Elements of traditional Chinese medicine (TCM) can be incorporated into any fantasy role-playing world, perhaps in an Asian setting, or as an exotic tradition practiced in foreign countries or by immigrants from far-off places. In the first part of this article, I'll describe briefly some aspects of TCM, and in the second, I'll give some ideas on how they could be used in fantasy role-playing. If you want to find out more about TCM, all of the books in the Further Reading list are held in the University libraries.
Chinese medical theory and practice has, of course, changed considerably over time, but shows remarkable continuity from about 500 B.C. onwards. Until then, healers were people, mostly women, called wu (sometimes translated as shaman or witch). The wu had two closely related abilities: she could speak to spirits, and she could heal the sick by exorcising the evil spirits that caused sickness. She could also go to the underworld in a spirit journey and find out how Death could be persuaded not to take a particular person. Illness could also be caused by ghosts who stole the souls of people, and the wu could send out her soul to search for the culprit. On finding it, she would make it release the soul, and then cure the sick by reuniting soul with body.
This early theory of disease causation was replaced by that of qi (ch'i), which remained the orthodox theory for the next two-and-a-half thousand years. The wu lost her role as healer, and physicians came to form a specialist profession with medical colleges and qualifying examinations. These doctors, who were usually men, used a wide range of methods to treat illness and injury, and also to promote health and prolong life. These methods included acupuncture and moxibustion, drugs and surgery, diet, breathing exercises and massage.
A first -class doctor could prevent disease before it took hold, and only a second -rate one had to wait for his patient to fall ill before he could diagnose and treat the problem. The doctor was therefore paid by his patients only when they were well. Naturally, the doctor had to pay for all costs of treatment. This method was fine for the wealthy who could afford to have a physician on retainer; poor people went to the doctor when they were ill and paid for the treatment they received, just as we do today.
Qi is the vital life force of human beings and of the universe. It is an energy that circulates in the body in anatomically fixed channels (meridians), and is of two kinds. The first is acquired at conception from the combined qi of the ovum and sperm, and cannot be replenished. It is gradually used up throughout life, and its total exhaustion causes death. The second kind of qi must he acquired regularly from food and air, explaining why eating and breathing are essential to sustain life.
TCM also uses the concept of yin and yang, found in various schools of Chinese philosophy. Yin and yang are the negative and positive components of all matter and energy in the universe, and qi, like everything else, is composed of a mix of both. If yin and yang are in the correct proportions, the body is healthy. If they are not, illness is caused. The aim of TCM is to restore the balance of yin and yang in the body, resulting in the restoration of health. In this view, the body is a self -repairing mechanism, and treatment enables the body to return to its natural, balanced state of health.
Acupuncture is the practice of inserting thin needles into subcutaneous connective tissue or muscle at specific points in the body (known as acupuncture points or acupoints). It is used in TCM to treat a wide variety of illnesses with unsupported claims for effectiveness. Whatever effects it may have in treating illness generally, it unarguably gives pain relief (analgesia) to a significant number of people: 55% to 85% of patients, compared with a general placebo effect of 30% for the treatment of chronic pain. Electroacupuncture, in which a small electrical current is passed through the needle, is used to produce anaesthesia for surgery. Acupuncture is also reported to impart a general feeling of wellbeing.
The physiological mechanism of the analgesic and anaesthetic effects of acupuncture is now clearly established. The needles stimulate peripheral nerve,. which then signal the brain to produce endorphins and monoamines - chemical transmitters that block pain. The production of endorphins, which are the body's natural opiates, may also account for the feelings of wellbeing that are produced by acupuncture. According to the Chinese theory, the needles are inserted at particular points on the qi circulatory system, and the acupuncturist uses the needles to manipulate the flow of qi to restore the correct balance of yin and yang in the body.
Moxibustion, the lesser-known cousin of acupuncture, is the practice of burning the dried leaves of artemisia vulgaris (mugwort) either directly on the skin or just above it, perhaps with a slice of ginger or bean paste placed between the moxa leaves and the skin. The material used must be artemisia; the plant may contain a pharmacologically active compound. Moxibustion was of the same importance in TCM as acupuncture, and was used for chronic illness whereas acupuncture was generally preferred for acute cases. Both acupuncture and moxibustion could be lethal, and hence forbidden: acupuncture, if lethal acupoints were used; moxibustion, if it was used when unnecessary, in which case it could cause the element of "fire" to enter the body.
TCM uses drugs of plant, animal and mineral origin. The traditional pharmacopeia contains thousands of plants, some of which are known to be pharmacologically active: dichroa febrifuga contains an anti-malarial agent, as does artemisia annua (sweet wormwood); ephedra sinica is the source of ephedrine, used to treat asthma; aconite (monkshood) is a cardiac poison and like digitalis, can be used as a heart stimulant in small doses; nux vomica is the source of strychnine; cannabis and opium are used for anaesthesia and analgesia.
