The more than one thousand years before the 5th century CE — spanning from the Spring and Autumn period through the Northern Wei dynasty in China, and from ancient Greece to the fall of the Western Roman Empire in Europe — marked the formative stage of the divergences between Chinese and Western medicine.
During this era, both East and West produced magnificent ancient civilizations, and on the whole, it is difficult to declare one superior to the other. But in the realm of medicine, significant differences began to emerge. In the Yellow River basin and the Aegean region respectively, two epoch-making medical masterpieces appeared: China produced the Huangdi Neijing (Yellow Emperor’s Inner Canon), attributed to the Yellow Emperor, and Zhang Zhongjing’s Shanghan Zabing Lun (Treatise on Cold Damage and Miscellaneous Diseases); ancient Greece produced the Hippocratic Corpus and Galen’s 17-volume anatomical magnum opus, On the Usefulness of the Parts of the Body. When comparing these works, one should pay particular attention to the subtle but consequential differences between them:
The more than one thousand years from the 5th century to the 17th century CE — from the Northern Wei through the end of the Ming dynasty in China, and from the fall of the Western Roman Empire through the Middle Ages to the 1640 English bourgeois revolution in Europe — constituted the principal historical period that widened the gap between Chinese and Western medicine.
China: China was in the golden age of feudal society, which produced a millennium of glorious development in Chinese medicine. Building upon the foundations laid by the Huangdi Neijing and the Shanghan Zabing Lun, Chinese medicine advanced by leaps and bounds, achieving brilliance in theory, methodology, prescriptions, and materia medica that Western medicine could not rival. The academic system of classical Chinese medicine gradually perfected and matured.
Europe: Europe endured a thousand years of darkness under the union of church and state. European medicine entered a long night of decline, abandoning the traditions of ancient Greece and Rome and being distorted by the Church onto a theological path, languishing in stagnation and decay. Thus, this historical period expanded the already-existing differences between Chinese and Western medicine to the point where mutual understanding became exceedingly difficult.
The brief three hundred years from the 17th century to the present have witnessed profound changes in both society and medicine.
The West: Driven by the Renaissance and the Enlightenment, the development of European science and technology boosted productive forces and gave birth to capitalist social institutions. Europe’s entirely new capitalist civilization opened a wholly new path of development for European medicine, forming a new academic system and distinctive scholarly character.
China: Modern China’s autocratic society severely constrained the development of science, technology, and productive forces. After the end of the feudal system, China entered a semi-feudal, semi-colonial society, causing its science, technology, and productive forces to fall far behind the West. Chinese medicine consequently entered a historical nadir, with few new breakthroughs while maintaining its established system and character. Although China entered a new historical era over the past century, the eastward spread of Western medicine shifted the focus from how TCM could achieve its own breakthrough and revolution. After the founding of New China, TCM — then at its historical low — gained new momentum and a renewed vitality.
Ancient China was a vast country bounded by the sea to the southeast and shielded by towering mountains to the northwest; beyond these barriers, there existed no highly developed cultures. This unique geographical environment produced a distinctive Chinese civilization. Chinese medicine originated within this civilization, which in turn was rooted in China’s climatic and geographical conditions. From remote antiquity, China’s climate tended toward aridity — the deposition of loess by cold, dry winter monsoons, the uplift of the Qinghai-Tibet Plateau, the retreat of coastlines, and the influence of dust-storm climates together shaped the Loess Plateau, a wordless chronicle of natural and terrestrial change. Chinese medicine arose within this climatic-geographical setting, and its methods of thinking, technical approaches, and medicinal resources were profoundly shaped by it. Over several millennia of development, Chinese medicine has maintained its unique theoretical system and clinical characteristics, exhibiting a continuous, unbroken, exclusionary, self-enclosed, and ultra-stable character — a character clearly linked to China’s geographical environment.
