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Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 25-28

The substance and cultural connotations of treating prior to disease

Science and Humanities Research Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Web Publication3-Jul-2018

Correspondence Address:
prof. Yishan Duan
Shanghai University of Traditional Chinese Medicine, Shanghai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CMAC.CMAC_13_18

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The substance of treating prior to disease in Traditional Chinese Medicine expects to dissipate symptoms before the disease occurs and maintain health until centenarian. This concept is a collective reflection of the intrinsic awareness of suffering by Chinese people. Moreover, its cultural connotations involve emphasis on preparation for adversity in times of safety and taking anticipative measures.

Keywords: Cultural connotations, substance, treating prior to disease

How to cite this article:
Duan Y. The substance and cultural connotations of treating prior to disease. Chin Med Cult 2018;1:25-8

How to cite this URL:
Duan Y. The substance and cultural connotations of treating prior to disease. Chin Med Cult [serial online] 2018 [cited 2021 Apr 13];1:25-8. Available from: https://www.cmaconweb.org/text.asp?2018/1/1/25/235845

What is the duty of a doctor? What is the purpose of a medical institution? Following the Confucius' remark on Shi ( The Classic of Poetry), “to sum up in one phrase,” the answers are treating prior to disease.

  The Substance of Treating Prior to Disease Lies in “prior to Disease” Top

Although the concept of treating prior to disease involves prevention of occurrence prior to disease, of changes in case of disease, and of relapse after recovery, its substance indeed lies literally in the words of Zhi (, treating) and Wei Bing (, prior to disease).

The phrase of Zhi Wei Bing originates from Su Wen ( Simple Questions) and Ling Shu ( Spirited Pivot). Si Qi Tiao Shen Da Lun ( On Spirit Cultivation in Four Seasons) takes it as the principles of dealing with diseases by the sage, as in “the sage treats prior to disease instead of treating disease, and manage prior to chaos rather than managing it.” It emphasizes on treating before the disease falls on. Ling Shu•Ni Shun ( Contradiction and Accordance from Spirited Pivot) connects it with a supreme practitioner, as in “the supreme practitioner needles prior to the occurrence of symptoms; inferior one needles when symptoms are prime; and the bad one needles while symptoms are declining.” Only those who needle prior to disease have grasped the supreme skills of medicine. These are textual examples to indicate the origin of treating prior to disease set emphasis on prevention of occurrence.

Records on supreme practitioners in treating prior to disease can be seen in much historical literature. He Guan Zi ShiXian ( Contemporary Virtue from He Guan Zi) documented Marquis Wen of Wei () once asked Bianque ) who among his brothers owned the supreme medical skills. Bianque answered, “my eldest brother observes the spirit of disease and prevents it before onset (invisible), so no one except the family know his skills; my elder brother treats disease while it's mild (skin-hair level), so men outside our county won't know his fame; I am good at needing vessels and employing decoctions (severe disease), and thus well-known with the noblemen.” The more far-reaching their fame is, the less skillful they are. The real intention of Bianque's remarks is treating a disease at different phases (invisible, skin-hair, and vessels) determines the skillfulness of a medical practitioner. It not only indicates Bianque's great modesty but also serves as a proper interpretation of the theory of treating prior to disease.

Sun Simiao () in the Tang dynasty made similar remarks as in Bei Ji Qian Jin Yao Fang Zhen Hou ( Diagnostic Manifestations fromEmergency Prescriptions Worth A Thousand Pieces of Gold),, “the supreme doctor treat prior to disease; middle doctor treat disease that is to happen; and the inferior doctor treat disease that happened.” The three kinds of diseases mentioned above are equal to “invisible,” “skin-hair level,” and “critical case” which needs needling the vessels, applying decoction or dissecting muscles. So to identify and treat diseases at different stages becomes the standard to distinguish the skillfulness of a doctor. How great minds think alike!

