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Theory and Classification in Traditional Chinese Medicine and the Development of Traditional Chinese PharmacologyBeginning from the Zhou Dynasty, traditional Chinese medicine (TCM) was divided into nutriology, internal medicine, surgery, and veterinary medicine. During the Tang period, further division appeared, such as internal medicine, surgery, pediatrics, ENT, external therapy, acupuncture, massage, witchcraft and incantation. More professional medical sciences appeared during the Song period. Apoplectic science, ophthalmology and gynecology were developed on the basis of Tang Dynasty classifications. In later dynasties, these classifications were preserved and further developed. Fundamental TCM Theory Legend has it that the ancient "Shen Nong tasted a hundred species of herbs and almost 70 species of poisonous plants a day." Some plants proved harmless and actually beneficial to man's health, capable of alleviating the seriousness of illness and restoring health. Repeated experience brought knowledge, which was passed down through the ages. This simple accumulation of experiences brought about the birth of the earliest Chinese science of medicine and knowledge of health preservation. This is regarded as the stage of "cognition of medicine and food." During the Xia Dynasty (c.21st century to c. early 17th century BC), alcohol was produced and used to treat diseases. During the Shang Dynasty (c. early 17th century to c. llth century BC) medicinal herb decoctions were being produced. During the Western Zhou period (c.11th century to 771 BC), professional doctors appeared, dealing with nutriology, internal medicine, traumatology and veterinary medicine. The Book of Rites records five categories of medicine: herbs, wood, insects, stone and grains. The Book of Songs tells of more than 50 species of plant which can be made into medicines, while the Classic of Mountains and Rivers records 126 kinds of medicine. During the Western Zhou period, a connection was found between some diseases and the change of seasons. People learned that the spread of disease could be increased by an abnormal climate and that epidemic diseases were infectious. During the spring and Autumn Period (770-476 BC), Yi He, a famous doctor of the State of Qin, created the theory of "six climatic conditions as the pathogenic factors of disease," believing that excess of any of the six climatic conditions (cloudy, sunny, windy, rainy, dark and bright) was the cause of disease. It was on this concept that the later theory of pathogenic wind, cold, dryness, humidity, fire and heat was based. According t6-textual research, by the end of the period of primitive society, people already knew how to prevent or treat diseases by expelling pathogens and taking exercise. Historical documents refer to a kind of dance to treat diseases. This "dance" became a prototype of the later therapeutic methods for expelling pathogens, by which people could relax their muscles and tendons to promote blood circulation and improve breathing. A jade pendant dating back to 380 BC is engraved with a description of the process and function of the promotion of Qi (vital energy, associated with breath): "The way to promote Qi is to take a deep breath and hold it. The retained breath can move, ex tending to the lower part of the body, where it can be settled and stabilized. As it is stabilized, it can develop and grow, and as it grows, all pathogenic evils will be expelled. The breath goes up and down naturally and smoothly to produce vitality. If one stops doing this, it will not work." Thus, methods of promoting and controlling Qi already existed in the early Warring States Period. During the Spring and Autumn and the Warring States periods, the newly emerging relations of production under feudalism promoted the rapid development of the productive forces. It was under these conditions that TCM and health-preserving science formed their systematic theories. The Yellow Emperor’ Classic of Internal Medicine, China's first classic book of medicine, was published at this time, creating a comprehensive theoretical system of TCM and health-preserving science. Before the publishing of the classic, TCM and health-preserving science were still being developed in practical experiments. The Yellow Emperor’ Classic of Internal Medicine, despite its name, was actually the result of a joint effort by many physicians of the period. It is divided into two parts: "Plain Questions" and "Miraculous Pivot," involving a total of 168 essays in 18 volumes. "Plain Questions" mainly relates the basic theories of physiological, pathological and medicinal therapeutic science, while "Miraculous Pivot" deals mainly with the theory of acupuncture and moxibustion, channels, collaterals and anatomy. The book's achievements are:
