A Preliminary Study of Medical Books on Health Care for the Elderly and Prolonging Life in the Early 20th Century

Abstract

The present research of Chinese medical history lack detailed discussions on Chinese medicine philology of the elderly and the various sorting of related literature of physiology and diseases both at home and abroad. Based on previous literature, the article aims to introduce the publishing trend of medical books on health cultivation and prolonging life on since modern times, generally describe its significance, and initially analyze the contents related to health cultivation for the elderly. The article finds out that after the scientific concepts were imported into China in large quantities from the beginning of the 20th century, the past superstitions rose again. The sciences of nutrition, bacteriology, and physiology in such books had all verified that the road to immortality was possible. The concept of longevity at the time emphasized a concept that could be controlled by science. With the advancement of scientific research and health concepts, people believed that they could eventually achieve immortality. It was obvious that people were filled with optimism about science at that time, thus gradually subverting the definition of the elderly.

1 Introduction

Medical historians are committed to seeking new themes in the field of history and devoting to the mission of searching truth and facts in history. They explore various social and cultural history issues such as birth, aging, illness, and death of people in history,^1–3 and pay attention to issues of life and health various groups,⁴ including research on medical practitioners,⁵ religious medicine,^6,7 women,^8–11 children, and other groups.^12–14 Relevant researches have been published on these issues as well as historical data collection or specialist research, and more emphases are laid on pediatric medicine compared to geriatric medicine.^15,16 However, there still exists a number of research areas and issues worthy of research from the perspective of the culture of traditional Chinese medicine (TCM) knowledge production. Judging from the current research results of medical history, there is a lack of relevant discussion on the literature of the elderly and various sorting out of related physiology and disease history both at home and abroad in spite of exceptions.^17,18 Human beings will eventually get old. Most families have elderly people.¹⁹ Humanistic historians should help people understand the body and recuperation details of the elderly people in history. In retrospect, TCM is a very special technique. It is not only “modern,” but has a lot of empirical experience and effective techniques that may exist in the ancient books. Even what modern Chinese medicine has mastered is only a small amount of ancient classic knowledge, regardless of the transformation of Chinese medicine literature scholars required to find various empirical and scientific possibilities from ancient books. The example of Tu Youyou (屠呦呦) is a good illustration. People all over the world reported her achievements on discovering the therapeutic efficacy of artemisinin, while TCM scholars laid her success on the inspiration from Zhou Hou Bei Ji Fang (《肘后备急方》 Emergency Formulas to Keep Up One’s Sleeve), an ancient TCM classic. In fact, Tu has already spent a lot of time investigating the diseases and treatment methods in various ancient books in the comparison of the curative effects in the early stage, which greatly contributed to her success. The example indicates that the ancient documents can also inspire new technological innovations to a certain extent.²⁰ TCM has practical values and benefits for the long-term care of the elderly, which has been confirmed by the scientific community. Many TCM scholars and practitioners have begun to explore the application of TCM from the perspective of empirical medicine.²¹ Another example is the investigation and research conducted by Lin Wenyuan (林文源). He implemented science, technology, and society (STS) to reflect on the experience and meaning of TCM to explore TCM knowledge, in order to achieve the possibility of interdisciplinary intervention to explore the boundaries of knowledge and benefit clinical application of modern TCM.²² This is the value of studying the history of TCM knowledge in the past.

2 Statistical analysis on ancient medical books on pension and life extension

There is a lack of in-depth research on the physiological characteristics, historical significance, and documentation of the elderly. The understanding of the medical community is still insufficient regarding the contribution of TCM health preservation to the physiology and disease treatment of the elderly during the Republic of China. Most literature briefly covers relevant issues from Huang Di Nei Jing (《黄帝内经》 The Yellow Emperor’s Inner Classic), Dao De Jing (《道德经》 The Book of The Way), Lyu Shi Chun Qiu (《吕氏春秋》 The Spring and Autumn of Lu Buwei), etc, or generally introduces the idea of preventive treatment of diseases, indicating a lack of unity and historical depth.²³ In general, the knowledge of TCM on the elderly is preserved in health-preserving medical books, and its meaning is often based on the concept of prolonging life. The paper would focus on these books. Take the medical book titled Shou Shi Bian (《寿世编》 Longevity Book) in the early Qing Dynasty as an example. The title might indicate that it is related to the health care of the elderly. But in fact, the book is written for the diseases and health care of children and women, and there is no content about the elderly.²⁴ In contrast, Yang Sheng Lei Yao (《养生类要》 Categorized Synopsis of Health Care), a medical book in the Ming Dynasty covered a lot of knowledge about the physiology and medicine of the elderly. For example: “When people grow old, if they have short urination, the disease is advancing.” The book also mentioned that the elderly would suffer yin deficiency, and the symptoms are as follows: “The muscles and bones of the elderly are weak, and they have no color on the dark face. They eat little, but they have much phlegm. They cough or gasp, and urinate quite a few times at night. They suffer impotence, and have weak feet and knees as well as a thin body. These symptoms are mostly due to long-term of kidney qi deficiency, triggering haggard sleep, sweating, fever, and thirst.”²⁵ The book contained many descriptions of the physiological symptoms of the elderly. Therefore, even books on health preservation or medical books named after “longevity” and “old age” required relevant provisions for analysis, in order to truly grasp the essence of the books and knowledge of the elderly. However, the scope of the study must be narrowed in order to make solid studies (Fig. 1).

