History of Traditional Chinese Medicine

Traditional Chinese medicine has been influenced by historical events and by the philosophies of Confucianism. This ancient medicine has been further molded by other cultures and systems as it spreads through other countries.  I will talk about the Zhou Dynasty period and the Hans Dynasty period and events that have contributed to Traditional Chinese Medicine. I will elaborate also about the well known philosopher Confucian and his ethical beliefs that play a significant role in Traditional Chinese Medicine today.  I will also mention how Acupuncture has spread throughout the world to different countries and how it has been embraced and practiced by different cultures.

The Zhou Dynasty is divided into four periods, Western Zhou 1100-771 BC, Eastern Zhou 700-256 BC, Spring and Autumn Period 770-476 BC and the Warring States Period 476-221BC. In the Western Zhou period, two famous persons emerged from this period, one being the social reformist and teacher Confucian and the other, his contemporary Lao-zi who was the founder of Taoism.  The culture of Confucianism is affluent in its contents and is enormously important to the culture and political existence of ancient China’s vast influences, it was unmatched by any other school of thought or culture (5). Moral ethics with ‘goodness’ as its core are significant to traditional Chinese medicine (5).  Confucianism’s views on ‘kindheartedness, material interests, on good and evil and on character cultivation’ were incorporated by the medical workers and thus became important in Chinese traditional medical ethics (5).  It was evidently noticeable that the medical profession and Confucianism shared common goals in terms of ethics.

Influenced by the Confucian thinking and culture, an advanced system of Chinese traditional medical ethics began with a distinct basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history (5).  Briefly, the concepts of this system mentions – to do one’s best to heal another, to rescue the dying, to show concern for those suffering from disease, to practice medicine honestly, to study medical skills thoroughly, to comfort oneself in a stately manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc (5). During the Warring States Period, the philosophy yin/yang and wuxing was further developed and the study of their uses began to be taught in schools and was written about in books. One famous book that was written during this period was Huang Di Nei Jing (The Yellow Emperors Medicine Classic). This book is significant today and it is one of the very first brief medical writings about Chinese Medicine (2).  This book also elaborates on the theory of yin and yang and the five elements or wuxing (2).  The concept of yin and yang came from the observation of nature and its environment (2).  Yin is referred to as the shady side of a slope while yang is referred to the sunny side.  This idea was used to comprehend other things which occurred in pairs and had corresponding and opposing characters in nature e.g. night and day, fire and water, male and female.  Ancient Chinese people recognized that almost all things could have a yin and yang nature. 

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The Yin and Yang theory gradually developed into a system of thought and was applied to other areas in Chinese culture, TCM being just one example where these theories are used to determine complicated relationships in the body (2). Yin and Yang is vital to Chinese culture and has been for thousands of years.  Today, in Traditional Chinese Medicine, the theory of Yin and Yang is used to understand, diagnose and treat diseases.  Traditional Chinese Medicine practitioner seeks to balance Yin and Yang in every patient (3). The Yin Yang application in the treatment of Chinese medicine is not likely to hinder or interfere with the regular functions of the body which is an important aspect of Traditional Chinese Medicine.  Based on the interpretation and processes of the natural world, ancient Chinese people acknowledged constant patterns of alteration and changes in the universe. Initially, these observations were interpreted using yin yang logic but were later expanded and thus The Five Elements theory evolved (2). The Five Element theory maintains that substances can be separated into one of five basic elements: wood, fire, water, metal and earth, each containing their own detailed characters and properties (2). The Five Elements theory corresponds to the diverse aspects of the natural world and the body, e.g. wood corresponds to spring and wind in the natural world and to the body, it corresponds to liver, gall bladder, eyes and tendons in the body.  Fire corresponds in the natural world as Summer, Heat and growth and to the body the Heart , the Small Intestine, tongue and vessels.  Earth corresponds to the natural world e.g. Late Summer and dampness and to the body, the stomach, spleen, mouth and muscles.

 The Metal element corresponds to the natural world as West, Autumn, Dryness and to the body, Lung, Large Intestines, Nose, skin and hair.  Water corresponds to the natural world, as north, winter and cold and to the body, the kidney, bladder, ear and bones.  The Yin Yang and Five Element theory formed a system of medicine and this today, is fundamental to Traditional Chinese Medicine (2).

During the Hans Dynasty, there were several medical books and famous physicians that evolved in this period.  The medical book Shennon Bencaojing (Classic of Herbal Medicine) was labeled as one of the most important and it is well thought to be the earliest complete Chinese pharmacopoeia reference. The book contains 365 Chinese medicines where 252 were from plant origin, from animals 67 and from minerals 46.  The medicines were separated into three groups, the first being the Superior which included 120 medicines which were known to be non-toxic containing energizing substances to preserve strength. The second category of the Classic of Herbal Medicine contained 120 medicines and these were used to prevent illness and rebuild ones vitality, Panax Ginseng being one of the most famous and currently used worldwide. The third category was considered inferior medicines that were known to be toxic with side effects and were used specifically for therapeutic treatments.

Also during the Han Dynasty, several well known physicians appeared, Chunyu Yi (215-167 BC) known as the first doctor to keep records of his patients whom he treated, Guo Yu the Emperors Court Physician and Fu Weng, both famous for their skills in acupuncture and moxibustion.  The book Shanghan Zabinglun known as the ‘sage of medicine’ was written by Zhang Zhongjin (150-129 AD). This book contains important findings and treatment methods based on the opinion of the symptoms of different pathological circumstances.  The six parts of the book also correspond to the six pairs of meridians (2). Physician Hua Tuo was well-known for his skilled ability as a surgeon and his use of anesthesia.  He also suggested physical exercises for patients and invented movements that were similar to five different animals, the tiger, deer, monkey, bear and bird (2). The information in these books and the use of the herbs described as well as the type of physical exercises suggested by one of its famous physician as a form of healing, are widely used today in Traditional Chinese Medicine (2).

