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Daoism’s influence on Chinese medicine is a complex and oft-debated topic. This is directly related to the difficulty and confusion regarding the study of Daoism as such, which, in turn, hinges on the question of how we define Daoism. In the past, and particularly in popular Western culture, it has served as an icon for those aspects of Chinese culture that were regarded as somehow mystical, supra-rational, spiritual, natural, and even anti-authoritarian, anti-Confucian, and anti-establishment. Chinese philosophies concerning nature, science, cosmology, and medicine have often been wrongly classified as Daoist, when they are in fact notions commonly held by most members of Chinese culture, regardless of their philosophical persuasion. The ideas discussed below under the heading of natural philosophy exemplify this.

For a more accurate discussion of Daoism and its specific influence on Chinese medicine, we would differentiate between philosophical Daoism, which laid the philosophical foundations in the early period, and religious Daoism, a subsequent development from the third century CE onward. Philosophical Daoism was, like Confucianism, a response to the social and political unrest of the Warring States period. It developed from the fifth to the third centuries BCE and needs to be understood in this particular sociopolitical context. Our current understanding is based primarily on two philosophical texts, namely the Dào Dé Jīng (道德经 Classic of the Way and its Virtue), attributed to a legendary person known as Lao Zi 老子, and Zhuāng Zǐ 庄子, a text named after its author.

Dào and Dé, the Way and its Virtue

What the writings of both Lao Zi and Zhuāng Zǐ have in common is a concern with transcending the limitations of human society and ordinary ways of thinking. These authors turned to nature for a solution to the problems of the day, in pursuit of their own version of the Dào or way. Confucius clearly practiced and taught his Dào as a key to correct social order found in the study of the ancient texts and rites. Daoists, by contrast, refused to delimit their Dào, and rather extended its meaning to refer to an ultimate reality, a cosmic way of the universe, and a single source of all existence. Being invisible, intangible, and ineffable, it could only be intuited in a non-discriminating and non-rational observation of nature.

In their original context of intending their teachings as political advice to rulers and other concerned individuals, the Daoist writers yearned for a return to a more natural way of life that contrasted sharply with what they conceived of as the Confucian tendency to meddle and interfere. By following the Dào and acting in harmony with the universe, one would gain dé 德, power (the same term that the Confucians had used in a moral sense to refer to the ruler’s virtue). Withthis power, the ruler would reverse the current downward spiral of decline and strife, not by interfering, but by letting things take their natural course. Such a ruler would return society to peace and harmony. The people would once again live in blissful simplicity and innocence. But what was this Dào and where could it be found?

Water, Butchers, and Non-Action

The Dào Dé Jīng begins with the mysterious statement that the Dào that can be Dào-ed (meaning ‘turned into a path that others can follow’ or ‘put into words’) is not the constant Dào (道可道非常道 Dào kè Dào fēi cháng Dào). For this reason, Daoist writings often sought to express their ideas through metaphor. To describe the Daoist Dào, perhaps the single most important metaphor is water. Being soft and yielding, it manages to break through rock by virtue of its nature, namely its tendency to seek out the lowest place. The notion of seeking out the lowest place is contrary to the ideas of the common folk, who aim for the highest place. Without striving, water gives birth to the myriad living things and is therefore the source of all creation.

The Dào of water was used to explain the ideal of wěi wǔ wěi 为无为, often translated as action through non-action. More concretely, it refers to moving in the qì of the cosmic Dào through time and space without striving or conscious effort, like fish swimming in the water or birds flying in the air. Regarding education, politics, or any other human activity, ultimate skill and knowledge were considered to result not from conscious effort and rational study, but from a spontaneous and unconscious resonance with the Dào of all things.

In one of the more well-known stories in the Zhuāng Zǐ, Butcher Dīng, famous for the effortless art of his butchering, is invited to explain his art to an open-minded feudal lord. Dīng refers to his technique of butchering an ox as the Way (Dào) that goes beyond skill and as stopping perception and letting the spirit run its course. An inferior butcher, unfamiliar with the internal patterning of an ox, hacks through bones and muscles with great effort and has to replace his knife every month. Butcher Dīng, in contrast, intuitively senses the natural spaces between the joints and, following these gaps with his knife, he effortlessly carves the ox in a single swift, dance-like stroke, not even dulling his knife. With a single stroke, it all comes apart like a clod of earth crumbling. In response, the feudal lord says: Excellent! By listening to Butcher Dīng I have learned how to nurture life (养生 yǎng shēng).