Figure 1: A comic describing harm on the elderly due to bad habits, stimulants, and anesthetics from Jian Kang Yao Jue (Essential Teachings on Health). (source from: http://read.nlc.cn/OutOpenBook/OpenObjectBook?aid=416&bid=5970.0).

So-called health care is not necessarily about the knowledge of the elderly. In the future, we should focus on the understanding of medical care for the elderly. There have been many achievements in the research of body history in the academic circle.^26–28 The research results are particularly fruitful, especially in the aspect of gender body history.^29–31 However, little emphasis is laid on the body meaning and cultural meaning of the young and the elderly. A representative study by Dr. Li Zhende (李贞德) presented the knowledge of physiology to pay attention to the physiological changes of women in old age.^32,33 Doctoral dissertation of Xiao Qi (萧琪) was also very innovative. The study explained the integration of the concepts of “elderly care” and “health preservation,” and theories and specific practices of medical care for the elderly under the development of medical theory since the Jin and Yuan dynasties.³⁴ The study has inspired the author to collect historical documents and literature. Therefore, how can these documents reflect the social and cultural significance of the body of the elderly? The scope of ancient Chinese medical books is quite broad, so it must be narrowed down. What kind of books and classics are worth sorting out? What changes have been made to the way they presented knowledge in modern times (1940–1949)? In order to answer these questions, this study have to first observe the medical books related to the health and treatment of the elderly in the history of Chinese medicine, and come up with an outline of the publication of a book before it can be effectively analyzed. The author sorted medical books on health care and cultivation for the elderly mainly from General Catalogue of Ancient Books of Traditional Chinese Medicine, and compiled them into Statistical Survey of Books on Health Cultivation in Modern Chinese Medicine. The survey is provided as an Appendix. The catalog with so many medical books is difficult to start. It is hard to find some of the books, such as Ji Bing Bu Jiu Lu (《疾病补救录》 The Records of Remedies for Diseases) compiled by Du Shizhang (杜时彰). It is difficult to prove that the book deals with the diseases of the elderly because the original book has not been seen. In other cases, health preservation in the title of the books sometimes refers to “rehabilitation” or “disease prevention.” These contents may not necessarily refer to the elderly, so they can be omitted. Common features have to be found before the study could focus on a specific research issue. It may be difficult to find the connotation without comparison.

Statistical Survey of Books on Health Cultivation in Modern Chinese Medicine is mainly based on statistics of new published books in modern times. Before analyzing the catalogue, it is necessary to first discuss the publishing status of ancient books published before 1840 related to the health and treatment of the elderly in modern times, and find out the problems. After that, the analysis can be more comprehensive. The basic findings are as follows.