Another medical classic is Emperor Shen Nong's Materia Medica, which summed up the experiences of the ancients living before he Qin and Han dynasties in the use of herbal medicines. It is composed of three volumes, describing the use of 365 species of medicinal herbs, which arc divided into three classes according to their toxic and curative effects. The first class, involving 120 species of non-poisonous herbs, may be used as tonic medicines. The second class of 120 varieties of poisonous or non-poisonous herbs may be used as medicines for treating diseases or as tonics, and the third class of 125 varieties of poisonous herbs as therapeutic medicines to relieve exterior pathogenic evils. These are the original classifications of medicines in ancient China. It also made a summary of the theory of medicinal formulae as "principals, associates, adjuvant and massagers" (the different roles played by different ingredients of a prescription) and the theory of "four natures of drugs" (cold, hot, mild and cool) and "five flavors of drugs" (pungent, sour, sweet, bitter and salty). Pathogenic cold should be relieved with heat-producing drugs, while pathogenic heat should be treated with cold-producing drugs. It closely relates the natures of different drugs to particular pathogenic factors, completing the therapeutic theory of TCM and laying a foundation of the development of Chinese herbal science. Other medical classics, such as the Treatise on Febrile and miscellaneous Diseases, performed the transition from theory to clinical practice. The book was written by the celebrated physician Zhang Zhongjing at the end of the Eastern Hart Dynasty (25-220), based on ancient medical instructions and a broad study of many others' Medical formulas. Unfortunately, the original work, comprising 16 volumes, was lost in the turbulence of wars. What remained was later compiled, edited and revised into two books: Treatise on Febrile Diseases and synopsis of the Golden Chamber. The former mainly relates the pathogenic factors and dialectical therapy of various kinds of acute febrile diseases, while the latter deals mainly with internal diseases as well as gynecological and pediatric diseases, surgery and ENT diseases. Its prescriptions are still used in clinical practice. Zhang was the first person ever to propose the four methods of diagnosis: observation (of the patient's complexion, expression, movements, tongue, etc.) auscultation and olfaction, interrogation, and pulse feeling and palpation. He also introduced the diagnostic method based on the "eight principal syndromes" (Yin and Yang, exterior and interior, cold and heat, and deficient and excessive), on which much of TCM is based. This book integrated the basic theory of the Classic of Internal Medicine with clinical practice, becoming one of the most influential works of TCM. Wang Shuhe, of the Western Jin (265-316), was not only versed in the medical classics but also in the ways of self-cultivation. One of his contributions was compiling and editing the Treatise on Febrile and Miscellaneous Diseases, which otherwise would not have been handed down to the present day. He also wrote and compiled the book Pulse Classic. This is the earliest treatise in China on the study of the pulse, giving a profound explanation of how various forms of pulse are related to different syndromes of diseases. Twenty-four variations of pulse conditions were classified, systemizing pulse, diagnostic theory and therapy in a way that could be readily applied to clinical practice. The work has occupied a very important position in TCM diagnosis. During the Sui Dynasty (581-618), Chao Yuanfang was commissioned by the imperial court to edit and compile the book, Treatise on the Causes and, symptoms of Diseases. This was the first treatise in China on the pathogenic causes and symptoms of disease. It analyzed the causes of various diseases and proposed a number of creative ideas, breaking away from some of the theories of his predecessors. Wang Bing of the Tang Dynasty (618-907) proposed the doctrine of the motion of the Five Elements (metal, wood, water, fire and earth) and Six Natural Factors (wind, heat, mildness, fire, dryness and cold), describing how to detect the development and the degree of seriousness of a disease, its method being somewhat similar to Arabian astrology. This doctrine was further developed during the Song Dynasty (960-1279), combining the Heavenly Stems and Earthly Branches (a system of numbering years) with the motion of the Five Elements and Six Natural Factors. Using this system, one could detect and calculate a certain year that might be affected by a certain natural factor, during which people would be most liable to contract a certain disease. This was based on the theory that the causes of diseases and their treatment are closely linked to the environment, climate and seasons. From this, the principles and methods of therapy could be worked out. Internal Medicine During the Jin and Tang periods, although the terminology of internal medicine was unknown, some medical literature contained a number of descriptions about the understanding of internal diseases and their prevention and treatment. The books Essential Prescriptions Worth a Thousand Pieces of Gold, by Sun Simiao (581-682), and Medical Secrets of an Official, by Wang Tao (670-755), are two voluminous works of the Jin and Tang periods, giving many descriptions of internal diseases. The books Peaceful, Holy, Benevolent Prescriptions and General Collection for Holy Relief are medical formularies compiled and edited by a staff of court physicians during the Song Dynasty. The categorization of diseases in these systematic and succinct books proved to be very valuable