History of Chinese Medicine and TCM

Yellow Emperor with sunglassesChinese civilization existed long before written record. Written accounts of Chinese civilization and values began approximately 5,000 years ago. Chinese/Eastern Asian medicine was first written down approximately 500 years later, about 4,500 years ago. The legendary ancestor of the Chinese civilization is Huang Di, The Yellow Emperor. He was likely not a single person, but an archetype. While writings attributed to Huang Di are prolific, it is likely that he did not write all that is attributed to him.

The most important book in Chinese Medicine, laying out the fundamentals of the discipline and the definitive text is the Huang Di Nei Jing or the Yellow Emperor’s Internal Classics. This is a compilation of herbalists over several decades (Spring and Autumn or 770-476BC to the Warring states or 475-221BC Dynasties). The work is broken into 2 parts:

Plain Questions, which is also called Simple Questions or Su Wen. These are the fundamentals of Oriental medicine philosophy.

Ling Shu or  Miraculous/Spiritual Pivot which details the channels, point locations, and energetics of the points.

Hua Tuo

Hua Tuo Hua Tuo, the first famous surgeon in Chinese medicine(current era 110-207) is the first famous surgeon in Chinese medicine. Hua Tuo is credited with the first recorded development and use of anesthesia. He is also largely responsible for the Chinese knowledge of anatomy and physiology. Hua Tuo preferred simpler methods of acupuncture and herbs, using a small number of acupoints and creating formulas with only a few herbs.

An illustrative story about Hua Tuo’s surgical skills:

One day a patient came to see Hua Tuo. Hua Tuo diagnosed the patient with ulcerative colitis (bleeding ulcer in the large intestine) and decided that surgery was needed. He gave the patient what he called an “anesthetic powder.” When the patient lost physical sensation in the area, he cut the abdomen, located the ulcer in the intestine and probably resected the bowel. After sewing the patient back together he applied “Spirits Lotion.” One month later the patient was completely recovered.

Not only was Hua Tuo a skilled physician, his medical practice also incorporated the practice of Qigong. Hua Tuo and invented and taught a style called “Frolic of the Five Animals” or “Five Animal Qigong,” which is still in use today. Five Animal Qigong is based on the movements and behaviors of the Tiger, Deer, Bear, Ape, and Crane. It is a powerful technique for self-treatment of cancer patients, as cancer cells tend to shrink and recede with regular practice of this qigong.

Five Animal Qigong

Hua Tuo invented the Jiaji points, 34 bilateral points along the erector spinae muscles of the back located from the first thoracic vertebra (T1) to the fifth lumbar vertebra (L5). These points are used forcentral nervous system dysfunctions (all other acupoints treat the peripheral nervous system) such as para- and quadraplegia. There is a possibility of regaining function with the use of these points.

Hua Tuo's Jiaji pointsCat’s Note: The insertion points for the Jiaji are at the intervertebral foramen along the spinal column at the gap junction where the central nervous tissue terminates and the peripheral begins. This is why these particular points can be used to reach the central nervous system. Traditionally the Jiaji points are along the thoracic and lumbar vertebrae only, but some modern practitioners use these same types of points along the cervical/neck area.

Hua Tuo died at the age of 97, not from old age, but because a general named Zao Cao ordered his death. Zao Cao had contracted an illness called “Tou Feng” or head wind. The general came to see Hua Tuo and was advised to have an operation. Suspecting Hua Tuo wanted to harm him, the general had him executed. Paranoid much?

Zhang ZhongJing

Zhang ZhongJing (also called Zhang Ji – AD 412-220) is the most famous of China’s ancient herbal doctors. He was originally a provincial governor who resigned his position in order to pursue the study and practice of medicine when he was approximately 50 years old. The driving motivation for this was a severe plague which swept China, claiming the lives of over two thirds of his family. With sadness, Zhang Zhongjing dedicated himself to finding a solution to this form of suffering.

