User:Madalibi/History of medicine in China

Started as work on the Wiki on "Chinese medicine" from the page on the History of Medicine. Now expanding into what will become a new page on the "History of Chinese Medicine" that will not be re-directed to the page on traditional Chinese medicine.

Plurality of medical practices. About all kinds of medical doctrines and practices (including Indian medicine, western missionary medicine, etc.), not just Traditional Chinese medicine.

Pre-Han and Han
The first traces of therapeutic activities in the territories that are now considered China date from the Shang dynasty (14th–11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, etc., which Shang elites usually attributed to curses sent by their ancestors. Other instances of illnesses were attributed to "evil winds" or "snow," both of which might also have been considered as spiritual entities. They attempted to cure these illnesses by placating the angry ancestors, usually with ritual offerings. There is no evidence that the Shang nobility used herbal remedies. For lack of documentation, the medical conceptions and practices of the larger population are even more difficult to assess.

Stone and bone needles found in ancient tombs have made Joseph Needham speculate that acupuncture might have originated in the Shang dynasty. But most historians now make a distinction between medical lancing (or bloodletting) and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels ("meridians") in accordance with theories related to the circulation of Qi. The earliest evidence for acupuncture in this sense dates to the second or first century BCE.

Wu 巫 ("shamans") and yi 醫 ("physicians")

Famous physicians of the Warring States

Medical divination, or "iatromancy"

Herbs and magic

The origins of acupuncture and moxibustion

Converging traditions

Wuwei bamboo slips: Han Wudi's soldiers

Before the advent of woodblock printing, texts were copied either on bamboo slips or on silk. The texts circulated at least among the nobility and were considered prestigious. We still know little about the medical culture of that era, but the fact that texts with similar contents have been found in various regions of China suggests that elite medical culture was already integrated to some extent.

Medicine was learned in the family or from masters who transmitted their skills and their texts to a few disciples. Though texts required initiation by a master in order to be intelligible, they also circulated outside medical circles.

The first medical classics
The foundational text of Chinese medicine is the Huangdi neijing, or Yellow Emperor's Inner Canon, which is composed of two books: the Suwen 素問 ("Basic Questions") and the Lingshu 靈樞 ("Divine Pivot"). Although the Neijing has long been attributed to the mythical Yellow Emperor (twenty–seventh century BCE), Chinese scholars started doubting this attribution as early as the eleventh century and now usually date the Neijing to the late Warring States period (5th century–221 BCE). Because the medical "silk manuscripts" dating from around 200 BC that were excavated in the 1970s from the tomb of a Han-dynasty noble in Mawangdui are undoubtedly ancestors of the received Neijing, scholars like Nathan Sivin now argue that the Neijing was first compiled in the 1st century BCE. The Inner Canon was the result of a long developing process based Yin Yang shiyi mai jiujing (Cauterization Canon of the Eleven Vessels of the Foot and Forearm) and the Wushi'er bingfang (Recipes for Fifty-two Ailments), two of the medical manuscripts written on silk that were excavated in 1973 from a Han-dynasty tomb in Mawangdui (Hunan province).

The Yellow Emperor's Inner Canon, the oldest received work of Chinese medical theory, was compiled around the first century BCE on the basis of shorter texts from different medical lineages. Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on the relation between humans, their environment, and the cosmos, on the contents of the body, on human vitality and pathology, on the symptoms of illness, and on how to make diagnostic and therapeutic decisions in light of all these factors. Unlike earlier texts like Recipes for Fifty-Two Ailments, which was excavated in the 1970s from a tomb that had been sealed in 168 BCE, the Inner Canon rejected the influence of spirits and the use of magic. It was also one of the first books in which the cosmological doctrines of Yinyang and the Five Phases were brought to a mature synthesis.

The Neijing made a break with prior medical conceptions, in which illnesses were commonly attributed to external pathogenic factors, including ghosts. In the Neijing, most illnesses were ascribed to imbalances in the organism. It was one of the first Chinese works to integrate the mature theory of Yin-Yang and the Five Phases or Five Agents (wuxing 五行, often wrongly translated as the "Five Elements" on the basis of a false analogy with the Greek Four Elements). The contents of the HDNJ "center on the new, universal model of illness based on vessel theory along with the methods of diagnosis and treatment that accompany it."

In the centuries that followed the completion of the Yellow Emperor's Inner Canon, several shorter books tried to summarize or systematize its contents. These books were instrumental to the formation of Chinese medical doctrines. The Canon of Problems (probably second century CE) tried to reconcile divergent doctrines from the Inner Canon and developed a complete medical system centered on needling therapy. The AB Canon of Acupuncture and Moxibustion (compiled by Huangfu Mi sometime between 256 and 282 CE) assembled a consistent body of doctrines concerning acupuncture ; whereas the Canon of the Pulse (ca. 280) presented itself as a "comprehensive handbook of diagnostics and therapy."

