Antiquity 2200 B.C.

During this period, different clans began to form, and survival was based on overcoming struggles with nature. As the early inhabitants hunted for food, they discovered that some foods could relieve illness while others were poisonous and could cause death. The discovery of fire was especially important because it allowed people to eat cooked food that was more easily digested.

At the same time, the generation of heat led to other findings. The earliest beginnings of using herbs, acupuncture, and moxibustion to cure disease were seen. While using hot stones to warm themselves, inhabitants realized that pressing them against certain parts of the body could help alleviate certain sicknesses. They also found that by using bone needles and pricking themselves in a particular spot could relieve pain in other areas of the body.

In addition, there were clan members who became specialists in these techniques, and were known as shamans (wu). The practice of medicine was very much integrated with magic to cure illness.

Two well-known legends at the time were those of the Yellow Emperor whose name was Huang Di, and the Fire Emperor who was bestowed the title Shennong. Shennong has numerous meanings in Chinese such as divine farmer, the heavenly husbandman, and a more modern interpretation as a distinguished doctor. It is unclear whether these emperors actually existed but some historians date their existence back to 2500 to 2700B.C.

Both of these important figures are the attributed author's of two well-known books that have contributed significantly to Traditional Chinese Medicine. These are the Huang Di Nei Ching(The Yellow Emperor's Medicine Classic) and the Shennong Bencaojing (Classic of Herbal Medicine). In actuality these books were written much later in history. It was common in ancient time's for the Chinese authors to assign authorship of books to the great teachers or important persons who influenced them. (TOP)

About the Shang:
The Shang people, one of China's earliest ancestors, lived in the Yellow River basin of China. During this period, medical principles were very primitive in form, and based on myths and?oracle bones legends as well as experience. Inscriptions on oracle bones of buffalo and tortoise shells describe the use of wine and hot water as medicine, and the use of needles and bronze knives as surgical instruments. In addition, these oracles shed light on a number of diseases and illnesses.

The Shang believed their existence was closely tied with the universe where they were located in the center with the heavens positioned above and the earth positioned below. The Shang also believed that the earth was flat and divided into three concentric squares. The concept of the universe was used to explain the laws of nature. Relationships were formed between the cosmos and humans. For example, the skin of the human body corresponded with the flat texture of the earth, the five internal organs corresponded to the five elements of wood, fire, water, earth, and metal, and the eyes and ears related to the sun and moon in the heavens.    (TOP)

The Zhou or Chou Dynasty approx. 1100-221 B.C.
This dynasty is divided into four periods:

* Western Zhou 1100-771 B.C
* Eastern Zhou 700-256 B.C.
* Spring and Autumn Period 770-476 B.C.
* Warring States Period 476-221 B.C.

* Western Zhou
The Western Zhou people migrated to the Shang region in 1111 B.C., initially adopting the Shang's customs. However, over time people started to rebel against the ancient customs and beliefs. It was an age of political and social unrest with a breakdown in the morals of the people. Feudalistic states were constantly at war with one another.

Confucianism and Taoism
Two important persons emerged from this period. One was Confucius (557-479 B.C.).
Confucius was a social reformist and a teacher. He wanted to restore order in this time of chaos. His contemporary, Lao-tzu (born in 590 B.C.), was the founder of Taoism. Taoism teachings were more philosophical whereas Confucianism teachings were more practical. Even today their philosophies are still important in the Chinese culture, and have helped shape the practice of Chinese medicine.

Confucius and Lao-tzu

* Eastern Zhou
An organized medical system developed during this period.

Court Physicians
According to the book Rites of Zhou or Rites of Chou, which recorded the ceremonies or systems for that time, the Eastern Zhou period had an organized medical system in which court officials of the emperor were trained in a variety of medical specialties. For example, jiyi were physicians who cured internal illnesses, yangyi were physicians who cured external illnesses such as wounds, skin problems, broken bones and other traumatic injuries, and shiyi were physicians who dealt with dietary problems. The first official Chinese veterinarians also appeared during this time.