It is surprising to find that many ancient health-preserving medical books have disappeared or at least not easily accessed in modern times. Compared with books on TCM such as cold damage or heat diseases, the books on traditional knowledge of health preservation and life extension have been seriously neglected in modern times.³⁵ The following books were published before the late Qing Dynasty (1840), and some were republished during the Republic of China. They are arranged in chronological order. These books included: Can Tong Qi Zheng Wen (《参同契正文》 Main Text of Kinship of the Three) (219), Yang Sheng Lun (《养生论》 On Health Preservation), Bao Pu Zi Nei Wai Pian (《抱朴子(内外篇)》 The Inner and Outer Analects of Bao Pu-zi), Yang Xing Yan Ming Lu (《养性延命录》 Records on Nurturing Nature and Prolonging Life), Tian Yin Zi (《天隐子》 The Gentleman hiding in the Heaven) (741), Su Nyu Fang (《素女方》 Formulas of the Immaculate Maiden), She Sheng Xiao Xi Lun (《摄生消息论》 Treatise on Health Cultivation and Ups and Downs), Yan Shou Di Yi Shen Yan (《延寿第一绅言》 The First Important Sayings for Prolonging Longevity) (1276), Tiao Xie Lei Bian (《调燮类编》 Life Preservation Arranged by Category) (1276), She Sheng Yue Ling (《摄生月令》 Health Cultivation According to the 12-month Season), Hun Su Yi Sheng Lu (《混俗颐生录》 The Records of Preserving Life in the World), Si Shi Yi Ji (《四时宜忌》 Taboos of Four Seasons), Xiu Ling Yao Zhi (《修龄要旨》 The Essential Teachings of Prolonging Life) (1442), Si Shi She Sheng Tu (《四时摄生图》 Graphs on Health Cultivation in Four Seasons) (2 editions), Zhi Yan Zong Yang Sheng Pian (《至言总养生篇》 Collection of Essential Teachings on Health Cultivation) (1449), Jiang She Bao Ming Pian (《将摄保命篇》 The Volume on Health Cultivation and Life Preservation) (1449), Fu Qi Chang Sheng Bi Gu Fa (《服气长生辟谷法》 Fulfilling Qi and Longevity by Fasting) (1449), Tui Peng Nuo Yu (《推蓬寤语》 Sayings after Removing Obstacles and Waking Up) (1570), She Sheng San Yao (《摄生三要》 Three Essential Teachings for Life Cultivation) (1591), Yang Sheng Fu Yu (《养生肤语》 Plain Sayings on Life Cultivation), Shi Se Shen Yan (《食色绅言》 Important Sayings on Food and Sex) (1615), Tian Xian Zheng Li Zhi Lun Zeng Zhu (《天仙正理直论增注》 Additional Commentaries to the Righteous Sayings of the Fairies), Huang Di Shou San Zi Xuan Nyu Jing (《黄帝授三子玄女经》 The Yellow Emperor’s Presenting the Sutra of Mysterious Female to Three Sons) and other books. These books probably had only one version during the period of the Republic of China, and they were all included in other books, including Cong Shu Ji Cheng Chu Bian (《丛书集成初编》 Preliminary Compilation of Book Series), Dao Zang Ju Yao (《道藏举要》 Quotes of Taoist Canon), Dao Zang Jing Hua Lu (《道藏精华录》 Records of Essences of Taoist Canon), San San Yi Shu (《三三医书》 Medical Books of Three Generations’ Experiences), etc. These books were published in other books rather than in a single volume. Therefore, the academic values lay more in the function of preservation and research more than dissemination and circulation.

A small proportion of medical books were not only included in other books. They were also published as separate editions, and some books even had several editions, which had a great influence on the circulation of knowledge. Among them, Shou Qin Yang Lao Xin Shu (《寿亲养老新书》 New Book on Longevity and Health Cultivation) (1307) originally written by Chen Zhi (陈直), supplemented by Zou Xuan (邹铉) of the Yuan dynasty was the most special. There were four block-printed editions of this book in the late Qing dynasty. In the Republic of China, there were three single editions of this book published in 1916, 1919, and 1935. The book was followed by Zun Sheng Ba Jian (《遵生八笺》 Eight Letter on Life Cultivation), with many editions in the late Qing Dynasty. During the Republic of China, there were two editions of Zun Sheng Ba Jian published as a single edition. As for other important medical books, such as Yang Lao Feng Qin Shu (《养老奉亲书》 Book on Healthcare for the Elderly and Parents) by Chen Zhi in the Northern Song dynasty, Yang Sheng Lei Zuan (《养生类纂》 Compilation of Health Cultivation), and Yang Sheng Yue Lan (《养生阅览》 Readings on Health Cultivation) (1220) by Zhou Shouzhong (周守中), etc., it is surprising that there were no separate editions in the Republic of China.³⁶ There were two editions of Shou Shi Qing Bian (《寿世青编》 Compilation of Prolonging Life) (1667), one of which was preserved in Zhen Ben Yi Shu Ji Cheng (《珍本医书集成》 Complete Records of Rare Medical Books). Yang Sheng Jing (《养生镜》 Health Cultivation Mirror) (1709) of the Qing dynasty had two printed editions in 1922 and 1933. As for the medical books with a single edition, there were the 1922 lithographic edition of Wan Shou Dan Shu (《万寿丹书》 The Elixir Book of Longevity) published by Jinan Benevolence Altar in 1624, and the printed edition of Shen Bao Ba Fa (《神保八法》 Eight Laws of Ancestral Spirits) published by Leshan Charity Society of the Republic of China in about 1820. Other medical books on health cultivation and longevity before the late Qing Dynasty had no publications. Compared with the special medical books on heat diseases, most books on health cultivation had few editions. Many books had only single editions or transcripts, which indicated that the number of people willing to read health cultivation books might be much less than those willing to read professional TCM books. Although longevity was the pursuit of ordinary people, curing diseases was obviously more urgent. If the disease could not be cured, longevity could not be achieved.

