Li Gao

Li Gao a physician of the Jin and Yuan period (1180-1251) who, observing that many of his patients suffered from exhaustion and weakness after war and famine, developed the doctrine that disease often arises from injury to the spleen and stomach and is best treated by strengthening the digestive and vital powers.

Life and Career

Li Gao, whose courtesy name was Mingzhi and who is also known by the title of Master of the Eastern Wall, was born in 1180 in Zhending, in what is now Hebei province, toward the end of the Jin dynasty. He came from a wealthy family and received a thorough education with a view to an official career, but illness and the misfortunes of his family drew him to medicine. His mother is said to have fallen ill and died while the physicians of the region failed to agree upon her treatment, and this loss is said to have turned him decisively toward the study of the healing art.

He studied under a celebrated teacher, a scholar and physician of the old capital, and he applied himself to the classical texts with the seriousness of a lifelong student. He was a contemporary of Zhang Congzheng, whose doctrine of attacking the pathogen he knew and weighed against his own experience. The disorders of the age, in which war, famine and dislocation brought widespread exhaustion and debility, shaped his clinical outlook and directed his attention to the conditions of deficiency.

He practised during the final years of the Jin dynasty and the early decades of the Yuan, a time of conquest and upheaval. He fled from the fighting and settled in the relative security of the north, where he continued to see patients and to teach. His reputation as a clinician and as a theorist grew, and he attracted students who carried his doctrines to later generations. The suffering that he witnessed among the displaced and the hungry gave his medicine a distinctive concern for the exhausted and the weakened, and it shaped the questions that he put to the classical texts.

The Spleen and Stomach

Li Gao's distinctive contribution was his doctrine of the spleen and stomach. In the traditional physiology these organs are the source of the body's vital energy, deriving it from food and conveying it to the whole system. Li Gao argued that when the spleen and stomach are injured, the supply of vital energy fails, the body's resistance declines, and disease results. He therefore held that many illnesses, especially those of a chronic and wasting kind, arise from a weakness of the digestive centre rather than from an external pathogen.

He developed this insight into a comprehensive pathology of deficiency. He described the ways in which the spleen and stomach may be damaged, whether by improper diet, by excessive worry and overwork, by cold and damp, or by the depletion brought on by war and famine, and he traced the consequences for the whole body as the vital energy sank and failed. This analysis gave physicians a framework for understanding and treating the debilitated and exhausted patient.

His doctrine implied a therapeutic emphasis quite different from that of the physicians of his time who stressed the expulsion of pathogenic influences. If disease arose from the failure of the vital centre, then treatment should aim to restore and strengthen it rather than to attack. He therefore favoured tonifying and warming remedies, especially those that supported the spleen and stomach, and he advised caution in the use of purging and cooling drugs that might further weaken the patient.

Rising Yang and the Governing of the Body

A further element of Li Gao's teaching concerned the movement of the vital energy within the body. He held that the clear and active influences should rise from the centre, while the turbid and heavy influences should descend, and that health depends upon the proper direction of this movement. In many diseases, he argued, the clear yang fails to rise, the vital energy sinks, and the body loses its strength and its resistance. Treatment should help the clear influences to rise and the turbid to descend.

He devised a number of famous formulas to restore this movement, based upon herbs that were held to raise the yang, to warm the centre, to nourish the spleen and to promote the flow of vital energy. Some of these prescriptions became among the most widely used remedies in the whole tradition, valued for their use in the treatment of fatigue, prolapse, weakness after illness and chronic digestive disorder. Their enduring popularity testifies to the practical value of his ideas.

His concern with the rising of the clear and the descending of the turbid reflected a broader conception of the body as a system of orderly movements that could be disturbed by illness and restored by treatment. This conception connected his doctrine to the older physiological theories of the Inner Canon and gave his practice a theoretical coherence that appealed to later physicians. It also helped to explain why the same weakness might show itself in so many different complaints, from weariness and poor appetite to prolapse and chronic infection.

The Treatise on the Spleen and Stomach

Li Gao set out his doctrines in a book whose title has been rendered as a treatise on distinguishing the spleen and stomach, one of the central texts of the Jin and Yuan period. In it he developed his account of the digestive centre and its role in health, presented his pathology of deficiency and of the sinking of the vital energy, and supplied the formulas by which the condition could be treated. The work became the founding statement of the school associated with his name.

The treatise is notable for its combination of theoretical argument with clinical detail, including records of cases that illustrate the application of his methods. Li Gao argued explicitly against the physicians who relied on attack and purgation, and he defended the use of tonics as the appropriate therapy for the debilitated. His reasoning was grounded in the classical texts, and he cited them extensively in support of his views.

He also wrote on other subjects, including explanations of difficult passages in the medical classics and discussions of the diagnosis of disease. His learning was wide, and his works include commentary on the difficulties of the ancient texts, written with the aim of clarifying their meaning for practising physicians. This scholarly side of his work supported his clinical and theoretical innovations.

Influence and Legacy

Li Gao became one of the four great masters of the Jin and Yuan period, and his doctrine of the spleen and stomach became a major current of later medicine. The school that he founded, sometimes called the Tonifying Earth School, emphasised the strengthening of the body's vital centre and influenced the treatment of deficiency diseases for centuries. His formulas passed into the standard repertoire of pharmacy and are still studied and used today.

His teaching complemented and corrected the more aggressive approaches of some of his contemporaries, reminding physicians that the strength and resources of the patient must be considered alongside the influence of the disease. This balanced view became part of the common inheritance of Chinese medicine, and later physicians drew upon it whenever they treated the weak, the aged and the convalescent.

He died in 1251, having lived through the end of the Jin and the establishment of the Yuan dynasty. He is remembered as one of the greatest physicians of his age, a clinician whose experience of the suffering of a war-torn world led him to a doctrine of nourishment and support, and whose careful reasoning and extensive writings gave that doctrine a lasting place in the tradition of Chinese medicine.

See also

• Four masters of the Jin and Yuan
• Traditional Chinese medicine
• Spleen and stomach
• Tonifying method