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Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 1-11

Premodern intercultural communication by reanalyzing the phrase “Da yi jing cheng (大医精诚)”

Center for Writing and Communication, School of Humanities, Tsinghua University, Beijing 100084, China

Date of Submission20-Dec-2021
Date of Acceptance02-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Jing Su
Center for Writing and Communication, School of Humanities, Tsinghua University, Beijing 100084
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CMAC.CMAC_7_21

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Culture is suid, not static. When one culture meets and blends with another, Western academic circles tend to use cultural hybridity to express a mixed state of culture. By reanalyzing the classic texts in relation to “Da Yi Jing Cheng (大医精诚)”, tracing the evolution of traditional medical ethics in history, and combining the knowledge of cultural hybridity, this paper suggests that cultural hybridity is not applicable to the discussion on the phenomenon of intercultural communication in the era before the rise of national states and modernity. A new discourse is needed to express intercultural integration, one that breaks through Western values and embodies the characteristics of Asian civilization. Civilization exchange and mutual learning can become the ideal model of intercultural communication under the background of the “Belt and Road Initiative”.

Keywords: Cultural hybridity, Da Yi Jing Cheng (大医精诚), intercultural communication, medical ethics, mutual learning between different civilizations

How to cite this article:
Su J. Premodern intercultural communication by reanalyzing the phrase “Da yi jing cheng (大医精诚)”. Chin Med Cult 2021;4:1-11

How to cite this URL:
Su J. Premodern intercultural communication by reanalyzing the phrase “Da yi jing cheng (大医精诚)”. Chin Med Cult [serial online] 2021 [cited 2021 Jun 18];4:1-11. Available from: https://www.cmaconweb.org/text.asp?2021/4/1/1/312780

  Introduction Top

Cultural hybridity is a main master trope in literary theory, literary criticism, and cultural studies and has gradually become the progressive research on cultural globalization and cross-cultural communication. Throughout the cultural hybridity researches in Chinese and foreign academic circles, the objective has been discussed the topic in the context of postcolonial theory. For example, Chen discussed the connotation evolution of “hybridity” in the American colonial literature from biological meaning to cultural meaning.[1] Xue dissected the process of identity reconstruction from cultural collision to cultural mixture in Chinese-American literary works.[2] Hirschmann focused on the national and cultural reconstruction of Mauritius after gaining independence from colonial ruling.[3] Suárez analyzed the exotic atmosphere, cultural mixture, and the complex tonality of subordinate identity in Macau literature.[4]

With the prevalence of media globalization in recent years, cultural hybridity has been applied to the description of cross-cultural communication phenomena and the discussion of mass media products. For example, Zhang and Shao understood the Sino-American co-production film represented by “Kung Fu Panda” as a cultural mixture to some extent.[5] Traditional, modern, global, and local cultures have been balanced and integrated in top-grossing films. Meanwhile, Wang believed that the ideological trend of consumerism in Chinese TV dramas is the reconstruction of esthetic taste in the name of cultural mixture; the warmth of commercialism replaces the real cultural diversity and is packaged as an advanced cultural orientation.[6]

In other countries, Prof. Kraidy from the University of Pennsylvania is the forerunner of introducing cultural hybridity from postcolonial theory to the study of journalism and communication. Using Derrida's deconstruction as a weapon of criticism, he revealed the legalization and naturalization process of cultural hybridity in mass media as represented by the Washington Post's “American Pop Culture Overseas” series. It has influenced the popularizations of American pop culture in developing countries and the rapid expansion of the United States' cultural industry globally.[7] In South Korea, Lee discussed the popularity of fans culture nurtured by South Korean dramas on global new media platforms, which he believed had led to pop cosmopolitans.[8] In South America, Ribke worried about the spread of Neo-orientalism and media imperialism in Brazil in the name of negotiated hybridity.[9] However, whether it is the framework of postcolonialism or the perspective of media globalization, the discussion on cultural hybridity never seems to involve the phenomenon of cross-cultural communication before the rise of nation states.

From an ontological perspective, cultural hybridity is a mixture of identities and genres.[10],[11] Hence, was there a phenomenon of “cultural mixture” in premodern times? If it existed, what were the similarities and differences between the “cultural hybridity” at that time and the “cultural hybridity” we discuss today? In other words, apart from cultural hybridity, are there any other concepts that can describe a phenomenon of cross-cultural mixing? Combining with the knowledge of cultural-hybrid concept, the objective of this study is to answer the above questions through the reanalysis of the “Da Yi Jing Cheng” text in the context of China's evolving traditional medical ethics history.

  Qian Jin Fang (《千金方》 Prescriptions Worth a Thousand Gold Pieces) and Its “Da Yi Jing Cheng” as a Cross-cultural Text Top

Sun Simiao (孙思邈 581–682) (Note 1), a great master of traditional Chinese medicine during the Sui and Tang dynasties, was born in Xi'an Huayuan (now Sun Jiayuan, Yaoxian County, Shaanxi Province). The Chinese people worship him in the temples of the King of Medicine. Sun Simiao firmly believed in the medical humanitarian spirit of “human life is of the utmost importance.” He extensively collected many medical classics, deleted the complicated and redundant parts, treasured the simple and plain contents, and compiled into the Bei Ji Qian Jin Yao Fang (《备急千金要方》 Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies) (652) for urgent use.[12] 30 years later, he compiled Qian Jin Yi Fang (《千金翼方》 Supplement to the Essential Prescriptions Worth A Thousand Gold Pieces) to resolve the deficiency of the Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies. Later, scholars considered these two books (collectively known as Prescriptions Worth A Thousand Gold Pieces) as the “Encyclopedia of Clinical Medicine.”[13]