Ancient Greece’s geographical environment was vastly different. The Mediterranean region was defined by rugged mountains extending to the coastline in overlapping, unbroken ranges of striking beauty. This terrain made transportation difficult, roads winding, and arable land limited. Cities were crowded, and wheat fields, vineyards, and olive groves were small. Before such mountains, human activity could only retreat. In the plains, the scarcity of large open spaces meant that farmland typically took the form of narrow strips or small parcels. This environment of limited connectivity led hundreds of city-states to remain independent of one another for long periods. Communication between cities inevitably included elements of international exchange. This geographical environment objectively fostered the openness and inclusiveness of Western medicine, which could readily absorb the medical knowledge of Sumer, Assyria, Babylonia, Persia, and ancient India. The broad exchange of information generated innovative thinking and made it easier to accept and assimilate medical achievements from different regions and dynasties, thereby promoting the emergence and flourishing of ancient Greek medicine.
China: Owing to its continental geography and cultural “isolation mechanism,” coupled with relatively favorable climatic conditions, China developed an agrarian mode of production and way of life at an early date. This way of life provided stable resources and fixed patterns of living, fostering communities based on kinship and geography, and giving rise to a mode of thinking characterized by fixity, convention, and tracing things to their roots. The proposition that “humans participate in and resonate with Heaven and Earth” articulated both the dependence of human life on the natural environment and the direct impact of environment on human physiology and pathology. Many diseases were attributed to a disharmony between humans and nature; the fusion of humanity and nature was considered essential to health. All of this profoundly influenced Chinese medicine. First, the formation of a medical system with yin-yang and five-element theory as its framework, a pronounced naturalistic orientation as its theoretical-technical hallmark, a strong pragmatic thrust as its driving force, and an indivisible holistic understanding as its normative standard was rooted in this human-geographical environment and agrarian economy. Second, Chinese medicine emphasizes that humans are products of nature, generated through the interaction of Heaven’s and Earth’s qi; thus humans share a basis of resonance with Heaven and Earth, and every change in the natural world produces a response — for better or worse — in the human body. Third, the medicines used in Chinese medicine come directly from nature; given the immense diversity of natural settings, the properties of medicines vary markedly with geography, requiring differentiated consideration in their use. Finally, this principle extends to clinical practice: patients living in different geographical environments must be treated according to local conditions.
The West: The Aegean region’s interlocking land-and-sea geography and uneven rainfall made it difficult for the ancient Greeks to sustain themselves through farming, as the Chinese did. Agriculture could not become Greece’s economic pillar. Nor, despite Greece’s maritime location, were Mediterranean conditions suitable for large-scale fishing. However, Greek handicrafts, navigation, and commerce were relatively well developed, maintaining extensive commercial and cultural ties with other regions — particularly Egypt and Western Asia — creating conditions for Greece to encounter and absorb the finest elements of neighboring civilizations. This way of life fostered a daring, adventurous spirit that made “the whole world home,” easily severing blood and geographical ties. It also nurtured an emphasis on individual ability and intelligence — an “exercise of the mind” — and a worldview predicated on the opposition of humanity and nature. Thus, ancient Greek medicine was founded upon an anthropocentric conception of nature, embodying a separation and opposition between humanity and nature. Dissatisfied with the notion that everything in the universe was created by gods, this open and free mode of thinking led to a spirit of truth-seeking — investigating objective explanations of natural and life phenomena — and thereby introduced deductive logic, atomism, and structural analysis into medicine.