Ginseng (partax ginseng) is an important all-round invigorating tonic and beneficial in all cases of chronic illness. No TCM pharmacy should be without it, although I don't vouch for its efficacy. Ginger is used for colds and coughs, apricot seeds for cough and constipation. In fact, the seeds and rinds of many fruits (such as plum, pomegranate and tangerine) are used for gastric disorders. Other plants are used to treat diseases such as hepatitis (gardenia jasminoides), injuries such as burns (sophora flavescens, used externally), and for infections and snakebite (lobelia chinensis). Drugs, of varying effectiveness, could be prescribed for virtually all injuries and illnesses.
Poison antidotes are also found in the Chinese pharmacy. Some examples are: (1) an overdose of medicine can be treated by tea made from roasted rice or by egg yolks swallowed whole; (2) arsenic poisoning by the juice of soybeans; (3) mineral drug poisoning by a liquid infusion of ginseng or white duck's droppings; (4) arrow poison by lotus root or hemp seed extract; (5) mushroom poisoning by drinking the clear fluid left after a clay -water mix has settled for a few minutes.
The early Chinese noticed that if an ill person took medicine, she or he might recover and thereby postpone death. From this, they reasoned that if medicine could put off death temporarily, perhaps it could put off death permanently, and turned to the search for the Elixir of Life. Unfortunately, the minerals they chose to work with–mercury, lead and arsenic–were extremely toxic. Cinnabar (mercury sulphide) was especially popular because of its red colour and association with life-giving blood. Not unexpectedly, the death rates from these experiments were rather high, with even emperors dying from elixir poisoning. After a short while of passing these deaths off as the transformation of the physical body to an incorporeal, immortal one, the alchemists changed to a less toxic repertory of experimental substances, in which gold was important.
The search for longevity and immortality is found in TCM, alchemy and some schools of Chinese philosophy such as Taoism. One school of thought advised that to prolong life, one should not overeat, breath too hard, sleep too long, release semen, or become intoxicated. All of these either injured or drained qi, and thus shortened life. These lifestyle constraints were perhaps not very popular, and it was just as well that certain herbs were believed to have the power to reverse aging and prolong life. Naturally, these grew in unknown and inaccessible parts, or had to be harvested at very special times (astrological conjunctions which occurred once every sixty years, for example). One plant of immortality was believed to grow on an enchanted island that floated somewhere in the eastern ocean, and early emperors spent small fortunes on expeditions sent to look for it.
The Elixir of Life, an alchemical concoction, was aimed at achieving bodily immortality: at the height of its popularity (4th century BC to 1st century A.D.), China had yet to come in contact with Buddhist ideas of soul and rebirth, and it was believed that although the soul did experience some sort of afterlife, it would, like the body, eventually perish. Bodily immortality was therefore essential for eternal life, but it could take the form of a “levitant aerostatic subtle body", a perfect body that could wander at will over the earth, among the clouds, and even the stars.
The effect that acupuncture can have in a fantasy campaign will depend on the way in which diseases are caused. If the causes of illness are those of the real world, the effects of acupuncture will be largely restricted to pain relief and anaesthesia, irrespective of the presence or absence of magic. This is because acupuncture is not magical. It is a rational technique, based on a rational, if incorrect, theory of disease causation.
If, on the other hand, the qi theory of disease is correct, then acupuncture will affect a great many diseases by correcting the imbalance in yin and yang, although cures are not instantaneous. Treatment may take weeks of repeated visits to an acupuncturist. As a guide, acupuncture could successfully treat anything influenced by a physiological process: infectious disease, migraine, stomach ulcers and so on could be treated, but anatomical changes such as osteoarthritis and cataracts could not, although they could he treated by other aspects of TCM. Cataracts, for instance, might be treated with surgery.
The GM could also decide that acupuncture can speed up the rate of healing from trauma. Anecdotal evidence of the healing of fractures under TCM (which uses many small splints instead of a single large one) is that it reduces healing time to about 60% of normal. Clearly, acupuncture has its biggest impact in a campaign either devoid of conventional instant healing magic, or in which such magic is available to the elite only. In any case, the most appropriate way in which to model acupuncture, irrespective of the theory of disease causation or the type of magic available, is as a learned skill. Magical spells are simply not true to the rational spirit in which acupuncture and TCM were held in China.
Longevity and Immortality
Herbs of immortality or Elixirs of Life could be introduced into a game in a number of forms. In one, the herb is extremely rare, perhaps unique, and the object of a great many, so far unsuccessful, quests. In another, the Elixir of Life is an alchemist's potion, produced according to scientific principles, not magical ones. It could be either commonplace or rare, but it is always possible that the commonly available ones are only toxic cinnabar drinks. It is also possible that a necessary, although unfortunate, side-effect of immortality is the abandonment of one's material body.
At any rate, the plant of immortality was believed to be extremely rare, and the Elixir of Life something available only to alchemists and emperors. They were both believed to have the power to confer bodily immortality, and more importantly, were one of the few ways in which this could be achieved. Their impact would diminish greatly if powerful healing and longevity magic was easily available. The truest representation of the Chinese tradition, therefore, is in a campaign in which such magic is rare, although elements of TCM can be applied in any type of fantasy campaign without incorporating the tradition as a whole. Perhaps the most essential aspect of the tradition is that it was rational, not mystical, and given the limited knowledge of the time, could be considered an almost scientific attempt to explain illness and health.
Further Reading (all available in the University of Queensland library)