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Sunday, June 30, 2019

Chinese philosophy

From Wikipedia, the free encyclopedia

Chinese philosophy
Yin-yang-and-bagua-near-nanning.jpg
Yin and Yang symbol with the bagua symbols paved in a clearing outside of Nanning City, Guangxi province, China.
Traditional Chinese中國哲學
Simplified Chinese中国哲学

Chinese philosophy originates in the Spring and Autumn period and Warring States period, during a period known as the "Hundred Schools of Thought", which was characterized by significant intellectual and cultural developments. Although much of Chinese philosophy begins in the Warring States period, elements of Chinese philosophy have existed for several thousand years; some can be found in the Yi Jing (the Book of Changes), an ancient compendium of divination, which dates back to at least 672 BCE. It was during the Warring States era that what Sima Tan termed the major philosophical schools of China: Confucianism, Legalism, and Taoism, arose, along with philosophies that later fell into obscurity, like Agriculturalism, Mohism, Chinese Naturalism, and the Logicians.

Early beliefs

Early Shang dynasty thought was based upon cycles. This notion stems from what the people of the Shang Dynasty could observe around them: day and night cycled, the seasons progressed again and again, and even the moon waxed and waned until it waxed again. Thus, this notion, which remained relevant throughout Chinese history, reflects the order of nature. In juxtaposition, it also marks a fundamental distinction from western philosophy, in which the dominant view of time is a linear progression. During the Shang, fate could be manipulated by great deities, commonly translated as gods. Ancestor worship was present and universally recognized. There was also human and animal sacrifice. 

When the Shang were overthrown by the Zhou, a new political, religious and philosophical concept was introduced called the "Mandate of Heaven". This mandate was said to be taken when rulers became unworthy of their position and provided a shrewd justification for Zhou rule. During this period, archaeological evidence points to an increase in literacy and a partial shift away from the faith placed in Shangdi (the Supreme Being in traditional Chinese religion), with ancestor worship becoming commonplace and a more worldly orientation coming to the fore.

Overview

Confucianism developed during the Spring and Autumn period from the teachings of the Chinese philosopher Confucius (551–479 BCE), who considered himself a retransmitter of Zhou values. His philosophy concerns the fields of ethics and politics, emphasizing personal and governmental morality, correctness of social relationships, justice, traditionalism, and sincerity. The Analects stress the importance of ritual, but also the importance of 'ren', which loosely translates as 'human-heartedness, Confucianism, along with Legalism, is responsible for creating the world’s first meritocracy, which holds that one's status should be determined by education and character rather than ancestry, wealth, or friendship. Confucianism was and continues to be a major influence in Chinese culture, the state of China and the surrounding areas of East Asia

Before the Han dynasty the largest rivals to Confucianism were Chinese Legalism, and Mohism. Confucianism largely became the dominant philosophical school of China during the early Han dynasty following the replacement of its contemporary, the more Taoistic Huang-Lao. Legalism as a coherent philosophy disappeared largely due to its relationship with the unpopular authoritarian rule of Qin Shi Huang, however, many of its ideas and institutions would continue to influence Chinese philosophy until the end of Imperial rule during the Xinhai Revolution.

Mohism, though initially popular due to its emphasis on brotherly love versus harsh Qin Legalism, fell out of favour during the Han Dynasty due to the efforts of Confucians in establishing their views as political orthodoxy. The Six Dynasties era saw the rise of the Xuanxue philosophical school and the maturation of Chinese Buddhism, which had entered China from India during the Late Han Dynasties. By the time of the Tang dynasty five-hundred years after Buddhism's arrival into China, it had transformed into a thoroughly Chinese religious philosophy dominated by the school of Zen Buddhism. Neo-Confucianism became highly popular during the Song dynasty and Ming Dynasty due in large part to the eventual combination of Confucian and Zen Philosophy. 

During the 19th and 20th centuries, Chinese philosophy integrated concepts from Western philosophy. Anti-Qing dynasty revolutionaries, involved in the Xinhai Revolution, saw Western philosophy as an alternative to traditional philosophical schools; students in the May Fourth Movement called for completely abolishing the old imperial institutions and practices of China. During this era, Chinese scholars attempted to incorporate Western philosophical ideologies such as democracy, Marxism, socialism, liberalism, republicanism, anarchism and nationalism into Chinese philosophy. The most notable examples are Sun Yat-Sen's Three Principles of the People ideology and Mao Zedong's Maoism, a variant of Marxism–Leninism. In the modern People's Republic of China, the official ideology is Deng Xiaoping's "market economy socialism". 