Sun Simiao and his Prescriptions Worth A Thousand Gold Pieces not only served as a link between past and future in the history of Chinese medicine but also played a vital role in the cross-cultural communication between Chinese and foreign medicine. Medical history experts such as Li Jingwei, Ma Boying, and Chen Ming all had special discussions on the subject. Generally speaking, Sun Simiao was proficient at annotating the classics, interpreting the history of classics, and understanding hundred schools of thoughts. He was a savant who combined Taoism, Buddhism, and Confucianism together,[13] “akin to today's doctor who can “converge traditional Chinese medicine and Western medicine.”[14] Sun Simiao's combination of Taoist, Buddhist, and Confucianist knowledge reflected the context of the times. After the introduction of Buddhism in the Eastern Han Dynasty, Buddhism's cultural influence and infiltration reached peak in the Sui and Tang dynasties; simultaneously, it demonstrated its efforts of using medicine as a carrier to integrate the ideals of Confucianism, Buddhism, and Taoism for the purpose of preserving people's health and longevity.

The Prescriptions Worth A Thousand Gold Pieces also contains declarations of medical ethics, “Da Yi Jing Cheng (大医精诚)” and “Da Yi Xi Ye (大医习业)”, which are comparable to the Chinese version of the Hippocratic Oath of Medicine. Among them, “Da Yi Jing Cheng” [Figure 1] has been integrated into Chinese medical practice for thousands of years and is regarded as a prominent representation of traditional Chinese medicine culture and, to a certain extent, even Chinese culture. In recent years, mainstream media such as Guangming Daily has appealed that the spirit of 'Da Yi Jing Cheng” needs to be carried forward for healthy China.[15] However, a “Da Yi Jing Cheng”, which “embodies the core of Chinese culture and enriches the connotation of Chinese culture,”[16] is also the result of cross-cultural communication, deeply imprinted with the influence of ancient Indian philosophy and Buddhist thought.
Figure 1: “Da Yi Jing Cheng” in the Museum of Medical History of the Chinese Academy of Traditional Chinese Medicine

Click here to view

The cross-cultural communication of traditional medicine reflected by the Prescriptions Worth A Thousand Gold Pieces is mainly in two aspects: First, the influence of Jīvaka, representative of Ayurveda medicine, and second, the influence of Buddhist medicine. Jīvaka was a famous doctor who lived in the same period as the founder of Buddhism, Sakyamuni in the ancient India. In view that Buddhism had not yet been fully formed, let alone infiltrated into Ayurveda medicine; Jīvaka can be regarded as the representative of the early Ayurveda medicine. His medical point of view, such as that stated in Volume 9 of the “Da Fang Deng Da Ji Jing (《大方等大集经》 Great Collection Scripture” or Mahāvaipulya mahāsamghāta sutra in Sanskrit), “All in the world is nothing but medicine”[17] has great influences on the extensive use of medicinal substances and the emphasis of food as medicine in Ayurveda medicine.

There are generally three kinds of views about Jivakan influences in the academic circles: the first school, represented by Prof. Chen Ming, holds that Jīvaka refers to a particular person named Jivaka Kumarabhrata in Sanskrit; in Chinese literature, the terms Qi Po (耆婆), Qi Yu (耆域), Zhi Yu (只域), Zhi Yu (祗域), and Shi Fu Jia (侍缚迦) all refer to this person.[17] Another school, represented by Prof. Ma Boying, believes that Jīvaka is the general name of monk doctors from India.[14] Those two views have a great influence. There is also a saying that Qi Bo (岐伯), who answers questions with the Yellow Emperor in the Huang Di Nei Jing (《黄帝内经》 Huangdi's Internal Classic) is a transliteration of Jīvaka.[18] There is still insufficient evidence and unclear trace of historical data about the last saying; hence, it has not been resonated by other scholars. If it is true, there will be a subversive reinterpretation of the history and cross-cultural exchange results between traditional Chinese medicine and traditional Indian medicine. After all, Huangdi's Internal Classic is the foundational work of traditional Chinese medicine. Therefore, this study adopted that Jīvaka was a real person, a famous ancient Indian doctor who came to China to practice medicine in the early days. Due to his popularity, he was indeed a pioneer in the cross-cultural traditional medicine practice between China and India.

The so-called prescriptions of Jīvaka are quoted in many places in the Prescriptions Worth A Thousand Gold Pieces. In Volume 12 “Gallbladder Organs (胆腑)” of the Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies, there is a chapter called “Pill Powder for Ten Thousands of Diseases (万病丸散).” Among its 13 poems, “Pill Powder for Ten Thousands of Diseases from Jīvaka (耆婆万病丸)” is the most representative one. This prescription contains 31 kinds of drugs, such as Niu Huang (牛黄 Calculus Bovis), She Xiang (麝香 Moschus), Xi Niu Jiao (犀牛角 Rhinoceros Horn), Zhu Sha (朱砂 Cinnabaris), Xiong Huang (雄黄 Realgar), Shi Xi Yi (石蜥蜴 Eumeces chinensis), etc., of which most are animal drugs. This prescription can cure “seven kinds of addiction, five kinds of epilepsy, ten kinds of leprosy, seven kinds of flying corpses, twelve kinds of demagogic poisons, five kinds of yellow diseases, twelve kinds of malaria, ten kinds of water diseases, eight kinds of strong winds, and twelve kinds of skirt arthralgia,” hence the name “Pill Powder for Ten Thousands of Diseases.”

