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This section discusses the development of Chinese medicine from the formative period to the present, including the medieval period, the Sòng-Jīn-Yuán Period, and the Míng-Qīng Period, and the modern era.

Contents

• The Medieval Period (220–960 CE)
• The Sòng-Jīn-Yuán Period (960–1368 CE)
• The Ming-Qìng Period (1368–1911 CE)

The Medieval Period (220–960 CE)

It is a common misconception among both Chinese and Western medical historians that the development of medical theory and practice largely stagnated during China’s Middle Ages, between the third and the tenth centuries, or from the end of the Hàn to the beginning of the Sòng Dynasty. One of the reasons is that numerous texts composed during the period of division between the Hàn and Táng Dynasties were lost in political upheavals. We therefore have an incomplete literary record for China’s Middle Ages.

Moreover, at least partly because of the current popularity of acupuncture in China, as well as in the West, research on the history of Chinese medicine became focused on the formative period during the Hàn Dynasty. This period is associated with the origin and development of acupuncture and its theoretical basis, e.g., the medicine of systematic correspondences. Consequently, other traditions of Chinese medicine, such as the materia medica and formulary literature discussed below, were overlooked. This resulted in a representation of Chinese medicine skewed towards acupuncture and its theoretical basis.

Even though in the centuries following the Hàn period, acupuncture became gradually less relevant to the clinical treatment of disease, Chinese medicine as a whole appears relatively stagnant when viewed exclusively from the perspective of acupuncture. There are in fact great advances during this period in the development of medicinal formulas and other branches of Chinese medicine which contemporary scholars have begun to address.^[18]

Medieval Medical Literature

Zhēn Jiǔ Jiǎ Yǐ Jīng (针灸甲乙经 The Systematic Classic of Acupuncture and Moxibustion), circa 259 CE, by Huáng-Fǔ Mì (皇甫谧). Zhū Bìng Yuán Hòu Lùn (诸病源候论 On the Origins and Manifestations of the Various Diseases), 610 CE, by Cháo Yuán-Fāng (巢元方). Qiān Jīn Yào Fāng (千金要方 Essential Formulas Worth a Thousand in Gold), 652 CE, by Sūn Sī-Miǎo (孙思邈). Wài Tái Mì Yào (外台秘要 Essential Secrets from Outside the Metropolis),752 CE, by Wáng Tāo (王涛).

During the period of division that followed the fall of the Hàn Dynasty, the medicine of systematic correspondences was further refined, and its clinical applications were expanded considerably. Wáng Shū-Hé studied pulse diagnosis, which had first been explained consistently in the Nàn Jīng. The pulse types described in his monograph entitled the Mài Jīng (Pulse Classic) are still used in modern clinical practice. An innovation of the Mài Jīng was the establishment of 24 pulse standard pulse types labeled as slow pulse, rapid pulse, etc., rather than in the traditional descriptive way (the pulse is slow, the pulse is rapid, …). Clear and concise definitions for each pulse helped to provide a conceptual grid for the assessment of pulses. Acupuncture and moxibustion therapy also continued to make advances. In the third century, the Zhēn Jiǔ Jiǎ Yǐ Jīng (Systematic Classic of Acupuncture and Moxibustion) by Huang-Fu Mi listed 300 acupuncture points on the twelve regular channels and 49 on the two midline channels. That is, 649 of the 670 points discussed in modern literature (bilateral points are counted twice). This represented a substantial expansion over the Nèi Jīng, which contained only 295 of the current 670.^[19] Like most other medieval medical texts, Huang-Fu Mi’s work represented an elaboration of previous medical ideas but offered no radical departure from the theoretical foundations laid in the earlier Hàn period classics.

In the early seventh century, the physician Cháo Yuán-Fāng wrote the Zhū Bìng Yuán Hòu Lùn (The Origin and Indicators of Diseases), which is the earliest book to enumerate systematically the causes and symptoms of diseases. From the same period stem several outstanding prescription works that adapted many of Cháo Yuán-Fāng’s ideas about etiological categorization and reasoning, and applied them to the organization of formulas. The two most important ones are the voluminous Qiān Jīn Yào Fāng (Essential Formulas Worth a Thousand Pieces of Gold) by Sūn Sī-Miǎo and the shorter Wài Tái Mì Yào (Essential Secrets from Outside the Metropolis) by Wang Tao.^[20]

Also during the Tang period, Wáng Bīng (王冰) produced a revision of the Sù Wèn (Elementary Questions) that notably included the addition of a highly complex body of knowledge, allegedly handed down from antiquity, explaining the relationship between illness and occurrences of summerheat, dampness, wind, dryness, cold, and heat in the course of the four seasons and over the years. This theory became formalized as the five periods and six qì doctrine (五运六气 wǔ yùn liù qì).^[21]

As a final note, it is important to take account of different ways in which the Western and Chinese medical experts have expressed and managed theoretical and practical innovation and progress in their respective traditions.