Chinese medicine arose within ancient China’s natural and social environment — an environment conducive to a unified holistic worldview, a generative philosophy of tracing origins, and an organic conception of constant change and movement. The philosophical framework best expressing these ideas is the ontology of vital qi (yuanqi). The theory of vital qi holds that the primordial substance of the world is qi — an undifferentiated, primordial breath: “Before qi was differentiated, chaos was one; all things are spontaneously generated, each endowed with vital qi.” Through movement, qi differentiates into yin and yang; yin and yang interact to generate all things, and the emergence and development of everything — including disease — unfolds within the process of yin-yang transformation. Under the influence of ancient Chinese culture and the philosophy of vital qi, Chinese medical theory emphasizes holism, organicism, and dialectics, excelling at identifying causes through pattern analysis and understanding the constant through the variable. Its concise language and thinking encode rich information; medical principles are often expressed succinctly, striving to capture the most essential truths. This meant that in forming its theories, Chinese medical practice stripped away the particulars and individuality of clinical cases while retaining the core and the universal. While this broadened the explanatory scope of Chinese medical theory to some degree, it also led different practitioners to interpret the same theory differently when moving from theory back to practice.
Western medicine emerged within the natural and cultural environment centered on the Mediterranean — Europe, Africa, and Asia — forming a worldview dominated by atomism. Atomism holds that atoms are the smallest indivisible material particles, and that different quantities of atoms, combined in different configurations, produce the myriad diversity of the cosmos. This worldview’s influence on Western medicine is evident: Western medicine regards the human body as a material construct composed of atoms or elements, and therefore decomposable. The mechanism of the body’s composition determines its dissectibility, making anatomy, dissection, and reductionism the inevitable research approach. Health or illness is likewise determined by whether the body’s material structure has been altered, leading to the study of human physiology and pathology at the anatomical level. Because this analytical approach relies on objective and concrete structures, different physicians’ interpretations of the same disease do not vary significantly.
Influenced by Confucian culture, Chinese medical practice is oriented toward the pursuit of goodness (shan); the physician’s purpose is to realize the Confucian ideal of benevolence.
Influenced by reductionism, and particularly by the European Renaissance, Western medical practice is oriented toward the pursuit of truth (zhen); the purpose of studying the human body is to interpret it objectively and accurately.
Chinese medicine does not advocate destroying the human body in order to understand its internal structure, believing that such an approach would violate the principle of goodness. Instead, it adopts a mode of thinking that proceeds from Heaven to humanity, employing the theories of yin-yang and the five elements to understand the body.
Western medicine strongly advocates dissecting the human body in order to clearly understand its internal structure, believing that only in this way can truth be attained. It separates humanity from nature and employs an analytical, reductive mode of thinking, relying on anatomy and experiment to understand the body.
In summary, although both East and West attempted to explain natural and human phenomena through materialist monism, the enormous differences behind this superficial commonality constitute the internal “genes” that caused Chinese and Western medicine to evolve along their respective paths — and the important historical-origin factors behind the divergence between them.
(1) Shared Early Characteristics: Early Chinese and Western medicine shared common features — passivity, non-theoretical nature, empiricism, and non-region-specificity. Their instinct for rescue and healing, food-seeking activities and medical knowledge, shamanic practices and medical origins, primitive anatomical understanding, and medical activities were all grounded in clinical practice and a holistic view of the human being. Both emphasized the body’s natural resistance to disease and neglected experimental research, having both emerged from the wasteland of humanity’s instinct for survival.
(2) Both Experienced Peaks and Valleys: China saw several peaks of development — the Qin-Han, Sui-Tang, Northern-Southern Song, and Ming dynasties — with its pace and level of advancement leading the world for long periods. Western medicine likewise experienced an accelerating peak from its origins through ancient Greece and Rome. TCM’s development gradually slowed in the late Qing period, plunging to a historical nadir after 1840 and falling behind Western medicine, before beginning to recover after the founding of the People’s Republic in 1949. Western medicine, for its part, entered a decline during the Middle Ages, falling into a trough lasting over a thousand years and falling far behind Chinese medicine, before surpassing it in modern times and reaching the commanding heights of global mainstream medicine.
(3) Both Received State Support and Encouragement.
(4) Both Produced Many Great Physicians who contributed enormously to the development of medicine.