Although the People's Republic of China has been historically hostile to the philosophy of ancient China, the influences of past are still deeply ingrained in the Chinese culture. In the post-Chinese economic reform era, modern Chinese philosophy has reappeared in forms such as the New Confucianism. As in Japan, philosophy in China has become a melting pot of ideas. It accepts new concepts, while attempting also to accord old beliefs their due. Chinese philosophy still carries profound influence amongst the people of East Asia, and even Southeast Asia.

Ancient philosophy

Spring and Autumn period

Around 500 BCE, after the Zhou state weakened and China moved into the Spring and Autumn period, the classic period of Chinese philosophy began. This is known as the Hundred Schools of Thought (諸子百家; zhūzǐ bǎijiā; "various scholars, hundred schools"). This period is considered the golden age of Chinese philosophy. Of the many schools founded at this time and during the subsequent Warring States period, the four most influential ones were Confucianism, Daoism (often spelled "Taoism"), Mohism and Legalism.

Confucianism

Kong Fuzi (Latin: Confucius)

Confucianism is a philosophical school developed from the teachings of Confucius collected and written by his disciples after his death in The Analects, and in the Warring States period, Mencius in The Mencius and Xunzi in The Xunzi. It is a system of moral, social, political, and religious thought that has had tremendous influence on Chinese history, thought, and culture down to the 20th century. Some Westerners have considered it to have been the "state religion" of imperial China because of its lasting influence on Asian culture. Its influence also spread to Korea, Japan, Vietnam and many other Asian countries. 

Confucianism reached its peak of influence during the Tang and Song Dynasties under a rebranded Confucianism called Neo-Confucianism. Confucius expanded on the already present ideas of Chinese religion and culture to reflect the time period and environment of political chaos during the Warring States period. Because Confucius embedded the Chinese culture so heavily into his philosophy it was able to resonate with the people of China. This high approval of Confucianism can be seen through the reverence of Confucius in modern-day China. 

The major Confucian concepts include rén 仁 (humanity or humaneness), zhèngmíng 正名 (rectification of names; e.g. a ruler who rules unjustly is no longer a ruler and may be dethroned), zhōng 忠 (loyalty), xiào 孝 (filial piety), and li 禮 (ritual). Confucius taught both positive and negative versions of the Golden Rule. The concepts Yin and Yang represent two opposing forces that are permanently in conflict with each other, leading to perpetual contradiction and change. The Confucian idea of "Rid of the two ends, take the middle" is a Chinese equivalent of Hegel's idea of "thesis, antithesis, and synthesis", which is a way of reconciling opposites, arriving at some middle ground combining the best of both. Confucius heavily emphasized the idea of microcosms in society (subunits of family and community) success's were the foundations for a successful state or country. Confucius believed in the use of education to further knowledge the people in ethics, societal behavior, and reverence in other humans. With the combination of education, successful family, and his ethical teachings he believed he could govern a well established society in China.

Taoism

Chinese glazed stoneware statue of a Daoist deity, from the Ming Dynasty, 16th century.
 
Bagua: Modern Taijitu with I Ching trigrams
 
Daoism is a philosophy and later also developed into a religion based on the texts the Tao Te Ching (Dào Dé Jīng; ascribed to Laozi) and the Zhuangzi (partly ascribed to Zhuangzi). The character Dao 道 (Dao) literally means "path" or "way". However, in Taoism it refers more often to a meta-physical term that describes a force that encompasses the entire universe but which cannot be described nor felt. All major Chinese philosophical schools have investigated the correct Way to go about a moral life, but in Taoism it takes on the most abstract meanings, leading this school to be named after it. It advocated nonaction (wu wei), the strength of softness, spontaneity, and relativism. Although it serves as a rival to Confucianism, a school of active morality, this rivalry is compromised and given perspective by the idiom "practise Confucianism on the outside, Taoism on the inside." Most of Taoism's focus is on what is perceived to be the undeniable fact that human attempts to make the world better actually make the world worse. Therefore, it is better to strive for harmony, minimising potentially harmful interference with nature or in human affairs.