Throughout this book, we repeatedly point to a salient difference between East and West. Western science, since Greek antiquity, has followed an ideal of progress where researchers strive to validate their personal achievements by presenting their ideas as innovative and radically different from older ideas. In contrast, Chinese physicians traditionally tried to present their ideas, not as innovations and radical departures from the past, but rather as a return to the intuitive wisdom of the ancient sages or as additional elaborations of prior teachings whose meaning may have become obscure in the current understanding. Thus, the medieval authors primarily published annotated collections, syntheses, and commentaries on the literature from the previous period. At first sight, these might not appear to our modern eyes as significant new developments of great creativity. Nevertheless, they were just as innovative and influential for the development of Chinese medicine as those of the previous centuries or the following period from the Song to the Yuan dynasties.

The Sòng-Jīn-Yuán Period (960–1368 CE)

This period of roughly 400 years from 960 to 1368 CE covers the rise and fall of the Sòng Dynasty, followed by foreign invasions such as that of the Jurchens who founded the Jin dynasty, and the Mongols who founded the Yuán Dynasty. It was a time of great economic and social transformation, which resulted in urbanization, economic specialization, a breakdown of the old aristocratic social order, and rapid developments in agriculture and industry.

The development of neo-Confucianist (理学 lǐ xué) movement during the Sòng Dynasty (960–1279) encouraged in-depth investigation of individual natural phenomena to understand the operation of cosmic principles as concrete manifestations of qì. In medicine, intensive efforts were made to verify the validity of the systems of correspondence by extending them to medicinal therapy. In this process, Zhāng Jī’s Shāng Hán Lùn, which had developed a system for analyzing febrile disease based on the six levels of penetration, attracted new interest. Before the Song, fewer than ten works had followed Zhāng Jī’s integration of medicinal therapy with the principles of systematic correspondence. It was in the Song period that Zhāng Jī’s approach became accepted into the medical mainstream.

Flavors in the Five Phases
Phase	Flavor	Viscus (dispatch house)
Wood	Sour	Liver
Fire	Bitter	Heart
Earth	Sweet	Spleen
Metal	Acrid	Lung
Water	Salty	Kidney

Since antiquity, the qualities of edible substances had been determined by their flavors and nature (nature here meaning the degree of heat or cold). In the theoretical literature, these qualities had been discussed as abstractions and in terms of their significance for dietary therapy. The Huáng Dì Nèi Jīng stated merely that Heat is treated with cold; cold is treated with heat. In the late Song, authors finally integrated the accumulated wealth of information on the flavors and natures of hundreds of medicinal substances into the yīn-yáng and five-phase framework. Medicinals were now described in terms of the five flavors paired with the five-phase system and in terms of hot and cold properties paired with yáng and yin.

The Sòng-Jīn-Yuán period brought a great flowering of specialized technical literature in many branches of medicine. In what follows, we briefly present the main figures of this period and their work.

Chén Wú-Zé (陈无择) wrote Sān Yīn Jí Yī Bìng Zhèng Fāng Lùn (三因极一病症方论 Unified Treatise on Diseases, Patterns, and Remedies According to the Three Causes). This introduced the notion of three different classes of disease causes: internal causes, external causes, and causes neither internal nor external. Internal causes were the seven affects. External causes were external evils. Causes neither internal nor external included dietary irregularities and trauma.

Liú Wán-Sù (刘完素) developed the ideas of pathomechanisms and the five periods and six qì contained in Wáng Bīng’s edition of the Nèi Jīng. He proposed a fire-heat theory to explain the notion that most diseases were attributable to fire and should be treated using cold and 2cool medicinals. He initiated what is called the Cold-Cool School (寒凉派 hàn liáng pài).

