A Historical Review Of The Chinese Medicine Concept Of Liver Asthenia And Sthenia And The Treatment Philosophy Of Invigoration And Enervation Based On The Knowledge Archaeological Method

PurposeThis article employs the knowledge archaeological method to review what the Chinese Medicine concept of liver asthenia and sthenia and its corresponding treatment philosophy of invigoration and enervation represent and their respective changes through different eras; seeks the reasons behind these changes; and attempts to construct an academic-ideological history of it.MethodDiscourse structure analysis was applied to medical literature on aspects such as the formation of the concepts of the "liver", asthenia, sthenia; their respective descriptions; and their ideological influences:1. The formation of the concept of the "liver"-how physicians defined the boundaries of the "liver".2. The formation and definition of the concepts of "asthenia" and "sthenia;" and their usage in determination of pathological scope using different diagnosis-treatment systems at different times.3. How the concepts of liver asthenia and sthenia were described, by its own and in relation to other concepts; and the sequence in which they appear in relation to each other within the context of the diagnosis-treatment system.4. The contexts in which will the concept of liver asthenia and sthenia will be raised.Conclusion1. In Chinese Medicine, the concept of the "liver" is one that is continuously changing.The process can be divided into three stages. Firstly, during the Han-Tang dynasties, the "liver" referred mainly to an anatomical liver, but which was built upon the theoretical foundations of the traditional Shu shu theory. Secondly, from the Song to early-Qing dynasties, the "liver" continued to be thought of as an anatomical liver, but was influenced by neo-Confucianism, and then became categorised under the syndrome differentiation of zangfu viscera system. Thirdly, during the late-Qing dynasty, under the influx and influence of western medical knowledge, two schools of thought arose-one that disregarded the concept based upon the anatomical liver, but emphasised the Chinese Medicine thought of a non-physical organ-system entity, which was favoured by physicians like Yun Tie Qiao; and the other that tried to reconcile with western medical knowledge, which was favoured by physicians such as Lu Yuan Lei.2. The concept of asthenia and sthenia is gradually shifting from a multi-faceted one to a unified pathogenesis conceptFor a long time since the Emperor’s Canon of Internal Medicine, this concept has taken on many rich meanings. Till the Song-Yuan dynasties, asthenia and sthenia still represented the strength of the pulse and the state of the physical body. From the Ming-Qing dynasties, with the development of the syndrome differentiation of eight principles, asthenia and sthenia became one pair of the eight principles, and its concept narrowed to a pathogenesis one. After the formation of People’s Republic of China, the concept was further narrowed and unified to mean pathogen excess and self-deficiency.3. Liver asthenia and sthenia diagnosis-treatment system underwent four stages of change:Firstly, during the Han-Tang dynasties, liver asthenia referred to a self-deficiency while liver asthenia referred to self-excess. Secondly, during the Song-Yuan dynasties, the concept underwent a significant expansion till sthenia included not only the internal excess but also the external pathogenic elements; and asthenia included organ-system qi and blood deficiency. Correspondingly, the concept of invigoration and enervation expanded. Thirdly, during the Ming-Qing dynasties, with the maturation of the syndrome differentiation of zangfu viscera system came the clinical application of the concept of liver yin. At the same time, the elucidation of the relationship between eight extra meridians and the "liver" generated much discussion and a liver-invigorating theory was developed. Lastly, from the late-Qing dynasty till now, with the influx and influence of western medicine came attempts to reconcile both medicine systems which once again redefined said concept.4. The modern concept of liver diagnosis in modern Chinese Medicine is a product of both Chinese and Western influences.The current syndrome differentiation of "liver" viscera system is under western anatomical and pathophysiological influence, but utilises Chinese Medicine terminology. Under this new system, the concept of "liver" comprises of both the Chinese Medicine concept which includes the liver meridian and ocular system, as well as the Western Medicine concept of the liver. This is in essence an amalgamation of the Ming-Qing syndrome differentiation of "liver" viscera system and western medical theory.Significance1. Explained that the development of the Chinese Medicine concept of liver asthenia and sthenia with its corresponding treatment philosophy of invigoration and enervation through history was not a linear and progressive process, but an ever-changing, ground-breaking and synergistic one. 2. Sorted out the changing tapestry of Chinese Medicine Liver diagnosis-treatment system, which will aid future investigation into Chinese Medicine theory and development history.