Warring States period

Legalism

Philosopher Han Fei synthesized together earlier the methods of his predecessors, which famous historian Sima Tan posthumously termed Legalism. With an essential principle like "when the epoch changed, the ways changed", late pre-Han Dynasty reformers emphasized rule by law. 

In Han Fei's philosophy, a ruler should govern his subjects by the following trinity:
  1. Fa (法 fǎ): law or principle.
  2. Shu (術 shù): method, tactic, art, or statecraft.
  3. Shi (勢 shì): legitimacy, power, or charisma.
What has been termed by some as the intrastate Realpolitik of the Warring States period was highly progressive, and extremely critical of the Confucian and Mohist schools. But that of the Qin dynasty would be blamed for creating a totalitarian society, thereby experiencing decline. Its main motto is: "Set clear strict laws, or deliver harsh punishment". In Han Fei's philosophy the ruler possessed authority regarding reward and penalty, enacted through law. Shang Yang and Han Fei promoted absolute adherence to the law, regardless of the circumstances or the person. Ministers were only to be rewarded if their words were accurate to the results of their proposals. Legalism, in accordance with Shang Yang's interpretation, could encourage the state to be a militaristic autarky.

Naturalists

The School of Naturalists or the School of Yin-yang (陰陽家/阴阳家; Yīnyángjiā; Yin-yang-chia; "School of Yin-Yang") was a Warring States era philosophy that synthesized the concepts of yin-yang and the Wu Xing; Zou Yan is considered the founder of this school. His theory attempted to explain the universe in terms of basic forces in nature: the complementary agents of yin (dark, cold, female, negative) and yang (light, hot, male, positive) and the Five Elements or Five Phases (water, fire, wood, metal, and earth). In its early days, this theory was most strongly associated with the states of Yan and Qi. In later periods, these epistemological theories came to hold significance in both philosophy and popular belief. This school was absorbed into Taoism's alchemic and magical dimensions as well as into the Chinese medical framework. The earliest surviving recordings of this are in the Ma Wang Dui texts and Huang Di Nei Jing.

Mohism

Mohism (Moism), founded by Mozi (墨子), promotes universal love with the aim of mutual benefit. Everyone must love each other equally and impartially to avoid conflict and war. Mozi was strongly against Confucian ritual, instead emphasizing pragmatic survival through farming, fortification, and statecraft. Tradition is inconsistent, and human beings need an extra-traditional guide to identify which traditions are acceptable. The moral guide must then promote and encourage social behaviors that maximize general benefit. As motivation for his theory, Mozi brought in the Will of Heaven, but rather than being religious his philosophy parallels utilitarianism.

Logicians

The logicians (School of Names) were concerned with logic, paradoxes, names and actuality (similar to Confucian rectification of names). The logician Hui Shi was a friendly rival to Zhuangzi, arguing against Taoism in a light-hearted and humorous manner. Another logician, Gongsun Long, told the famous When a White Horse is Not a Horse dialogue. This school did not thrive because the Chinese regarded sophistry and dialectic as impractical.

Agriculturalists

Agriculturalism was an early agrarian social and political philosophy that advocated peasant utopian communalism and egalitarianism. The philosophy is founded on the notion that human society originates with the development of agriculture, and societies are based upon "people's natural prospensity to farm."

The Agriculturalists believed that the ideal government, modeled after the semi-mythical governance of Shennong, is led by a benevolent king, one who works alongside the people in tilling the fields. The Agriculturalist king is not paid by the government through its treasuries; his livelihood is derived from the profits he earns working in the fields, not his leadership. Unlike the Confucians, the Agriculturalists did not believe in the division of labour, arguing instead that the economic policies of a country need to be based upon an egalitarian self sufficiency. The Agriculturalists supported the fixing of prices, in which all similar goods, regardless of differences in quality and demand, are set at exactly the same, unchanging price.

Early Imperial era philosophy

History

Qin and Han Dynasties

A Western Han (202 BC - 9 AD) fresco depicting Confucius (and Laozi), from a tomb of Dongping County, Shandong province, China
 
The short founder Qin dynasty, where Legalism was the official philosophy, quashed Mohist and Confucianist schools. Legalism remained influential during the early Han Dynasty under the Taoist-Realist ideology Huang-Lao until Emperor Wu of Han adopted Confucianism as official doctrine. Confucianism and Taoism became the determining forces of Chinese thought until the introduction of Buddhism

