Chinese Medicine "The method of appropriately using herbs in accordance with the symptom and sign presentation of the

patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the meridian it has entered." - Zhang Jiegu

------The most glorious epoch in Chinese medical history was the Han dynasty, 206 B.C264 A.D. This is sometimes referred to as the Age of Science in Chinese medical history. Great stress was laid on direct observation during this period. It was in this period that we had the greatest medical Trio in Chinese history, namely Tsang Kung, Chang Chung-ching- the Hippocrates of China, and Hua To.

Tsang Kung was the first medical man in China to introduce clinical case taking.

Chang Chung-ching is well-known for his Essay on Typhoid which is regarded as a classic in Chinese medicine. It was he who advocated the use of enema, and also hydrotherapy, for treating fever. He contributed much to the medical world, especially in his own period.

Hua To was the most celebrated surgeon in the Three Kingdoms period (221-264 A.D.). It is usual to associate anaesthetics with him. According to the Later Han Annals, Hua To caused the patient to take an effervescing powder in wine which rendered him completely unconscious. He then opened the abdomen, washed and cut the diseased portion. He sutured the parts together and applied a salve to the wound which cleared up in four or five days, the patient completely recovering within a month. The surgical skill of Hua To is highly commended by all Chinese medical men.

During the Tsin dynasty (265-419 A.D.) two noteworthy features were the Classic on Pulse by Wang Shuo-ho and the first authentic description of small-pox in the

publication of Chou Hou Pei Chi Fang or Handbook of Prescriptions for Emergencies by Ko Hung.

As is probably known, the most characteristic and typical Chinese method of diagnosing diseases is the feeling of the pulse.

In his handbook Prescriptions for Emergencies, Ko Hung descibed small-pox in the following words: Recently therfc are persons suffering from epidemic sores which attack the head, face and trunk. In a short time they spread all over the body. The sores have the appearance of hot boils containing some white matter. While some of these pustules are drying up, a fresh crop appears. Patients who recover are disfigured with purplish scars which do not fade until after a year. The people say that it was introduced in the reign of Chien Wu when the king was fighting the Huns at Nanyang. The name 'Hunpox' was given to it. In the Ta^ng dynasty, following close on the heels of the introduction of Buddhism into China, came Indian ideas and therapeutic measures. The Taoists also exercised influence by inventing a system of charms for curing diseases. In this dynasty there were two very outstanding medical men, namely Sun Szu-mo and Wong Tao who published two important works called Thousand Gold Remedies and the Medical Secrets of an Official. These two famous medical works sum up the advances and medical thought of all the previous dynasties.

Thus, in the Thousand Gold Remedies, it was pointed out that cholera was caused by eating food which was contaminated and was not due to the evil influences of demons as generally believed by the public at that time. In the same book is mentioned the use of catheterisation for retention of urine. \ It is significant to note that the Medical Secrets of an Official as well as the Thousand Gold Remedies recommend the use of thyroid gland for the treatment of goitre. Organotherapy, formerly much ridiculed by foreigners, but now hailed as a valuable modern discovery, has been known to every Chinese house-wife. The common practice of administering kidney for backache, lungs for consumption and cough, brain for nervous weakness, etc., may be too far fetched, but the basic idea of endocrinology exists. In recent years a great variety of glandular substance has been used in medicine. Of these the thyroid, pituitary, suprarenals, pancreas, liver and the placenta, have been found to be of therapeutic value. It is remarkable that many of them have been used and incorporated in Chinese pharmacoepia for ages past. The Ming dynasty is the most glorious in the history of the pharmacoepia of China. The most important contribution is the Pen Tsao Kang Mu, the National

Pharmacopoeia of China, compiled by Li Shi-chen . This is one of the most popular works on Chinese medicine, and is considered a great classic. It consists of some 52 comprehensive volumes divided into the vegetable kingdom, the animal kingdom, the mineral kingdom and others, with a description of 1,892 kinds of different substances. It contains many drugs which are common in both the East and the West. It took Li Shi-chen, the city magistrate, almost thirty years of hard work to complete this commendable piece of good work. This book is extremely rich in remedies, especially those of the vegetable origin, and offers a rich field for scientific research. Considerable attention has been directed to it by foreign writers, notably Du Halde who translated part of it into French in 1735 and Porter Smith in 1871. In 1911, Stuart extensively revised Smith's work and published the Chinese Materia Medica, the vegetable kingdom. Works on the mineral kingdom and the avian kingdom were published by Bernard Read in recent years. An attempt was started by the Chinese Government to carry out scientific research on the drugs contained in the Chinese Materia Medica, but the war with Japan aborted the work. Perhaps, the earliest Chinese drug that has won its way abroad is China root, the socalled Chinese sarsaparilla, once reputed as a remedy for syphilis. Its fame spread as far as to India, Persia and Turkestan in the 16th century, and in Indian literature it was mentioned that syphilis came from Europe but China root could cure it. Eumenol, a liquid extract of tang kuei, was introduced into Europe by the Germans in 1899, and is said to be effective in menstrual disorders.