(5) Same Disease, Different Treatment; Different Disease, Same Treatment: In Chinese medicine, pattern differentiation determines that the same disease with different patterns receives different treatment principles, while different diseases sharing the same pattern may be treated similarly. Western medicine displays the same characteristic: with the growing development of genetic testing and targeted therapy in recent years, we have found that different tumors sharing the same driver gene can be treated with the same targeted drug, while a single tumor with different driver genes may require different targeted drugs — a principle that coincides perfectly with the Chinese medical concepts of treating the same disease differently and treating different diseases the same way.
(6) Both Are Crystals of Human Wisdom. Whether Chinese or Western medicine, both are treasures formed during humanity’s struggle against disease — the shared spiritual and health heritage of all humankind.
This series is a collective creation.
中文原文 / Chinese Original
公元5世纪之前的1000多年（在中国是从春秋战国到南北朝的北魏，在欧洲是从古希腊到西罗马帝国灭亡）是中西医学差异的萌发阶段。
这个时期东西方都创造了辉煌的古代文明，从整体上说，两者很难分出高低。但就医学而言：
附近的黄河流域与爱琴海区域，分别产生了两部划时代的医学巨著：中国有以黄帝名义著述的《黄帝内经》和张仲景的《伤寒杂病论》，古希腊有希波克拉底的《希波克拉底文集》和盖伦的17卷本解剖学巨著《人体各部位的作用》。将其进行比较，两者更应注重它们之间隐而不显的差异：
公元5世纪到公元17世纪的1000多年（在中国是从南北朝的北魏到明朝灭亡，在欧洲是从西罗马帝国灭亡到1640年英国资产阶级革命的中世纪）是造成中西医学差异的主要历史时期。
中国：中国处于封建社会的鼎盛时期，成就了中国医学发展辉煌的1000年。此时，中国医学在《黄帝内经》《伤寒杂病论》时代的基础上长足地向前发展，在理法方药各个方面都创造了西方医学无法比拟的辉煌成就，经典中医学的学术体系逐步完善、臻于成熟。
西方：欧洲处于政教合一的黑暗的1000年，欧洲医学进入漫漫长夜的衰落。欧洲医学抛弃了古希腊、古罗马的传统，被教会扭曲到神学道路上，处于停滞、衰落和凋敝之中。这段历史将中西医学之间业已存在的差异扩大到了难以沟通的程度。
从17世纪至今的短短300年，无论社会还是医学，都发生了深刻变化。
西方：在文艺复兴和启蒙运动的推动下，欧洲科学技术的发展促进了生产力的提高，催生了资本主义的社会制度。欧洲全新的资本主义文明为欧洲医学开辟了一条全新的发展道路，形成了全新的学术体系和学术特色。