Confucianism was particularly strong during the Han dynasty, whose greatest thinker was Dong Zhongshu, who integrated Confucianism with the thoughts of the Zhongshu School and the theory of the Five Elements. He also was a promoter of the New Text school, which considered Confucius as a divine figure and a spiritual ruler of China, who foresaw and started the evolution of the world towards the Universal Peace. In contrast, there was an Old Text school that advocated the use of Confucian works written in ancient language (from this comes the denomination Old Text) that were so much more reliable. In particular, they refuted the assumption of Confucius as a godlike figure and considered him as the greatest sage, but simply a human and mortal

Six Dynasties

The 3rd and 4th centuries saw the rise of the Xuanxue (mysterious learning), also called Neo-Taoism. The most important philosophers of this movement were Wang Bi, Xiang Xiu and Guo Xiang. The main question of this school was whether Being came before Not-Being (in Chinese, ming and wuming). A peculiar feature of these Taoist thinkers, like the Seven Sages of the Bamboo Grove, was the concept of feng liu (lit. wind and flow), a sort of romantic spirit which encouraged following the natural and instinctive impulse.

Buddhism arrived in China around the 1st century AD, but it was not until the Northern and Southern, Sui and Tang dynasties that it gained considerable influence and acknowledgement. At the beginning, it was considered a sort of Taoist sect. Mahayana Buddhism was far more successful in China than its rival Hinayana, and both Indian schools and local Chinese sects arose from the 5th century. Two chiefly important monk philosophers were Sengzhao and Daosheng. But probably the most influential and original of these schools was the Chan sect, which had an even stronger impact in Japan as the Zen sect.

In the mid-Tang Buddhism reached its peak, and reportedly there were 4,600 monasteries, 40,000 hermitages and 260,500 monks and nuns. The power of the Buddhist clergy was so great and the wealth of the monasteries so impressive, that it instigated criticism from Confucian scholars, who considered Buddhism as a foreign religion. In 845 Emperor Wuzong ordered the Great Anti-Buddhist Persecution, confiscating the riches and returning monks and nuns to lay life. From then on, Buddhism lost much of its influence.

Schools of thought

Xuanxue

Xuanxue was a philosophical school that combined elements of Confucianism and Taoism to reinterpret the I Ching, Tao Te Ching, and Zhuangzi. The most important philosophers of this movement were Wang Bi, Xiang Xiu and Guo Xiang. The main question of this school was whether Being came before Not-Being (in Chinese, ming and wuming). A peculiar feature of these Taoist thinkers, like the Seven Sages of the Bamboo Grove, was the concept of feng liu (lit. wind and flow), a sort of romantic spirit which encouraged following the natural and instinctive impulse.

Chan

The Sakyamuni Buddha, by artist Zhang Shengwen, 1173-1176 CE, Song dynasty.
Buddhism is a religion, a practical philosophy, and arguably a psychology, focusing on the teachings of Gautama Buddha, who lived on the Indian subcontinent most likely from the mid-6th to the early 5th century BCE. When used in a generic sense, a Buddha is generally considered to be someone who discovers the true nature of reality

Buddhism until the 4th century A.D had little impact on China but in the 4th century its teachings hybridized with those of Taoism. Buddhism brought to China the idea of many hells, where sinners went, but the deceased sinners souls could be saved by pious acts. Since Chinese traditional thought focused more on ethics rather than metaphysics, the merging of Buddhist and Taoist concepts developed several schools distinct from the originating Indian schools. The most prominent examples with philosophical merit are Sanlun, Tiantai, Huayan, and Chán (a.k.a. Zen). They investigate consciousness, levels of truth, whether reality is ultimately empty, and how enlightenment is to be achieved. Buddhism has a spiritual aspect that compliments the action of Neo-Confucianism, with prominent Neo-Confucians advocating certain forms of meditation.

Mid to Late Imperial era philosophy

History

Neo-Confucianism was a revived version of old Confucian principles that appeared around the Song dynasty, with Buddhist, Taoist, and Legalist features. The first philosophers, such as Shao Yong, Zhou Dunyi and Chang Zai, were cosmologists and worked on the Yi Jing. The Cheng brothers, Cheng Yi and Cheng Hao, are considered the founders of the two main schools of thought of Neo-Confucianism: the School of Principle the first, the School of Mind the latter. The School of Principle gained supremacy during the Song dynasty with the philosophical system elaborated by Zhu Xi, which became mainstream and officially adopted by the government for the Imperial examinations under the Yuan dynasty. The School of Mind was developed by Lu Jiuyuan, Zhu Xi's main rival, but was soon forgotten. Only during the Ming dynasty was the School of Mind revived by Wang Shouren, whose influence is equal to that of Zhu Xi. This school was particularly important in Japan.