Zhāng Cóng-Zhèng (张从正) proposed that most diseases were attributable to an external invasion of evils and that when evil qì was dispelled, right qì was quieted. He objected to the excessive use of supplementing medicinals and principally based his treatments on the use of medicinal substances that caused sweating, vomiting, or precipitation (downward purging). He initiated what came to be known as the Offensive Precipitation School (攻下派 gōng xià pài) for its concentration on medicinal formulas that purged the body of evils by freeing the stool.

Lǐ Gǎo (李杲), also known as Lǐ Dōng-Yuǎn (李东垣), concentrated his studies on the stomach and spleen, and proposed that damage to the spleen and stomach was the cause of most illnesses. Thus, he based his treatments on supplementing this pair of organs. He initiated the school that came to be known as the Earth-Supplementing School (补土派 bǔ tǔ pài) or Spleen-Stomach School (脾胃派 pí wèi pài).

Sòng-Jīn-Yuán Medical Literature

Sān Yīn Jí Yī Bìng Zhèng Fāng Lùn (三因极一病证方论 Unified Treatise on Diseases, Patterns, and Formulas According to the Three Causes), 1174, by Chén Yǎn (陈言, also called Chén Wú-Zé 陈无择) Sù Wèn Xuan Ji Yuan Bing Shi (素问玄机原病式 Exploration of Elementary Questions and Pathomechanisms), Liú Wán-Sù (刘完素, also called Liú Hé-Jiān 刘河间), 1188 Rù Mén Shì Qīn (儒门事亲 Confucian Service to Parents), Zhāng Cóng-Zhèng (张从正, also known as Zhāng Zǐ-Hé 张子和), 1156-1228 Pí Wèi Lùn (脾胃论 On the Spleen and Stomach), Lǐ Gǎo (李杲 also called Lǐ Dōng-Yuán 李东垣), 13th century Gé Zhì Yú Lùn (格致余论 Inquiry into the Properties of Things), 1347 CE, by Zhū Zhèn-Hēng (朱震亨, also known as Zhū Dān-Xī朱丹溪)

Zhū Zhèn-Hēng (朱震亨), better known as Zhū Dān-Xi (朱丹溪), proposed the notion that yáng is often superabundant, and yīn is often insufficient. He recommended the use of yīn-nourishing medicinals and founded what is called the Yīn-Nourishing School (养阴派 yáng yīn pai).

The last four physicians mentioned—Liú, Zhāng, Lǐ, and Zhū—are known as the Four Great Physicians of the Jin-Yuan (金元四大家 jīn yuán sì dà jiā). Even though each of them offered different explanations of pathology and different approaches to treatment, the common trait shared by all was their specialized focus on a single etiology or treatment as the vehicle for expressing innovative ideas and contributing to the general development of Chinese medicine.

A further noteworthy event in the Yuán Dynasty was the appearance of a book called Áo Shì Shāng Hàn Jīn Jìng Lù (敖氏伤寒金镜录 Áo’s Cold Damage Golden Mirror Record), which is believed to have been the first systematic description of tongue conditions. It was discovered by Dǔ Qīng-Bì (杜清碧), who added 24 tongue drawings to the original 12, and published it in 1341. It was not until the Míng Dynasty that tongue diagnosis, now an important element of the four examinations, began to be integrated into mainstream medicine.

The Ming-Qìng Period (1368–1911 CE)

The Míng Dynasty was a high point in medical literature. A major publication was the Běn Cǎo Gāng Mù (本草纲目 Comprehensive Materia Medica) written by Lǐ Shí-Zhēn (李时珍) and first printed in 1590. It presented not only a comprehensive summarization of the pharmaceutical knowledge of its time, but it also contained voluminous information on every aspect of the natural sciences: botany, biology, geology, geography, and agriculture, to name just a few.

A truly monumental achievement, its significance reaches far beyond its pharmaceutical use. It discusses 1,892 medicinal substances and contains over 1,000 illustrations and over 11,000 medicinal formulas. The individual entries for each medicinal include explanations of names, extensive discussions of regional and other varieties, historical uses, information about nature and flavors, medicinal usage and major formulas, as well as instructions on cultivating, harvesting, storing, and processing. Similarly, comprehensive works were also produced in the field of acupuncture.

Lǐ Shí-Zhēn is also noted for Bīn Hú Mài Xué (滨湖卖学 Bīn-Hú Sphygmology), which appeared years before the Běn Cǎo Gāng Mù in 1564. This book, based on the the Nèi Jīng and the Mài Jing` and numerous other sources, represented a culmination of clinical knowledge about the pulse.