Ma Boying commented that the “Pill Powder for Ten Thousands of Diseases from Jīvaka (耆婆万病丸)” sounds like sticking plasters sold on the street, but Chen Ming considered this view to be biased. He quoted Sun Simiao's self-evaluation and found that Sun Simiao had also experienced the process from “impersonal” through “effective drug for emergency” to “knowing its divine effect” that “no wisdom can understand.”[19] From this statement, we can infer that Ayurveda medicine represented by Jīvaka was a medical trend at that time, which had aroused curiosity in great traditional Chinese medicine practitioners such as Sun Simiao. More importantly, neither doctors nor patients had the understanding of evidence-based medicine before the rise of modern medicine. Physical verification such as “Shennong's Tasting of Herbs (神农尝百草)” was the primary way of recognizing and accepting new medical knowledge. In addition, traditional Chinese medicine is pragmatistic orientation.[20] It continues to absorb and incorporate medical experience and skills from foreign culture into its own system, as it believes that treating diseases and saving lives should not be delayed. This is one of the remarkable characteristics of traditional medicine's cross-cultural communication in ancient times.

There are more medical prescriptions named after Jīvaka in the Supplement to the Essential Prescriptions Worth A Thousand Gold Pieces. For example, the Jīvaka decoction (耆婆汤) listed in Volume 12, “Dietary Therapy for the Aged (养老食疗第四),” is often prepared with ghee and honey. This is very different from the medical customs of the Central Plains but is a typical custom in Ayurveda medicine. Another example in Volume 22, “Fei Lian (飞炼),” which consisted of the prescription “Jīvaka cures all diseases in the internal organs and tonifies the old for many years (耆婆大士治人五脏六腑内万病及补益长年不老方).” This prescription is special. “If take it continuously, one will live a 1000 years, become immortal and transcend.”[21] This statement is a typical Taoist saying. Zi Shi Ying (紫石英 Fluoritum) is also a common medicine used in Taoist alchemy, but Gan Cao (甘草 Radix Glycyrrhizae), Feng Mi (蜂蜜 Honey), and other drugs with ancient Indian characteristics have been added. This prescription can be described as a combination of traditional Chinese medicine and traditional Indian medicine. Therefore, the prescription is not the creation of Jīvaka, but the naming of the prescription demonstrated the appeal of Jīvaka in the medical profession and among the people at that time.

The Supplement to the Essential Prescriptions Worth A Thousand Gold Pieces also has a dedicated chapter on “treating evil diseases by Jīvaka (耆婆治恶病)” with 11 prescriptions. Most of the Jīvaka prescription have actually strong Taoist characteristics, for example “the fairy Mr. Huang Ling treats all leprosy with naive Baiwei pills (仙人黄灵先生用天真白畏丸治一切癞病方)” and “Jiu Xiaojun treats ten kinds of indescribable people with all kinds of disease that cannot be cured (九霄君治十种大癞不可名状者服之病无不愈方). Only E Wei Lei Wan Powder (阿魏雷丸)is from the ancient Indian medicine. In particular, Sun Simiao described this prescription, “Hu said, 'For Kāmalā disease, the doctor shows an arch hand, and there is no cure. This is called the right result.'” “Arch hand (拱手)” is a Buddhist term. It is also mentioned in Volume 17 of the Da Ban Nie Pan Jing (《大般涅槃经》 Mahaparinirvana Sutra), “such as Kāmalā disease, the doctor shows an arch hand.” “Kāmalā disease” is also a Sanskrit term used to describe a malignant disease in ancient time. It is closely related to jaundice in modern understanding.

In addition to the inclusion of Jivakan prescriptions, the concept of Buddhist medicine had also deeply influenced Sun Simiao. Although Buddhist medicine and Ayurveda medicine are different, their basic concepts are similar. Ayurveda medicine originated from Brahmanism, whereas Buddhist medicine emphasized “precepts, meditation, and wisdom (戒、定、慧).” Using Buddhism as the guiding ideology, Buddhist medicine focuses on consciousness, truth, and awareness. It advocates spiritual practice, homology of medicine and food and heavily incorporated essence of Ayurveda medicine. As early as the Eastern Han Dynasty, An Shigao (安世高) of the Parthian Empire and Zhi Facun (支法存) from the Tokhara introduced Buddhist medicine by means of translating the Buddhist sutras into territory of Han Dynasty at that time. However, for traditional Chinese medicine doctors, Tao Hongjing (陶弘景) was probably the pioneer to introduce Buddhist medicine to China. When he annotated (falsified, according to some scholars) Zhou Hou Jiu Zu Fang (《肘后救卒方》 Handbook of Prescriptions for Emergencies) written by his predecessor Ge Hong (葛洪), he added the Buddhist concept of 101 diseases and changed the original title into Bu Que Zhou Hou Bai Yi Fang (《补阙肘后百一方》 Supplement to the Handbook of Prescriptions for 101 Emergencies). However, the content of the handbook did not state any theory of Buddhist medicine.