This story demonstrates how the ideal of effortless action, of intuiting the natural order of things and then choosing the most advantageous and easiest course of action by following their nature, is a result of an intuitive and non-rational unity with the Dào. Given the correlations and correspondences between the different realms of reality in early Chinese thought, it then becomes obvious how this wisdom would be applied to the political ordering of the state, on the one hand, and to the treatment of the human body, on the other. A superior butcher chooses the easiest way of carving an ox by closing his eyes and following the Dào with his spirit. Similarly, a ruler learns how to take advantage of the Dào, the natural order of things, and to choose the easiest, most natural course rather than to exert energy by going against the natural course of things. As a result, he will not only order society but ultimately benefit himself personally by learning how to nurture life.

The Sage Life

In response to Confucian activism in government, the Daoists advocated stillness and passivity. The Daoist application of the ideal of non-action to government and its contrast to the activism advocated by Confucians, is exemplified by a story in the Zhuāng Zǐ about two busybodies called Fast and Furious, the Emperors of the North and South Seas: In a well-intentioned effort to enlighten Hun-Dun, the primordial chaos, they drill one opening into its undifferentiated mass every day, presumably to increase its ability to perceive the outside world. As a result, Hun-Dun dies on the seventh day. Rather than interfering with the Dào, or natural course of things, the ruler—or anybody else—should try to follow it by attaining a state of oneness with the rest of the universe and then acting out of this frame of mind. As the Dào Dé Jīng advises, the sage ruler should merely empty people’s minds and fill their bellies, weaken their will and strengthen their bones (虚其心，实其腹，弱其志，强其骨 xū qí xīn, shí qí fù, ruò qí zhì, qiáng qì gǔ) and keep them always without knowledge and without desire.

Although the Dào Dé Jīng, in particular, should be understood first as offering advice to be applied in government, many Daoist writings tend to express a quietist and escapist attitude. Instead of social involvement, they advocate a retreat from society and its man-made distractions. They celebrate the return to a simple life close to nature, devoted to individual purification and the cultivation of the Dào within one’s own mind and body, preserving what is within, rather than exhausting oneself in struggles with the outside world. Especially in the centuries after the collapse of the Hàn Dynasty in 220 CE, practices associated with physical and spiritual self-cultivation, called nurturing life (养生 yǎng shēng), became increasingly popular. These were later incorporated into the pursuit of immortality in religious Daoism.

Complementary Opposites, Reversal, and Femininity

Another central theme in Daoism is the unity of complementary opposites that is also observed in the doctrine of yīn and yáng. Daoists envisioned an ideal state of balance between opposites, of returning to the original Oneness that underlies the extreme poles of yīn and yáng or male and female. Thus, the Dào moves in continuous cycles of change and reversal. Accordingly, a position of weakness might lead to strength, or going down might enable one to rise to the top.

Here again, water is the perfect metaphor for the virtues of weakness, yielding, softness, and going down rather than up. Directly associated with these virtues and supplying an extension of these attributes are the qualities of femininity and of yin. These provided a second set of evocative metaphors that incorporated cultural as much as biological associations ranging from life-giving and nurturing to yielding, receiving, and being dark and mysterious. This affinity with and idealization of the female principle in Daoist literature had the ultimate goal of attaining the opposite in the cycle of reversal. This was an ideal that, from the Hàn Dynasty onward, came to be shared by all philosophical—and medical—schools.