Toward the end of the Later Han dynasty, Zhang Zhongjing (ca. 150–219), who might have been Governor (taishou 太守) of Changsha Commandery toward the end of the second century A.D., compiled a book called Shanghan zabing lun ("Treatise on Cold Injury and Miscellaneous Illnesses") sometime between 196 and 220 CE, at the end of the Han dynasty. This book's preface contains the earliest known reference to the Neijing Suwen. Focusing on drug prescriptions rather than acupuncture, it was the first medical work to combine Yinyang and the Five Phases with drug therapy. This formulary was also the earliest Chinese medical text to classify symptoms as clinically useful zheng. Soon lost in the wars that ravaged China in the period known as the Three Kingdoms, Zhang's treatise was re-constituted by Wang Shuhe (王叔和) in the 3rd century on the basis of surviving fragments. Having gone through numerous changes over time, it now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty.

The Shennong bencao jing, named after a legendary sage king, was compiled around the first century CE. Though its original text was quickly lost, it was reconstructed and expanded by Tao Hongjing, whose version formed the basis of later Chinese materia medica.

Three Kingdoms to Tang
(First paragraph still as I found it here.)

The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215–282 A.D), also quotes the Yellow Emperor in his Jiayi jing, ca. 265 A.D. During the Tang Dynasty, Wang Bing 王冰 claimed to have located a copy of the originals of the Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the eleventh century A.D., and the result is our best extant representation of the foundational roots of traditional Chinese medicine.

".... the possibly legendary figure of Hua Tuo (110–207), whose successes in surgical practice are reminiscent of similar reports of achievements by the Indian physician Jivaka. He, too, had no successor to carry on his art; the frequent references in Chinese and Western secondary literature to Hua Tuo as an early example of surgery and anesthesiology present a distorted picture of the atual significance of such practices in China."

Wind medicine

The importance of "formularies," or books of recipes

Buddhism and Indian medicine
"Only purely religious elements of Indian healing gained a foothold in China, developing into an important component of the total spectrum of available medical / care."

"The only author influenced by such concepts was Sun Simiao. Often mentioned in Western sources as an example of "the purported Buddhist influence on Chinese medicine. But no mention is made of the fact that Sun Simiao had no followers in this respect." Four-element theory had almost no impact.

"Sun Simiao's interest in the four-element doctrine remained an insignificant footnote in the history of Chinese medicine."

Song dynasty
The Song dynasty (960–1279) was a period of great transformation for Chinese medicine. Under the initiative of two emperors who were interested in medicine. The Song founding emperor Taizu (960–976), his brother Taizong (976–997), and their successor Zhenzong (997–1022) were all interested in medicine, but the revival of classical medicine (based on the Yellow Emperor's Inner Canon, or Huangdi Neijing), started in the reign of Renzong (1022–1063).

The Bureau for Revising Medical Texts
Jiaozheng yishu ju 校正醫書局

The development of printing and the diffusion of medical knowledge and techniques.

Interest of elites in medicine.

Medical governance
Treating epidemics, medical education.

Rising influence of the Suwen and the Shanghan lun.

Doctrinal integration
Integration of previous doctrines.

Public pharmacies
Check Goldschmidt on that. Unschuld calls the huimin yaoju (which he translates as "charitable apothecaries") "a scandal-ridden and limited program that never achieved more than a brief significance."

Jin physicians
Cheng Wuji

Zhang Yuansu, Li Gao, Wang Haogu

Zhang Congzheng and "attacking" cures

The Yuan synthesis
Northern medicine comes south. Zhu Zhenheng. The integration of medicine with Daoxue 道學.

Ming developments


The influence of Zhu Zhenheng

"Scholar-physicians" (Ruyi 儒醫)

New conceptions of vitality and the "Warm-replenishing" (wenbu 溫補) movement

Acupuncture marginalized?

Pharmacology

Late Ming epidemics

Qing dynasty
The crystallization of "Warm-factor disorders" (wenbing 溫病)

The Manchus and smallpox

Jesuit missionaries at the court

Nineteenth-century missionaries

Cholera and the plague

Republican China
Calls for elimination of Chinese medicine. New institutions created to support it. Government indecisive.

Reforms in Japan.

Modern acupuncture.

People's Republic of China
Much of what we know as TCM today emerged from reforms that were made in China after 1949 under the leadership of the Communist Party.

The modernization of Chinese medicine and the rise of "TCM."