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Beliefs in the supernatural and religious beliefs pertaining the supernatural have influenced Chinese medicine, where vestiges of them are still visible to this day.

Ancient Religious and Supernatural Beliefs: of religion in the Shāng Dynasty (商朝1600–1046 BCE), most is known to historians about the religion of the elite. They believed in an afterlife, as evidenced by the elaborate burial tombs built for deceased rulers containing carriages, utensils, sacrificial vessels, weapons, and objects of jade believed to protect against decay or confer immortality. The Shāng elite believed in a hierarchy of gods headed by Shāng Dì (上帝, also simply referred to as Dì), the Highest or Supreme Deity, the ultimate spiritual power. Shāng Dì was believed to control victory in battle, success or failure of harvests, weather conditions such as the floods of the Yellow River, and the fate of the kingdom. The supernatural world of the Shāng was also populated by spirits of the deceased. Shāng Dì was believed to work through lesser gods and to be too distant to be worshiped directly by ordinary mortals. However, the Shāng kings proclaimed that Shāng Dì had made himself accessible through the souls of their royal ancestors, both in the legendary past and in recent generations as the departed Shāng kings joined him in the afterlife. The emperors could thus successfully entreat Shāng Dì directly through rituals and sacrifices. Many of the oracle bone inscriptions record these petitions, usually praying for rain but also seeking approval from Shāng Dì for state action. In the later Shāng, Shāng Dì became conflated with Heaven (天 tian), originally the god of the sky.

The new rulers of the following Zhōu Dynasty (周朝) 1046–256 BCE a justified taking over Shāng wealth and territories by claiming that Heaven (Shāng Dì) had imposed a moral mandate on them to replace the Shāng and return good governance to the people. The Mandate of Heaven (天命 tiān mìng) was presented as a religious pact between the Zhōu people and their supreme god in heaven (literally the sky god). Since worldly affairs were supposed to align with those of Heaven, Heaven conferred legitimate power on a single person, the Zhōu ruler. In return, the ruler was duty-bound to uphold heaven’s principles of harmony and honor. Any ruler who failed in this duty, who let instability creep into earthly affairs, or who let his people suffer would lose the mandate. Under this system, it was the prerogative of spiritual authority to withdraw support from any wayward ruler and to find another, more worthy one. In this way, Heaven legitimated regime change. This also allowed any contender to power to justify overthrowing a ruler by moral superiority.

Although Shāng Dì was the supreme deity, he never became the center of an enduring monotheistic religion of the people. Popular Chinese religions have typically always been polytheistic. Shāng Dì’s metamorphosis into Heaven marked a change toward a more abstract, cosmological conception as the ultimate force of the universe, which continued in the Qín-Hàn Period and down the ages, appearing in Confucian and Daoist literature. After the major unification of the Chinese world by the Qín , the word Di came to be used in the compound 皇帝 (huáng dì) to denote emperor. It also appears in the name 黃帝 (huáng dì), the Yellow Emperor or Yellow Thearch, a legendary sovereign and cultural hero of ancient times, after whom the Nèi Jīng takes its name. When Christian missionaries entered China much later in history, Shāng Dì was the name given to the one God of the Christians. Because of certain theological misgivings, this name was officially replaced by 天主 tiān zhǔ (literally, Heavenly Lord) among Catholics and 神 shén (lit., spirit, deity) among protestants, although it nevertheless continues to be used for any supreme deity to this day.

During the Hàn Dynasty (206 BCE–CE 220), supernatural beliefs had three major strands: ancestor worship; demons and spirits; and the gods inhabiting a celestial realm (including Shāng Dì). Numerous kinds of demons and spirits inhabited the world, among them restless souls of the recently deceased who had not been given an appropriate burial by the living. They inhabited the yīn realm (阴间 yīn jiān), which partly overlapped with the human world. Ancestor worship rested on the notion that a family’s ancestors were protectors of living family members. The heaven of the gods was modeled on the newly unified Chinese empire and was populated by gods or spirits that, like their earthly counterparts, exercised bureaucratic functions. Many aspects of daily life involved propitiating the supernatural world and keeping the world of the living attuned to that of the spirit world.

In their origins, beliefs in supernatural causality predated Confucianism and Daoism and thus was not the product of either philosophical tradition. However, it did influence them. Confucianism adopted ancestral worship yet, being a philosophy that envisioned a healthy society in terms of harmonious relations among the living, it gave little credence to the world of demons and spirits. As a deterministic social philosophy, it helped to pave the way for the new deterministic medicine exemplified by the Nèi Jīng. By contrast, Daoism, in its religious form that developed in the Hàn Dynasty, tended to embrace many prevailing supernatural beliefs. It became something of a collecting place for all the contents of the other world.

This aspect of religious Daoism is prominently seen in shamanist practices, which are still very much alive in Taiwan, although they have virtually disappeared from mainland China. Taiwan is famous for its jī tóng 乩童 or 童乩 tóng jī, people believed to have been chosen by a particular shén 神 god or spirit as the earthly vehicle for divine expression. When possessed, a jī tóng may beat himself with a nail-studded ball at the end of a cord and handle to the point that he draws blood from multiple wounds on his back. A jī tóng appears to be entirely under the control of forces in the spirit world, and hence different from other shamans called wū 巫, who gain control of forces in the spirit.

Supernatural Beliefs and Medicine: Treatment of disease has many strands in China. What practitioners and patients in the modern West know as Chinese medicine, or even traditional Chinese medicine, is most often limited to medical ideas that were discussed and practiced in the literate tradition. Moreover, these tenets have been deemed suitable for modern Western minds by authorities in both China and the West.

