague bacillus [bubonic plague] had long been endemic…’, but also because the Mongol empire made overland travel fast and predatorily safe throughout the empire, thus encouraging unprecedented traffic from one side of Eurasia to the other which of course brought much cross-disease contamination (Christian p. 426). Ultimately, the Mongol empire proved a violent explosion of cross-cultural interaction that facilitated mass epidemics across Eurasia in the form of bubonic plague hence the main concern for physicians in the Ming dynasty was controlling febrile disease epidemics.

Wu Youke came up with a new theory of epidemic pathogenic factors, which appeared in his book Epidemic Pestilence. He came to the conclusion that there was another type of Qi not yet recognised that entered people through the mouth or nose rather than through the skin. This was a theoretical breakthrough and became a cornerstone of seasonal febrile disease diagnosis and treatment (Zhiya et al. p. 155).

During the Ming Dynasty extensive study was undertaken in the fields of acupuncture and moxibustion by specialists in acupuncture, which greatly developed and promoted this field. Some books of this era include: Xu Feng’s 1439 work, A Completed Collection of Acupuncture and Moxibustion, which was based on the summarisation of historical acupuncture texts; Wang Ji’s Catechism on Acupuncture and Moxibustion an academic discourse of the 20+ compound manipulation methods (1530); and in 1601 Yang Ji Zhou’s Great Compendium of Acupuncture and Moxibustion which was also a summarisation of historical acupuncture texts (Cheng p. 6).

Because herbal medicine became dominant during the Qing Dynasty and nobility somehow got the idea the acupuncture was below them, the academic study of acupuncture declined severely, although the general public still continued to use it (Cheng p. 6). Even though the development of acupuncture was impaired there were still some books published on acupuncture which included Liao Ren Hong’s A Collection of Acupuncture and Moxibustion (1874) and Cheng Dan An’s Chinese Acupuncture and Moxibustion Therapeutics (1931) (Dong p. 47). In 1822 the acupuncture department of the Imperial Medical College was abolished on the basis that “acupuncture and moxibustion are not suitable to be applied to the Emperor” (Cheng p. 7).

In 1840 Western medicine began to be introduced into China by Christian missionaries. In 1899 Liu Zhongheg took the first step on the path to combining traditional Chinese medicine with Western medicine in his book Illustrations of the Bronze Figure with Chinese and Western Medicine (Cheng p. 7).

Although traditional Chinese medicine had not been officially studied since 1822, the new Chinese government of 1914 tried to totally ban Chinese medicines by adopting measures to restrict its use; however the government’s dissidents had different ideas. In 1944 Chairman Mao Zedong, leader of the Chinese Communist Party gave a speech advocating the return to the practice of traditional Chinese medicine which started China back on the road of academic advancements in traditional Chinese medicine. In April 1945 the first acupuncture clinic was opened in a comprehensive hospital (Cheng p. 7).

Since the foundation of the People’s Republic of China, the Chinese Communist Party has paid great attention to inheriting and developing the legacy of traditional Chinese medicine and pharmacology (Cheng p. 8). At present in the field of traditional Chinese medicine there are 400,000 doctors, 1,500 hospitals, 1 million beds, 32 universities and 30 TAFEs (Xue p. 49).


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Cheng, X.-n., Deng, L., & Cheng, Y. (Eds.). (1987). Chinese acupuncture and moxibustion. Beijing: Foreign Languages Press.

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