Zhuāng Zǐ contains an abundance of entertaining and humorous stories to show the relativity of all value judgments and the limitations of rational knowledge and language. A common theme is the virtue of uselessness in a society fraught with so many unpredictable dangers. Cripple Shu, for example, is pitied by everyone for his infirmity and ugliness, but in the end avoids military draft and labor conscriptions and is thereby able to live out his natural lifespan. Related to this is another key point: The limitation of our ordinary sense perceptions causes us to make biased judgments of right and wrong, good and bad, this and that, which can be compared to a frog’s view of the sky from the bottom of a well. How do we know whether, in his famous dream of the butterfly, Zhuāng Zǐ is a person dreaming he is a butterfly or a butterfly dreaming it is Zhuāng Zǐ dreaming he is a butterfly? Or whether death, as the transition to another level of existence that we know absolutely nothing about, is a sad event to be mourned or a reason for celebration?

These playful stories also emphasize the limitations of rationality and human language, which, having been created by human rationality, cannot take us beyond itself. Thus, the Dào Dé Jīng states that those who know it, don’t talk, and those who talk about it, don’t know (知之者弗言，言之者弗知 zhī zhī zhě fú yán, yán zhī zhě fú zhī). The sages realized this and instead responded to the world directly and intuitively. In so doing, they reached the realm beyond, a place of untrammeled freedom from social conventions, of mysterious power to transcend the ordinary, of limitless depth, space and time. and this is what they referred to as the Dào.

Religious Daoism

In the Hàn Dynasty and the centuries that followed, popular forms of Daoism arose. At first, they centered around health-cultivation practices and an alchemical and magical search for longevity and immortality through the consumption of cinnabar and gold. In time, the veneration of deities and folklore figures together with the vast and complex mythology of the Chinese people was incorporated—a process that was influenced by Buddhism. From the 7^th to the 10^th centuries, a celibate monkhood also developed, their practice influenced by Buddhist teachings concerning morality and the pursuit of health, longevity, and immortality.

The gods of the Daoist pantheon, unlike the omniscient and omnipotent monotheistic Gods, have limited powers. They are assumed to be human in form and to be like government officials, very unlike the intimate fatherly Christian God who knows our every thought. Practitioners offer them prayers, incense, and offerings for their help and protection. Advanced adepts communicate with them for spiritual guidance.

Belief in personified gods sets religious Daoism apart from the original abstract notion of the Dào spoken of by Lǎo Zǐ and Zhuāng Zǐ. The stylization of the gods as government functionaries reflects an acceptance of a social hierarchy embraced by Confucians but opposed by the founders of the philosophical doctrine of Daoism.

Practitioners often address questions to the gods by divination techniques such as the use of jiāo bēi (筊杯) , divination blocks, that are thrown to answer a yes or no question. Thus, religious Daoism retains older beliefs in magical causality.

Religious Daoism, which is still very much alive in Taiwan, is characterized by numerous holidays with pilgrimages and parades for venerating different gods. It provides collective ceremonies replete with noise and spectacle that are not found in Confucianism and Buddhism. Before the advent of radio, television, and Netflix, religions around the world provided most of the entertainment available. In China, religious Daoism provided most of the holidays, ceremonies, parades, and feasts. Besides the pantheon of Daoist gods, integral aspects of religious Daoism include the cult of immortality, practices of external and internal alchemy, and rituals such as visualizing meditation. Very conspicuous in many Daoist temples is a rich portrayal of Chinese mythology that captures the imagination and invites the beholders into a reality beyond sensory experience.

Daoism vs. Confucianism

Daoism and Confucianism, often considered to be the antithesis of each other, have more in common than might at first meet the eye. Both are philosophies about how people and the world thrive by living according to a Dào. Confucianism stresses the need for rites and social convention to oil the wheels of society. Daoism sees human society as merely a part of the universe that operates according to the Dào. Both have a belief that when people keep to their true roles, society will function in orderly fashion. The Confucianists believe that a benevolent ruler can ensure social order without force, like the wind effortlessly swaying the grass. The philosophical Daoists believed that living a simple life in accord with nature is the way to prevent social disharmony. Both see life as an almost magical balance of forces.

