1. Overview of the Development of Ancient Chinese Medicine
Traditional Chinese Medicine (TCM) encompasses thousands of years of experience and theoretical knowledge of the ancient Chinese people in combating diseases. Guided by a primitive materialistic view and spontaneous dialectical thinking, it gradually formed and developed into a medical theoretical system through long-term medical practice. It originated in primitive society, stemming from the primitive people’s worship of nature. By the Spring and Autumn and Warring States periods, a basic medical theoretical system had been established. Through the development and continuous improvement over various dynasties, TCM has matured and has had a profound impact and significant importance on the healthcare systems of countries around the world.
TCM is based on the theories of Yin-Yang and the Five Elements, viewing the human body as a unity of Qi (vital energy), form, and spirit. Through the four diagnostic methods of “observation, listening, inquiry, and palpation,” it seeks to explore the causes, nature, and location of diseases, analyze the pathogenesis and changes in the five internal organs, meridians, joints, Qi, blood, and body fluids, and determine the balance of pathogenic and healthy factors. This leads to the naming of diseases and the summarization of syndromes, allowing for the formulation of treatment principles such as “sweating, vomiting, purging, harmonizing, warming, clearing, tonifying, and reducing.” Various treatment methods are employed, including herbal medicine, acupuncture, tuina (Chinese therapeutic massage), cupping, qigong, and dietary therapy, to achieve a balance of Yin and Yang and restore health.
TCM originated in primitive society, and by the Spring and Autumn and Warring States periods, the theoretical framework of TCM had already taken shape, with the emergence of anatomy and medical specialties. The “Four Diagnostics” were adopted, and treatment methods included stone therapy, acupuncture, decoctions, moxibustion, guiding exercises, and incantations. During the Western Han Dynasty, the theories of Yin-Yang and the Five Elements began to explain human physiology, leading to the emergence of medical artisans, gold needles, and copper keys. In the Eastern Han Dynasty, the famous physician Zhang Zhongjing appeared, who had a profound understanding of the “Eight Principles” (Yin-Yang, exterior-interior, deficiency-excess, cold-heat) and summarized the “Eight Methods.” Hua Tuo was renowned for his expertise in surgery and anesthesia, and he created the health exercise “Five Animal Frolics.” In the Tang Dynasty, Sun Simiao summarized previous theories and experiences, collected over 5,000 prescriptions, and adopted syndrome differentiation in treatment, earning him the title of “King of Medicine” due to his high medical ethics. After the Tang Dynasty, Chinese medical theories and texts were widely disseminated to Korea, Japan, Central Asia, and West Asia. During the Song Dynasty, the government established the Hanlin Medical Academy, and medical specialties became nearly complete, standardizing acupuncture points due to discrepancies caused by copying, and publishing the “Illustrated Classic.” After the Jin and Yuan Dynasties, TCM began to decline. After the Ming and Qing Dynasties, the Warm Disease School and the Modern Prescription School gradually replaced the Classical Prescription School. The publication of Li Shizhen’s “Compendium of Materia Medica” in the late Ming Dynasty marked the decline of pharmacology in TCM. During the same period, Mongolian and Tibetan medicine were influenced by TCM. In Eastern medicine in Korea, significant development also occurred, exemplified by Heo Jun’s writing of the “Treasured Mirror of Eastern Medicine.”