Sun Simiao was the first person to properly introduce the concept of Buddhist medicine into the system of traditional Chinese medicine. Been influenced by Ayurveda medicine, Buddhist medicine adopted and transformed its concept. The four major elements (earth, water, fire, and wind) and 101 (百一 each element causes 101 diseases; thus, four elements cause 404 diseases) are its outstanding characteristics (Note 2). Sun Simiao attempted to integrate the four major elements in Buddhist medicine and the five elements in traditional Chinese medicine. In the fourth chapter, “The Diagnosis (诊候第四)” of the Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies, he tried to form a diagnostic theory that integrates both cultures:

The four elements, Earth, Water, Fire, and Wind, together constitute the balance of the human body. If the element of fire loses its balance, the whole body is steamed with heat. If the element of wind loses its balance, the whole body becomes stiff and the pores become blocked. If the element of water loses its balance, it will result in swelling of the body, chest fullness, and panting. If the element of earth loses its balance, then the person cannot lift the four limbs and become voiceless. If a body lives without the element of fire, then it becomes cold; without the element of wind, then the person becomes breathless; without the element of water, then the blood stops running; without the element of earth, then the body is broken into pieces. However, the quack doctors who do not understand the four elements' mechanisms do not pay attention to checking the patient's pulse either. When it comes to treating illness, these quack doctors only allow the five elements of the body to restrain one another. Such treatment is akin to adding oil to a flaming fire. It will result in negative consequences for the patient. Therefore, doctors cannot be too careful in handling the illness. Once the four elements achieve balance, then the spirit will be at peace. If one element loses its balance, then it will cause 101 illnesses, with the spirit losing its balance as well. If all four elements lose their balance, there will be a total of 404 illnesses that take place altogether. Thus, there is another saying that although there is a chance that 101 illnesses can be healed without treatment, it is better to treat these illnesses carefully so that the patient can fully recover. For 101 illnesses that are not easy to cure, the only occasion when no treatment is needed is when the patient dies from the illnesses.[12]

The Supplement to the Essential Prescriptions Worth A Thousand Gold Pieces also has the characteristics of Buddhist medicine. In Volume 12, a prescription of taking sweet sedge (服菖蒲方) is recorded and translated by “Varmanmydy, the Tripitaka master of the Yituo temple in the Rajgir city of Magadha in India, who arrived with the Turkic ambassador from the 8th year of the Da Ye period of the Sui Dynasty to July 23, the 6th year of Wu De period of the Tang Dynasty for the Bhadanta master, the abbot of Jing Tu temple in Luo Zhou.”[21]

Another example is the Agada prescription (阿迦陀圆方), which is the abbreviation of “Tathāgata (多陀阿迦陀)” in Sanskrit. Agada refers to Bhaisajyaraja Buddha (净眼如来), a bodhisattva that is depicted on the left of Shakyamuni Buddha. He distributes medicine to the people and delivers them from torment. Besides, the Brahmanism physical and breathing exercise, that is, yoga, was also compiled into the Prescriptions Worth A Thousand Gold Pieces by Sun Simiao, recorded as the 18 movements of “Indian massage” (”天竺国按摩”十八势) in Volume 27 of the Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies.

Some of the prescriptions and skills originated from ancient India were recorded in the Prescriptions Worth A Thousand Gold Pieces and handed down. Typical examples such as the Pill Powder for Ten Thousands of Diseases from Jīvaka (耆婆万病丸) have since appeared in Wang Tao's Wai Tai Mi Yao (《外台秘要》 Arcane Essentials from the Imperial Library) and Japan's Tanba Yasunori's Ishinpō (《医心方》 Formulary from the Heart of Medicine). Ma Boying believes that the famous prescription of traditional Chinese medicine “Niu Huang Qing Xin Pill (牛黄清心丸)” is inherited from the Pill Powder for Ten Thousands of Diseases from Jīvaka (耆婆万病丸).[14] Wu Jutong's Wen Bing Tiao Bian (《温病条辨》 Systematized Identification of Warm Diseases) published in 1798 in the Qing Dynasty recorded this “Niu Huang Qing Xin Wan” prescription. Their composition is similar although the ingredients have been reduced to 17.[14] However, some cross-cultural prescriptions were gradually marginalized over the years, probably because their efficacy was no longer practical, but was also related to the dominant religious culture and its attached medical practice preferred by the ruling class.

However, “Da Yi Jing Cheng” which has been preserved for thousands of years and praised by generations is the crystallization and inheritance of cross-cultural communication between China and ancient India. “Da Yi Jing Cheng” is recorded in the second preface of the Essential Prescriptions Worth A Thousand Gold Pieces for Emergencies, after “Da Yi Xi Ye.” It can be speculated from the position of “Da Yi Xi Ye” and “Da Yi Jing Cheng” in the book that Sun Simiao emphasized medical ethics over medical skills and pharmaceuticals, highlighting the virtues of the doctor, which had a profound impact on later generations.

The “Da Yi Xi Ye” preface is only about 200 words. Its objective is that medical practitioners must be well informed and well versed with the past medical works, such as “Su Wen (《素问》 Plain Questions),” “Zhen Jiu Jia Yi Jing (《针灸甲乙经》 A-B Classic of Acupuncture and Moxibustion),” “Huang Di Zhen Jing (《黄帝针经》 Huangdi's Acupuncture Classics),” “Ming Tang Liu Zhu (《明堂流注》 Annotation According to Acupuncture Models),” and “Ben Cao Yao Dui (《本草药对》 The Herbal Pairs).” The theme focuses on the thoughts of numerous schools, especially Taoism. “If one can learn to master it, it will greatly benefit and prefect one's medical profession.”[12] This extract text has an obvious undertone originated from the Confucian concept of knowledge, but because the “Da Yi Xi Ye” is relatively short, it is usually clustered under “Da Yi Jing Cheng.”

The “Da Yi Jing Cheng” was written in no more than a thousand words but manifested “the perfect integration of Confucianism, Taoism, and Buddhism.”[14] For Taoism, Sun Simiao was already respected as the “immortal (真人)” who refused the appointment as well as a high post and salary offered by Emperor Taizong and Gaozong of Tang and lived in seclusion in Taibai, Zhongnan, Emei, and Wutai mountains to discuss the cultivation of good health and temperament. His actions distinctly demonstrate the Taoist characteristics of the sayings “standing aloof from the mundane affairs (出世)” and “letting things take their own course (无为).” Argument in the “Da Yi Jing Cheng” is constructed in the names of Zhang Zhan (张湛) [Note 3] and Lao Zi, reflecting Sun's Taoist natures. However, Taoism functions as the outer layer of this book only. The spiritual core of the book corresponds to Confucian and Buddhist thoughts, both of which are embodied in the text.