in clinical practice. The book Summary of Internal Diseases by Xue Lizhai (1488-1558), a celebrated specialist in internal and miscellaneous diseases of the Ming Dynasty (1368-1644), was the first Chinese publication to use the term "internal disease" in its title. The book's descriptions of diseases are illustrated by cases from clinical practice, promoting the development of studies on internal and miscellaneous diseases. The features of the studies on internal medicine during the Ming and Qing (1644-1911) dynasties include controversies among various academic schools of medical science focusing on theories, ancient medical doctrines and clinical practices and experiences. Surgery and Osteology Hua Tuo, the best-known medical specialist of the Eastern Han period, is honored as the founder of surgery in China. He is credited as the first to use the drug "Mafeisan" as an anaesthetic agent and is regarded as a pioneer in surgical treatment. Liu Juanzi's Remedies Left by Ghosts was written during the Jin Dynasty and later revised and edited. It is the earliest treatise on surgery in China. During the Song and Yuan (1271-1368) dynasties, a number of important works on surgery were published, such as the Tested Formulae for Deep-Rooted Furuncles on the Back by Li Xun, the Essence of External Diseases by Qi Dezhi, and the Essence of Diagnosis and Treatment of External Diseases by Chen Ziming. The book Effective Formulae Handed Down for Generations, by Wei jinglin, is the most detailed extant Chinese medical publication on osteology. It gives a detailed account of the fractures of the limbs and dislocation of joints, fractures of the spine, wounds and sprains, arrow wounds, and relocation and treatment. Many therapeutic methods and tools are described. The book gives the first description of treating a broken spine by hanging up the body. It also describes methods of anesthesia. Wang ji, of the Ming Dynasty, had presented many insights on medical theory, based on his studies. He summed up the results of his research on surgery in 1519 in the book Theory and Case Reports on External Diseases. Other important works included the Manual of External Diseases, by Wang Kentang, and the Orthodox Manual of External Diseases, by Chen Shigong. Obstetrics and Gynecology Obstetrics and gynecology became an independent science in the Song Dynasty, a special department being created in the Bureau of Imperial Physicians. Ten Problems in Obstetrics, by Yang Zijian, explains ten forms of normal and abnormal childbirth, based on clinical experience. Incase () f an abnormal childbirth, methods of diagnosis and treatment are given, including the turning of the infant in the womb. Chen Ziming was not only a surgeon, but also a very good obstetrician-gynecologist. His book Complete Effective Prescriptions for Women gives a full account of the causes and symptoms of obstetric and gynecological diseases and their treatment. Other works like the Treatise on Obstetrics, by Li Shisheng, the Collection of Treasured Experiences in Obstetrics, by Guo Jizhong, and the Treasured Handbook for Household Hygienic Obstetric, by Zhu Ruizhang, all made important contributions to obstetrics and gynecology in China. Pediatrics Although there had been previous monographs on the subject, pediatrics reached a new high level in the Northern Song Dynasty with Qian Yi's Key to Treatment of Children’s Diseases. This is the oldest surviving treatise on pediatrics in China. The book was edited and compiled by Yan Xiaozhong, a student of Qian Yi, based on his teacher's theories and 40 years of clinical experience. It stresses the physiological and pathological differences between children and adults and describes dialectical methods of treatment based on the five key internal organs. It also presents a number of new prescriptions. Qian is honored as the founder of pediatrics in China. Remedy Prescriptions for children’s Macula Disease written in the Northern Song Dynasty by Dong Ji was the first monograph in China on the disease. Acupuncture and Moxibustion In the voluminous Classic of Acupuncture and Moxibustion, the Western Jin physician Huangfu Mi systemized and substantiated the theory of acupuncture and moxibustion, laying the foundations for later development of the science. During the Song Dynasty, Wang Weiyi created a bronze figure to demonstrate the acupuncture points and wrote the Illustrated Manual of Acupoints, greatly promoting the development of the science. Xu Feng, a famous specialist of acupuncture and moxibustion in the Ming Dynast, wrote A Complete Handbook on Acupuncture and Moxibustion. Gao Wu's Collection of Gems in Acupuncture and Moxibustion reflects the comparatively high level of the science in the middle of the Ming period, making new contributions to the development of the science. A Great Compendium of Acupuncture and Moxibustion, written by Yang Jizhou of the Ming Dynasty, greatly influenced succeeding generations. Pharmacology Prior to the Qin Dynast), the desire of rulers to achieve immortality led necromancers to produce so-called panaceas, based on metallurgical techniques. Thus, alchemy was born. The book Kinship of the Three and the Book of Changes written by Wei Boyang of the Eastern Hart period is the earliest extant document of alchemy in