What China’s populations may have done throughout the centuries to treat their illnesses is to a certain extent a matter of speculation until at least the Sòng Dynasty. Then, after the development of the printing press, more historical texts survived because of the abundance of printed copies. We know that in the Shāng and Zhōu the ruling elite attributed illness without any immediate natural cause, such as injury or exposure to the elements, to the wrath or displeasure of the ancestors or to gods, spirits, and demons. In the Hàn Dynasty, the elite favored the deterministic medicine of the Nèi Jīng. Nevertheless, supernatural explanations for illness that had no obvious immediate natural causes persisted much longer among the5 common folk of China. This was especially the case for mental illnesses, epilepsy, sudden diseases like heart attack, epidemics, and diseases that were difficult to treat Although some of these beliefs were reinterpreted in more deterministic terms, many supernatural beliefs persisted alongside the deterministic medicine of the literati. This is not hard for us to believe in the twenty-first century when we consider that some segments of the population have been convinced that AIDS as divine retribution for homosexuals and drug addicts.

Supernatural explanations of health and sickness were influenced by all three strands of supernatural belief described above. Demons and spirits were considered to have a disruptive effect on the world of the living, and in particular were a major cause of illness. An illness so caused could be prevented and treated by amulets warding off evil spirits, by incantations, and by shamanic exorcist ceremonies.

Whether an individual remained healthy or fell ill was often explained in terms of Heavenly retribution (报 bao) for good or bad moral behavior of the individual or his or her ancestors. When an epidemic occurred, some families and individuals were affected, while others were spared. Families that were struck were those that had to pay for the sins of ancestors. Families spared were those whose ancestors were morally upright. Individuals were struck or spared depending partly on their own moral behavior but also on that of their ancestors. An evil person who was spared was regarded as being saved by the good deeds of their ancestors, while a good person who was struck was regarded as having to redeem the evil deeds of their ancestors.

Many beliefs concerning the supernatural causes of disease were assimilated into the deterministic medicine of the Nèi Jīng in various ways. Seeing ghosts and ghost oppression (ghosts sitting on a patient’s chest) became symptoms of illness that were explained in terms of natural causes. Illness caused directly by demons and spirits was in some cases re-explained in terms of the fear and worry they caused. Since illnesses caused by demons and spirits were noted to have some degree of seasonality, they could easily be merged with the same illnesses explained in terms of seasonal weather differences. Epidemics exacting a high mortality rate that were supernaturally explained by demons and spirits passing from a dying individual into another living person (疰 or 注 zhù, infixation) could also be explained in terms of natural causality by contagion and prevented by isolation.

The Thirteen Ghost points (十三鬼穴 shí sān guǐ xué) attest to the belief that illness could be caused by ghosts or demons, which could be dispelled by needling certain points on the body. Demons were believed to cause illnesses that had no obvious immediate natural cause. Prominently among these were mental diseases. All the ghost points treat conditions like mania, withdrawal, and epilepsy.

Though supernatural explanations of illness were partially assimilated into natural-cause explanations, they were never absorbed completely. They continued to exist as alternative explanations alongside natural causes. In fact, after the initial development of theories of illness wholly attributable to natural causes, there was an upswing in supernatural explanations from the end of the Hàn Dynasty. After the appearance of the Nèi Jīng, Nàn Jīng, and Shāng Hán Zá Bìng Lùn, the earliest classics of medicine explaining health and sickness by the laws of nature, works by medical scholars such as Wáng Shū-Hé and Sūn Sī-Miǎo contained considerably more references to the supernatural. Although from the Sòng Dynasty onward, supernatural explanations played only a minor role in ideas about health care, it was the challenge of the Western scientific worldview in the 19^th and 20^th centuries and the forceful eradication efforts mounted by the socialist government of China in the latter part of the twentieth century that most effectively reduced them. However, supernatural components to healing are likely always to have a modest following.

But let us return to the past. Tension always existed between physicians and those who believed in supernatural causes of disease. Just as in Western medical history, we know from literati physicians’ derogatory comments that popular beliefs and superstitions were often seen as ineffective or even as dangerous to the patient’s health. Already in early times, health care was big business, and scholars wrote essays, and politicians passed laws, against charlatans enriching themselves by deceiving a gullible population desperate for miracle cures. This, of course, applies to both religious and medicinal practitioners, and it would be wrong to dismiss any healing in Chinese medical history that involved supernatural powers as mere superstition, practiced by the desperate uneducated masses.

A concrete example can illustrate what this interplay of differences in agendas, practices, class, and gender looked like in clinical practice: A common topos in early gynecological literature was to warn against the invasive meddling of female caregivers and bystanders: midwives, aunties, and neighbors, during labor and delivery. According to the writings of male literate doctors, village women congregating around a woman in childbirth caused dangerous complications by frightening her with stories, impatiently engaging in unnecessary interventions to speed labor or upsetting her afterward when the newborn was not as expected. Furthermore, shamans on the scene would warn that the blood of childbirth was highly offensive to the spirit world. At this life-threatening moment, mother and child needed protection from supernatural powers.

Quite ironically when compared to their early European and American counterparts, Chinese professional male physicians recommended isolating the woman and letting nature take its course. They tended to limit their own role to giving the woman moral encouragement, administering strengthening and calming decoctions, and guiding her along what they saw as a natural process with as little medical intervention as possible. Nevertheless, all these writers acknowledged the significance of supernatural factors during conception, labor, and delivery. Hence, Sūn Sī-Miǎo, for example, stated that male and female infertility was caused not just by physiological factors such as a misshapen or cold vagina or insufficient male essence but also by the parents having mismatched birth signs or by neglect of the ancestral tombs. The ritual preparation of the birth chamber, the auspicious positioning of the woman during labor and delivery, the timing of the birth, and the disposal of the placenta were matters of great concern for all levels of the population, with grave effects assumed for the health of the mother and the child if established protocols were not followed.

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