Understanding the Past: A Historical Timeline of Chinese Medicine
By Professor Wang Jin-Huai
The emergence of disease follows the emergence of life. From the beginnings of humankind there have been invasions by disease, thus from those earliest times humans have been groping for ways to overcome illness. It is important to remember that our medical activities began long before civilizations existed, before there were any written languages or records. China was one of the earliest civilized countries in the world, archeological material proves that the roots of China's written language extend back seven thousand years. Ancient texts from that early time period show a record of "Stone Needle Acupuncture" already in existence, which is the use of needles made from stone to treat illness. Most likely, this is a method developed and handed down from the stone age. Ancient texts also record "Shen Nong tastes a hundred herbs in a single day and meets seventy toxins" and "Fu Xi drew the eight trigrams, and created nine needles." Historians believe that Shen Nong and Fu XI were early tribal leaders. Later on, approximately 5,000 years ago, the leader of one clan defeated the others and became known as the Yellow Emperor, occupying central China. They then began weaving silk into clothing and established a formal written language. It is said that at that time, the Yellow Emperor, a doctor named Qi Bo, and his trusted advisors held far reaching discussions and research into medicine and acupuncture. 2,500 years later, in the Spring and Autumn Warring States Period, these early records and the oral transmissions from the time of the Yellow Emperor were edited into the earliest surviving text written by medical specialists, The Yellow Emperor's Classic of Internal Medicine, which brought together the medical experience from earliest known times.
China has detailed records of successive Imperial reigns starting from the Xia dynasty (approx. 21st c B.C. to 16th c BC) During the Shang dynasty,which succeeded the Xia, (16th c BC to 11th c BC), In step with the development of agriculture, the brewing of alcohol, silk weaving, astronomy/astrology, and the calendar all saw great achievements. Today, we still marvel at the the unequaled exquisiteness of archaeologically excavated bronze ware from the Shang dynasty. Excavated records of divination from the Shang dynasty, in the form of carvings on tortoise shells and animal bones (oracle bones), show references to headaches, eye ailments, abdominal ailments, parasites, and many other illnesses. At that time, medicinal alcohol and boiled medicinal compounds were already in use for treating illness. Yi Yin, a minister from the founding of the Shang dynasty who had been elevated from a slave to a government official, is noted as also being a talented chef who was skilled at using herbs to create boiled medicinal compounds for curing disease. Historical records note that he wrote a book titled, Yi Yin's Soup Classic.
In the Western Zhou dynasty (11th c BC to 771 BC) imperial doctors were divided into four departments: Dietetic (food and beverage hygiene); Diseases (internal medicine); Sores (external medicine); and Veterinary. There are medical records showing a system of using a chief doctor to administrate and evaluate other doctors. The number of commonly used medicinal materials at that time exceeded 100, consisting of herbs, animal material, and minerals. These historical facts are recorded in the Zhou dynasty's system of standards, Zhou Dynasty Rites, the first ancient compilation of verse, The Classic of Poems, and The Mountain Sea Classic. Worth noting is that in the Zhou dynasty, the dietetic physician was elevated to a very high position and dietetic therapy had a huge impact on following generations. Historically, all Chinese medical experts expounded on this aspect of therapeutic treatment, and Chinese material medica contains many kinds of fruits, vegetables, grains, and meats. Today, specialized dietetic texts dating from the Tang dynasty, entitled Medicine Amidst Food and Culinary Therapies, are still published in China.
The Spring and Autumn Warring States Period (BCE 770- AD 221), produced the "A hundred schools of thought contend" trend. All types of academic ideology were encouraged and reached quite high levels. It was during this time that medical researchers compiled the written records and oral knowledge of Chinese medicine from the previous ages and wrote The Yellow Emperor's Classic of Internal Medicine. This book systematized and consolidated ancient medical experience and theory into one compendium. Using the philosophical ideologies of Yin, Yang and the Five Elements, The Yellow Emperor's Classic of Internal Medicine demonstrated that the human body is an organic whole, and that its health and illness is intimately connected to the natural environment. It expounds on meridian theory, as well as many other issues, such as, physiology, pathology, prevention, diagnosis, treatment, acupuncture and moxibustion, use of materia medica, etc. The Yellow Emperor's Classic of Internal Medicine represents ancient Chinese medicine's brilliant achievements in the areas of the mechanics of life in the human body; knowledge of the body's construction and functions; description of the blood and circulation; the effects of emotion on health; emphasis on prevention, etc. It made a vast and profound impact on successive generations of medical practitioners and scholars, and has continually guided Chinese medicine's clinical application.