* Spring/Autumn Period
A number of physicians contributed a great deal of knowledge to TCM in this period. One notable physician was Bian Que. Bian Que's skills were based on the four fundamental examination procedures of Chinese medicine. He would observe his patient's tongue, nose, ears, face, eyes, mouth and throat, listen to his patient's speech, coughing, or other bodily vibrations, take a complete history of the patient's problem, and lastly he would feel the patient's pulse. Bian Que also believed illness was caused by the imbalance of yin and yang. Using these examination techniques, Bian Que was an expert in many fields of medicine including gynecology, pediatrics, ophthalmology, psychiatry and otorhinolaryngology (ENT). (TOP)

* Warring States Period
During the Warring States Period China's feudalistic government split into seven different states. It was around this time period that the yin/yang philosophy and the use of five elements to describe causes for illness, were further developed and their uses began to be taught in schools and written about in books.

Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic)
Although the HuJang Ti Nei Ching book's authorship is attributed to the Yellow Emperor, it was actually written by several authors over a long period of time. This book is further divided into two sections. The first is the Suwen (The Book of Plain Questions) that was written in the late Spring/Autumn and the Warring States periods. The second part is called the Lingshu (The Vital Axis) and was written sometime in the second century B.C. with revisions taking place up to the Han Dynasty (206 B.C.- 25 A.D.). This book is very significant because it was one of the earliest concise medical writings about Chinese medicine. Beyond medicine, this book also presents ethical, philosophical and religious considerations; the three themes that run through the book are the theory of Taoism, yin and yang, and the five elements.

Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic)

The theory of Taoism, yin and yang, and the five elements are the main themes in the Huang Ti Nei Ching

In 1973 and 1974, excavation of the Mawangdui tombs revealed medical writing dating back to 168 B.C. One text called the Wushier Bingfang (The Fifty-two Prescriptions), detailed 52 ailments and 52 prescriptions, and was the earliest written reference of Chinese pharmacology. Despite the fact that these writings are the earliest known Chinese medical references, the Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic) still remains one of the most respected and studied texts on Chinese medicine. Even today scholars on Chinese medicine still refer to the wealth of knowledge in this book.                (TOP)

The Three Kingdoms Period 220 - 280 A.D.

* Wei 220-265 A.D.
* Shu Han 221-263 A.D.
* Wu 222-280 A.D.

Jin Dynasty 265 - 420 A.D.
(Carried over from Wu Kingdom)
* Western Jin 265-316 A.D.
* Eastern Jin 317-420 A.D.

Southern Dynasty 420 - 589 A.D.
(Carried over from Eastern Jin and ruled
Southern China)
* Song 420-479 A.D.
* Qi 679-502 A.D.
* Liang 502-557 A.D.
* Chen 557-589 A.D.

Northern Dynasty 386 - 581 A.D.
(Ruled Northern China)
* Northern Wei 386-534 A.D.
* Eastern Wei 534-550 A.D.
* Western Wei 535-556 A.D.
* Northern Qi 550-577 A.D.
* Northern Zhou 557581-A.D.

About the Chinese Middle Ages
Renowned French, Chinese historian Jacques Gernet called the period from 200581 A.D., the Chinese Middle Ages. The Han Dynasty ended with the military taking over China and splitting the country into three kingdoms.

The empire of the Three kingdoms (250 A.D.)

During this time, the Northern Chinese were considered to be more militant and less sophisticated than their Southern counterparts. At the same time, Buddhism was rapidly spreading throughout all parts of China. The Northern Wei especially welcomed the religion's presence because it was seen as a way to consolidate power. Buddhism also led to the influx of Indian culture into China.
As a result, knowledge concerning mathematics, astronomy and medicine flourished during this period. Many monks had medical knowledge because it was a necessity when making long pilgrimages to be able to administer medical care when no doctors were available.

Development of Physician Education
During this time, medical education was elevated to a higher standard. In 443 A.D., Qin Cheng-zu, an imperial medical officer, petitioned Emperor Wen of the Song Kingdom to appoint physicians to teach medical students. It was the first time the government assigned teachers to educate students on Chinese medicine. Although the Imperial Academy was established in 124 B.C., it mainly focused on teaching subjects such as literature, philosophy and administration. Little emphasis was placed on medicine. However, by 493 A.D., the Imperial Academy had expanded to include lectureships and chairs for teaching Chinese medicine.

