A Brief Travel Through The History of Chinese Medicine

The History of Chinese Medicine is very long, with its beginnings dating to well before the life of Christ. Here in 21st century Canada, it is difficult and perhaps even impossible for us to fully grasp the nature of such a time scale of development. The earliest archaeological evidence of acupuncture indicates beginnings over 2000 years before Sir John A. Macdonald was born! Chinese Medicine was not developed at one point in time or by one person. It has been developed by an entire civilisation over centuries of revision, refinement and adjustment to different social, cultural, political and scientific trends . Many physicians and clinicians have contributed to the full body of knowledge known today as Chinese Medicine. This synopsis gives a brief overview of some of the more seminal moments in the history of this Medicine, running chronologically through each era of Chinese history.

The Periods of Chinese History

Much of premodern China is demarcated historically as a series of dynasties. The major dynasties and modern eras are listed below.

  • Xia – 2100-1523 BC
  • Shang – 1523-1027 BC
  • Zhou Dynasty – 1027-221 BC
  • Qin Dynasty – 221-206 BC
  • Han Dynasty – 206 BC – 220 AD
  • 6 Dynasties – 220-589
  • Sui Dynasty – 590-617
  • Tang Dynasty – 618-906
  • 5 Dynasties – 907-960
  • Song Dynasty – 960-1264
  • Yuan Dynasty – 1264-1368
  • Ming Dynasty – 1368-1643
  • Qing Dynasty – 1644-1911
  • Republic of China – 1911
  • People’s Republic of China – 1949

The eminent sinologist, Paul Unschuld has noted a distinct difference between how we handle knowledge in modern Western societies and how traditional Chinese society handled knowledge. The evolution of ideas in Western cultures is characterised by Replacement. That is, if a previously held idea is inconsistent with the prevailing paradigm or worldview, it is rejected/discarded. The evolution of ideas in Traditional Chinese culture is characterised byAccumulation (syncretism). The Chinese are traditionally a highly practical people. If an idea works, it will continue to be used even if it is inconsistent with newer models of reality. So the full body of Chinese Medicine is characterised by many different theories, ideas and principles which often contradict one another but which remain in use due to their clinical effectiveness and profound insights.

Shang Dynasty (1523 BC – 1027 BC) 

  • Dominated by themes of shamanic and ancestral Medicine
  • Community consisted of all the Living and Dead.
  • Health was perceived to depend on harmony between the Living
  • and the Dead
  • The only recognised ‘natural’ cause of illness was Wind

Zhou Dynasty (1027 BC – 221 BC) 

 

  • Confucianism arose in the middle Zhou Dynasty.
  • Key Confucian themes included
  • – Impacts of Human Behaviour on Social Outcomes
  • – Importance of Moderation in Lifestyle
  • – Shifted thinking away from demonic illness causation to human action
  • Taoism arose in the late Zhou. A key Taoist theme was the notion that the
  • Laws of Nature were ultimately beyond Human Comprehension

Qin Dynasty (221 BC – 206 BC) 

  • All books except those on Medicine, Agriculture, Oracles were burnt
  • Standardisation of weights, measures, road width.

Han Dynasty (206 BC – 220 AD) 

This was such a productive and creative period that even today, the Chinese people are sometimes referred to as ‘People of the Han’ This period saw the complete development of a Medicine of Systematic Correspondence (the basis of much of Chinese Medicine) over its full 400 year period