3 Publishing situation of relevant medical books in modern times

The section would focus on the continuation of versions of medical books in modern times. We will first look into the publishing situation in the late Qing dynasty (1840–1911). For example, there were three editions of Lao Lao Heng Yan (《老老恒言》 Eternal Teachings on Health Care for the Elderly) (1773) in the late Qing Dynasty. There also existed a lithographic edition of the book published by Shanghai Hongzhang Publishing House in 1928 during the Republic of China. Another special book was Wei Ji Yu Bian (《卫济余编》 Additional Compilation of Healthcare and Longevity) (1813) compiled by Wang Rangtang (王纕堂) in the late Qing dynasty. In addition to introducing the method of preserving health and prolonging life, this book covered all aspects of daily life, such as daily activities, communication, clothing, diet, and games, which were beneficial to physical and mental health. This book was published in nine editions throughout the 19th century, and it was widely circulated, which was worthy of further research. However, the book was not published in the Republic of China.³⁷ In a nutshell, health cultivation books had few editions and were not widely circulated compared to books on various TCM theories during the Republic of China. Health cultivation books were very influential in the late Qing dynasty. However, with a more prosperous publication industry in the Republic of China, these books disappeared from the market. What was the reason behind it? The study believes that there might be newer and more influential theories or publications replacing the existing knowledge system. The old knowledge system had not completely disappeared, because there were still health cultivation books published in separate editions, indicating that there was a market. However, it was still necessary to explore the appearance of new knowledge, and the conflicts and dialogs between knowledge carriers.

It could be concluded from Statistical Survey of Books on Health Cultivation in Modern Chinese Medicine (Appendix) that as for the newly published medical books since the late Qing dynasty, the ones that had actually printed more than two editions from the late Qing dynasty to the Republic of China included three editions of Yi Shen Ji (《颐身集》 Collection of Recuperating Body and Mind) (1850), five editions of Yang Bing Yong Yan (《养病庸言》 C ommonplace Sayings on Conditioning and Recovering) (1877), two editions of Zhen Shang San Zi Jue (《枕上三字诀》 Three Character Teachings on Sleeping) (1879), 11 editions of Zhong Wai Wei Sheng Yao Zhi (《中外卫生要旨》 Essentials of Chinese and Foreign Health) (1883), eight editions of Yang Sheng Bao Ming Lu (《养生保命录》 Records on Health Cultivation and Preservation) (1890), two editions of Bao Shen Bi Lan (《保身必览》 Required Readings on Health Preservation) (1900). Wei Sheng Xue Wen Da (《卫生学问答》 Questions and Answers on Health Care) (1901) had a total of 6 editions, but only one edition during the Republic of China. The books mentioned above were initially published in the late Qing Dynasty, but only Yang Sheng Bao Ming Lu was printed in seven editions during the Republic of China. Other books were only published in the late Qing Dynasty, and were not published again after the founding of the Republic of China. For example, the famous Zhong Wai Wei Sheng Yao Zhi was published in large quantities in the late Qing Dynasty, but it was not reprinted by the time of the Republic of China. As for the publication of medical books after the Republic of China, there were nine editions of Xin Shen Qiang Jian Zhi Mi Jue (《心身强健之秘诀》 The Secrets of Mental and Physical Health) (1913); two editions of Jin Shi Chang Shou Fa (《近世长寿法》 The laws of Longevity in the Modern Times) (1913), two editions of Yan Shou Xin Fa (《延寿新法》 New Laws on Prolonging Life) (1914), two editions of Qi Da Jian Kang Fa (《七大健康法》 Seven Great Health Laws) (1914), two editions of Chang Sheng Shu (《长生术》 The Techniques of Longevity) (1916), three editions of Chang Sheng Bu Lao Zhi Mi Jue (《长生不老之秘诀》 The Secrets of Immortality) (1917), two editions of She Sheng Lun (《摄生论》 The Theory of Health Cultivation) (1918), two editions of Kang Jian Lun (《康健论》 Health Theories) (1921), three editions of Yan Shou Yao Yan (《延寿药言》 Suggestions on Prolonging Life) (1924), two editions of Jian Kang Mi Jue (《健康秘诀》 Secrets of Health) (1930), two editions of Zhong Guo Yang Sheng Shuo Ji Lan (《中国养生说辑览》 General Compilation of Chinese Health Cultivation Theories) (1930), three editions of Yang Sheng Yi Yao Qian Shuo (《养生医药浅说》 Preliminary Comments on Health Cultivating Medicine) (1938), and two editions of Chang Shou Zhi Tiao Jian (《长寿之条件》 Conditions for Longevity) (1949) (Note 1).