中国：近代中国的专制社会严重束缚了科学技术和生产力的发展，中国结束封建社会制度以后却进入了半封建半殖民地社会，致使科学技术和生产力大大落后于西方，中国医学也因此进入了历史的低谷，没有多少新的突破而保持着业已形成的体系和特色。近百年来，中国虽然进入了新的历史时期，但由于西医东渐使得中医不是如何实现自身的突破和革命。新中国成立后，处于历史低谷的中医获得了新的发展，出现了新的活跃局面。
古代中国是一个幅员辽阔的国家，东南为浩瀚海围，西北近峭壁崇岭离隔，在这些屏障之外，没有高度发达的文化。这一独特的地理环境造就了独特的中华文化。中医学起源于中国古代文明，古代文明滋生于中国古代的气候地理环境。中国远古时代气候一直趋向于干旱，干冷的冬季风的搬运形成黄土的沉积，青藏高原的隆起，海岸线的后退，沙尘暴气候的影响，黄土高原形成是一本自然界变化和地球变化的无字天书。中医药学在这种气候地理环境中发生，其思维方法、技术手段和药物资源都受其深刻影响。中医药学发展了几千年，一直保持着其独特理论体系和临床诊治特色，具有一种一脉相承没有中断的排外的、自我封闭的和超稳定的特点，这一特点的形成显然与中国的地理环境紧密相关。
古希腊与中国地理环境大不相同，地中海地区重峦叠嶂，群山一直延伸到岸边，层层叠叠，绵延不绝，风景秀丽。它们导致交通不便，道路弯曲，田园空间有限。城市拥挤，麦田、葡萄园乃至橄榄园面积狭小。在大山面前，人类的活动总是望而却步。在平原地区，由于缺少大片空地，农田往往呈带状或块状。这种有限便利的环境导致数百个城邦小国长期以来彼此独立。城际之间的交流就包含了较多的国际交流的因素。由此，这种地理环境在客观上导致了西方医学之开放性特征、融合性特征，能够容易吸收苏美尔医学、亚述和古巴比伦医学、波斯医学和古印度医学。信息在大范围的交流产生创新意识，更容易接受并吸收不同地区、不同王朝的不同学科的理论和方法创造的医学成就，促进整个古希腊医学的产生和繁荣，这是古希腊医学迅猛发展之重要原因。
中国：由于陆性地理环境与文化”隔绝机制”，再加之相对适宜的气候地理条件，中国古代很早就发展起了以农牧业为主的生产和生存方式。这种生存方式给人们提供了稳定的生存资源、固定的生活方式，形成以血缘和地缘为主的群居聚落，形成固定不变、墨守成规、追根溯源的思维方式。提出”人与天地相参，与日月相应”的观点，一方面说明人类生命对自然环境的依赖性，一方面强调环境会直接影响人体的生理和病理。认为人的很多疾病就是因人与自然关系失调所致，天人融合是保证人体健康的重要条件。这一切对中医学产生了深刻的影响。首先，中医学之所以形成了以阴阳五行理论为骨架，以突出的自然倾向为理论技术特征，以强烈的直接实用取向为动力，以不可分割的整体认识为规范的医药体系，是以这种人文地理环境和农业经济为基础条件的；其次，中医学强调人是自然的产物，是天地气交化而生成，人与天地就有相通相感的基础，天地自然的每一变化，都会在人体上产生或好或坏的反响；再次，中医所使用的药物，多是直接从自然中来，由于自然背景的千差万别，因而随着地理环境的不同，药物性能有着明显的差异，使用时需考虑和区别对待。最后，上升为诊病治病时的理论把握——患者生活的地理环境不同，医家在诊治疾病时必须因地制宜。
西方：古希腊所处的爱琴海地区海陆交错的地理条件和降水丰沛不均的气候条件使得古希腊人难以像中国人那样在田地里依靠农耕方式谋生，农业难以成为古希腊的经济支柱。此外，古希腊虽然靠海，但地中海的海洋条件却不适于鱼类的大规模繁殖生长，因此渔业也未能成为古希腊的经济支柱。但古希腊的手工业、航海业和商业却较发达，同其他地区，特别是同埃及和西亚各国有着广泛的商业、文化联系，为古希腊接触和吸收周边地区的文明精华创造了条件。这种生存方式成就了古希腊人敢于冒险以”四海为家”，这就容易割断了人们之间血缘关系和地缘关系，也形成了依靠自己的能力和智慧的”锻炼思维”和天人对立观念。因此，古希腊医学建立在”人类中心论”的自然观之上，体现出在天人关系上的分离与对立，从而不满于宇宙中的一切都是由神创造的观点，这种开放和自由的思路导致进而寻求真理的精神，探究自然现象和生命现象的客观解释，从而将演绎逻辑方法、原子论和结构分析等理论和方法也应用到医学上来。