  • Ma Wang Dui Texts 
    • Written in the late -3 to -2 Century, these texts were excavated by
    • archaeologists in 1973 from the tomb of a Han Dynasty Prince in Hunan
    • Province. They had been buried in 168 BC.
    • They are now considered to represent a reasonable boundary for the
    • point in time at which Medicine became distinct from Religion.
    • These texts contain descriptions of 11 of the 12 Separate Acupuncture
    • Channels (Pericardium channel is missing).
    • Each Channel is associated with specific symptoms
    • Some channels are even named after their symptomatic focus.
    • For example, the Large Intestine Meridian is called ‘the tooth
    • meridian’.
    • These texts contain medical theories describing the idea that channels
    • are subject to repletion, vacuity, and undesirable movement. These
    • ideas remain central to acupuncture practice today.
    • No mention of points are found, indicating that the concept of channels
    • predates the concept of acupuncture points.
    • No mention of needles, only moxibustion; indicating that moxibustion
    • predated needling as a therapy.
    • No mention of the idea of Qi circulation
    • No disease theory
  • Huang Di Nei Jing (Yellow Emperor’s Canon of Internal Medicine)
    • Written in -2 to -1 Century.
    • This text is arguably the single most important text in the
    • canon of Chinese Medicine. In legend, it is dated to -2700 to -2600, the
    • time of the Yellow Emperor. The text is written as Dialogue between
    • Huang Di and Minister Qi Bo.
    • The Nei Jing, as it is known, has 2 parts, each with 81 Chapters.
  • Nei Jing Su Wen (Fundamental Questions)
    • contains medical theory.
  • Nei Jing Ling Shu (Spiritual Axis)
    • is an acupuncture manual.
      • Yin Yang theory and 5 Phase theory are present in the Nei Jing.
      • The Nei Jing is not rigorously structured or systematic.
      • It has clearly been written by many authours.
      • 12 regular channels identified.
      • 295 acupuncture points identified (670 presently).
      • An internal anatomy composed of 11 organs (5 Zang and 6 Fu) is
      • recognised.
      • Therapy discussed in the Nei Jing includes Bloodletting, Needle
      • Insertion, and Moxibustion at specific points; all tending to be quite
      • localised.
      • Beyond Wind, the Nei Jing recognises other Internal and External
      • causes of disease, including climatic factors and emotions.
      • Treatment is allopathic
      • Terminology used in the Nei Jing reflects political, social and
      • engineering structures of the day.
  • Nan Jing (Classic of Difficulties) 
    • Written in the 1st century, the Nan Jing has 81 Chapters.
    • It contains a mature development of Medicine of Systematic
    • Correspondence. The Nan Jing integrates all aspects of health care
    • into Yin-Yang and 5 Phase doctrines. All Channels connected in one
    • circuit of Qi circulation. The Nan Jing contains a highly formal
    • development of positional pulse diagnosis at the wrist, with
    • 3 identified depths at each of 3 positions on each wrist for a total
    • of 18 wrist locations where pulse quality has interpretable significance.
    • Demonology and Magic are entirely absent in the Nan Jing.
    • The choice of Acupoints is based on systematic understanding of Qi
    • circulation. The goal of treatment in the Nan Jing is not so much to
    • treat a disease or symptom but to adjust Qi to an ideal state.
  • Shang Han Lun (Discourse on Cold-Induced Disorders) 
    • Written around 198 by Chinese physician, Zhang Zhong-Jing
    • This is the 1st major text of Herbal Medicine.
    • Details progression of epidemic acute febrile disease through 6 levels.
    • The Shang Han Lun is a major foundation of modern day Traditional Chinese Herbal Medicine
  • Hua Tuo – Hua Tuo was a famous physician, surgeon, and diagnostician.
    • He developed a physical exercise known as the 5 Animal Frolics.

 

Six Dynasties (220 – 589) 

Zhen Jiu Jia Yi Jing (The Systematic Classic of Acupuncture and Moxibustion)

This text was written by Chinese physician, Huang Fu Mi in 282.

It is a complete technical book on Acupuncture and Moxibustion.

This text was the first to focus on Acupuncture for Disease prevention

(the idea that the superior physician treats disease before it arises).

It establishes a modern text book format (each channel, points on the

channel, locations, needling specifics, actions and effects)

Mai Jing (Pulse Classic) 

Written by Chinese physician, Wang Shu He, in 280, the Mai Jing

established 24 pulse qualities

First Export of Medical Practices to Neighbouring Countries

Korea, Japan, Vietnam

Tang Dynasty (618 – 906) 

Qian-jin Yao fang (Thousand Ducat Prescriptions) 652

Qian-jin Yi fang (Supplement to Thousand Ducat) 682

Written by famous Chinese physician, Sun Si Miao

These are mostly Herbal Texts with many new formulae for febrile

diseases and Women’s diseases. Sun Si Miao developed the format

for Acupuncture Charts still in use (front, side, back views) today.

He systematised the Body Inch (cun) Acupoint location system

Sun Si Miao developed the use of Ashi points (an early trigger

point concept).

He described 13 ‘ghost points’ with specific applications for

psychiatric conditions.

Search for Immortal Elixirs was the focus of much Herbal work

7 of 22 Tang rulers died from formulas intended to impart immortality

Four specialised types of Doctor recognised during the Tang Dynasty.

Physician (herb doctor), Acupuncturist, Masseur, Exorcist

Korea and Japan formalised Medical education with establishment of

Medical Colleges during this time period.

Nei Jing, Nan Jing, Zhen Jiu Jia Yi Jing were core of curriculum

Practice of Acupuncture was, for first time, related to seasonal and

other cycles of Chinese Calendar (The Tang dynasty edition of the

Nei Jing Su Wen contained chronobiological concepts).

Song Dynasty (960 – 1264) 

Bronze Man 

This famous life size model was constructed in 1026, after the Emperor

ordered life size bronze statue with holes. During the qualifying

examination for physicians, it was filled with water and covered in wax.

When the correct point locations were needled, it would leak.

Zhen Jing Zhi Nan (Compass Bearings for Acupuncture and Moxibustion)

Written by Chinese physician, Dou Han Jing in 1241.

Contains an elaboration on Diurnal, Monthly, Seasonal, Annual cycles

of Qi according to which Acupuncture is performed

Zi Wu Liu Zhu Zhen Jing

Written by Chinese physician, He Rou Yu

Contains specific Biorhythmic treatments

The Four Schools 

Cold and Cooling School

Led by Liu Wan Su (1120 – 1200)

Attacking School

Led by Zhang Zhe (1156 – 1228)

Dominated by the theme that we are sick because of toxins.

This school advocated that tonics were overused.

Therapies promoted sweat to cool and expel toxins, induced vomitting

to expel poison and promoted bowel movements to expel toxins.