Acupuncture and Moxabustion
Acupuncture, known as zhenjiu jiayijing in Chinese, was widely accepted by the Chinese population. Its use may have originated out of the Chinese fascination of relieving referred pain, defined as pain that manifests in one part of the body but originating from somewhere else. Many of the physicians mentioned previously such as Qin Yueren, Zhang Zhongjing, Hua Tuo, and Fan A used this therapy when treating patients. The Lingshu (The Vital Axis), a book from the Huang Ti Nei Ching (The Yellow Emperor's Classic of Internal Medicine) has a whole section dedicated to the use of accupuncture. (TOP)

* Zhenjiu Jiayijing (The ABC of Acupuncture and Moxibustion)
The man who wrote what is considered the bible of accupuncture and moxibustion was Huangfu Mi (215282 A.D.). His biggest contribution was a book called Zhenjiu Jiayijing (The ABC of Acupuncture and Moxibustion), which is considered to be the earliest complete reference guide to acupuncture and moxibustion. This book starts by discussing TCM concepts involving anatomy, and physiology and progresses to describing the theory of meridians. In addition, it outlines the location of the acupuncture points, discusses the techniques used to manipulate the needles, and describes the clinical applications and therapeutic benefits of both acupuncture and moxibustion.

Meridian and Pulse Study
By now the concept of blood and circulation was fully entrenched in the practice of Chinese medicine. It was thought that there were two separate systems of circulation within the body, each with a different fluid flowing though it. Blood was known to pump from the heart and into vessels throughout the body. Qi was considered a form of energy that pumped from the lungs, and circulated throughout the body on invisible tracts called meridians or channels.    (TOP)

* Wang Shuhe and the Maijing (Pulse Classic or Manual on the Pulses)

Wang shuhe, the Promoter of Pulsing
Wang Shuhe (265317 A.D.) wrote the Maijing (Pulse Classic or Manual on the Pulses), which was a compilation of all the knowledge on pulse diagnosis up to this point in history. In Chinese medicine feeling the pulse is perhaps the most important examination technique used when diagnosing a patient because how a pulse feels indicates different illnesses. In this book, 24 different kinds of pulses were identified.

Chinese Prescriptions
* Alchemy and Ge Hong

Alchemists can be considered the first pharmacists. Their popularity arose out of the Taoists quests for longevity. In their search for the magic elixir of life, alchemists would experiment with different methods of combining chemicals and minerals to create new medicines or tonics. Ge Hong (281341A.D.) a famous alchemist and physician at that time. His greatest achievement was his book Zhouhou Beijifang or Zhouhou Jiuzufang (Emergency Prescriptions or Handbook of Medicine for Emergencies) which was considered to be a how to guide for medical emergencies. It was concerned with practical approaches to medical problems and included prevention strategies such as the use of quarantine for contagious diseases. In his book, he proposed cures that were quick, cheap, and easily accessible. Some are still used today. For example, ephedra sinica is used in the treatment of asthma and dichroa febrifuga is used to treat malaria. Illnesses discussed in this book included typhoid, dysentery, malaria, smallpox, leprosy and cholera, which were common during those times.

Materia Medica
Another important figure in the development of Chinese medicine was Tao Honjing (456536 A.D.), who was especially renowned for his commentaries on the Shennong Bencaojing (Classic of Herbal Medicine). He increased the number of listed herbal medicines in the Shennong Bencaojing (Classic of Herbal Medicine) from 365 to 730, and furthered the information on the herbs' nature, location, and time of harvesting. The new book was entitled Shennong Bencaojing Jizhu (Annotations to the Classic of Herbal Medicine). It dominated the pharmaceutical literature until the middle of the 7th century A.D. He also completed Ge Hong's Zhouhou Beijifang (Emergency Prescriptions), which was re-titled Zhouhou Baiyi Fang (101 Emergency Prescriptions).
These prescriptions and those of other alchemists and Chinese doctors were often circulated using handwritten copies. Sometimes they would also be carved into the stone caves that served as Buddhist sanctuaries. One example is the Buddhist caves of Longmen (also called Dragon's Gate located south of Loyang in Henan province). There you can find approximately 100 prescriptions carved into the walls near the end of the 6th century A.D. Ge Hong's use of dichroa febrifuga for the treatment of malaria is an example of one such prescription carved at this location.