Unfortunately, as this text was passed down from one generation to the next through many wars and dynastic changes, some articles were lost. The Yellow Emperor's Classic that we have today consists of eighteen volumes, 162 articles. The Spring and Autumn Warring States Period also produced the first of several doctors who have been deified in legend and story.Known as Bian Que (originally called Tai Yue Ren), he was adept at using acupuncture and moxibustion, boiled herbal prescriptions, and massage in internal medicine, external medicine, gynecology, and pediatrics for the treatment of all kinds of illnesses. Additionally, he laid the foundation for the use of pulse reading for diagnosis in Chinese medicine. The historical work from the first century BC Historical Records contains texts that demonstrate his skill and provide guidance on the conduct of doctors. He trained quite a few disciples and his medical teachings were summed up in a book entitled Classic of Difficult to Treat Illnesses.
There was a medical scientist in the Eastern Han period named Zhang Zhongjing (b150 A.D. d219 AD) who wrote a sixteen volume work entitled Discussion of Cold Induced Disorders. In the areas of epidemic, external heat disorders, jaundice, gynecology, and others, this text set down a complete set of treatment principals. Zhang Zhongjing's theory and prescriptions are still of great practical value today.The famous physician from the end of the Eastern Han period, Hua Tuo (b110 AD d208 AD, approx.) was a master of each aspect of internal and external medicine. In particular, his surgical skills reached a very high level. He invented an anesthetic called Mafei San (boiled anesthetic), which was taken orally and caused the patient to lose consciousness. With the patient unconscious, it was possible to remove tumors and toxic sores in muscle and skeletal tissue. In cases where there was a disorder in the stomach or intestines, it was possible to cut through abdominal wall and perform surgery on the internal organs.
After surgery, the incisions were stitched, and a cream was applied topically to the area. The wound is said to have healed in four or five days, and that a month later the patient was back to normal. During the Jin and Tang dynasties (265 AD to 907 AD), Chinese medicine experienced great development.After surgery, the incisions were stitched, and a cream was applied topically to the area. The wound is said to have healed in four or five days, and that a month later the patient was back to normal. During the Jin and Tang dynasties (265 AD to 907 AD), Chinese medicine experienced great development.
In the study of the origins of disease, diagnosis, pharmacology, specialization, medical training, and other aspects, great achievements were made. The Tang dynasty was a historical climax in the development of Chinese culture and economy. China and the Arabian countries, India, Japan, and others had quite a lot of medical exchange, and China absorbed much medical information from these other countries. Arabic pharmacies opened up shop in China, thereby passing on their prescriptions. Many medical specialists came forward, and they wrote many comprehensive works with abundant content. To simply list the names of the works produced in that time period would take several pages. In this short article we can only briefly point out some of the highlights.
During the third century AD (Jin dynasty), the medical specialist Wang Shuhe organized the theories of pulse reading from Bian Que, Hua Tuo, Zhang Zhongjing, and other specialists. He then combined that information with his own experience and produced China's first comprehensive work on pulse reading, The Pulse Classic, consisting of ten articles in total. It summarizes the pulses into 24 types, and expounds on the relationship between the pulse, physiology, and pathology. This systematized the theory and method of pulse reading. Pulse diagnosis is one of the outstanding achievements of Chinese medicine.The great medical scientist Ge Hong (b. 284 AD d. 364 AD) was a famous Daoist alchemist. During his lifetime, he wrote many works, among which was Prescriptions from the Golden Cabinet, containing 100 articles. In internal medicine, external medicine, miscellaneous illnesses, Qigong, and other areas, it has extremely valuable information. In Those Who Cherish Life (seventy articles), there are twenty articles devoted to the discussion of "Lian Dan", or longevity formulae.