4 An analysis of new published health cultivating medical books in the Republic of China

From the preliminary statistics, Xin Shen Qiang Jian Zhi Mi Jue by Fujita Leisai (藤田龄斋) and Jin Shi Chang Shou Fa by Tanaka Yukichi (田中佑吉) were translated into Chinese in 1913. The latter was translated by Ding Fubao (丁福保) (1874–1952). In the following year, Wu Tingfang (伍廷芳) (1842–1922) published Yan Shou Xin Fa, and Qi Da Jian Kang Fa edited by Matsuo Lai from Japan was also translated in the same year. It was obvious that a large number of new books on prolonging life, longevity, health cultivation, and immortality appeared between 1913 and 1918. For example, the popular translation book Xin Shen Qiang Jian Zhi Mi Jue in the Republic of China regarded that Japan had instead revived the ancient Chinese theories of health and health cultivation.³⁸ The books did not emphasize material and science, but emphasized the relationship between spirit and body, focusing on various relationships of health cultivation with the body and the mind. Furthermore, they laid emphasis on techniques such as meditation, breathing, and inhaling, which was rather unique at the time. The books combined longevity of the people with national strengths, enhancing the importance of prolonging lifespan and healthy life to national development.³⁹ To some extent, the discussion of health cultivation and longevity or the elderly in modern medical books was influenced by Japanese medicine in the early stage. There were quite a few medical books translated from Japan, and some of them were not mentioned in the General Catalogue of Ancient Books of Traditional Chinese Medicine. There existed severe mistakes in sorting out the editions of such books, and the value of these books were underestimated. Take Jiang Jian Shi Xin Shen Duan Lian Fa (《江间式心身锻炼法》 Sound mind and body) (1919) as an example. From its publication in 1919–1925, the book had more than four editions in print. The book claimed that the health cultivating activities in the book had similar sayings with those of Daoism and Buddhism, and emphasized on belly breathing and meditation. To cultivate health and achieve longevity was indeed one of its important purposes.⁴⁰ However, these books were not dedicated to health cultivation of the elderly. Instead, they introduced these techniques as new popular means to cultivate health (Fig. 2).

Figure 2: Front cover of Shen Xin Qiang Jian Mi Jue (Secret Teachings on Physical and Mental Health). (source from: http://read.nlc.cn/OutOpenBook/OpenObjectBook?aid=416&bid=93814.0).

Another obvious trend was the transformation from health preservation and cultivation to longevity and immortality. It showed a great gap between people in this era and the elderly who need long-term care in the current sense in the face of “getting old.” At the beginning of the 20th century, various new researches on physiology and basic medicine of Western medicine had been taken place one by one. The advancement of nutritional chemistry enabled life span and physical fitness to be controlled by the nutrients from diets.⁴¹ Life span could be extended through scientific research and taking additional nutrients or medicines.⁴² As a popular saying went, “Longevity lies in food.” It was essential for the elderly to pay attention to their daily diets and methods to take them in order to maintain health.⁴³ According to the definition around 1930, healthcare was defined as “the study of maintaining health,” which had the function of prolonging life. The theory believed that longevity could be achieved as long as the body could be strengthened so that the organs could perform their proper functions, and the source of diseases be eliminated so that infectious diseases would not invade the body. Some people believed that by paying attention to the two aspects mentioned above, mankind could prolong their lives, “increase the average life-span,” and enjoyed the happiness of life to serve the society. Eliminating the source of diseases could be attributed to TCM and Western internal medicine, while strengthening the body in modern times usually referred to several major aspects such as rest, fatigue control, brain power, sexual desire, and supplementing various new nutrients.⁴⁴