2. Famous Ancient Physicians and Important Medical Classics
1. Huangdi Neijing (The Yellow Emperor’s Inner Canon)
Abbreviated as “Neijing,” the original text consists of 18 volumes. Among them, 9 volumes are titled “Suwen” (Simple Questions); the other 9 volumes are untitled, and during the Han and Jin Dynasties, it was referred to as “Nine Volumes” or “Needle Classic,” and after the Tang Dynasty, it was called “Ling Shu” (Spiritual Pivot). It is not the work of a single person or time, with the main parts formed from the Warring States to the Eastern Han period. Each part consists of 81 chapters, totaling 162 chapters. “Suwen” mainly discusses the laws of natural changes and the relationship between humans and nature; the core content of “Ling Shu” is the theory of organs and meridians. It is the earliest existing traditional medical masterpiece in China that studies human physiology, pathology, diagnostics, treatment principles, and pharmacology. It summarizes the medical experiences and academic theories from the Spring and Autumn to the Warring States periods and incorporates knowledge from astronomy, mathematics, biology, geography, anthropology, and psychology before the Qin and Han Dynasties. Using the theories of Yin-Yang, the Five Elements, and the unity of heaven and humanity, it provides a comprehensive explanation of human anatomy, physiology, pathology, as well as the diagnosis, treatment, and prevention of diseases. Theoretical foundations established in TCM include the “theory of Yin-Yang and the Five Elements,” “pulse theory,” “organ theory,” “meridian theory,” “etiology theory,” “pathogenesis theory,” “symptoms,” “diagnostic methods,” “treatment principles,” and “health preservation theory,” reflecting the ancient Chinese thought of the unity of heaven and humanity, establishing a unique theoretical system of TCM, and becoming the theoretical foundation and source for the development of Chinese medicine.
2. Shanghan Zabing Lun (Treatise on Cold Damage and Miscellaneous Diseases)
Written by Zhang Zhongjing of the Eastern Han Dynasty. Zhang Zhongjing (150-219 AD), whose name was Ji, was from Nanyang. This book includes differentiation of the six meridians, differentiation of miscellaneous diseases, and the Pingmai method. It particularly contains detailed discussions on the six pathogenic Qi, the pulse patterns of heat and cold diseases, and the treatment of various conditions, which is the most significant feature that distinguishes this book from other versions. The book also lists many case studies and preserves a large number of effective prescriptions. The content is rich, with a coherent connection between theory, methods, prescriptions, and medicines, and it remains an important medical text for learning TCM today.
In this work, Zhang Zhongjing created three world firsts: the first recorded methods of artificial respiration, medicinal enema, and treatment of biliary ascariasis. For nearly 2,000 years since its completion, “Shanghan Zabing Lun” has maintained a strong vitality, being recognized as the ancestor of Chinese medical treatises and praised by academia as the most influential clinical classic that emphasizes dialectical treatment and has its own unique system. Most of the prescriptions listed in the book are well-combined, and many have been confirmed by modern science. Over four to five hundred scholars have explored its theoretical prescriptions, leaving nearly a thousand specialized works, thus forming a brilliant and unique Shanghan school in the history of TCM. According to statistics, as of 2002, nearly 2,000 books had been published solely for the study of “Shanghan Zabing Lun.”
3. Shennong Bencao Jing (Shennong’s Classic of Materia Medica)
Also known as “Shennong Bencao,” abbreviated as “Bencao Jing” or “Bencao,” it is the earliest existing pharmacological work in China. The author is unknown, and “Shennong” is a legendary name. The book is divided into three volumes, listing 365 kinds of medicines (252 plant medicines, 67 animal medicines, and 46 mineral medicines), categorized into upper, middle, and lower grades. The text is concise and ancient, becoming the essence of TCM theory. The date of its completion has been debated, with some claiming it was completed during the Qin and Han Dynasties, while others suggest it was during the Warring States period.
In Chinese history, there is a legend that “Shennong tasted hundreds of herbs… and encountered seventy poisons in one day,” reflecting the arduous process of ancient laborers discovering medicines and accumulating experiences in their struggle against nature and diseases, which is also a true portrayal of the origins of herbal medicine from productive labor.
The book provides detailed records of each medicine’s origin, properties, collection time, medicinal parts, and main indications. It also summarizes how various medicines can be combined and applied, as well as simple preparations. More importantly, as early as two thousand years ago, our ancestors had discovered many effective medicines through extensive therapeutic practices, such as Ma Huang (Ephedra) for treating asthma, Da Huang (Rhubarb) for purging fire, and Chang Shan (Dichroa febrifuga) for treating malaria. These have been confirmed by modern scientific analysis.
In ancient China, most medicines were plant-based, so “Bencao” became synonymous with them, and this book was named “Bencao Jing.” During the Han Dynasty, the trend of venerating the ancient was prevalent, and people respected the past while belittling the present. To elevate the status of this book and enhance people’s trust, it borrowed the well-known legend of Shennong tasting hundreds of herbs to discover medicines, naming it “Shennong Bencao Jing.” This is similar to how “Neijing” is attributed to Huangdi, both intended to invoke the names of ancient sages.