the world. It is now universally accepted that China is the birthplace of alchemy, the forerunner of chemistry. During the Jin Dynasty, alchemy was widespread. The Works of Master Bao Pu, by Ge Hong, contains some articles on the practice of alchemy, including the equipment needed and formulae. Improvements were made during the Tang Dynasty. Alchemists at that time were producing calomel, Hongshendan and Baijiang dan for treating dermatosis; similar kinds of drug are still used today. Medicinal Preparations One of the key approaches of Chinese medicinal preparations is the roasting and boiling of medicinal herbs. Records of these methods can be found in the Classic of Internal Medicine. Formulae listed in such publications as the Treatise on Febrile Diseases and the Synopsis of the Golden Chamber recommended that ingredients be roasted and boiled. During the Song Dynasty (420-479) of the period of the Southern Dynasties, based on previous experience, Lei Xiao edited and compiled three volumes of Lei's Treatise on the Preparation of Drugs, the earliest monograph on the subject in China. Lei was the founder of drug preparations. His book had a great in the Ming Dynast, wrote A Complete Handbook on Acupuncture and Moxibustion. Gao Wu's Collection of Gems in Acupuncture and Moxibustion reflects the comparatively high level of the science in the middle of the Ming period, making new contributions to the development of the science. A Great Compendium of Acupuncture and Moxibustion, written by Yang Jizhou of the Ming Dynasty, greatly influenced succeeding generations. Pharmacology Prior to the Qin Dynasty, the desire of rulers to achieve immortality led necromancers to produce so-called panaceas, based on metallurgical techniques. Thus, alchemy was born. The book Kinship of the Three and the Book of Changes written by Wei Boyang of the Eastern Hart period is the earliest extant document of alchemy in the world. It is now universally accepted that China is the birthplace of alchemy, the forerunner of chemistry. During the Jin Dynasty, alchemy was widespread. The Works of Master Bao Pu, by Ge Hong, contains some articles on the practice of alchemy, including the equipment needed and formulae. Improvements were made during the Tang Dynasty. Alchemists at that time were producing calomel, Hongshendan and Baijiang dan for treating dermatosis; similar kinds of drug are still used today. Medicinal Preparations One of the key approaches of Chinese medicinal preparations is the roasting and boiling of medicinal herbs. Records of these methods can be found in the Classic of Internal Medicine. Formulae listed in such publications as the Treatise on Febrile Diseases and the Synopsis of the Golden Chamber recommended that ingredients be roasted and boiled. During the Song Dynasty (420-479) of the period of the Southern Dynasties, based on previous experience, Lei Xiao edited and compiled three volumes of Lei's Treatise on the Preparation of Drugs, the earliest monograph on the subject in China. Lei was the founder of drug preparations. His book had a great influence on later generations and the 17 TCM roasting and boiling methods were developed on the basis of it. Chinese Herbal Medicine - The development of materia medica constitutes an important part of Chinese medicine. During the Southern and Northern Dynasties, on the basis of Shen Nong’s Materia Medica, the famous medical and health-preservation expert Tao Hongjing edited and compiled three volumes of the Collective Notes to the Materia Medica, to which he added the "Records of Famous Physicians." It was on the basis of Tao's work that the Tang Dynasty Newly Revised Materia Medica was completed. It was the first pharmacopoeia to be published by a government in China and also the earliest state pharmacopoeia in the world. Medicine was given a position of great importance by the emperors of the Northern Song Dynasty. From the sixth year of the Kaibao reign period (973), the imperial governments organized a series of revisions of publications on materia medica over a period of more than 140 years. These included the Kaibao Materia Medica and Jia You's Supplementary Notes to Shen Nong's Materia Medica. The Illustrated Canon of Materia Medica was the first block-printed illustrated medicinal publication in China. It focuses on the discrimination of medicinal plants and each species in the book is illustrated and explained. The great pharmacologist Li Shizhen of the Ming Dynasty developed the science of materia medica to a new height. In his book Compendium of Materia Medica, he gave a detailed account of the properties, flavor, origin, shape, way of collecting, process of preparation, pathological study and prescription of each species of herbal medicine. Li corrected many mistakes in the discrimination of drugs, which had appeared in past works. He classified herbal medicines into 16 groups according to their natural origin and properties. Within each of these groups are subdivided into 60 sub-groups, making a creative contribution to drug classification. During the Qing Dynasty, Zhao Xuemin's Supplement to the Compendium of Materia Medica was a further improvement on the Compendium of Materia Medica.
Cultural Features of Chinese Medicine
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