In the aspect of chemical pharmaceuticals, it produced a tremendous contribution. Ge Hong's works hold deep knowledge for present day and future researchers to unearth.The Tang dynasty medical scientist, Sun Simiao (b540 AD d682 AD), was from ShaanXi province, Yao county. He was a child prodigy, and at 15 he not only had a thorough understanding of Daoism and the classics of many of its sects, but had also deeply researched Buddhist classics. Sun Simiao not only earnestly studied the ancient classics of Chinese medicine, he also diligently gathered experience from folk medicine. Gathering knowledge from so many sources, he was able to understand, systematize and summarize the theory and methods of those who came before him, thereby bringing new content to Chinese medicine. Sun Simiao deeply researched and understood each aspect of Chinese medicine, including physiology, pathology, diagnosis, treatment, herbs, prescriptions, and other essential theory, as well as internal medicine, external medicine, gynecology, pediatrics, acupuncture, massage, Qigong, alchemy, and dietetics. His text, The Thousand Ducat Formulas, containing 30 articles, divides each type of illness into 232 categories, organized according to the internal organ system, as well as modern medical methods. The contents are abundant, including 5,300 prescriptions. The text records content from previous ancient works that is now lost, as well as culling medicine from the common folk, minority races, and foreign treatment methods. It also has many prescriptions that Sun Simiao created himself. His Supplement to the Thousand Ducat Formulas, also containing 30 articles, expounds a great deal on herbs, giving instructions for the correct time to harvest and processing methods of 233 types of herbs. This text brings up the point that due to differing quality of soil, different water composition, and different climates, the same herbs from different areas can have great variation in quality. He made detailed recordings on the locations herbs grow and also divided medical materials into the categories of: jade; stone; plant (grass and trees); insects; fish; fruit; vegetable; grains; and unprocessed grains. In total, he researched 873 types of medical materials. He said, "Whenever treating illness, if food can be used, then there is no need to take medicine." In one article, he introduces how unprocessed grains, meats, fruits, and vegetables can be applied in treating illness. He believed that women have special physiology, and that during menstruation, pregnancy, and birthing are more susceptible to illness. He categorized gynecological illnesses separately, and wrote Women's Prescriptions, totaling seven articles which contained 509 prescriptions and 27 moxibustion methods. Sun Simiao also wrote extensively on sexual practices for health and cultivation.
During the Song and Yuan periods (960 AD to 1368 AD), due to the invention of printing technology and further advances in paper making, large quantities of Chinese medical texts were printed and published. This caused Chinese medicine to spread, giving rise to widespread and deep research. Specialization in Chinese medicine continued to develop, and many experts emerged. In addition, many different schools of thought, with different academic arguments, came into existence and brought about many new view points.During the Song dynasty, there was a coroner, Song Ci, who in 1247 wrote Removing Injustices, containing four articles, which recorded human anatomy, coronary methods, emergency treatment, detoxification, and other information. This text is a fairly early work on medical examination. It was used continuously for 600 years, was translated into foreign languages and spread internationally.
In acupuncture and moxibustion, the specialist Wan Weiyi wrote The Illustrated Classic on Acupuncture and Moxibustion, containing three articles. In addition, in 1027, he designed and cast two life size "Acupuncture and Moxibustion Bronze Men" (acupuncture models), which were used in training and testing doctors. The meridians and acupoints were carefully carved on the Bronze Man's exterior (354 points), and during study and testing, the outside of the Bronze Man was sealed with wax, hiding the points, and the inside was filled with water. When a needle was inserted accurately into a point, water would leak out. It had great value in practical application and education. In addition, in the area of acupuncture methodology the "Relative Flow" method of the Song - Yuan period spread and became more popular, becoming more perfected. This method was developed from what The Yellow Emperor's Classic of Internal Medicine calls "The Heavens and Humans are Interrelated." It is regarded that the changes in the flow of blood and Qi in the human body follow the changes of day and night and the four seasons, much like the patterns in the rise and fall of the tide. The human body's internal physiological changes function according to what modern science might call the "biological clock". At different times, different acupuncture points are selected to treat illnesses, producing fantastic results.
As a result of the government of the Song dynasty's efforts to regulate the medicine trade, a ministry of medicine was established. They adopted the prescriptions of medical scientists, as well as those of the folk, and an official text of five articles entitled The Bureau's Beneficial Prescriptions was published. In 1151, the text was increased to ten articles, systematizing and classifying the medicine into groups like "Pills" and "Powder Medicine". These classifications made it easier to store and use medicines. Many famous pills and powder prescriptions from that time are still in use to today.The number of medical materials in use in the Song dynasty reached 1,746. In the Song and Yuan period, foreign trade in China was developing, and there were 60 types of Chinese medicines that reached Europe through Arabian merchants. Marco Polo's Travels records the circumstances of Chinese medicine being transported to two Italian cities during the Yuan dynasty. In 1270, during the Song Dynasty, Arabian style hospitals were established in China, books on Arabian medicine were translated into Chinese, both enriching Chinese herbs and medical technology.