中医学是在中国古代自然和社会环境中产生的，这种环境易于产生统一的整体观、追根溯源式的生成论思想、运动变化的有机论观念。最能表达这些思想的就是元气本体论。元气论认为，世界的物质本原是元气，元气是混沌未分的本原之气。”元气未分，混沌为一”，”万物自生，皆禀元气”。元气运动而分化为阴阳，阴阳交而化生万物，万事万物包括疾病的产生与发展的过程都是在阴阳变化的过程。受古代中国文化和哲学元气论的影响，中医理论强调整体观、有机观、辩证观，善于审证求因，知常达变。用简练的语言和思维包含丰富的信息，医理往往言简意赅，力求反映最本质的道理。这就造成了中医实践在形成理论时剔除了病例的细节和个性，保留了主体和共性。这虽然在一定程度上扩大了中医理论的解释范围，却也导致不同的医生在从理论再到实践的过程中对同一理论的解释产生差异。
西医学是在以地中海为中心的欧、非、亚的自然环境和文化环境中滋生的，形成基于原子论为主导地位的自然观。原子论认为，原子是一种最小的不能再分的物质颗粒，不同数量的原子按照不同的连续性组合在一起，形成了千差万别的宇宙万物。这种自然观对西医学的影响主要体现在：西医学把人体看成一种物质构成，是由原子或元素组合而成，因而是可分解的，人体的组合发生机制决定着其可拆卸性，解剖、分解和还原成为必然的研究思路。人的健康与否同样是由人体的物质结构性是否改变所决定，这就在人体的解剖学层面研究人体生理、病理状态。这种分析方法依据的是客观和具体结构，不同医生对同种疾病的解释不会有太大的差别。
中医学由于受儒家文化的影响，其医学实践以求善为导向，为医者的目的是实现儒家的仁爱；
西医学由于受还原论的影响，特别是欧洲文艺复兴运动促进西医以求真为指归，研究人体的目的是为了客观真实地解读它。
中医不主张破坏人体去认识其内部结构，认为这样才合于善；中医采用从天到人的思维方式，借用阴阳五行学说去认识人体。
西医强烈主张要破坏人体，从而能清楚地了解人体的内部结构，西医认为这样才能做到求真；西医则将天人分开，采用分析还原的思维方法借用解剖和实验认识人体。
总之，虽然东西方都是试图用唯物一元论来解释自然及人体现象，但这种一致性背后的巨大差异则是中西医学沿着各自的道路演进的内在”基因”，也是导致中西医学差距的重要历史起源因素。
（1）早期中西医学具有共同特征，如被动性、非理论性、经验性、无地域性等，其救护本能与医疗行为、求食活动与医药知识、巫术活动与医学渊源、朴素原始的解剖知识、医事活动等都以临床实践和对人的整体认识观为基础，强调机体对疾病的自然抗御，忽略实验研究等，都是从人类求生的本能荒漠中走过来的，两者有众多的相同或相似之处。
（2）都经历过高峰低谷。中国出现了秦汉、隋唐、两宋、明朝等几个发展高峰，其发展速度和水平长期在世界上遥遥领先。而西医学从起源到古希腊、罗马的是加速发展高峰。中医清后期发展速度慢慢下滑，到1840年之后跌入了历史的低谷，发展速度落在西医学之后，1949年建国后开始向上回升。而西医从中世纪发展速度下滑，跌入一个长达1000多年的历史低谷，发展速度和水平远远落在中医学之后。近代发展超过中医，达到了世界医学主流医学的制高点。
（3）都受到过国家的支持与鼓励。
（4）都出现了许多医家大能，为医学的发展贡献了许多力量。
（5）同病异治，异病同治：中医辨证论治，同一种病，不同证型，治则治法就有不同，而不同疾病，如果证型相同，则治则治法也可能相同。而在西医学上，也有同样的特点，特别是近些年来，基因检测及靶向治疗的日益发展，我们发现，不同肿瘤如有相同驱动基因，可用同种靶向药物治疗，而同一肿瘤如有不同驱动基因，可用不同靶向药物治疗，这与中医学的同病异治、异病同治的理念不谋而合。
（6）都是人类智慧结晶。无论中医还是西医，都是人类在与疾病斗争过程中，形成的医学瑰宝，是全人类共同的精神财富、健康财富。
本连载系集体创作。
发表回复