4. Nanjing (Classic of Difficult Issues)
A theoretical work of TCM. Originally titled “Huangdi’s Eighty-One Difficult Issues,” it consists of three volumes. The original title is attributed to Qin Yue, and “Nanjing” means “questions and difficulties” or “difficulties explained.” The “Jing” refers to the “Neijing,” meaning it addresses the difficulties in the “Neijing.” The author presents what he considers difficult points and questions, explaining and elaborating on them one by one. The entire book is divided into eighty-one difficulties, discussing various issues related to the functions and forms of the internal organs, diagnostic methods, pulse patterns, and acupuncture techniques. However, it has been verified that this book is a work of attribution, likely completed before the Eastern Han Dynasty (some say during the Qin and Han periods). The book is compiled in a question-and-answer format, hence the name “Nanjing.” The content includes basic theories such as pulse diagnosis, meridians, organs, Yin-Yang, etiology, pathology, Ying and Wei (defensive Qi), Shu points, and acupuncture, while also listing some diseases. The book primarily focuses on basic theories, combining some clinical medicine, with an emphasis on pulse diagnosis, organs, meridians, and Shu points. Among the first 22 difficulties, pulse diagnosis is discussed; difficulties 23-29 address meridians; 30-47 discuss organs; 48-61 cover diseases; 62-68 focus on Shu points; and 69-81 elaborate on acupuncture techniques. The book enriches and develops the theoretical system of TCM with its academic insights on the Mingmen (Gate of Life) and Sanjiao (Triple Burner) and its discussions on the Seven Collaterals (seven key digestive points) and Eight Meetings (the convergence points of Qi in organs, meridians, blood, and essence). It also clearly states that “there are five types of cold damage” (including wind stroke, cold damage, damp warmth, heat diseases, and warm diseases) and elaborates on various diseases of the five internal organs, which has been valued by later generations of physicians. The content of the book is concise and the analyses are subtle, often mentioned alongside the “Neijing” in TCM classics, and it is regarded as one of the most important classical medical texts. There are various editions and annotated versions.
3. Introduction to Famous Ancient Physicians in China
1. Father of Acupuncture — Huangdi, surname Ji, Xuan Yuan. Huangdi is the legendary common leader of various tribes in the Central Plains. The existing “Neijing” is attributed to Huangdi discussing medicine with Qi Bo and Lei Gong. This book’s treatment methods often use acupuncture, hence the detailed records and discussions on acupuncture points and techniques.
2. Father of Medicine — Bian Que, surname Qin, a native of the Warring States period in the Bo Hai region (now Renqiu, Hebei). The crown prince was in a state of death, but he treated him back to life; Qi Huan Gong was not ill, yet he knew he would not rise in five days, gaining fame for his diagnostic skills. His biography and medical cases are recorded in the “Records of the Grand Historian: Strategies of the Warring States,” where he is revered as the advocate of pulse diagnosis.
3. Divine Physician — Hua Tuo (145-208), also known as Fu, courtesy name Yuanhua, from Pei County (now Bozhou, Anhui) during the late Eastern Han Dynasty. He was proficient in internal, external, gynecological, pediatric, and acupuncture disciplines, particularly excelling in surgery. For diseases like “intestinal accumulation,” he used a narcotic drink, and in a moment, the patient felt as if intoxicated, allowing him to perform abdominal surgery.
4. Medical Sage — Zhang Zhongjing, courtesy name Ji, from Xiangyang County (now Nanyang, Henan) during the late Han Dynasty. It is said that he once served as the governor of Changsha, where there was an outbreak of cold damage, resulting in many deaths. His work “Shanghan Zabing Lun” summarizes over 300 years of clinical practice in the Han Dynasty, making significant contributions to the development of Chinese medicine.
5. King of Medicine — Sun Simiao (581-682), from Huayuan, Jingzhao (now Yaozhou, Shaanxi) during the Tang Dynasty, known for his high medical ethics and superb medical skills. After curing the empress’s headache, the court wanted to keep him as a royal physician, but he lied about seeking the “elixir of life” to present to the emperor and escaped. The person monitoring him falsely reported that he fell and died while gathering herbs, and the emperor posthumously honored Sun Simiao as the King of Medicine.