We can also use the well-known idiom of “bending chimney and removing fuel (to prevent fire)” to support this collaterally. There was a fable recorded in Han Shu Huo Guang Zhuan ( Biography of Huo Guang from The History of Han). One guest found the chimney in the host's house was upright, and there was a pile of firewood, so he advised the host bend the chimney and move away the wood in case there should be a fire. The host didn't follow it and soon expected a fire. Thanks to the neighbors' help, the fire was put out, and the host had to treat them with a feast. According to their contributions, the neighbors were seated orderly. However, the one who warned the host early was not invited. Some told the host if the advice were accepted, there wouldn't be a fire and the feast. If we shall learn a lesson from the story, it must be emphasis on prevention.

Then how do we achieve the ideal of treating prior to disease? The solution lies in the first chapter of Su Wen (Simple Questions)--- Shang Gu Tian Zhen Lun ( On Antique Innate Purity), “avoid evil and invading wind properly, keep a calm mind, call to play the natural property of vital qi and maintain one's spirit inside, then how will a disease occur?” If you avoid exogenous wind and nourish vital qi inside, keep a calm mind with little lust, consolidate the three treasures of essence, qi and spirit, disease can't attack you. “Those who know the Tao of health will follow the laws of yin and yang, maintain a harmonious life with proper diet and living habit, consume moderate physical power, and thus keep an integrate physique with spirit, and live up to one's destined age [Figure 1].”
Figure 1: Fatigue

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The scholars who are expert at research on the Inner Classic will grasp the substance of treating prior to disease profoundly. Wang Bing in the Tang dynasty and Lin Yi in the Northern Song dynasty are masters at collating and annotating Su Wen ( Simple Questions) After they had finished their works, they would praise highly the tremendous functions Su Wen had played in writing the preface. Wang Bing remarked, “the emperor and his officials won't expect an early death; and both the Chinese and foreigners will expect a prolonged life.” Lin Yi and his colleagues argued, “to be aware of the danger in times of peace is the main concerns of the previous sages; and to treat and sympathize people's suffering is his Majesty's great benevolence.” They also mentioned, “to treat the body with it (Su Wen) will prevent the disease before onset,” and “to attract harmony and dispel disaster, making all people live a happy and healthy life.” Therefore, the ultimate purpose of the sage's treat and the supreme doctor's needling is to dissipate symptoms prior to disease and achieve longevity until centenarian. This also accommodates the supreme expectation of medical treatment and the core thoughts of treating prior to disease recorded in medical classics.

  The Cultural Connotations of the Concept of Treating Prior to Disease Top

Culture can be categorized into a generalized culture which is the sum of material and spiritual asset created by the human kind during the whole historical period, and the narrowly defined culture which mainly refers to the ideology of human society. What we've discussed in this article pertains to the latter. The concept of treating prior to disease originates from the awareness of suffering by Chinese people, which can date back to no later than Shang and Zhou dynasties. After King Wu of Zhou overturned the rule of Yin Shang (), he didn't go beyond himself but reflected on the lessons of how Jie of Xia and Zhou of Yin lost their kingdom. By realizing the law of transformation from quantitative changes to qualitative changes, he “dedicated himself to government affairs day and night,” from Shang Shu Lv Ao ( Mastiff from Lv State of The Book of Documents), showing a strong awareness of the danger beforehand. The dynasty of Zhou thus lasted over 800 years from 11th century BC to 3rd century BC being the longest ruling dynasty in Chinese history.

The awareness of suffering involves not only recognizing realistic or possible suffering but also managing to eliminate the dangers existing and prevent new onsets. As a human consciousness, it is both the real reflection of the passive objective by the active subjective and guiding of the objective to go back to the right tract, embodying human wisdom and courage. Since the suffering it projects is real or possibly realistic, it's essentially different from the suffer from imaginary fears. The relation between the awareness and the treating prior to disease can be elaborated in the following two aspects.

