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原機啟微

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Text ID
KR3em001
Date
1370–1391
Dynasty
元

Yuánjī qǐwēi 原機啟微

Disclosing the Subtleties of the Originating Mechanisms [of Eye Disease] by 倪維德 Ní Wéidé (1303–1377, zì Zhòngxián 仲賢, hào Mínzhāi 敏齋), YuánMíng physician of Wúzhōng 吳中.

About the work

A two-juǎn (上, 下) systematic ophthalmological treatise by the late-Yuán / early-Míng Wú physician Ní Wéidé, the earliest fully extant Chinese ophthalmology monograph organised around aetiology rather than around the older “seventy-two diseases” symptomatic taxonomy of the Lóngmù lùn 龍木論 tradition (KR3em003). The work groups all eye disease under eighteen aetiological categories (e.g., “yínrè fǎnkè” 淫熱反克 — heat-excess violating its controlling phase; “fēngrè bùzhì” 風熱不制 — uncontrolled wind-heat; “qīqíng wǔzéi láoyì jībǎo” 七情五賊勞役飢飽 — the seven emotions, five thieves, overwork and dietary disorder; “xiě wéi xié shèng níng ér bù xíng” 血為邪勝凝而不行 — blood overcome by perversity, congealed and not flowing; “qì wéi nù shāng sàn ér bù jù” 氣為怒傷散而不聚 — qì damaged by rage, dispersing and not gathering; “yáng shuāi bù néng kàng yīn” 陽衰不能抗陰 — yáng-decline unable to resist yīn, i.e. night-blindness; “yīn ruò bù néng pèi yáng” 陰弱不能配陽 — yīn-weakness unable to match yáng, i.e. internal cataract; “wéi wù suǒ shāng” 為物所傷 — traumatic injury; “shānghán yù hòu” 傷寒愈後 — sequelae of Cold-Damage disorder; “wángxuè guò duō” 亡血過多 — excessive blood-loss; and so on). Each category is paired with carefully matched prescriptions drawn principally from Lǐ Dōngyuán 李東垣 (李杲), Zhāng Zǐhé 張子和 (張從正), and Zhū Dānxī 朱丹溪 (朱震亨) — the great JīnYuán synthetic medical lineage of which Ní was the recognised ophthalmological heir. The KR-edition is sourced from the jicheng.tw (漢學文典) digital corpus and is the canonical text of late-imperial Chinese ophthalmology, repeatedly re-edited into the Qīng (including incorporation in KR3e0090 《醫宗金鑑》 and the Sìkù quánshū).

Prefaces

The front matter does not preserve a self-contained author preface; it instead presents a long appended doxographical anthology (附錄論目為血脈之宗 “Appended discussions: that the eye is the root of the blood-vessels”) drawn from the Nèijīng 內經, the Yuánbìng shì 原病式 of 劉完素 Liú Wánsù, 李杲 Lǐ Dōngyuán, 張從正 Zhāng Zǐhé, 朱震亨 Zhū Dānxī, Lóu Quánshàn 樓全善 (樓英), and Chén Wúzé 陳無擇 (陳言). The anthology is editorially commented in the third person (“Jǐn àn …” 謹按 / “Àn …” 按), and presents the framework into which Ní’s eighteen-cause taxonomy is then placed. The historically important framing-claim is the editorial gloss that “the eye is the chief manifestation of the qì and blood of the five viscera and six bowels — surely it cannot be confined to the vulgar five-wheel and eight-quadrant (wǔlún bākuò 五輪八廓) schema alone”, programmatically announcing Ní’s break with the Lóngmù lùn tradition’s five-wheel symbolism in favour of a JīnYuán physiological aetiology.

Abstract

Ní Wéidé was a Wúzhōng (Sūzhōu) physician of the transitional Yuán–Míng generation; CBDB and the standard biographies (Wúxiàn zhì, Goodrich-Fang 2:1095, Zhōngguó yījí tíyào) agree on the lifedates 1303–1377. He studied with 王履 Wáng Lǚ (a disciple of 朱震亨 Zhū Dānxī) and was reckoned the principal carrier of the Dānxī school’s ophthalmological line. The Yuánjī qǐwēi was completed late in his life and is conventionally dated to between 1370 (after the founding of the Míng) and 1391 (the date of the earliest known Hóng-wǔ-era circulation, attested in Xuē Jǐ’s 薛己 (薛己) Jiā-jìng-era expanded re-edition); his death in 1377 supplies the firm terminus ante quem for composition proper. The early Míng circulation was via manuscript; the first major print transmission is the 1530s Jiājìng re-edition by Xuē Jǐ, who added an “appended discussions” (附論) section and twenty supplementary cases — the form in which the text mostly continued to circulate and the form preserved in KR3e0090 《醫宗金鑑·眼科心法要訣》 (KR3em007). The work is the earliest fully extant Chinese ophthalmology monograph to organise eye disease causally rather than symptomatically, and one of the very few medical works to make the Jīn–Yuán qìxuè/zàngfǔ aetiology programmatically primary. It is the indispensable witness to the late-Yuán Dān-xī-school synthesis applied to ophthalmology.