During the Yuan Dynasty, China was controlled by the Mongolians. There was quite severe intellectual oppression and the people were separated into four levels, similar to a cast system. Many intellectuals turned to researching medicine, as there was more freedom in this area. This produced quite a few famous medical scientists, though it's not possible to list all of them in detail here. Of special note were the medical scientists Liu Wansu, Zhang Congzheng, Li Guo, and Zhu Zhenheng. Each put forth new view points in Chinese medicine and collectively are known as the "Four Masters of the Jin Yuan Period". Jin refers to the dynasty preceding the Yuan. Among these four, Liu Wansu provided profound discussions of human physiology, pathology, and the significance of the natural environment. He brought into play the philosophy of medicine of The Yellow Emperor's Classic of Internal Medicine, believing that in researching medicine, one cannot overlook the laws of change in nature. Whether studying physiology, pathology, diagnosis, or treatment, one must bring the natural environment into one's research. His records of treatment have abundant content, and are noteworthy to any practitioner.In the Yuan dynasty, Chinese orthopedics experienced significant development. As China was under foreign rule, it was a long period of war, rebellions and chaos. There were many mounted soldiers who went on expeditions, thus there were many external injuries, dislocated joints, and broken bones. In 1343, a specialized text on orthopedics, reflecting the high level attained at that time, was published. The text introduces methods of setting spinal fractures by suspending the patient and also includes methods for setting dislocated shoulders, elbows, knees, and ankles. During treatment, Flos Daturae (Yang Jin Hua) and other Chinese herbs were used for general anesthesia. At that time, these were the most advanced methods in the world. In the area of orthopedics, Chinese medicine has ingenious treatment techniques as well as internally and externally applied herbal compounds to speed healing. Unfortunately, much of this knowledge now only exists among the common folk.
The Ming and Qing dynasties (1368 AD to 1911 AD) marked the later period of feudalism. Popular thinking and culture was autocratic, pushing greater numbers of intellectuals away from discussions of government and social issues and towards the documentation and systematization of Chinese medicine. Many "Confucian Physicians" emerged, learning outside of the government system, usually with family elders or as apprentices of famous doctors. Every part of Chinese medicine was enriched, the amount of materia medica increased and there were many new achievements.The great pharmacologist of the Ming dynasty, Li Shizhen, (b1518 AD d1593 AD) spent thirty years consulting some 800 texts and personally harvesting herbs for use in treatment to write the great classic, Materia Medica , containing 52 articles. The text contains 1,900,000 Chinese characters and records 1,892 medical materials from plants, animals, and minerals. There are 1,110 illustrations and 10,191 prescriptions. It is not only a great work on the study of medical material, but also a detailed text on botany, zoology, and mineralogy. There are 1,094 herbs recorded in the text, detailing their type, form, flavor, nature and application in treatment. It provides precious information for plant specimen harvesting, recognition, and differentiation. In the areas of human physiology, diagnosis, and acupuncture and moxibustion, the text also displays deep research. Though originally containing six books, sad enough, three sections have been lost. As a youth, Li Shizhen had taken the civil service exam, but was passed over. The examination system of that time caused many people of great talent to be overlooked, so he chose to devote all his energies to researching medicine. Li Shizhen was also a good poet and wrote three books about literature and history, all lost as well. His Materia Medica (known in Chinese as Ben Cao Gangmu) was complete when he was 61 (1578). Surprisingly, he couldn't find anyone to publish it. Not until three years before his death did he find a publisher in Nanjing who was willing to print it. The year before his death, he made a sample of the text as a gift for the emperor, in hopes that the emperor would take interest in publishing it for the welfare of the people. It was three years after his death that the publisher in Nanjing finally came out with the first printing (1596). His son presented and dedicated a copy to the emperor of the Ming Dynasty, but it wasn't until 1603 that a second edition was published. It then spread quickly across the entire country and received widespread acceptance. There were several dozen reprints and in 1606 it was published in Japan. Later, it was also translated into several European languages.