Several examples would be provided. Chang Sheng Bu Lao Zhi Mi Jue by Gu Shi (顾实) published in 1917 was actually a translation of the book Immortality written by a Japanese author Yuubi Aoyagi (青柳有美) published by Tokyo Sangyo no Sekaisha (Tokyo Industrial World Publishing House) in 1916. The book introduced a wide range of new Western health knowledge, as well as the Japanese meditation and breathing methods. Thus, it was in line with the inference above that to some extent, modern Chinese medical books on healthcare for the elderly were influenced by the knowledge of Japanese medical books. When Gu Shi translated this book, he mentioned that many of the examples in the original book were stories of foreigners prolonging their lives, which were not friendly to Chinese readers. Therefore, he added many Chinese examples, and the content was somewhat different. The author would add Chinese health cultivation methods, believing that they could “promote the quintessence of the country.”⁴⁵ In addition, the advertisements at the end of the book emphasized that even though Japanese meditation and breathing methods were introduced, the concept of “longevity” mentioned in the book were actually the principles of Daoism. Therefore, the value of this book lay in using scientific methods to explain the existing Taoist theories.⁴⁶ The book had several themes, with special emphasis on knowledge about diet, spirit, daily life, and other aspects. Overall, it focused on “abstinence” and “a careful diet.” The book mentioned achieving immortality by dieting, and it had already mentioned the discovery of vitamins,⁴⁷ but the name of vitamin was not widely accepted. It was not until the 1920s did Chinese people become familiar to this name.⁴⁸ In the chapter “Bu Lao Bu Si Fa Zhi Xin Fa Jian” (不老不死法之新发见 New Discoveries of Immortality), the book focused on bacterial treatments and discoveries of new nutrients. Since infectious diseases were still the main causes of the high death rate among Chinese people at that time,⁴⁹ this book concluded that human beings could realize the dream of immortality by paying attention to the prevention of infectious diseases. Additionally, the book also introduced the technology of producing serum at that time, and believed that in the future, chemical enzymes secreted by longitudinal cells in white blood cells can be extracted from animal plasma to produce new serum, which could be injected into the bodies of the elderly. After that, the bacteria that dominated the destruction and decomposition of the body could no longer destroy the cells, and mankind would naturally achieve immortality. The book quoted the research of Mechnikov (Илья Ильич Мечников, 1845–1916), who believed that human beings could live up to 145 years old and achieve an ideal “immortality.” In a nutshell, the book was filled with optimism about the progress that an unknown science could deduce within a reasonable range.⁵⁰

Wu Tingfang compiled and published Yan Shou Xin Fa. His friend Qu Hongji (翟鸿禨) pointed out that Wu once served as an official with him. He reminded that Wu loved taking about “the essentials of healthcare,” and stuck to the methods including eating vegetarian food, paying attention to daily life and rules, taking deep breaths of fresh air every day, and etc. After more than 10 years apart, the two met in Shanghai. Qu was amazed that Wu who was over 70 years old looked like what he was in his forties. Moreover, Wu was full of vigor. His ears and eyes were bright, his beard and hair were black, and his teeth were strong. He did not appear to be old. Wu pointed out that he achieved all this by referring to rules of healthcare. After that, Wu wished to compile the book, and intended to teach the Chinese people, hoping that everyone in the world could achieve longevity.⁵¹ The book was interesting that Wu intended to introduce a law of not getting old or getting old slowly, rather than things that people who were already old should pay attention to. The book revealed great optimism towards modern scientific laws about healthcare, and its language presented a thinking of anti-aging under the theory. It was the writing style of books published under the name of “prolonging life” or “longevity” at that time. Similar traces could be found in books named after healthcare or health for the elderly. A translated book Jian Kang Yao Jue (《健康要诀》 Essential Teachings on Health) pointed out that some people were very old at 50, whereas some people were not old at 70. A quotation from the book read “Age cannot be measured by years.” Such discussion obviously chose health as the criterion for measuring peoples’ age. The book believed that the most important things to achieve health were diet nutrition and prevention of germs and bacteria, and translated the latter as “anti-virus.”⁵² Many life extension books discussed food hygiene, including cooking, kitchen cleanliness, and food safety. They would mention the relationship between vectors, including mice, mosquitoes, and flies, and ingredients. Using Western scientific methods to eliminate diseases was a major content in books on longevity.⁵³ As for the prevention of diseases, the titles of the books could be deceiving. For instance, a book titled Shi Yong Chang Shou Fa (《实用长寿法》 Practical Laws on Longevity) seemed to introduce laws on health cultivation and Longevity at first glance. However, the book did not mention any contents about the elderly. It was a special book on disease prevention and treatment, and discussed mainly on achieving longevity by preventing tuberculosis.⁵⁴ Therefore, the original book must be found for review before further analysis, rather than relying solely on the titles and the catalogues (Fig. 3).