  The Awareness of Suffering Emphasizes on Preparation for Adversity in Times of Safety Top

The awareness of preparation for adversity in times of safety was most discussed in the most ancient Confucian classics of Shi ( Classic of Poetry), Shu ( The Book of Documents) and Yi ( Classic of Changes) in China. Shi·Chi Bao ( Owls from the Classic of Poetry) recorded, “before it began to rain, the owls had started building their nests and twined the doors with root barks of mulberry tree.” That's where the idiom of taking precautions against rain derived from. In Shang Shu Da Yu Mo ( Strategy of Great Yu from the Book of Documents), the minister of Bo Yi () used to advised Yu () to be cautious, keep to the laws, and do not indulge himself in leisure and lewdness in case there would be a overturn of a kingdom. Zhou Yi ( Yi Classic of Zhou) sprang up in the Shang and early Zhou dynasties and was a divine book to tell good or ill luck with augury of milfoil, full of philosophies regarding awareness of future suffering. The remarks of “is the author of Yi Classic aware of future adversities?” from Xi Ci Xia ( Second Half of Systemic Introduction) must have disclosed the content of the book [Figure 2].
Figure 2: Sub-health

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Yi Pi ( Divinatory Symbol of Pi) noted, “think of the perish and connect it with the root of mulberry tree.” If something is connected with the root of mulberry tree, it will be hard for it to detach. Xi Ci Xia ( Second Half of Systemic Introduction) explained this with Confucius' remarks, “the gentleman should never forget what brought about the peaceful and normal government of his life/country when he rules; therefore, he can keep safe himself and his home/country.” The quotations from the Pi Symbol signals that the occurrence of dangers, perish and wars is the result of taking for granted the joy, existence, and peace a country enjoys can last forever. On the contrary, a gentleman must always keep in mind that dangers, perish, and disaster will fall on him while he is far from these and connect his safety firmly with the root of mulberry tree.

Hence, it is to treating prior to disease by Traditional Chinese Medicine (TCM) doctors. If you are hounded by diseases, that's because you thought your previous health was forever and thus feared for nothing. Therefore, when you are healthy, you must be cautious for possible invasion of evils. As Chapter 71 of Lao Zi () told us, the one with superior wisdom (sages) will take seriously a possible disease, so he can keep healthy and be free of disease; the one with inferior wisdom does the opposite, so he will incur disease.

If we explore it deeper, in terms of time for worries, the real concern lies in when you are joyful rather than when you worry; and in terms of who shall worry, the one who is enjoying happiness shall instead of the worried. Be satisfied with an easy life, then a worry casts; the happy man who only thinks of happiness will be victim of worries. Just as what is told in Shi Jing Xiao Min (, Xiao Min of The Classic of Poetry), “be cautious like stepping on the edge of an abyss or standing on thin ice,” one shall be extremely cautious before he step upon the edge of an abyss or thin ice, or be careful as if he were the one who is doing so.

This is also the case in treating prior to disease by TCM doctors. You should worry about contracting a disease before it attacks you, and the healthy one shall be cautious rather than the deceased one. The healthy person then shall prevent any disease with cautions. Moreover, if he is diseased, the one shall keep calm and optimistic, call forth a courageous will to fight against it, and act on doctor's orders and expect the treatment will steer you out of the darkness and adversity.

The awareness of suffering is most clearly elaborated in Meng Zi (). Gao Zi Xia ( the LatterChapter of Gao Zi) recorded, “if there is no loyal dissuasion from ministers and an enemy country, a country will definitely perish; that's why we know survival on worrying for tomorrow and perish because of no worries.” There is also a phenomenon called catfish effect. If you want to bring as many sardines alive as you can back to make can-food, you need to put several catfishes in the cabin. Hence, the sardines would move about to escape from being eaten, to make it to the port alive. This effect reveals the principle of how a crisis activates vitality, which shares the truth with the general rule of dying of indulge in ease and survival on worrying for the future.