Up to this time, Zhāng Jī’s Shāng Hán Lùn had constituted the only theory-based understanding of febrile diseases. Zhāng’s understanding of these diseases was based on the notion that they were predominantly caused by wind and cold, hence the title of his book, On Cold Damage. However, another cause of febrile disease, warm evil (温邪 wēn xié), had been mentioned in the Nèi Jīng and was recognized by Zhāng Jī. In the Míng Dynasty, writings on warm diseases became more plentiful. This development appears to have been attributable on the one hand to the opening of south China where febrile diseases tended to be different than in the north, and on the other hand to the pestilences arising as a result of wars.

In this period, Wú Yǒu-Xìng (吴有性) wrote Wēn Yì Lùn (瘟疫论 On Warm Epidemics, 1642) which explained in detail the laws governing the origin, development, and pattern identification of warm epidemics. He notably posed the etiological notion of a contagious perverse qì (疠气 lì qì). This notion represented a break from the traditional conception of febrile diseases as caused by climatic influences (e.g., the wind and cold of the cold damage school) and made a significant contribution to the foundation of the doctrine of warm diseases.

In the Qìng Dynasty, a comprehensive doctrine of warm diseases began to emerge. Ye Tian-Shi (叶天士) published the Wēn Rè Lùn (温热论 On Warm Heat, 1746) which introduced the four-aspect pattern identification system by differentiating defense, qì, provisioning,^[22] and blood. The physician Xuē Xuě (薛雪) in the Shī Rè Tiáo Biàn (湿热条辨 Systematized Identification of Damp-Heat, 1831) described damp-heat disease patterns in detail. Finally, in the Wēn Rè Jīng Wéi (温热经维 Warp and Weft of Warm Heat, 1852), Wáng Shì-Xióng (王士雄) brought together all the theories of his predecessors in a complete doctrine of warm diseases.

Lastly, we should mention the Yī Zōng Jīn Jiàn, Golden Mirror of Medicine (医宗金鉴 by Wú Qiàn (吴谦) et al., which was published in 1742. This comprehensive work covers numerous branches of medicine and includes the texts of numerous previous works including the Shāng Hán Lùn and Jīn Guì Yào Lüè.

Míng-Qīng Medical Literature

Bīn Hú Mài Xué (滨湖卖学 Bín-Hu5 Sphygmology), 1564, by Lǐ Shí-Zhēn (李时珍) Běn Cǎo Gāng Mù (本草纲目 Comprehensive Materia Medica, 1590, by Lǐ Shí-Zhēn (李时珍) Wēn Yì Lùn, On Warm Epidemics (瘟疫论), 1642, by Wú Yǒu-Xìng (吴有性) Wēn Rè Lùn, On Warm Heat(温热论), 1746, by Yè Tiān-Shì (叶天士) Shī Rè Tiáo Biàn, Systematized Identification of Damp-Heat(湿热条辨), 1831, by Xuē Xuě (薛雪) Wēn Rè Jīng Wèi, Warp and Weft of Warm Heat (温热经维), 1852, by Wáng Shì-Xióng (王士雄) Yī Zōng Jīn Jiàn, Golden Mirror of Medicine (医宗金鉴), 1742, by Wú Qiàn (吴谦) et al.

As many examples have shown, a key point in the history of Chinese medicine is that it was never an integrated system. It has always been an accumulated body of knowledge. Although new insights continually appeared, older ones were not discarded. Thus, as time went on, the earlier classics gained rather than lost in value, and the formative period of Chinese medicine came to be seen as a golden age unsurpassed by later generations. Two notions basic to the modern Western sciences, including Western medicine, failed to ever develop in Chinese medicine. One is that any explanation of a phenomenon or any justification of a treatment must be demonstrable by repeatable experiment. The other is that the simultaneous existence of two different theories concerning a single phenomenon necessarily means that at least one of them is wrong. This fundamental difference between Chinese and Western scientific thinking in the structure of Chinese medical knowledge only gained the attention of Chinese medical thinkers when Western learning began to enter China in the 19th century. For further discussion of this, see Pragmatism, Empiricism, and Trial and Error in paradigms.

Links to Other Periods

• History 1: The Formative Period
• History 2: The Early Medical Classics
• History 4: The Modern Era (1911–present)
• History 5: Internationalization

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