Figure 3: Front cover of Lao Ren Yan Nian Shu Yu Lao Ren Xing Niao Bi Zheng He Bian (A Combined Compilation on the Methods of Prolonging Life and Senile Urinary Syndrome for the Elderly). (source from: http://read.nlc.cn/OutOpenBook/OpenObjectBook?aid=416&bid=97636.0).

In addition, Ding Fubao published Lao Ren Yan Nian Shu Yu Lao Ren Xing Niao Bi Zheng He Bian (《老人延年术与老人性尿闭症合编》 A Combined Compilation on the Methods of Prolonging Life and Senile Urinary Syndrome for the Elderly) in the mid-1930s. The exact publication date of the book remains unclear. Yet, Ding mentioned that the book was published after his 60s in the preface, so that the book might be published in year 1934 or 1935. The book was a combination of health cultivation and pathology, featuring an emphasis on daily diet. Ding pointed out that: “The secret of longevity may lie in one’s diet. A big eater would boast of his good appetite. However, the ancient health regimens all took the precept of not being too full every meal, and it is appropriate to not overeat. This is an excellent lesson. Therefore, those who want to live a long life should limit their drinking and eating when they are young and strong. For those who are fond of drinking, as they grow older, they would drink less and less, and prefer plain vegetables than greasy meat. The preference of their diet corresponds to their age.”⁵⁵ The saying basically focused on not overeating or eating too much, and the elderly should prefer a plain and light diet. During the period of the Republic of China, there were discussions on which food, meat or vegetables, was better for the body. Those who advocated eating more meat believed that eating more grains, vegetables, and less meat would reduce the resistance to diseases. At the same time, Westerners had a more meat-based diet, and they cast great influence to the East, so the trend of meat eating was very popular. However, Ding did not think so. He believed that according to statistics, a person with a meat-based diet was more likely to suffer from diseases such as cerebral hemorrhage and gastric cancer. He thought that “These diseases which were most common in the elderly and young people were all due to the harm of eating meat.” Therefore, from Ding’s perspective, ordinary people promoted eating meat to increase physical strength, but they suffered the opposite outcomes.⁵⁶ Ding believed that longevity could only be achieved by a moderate diet, and this point of view was the traditional Chinese view of life and health cultivation.⁵⁷ Smoking and drinking were even more taboo for those who pursue longevity. Ding mentioned that:

“Drinking a small amount of alcohol is not harmful, but drinking a large amount or drinking strong alcohol, such as whiskey, brandy, etc., is of course unhealthy. Smoking cigarettes is of little harm, but strong cigarettes such as cigars and so on are harmful to the heart. People who want to live a long life must not damage the heart and blood vessels. Therefore, they must quit smoking and drinking that are harmful to the heart and blood vessels. If young and strong people smoke cigars frequently, their bodies will lose weight immediately. If they quit smoking, they will gain weight, become strong, and regain appetite. Therefore, smoking is extremely unsuitable for old people with weak bodies.”⁵⁸

Ding’s theory of longevity often used actual pathology as the basis to explain the principles of various taboos for the elderly. Ding’s book also introduced several new technologies on health cultivation in the West, one of which was the “rejuvenation” method that was popular at that time. The author has already discussed it in a special monograph.⁵⁹ An example would be provided to show that Ding believed the method could not be trusted, thus revealing a multi-dimensional thinking at that time. Ding wrote that:

“Recently, there is a so-called rejuvenating method which claims to be able to turn the elderly into the youth. The method stems from the hope of the elderly, who have the rejuvenation surgery operated. Other people do not need to stop the operation naturally. However, doctors should not persuade the elderly to perform the rejuvenation surgery. In the contrast, the doctors should suggest the people pay attention their deeds. In order to live longer, one must live a life in accordance with the laws of healthcare from a young age, so as not to quickly get old. Once one grows old, and he seeks to use the method of rejuvenating to regain youth, whether it will have any effect is not credible.”⁶⁰

Ding believed that the so-called rejuvenation method was actually the “self maintaining method” for the elderly, and of course family members should also help. If the elderly were not able to support life on their own, there should be a institution similar to the Western “nursing home.” Ding thought that, “…gather such elderly people in one place, and give them a considerable amount of work in accordance with their age, so that they can live and provide for themselves. Such social undertakings should be carried out by the state government, or be managed by local governments. Furthermore, they could be established by individuals as charity.” Unfortunately, Ding did not discuss further on this issue.⁶¹ His book still laid a general emphasis on dietary care, thus revealing that dietary therapy should be the focus of elderly care and health cultivation during this period, which was worthy of further study and research.