During the Ming and Qing dynasties, there was much research in contagious diseases and acute heat complexes. Many effective treatments came from this, and the "Warm Disease Sect" was formed at this time. In the 16th century, China produced a man-made smallpox vaccine which was used all across the country and was exported to other nations. By the 18th and 19th centuries, Chinese medicine was spreading to the countries of Europe and the Americas.In the Ming and Qing dynasties, printing was quite developed, and many comprehensive, series, and specialized texts were produced. For example, The Ancient - Modern Medical Encyclopedia, containing 100 articles. Popular Beneficial Prescriptions, containing 168 articles, brings together more than 60,000 prescriptions. The Ancient - Modern Illustrated Classic - Complete Medical Recordings, containing 520 articles, collects the works and achievements of 18th century medicine. It has precious value for reference and consultation. Many other texts by medical specialists were published during that period as well.
Chinese medicine developed and was passed on from a very early time, so the legacy it has left is extremely abundant. According to statistics from the mid-1950s, works from previous periods exceeded 8,000, consisting of over 100,000 volumes. In addition, works from literature, history, Daoism, and Buddhism all contain much medical information.From the beginning of the Opium War in 1840, China was continually defeated by outside forces. China lost land in war reparations and its autonomy in many cities. There were some Chinese people who, as a result of the national crisis, developed a cultural inferiority complex and produced a tide of complete opposition to their own culture. Western medicine took root, and Chinese medicine went into a hundred year decline. In 1914, the government of the Northern warlords put forth the "Abandon Chinese Medicine" statement, and in 1928, at the central committee on hygiene, the Nationalists (KMT) put through a resolution to "Abolish Chinese medicine in order to remove the obstacles to the cause of medicine and hygiene". In addition, they resolved to wipe out the six methods of traditional Chinese medicine.
After the establishment of the People's Republic of China in 1949, the newly established Ministry of Health continued the Nationalists' practice of supporting western medicine, outlawing the use of Chinese medicine in hospitals. In 1953, however, a concerned central government official began to fear for the disappearance of Chinese medicine and brought the issue to light. In 1954, the central government sent out a memo throughout the entire country that Chinese medicine was to be supported and saved. Beginning in Nanjing, a Chinese medicine hospital and a Chinese medicine university was established, with other cities following their lead in the next two years. In 1958, it was suggested by the government that western medicine doctors should learn about Chinese medicine. Unfortunately, Chinese medicine, as a reflection of traditional Chinese culture, underwent a period of extreme hardship during the Cultural Revolution. From 1966 to 1976, traditional doctors were purged from the schools, hospitals and clinics, and many of the old practitioners were jailed or killed. In 1976, under the auspices of Lu Binkui, the man who established the first hospital and university in Nanjing, a document was again submitted to the central government. Its message was simple: there were almost no more traditional doctors left, and that without immediate action, it would be impossible to assemble any teaching staff and the last of the living practitioners would be dead. Again, the central government took note, and a memo was sent throughout the country to support Chinese medicine. In 1979, the National Association for Chinese Medicine was established, and many of the traditional texts underwent editing and were republished. In these last few decades, while Chinese medicine has existed in a fragile state, hope has also sprouted as interest in it grows both in China and abroad.Chinese medicine has undergone nearly 100 years of rejection and attack, yet it wasn't eradicated. This is because in treatment and health preservation, Chinese medicine produces outstanding results that are difficult to substitute, and has always enjoyed a high degree of popularity among the common people. In the vastness of rural China, it is even more welcome and relied on. Following the development of modern science and philosophy, some scientists are recognizing the precious value of Chinese medicine. It is likely that in the future this will bring about a new phase in the work of unearthing and researching Chinese medicine. There are some medical specialists in both the East and West who also believe that Chinese medicine will open a new pathway for Western medicine, and that in the West the treasure house of Chinese medicine awaits discovery.
A true Daoist at heart, the late Professor Wang Jin-Huai (1935-2002) was a calligrapher, classics scholar, and practitioner of Chinese medicine in the Confucian style. Researching traditional medical texts was one of his great loves, particularly The Yellow Emperor's Classic of Internal Medicine. The excerpt translated above is taken from a textbook he authored for use by westerners learning the language and concepts of Chinese medicine before beginning medical studies. It was translated by Roger W. Jacques and edited by Andrew Nugent-Head, MSOM. We greatly miss his presence as a resource, teacher, and friend.