The Confucian thought of engaging in worldly affairs and emphasizing interpersonal relationship is also manifested in the “Da Yi Jing Cheng.” This is totally different from the traditional Taoist doctors' philosophy which stresses on internal peace, as well as alchemists who incite people to become immortal via alchemy. The “Da Yi Jing Cheng” urged doctors to have a sense of compassion:

If there is a patient who comes for treatment, the doctors must not judge whether the patient is rich or poor, or whether his or her social status is high or low. No matter the patient beautiful or ugly, enemy or friend, compatriot or foreigner wise or foolish, the doctors must treat the patient without discrimination, as he/she treats with his/her closest kin.[12]

Further, the statement that “the doctor must not be indecisive and overcautious or consider only his/her personal fortune and livelihood and thus do not treat the patient.”[12] Also demonstrated the Confucian theory that people must love others. “One who undertakes medical profession must have a mastery over the origin of medicine and work hard; he/she must not believe easily on rumors and claim that the medical profession has been fully mastered;” “if a doctor happens to cure one illness and thus become arrogant, claiming himself/herself to be unparalleled in the world, then he/she cannot be called as a doctor.”[12] These sayings also represent the characteristics of modesty, search of ultimate truth, and active engagement in Confucianism.

What is more important is the introduction of Buddhist thought. It is very interesting that the saying, which bears the Buddhist overtone most, is written in the name of Taishang Laojun, who is a key figure in Taoism. It is deemed a deliberate intention of Sun Simiao Buddhist thought with Taoism due to the fact that rulers of the Tang Dynasty were in favor of Taoism and that it would be more convincing if the words were uttered from Taishang Laojun. This is also a cross-cultural strategy that aims at fitting its audience. The end of “Da Yi Jing Cheng” stated that:

According to Taishang Laojun, if one does good deeds publicly, he/she will be repaid by people who benefitted from it; however, if one does good deeds privately, then he/she will be repaid by the spirit. If one does wrongdoings publicly, he/she will naturally be revenged by people who suffer from it; however, if one does wrongdoings publicly, he/she will be revenged by the devil. When glimpsing into these two kinds of acts, is it not true that good deeds and wrongdoings will eventually be repaid either publicly or privately? Therefore, doctor must not only seek wealth with his medical skills; he/she has to make up his/her mind to save others in pain, so as to accumulate good deeds in the afterworld. When the doctor dies and goes to the underworld, he/she will be repaid by the good deeds that he/she has done. Moreover, doctor must not prescribe precious and expensive medicine that is hard to find for the patients of great wealth and high social position, so as to show off his/her medical skills. These actions do not comply with the principle of benevolence and loyalty proposed by Confucius. I aim to save life and help people; therefore, I discuss thoroughly the trivial details. Moreover, I hope people who take up medical profession will not feel ashamed of my vulgarity.[12]

The theory of Karma is influenced by Buddhism [Note 4], or to be more exact, originated from Ao Yi Shu (《奥义书》 Upanishad). It was the most characteristic philosophical concept in the South Asian subcontinent in Brahman times and has deeply influenced the whole ancient Indian philosophy.[22] By applying the Karma theory, Sun warned doctors against using their medical skills as a way of accumulating wealth, as well as deciding to treat or not to treat based on patient's wealth. Instead, he advocated that doctors should have the original intention of easing patients' suffering, aim at saving others and treating them without discrimination. He also introduced the Confucian principle of loyalty and benevolence and Taoist thinking of living beings into medical profession, making a complete harmony of various cultures. Besides, the choices of words used in the “Da Yi Jing Cheng” such as “alleviating all people from pain,” “killing other creatures to save the patient's life will only distance the patient from full recovery,” and “doctors must not have even the slightest thought of displeasure,” all display classic Buddhist thinking.

In summary, the Prescriptions Worth A Thousand Gold Pieces written by Sun Simiao, especially the “Da Yi Jing Cheng,” is a typical embodiment of how cross-cultural spread happened between ancient traditional medicine. If the Prescriptions Worth A Thousand Gold Pieces is more of a prescription and skills exchange between China and India, then the “Da Yi Jing Cheng” has risen to the integration of ideologies. It gradually becomes the core of traditional Chinese medicine culture and is still one of the essential medical ethics with Chinese characteristics.

  Cultural Hybridity or Mutual Learning among Civilizations: How to Understand Premodern Cross-Cultural Communication Top

Through the text analysis of Sun Simiao's Prescriptions Worth A Thousand Gold Pieces, it is clear that the “Da Yi Jing Cheng,” which “embodies the core of Chinese culture and enriches the connotation of Chinese culture,” is a cross-cultural product. It is also clear that the medical ethics contained in traditional Chinese medicine is the result of religious propagation and cultural blending, which changes in time with the dominant thought. Culture is fluid, not static.

Returning to the question raised at the beginning of this article, is the “Da Yi Jing Cheng” a cultural hybridity to some extent? If we take it literally, the “Da Yi Jing Cheng,” which contains Confucianism, Buddhism, and Taoism, is obviously a hybrid or mixture, but it is not in line with the context of postcolonialism and has nothing to do with the globalization brought on by mass media communication. How should we understand and describe the premodern cross-cultural “hybridity”?