Other Important Medical Contributions
Other important Chinese medcial works of this time are Lei Xiao's (born in 15 A.D.) Lei Gong Baozhilun (Treatise on the Preparation of Lei Gong's Remedies) and Liu Juanzi Guifang, the earliest known treatise on Chinese surgery. Lei Gong Baozhilun (Treatise on the Preparation of Lei Gong's Remedies) focused on the vegetable-based medicines unlike Ge Hong's work that focused on chemical remedies to cure illnesses. In addition, this book outlines the various ways of preparing these medicines such as cooking them over an open fire (bao), steaming (zheng) or boiling them (zhu). The later book, Liu Juanzi Guifang, provides a wealth of information on the experiences gained up to the fifth century in the treatment of wounds caused by metal instruments and of ailments affecting the skin such as boils, anthrax and abscesses. The use of mercurial ointment is mentioned for curing certain skin conditions.        (TOP)

About the Qin

Emperor Qin Shi Huangdi was the first emperor to unite China. He did this not only through force, but also by standardizing systems throughout the country such as currency, writing, weights and measurements. His policies were strict and many nobles and scholars disliked them. He put 460 scholars to death as a warning to those who considered opposing them. His most infamous act was the burning of the books in 213 B.C. As a result, many important writings from ancient China were lost. Fortunately some texts on divination,medicine and agriculture were saved. Eventually his empire fell apart with the uprising of the peasants that led to the founding of the Han Dynasty.

Burning books and burying scholars alive

Han Dynasty 206 B.C. - 220 A.D.
* Western Han 206 B.C.24 A.D.
* Eastern Han 25220 A.D.

About the Han
Liu Bang launched the Han Dynasty in 206 B.C. and adopted the systems and harsh laws initially put in place by Emperor Qin Shi of the Qin Dynasty. During the years of 9 to 23 A.D., Wang Man founded a new dynasty called the Xin, which marked a break between the Western and Eastern Han. However, his reign was short lived and in 23 A.D. a rebel peasant army, the Red Eyebrows put Wang Mang to death signaling the beginning of the Eastern Han Dynasty.

Expanded empire of Western Han Dynasty

During this period, nomadic tribes were constantly invading China. As a result the Western Han Dynasty expanded its empire into what is today known as Mongolia, Manchuria, Korea, South China, Vietnam, and Central Asia. The Silk Road in Northwest China was a popular communication and trade route. The Han dynasty was also a time of innovation with vast developments in the arts, philosophy and technology. For example, Zang Heng (78139A.D.), a scientist and astronomer, invented the first seismograph in the 2nd century.

The Role of Philosophy and Religion
Philosophy, societal values and religion played key roles in shaping the practice of Chinese medicine. Many sects and religions including Buddhism were introduced or already well-established by this time. In addition, books that examined ancient Chinese history made their appearance. One of the famous examples was Sima Qian (c. 14585 BC), who finished the classic Shi Ji (The Historical Records) which detailed China's history from the earliest times to his own day. This set a standard for all subsequent Chinese historical writing. The quality of medical writings also improved as more medical texts were being written

Confucius and his disciples, the sage's disciples played a decisive role in spreading his teachings.

Taoism and Immortality

One popular Taoist concept was that of longevity. Many emperors sought out herbs or elixirs that could make them immortal. Other religions such as Buddhism also aimed to discover the secrets of Shangri-la by turning to Taoism. For example, Emperor Lingdi (168189 A.D.) of the Han Dynasty invited Buddhist monks of another Taoist sect from India to his court in hopes that they would be able to provide him the elixir of immortality. These immortality elixirs were the origins of Chinese prescriptions.
Development of Medical System and Education
Apprenticeships were a common means of educating new physicians in the Western Han Dynasties. These apprenticeships were mostly handed down through families because this insured a steady and reliable income. The prestige of the doctor was based on how many generations the family had been practicing medicine. In fact, one medical book from that period warned against taking medication from a physician if his family had been practicing medicine for less than three generations. The selection of apprentices was a stringent process. Even the Huang Ti Nei Ching (The Yellow Emperor's Classic of Internal Medicine) emphasized a careful selection of the apprentice since his success would bring the master fame. Other ways of becoming a doctor included studying prescriptions made by other doctors in a pharmacy or by self-study of medicine.

Examinations to recruit qualified physicians were introduced during the Han Dynasty. Emperor Yuan in 43 B.C. required all his attendant officials who were doctors to be tested. Interestingly, this examination was not necessarily based on medical knowledge, but rather the ability to be simple in life, honest in dealings, polite in social intercourse, and good in conduct.