5 Conclusion

There were various books on medicine, divination, and astrology among the traditional Chinese classics and literature, which was an important phenomenon in the history of books. As far as medicine is concerned, traditional Chinese literature covered a wide range of aspects including internal medicine, surgery, gynecology, pediatrics, and other subjects, whereas geriatrics was missing. Therefore, it is necessary to examine the traces of the elderly mentioned in traditional Chinese literature mainly from books on health cultivation supplemented by books about medical prescriptions, to capture the historical features of the elderly and its related knowledge. It could be concluded from the study that the trend of “canonicalization” of such medical literature was not strong.^62,63 Many famous ancient books disappeared during the Republic of China, and few doctors recited and annotated these books repeatedly. The old theories were very easy to integrate with new ones, so new books on health cultivation for the elderly appeared before and after, which were the characteristics of medical books on longevity.

It is human nature to cherish life and avoid death. The pursuit of longevity or immortality has been the common hope of mankind since ancient times. Immortality is regarded as a special state of health cultivation especially in the Chinese culture, but unfortunately no one can achieve it. However, after the concept of science was imported into China at the beginning of the 20th century, many ancient superstitions were subverted. Achieving immortality should have been proved unreasonable. However, people’s dreams of pursuing it took a step further with the development of science. At least, prolonging long, or pursuing longevity is no longer unrealistic. The study found that that science, including nutrition, bacteriology, physiology and other aspects, worked together to verify that pursuing immortality is somehow feasible. At the special period, TCM and Taoist theory were compatible with new Western theories, rather than being considered as an old thinking which needed to be discarded or put into a museum.⁶⁴ The study concludes that new theories from the West and Japan could be integrated with traditional concepts or health cultivation philosophies. The appeals of traditional culture, such as pleasurable emotions, diet control, desires, etc, could be continuously found in the books on health cultivation and longevity in the early 20th century. They were not eliminated due to the evolution of social concepts.

The concept of longevity in the early 20th century emphasized a concept that could be controlled by science. It believed that with the development of scientific research and progress, mankind would eventually achieve immortality, though it would surely take time. As Gu Shi mentioned in his book: “Modern people got the way for immortality, which Emperor Qin failed to find in Penglai.”⁶⁵ The statement indicated optimism about the science on longevity in the future, and was trying to gradually subvert the definition of aging in the past. The study has not discussed in detail the diet discussed by people at that time. In addition to food and diet, there are also concepts of medicine and supplements, which are also related to immortality. The detailed content and operation methods need to be further demonstrated.

Notes

Note 1: These books did not include those with little reference to health cultivation, including two editions of Jing Fa Xu Zhi (《净发须知》 Instructions for Clearing Hair) (1895), two editions of Qing Nang Mi Lu (《青囊秘录》 Secret Records about Medicine) (1922), two editions of Ya Pian Yu Wei Sheng (《鸦片与卫生》 Opium and Health Care) (1928), etc.

Note 2: Shou Shi Quan Shu (《寿世全书》 Encyclopedia of Longevity) included six books, which were: Xian Shu Mi Ku (《（脱俗超凡）仙术秘库》 Vault of Immortality) compiled by Wang Kentang (王肯堂) and proofread by Qinglanshi (清岚氏), Shi Yan Chang Ming Fa (《（古今中外）实验长命法》 Pursuing Longevity by Experiments) complied by Hu Jiaying (胡嘉英) and Ye Guanqun (叶冠群), Nan Nyu Yang Sheng Shu (《（延年益寿）男女养生术》 Health Cultivation of Men and Women) compiled by Wu Lyuji (吴履吉), Bai Bing Zhi Liao Fa (《（妙手回春）百病治疗法》 Cure for All Diseases), Yu Er Zhi Nan (《（家庭必备）育儿指南》 Parenting Guide), and Nan Nyu Jie Yu Bao Jian (《男女节欲宝鉴》 Precious Mirror of Abstinence for Men and Women) compiled by Liu Renda (刘仁达).

Acknowledgments

The study referenced the project “Compilation and Research of Traditional Chinese Medicine Classics in Geriatric Medicine” hosted by scholars including Luo Lunqian (罗纶谦), Huang Junxiong (黄俊雄), etc. It referred greatly to “monographs” part of the project, which included health-preserving prescription books from TCM literature. The project focuses on clinical practice, so it is not possible to comprehensively sort out the connotations of medical books in this part, but it has given the general direction of the types of data collected in this article. The project is funded by Research Institute of Chinese Medicine, MOHW, and the project number is MOHW106-NRICM-C-124-000005.

Funding

None.

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

PI Kuoli has done the research and the writing of the paper.

Conflicts of interest

The author declares no financial or other conflicts of interest.