Both philosophies have little interest in supernatural beings. However, Confucianism includes ancestor worship and religious Daoism has a pantheon of gods. Insofar as ancestors can be considered akin to gods, Confucianism and Daoism are both polytheistic. The notion, shared by all the Abrahamic religions, of a creator God who represents good as distinct from evil and who demands submission is quite alien to the Chinese mind. In China’s rich mythology, we find the supreme deity, 上帝 Shāng Dì, but beliefs about this god never coalesced into a fully-fledged monotheistic religion. As we said before, Shāng Dì, or Heaven, was believed to work through lesser gods and to be too distant to be worshiped directly by ordinary mortals.

Furthermore, Daoism and Confucianism were complementary. While Confucianism provided an authoritarian framework of social cohesion, philosophical Daoism provided additional means of personal growth and liberation, and religious Daoism provided food for the imagination in vistas of a world beyond the senses. Thus, each met different needs.

Chinese people do not normally choose to identify themselves as Confucians and Daoists. Confucian values are generally shared by the Hàn population (ethnic minorities account for only 10% of the population), whatever religion they hold. People who believe in religious Daoism do not see their religion as defining their identity in the way that members of Abrahamic religions often do. Religion in China has less of the tribalism that characterizes religions in other parts of the world. This may be attributed to the secular influence of Confucianism, to the principle of non-meddling in philosophical Daoism, and to the polytheism of Chinese folk religious that were absorbed into religious Daoism.

One thing Daoists and Confucianists agree on is that a good lifestyle is a major key to good health.

Daoism and Medicine

As stated above, medicine is a social art, concerned with treating another person’s body and mind. Daoist texts explicitly rejected commonly accepted social duties and responsibilities and even warned against interfering in other people’s lives. One could thus argue that Daoism was, at least in principle, opposed to medical practice. Nevertheless, the Daoist quest for a return to a natural state of being in oneness with the Dào led them to form concrete ideas about what was natural, both within the human body and in its interactions with the outside. These obviously affected medical theories of pathology, health, and therapy in Chinese culture at large.

On the most elemental level, medical action runs counter to the principle of wu wei, non-action, since the human body is naturally healthy and in tune with the Dào and therefore should be left alone rather than manipulated artificially. Daoist texts contain advice that could be directly applied to medical practice. The Dào Dé Jīng states:

Be non-interfering in going about your business and savor the flavor of the unadulterated in what you eat… Take account of the difficult while it is still easy, and deal with the large while it is still tiny… Thus, it is because the sages never try to do great things that they are indeed able to be great.

Wú wéi does not necessarily mean taking no action at all, but rather taking a line of action that causes the least disturbance, the line of least resistance or, even more actively, in returning something to its original, natural state of being. In medicine, it finds expression in the principle of treating illness before it arises. This notion is reflected in the classification of materia medica, where medicinals were classified in a three-fold hierarchy of rulers, ministers, and assistants (different from the later four-fold hierarchy of sovereigns, minsters, assistants, and couriers of formula composition). The rulers nourish life, the ministers nourish the body, while the assistants treat disease. This hierarchy reflects the precedence of disease prevention over the treatment of disease.

Although Chinese medicine could be viewed as a Daoist art and although Daoist literature may have provided the foundation from which medical literature originated, it is impossible to know conclusively. What is knowable is that many concepts in ancient Chinese medical texts resonate deeply with parallel philosophical descriptions in early Daoist literature. Archaeological discoveries like the medical manuscripts from Mǎ-Wáng-Duī11. From the Mǎwángduī Manuscripts, Tāi Chǎn Shū (胎产书) , in Donald Harper, Early Chinese Medical Literature, Kegan Paul International, 1998 (page 378). are evidence that similar ideas could be found in both the early medical and philosophical literature. For example, the creation of the fetus was described as entering into and exiting from obscure darkness, an image quite similar to descriptions of the material world emerging from the Dào and ultimately from a place of emptiness and darkness.

As discussed in analogy vs. analysis: lung, metal, Sovereign, the theories concerning the lung’s association with metal appear to be closely related to ideas originating in Daoist practices of alchemy and breath control. Since core Chinese medical theories are heavily reliant on analogies with the natural, social, and political realms, it is not surprising that certain Daoist ideas prevalent in early China influenced their formulation.