During the Qing dynasty many philosophers objected against Neo-Confucianism and there was a return to the Han Dynasty Confucianism, and also the reprise of the controversy between Old Text and New Text. In this period also started the penetration of Western culture, but most Chinese thought that the Westerners were maybe more advanced in technology and warfare, but that China had primacy in moral and intellectual fields.

Schools of thought

Neo-Confucianism

Zhu Xi leading figure in Neo-Confucianism
 
Wang Yangming also an important figure in Neo-Confucianism
 
Despite Confucianism losing popularity to Taoism and Buddhism, Neo-Confucianism combined those ideas into a more metaphysical framework. Its concepts include li (principle, akin to Plato's forms), qi (vital or material force), taiji (the Great Ultimate), and xin (mind). Song dynasty philosopher Zhou Dunyi (1017–1073) is seen commonly seen as the first true "pioneer" of Neo-Confucianism, using Daoist metaphysics as a framework for his ethical philosophy. Neo-Confucianism developed both as a renaissance of traditional Confucian ideas, and as a reaction to the ideas of Buddhism and religious Daoism. Although the Neo-Confucianists denounced Buddhist metaphysics, Neo-Confucianism did borrow Daoist and Buddhist terminology and concepts. Neo-Confucianist philosophers like Zhu Xi and Wang Yangming are seen as the most important figures of Neo-Confucianism.

Modern era

During the Industrial and Modern Ages, Chinese philosophy had also begun to integrate concepts of Western philosophy, as steps toward modernization. Notably, Chinese philosophy never developed the concept of human rights, so that classical Chinese lacked words for them. Until 1864, W.A.P. Martin had to invent the word quanli(Chinese:权利/權利) to translate the Western concept of "rights" in the process of translating Henry Wheaton's Elements of International Law into classical Chinese.

By the time of the Xinhai Revolution in 1911, there were many calls such as the May Fourth Movement to completely abolish the old imperial institutions and practices of China. There have been attempts to incorporate democracy, republicanism, and industrialism into Chinese philosophy, notably by Sun Yat-Sen at the beginning of the 20th century. Mao Zedong added Marxism, Stalinism, Chinese Marxist Philosophy and other communist thought. 

When the Communist Party of China took over the reign, previous schools of thought, excepting notably Legalism, were denounced as backward, and later even purged during the Cultural Revolution, whereas their influences on Chinese thoughts remain until today. The current government of the People's Republic of China is trying to encourage a form of market socialism

Since the radical movement of the Cultural Revolution, the Chinese government has become much more tolerant with the practice of traditional beliefs. The 1978 Constitution of the People's Republic of China guarantees "freedom of religion" with a number of restrictions. Spiritual and philosophical institutions have been allowed to be established or re-established, as long they are not perceived to be a threat to the power of the CPC. Moreover, those organizations are heavily monitored. The influences of the past are still deeply ingrained in the Chinese culture.

New Confucianism

New Confucianism is an intellectual movement of Confucianism that began in the early 20th century in Republican China, and revived in post-Mao era contemporary China. It is deeply influenced by, but not identical with, the Neo-Confucianism of the Song and Ming dynasties.

Philosophers

  • Confucius, seen as the Great Master but sometimes ridiculed by Taoists.
    • Mencius, Confucius' follower having idealist inspiration
    • Xun Zi, another Confucius' follower, closer to realism, teacher of Han Fei and Li Si
    • Zhu Xi, founder of Neo-Confucianism
    • Wang Yangming, most influential proponent of xinxue or "state of mind."
  • Lao Zi, the chief of Taoist school.
    • Zhuangzi, said to be the author of the Zhuangzi.
    • Liezi, said to be the author of the Liezi.
  • Mozi, the founder of Mohist school.
  • Shang Yang, Legalist founder and pivotal Qin reformer
  • Han Fei, one of the most notable theoreticians of Legalism
  • Li Si, major proponent and practitioner of Legalism

Concepts

Although the individual philosophical schools differ considerably, they nevertheless share a common vocabulary and set of concerns. 

