Traditional Chinese Medicine (TCM) – History and Practice

The earliest evidence of Chinese Medicine can be found in the Early Stone Age.

Even though the onset of the Chinese medical history was decidedly influenced by shamanic beliefs and practices, it slowly and increasingly incorporated empirical, medical- biological experience and approaches:

Pulse taking, tongue diagnosis, the teachings of Yin and Yang, the Five Elements, the physical substances and the organs were included into the existing Taoist and Confucian medical models.

Traditional Chinese Medicine (TCM), in the way it is understood today, as the sum of numerous diagnostic, therapeutic and philosophical concepts, began at the earliest in the Xia Dynasty (2205 - 1766 BC) and no later than in the Shang Dynasty (1766-1122 BC).

The basis of the traditional medical understanding was- and remains until today- the notion that human beings are embedded in their natural environment, as well as connecting observations of nature to cosmological and geomantic ideas. The first written records of Chinese healing arts originate from the 14th to the 13th century BC, but do not yet contain medical contexts or insights.

The fundamental teaching of Yin and Yang, which forms the basis for the entire Eastern medical tradition, was first described in approximately 700 BC in the "Book of Changes" (Yi Jing -I Ching-). The oldest medical reference book, the "Yellow Emperor's Classic of Internal Medicine" (Huang Di Nei Jing), probably originated between 475 and 221 BC (Warring States Period).

In the dialogue between the legendary Yellow Emperor (Huang Di) and the (divine) doctor Qi Bo, the essential and basal perceptions of Traditional Chinese Medicine were propounded for the first time; ideas that are still today valid in the traditional Far Eastern medicine.

In the following centuries the previously existing knowledge was systematised and complemented. In this way the "Classic of Difficulties" (Nan Jing) which is attributed to Bian Que (approx. 500 BC), comments and completes passages that are difficult to understand in the Huang Di Nei Jing (the Yellow Emperor).

Huang Tuo (141-212) first began using acupuncture and herbs for anaesthesia during surgical procedures. Zhang Zhong Jing (150-219) is regarded as the founder of differential diagnosis in TCM. His book on cold influenced diseases Shang Han Lun -The Wellsping of Chinese Medicine) is still valid today.

From the 3rd century stem: a fundamental work on moxibustion and emergency medicine- the Zhou Hou Bei Ji Fan (prescription for emergency Medicine attributed to Ge Hong),  and the Mai Jing (the pulse classic) which describes the possibilities of pulse taking in great detail. However, Bin Hu is regarded as the "father of the pulse". He lived in the 5th century BC and had already established diagnoses with the help of pulse taking.

The first reliably dateable classic work which exclusively focuses on acupuncture and moxibustion Zhen Jiu, (The Great Compendium of Acupuncture and Moxibustion), also originated in the 3rd century AD and systematically summarises the existing knowledge on acupuncture and moxibustion.

In his writings, Sun Si Miao, a famous physician of the early Tang Dynasty (618-907), deals with the key questions of contemporary healing arts. He is the first to mention to the Ashi points, the painful points on the body that can be included in acupuncture treatments.

During the Tang Dynasty (618-907) acupuncture, moxibustion and pharmacology for the first time became independent and distinguished disciplines. Medicine acquired to some extent official scientific status.

At the beginning of the 7th C, upon imperial decree, the first school for medical training was established. The training consisted in the general healing arts (which included surgery, paediatrics, moxibustion, ophthalmology, nose and throat medicine and dental treatment), acupuncture, healing massage, as well as "magical spells" (that mainly originated in Buddhist practice).

The introduction of state exams in 1188 gave rise to the title of: "officially certified physicians" (Ru Yi), "ordinary medical practitioner" (Yong Yi) and "traveling doctors" (Chuan Yi).  Social ranking gave higher status to these state- certified doctors. This form of social differentiation of the medical profession remained until the end of the last imperial dynasty in 1911.