ShangHanLunAfter several decades he finished his book, Shang Han Lun, also called Shang Han Za Bing Lun. The title translates to Treatise on Febrile Diseases. You might also see this referred to as “Cold Injured Diseases.” (More on this in later classes.) The Shang Han Lun contains over 100 effective formulas, many of which are still in use today. It also provides a theoretical framework that led to hundreds of books which analyze, explain, and refine Zhang Zhongjing’s theories. It contains 397 articles and 112 prescriptions. The Shang Han Lun is a cornerstone of TCM history and theory.

This great medical text could have been lost to history if it were not for the efforts of a later physican named Wang ShuHe. Wang ShuHe recovered the book, reworked it a bit and split it into 2 parts:

  1. The Treatise on Febrile Diseases (Shang Han Lun).
    This part discusses the invasion of the body by externally introduced pathogens
  2. The Golden Chamber (Jing Kui Yao Lue) which covers internal disease, diet, stress, etc.

Cat’s Note: One section is best known for formulas which are still widely used today in TCM. One in particular is called Xiao Yao San. You will also see it referred to as Tang-Kui (or Danggui) and Peony Formula and also as “Free and Easy Wanderer.”) Xiao Yao San is a gynecological remedy used for infertility, disorders during pregnancy, prevention of miscarriage, post partum weakness, PMS, and menstrual dysfunction. I’m betting at least some of you readers are on it right now!

Huang-fu Mi

Huang-fu MiHuang-fu Mi (214-282 AD) lived to see the end of the later Han Dynasty. He is famous for his skills in acupuncture therapy. He composed many literary works and was very influential during his time. He studied Chinese medicine thoroughly and by the end of his life had compiled one of the prominent acupuncture works in history, Huang Di Zhenjiu Jia Yi Jing or The Yellow Emperors Acupuncture A and B. This classic, often nicknamed Jia Yi Jing, consists of 12 scrolls and 128 chapters. It not only summarized the entire knowledge of acupuncture at the time, but added a sizeable amount of new information. Later generations of acupuncturists needed only to learn Huangfu Mi’s book to understand the secrets of the art. This classic influenced the art of acupuncture in China as well as countries around the world such as France, Korea, and Japan.

Wang Shuhe

Wang-shu heWang Shuhe, whom you might remember from the discussion about Zhang Zhongjing above, lived from AD 210 – 285 during the Western Jin dynasty. Wang Shuhe is the great pulse diagnosis expert in Chinese medical history. He wrote Mai Jing or The Pulse Classics (which you might also see titled “The Classic of Pulses”) detailing 24 pulses. The 10 scrolls of this work describe the pulse positions and methods for reading the pulse. We use this as the basis for our current pulse diagnosis, though we now learn 28 pulses rather than 24.

Sun Simiao

Sun Simiao is the “King of Herbs.” Sun Simiao (AD 590-682) was a famous doctor during the Tang dynasty. He is famous not only for his herbal knowledge, but also for his medical ethics and desire to help the poor. He may be the first guy in recorded history to practice the community acupuncture model, chSun Si Miao statue in front of QingDao Medical School, Chinaarging fees on a sliding scale and recommending food therapy as a simple remedy to illness. He recommended seaweed to people living in the mountains who suffered from goiter and recommended the liver of oxen and sheep for people suffering from night blindness. (Later you will learn that the Liver “opens” to the eyes and when the blood of the Liver becomes deficient it can result in eye problems such as night blindness, dry eye, and more.)

A Daoist practitioner, Sun Simiao understood the virtue of medicine. “Human life is worth a thousand gold bars, with a virtue of one prescription you can fix it” is a quote from Sun Simiao. In 652 he compiled the famous Qian Jin Yi Fang, also called Prescriptions Worth a Thousand Gold for Emergencies, 30 scrolls worth of herbal scripts. Later he composed a second work of 30 scrolls, Qian Jin Yi Fang (no idea what the translation is, sorry). His writings contain some things you don’t expect to find in medical texts in the era in which we live including demon dispelling remedies, spells for some herbal formulas, and toxic alchemical preparations.