6. Father of Forensic Medicine — Song Ci, from Fujian during the Song Dynasty. In 1247, he summarized the experiences of forensic medicine in the Song Dynasty and his insights from serving as a judge four times, writing the “Collected Records of Washing Away Injustice,” which is the earliest forensic literature in the world.
7. Saint of Medicine — Li Shizhen, courtesy name Dongbi, from Qizhou (now Qichun, Hubei) during the Ming Dynasty. He spent a long time collecting herbs in the mountains and among the people, referencing over 800 medical texts from various dynasties, and after 27 years of hard work, he completed the “Compendium of Materia Medica,” which lists 1,758 kinds of medicines and has been translated into Japanese, French, German, Russian, and other languages.
4. Small Knowledge of TCM Culture
Qihuang Technique: During the 26th to 22nd centuries BC, Huangdi was the legendary common leader of various tribes in the Central Plains, surname Ji, known as Xuan Yuan. Qi Bo, a legendary physician, was a minister of Huangdi. The earliest existing theoretical work of TCM is the “Neijing,” which is attributed to Huangdi discussing medicine with Qi Bo in a question-and-answer format, also known as “Huangdi Neijing.” Later generations referred to TCM as “Qihuang” or “Qihuang Technique,” originating from this.
Master of Medicine: The “Records of Confucius” states: “In matters, there is nothing he does not understand, hence he is called a sage,” meaning he is knowledgeable in all areas. The term “master” refers to someone who specializes or is passionate about their work. The term “master of medicine” is a high praise for a physician’s superb medical skills.
Hanging Gourd: The “Book of the Later Han: Biography of Fei Changfang” records that there was an old man selling medicine in the market, hanging a gourd at the market entrance. His medicines were effective in curing diseases, attracting people’s attention. It was later discovered that this miraculous old man would jump into the gourd after the market closed. In ancient times, medicine and pharmacy were not separated, and “hanging gourd” became a term for practicing medicine. Some practicing physicians also used gourds as signs to indicate they were open for consultation, and later generations referred to the achievements of physicians as “hanging gourd to benefit the world.”
Apricot Forest: During the Three Kingdoms period, Dong Feng was a skilled physician with high medical ethics. He treated patients without accepting payment or gifts, only asking those he cured to plant apricot trees in front of his house as a memorial. Those who recovered from serious illnesses planted five trees, while those with minor ailments planted one. Years later, a forest grew, laden with red apricots. He built a “herb warehouse” and told people that anyone wanting apricot fruits could exchange a container of grain for a container of apricots. The grain he accumulated was used to help the poor. People were very grateful to him and presented him with plaques inscribed with “Apricot Forest,” “Medical Forest,” “Fame Spreads in the Apricot Forest,” and “Spring Warmth in the Apricot Forest.” These praises became elegant titles for physicians with high medical ethics and superb skills.
Tiger Guarding the Apricot Forest: Legend has it that one day, Dong Feng encountered a tiger lying in the grass. Upon closer inspection, the tiger showed no signs of aggression, lying still, opening its mouth, breathing heavily, and shedding tears, appearing to be in pain, seeking Dong Feng’s treatment. Dong Feng carefully observed the tiger and said, “Come back here tomorrow at this time, and I will treat you.” The tiger nodded and left. The next day, Dong Feng wore two iron rings on his arms, asked the tiger to open its mouth, and used the rings to prevent being bitten. He extracted a bone from the tiger’s throat, curing its ailment. Later, the tiger, in gratitude, guarded the apricot forest for Dong Feng. Today, the phrase “tiger guarding the apricot forest” is used to praise physicians with superb medical skills like Dong Feng.
Reborn Hua Tuo: Once, Hua Tuo saw a funeral procession and noticed blood flowing from the coffin, resembling that of a living person. He rushed forward to provide treatment and ultimately saved a woman who had been falsely declared dead, earning him the title of “Divine Physician.” He was proficient in internal, external, gynecological, pediatric, and acupuncture disciplines. The “Romance of the Three Kingdoms” states that he could perform a craniotomy for Cao Cao to treat his headache. Later generations use the term “reborn Hua Tuo” to praise physicians with excellent medical skills.