1341 saw the emergence of "The Exposition of the 14 Main Meridians" (by Huo Boren) and approximatively two hundred years later the "Studies on the Eight Extraordinary Meridians" (Xu Feng 1439), both textbooks whose statements are still valid today.

During the time of the Jin (1115-1234) and Yuan Dynasty (1274-1368) there were four famous schools that each set a slightly different therapeutic focus. Their respective traditions were reflected up to modern times in the schools of Li Dong Yuan ("School of the Middle" or "Earth- nourishing school"), Zhu Dan Xi ("Yin Nourishing School") , Zhang Zi He ("Purging/detoxification school") and Liu Wan Su ("Cold and Coolness school).

1530 the "Concerning Acupuncture and Moxibustion" (by Wang Ji) was published and with the publication of "The Source of Acupuncture and Moxibustion", as well as 1817 (Li Xuechuan) with the systematic listing of the 361 acupuncture points on the 14 meridians, acupuncture reached another point of culmination. Through the loss of the tradition, however, its public recognition declined so far during the Qing Dynasty (1644-1840) that in 1822 the department for acupuncture and moxibustion in Peking was closed. It was no longer recognised in the imperial court as adequate therapeutic approach for the emperor. Hence began the decline of the Traditional Chinese Medicine that had known its peak especially in the time of the Ming Dynasty (1368-1644).

The last important works published were "The Golden Mirror of Medicine" (by Wu Qian) a compendium of the traditional healing arts with a particular emphasis on herbal medicine and in 1642- to complement the differential diagnostic work "discussion Cold Induced Illnesses" by Zhang Zhong Jing- the paper on the "dispelling of febrile diseases".

Surgery (Wai Ke) only takes a marginal position in Chinese medicine. Its developing approaches were never consistently pursued and surgical interventions rarely mentioned. Hua Tuo (141-212) was the first Chinese doctor, who carried out surgeries making use of medicinal anaesthetics. Chen Shi Gong (1555-1636) also became known as surgeon. His "Standard textbook on surgery" (Wai Ke Zheng Zong) also contains an ethical codex for physicians, the so-called "Five Prohibitions":

  • Never to be late when one is called to a patient, whether he is rich or poor and to administer the necessary medicine or treatment with or without payment.

  • Never to examine a woman, girl or nun without the presence of a third person and to observe confidentiality.

  • Never to substitute the valuable components of medicine by inferior ones.

  • Never to leave the practice during consultation times for the purpose of leisure and pleasure and to personally attend the patient, to carefully and legibly issue the recipes.

  • Never to have immoral thoughts, when the patient is a prostitute or the mistress of a man; to treat these people as respectable people too, to leave the house of the patient immediately after the treatment and only to return upon request.

The Shennong Bencaojing (Classics of Shennong for Herbal Medicine or the Divine Farmer's Herb-Root Classic) is seen as basis of Chinese traditional herbal therapy (Zhong Cao Yao) and is attributed to the brother of the Yellow Emperor. Research however, dates it in the period between the second century before and the second century after the birth of Christ.

This early work on herbal therapy, which later authors repeatedly refer to, lists the names and possible applications of the known "medicinal herbs", which may indeed also emanate from animal origin.

Initially pharmacology was mainly still classified with magical- religious medicine and up to modern times did herbalism remain in its social rank behind acupuncture and moxibustion, because it was mainly used by the wandering doctors,

The knowledge of herbal therapy was passed on throughout many generations of doctors, reviewed and re- evaluated, by omitting outdated, useless or even harmful recipes, as well as those that were attributed to superstitious beliefs.

For example the Bencao Gangmu by Li Shizhen (Handbook on Chinese Materia Medica) was published in 1578. The 1872 herbs and over 10 000 formulas were newly systematized and summarised for the first time in one place.