According to Prof. Kraidy's research, the earliest discussion on hybridity appeared in the 18th century, and its context was the colonial expansion of Britain, France, and even the United States.[7] The initial worry came not from the colonized but from the colonists themselves, that is, they worried about the perceived contamination of the White European bloodlines. Thus, whether hybrid vigor theory or hybrid sterility theory, they are based on White Supremacist Theory. Therefore, Young pointed out that cultural hybridity is a symptomatic of the enlightenment's failure to come to terms with its racist underside;[23] Chen also pointed out that biological hybridity is the predecessor of cultural hybridity.[1]

With the rise of the decolonization movement in non-Western countries, intellectual elites tried utilizing cultural hybridity to establish an integrated national identity rather than just been recognized as an overseas state of a colonial country. In Latin America, “mestizaje” (Spanish, which contains the meaning of blood hybridity) has been gradually established as an ideology to win the recognition of Spanish colonial descendants and native population, as well as to unite the society, but its conceptual essence is still deeply racialized.[24]

Since the 20th century, hybridity has gradually shifted to literary works and the description of cultural phenomena. Gilroy Paul's The Black Atlantic: Modernity and Double-Consciousness is the classic example. Bhabha Homi, the representative of postcolonialism theory, is the first person to introduce hybridity into postcolonial research. In his landmark book Of Mimicry and Man, Bhabha creatively understood the cultural hybridity of colonies as a kind of collusion; people's fascination with colonists' culture makes them imitate, integrate, and yet struggle.[25]

After the rise of globalization, cultural hybridity is ushered in as a new discussion. Researchers focus on transcultural dynamics between traditional and modern, local and global, and the reconstruction of social order[26],[27],[28] brought about by cultural hybridity. Alternatively, they would discuss how the formation of cultural hybridity has accelerated from the perspective of media and new media. No matter how it has been discussed, there are basically two orientations in the study of cultural hybridity: first, it adopts the orientation of description and ontology and holds that cultural hybridity is a phenomenon, a trend of globalization, and a communicative practice. The second orientation adopts a critical and political orientation that behind cultural hybridity is hegemony and inequality, is the extension of neoliberalism, and is the capitulation of noble culture. Kraidy called it corporate multiculturalism.[7]

At this point, we can confirm that cultural hybridity is an academic concept full of historical context. The rise of modernity is the premise that it can enter the academia and constitute as a research problem. Just as the critic Werbner stated, all cultures are always hybrid. The reason why cultural hybridity constitutes a problem is because the symbolic world and social order have been historically reconstructed.[29] The colonization of the West, the resistance of the non-Western countries, the imbalance cultural strength between the East and the West, and the unfair flow of global cultural communication are the reasons why cultural hybridity has always maintained its academic vitality. From biological hybridity to cultural hybridity, the discussion of hybridity also highlights the process of Western colonization from military conquest to cultural assimilation. Therefore, similar to the concept of cultural imperialism, there is a debate on optimism, criticism, naturalization, or deconstruction around the nature of cultural hybridity.

This study holds that cultural hybridity and cultural conflict can be understood as a pair of intertextuality under the dominant values of the West. The so-called cultural conflict or clash of civilizations is a classical theory put forward by Huntington in the postcolonial era. Huntington believes that cultural characteristics and differences are more difficult to change than politics and economy; they are also less easy to compromise and resolve, so cultural conflict becomes Western ideology's biggest crisis after the end of the Cold War. “In the former Soviet Union, the communist can turn into nationalist, so do the rich and the poor. However, a Russian cannot turn into an Estonian, an Azerbaijani, or an Armenian. The core issue of cultural conflicts lies in the question of “what are you?,” which is predetermined and unchangeable.”[30]

From this classic expression, it can be seen that the premise of Huntington's thinking is placed in the world after the emergence of the nation states and the rise of modernity. In premodern times, the rise and fall of nations and the change of identity are, in fact, a normal state, but no scholar has ever regarded it as a crisis. Therefore, the cultural hybridity and cultural conflict that we are discussing today are actually the embodiment of the typical dualism thinking mode from the West. Just like asking, are you going to be me or him? The West and the East have different cultures, either they move toward mixture or conflict. As mentioned earlier, hybridity is often a process in which cultural subjects with hegemonic status mix with cultural subjects without hegemonic status through the hard power of economy and politics. To apply Derrida's deconstruction theory, behind the clear statement of mixture lies its vague but ambitious meaning. From the perspective of discourse analysis,[31] there is no difference between cultural conflict and cultural hybridity in epistemology.

Based on the abovementioned understanding of cultural hybridity, this study holds that there is a need to break away from the Western values and find a new discourse for cross-cultural blending that reflects the characteristics of the Asian civilization.

First, the concept of cultural hybridity does not apply to premodern cross-cultural communication and cultural integration. In premodern cross-cultural communication, cultural blending does not necessarily arise in the worry and discussion of identity crisis, whether for the culture that exports or the one that imports. Take Sun Simiao for an example; he delivered the Karma theory by means of Taishang Laojun's preaching, which became a historical classic and the oath of all Chinese medicine doctors. What is more, cultural blending is not a synchronic phenomenon of global communication by mass media. Like slow journalism, it has a longer process, which allows it to fulfill its slow, gradual, and dispersive permeation and influences both parties in the cross-cultural relationship. In fact, Anderson reveals that a national state is an imaginary community. It is because of this imaginary that the discussions of cultural identity, identity crisis, and cultural colonialism appear.[32] In other words, in the times when the imaginary community does not exist and the border of nation and state is flexible and fluid, how can there be such a thing as identity crisis?