Acupuncture was introduced to Japan during the 6^th century through Korea and has since been practiced for over 14 centuries in this country (6). The oldest form of information recorded of any medical literature arrived in Japan from China in 562. In these literatures the use of herbal drugs and acupuncture is mentioned. (7).  Chinese medicine was brought into Japan through Korea however as direct travel became possible between the two countries,  Chinese medicine was imported directly thus Chinese Medicine began to spread in the medical arena  in Japan(7).  Over time, the technique and the way Acupuncture was practiced developed a different art and philosophy towards acupuncture.  Compared to Chinese needles, Japanese needles have a smaller gauge and are sharper causing less pain to patients. The depth of the insertion for Japanese needling is very gentle and superficial compared to Chinese needling being deeper in insertion.  With Chinese acupuncture, the use of herbs is much more integrated with treatment as compared to Japanese treatment.  Also, with Chinese Acupuncture, needles are manipulated a lot more to stimulate the flow of Qi than in Japanese acupuncture (6).

 On the other side of the globe in the medical arena of the United States, interest in acupuncture was aroused fairly late and fluctuated between the eighteenth and twentieth century.  In the early 1800s, Articles about acupuncture appeared in several U.S. medical journals.  After experimenting on prisoners, physician Dr. Franklin Baché, stated that acupuncture was, at the time, an effective pain-management technique (published in the North American Medical and Surgical Journal in 1826) (4).  In 1829, a surgical book, Elements of Operative Surgery was written containing a section outlining techniques used in acupuncture. In 1836, Dr William Markley Lee wrote a commentary in the Southern Medical Journal supporting acupuncture as a pain relief.  He also wrote a commentary “Acupuncture as a Remedy for Rheumatism” in the Boston Medical and Surgical Journal, in the same year (4).  Very little about acupuncture was mentioned until 1859, when Dr. Samuel Gross, in A System of Surgery, talked about acupuncture, saying its advantages had been overrated. In 1892, Sir William Osler wrote in his classical textbook: The Principles and Practices of Medicine that lumbar acupuncture is the most efficient treatment for managing acute pain.    Six editions were further republished for the same book by D. Appleton and Company in New York. However, acupuncture remained curbed in the academic curiosity. It wasn’t until former President Nixon’s visit to China in 1972, where acupuncture modality and practices stirred interest with the visitors from the United States.  Upon returning from China, US Major General Walter of the U.S. Air Force and physician to Nixon, wrote an article in the July 1972 issue of Readers Digest, with the heading, “I Watched Acupuncture Work,”(4).

This commentary in itself helped to popularize acupuncture in the United States. Prior to the former Presidents visit to China, James Reston, vice president of The New York Times, had an appendectomy surgery performed in Beijing, China, under acupuncture anesthesia. During his operation, he remained awake and observed the entire surgical procedure. In 1971, a New York surgeon, Dr. Samuel Rosen witnessed acupuncture being used as anesthesia during his visit to China and it was mentioned later that he was not able to explain medically what he had seen. 

Soon after, several US physicians travelled to China and witnessed successful acupuncture anesthesia for several different treatments and operations including dental extraction.  During these operations, the US physicians observed that patients were aware and reactive to the surgeons and were amazed that some acupuncture needles were inserted far from the surgical sites with no Western anatomical bearing between them (4).  In 1997, after increasing clinical evidence, acupuncture was formally recognized for its value in relieving pain, morning sickness, headaches, asthma as well as fibromyalgia by the National Institutes of Health (4). Today, thousands of open heart operations have been performed under acupuncture, with a success rate of 90%.  Young children with congenital heart problems have had successful results having had surgery under acupuncture (4).  Heart disease operations have also been performed successfully with acupuncture (4).

In conclusion, it can be summarized, that Traditional Chinese Medicine has been greatly influenced by ancient Chinas historical events and the philosophies of Confucian that has been traced back thousands of years ago.  Confucianism is the principle ethic used today in Traditional Chinese Medicine.  The theories of Yin Yang and the Five Elements that were expanded during the Warring States are significant today to Traditional Chinese Medicine.  Acupuncture has been introduced and accepted by other cultures and countries over the last few centuries and continues to be used widely as an alternative natural method of healing worldwide.

References:

1. Shen Nong. Traditional Chinese Medicine (TCM). The Zhou or Chou Dynasty approx. 1100-221BC: Available at: http://www.shen-nong.com/eng/history/zhou.html [accessed 7th November 2018]
2. Shen Nong. Traditional Chinese Medicine (TCM). Hans Dynasty 206BC – 220 AD: Available at: http://www.shen-nong.com/eng/history/qinhan.html [accessed 2nd November 2018)
3. Traditional Chinese Medicine WORLD FOUNDATION. Yin and Yang Theory: Available at:  https://www.tcmworld.org/what-is-tcm/yin-yang-theory/ [accessed 2^nd November 2018]
4. NCBI. PMC US National Library of Medicine National Institutes of Health: Medical Acupuncture. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796320/ [accessed 2^nd November 2018]
5. Guo Z. Chinese Confucian culture and the medical ethical tradition: Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376720/  [accessed 2^nd November 2018]
6. Integrative Medicine & Holistic Health Association: Available at: http://www.imholistichealth.org/the-7-key-differences-between-chinese-and-japanese-acupuncture/ [accessed 7^th November 2018)
7. National University of Health Sciences.  Korean, Japanese and Chinese Acupuncture: Available at: https://www.nuhs.edu/news/2014/8/korean,-japanese-and-chinese-acupuncture-what%E2%80%99s-the-difference/ [accessed 7^th November 2018]