Stomach and Spleen School

Led by Li Gao a.k.a. Li Dong Yuan (1180 – 1251)

Dominated by the theme that most illness was from damage to Spleen

and Stomach systems. Formulas developed are still used today for

digestive troubles, allergies, and chronic fatigue.

Nourish Yin School

Led by Zhu Zhen Zhen (1281 – 1358)

Dominated by the theme that protecting Yin should be the priority.

Yin is easy to lose and difficult to replace while Yang is easy to build.

Ming Dynasty (1368 – 1643) 

Zhen Jiu Da Quan

Written in 1439 by Xu Feng

This was the first text to systematically describe 8 Extraordinary

Vessels (originally mentioned in Nei Jing)

Zhen Jia Ju Ying

Written in 1529 by Gao Wu

This text promoted the use of Supplementation and Drainage Points.

Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion)

Written in 1601 by Yang Ji Zhou

10 volumes

Ben Cao Gang Mu (The Great Pharmacopia)

Written in 1578 by Li Shi Zhen

50 volumes

1892 herbs, 1000 formulae

Bin Hu Mai Xue (Pulse Studies of the Lakeside Master)

Written in 1564 by Li Shi Zhen

27 Pulse Qualities

Chimkyu Yokyol

Written by Korean monk, Sa-Am

system of 5 phase treatment which forms the basis of modern

day Korean constitutional acupuncture.

Mubunryu School – Japan

Developed by Japanese physician, Isai Misonou.

Hara (abdominal) based diagnosis system was developed which still

forms the basis of many Japanese palpatory styles of acupuncture

in practice today.

Qing Dynasty (1644 – 1911) 

Increasing infiltration of Western thought

Small pox vaccine (1805), first missionary surgeon (1835), Translation of

Western Medical Texts (1850’s), China’s First Western Medical

School (1886)

In Vietnam, Lan Ong wrote Y Ton Tam Linh in 1700’s which became basis

for eventual development of French Vietnamese Acupuncture

In Korea, Lee Jaema developed 4 constitution medicine in late 1800’s

In Japan, Waichi Sugiyama (a blind practitioner) invented Shinkan

(the insertion tube) in late 1600’s. This enabled thinner needles,

painless insertion and freed the left hand for palpation (a highly revered

approach in many modern-day classically based Japanese acupuncture

styles. Sugiymama established the first acupuncture school for the Blind

(now 40% of classically-based practitioners in Japan).

In Japan, shonishin (pediatric) developed in 1700’s as are unique Japanese

moxibustion techniques.

Republic of China (1911 – 1949) 

This period witnessed a severe decline in all TCM approaches.

By 1912 much of Traditional Medicine had been abandoned.

In 1914, the Minister of Education declared an intention to abolish Chinese

Traditional Medicine altogether.

‘Modern Acupuncturists’ were criticized by Xu Da Chun (an avid proponent

of classical styles and leader of Han Xue movement) for incorrect channel and

point location, over reliance on formula acupuncture, ignorance of 5 phase

points, loss of supplementation and drainage theory and technique and

ignorance of seasonal correspondences.

Georges Soulie de Morant, a French diplomat in China began a very

comprehensive transmission of Classical Acupuncture to France, a critical

point in the Westward transmission of acupuncture.

Public Health Officials authoured “A Case for the Abolishment of Old

Medicine to Thoroughly Eliminate Public Health Obstacles”, in which it was

stated “the theories of yin and yang, the five elemental phases, the six

atmospheric influences, the zang fu systems, and the acupuncture channels

are all illusions that have no basis in reality”, “old medicine is still conning the

people with its charlatan, shamanic and geomancing ways”.

This proposal was not implemented due to widespread protest by doctors

and patients.

By 1930’s, there was only one acupuncturist in all of Canton

People’s Republic of China (1949 +) 

While pre-revolutionary Mao Zedong wrote about Traditional Medicine as

being backward, once in power, he reversed these earlier views.

Mao Zedong saw Chinese Medicine as serving his political ambitions since it

was ‘self-reliant’, ‘among the people’, ‘native’ and ‘patriotic’.

The mid 1950’s saw the establishment of 4 major Colleges of Chinese

Medicine; Chengdu, Beijing, Shanghai and Guangzhou, followed by Nanjing.

In 1958, Mao Zedong issued a vision of Chinese – Western medicine

integration. He advocated the elimination of what he felt were the ‘feudal

elements’ of Chinese Medicine. A program was implemented to train

thousands of Western medical doctors in highly abbreviated and simplistic

Chinese Medicine. These doctors became the main administrators of TCM

colleges.

The late 1960’s and early 1970’s were dominated by the Barefoot Doctor

Movement, a program which saw thousands of individuals trained in a sort of

first aid acupuncture and disseminated to all corners of China to serve as

primary health care providers in factories and fields.

For details of this period, see ‘Chinese Medicine in Crisis’ by H. Fruehauf

at http://www.jcm.co.uk/SampleArticles/tcmcrisis.pdf

Setting Standards for the Practice of Classical Acupuncture  and Chinese Medicine in Prince Edward Island