Qing Nang: Refers to the bag used by ancient physicians to hold medical texts, later used to refer to medical skills. The “Book of the Later Han: Biography of Hua Tuo” states: “The jailer would often offer wine and food to Hua Tuo, who, feeling grateful, said: ‘If I die, it is not my fate. I have a Qing Nang that has not been passed down, and if you cannot inherit it, I will write it down for you.'” When the jailer returned home, he asked his wife for the book, but she said: ‘Even if you learn the divine skills, you will ultimately die in prison, so I burned the bag.'” Because Hua Tuo was skilled in medicine and traveled widely, he gained a great reputation, thus “Qing Nang” also became a term for medical skills.
Great Physician of the People: Sun Simiao, the King of Medicine during the Tang Dynasty, was known for his high medical ethics and is regarded as a model in the medical community. In his work “Essential Prescriptions Worth a Thousand Gold,” he wrote: “If someone comes seeking help due to illness or disaster, do not ask about their wealth or poverty, grievances or friendships, or whether they are Chinese or foreign, wise or foolish; treat them all as close relatives. Do not hesitate or worry about good or bad outcomes, protect your own life. With deep compassion, do not avoid day or night, cold or heat, hunger or thirst, fatigue, and wholeheartedly rush to help, without any ulterior motives. Only then can one become a great physician of the people.” Later generations respect physicians with high medical ethics as “great physicians of the people.”
5. TCM Culture in Classical Literature
1. During the Southern Song Dynasty, Xin Qiji was a great poet and patriot in Chinese history. His existing more than 600 poems cover politics, philosophy, friendship, love, pastoral scenery, folk customs, daily life, and reading experiences, with a wide range of themes. Among them, the most interesting is a poem titled “Man Ting Fang. Quiet Night Thoughts,” written to his long-lost wife, expressing his longing: “The mica screen opens, the pearl curtain closes, preventing the wind from scattering the incense. Parting feelings are heavy, golden threads weave sulfur, the shadows of cypress and osmanthus intertwine, leisurely rising, playing in the mercury pond. The head of forsythia sweeps past half summer, cooling the thin mint gown. A hook of moon on the vine, an ordinary mountain night, dreaming in the battlefield. Long ago, light powder and rouge, alone in an empty room. Wanting to continue the broken string but unable, Aconite and bitter herbs, the most painful. Angelica,熟地, and chrysanthemum yellow.” The poem cleverly uses the names of 25 Chinese medicinal herbs, creating a vivid and engaging expression.
2. The author of “Journey to the West,” Wu Cheng’en, was also skilled in herbal medicine. In “Journey to the West,” there are many stories of using TCM to treat diseases, written in accordance with medical principles. He wrote a poem titled “Xijiangyue,” depicting the fierce battle between Sun Wukong and the hunters invading Huaguo Mountain: “Stones smash Aconite to pieces, sand flies and sea horses are all injured. Ginseng and cinnamon are busy in front of the ridge, blood stains the ground with vermilion. Aconite cannot return home, betel nut cannot return to its hometown. The bones lie lightly powdered on the mountain field, the red lady waits at home.” The poem vividly describes the fighting scene and uses the names of herbs such as Aconite, sea horse, ginseng, cinnamon, vermilion, and others.