Cat Note: This is some of the magical aspect of Chinese Medicine that gets somewhat swept under the rug in western TCM schools, as it is not particularly palatable to the current western mindset, nor does it help our case in the biomedical world as we strive to work alongside MD’s and hospitals. Nevertheless, this is a powerful aspect of Chinese medicine. Please explore Qigong to get a small taste of this magic and energy. You might also check a few books in the library or online on this subject. There is also some material on YouTube on these topics, though you have to be judicious about the source of some of the online resources. There’s definitely something missing in the way Chinese medicine is presented in this culture.

Liu Wansu

Liu WansuLiu Wansu(1120-1200) lived and practiced during the Jing Dynasty. After observing the high incidence of fever and inflammation in serious diseases he promoted the concept of using herbs that were cool in nature to treat these fevers and inflammations, thus bringing balance back to the body, cooling the fever and reducing inflammation. This concept was counter to many of his predecessors and fellow practitioners who focused on warming herbs. Liu Wansu’s ideas predates the common western conceptions about contagious disease.

Liu Wansu did a detailed study of the Nei Jing Su Wen or Plain Questions of the Yellow Emperor’s Internal Classic, describing the etiology (origin or cause) of disease in relation to the teachings of this famous text.

Zhang Zihe

Zhang Zihe (1156-1228AD) is known as the developer of the ‘Attacking School’ of Chinese medicine. This philosophy emphasized the use of diaphoretics, emetics, and purgatives to attack pathogens and drive them out of the body. (This is a revival of the early Han Dynasty techniques of driving out ‘demons.’) Pathogens are an excess of something in the body (these can be from things that came in from outside the body or from something generated internally). The techniques taught in the Attacking School eliminate that excess by dispelling or removing it. You will often see this referred to as “sedating” or “reducing” the excess, which is a polite way to say you’re going to pop a cap in it. “Sedate excesses, tonify deficiencies” is a common theme in TCM.

Li Dongyuan

Li DongyuanLi Dongyuan (aka, Li Gao) lived from 1180-1252AD. This doctor is best known for his teaching that most diseases have their root in injury to the Stomach and Spleen system which results from intemperance or poor choices in eating and drinking, overwork without enough rest, and imbalance or excess of the seven emotions.

Digestion, said Li Dongyuan, is the key to health. You can read about his philosophy, medical practices, and see many herbal scripts in Pi Wei Lun or Treatise on the Stomach and Spleen. Many of his herbal scripts are still in use today. One of his famous scripts is Bu Zhong Yi Qi Tang (Ginseng and Astragalus) which treats muscle atrophy, prolapse of internal organs, fatigue, and fibromyalgia as well as boosting immunity.

We still use this concept in eastern Asian medicine today: too much cold or sedating effects of herbs, foods, and medications can lead to disease and obesity.

Zhu Danxi

Zhu Danxi is also known as Zhu Zhenheng (1280-1358AD). He believed that people suffered from chronic disease mainly due to overindulgences in pleasurable things and activities which results in debility of the Yin Essence. He recommended temperance and the use of tonic formulas, especially those nourishing the Kidney and Liver.

Zhang Jingyue

ZhangjingyueZhang Jingyue (Ming Dynasty, AD 1583 – 1640) was a prolific writer and produced works on pulse diagnosis, gynecology, pediatrics, surgery, and an analysis of theNei Jing which is somewhat confusingly referred to as the Lei Jing. He believed that yang qi and yin essence are rooted in the kidney and therefore advocated that life cultivation should concentrate on enhancing the kidney with simultaneous consideration of yin and yang.

Zhang Jingyue established a set of tonic prescriptions with the actions of mutual tonification of yin and yang which are still in use. He also put forward the theory of “life cultivation in the middle-aged” (which attaches importance to life cultivation in middle-aged people). This has a positive significance for prevention of premature aging and senile diseases.