Another argument often used to validate a Daoist origin of Chinese medicine is that Daoist adepts gained much practical knowledge about nature by living a hermitic life devoted to physical and spiritual self-cultivation. The knowledge gained in such practices contributed greatly to medicine, in particular in the realms of medicinal therapy, alchemy, and life-prolonging practices like diet, sex, breathing exercises, and gymnastic practices precursory to the modern qì-gōng (气功) and tài-jí-quán (太极拳) .

Initially, however, the first Daoist practitioners did not unequivocally advocate life-extending practices. To be sure, early Daoist texts contain numerous references to practices of qì cultivation and idealize a life focused on protecting one’s natural bodily reserves to achieve a state of oneness with the Dào not only in one’s consciousness but also within the body. One of the rewards of this practice was the attainment of supernatural powers and the ability to transcend the limitations of ordinary human existence. Nevertheless, an intentional effort to extend one’s life beyond the heavenly allotted lifespan could be—and occasionally was—interpreted as going against the natural aging of the human body and therefore as contrary to the original spirit of the early philosophical teachings. Practices of nurturing life (养生 yǎng shēng) neither originated in Daoist circles nor were monopolized by Daoists. Archaeological evidence suggests that such practices were as popular among the early Chinese elite as dietary supplements, stress-relief tactics, or jogging are among contemporary executives.

This situation changed with the rise of religious, as opposed to philosophical, Daoism from the third century CE onward. Especially in Southern China, the cult of immortality led to increasing numbers of adepts to devote their lives exclusively to efforts of physical self-transformation. Originally, practices of nurturing life had aimed at increasing health and counteracting the negative effects of environmental influences that accelerated the decline of old age, such as stress, extreme weather, overwork, excessive emotions, or a sumptuous lifestyle with over-indulgence in sex, food, and alcohol. In religious Daoism, the goal was extended beyond the attainment of physical health to the extreme of reversing the process of aging altogether and returning to the original perfected state of oneness with the Dào in the physical body. There were some serious devotees who engaged in practices that were in fact quite detrimental to their health and even contributed to their premature demise. For example, they consumed a diet solely of pinecones, dew, or mushrooms. They controlled the circulation of qì by decreasing the rate of breathing to the point of asphyxiation. Some even habitually ingested toxic alchemical substances, most notably cinnabar, a form of mercuric sulfide. The occasional deaths resulting from such extreme practices were celebrated as proof of having attained the ultimate goal of shī jiě 尸解 release from the corpse, a process likened to the transformation of a chrysalis into a butterfly.

Daoist literature abounds with accounts of xiān 仙, immortals who are reputed to live in mountain paradises, travel through boundless universes, commune with the Daoist gods and goddesses, and occasionally reappear in the human world. Written texts often credit them with the transmission of magical formulas, amulets, and talismans. Although apart from commonly held knowledge, ideas from religious Daoism concerning the cult of immortality and the possibilities and limitations surrounding the transformation of the human body nevertheless influenced medical and popular conception.

The cross-fertilization between Daoism and Chinese medicine is visible throughout the historical records. Some famous physicians like Sūn Sī-Miǎo (孙思邈) might have been active Daoist priests or, at least, were posthumously incorporated into the Daoist pantheon for their ability to heal the human body by aligning it with the macrocosm and thereby attaining unity with the Dào. Yet the fact remains that most Daoist priests were not physicians and most physicians were not Daoists priests. The philosophies of Confucianism and Daoism have been regarded as diverse yet complementary teachings that address different aspects of the individual’s needs to cultivate a balanced and integrated existence in a social as well as a natural environment. As in any other culture, philosophical and religious developments in early China were obviously instrumental in shaping medical developments. However, to view Chinese medicine as a Daoist art would be like considering Western medicine a Christian art.

Qì, Yīn-yáng, and the Five Phases in Relation to Daoism

Before we conclude this discussion of the philosophical influences on Chinese medicine, it is necessary to address a last issue of contention. Daoism’s quest for a balance between extremes and for harmony with the Dào and the natural environment has proven attractive not only to medical practitioners throughout Chinese history but also to contemporary Western followers. Nevertheless, the preceding discussion should have demonstrated that it is extremely difficult to differentiate between ideas and practices that can be classified as Daoist and those ideas that were more generally accepted in Chinese culture. Some ideas were first promoted by other philosophers and textual traditions and only subsequently incorporated into Daoism as they were accepted by the culture at large. It is historically inaccurate to refer to these as Daoist. The clearest example of this mistake is the notion that theories about qì, yīn and yáng, and the five phases, as well as the physical practices related to these, originated in philosophical Daoism.