Basic medical service on a national level was also introduced during this dynasty. Physicians were divided into two groups. There were the imperial court physicians who attended to the emperor, and the physicians who attended to the army and the common people within the provinces of the empire.        (TOP)

Shennong Bencaojing (Classic of Herbal Medicine)

Shennong Bencaojing (Classic of Herbal Medicine)
One of the most important medical books to come out of the Han Dynasty was the Shennong Bencaojing (Classic of Herbal Medicine). The word bencao means essential herb. While its attributed author is the Fire Emperor discussed earlier, no one knows for sure who wrote it. What is known is that it was written between the 1st and 2nd century B.C., and is considered to be the earliest complete Chinese pharmacopoeia reference.

This book lists a total of 365 Chinese medicines from which 252 were of plant origin, 67 from animals, and 46 from minerals. Each medicine was divided into one of three categories. The superior category included 120 medicines, which were considered to be non-toxic and contain invigorating effects to preserve vitality or prolong life. One of the most famous herbs in this category is ginseng (Panax ginseng). The second category included average medicines of which 120 were listed. Medicines in this category were used to prevent illness and restore the individual's vitality. However, the medicines listed here containing herbs such as Chinese angelica (Angelica sinensis) and ephedra (mahuang) could sometimes be toxic and should be used carefully for certain ailments. The third category included 125 inferior medicines that were considered to be toxic with side effects, and were specifically used for therapeutic purposes to treat diseases. Croton (Croton tiglium) is an example of an herb in this category which helps to relax the bowels, relieve edema (swelling) or eliminate phlegm evils.

Ginseng
Superior category

Chinese angelica                                                     Ephedra

The second category

Croton tiglium
The third category

Prominent Physicians of the Han Dynasty
During the Han Dynasty several prominent physicians emerged. Chunyu Yi (215167 B.C.) was the first doctor to keep medical records on the patients he treated. Guo Yu, who was the court physician of Emperor He, and Fu Weng were two doctors of the first century A.D. who were renowned for their skills in acupuncture and moxibustion.

A copy from Shanghan zabzabinglun (Discourse on Fevers and Miscellaneous Illnesses)

Zhang Zhongjing also known as Zhang Ji (150219 A.D.) was considered to be a 'sage of medicine.' He penned a book called Shanghan Zabzabinglun (Discourse on Fevers and Miscellaneous Illnesses), which dealt with the treatment of many febrile conditions. The book contains six parts, which correspond to the six pairs of meridians. It is significant because it discusses diagnosis and treatment methods based on an assessment of the symptoms of different pathological conditions. Later in the Song dynasty (9601279A.D.), his book was rewritten and divided into two books called Shanghanlun (Treatise on Febrile Diseases) and Jinkui yaolue (Summary from the Golden Chest).

Hua Tuo (141208 A.D.) was a contemporary of Zhang Zhongjing. He traveled from town to town treating patients and learning from other doctor's practices. He is famous for his skill as a surgeon and his use of anesthesia. The anesthesia was given as a powder called mafeisan that was dissolved in a fermented drink before performing surgery. It has been suggested the powder may have been hemp since its uses were unknown at that time. Besides performing surgeries, Hua Tuo also recommended the use of physical exercises for his patients. He devised movements that were similar to the movements of five different animals. These were the tiger, deer, bear, monkey and bird. It is said that one of his disciples Wu Pu lived to be 90-years-ol＆d due to these exercises. Another of Hua Tuo's disciples called Fan A was a great acupuncturist. He devised methods to extend it use to the back and thorax. Unfortunately many of Hua Tuo's works have been lost, and surgery became unpopular because most Chinese beliefs and laws of the time did not look favorably on it.

Dong Feng was another well-known physician who practiced towards the end of the Han Dynasty during the reign of Emperor Xian.

The end of the Han Dynasty
In 184 A.D., the Yellow Turbans successfully broke up the Han Dynasty. The army generals held the real power and this led to the Three Kingdoms period of the 3rd century A.D. One general called Cao Cao was especially militant. He has requested Hua Tuo to remain in his service after being treated for a migraine headache. After Hua Tuo refused, Cao Cao had him killed.    (TOP)