The following is a syndicated post that first appeared at http://circulatingnow.nlm.nih.gov/2015/12/03/wrapped-in-flesh-views-of-the-body-in-east-asian-medicine/ See the original post for the images from the NLM collection that accompany the article.

How do you assess the state of a broken bone when you can’t directly see it? Writing in 1808, Chinese doctor Qian Xiuchang discussed a problem shared by healers world-wide prior to the X-ray age: “When someone has a dislocated or fractured bone, the bone and joint are wrapped in flesh. Looking at it from the exterior, it is hard to get a clear understanding, and there is the danger of making an error.” To improve the state of bonesetting knowledge, Qian compiled Supplemented Essentials on Medicine for Injuries (Shangke buyao). That book can be found in the collection of the National Library of Medicine and is now accessible online.

An innovative feature of Qian’s text is that it includes two drawings of the human skeleton, shown from the front and the back. Chinese medical texts had long included written descriptions of the body’s “bones” (gu), a term that included individual bones as well as palpable bony landmarks. These were particularly important in acupuncture, where practitioners used them as reference points to locate the spots where needles could be inserted. Some acupuncture diagrams also outlined the positions of major bones. However, prior to the nineteenth century, Chinese texts on therapeutic medicine did not contain diagrams of the full skeleton. In 1742, when the Imperial Medical Academy compiled a textbook on bonesetting, the illustrations only indicated the position of bones by labels on the outside of human figures. In 1770, however, the Qing imperial government promulgated a set of official inquest forms in order to standardize forensic investigations on skeletal remains. It was these forensic diagrams of the skeleton that Qian Xiuchang borrowed and reproduced in his work on treating injuries, so that readers could more easily learn the forms of bones hidden beneath the skin.

Qian Xiuchang, a native of Shanghai, had received some degree of classical education and he had presumably once aspired to success in the civil service examinations that defined members of the Chinese socio-political elite. He became interested in injury medicine after he broke his leg. He apprenticed with the doctor who cured him and eventually became successful enough to attract disciples of his own. Seven of them helped to collate his Supplemented Essentials, which discussed a wide range of traumatic injuries caused by weapons, blows, and falls. It also featured a laudatory preface from Su Chang’a, a former Shanghai magistrate who became a supporter after Qian saved the life of a prisoner who had attempted suicide.

It was an era when the Chinese were critically re-evaluating received teachings, including those on medicine. At the time that Qian’s text was printed, another doctor, Hu Tingguang, was completing his own manuscript on injury medicine and also incorporated forensic diagrams of the skeleton. Both books sought to address the shortcomings of the imperial bonesetting manual. Besides using forensic medicine—and diagrams of the human skeleton—to improve their readers’ knowledge of the bones, they also incorporated forensic teachings on “mortal points,” namely spots on the body where injuries were particularly dangerous.

Qian’s Supplemented Essentials thus leads us to consider an understudied aspect of East Asian medical history: how doctors investigated and understood the body’s material structures and components. The present-day view is that “traditional Chinese medicine” is primarily interested in the body’s energies and vital functions and not in anatomy or body structures. Historically, however, that was not precisely the case. East Asian healers argued about how to define the parts of the body and their relation to health, injury, and disease, and like Qian Xiuchang, pursued different methods for improving their knowledge of the body: textual study and introspection, the dissection and observation of corpses, careful observation of healthy and diseased people.

These issues took center stage at an extraordinary workshop. Held October 2-4, 2015 at the University of Michigan, Comparative perspectives on body materiality and structure in the history of Sinitic and East Asian medicinesbrought together an international group of scholars (including historian Michael Sappol of the National Library of Medicine) to discuss medical portrayals and practices of the body, from the first century A.D. to the nineteenth, in China, Japan, Korea, Vietnam, the Mongol Empire, and Tibet.

The workshop explored a number of questions. How did different representations of the body co-exist with each other within a given cultural context? The anatomical images and descriptions in Tibetan medical treatises, for example, included those based on examination of corpses as well as those elaborating humoral and vitalistic beliefs and those metaphorically comparing the body’s components to a palace or to a kingdom’s rulers and ministers . Different body views were linked to different explanations for how and why illness afflicted the body, and to different therapeutic methods.

Competing images of the internal organs circulated in China, Japan, Korea, and Vietnam, and were the subject of debates about how internal structures were connected to each other and to imagined centers of primordial vitality.

The conference also explored the status and value assigned to medical illustration compared to textual descriptions of the body, and how visual conventions from various realms of medicine influenced each other. In early nineteenth-century Japan, for example, both the bonesetting expert Kako Ryōgen (1810) and the surgeon Hanaoka Seishū (1760–1835) employed images in which the body’s flesh was transparent or invisible. Finally, the conference highlighted the historical importance of surgery, bone setting, and other manual therapies that required healers to physically manipulate the body’s components.

The rich diversity of presentations, the wealth of ideas and material, and the lively discussions that ensued, showed the creative vigor of contemporary scholarship on East Asian medicine, enormously facilitated by the increasing number of rare books and manuscripts that have been digitized by the National Library of Medicine and other libraries and made accessible online for researchers throughout the world.