Among the terms commonly found in Chinese philosophy are:
  • Dao (the Way, or one's doctrine)
  • De (virtue, power)
  • Li (principle)
  • Qi (vital energy or material force)
  • The Taiji (Great Heavenly Axis) forms a unity of the two complimentary polarities, Yin and Yang. The word Yin originally referred to a hillside facing away from the sun. Philosophically, it stands the dark, passive, feminine principle; whereas Yang (the hillside facing the sun) stands for the bright, active, masculine principle. Yin and Yang are not antagonistic, they alternate in inverse proportion to one another—like the rise and fall of a wave.
Among the commonalities of Chinese philosophies are:
  • The tendency not to view man as separate from nature.
  • Questions about the nature and existence of a monotheistic deity, which have profoundly influenced Western philosophy, have not been important in Chinese philosophies or a source of great conflict in Chinese traditional religion.
  • The belief that the purpose of philosophy is primarily to serve as an ethical and practical guide.
  • The political focus: most scholars of the Hundred Schools were trying to convince the ruler to behave in the way they defended.

Bloodletting

From Wikipedia, the free encyclopedia

Ancient Greek painting on a vase, showing a physician (iatros) bleeding a patient
 
Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fluids were regarded as "humours" that had to remain in proper balance to maintain health. It is claimed to have been the most common medical practice performed by surgeons from antiquity until the late 19th century, a span of almost 2,000 years. In Europe the practice continued to be relatively common until the end of the 18th century. The practice has now been abandoned by modern style medicine for all except a few very specific conditions. It is conceivable that historically, in the absence of other treatments for hypertension, bloodletting sometimes had a beneficial effect in temporarily reducing blood pressure by reducing blood volume. However, since hypertension is very often asymptomatic and thus undiagnosable without modern methods, this effect was unintentional. In the overwhelming majority of cases, the historical use of bloodletting was harmful to patients.

Today, the term phlebotomy refers to the drawing of blood for laboratory analysis or blood transfusion. Therapeutic phlebotomy refers to the drawing of a unit of blood in specific cases like hemochromatosis, polycythemia vera, porphyria cutanea tarda, etc., to reduce the number of red blood cells. The traditional medical practice of bloodletting is today considered to be a pseudoscience.

In the ancient world

A chart showing the parts of the body to be bled for different diseases, c. 1310–1320
 
Points for blood-letting, Hans von Gersdorff (surgeon), Field book of wound medicine, 1517

Passages from the Ebers Papyrus may indicate that bloodletting by scarification was an accepted practice in Ancient Egypt. Egyptian burials have been reported to contain bloodletting instruments. According to some accounts, the Egyptians based the idea on their observations of the Hippopotamus, confusing its red sweat with blood, and believing that it scratched itself to relieve distress.

In Greece, bloodletting was in use in the fifth century BC during the lifetime of Hippocrates, who mentions this practice but generally relied on dietary techniques. Erasistratus, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood and advised that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and vomiting. Herophilus advocated bloodletting. Archagathus, one of the first Greek physicians to practice in Rome, also believed in the value of bloodletting. 

"Bleeding" a patient to health was modeled on the process of menstruation. Hippocrates believed that menstruation functioned to "purge women of bad humours". During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting.

The popularity of bloodletting in the classical Mediterranean world was reinforced by the ideas of Galen, after he discovered that not only veins but also arteries were filled with blood, not air as was commonly believed at the time. There were two key concepts in his system of bloodletting. The first was that blood was created and then used up; it did not circulate, and so it could "stagnate" in the extremities. The second was that humoral balance was the basis of illness or health, the four humours being blood, phlegm, black bile, and yellow bile, relating to the four Greek classical elements of air, water, earth, and fire respectively. Galen believed that blood was the dominant humour and the one in most need of control. In order to balance the humours, a physician would either remove "excess" blood (plethora) from the patient or give them an emetic to induce vomiting, or a diuretic to induce urination. 

Galen created a complex system of how much blood should be removed based on the patient's age, constitution, the season, the weather and the place. "Do-it-yourself" bleeding instructions following these systems were developed. Symptoms of plethora were believed to include fever, apoplexy, and headache. The blood to be let was of a specific nature determined by the disease: either arterial or venous, and distant or close to the area of the body affected. He linked different blood vessels with different organs, according to their supposed drainage. For example, the vein in the right hand would be let for liver problems and the vein in the left hand for problems with the spleen. The more severe the disease, the more blood would be let. Fevers required copious amounts of bloodletting.