The theory of systematic correspondences between the microcosm of the human body and the macrocosm and, related to this, the concepts of qì, yīn-yáng, and the five phases, have always been fundamental to the creation and development of Chinese medicine in every aspect of physiology, pathology, and therapy. No description of Chinese medicine can do without them. Their origin springs from an intellectual tradition of the Warring States period, which is commonly called natural philosophy. As a third response to the social disorder of this time and parallel to both Confucianism and Daoism, theories arose about the order of the cosmos and universal laws that regulated the interaction between the three realms of Heaven, Earth, and Humanity. In this school of natural philosophy, qì served as the material foundation that connected the various microcosms. In each of these levels, the Dào was the law by which the various manifestations of qì reacted to and transformed into each other. By the time of the Hàn Dynasty, this view of the universe had grown such deep roots in the fertile soil of Chinese thought that it had become one of the basic premises with which the Chinese interpreted nature, their bodies, and society. It has remained so ever since. Even the arrival of Western science has not displaced it entirely. Whenever we approach a Chinese text, be it one of political, medical, or philosophical content, we need to be aware that any insight concerning the nature of the universe divulged therein, the macrocosm, could equally be applied to the microcosms of the human body, human society, or to nature at large.

Daoism and the West

Many Westerners have embraced philosophical Daoism because it offers the notion of an impersonal unifying principle of the universe in contrast to the personalized single deities of Christianity and Judaism. The concept of a universal Dào that directs all change and correlates and harmonizes the various microcosms with the macrocosm of the universe is also an attractive idea for Westerners at a time when apparent chaos manifests in everything from climate change to internet wars and international terrorism. In contrast to the limitations of scientific reductionism and rationality, of ordinary language, and of conventionally held absolute values, Daoism opts for deeper insights that can only be grasped intuitively and a shift in perception that results from a more expansive viewpoint. This celebration of an intuitive approach to knowledge is particularly relevant in a field like medicine: Many practitioners view healing as more than treating specific diseases in the material body. Their goal as a healer is to restore harmony and balance on a deeper and more comprehensive level. Originally countering the rigid hierarchical order of the Confucian design, Daoism’s rejection of socially established moral norms and its idealization of a simple life in accord with the rhythms of nature is equally appealing to individuals caught up in the treadmill of an increasingly hectic and complex life in our modern world. The mystical poetry of the Dào Dé Jīng and even the whimsical stories and colorful characters in Zhuāng Zǐ exemplify and inform the refreshing appeal of Daoist literature, which has been rightly appreciated by readers of all cultures and ages. Despite this informed appreciation, the distance in space and time between classical Chinese and modern Western cultures has made the unbiased and complete transmission of Daoism difficult, to say the least. However, the popularity of Daoism is slowly resulting in the increased availability of critical yet concise secondary literature on the topic22. A highly readable introduction to Daoism that dispels many popular Western misconceptions is Livia Kohn, Daoism and Chinese Culture, Three Pines Press, Cambridge, MA, 2001. We might also mention Roger Ames and David L. Hall, Dào Dé Jīng. A Philosophical Translation, Ballantine, New York, 2003, and Angus C. Graham, Chuang-tzu, the Inner Chapters, reprint Mandala 1991. Also informative is A Daoist Theory of Chinese Thought: A Philosophical Interpretation, Chad Hansen, Oxford University Press, 1992. On the difference between philosophical and religious Daoism is Russell Kirkland’s Taoism: The Enduring Tradition, Routledge, 2004. On Daoism in modern China is Ian Johnson, Souls of China: Return of Religion After Mao, Pantheon, 2017. and on historically accurate translations of primary sources by authors with the necessary training in classical Chinese language and culture.

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