3. “Dream of the Red Chamber” is an encyclopedia of traditional Chinese culture, containing a large amount of content related to TCM, reflecting the deep connection between TCM and traditional culture. The book has eleven chapters named after TCM, such as “Zhang Taiyi Discusses Illness in Detail,” “Shi Qilin Discusses Yin and Yang,” and “Hu Yongyi Misuses Tiger and Wolf Medicines,” indicating the importance of TCM in Cao Xueqin’s mind. From the perspective of disease classification, it includes common and frequently occurring internal diseases: the wind-cold of Jia Yucun, the diarrhea of Liu Laolao, the heat stroke of Daiyu, as well as difficult and miscellaneous diseases, such as the cough that Lin Daiyu suffers every year after the spring equinox and autumn equinox, resembling the popular concept of “chronobiology” today. It also includes gynecological issues: the amenorrhea that caused the death of Qin Keqing, the menstrual irregularities that Wang Xifeng was embarrassed to mention; pediatric issues: the fetal heat that Baocai treated with “Cold Fragrance Pills,” and the measles and convulsions of Qiaojie; even involving some strange diseases treated with incantations and qigong, such as the evil diseases that Fengjie and Baoyu were afflicted with due to magic, and Miaoyu’s spiritual disturbance during meditation. From the perspective of prescriptions and medicines: in the eleventh chapter, Qin Keqing’s prescription includes ginseng and sixteen other herbs; in the fifty-first chapter, there are the tiger and wolf medicines misused by Hu Yongyi, such as Ma Huang and Zhi Shi; and various prescriptions scattered throughout the book include Ginseng Nourishing Pills, Dushen Decoction, Eight Treasures Yimu Pills, Left Reversion, Right Reversion, and more than twenty prescriptions. The diversity of diseases, the meticulous classification, and the abundance of prescriptions indicate that only those well-versed in medical principles can comprehend them, showcasing Cao’s profound knowledge of TCM.
4. The Ming Dynasty writer Feng Menglong once wrote a love letter titled “Gui Zhi Er” using medicinal names: “You say I have betrayed my heart, with no evidence of Zhi Shi. It makes me stomp through the earth’s skin, willing to swear an oath to Wei Lingxian. I think of you with Xi Xin, and you know well the thickness of Hou Po, do not treat my love letter as old paper. I think of ginseng as the most painful parting hate, just for the sweetness of licorice to coax me to this day, Huang Lian’s heart is bitterly worried for you, Bai Zhi Er cannot express the feelings of parting, advising the gentleman not to be ungrateful.” This love letter uses the names of herbs such as Zhi Shi, earth skin, Wei Lingxian, Xi Xin, Hou Po, old paper, ginseng, licorice, Huang Lian, Bai Zhi, and others.
5. There is also a folk legend that Cao Cao heard of Hua Tuo’s great reputation and wanted to test his skills. He casually recited a four-character poem: “Lotus in the chest, autumn flowers of West Lake. Clear sky at night, first entering the realm. Eternal life and peace. Mother gains profit, alerting family members. Five minus thirty, the deadline is approaching. Great plans in mind, military advisors are hard to mix. Bone-setting doctor, honest and loyal. Incompetent and lacking skills, the pharmacy closes.” Hua Tuo, upon hearing this, quickly wrote down the names of sixteen kinds of Chinese herbs: Chuanxinlian, Hangju, Mantianshu, Shengdi, Wannianqing, Qiannianjian, Yimucao, Fangji, Shanglu, Danggui, Yuan Zhi, Ku Shen, Xuduan, Hou Po, Baizhu, and Myrrh. Cao Cao was deeply impressed.
6. Related Idioms in Medical Culture
Eight-year-old man — White-headed old man
Hundred-year-old fruit shell — Dried tangerine peel
Wheat after the beginning of summer — Da Huang (Rhubarb)
Snow flying everywhere — Silver flower
Twenty-one days — Sanqi (Notoginseng)
May’s grain stalks — Xia Ku Cao (Summer withering grass)
Recently cultivated farmland — Sheng Di (Rehmannia)
Knife hanging at the waist — Fang Ji (Sarpagandha)
Branches hanging gourds — Mu Guo (Papaya)
Overdue and not returning home — Dang Gui (Angelica)
Walls built around the house — Fang Feng (Siler)
Written at the End
Traditional Chinese Medicine is the essence of ancient Chinese culture and the crystallization of thousands of years of wisdom from the ancient Chinese people. The development of TCM contributes to the growth and strength of modern medicine in China and around the world. Great wisdom appears foolish, and great skill appears clumsy. TCM culture embodies the ancient Chinese people’s reflections on the vast world and their respect for all living things. Chinese civilization is like a vast and boundless ocean, embracing all rivers and incorporating diverse elements. I believe that TCM culture, as a part of Chinese civilization, will undoubtedly endure through the ages and continue to possess vibrant vitality.