Middle Ages

The Talmud recommended a specific day of the week and days of the month for bloodletting, and similar rules, though less codified, can be found among Christian writings advising which saints' days were favourable for bloodletting. During medieval times bleeding charts were common, showing specific bleeding sites on the body in alignment with the planets and zodiacs. Islamic medical authors too advised bloodletting, particularly for fevers. It was practised according to seasons and certain phases of the moon in the lunar calendar. The practice was probably passed by the Greeks with the translation of ancient texts to Arabic and is different than bloodletting by cupping mentioned in the traditions of Muhammad. When Muslim theories became known in the Latin-speaking countries of Europe, bloodletting became more widespread. Together with cautery, it was central to Arabic surgery; the key texts Kitab al-Qanun and especially Al-Tasrif li-man 'ajaza 'an al-ta'lif both recommended it. It was also known in Ayurvedic medicine, described in the Susruta Samhita.

Use through the 19th century

Ioannis Sculteti, Armamentium Chirugiae, 1693 – Diagrammed transfusion of sheep's blood
 
Bloodletting-Set of a Barber Surgeon, beginning of the 19th century, Märkisches Museum Berlin
 
Even after the humoral system fell into disuse, the practice was continued by surgeons and barber-surgeons. Though the bloodletting was often recommended by physicians, it was carried out by barbers. This led to the distinction between physicians and surgeons. The red-and-white-striped pole of the barbershop, still in use today, is derived from this practice: the red symbolizes blood while the white symbolizes the bandages. Bloodletting was used to "treat" a wide range of diseases, becoming a standard treatment for almost every ailment, and was practiced prophylactically as well as therapeutically. 

Scarificator
 
Scarificator mechanism
 
Scarificator, showing depth adjustment bar
 
Diagram of scarificator, showing depth adjustment
 
A number of different methods were employed. The most common was phlebotomy, or venesection (often called "breathing a vein"), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. In arteriotomy, an artery was punctured, although generally only in the temples. In scarification (not to be confused with scarification, a method of body modification), the "superficial" vessels were attacked, often using a syringe, a spring-loaded lancet, or a glass cup that contained heated air, producing a vacuum within (see fire cupping). There was also a specific bloodletting tool called a scarificator, used primarily in 19th century medicine. It has a spring-loaded mechanism with gears that snaps the blades out through slits in the front cover and back in, in a circular motion. The case is cast brass, and the mechanism and blades steel. One knife bar gear has slipped teeth, turning the blades in a different direction than those on the other bars. The last photo and the diagram show the depth adjustment bar at the back and sides. 

Bloodletting in 1860, one of only three known photographs of the procedure.
 
Photograph of a Bloodletting in 1922
 
Leeches could also be used. The withdrawal of so much blood as to induce syncope (fainting) was considered beneficial, and many sessions would only end when the patient began to swoon. 

William Harvey disproved the basis of the practice in 1628, and the introduction of scientific medicine, la méthode numérique, allowed Pierre Charles Alexandre Louis to demonstrate that phlebotomy was entirely ineffective in the treatment of pneumonia and various fevers in the 1830s. Nevertheless, in 1838, a lecturer at the Royal College of Physicians would still state that "blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly", and Louis was dogged by the sanguinary Broussais, who could recommend leeches fifty at a time. Some physicians resisted Louis' work because they "were not prepared to discard therapies 'validated by both tradition and their own experience on account of somebody else's numbers'."

Bloodletting was used to treat almost every disease. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed.

There were also theories that bloodletting would cure "heartsickness" and "heartbreak". A French physician, Jacques Ferrand wrote a book in 1623 on the uses of bloodletting to cure a broken heart. He recommended bloodletting to the point of heart failure (literal).

Leeches became especially popular in the early nineteenth century. In the 1830s, the French imported about forty million leeches a year for medical purposes, and in the next decade, England imported six million leeches a year from France alone. Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe.


Bloodletting was also popular in the young United States of America, where Benjamin Rush (a signatory of the Declaration of Independence) saw the state of the arteries as the key to disease, recommending levels of bloodletting that were high even for the time. George Washington asked to be bled heavily after he developed a throat infection from weather exposure. Within a ten-hour period, a total of 124–126 ounces (3.75 liters) of blood was withdrawn prior to his death from a throat infection in 1799.