Traditional Chinese Medicine in China

Traditional Medicine in Japan

Traditional Far Eastern Medicine in Europe

Life Care (Yangsheng) and Tuina

The origins of self-care in the understanding of traditional oriental medicine, can be partly be attributed to Bodhidharma. Who approximately in 530 BC, is said to have introduced a system of exercises to maintain health and mental training.

This exercise system, Dao Yin (directing Qi, Japanese Do-in), includes both physical and breathing exercises, and also self-treatment through the massage and stimulation of specific acupuncture points.

In accordance with the maxim of Hua Tuo that "the wise doctor doesn't heal but prevent disease", Dao Yin became the classic precursor of the currently known Qi Gong, which soon became an integral part of Traditional Chinese Medicine. Over time it spread together with other traditional healing arts (acupuncture, moxibustion, herbal therapy and dietetics) throughout extensive parts of Asia. In addition,  very early forms of massage (Tui Na or also An Mo), were developed by Chinese doctors and is first mentioned in the Huang Di Nei Jing. More or less concurrently to the "Yellow Emperor's Classics of Internal Medicine" (475 and 221 BC), the first book on healing massage originated, "the classic of the ten chapters on massage and breathing exercises". Tui Na is based on the same theoretical basis as acupuncture and herbalism. Particularly significant is the belief that inner functions of the body are connected to the body's surface via classifiable pathways and channels. Awareness of these relationships gives rise to the ability to treat inner physical functions and balance organs, via the stimulation of specific points and zones at the surface of the body.

Acupressure (Zhi Zhen Liao Fa) is one segment of Tui Na, which uses fingers instead of needles to affect acupuncture points. It is also mentioned in the "prescription for emergency medicine" (3rd C AD), where the treatment of an unconscious patient through finger pressure on GV26 (Ren Zhong) is reported.

Already very early on, in the time of the Wei and Jin Dynasty (220-420) there were already specialised Tui Na clinics in China. Since the establishment of the Imperial Medical Academy at the beginning of the 7thC, Tui Na was one of the taught healing methods, with which in particular children were treated.

During the Ming Dynasty (1368-1644) healing massage for children (Xiao Er Tui Na) was developed into an independent discipline within Chinese Medicine. This was based to the fact that Chinese doctors already early on recognised that children differ physiologically, anatomically and energetically from adults. Acupuncture points and meridians in children do not have validity to the same extent.

From here a special repertoire of points and treatment techniques for children was developed, which differs from acupuncture and massage methods for adults. Tui Na is still today ranked highly with in Traditional Chinese Medicine. 

It is mainly applied to sensitive and needle- sensitive patients, as well as children. It is also successfully used for other ailments and disorders that respond to acupuncture and moxibustion.

Tuina and Shiatsu

 In Japan, where the teachings of Chinese medicine were adopted, "Japanese Massage" (Anma) developed from Tui Na. In the Edo period (approximately 300 years ago) Japanese doctors had to study Anma to familiarise themselves it the structure of the human body, as well as its energy pathways and pressure points. This was in order to understand the foundational principles of eastern medicine, as well as to develop the necessary practical skills. As a consequence, depending on the nature of each case, the adequate treatment method was applied, in other words: herbalism, acupuncture, moxibustion or manual treatment. Later on the therapeutic use and importance of Anma was lost. Soon massage was only used to alleviate muscle tension and finally only to generate pleasant and pleasurable feelings. This lead to the fact that Anma was no longer regarded as a medical form of therapy.

Those Anma therapists, who continued to work on the basis of traditional eastern medicine and in addition also integrated the insights of "western" medicine into their work. Gave their work the name Shiatsu, which literally means "finger pressure". This was to evade the restrictive legal regulations that Anma was meanwhile subjected to.

In 1955 Shiatsu was first recognised as legitimate therapeutic method (albeit still a branch of Anma). Then in 1964, it was fully recognised, as clearly independent from Anma and other massage techniques.

Acupuncture

Moxibustion

Cupping and scraping

Yangsheng. Care, maintenance and cultivation of life

Qi Gong

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