Another Cat Note: It could be argued that 80-85% of diseases today are lifestyle related, including high blood pressure, high blood sugar, and high cholesterol. These result from Yin deficiency/Yang excess. To nourish Yin, nourish the Kidney and Liver while reducing your desires. Yin is the body’s essence, fluids and blood. Yang is activity, mental effort, and thinking. You need daylight to produce Yang and night to nourish the Yin. Too little sleep results in a lack of Yin — so don’t work the night shift if you can avoid it! To remedy an excess of Yang and a deficiency of Yin, get to sleep earlier, reduce your desires and practice temperance in all things. This is the ‘middle way’ of Buddhism. Qigong and meditation can help with both desire and temperance.

Li Shizhen

Li_Shizhen_Stamp_of_ChinaLi Shizhen (1518 – 1593) is considered to be China’s greatest naturalist. He was very interested in the proper classification of the components of nature. He sifted through the vast array of herbal lore over a span of 40 years and wrote his information into the Ben Cao Gang Mu (or in English, The Copendium of Materia Medica), a treatise on pharmacopoeia, botany, zoology, mineralogy and metallurgy. This book has been reprinted frequently and five of the originals still exist. A rough translation of the herbal entries was published in English by two British doctors who were working in China at the end of the 19th century (Porter and Smith) though extracts of it were published in Europe since 1656. Ben Cao Gang Mu contains 1892 different herbs. It is divided into 6 sections, 52 scrolls, and 60 different categories.

Hey there. Cat again: Just for a fun historical perspective, during this same time period (around 1550 AD) in other parts of the world, the Protestant Reformation was just starting to really piss off the Pope, the Jesuit Order was formed, the Spanish had just finished killing off the Aztec empire, Nostradamus wrote his first almanac, and Altan Khan besieged Peking/Bejing. There’s a PBS video about this regarding the Great Wall of China and how Altan Khan broke through it and torched the ‘burbs of Peking. Check it out in your vast amounts of spare time as a TCM student.

Wu Youxing

Wu Youxing (AD 1582 to 1652) developed the concept that some diseases were caused by transmissible agents which he called pestilential factors or “li qi.” His book, Wen Yi Lun or Treatise on Acute Epidemic Febrile Diseases is regarded as the main etiological work that introduced the concept of germs causing epidemic disease. Ultimately, this was attributed to Westerners… Before Wu Youxing’s theories, disease was thought to be caused by one or a combination of the six evils: Wind, Cold, Damp, Heat, Summer Heat, and Dryness. Wu Youxing’s work did not negate these six evils, but rather added the 7th one in the list: Li qi or transmissible agents.

Ye Tianshi

Ye TianshiYe Tianshi (1690-1760 AD) is famous for his thesis on febrile (feverish, hot, burning) diseases, Wen Re Lun or Treatise on Epidemic Fevers, published in 1746. He postulated that febrile disease progresses in four stages from the exterior of the body to the interior. These four stages are as follows:

 

  1. Wei Level
    The Wei Level of febrile epidemic disease affects the outer layer of the body’s defenses, which you will learn later is called the Wei Qi, the outer protective layer.
  2. Qi Level
    This is slightly deeper into the first layer of the interior of the body where the pathogen encounters and challenges the vital qi of the body.
  3. Jing or Nutritive Level
    By the time a disease gets this far it has gotten to the storehouse of the body and is difficult to stop because now it has resources to nourish it. Kind of like enemy troops capturing a supply line, you know?
  4. Xue or Blood Level
    This is the deepest level. By this time the patient is in deep, deep trouble. No good can come of this!

Ye Tianshi also wrote a book, even more famous than the last, called Detailed Analysis of Febrile Diseases or Wen Bing Tiao Bian. You’ll study these Four Stages later in Diagnostics.

If you take the time to trace the history of disease, you might see that most diseases, 2000-5000 years ago were mostly cold diseases and were treated with warm and hot herbs. Liu Wansu was on the cutting edge of the shift in disease, noticing that diseases were becoming hot in nature and should be treated with cooling herbs. This is still applicable today.