The internal structure: juǎn shàng (卷之上) contains the first twelve causal headings (eye-disease arising from heat-excess, uncontrolled wind-heat, seven-emotion/overwork damage, blood-congestion, qì-dispersion, blood-mixing-and-knotting [pterygium-like growths], heat-accumulation/abscess, yáng-decline/night-blindness, yīn-weakness/internal-cataract, heart-fire overpowering metal and water, internally-tight-externally-slack [trichiasis], and “guest perversity in the eight extraordinary vessels” 奇經客邪) — i.e. the principal endogenous and structural eye diseases. Juǎn xià (the appendix-cum-completion) contains the further headings on trauma (為物所傷), sequelae of Cold Damage, “strong yáng striking solid yīn” 強陽摶實陰 (miosis), excessive blood-loss, the residual toxin of bānzhěn 斑疹 (smallpox / measles sequelae), and gān-eye 深疳 (paediatric nutritional ophthalmopathy). Each cause is treated by name, by mechanism (with explicit physiological derivation, often dialogically in Q&A form), by characteristic signs, and by a precisely-matched core prescription — many of them now canonical: Sháoyào qīnggān sǎn 芍藥清肝散, Tōngqì lìzhōng wán 通氣利中丸, Qiānghuó shèngfēng tāng 羌活勝風湯, Cháihú fùshēng tāng 柴胡復生湯, Dāngguī yǎngróng tāng 當歸養榮湯, Zhùyáng huóxuè tāng 助陽活血湯, Jiājiǎn dìhuáng wán 加減地黃丸, Juémíng yìyīn wán 決明益陰丸, Chuānxiōng xíngjīng sǎn 川芎行經散, Cízhū wán 磁朱丸, Shíhú yèguāng wán 石斛夜光丸, Yìyīn shènqì wán 益陰腎氣丸, Zīyīn dìhuáng wán 滋陰地黃丸, Háiyīn jiùkǔ tāng 還陰救苦湯, Chúfēng yìsǔn tāng 除風益損湯, Juémíng yèlíng sǎn 決明夜靈散, Língyángjiǎo sǎn 羚羊角散, Fúlíng xièshī tāng 茯苓瀉濕湯, etc.

The work also preserves the earliest detailed Chinese description of operative needle-couching for cataract (內障 nèizhàng): the patient washes the eye with ice-cold water until the blood-vessels are still, the operator fixes the eyeball between the thumb and index of the left hand, and the right hand directs a “duck-tongue needle” (yāshé zhēn 鴨舌針) into the white sclera “about the breadth of a grain of black millet from the black-of-the-eye,” rotates the shaft, scrapes the obstructing membrane with the cutting edge, and — if the membrane reseats — re-operates; the post-operative dressing is a wad of black beans bound under cotton over the closed lid for five to seven days. The procedure descends from the South Asian jalauka-needling tradition that entered China via Buddhist translations in the Táng (see Hinrichs and Barnes 2013, pp. 78, 196).

Translations and research

  • No complete Western-language translation has been published. The work is, however, the single most-studied Chinese ophthalmology text in modern PRC scholarship; standard modern critical edition: 倪維德著、和中浚校註《原機啟微校註》 (北京：中國中醫藥出版社, 1997). It is also included in 《中國醫學大成》.
  • Background on the late-Yuán Dānxī school transmission: Hinrichs and Barnes (eds.), Chinese Medicine and Healing: An Illustrated History (Harvard, 2013), pp. 109–113 (Jīn–Yuán synthesis), 78 and 196 (Indian-derived couching for cataract).
  • For the work’s reception in the imperial Qīng curriculum see KR3em007 Yīzōng jīnjiàn · Yǎnkē xīnfǎ yàojué 醫宗金鑑·眼科心法要訣, which reproduces the Yuánjī qǐwēi aetiological framework verbatim in several places.

Other points of interest

The eighteen-cause taxonomy of Yuánjī qǐwēi is the prototype of the MíngQīng “syndromic-aetiological” ophthalmology that supplanted the older 龍木論 seventy-two-disease scheme. It is also the principal channel through which the Indo-Buddhist couching-for-cataract procedure (already attested in KR3em011 Yínhǎi jīngwēi 銀海精微) entered the consensus literate-medical curriculum: Ní’s procedural description is the earliest set out in fully physician-controlled language.

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