To sum up, the relation between the awareness of preparation for adversities in times of safety and treating prior to disease involves ¬ worrying for dangers while one is safe will ensure safety, while concerning only safety will endanger the safe one; -taking prevention prior to disease will keep one healthy, while thinking of no prevention will incur disease.

  The Awareness of Suffering Focuses on Taking Anticipative Measures Top

As awareness of suffering, taking anticipative measures laid its foundation on the basis of telling good or bad luck, and measurement of quantitative and qualitative changes [Figure 3].
Figure 3: Sub-health Regulation

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As mentioned before, Zhou Yi ( Yi Classic of Zhou) is a divination book to tell good or ill luck. Hence, Xi Ci Shang ( First Half of Systemic Introduction) defined, “the sign to tell good or bad luck is called a Yao (, trigram),” and all the 384 trigrams in the book made every effort to introduce good or ill signs and how to embrace or avoid them wisely. The Chapter 58 of Lao Zi () held that “misfortune and fortune are mutually rooted; nothing can be fairness forever as it will turn scheme; and the kind will become heartless as well.” These pairs of contradictions such as misfortune and fortune, fairness and scheme, kind and heartless, exist in one integrate entity, rely on and can be transformed into each other, with no ultimate. This dialectic requests we pay constant attention to the state changes of things, and try to avoid misfortune and pursue good fortune.

As regards the issue of quantitative and qualitative changes, theories originated from Lao Zi (), as in Chapter 64, “It's easy to keep safe, plan for the future, break the fragile, and dissipate microparticles, prepare before something happens and rule before rebel rises” and “a big tree begins its life from a bud; a tall construction starts with a brick; and a long journey counts from your steps.” These have demonstrated the general development rules of things such as changes from small to big, from invisible to obvious, and from quantitative to qualitative. Zhou Yi Kun Gua ( Sign of Kun from Yi Classic of Zhou) argued, “good fortune goes to the family of virtue; and misfortune falls upon the family without virtues; if a minister or a son kills the emperor or one's father, there must be signs and a long time of hatred behind this.” Yi Classic () explained, “It is inevitable (normal) for the frost stepped on to be turned into ice.” That also suits for the explanation of the evil deeds above. If one needs to prevent it from the transformation, he must perceive the origin as early as possible, which is known as “from small things one can see how things develop.” Zhang Jiebin once elaborated this in his work of Lei Jing Fu Yi ( Appendixes to Classified Classic), “that the frost stepped on would turn into ice taught us to be cautious about small beginnings; and this was indeed the doctrine of medicine and helm of life.” Applied to medicine, the cautious attitude toward things is treating prior to disease. Moreover, he also deemed this as a supreme concern of medicine.

Just because of this, the ancient Chinese philosophers attached great importance to seizing the opportunity and taking precautions to kill the trouble in its infancy. As Xi Ci Xia ( Second Half of SystemicIntroduction) told, “The gentleman is good at seizing the opportunity and won't wait;” once a sign is caught or forecast, he shall take precautions correspondingly. The teachings of “excellent doctors will treat the disease at skin-hair level” from Yin Yang Ying Xiang Da Lun ( On correspondence of Yin and Yang with Manifestations) and “the supreme doctor will treat the disease when it has just sprouted” from Ba Zheng Shen Ming Lun ( On Eight Great Seasonal Regulations of Simple Questions) actually contain parallel thoughts “seizing the opportunity” does. They only differ in the latter related to treating prior to disease and the former regarding awareness of suffering.

The remarks from Huan Nan Zi (), “an excellent doctor will treat a disease before its onset, so there is no disease actually in existence; the sage will manage issues before they become issue, so there will not be any actual issue to be dealt with,” did indicate the common truth the concept of treating prior to disease and the awareness of suffering shared.

Translator: Yingshuai Duan

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  [Figure 1], [Figure 2], [Figure 3]


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