Second, the concept of cultural hybridity does not match non-Western values and cultural orientation. Dualism is not a universal concept. China does not have such “either or relation,” “self-other” Western thinking. Instead, inclusiveness, harmony in diversity, as well as respect and appreciation, for other cultures are the essence of China's traditional culture. As Prof. Kraidy rightly points out, the contemporary cultural hybridity is the company-oriented multiculturalism, beautifying the global expansion of commercialized culture as its hybridity with local culture.[7] To put it simply, the various cultures in the Chinese culture resemble a great bowl of mixed vegetables in harmony, but cultural hybridity has within itself a force of blending and squeezing, wishing to turn the mixed vegetables into blended juice. Although the same integration happens, the consequence of hybridity transforms the original culture beyond recognition into a totally new pattern.

At last, the concept of “cultural exchange and mutual learning” proposed by Xi Jinping concerning the Belt and Road Initiative is more suitable than that of cultural hybridity to describe premodern, non-Western cross-cultural communication and cultural integration. On March 27, 2014, President Xi delivered a speech that bears historical meaning and is renowned globally as the “new concept of civilization” and “the manifesto of civilization” in the Headquarter of the UNESCO. He put forward systematically the concept of “cultural exchange and mutual learning.” In the same year of the international symposium commemorating the 2565th birthday of Confucius, President Xi delivered another speech on how to properly approach different countries, different cultures, and how to properly handle traditional culture and contemporary culture. He further explained the historic origin and practical values of the concept of “cultural exchange and mutual learning.” Therefore, the concept of “cultural exchange and mutual learning” became key words of President Xi when outlining the community building with shared future for mankind in the Belt and Road Initiative. Under the new historic conditions, this concept was to emphasize first, “cultures are various, which is the reason for such mutual learning in human civilization;” second, “cultures are equal, which lays the premise of mutual learning;” and third, “cultures are all embracing, which provides the driving force of mutual learning. The exchange of culture and mutual learning is the significant force that pushes forward civilization of humankind and global peace.”[33] In other words, the exchange of culture and mutual learning presents the traditional Chinese wisdom and is also endowed with new explanation and leadership in the background of globalization and the rise of “others.”

The character “鉴 (Jian)” has a long history in China's traditional culture. It originally refers to the utensil that holds water. Later, it was used as a mirror because it was made from bronze. Therefore, its meaning has extended to include observing and learning. For example, the saying of “learning from history, we can know the rules of rising and falling; the studying from people, we can know the patterns of gain and loss,” are deeply rooted in the critical thinking of traditional Chinese culture. In 2015, a great breakthrough has been achieved in the archaeological discovery of the Haihun Marquis Mausoleum; the earliest Confucius image was found embedded in a screen buried in the west room of the main coffin[34] [Figure 2]. This twofold screen not only has the painting of Confucius but also has a bronze mirror carved with “Yi Jing Fu (《衣镜赋》 Prose on Clothes and Mirror).” Therefore, it can be seen that as early as the Qin and Han Dynasty, China has developed the culture of “referencing to mirror (镜鉴).” The mirror can tidy ourselves, whereas the painting of Confucius can help in providing reference to adjust our behavior. It is not difficult to tell that the culture of “Jian” is actually a kind of philosophy of knowledge,[35] which has the critical thinking of introspection and self-examination. That is to say, we refer to other things so that we can better disseminate our culture as well as develop ourselves and improve our thinking and action.
Figure 2: Confucius Mirror discovered in Haihun Marquis Mausoleum

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Therefore, the exchange of culture and mutual learning includes two processes of communication: one been the communication and interaction between subjects and the other been the subject's conversation with oneself and his/her production based on the former process. To some extent, the latter will be valued more in that cross-cultural communication does not aim at adaptation or occupation but at how to improve and adjust our own cultural practice. Take China's traditional culture as an example. It develops itself during the process of continuous learning and gradually becomes perfect.

The author compared the difference between two cross-cultural communication models. It can be seen from the model of cultural hybridity [Figure 3] that first, hybridity is the product of modernity instead of ancient times. Second, when cultural practice A encounters cultural practice B, cultural hybridity always ends with one consuming the other. Cultural practice A is transformed according to cultural practice B's viewpoints of the world, values, and civilization. Therefore, it appears to have cultural practice B's characteristics but mingled with some superficial elements of its own culture. Compared with the model of cultural exchange and mutual learning [Figure 4], first, it does not happen only in modern times but continues throughout the cultural communications of humankind. In fact, the effect of cross-cultural communication is that a culture not only understands and acknowledges the traditional medicine of another culture, but integrates part of the content into its own system of knowledge and practice, and gradually develops or transforms the original culture. Thus, the developed or transformed culture can also be regarded as the product of cultural exchange and mutual learning. Second, cultural exchange and mutual learning do not aim at consuming the other party. When cultural practice A encounters cultural practice B, they may, in some degree, blend together, or they may produce a new cultural practice C that perpetually develops after mutual learning. Therefore, the effect of “mutual learning” lies in self-improvement as time proceeds.
Figure 3: The model of cultural hybridity

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Figure 4: The model of cultural exchange and mutual learning

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Thus, cultural exchange and mutual learning not only position the subjects of cross-cultural communication as equal instead of being the colonist and the colonized, or the hegemonic and the inferior, but also stress the purpose of communication, that is, to learn and develop oneself, rather than hybridize, divert or worse, eliminate. To some extent, cultural exchange and mutual learning emphasize the process rather than the result. In other words, the exchange and mutual learning are not an expression based on dualism, but a representation of the saying that “every beauty is unique and worthy of our appreciation, and if this appreciation can be applied universally, then the world will be in complete harmony.”[36] This is a typical expression of multiculturalism in accordance with the spirit of China's traditional culture as well as the dialectics of the evolution of human civilization.