Sidebar, because you know I just can’t resist:
Infectious diseases due to viral infection (mumps, strep, HIV, SARS, Bird flu, etc.) are considered to be warm diseases. Autoimmune diseases come from inside the individual, not from outside sources like febrile disease. These are due to an imbalance of Yin and Yang.

The Global Development of TCM

From the 5th to the 7th Century the medicine of China was exported to Japan by Jian Zhen, a monk/doctor who took books and herbs with him when he fled the wars in China. Shiatzu, Japanese massage, means “acupressure” in Chinese. Chinese medicine has also found its way to Korea (check out Korean Hand Therapy Acupuncture) where it is widely advanced and used. Acupuncturists in Korea go through a rigorous 8 year program of study and have MD status when they are done. France has the oldest oriental medicine (OM) program in Europe, closely followed by Germany. By contrast, OM wasn’t introduced into North America until the early 1970’s when Richard Nixon went to China.

A rather big note from Cat:
If you’re still reading, you might have noticed there is a serious gap in information between the 1700’s and the current century. You can still find books that talk about it, but you may not get this information in class. This is definitely not the version sanctioned by the People’s Republic of China, but a compilation of what I have learned in reading over the years. Dr. Robert Chu, a student of Master Tung’s acupuncture, addresses this in his public teachings. Master Tung was one of the survivors of the Cultural Revolution who escaped to Taiwan and brought his family system of acupuncture with him and passed this knowledge along to his students.

Cultural Revolution purge old waysAs early as the 1910’s there were those in charge of Chinese politics, most notably the Minister of Education who was named Wang Daxie, who wanted to westernize healthcare in China and abandon traditional medicine. By 1929 opening schools of Chinese medicine was prohibited, despite a lot of really angry people who protested this ruling. More restrictive measures followed and it seemed there was an all-out war against traditional or national medicine. Resistance prevailed however and many began to suggest that the combination of ancient medicine and modern medicine would be the best way to tackle China’s sick and poor.

World War II interrupted this progress. You can read all about China and how it suffered under Japan’s occupation on your own, as it is heavily documented. Suffice it to say that the occupation did nothing positive for China. Mao Zedong came to power in China along with Communism in 1950 and attempted to correct the instability, poverty, and disease conditions that were rampant in the country.

Cultural Revolution Destroy the Old World Forge the New World

Destroy the Old World, Forge the New World

This is where the information about what was happening to medicine in China becomes rather edited and vague. Even Dominique Hoizey, who writes extensively about the details of medicine in China, glosses over any mention of persecution of classical and family acupuncture practitioners. Information about this comes through first-hand stories of those who fled and survived. As in all histories, the victors tell the tales while the victims are often unheard. It seems to me that there is enough evidence to suggest something shady, politically motivated, and unsavory was happening to the generations-old medicine.

Before the Cultural Revolution in the 1960’s that followed Mao’s ascension to power, acupuncture was practiced by whole families who had passed the knowledge down for generations and were well known for their skill and healing abilities in needling, cupping, gua sha, and moxibustion. This was true for thousands of years. After the Cultural Revolution, however, many of these practitioners went into hiding, fled the country, or were killed. Skilled practitioners and family scholars began to emerge in Korea, Japan, and Taiwan. Master Tung Ching-Chang, a master acupuncturists from Taiwan, was one such survivor.

Cultural Revolution barefoot doc

Barefoot Doctor

It still is not clear how much valuable knowledge about acupuncture was lost in the 20th century. What is clear is that what is marketed as “Traditional Chinese Medicine” is nothing of the sort. Dr. Robert Chu, a renowned practitioner of Master Tung’s and Classical Acupuncture systems in California, points out that the task of creating TCM was given to internal medicine doctors in China who were herbalists, not acupuncture professionals. While it is early to go into the specific details, bear this in mind as you study TCM. You will notice at some point that the classics of acupuncture never mention things TCM professionals take for granted such as Spleen Qi deficiency, Liver Qi stagnation, or Kidney deficiency, because these are herbal medicine diagnoses, not acupuncture diagnoses.