Bloodsticks for use when bleeding animals
 
One reason for the continued popularity of bloodletting (and purging) was that, while anatomical knowledge, surgical and diagnostic skills increased tremendously in Europe from the 17th century, the key to curing disease remained elusive, and the underlying belief was that it was better to give any treatment than nothing at all. The psychological benefit of bloodletting to the patient (a placebo effect) may sometimes have outweighed the physiological problems it caused. Bloodletting slowly lost favour during the 19th century, after French physician Dr. Pierre Louis conducted an experiment in which he studied the effect of bloodletting on pneumonia patients. A number of other ineffective or harmful treatments were available as placebos—mesmerism, various processes involving the new technology of electricity, many potions, tonics, and elixirs. Yet, bloodletting persisted during the 19th century partly because it was readily available to people of any socioeconomic status.

Possible validity

In the absence of other treatments, bloodletting actually is beneficial in some circumstances, including hemochromatosis, the fluid overload of heart failure, and possibly simply to reduce blood pressure. In other cases, such as those involving agitation, the reduction in blood pressure might appear beneficial due to the sedative effects. In 1844, Joseph Pancoast listed the advantages of bloodletting in "A Treatise on Operative Surgery". Not all of these reasons are outrageous nowadays:
The opening of the superficial vessels for the purpose of extracting blood constitutes one of the most common operations of the practitioner. The principal results, which we effect by it, are 1st. The diminution of the mass of the blood, by which the overloaded capillary or larger vessels of some affected part may be relieved; 2. The modification of the force and frequency of the heart's action; 3. A change in the composition of the blood, rendering it less stimulating; the proportion of serum becoming increased after bleeding, in consequence of its being reproduced with greater facility than the other elements of the blood; 4. The production of syncope, for the purpose of effecting a sudden general relaxation of the system; and, 5. The derivation, or drawing as it is alleged, of the force of the circulation from some of the internal organs, towards the open outlet of the superficial vessel. These indications may be fulfilled by opening either a vein or an artery.

Controversy and use into the 20th century

Bloodletting gradually declined in popularity over the course of the 19th century, becoming rather uncommon in most places, before its validity was thoroughly debated. In the medical community of Edinburgh, bloodletting was abandoned in practice before it was challenged in theory, a contradiction highlighted by physician-physiologist John Hughes Bennett. Authorities such as Austin Flint I, Hiram Corson, and William Osler became prominent supporters of bloodletting in the 1880s and onwards, disputing Bennett's premise that bloodletting had fallen into disuse because it didn't work. These advocates framed bloodletting as an orthodox medical practice, to be used in spite of its general unpopularity. Some physicians considered bloodletting useful for a more limited range of purposes, such as to "clear out" infected or weakened blood or its ability to "cause hæmorrhages to cease"—as evidenced in a call for a "fair trial for blood-letting as a remedy" in 1871.

Some researchers used statistical methods for evaluating treatment effectiveness to discourage bloodletting. But at the same time, publications by Philip Pye-Smith and others defended bloodletting on scientific grounds.

Bloodletting persisted into the 20th century and was recommended in the 1923 edition of the textbook The Principles and Practice of Medicine. The textbook was originally written by Sir William Osler and continued to be published in new editions under new authors following Osler's death in 1919.

Phlebotomy

Today it is well established that bloodletting is not effective for most diseases. Indeed, it is mostly harmful, since it can weaken the patient and facilitate infections. Bloodletting is used today in the treatment of a few diseases, including hemochromatosis and polycythemia; however, these rare diseases were unknown and undiagnosable before the advent of scientific medicine. It is practiced by specifically trained practitioners in hospitals, using modern techniques. In most cases, phlebotomy now refers to the removal of small quantities of blood for diagnostic purposes. However, in the case of hemochromatosis, which is now recognized as the most common hereditary disorder in European populations, bloodletting (venesection) has become the mainstay treatment option. In the U.S., according to an academic article posted in the Journal of Infusion Nursing with data published in 2010, the primary use of phlebotomy was to take blood that would one day be reinfused back into a person. 

In alternative medicine

Though bloodletting as a general health measure has been shown to be harmful, it is still commonly indicated for a wide variety of conditions in the Ayurvedic, Unani, and traditional Chinese systems of alternative medicine. Unani is based on a form of humorism, and so in that system, bloodletting is used to correct supposed humoral imbalance.

Teacher

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Teacher A teacher in a classroom at a secondary school in ...