In this model, the outcome of cross-cultural traditional medicine communication is mutual integration, where there is a bit of you in me and a bit of me in you, and it then passes on from generation to generation. For example, “Da Yi Jing Cheng” intricately integrated the thinking of Buddhism, Taoism, and Confucianism together. Likewise, the Prescriptions Worth A Thousand Gold Pieces absorbed Jivakan prescriptions and Buddhist medical skills with the purpose of improving people's health. More examples such as the skill of golden edge to treat eye disease gradually assimilated to be part of traditional Chinese medicine and the integration of Ayurveda and Tibetan medicine in traditional Chinese medicine pulse diagnostic theory. However, chances are that the communication happened but did not last and vanished in history. For example, the practice of using honey to process a mummy prevailed in the Yuan Dynasty, but it eventually perished into history. Sometimes, there may no intersection between the two cultures even after encountering one another, and they would run parallel. Each culture would develop individually without conflict, and there is no need to argue which theory or medicine belongs to whom.

It is worth noting that cross-cultural communication that takes the model of cultural exchange and mutual learning does not mean expansion. For example, as the most powerful empire of the time, the Tang Dynasty, where Sun Simiao lived, was politically stable, economically strong and possessed military power. However, it was very interested in learning the culture, philosophy, and religion of India, a disintegrated country, which had a backward economy and could easily be defeated by Wang Xuance, an ambassador of Tang with borrowed troops. There were scholars continuously setting out for India to study its culture. This is totally different from the contemporary West that extends its culture with military power.

Based on the aforesaid analysis, cultural exchange and mutual learning can be considered as an ideal model in the study of cross-cultural communication. However, it is worth mentioning that, according to the explanation proposed by Prof. Zhao Tingyang in his reprinted book, the Tianxia System, “to conclude the Tianxia system from China's ancient philosophy does not mean that it sticks to the past and rejects the present, nor does it mean that the political system in ancient China is perfect. The truth is, monarchs that could really realize the concept of Tianxia are just a few only.”[37] The purpose for Prof. Zhao to put forward such system is to establish a national view or a global view that transcends nation states so that an ideal model can therefore be built to guide the reality. Likewise, the theory of the public sphere proposed by Habermas, though originated from early capitalist Europe, does not aim at archeological discovery. Instead, it is an expression of discontent against the feudalization of the current public sphere as well as the loss of individual subjectivity. It is the intellectual's means of expressing their concern and providing remedy for the sick reality.

Using the same principle, the author has tried to extract the ideal model of cultural exchange and mutual learning from the premodern research without lingering on the past. As a matter of fact, all traditional medicines are the coexistence of the dross and the essence, the masses and nonmasses, but it is not the emphasis of this paper. The author has used traditional medicine as a starting point to discuss the future prospect of a cross-cultural communication under the guidance of non-Western thinking. By rediscovering and researching into the cross-cultural communication practice throughout the history of Eastern civilization, the author has provided a new theoretical paradigm and a new way of thinking. In this way, we can expect future cross-cultural communication along the civilizations of Belt and Road Initiative to shake off the yoke of political influence and economic powers. Let civilization to return to its subjectivity. Let the intersubjectivity between civilizations to be recovered. Let us march toward the belief of “one world with different kinds of voices and glories.”

As a conclusion, academic concept brought up in modern times such as cultural hybridity cannot be taken for granted and thought that it is suitable to describe the communication of entire history of humankind. Nor does it necessarily have explanation of the future. In this paper, using the “Da Yi Jing Cheng” as an example, the author has critically considered premodern cross-cultural communication and endeavored to expound and enlighten on this subject.


Note 1: The year of Sun Simiao's birth and death is controversial in academic circles. This paper quotes the year in Prof. Li Jingwei's Zhong Yi Shi (《中医史》 History of Traditional Chinese Medicine) (Hainan Publishing House, 2015 Edition).

Note 2: During the three Kingdoms period, Zhu Luyan and Zhiyue, two Hu monks (胡僧) of the Eastern Wu Dynasty, first introduced the four major elements and 101 theory in the translation of the Fo Shuo Fo Yi Jiing (《佛说佛医经》 Buddhist Medical Sutra). If you look at the names, you can see that they are people from ancient India and Dayuezhi (大月支) country, respectively.

Note 3: Zhang Zhan, scholar of the East Jin Dynasty, Author of Zhuang Zi Zhu (《庄子注》 Annotation on Zhuang Zi), Lie Zi Zhu (《列子注》 The Lie Zi Note), and Yang Sheng Yao Ji (《养生要集》 The Major Collection of Health Preserving). He is the representative figure of Taoism.

Note 4: Most scholars hold that the theory of Karma is influenced by Buddhism and that Sun is the representative of the hybrid integration of Confucianism, Taoism, and Buddhism. However, according to ”Retribution Concept” and Chinese Traditional Medical Ethics, written by Zhang Sunbiao and Lin Nan, it is stated that there was a similar type of “retribution concept” in traditional Chinese culture. For example, The Book of Changes stated that “if one's good deeds do not accumulate, he/she will not make his lifelong fame; rather, if one's wrongdoing does not accumulate, he/she will not be led to death.” The retribution concept in traditional Chinese culture does not have the meaning of afterlife and frequently refers to only this life. It is more like a concept persuading people to do good deeds, which is different from Karma. Therefore, the author also admits that there is no discussion that good deeds and wrongdoings will eventually be repaid either publicly or privately after examining Lao Zi's Tao Te Ching. Here, Sun gives his viewpoint on the pretext of Lao Zi's viewpoints.


This study was financed by a grant from The National Social Science Fund of China (No. 18ZDA322).

Conflicts of interest


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