TCM has nevertheless been heavily marketed by the Chinese government as traditional and is the accepted form of Chinese medicine across the world. It is this form that you will also find when you take your boards and apply for state licensure.

Cultural Revolution acu in surgery

Acupuncture anesthesia in a Chinese hospital

The final takeaway message here is this: TCM, though it is an effective form of medicine, was created in the 1950s-1970’s by a committee of herbalists who superimposed herbal diagnoses and filters onto the science and art of acupuncture. It could be argued that Traditional Chinese Medicine is traditional only in its’ herbal knowledge and treatment strategies. If you are searching for traditional acupuncture you will need to look in the classic works and, depending on the school you attend, you may have to do it outside of your formal education.

Characteristics of TCM:

  1. Application of Chinese philosophy, such as Yin/Yang and Five element theories in TCM
    Chinese medicine is based on restoring harmony and balance to the body. You are well when Yin, Yang, and internal organ energies (often referred to as “Zangfu”) are balanced. Much, much more on this later.
  2. The concept of Wholism
    Wholism means the whole picture. Left is a copy of right. Superior is a copy of inferior. Treat thewhole body, not just the symptoms or diseases. Oriental medicine observes from a whole body standpoint, paying attention to pulse, nails, eyes, tongue, hair, voice, teeth and gums, posture –everything is relevant because every detail reflects the whole.
    Cat’s Note: Sometimes in clinic I refer to TCM as “Sherlock Holmes” medicine because all of the tiny details add up to a complete picture. No detail is insignificant and all details contain clues to the whole picture. There’s a holographic universe in each body.
  3. Advanced Channel and Point system
    Channels/meridians and acupoints allows an acupuncturist to treat internal organs from outside the body. Energies flow through the body along the meridians from deep inside to outside and back again. You can thus affect the energy going in by treating it when it comes to the surface.
  4. Treatment of disease according to pattern diagnosis and differentiation
    You will get so much more material on this as you progress through your program that when you graduate you’ll be amazed that there was ever a time when you did not know this.

The Very Least You Need To Know

Know the names of the four most important books in Chinese medicine and who wrote each.

  1. Yellow Emperor: Yellow Emperor’s Internal Classic
  2. Zhang Zhongjing: Shang Han Lun or Treatise on Febrile Diseases
  3. Zhang Zhongjing: Golden Chamber
  4. Warm Diseases

Know the four great doctors in the Jing Dynasty and their contributions to Chinese medicine

  1. Liu Wansu: cold herbs for hot diseases
  2. Zhang Zihe: the “Attacking School”
  3. Li Dongyuan: Treatise on Stomach and Spleen
  4. Zhu Danxi: disease comes from overindulgence

 

Sources

  • Source: Wu, Qianzhi. “Foundations of Chinese Medicine.” AOMA Graduate School of Integrative Medicine, Austin Texas. Fall 2007. Lecture Series.
  • Ni, Maoshing. The Yellow Emperor’s Classic of Medicine. Boston MA: Shambhala Publications, 1995. Print.
  • Zhongjing, Zhang. Synopsis of Prescriptions of the Golden Chamber. Middle Island NY: New World Press, 1987. Print.
  • Hoizey, Dominique. A History of Chinese Medicine. Edinburgh UK: Edinburgh University Press, 1993. Print.
  • Yang, Shou-zhong. Li Dong-Yuan’s Treatise on the Spleen & Stomach. Boulder CO: Blue Poppy Press, 1993. Print.
  • Beinfield, Harriet. Between Heaven and Earth. New York NY: Ballantine Books, 1991. Print.
  • Kaptchuk, Ted. The Web That Has No Weaver. New York NY: Congdon & Weed, 1983. Print.
  • Chu, Robert. “Essential Tung’s Points.” Lotus Institute of Integrative Medicine, City of Industry CA. 2012. Continuing Education Lecture Series.