Macanin, a preparation from a Chinese seaweed, has been put on the market by the Japanese and vigorously advertised as a sub-stitute for santonin for the treatment of round worms. The treatment of leprosy with Chaulmoogra is an old-time remedy of China and only in recent years was brought to light by western-trained doctors.

The now famous Ephedrine, which took Europe and America literally by storm, is derived from ma huang, a Chinese herb which has been used in China for treating asthma for more than four thousand years. It was first brought to the notice of the western world by Drj K. K. Chen in 1926 and has since been exten sively used everywhere.

There are still many other drugs which are still unknown to the outside world and which require scientific investigation. Such in vestigation would undoubtedly result in many remedies of great

value being found. It is interesting to note that the Chinese people pay great attention to food and nutrition. An analysis of Chinese foods shows that they are rich in vitamins and other nutritional elements.

Acupuncture, consists of puncturing certain points of the body with needles of all kinds. 367 such points are described, each having its own name and supposed relationship with internal organs.

In the Sung dynasty a copper model of the human body was made which was pierced with holes at the proper places for puncturing. The figure was covered with paper, pasted on, and the student was required to learn where to drive the needle. Acupuncture spread to Japan very early. It!was introduced into Europe by Ten-Rhyne, a Dutch surgeon, at the end of the 17th century and was much extolled in France early in the 19th century. Recently Sir James Cantlie and others tried it oq sprains and chronic rheumatism and reported very favourably on it. Owing to the ignorance of asepsis by native doctors more harm than good is done by its practice. But sometimes miraculous results are witnessed and with further scientific investigation it might, no doubt, prove a valuable addition to our armamenta.

Massage has been practised from time immemorial. Its value was fully recognized and in the Tang dynasty it was elevated as a science, forming one of the seven departments of medicine. A special chair was established with a professor in charge. After the Sung dynasty it degenerated and at the present day it is mostly in the hands of the barbers and the blind. Massage was first brought to European notice in the last century through the publications of the Jesuit fathers.

Preventive medicine was only stressed in recent years by scientific medical men, but in China the idea that "Prevention is better than cure" has been advocated long ago. I quote the following passages from different writers in support:

In the Su Wen, The Basis of Chinese Medicine, supposed to be edited by Emperor Huang Ti, it is said: "The sage does not treat those who are ill but those who are well."

Huai Nan-tzu said: "The good doctor pays constant attention to keeping people well so that there will be no sick ness." In the Difficult Classic (Nan Ching), it is said: "The skilful doctor treats those who are well but the inferior doctor treats those who are ill." In the Nei Ching, Canon of Medicine, it is said: "The good physician first cures the disease of the nation, then human ailments." Hygiene and Public Health were also in an advanced state during the Chou dynasty. The writings of Confucius, Huai Nan-tzu, Kuan Chung and others contain numerous references to them. Thus, as regards food and drink, Confucius advised one to abstain from rice which had been injured by heat, moisture and turned sour; fish and meat that was stale; what was discoloured; what was of bad flavour; anything that was not in season, etc. The relation between contaminated food and disease was recognized. The Confucian Analects said: "Diseases enter by the mouth." "Eat nothing that is improperly cooked." "Meat and wine bought from the street stands must not be taken." Many of the so-called "new" methods can be traced back to China. Take for instance Fletcherism; that is, thorough mastication of food. It was first advocated by an American, named Fletcher; hence the term. Mr. Gladstone, the Grand Old Man of England,who lived to be 85, was so convinced of its benefits that he chewed every mouthful of food 36 times before swallowing it. Strange to say, Ho Yang-heng long ago described: "Rice (i.e. food) should be chewed into pulp before swallowing. It nourishes the heart and abdomen. It tastes better and is more nutritious." Again, health advocators teach that the teeth should be brushed twice a day. It is interesting to note that Sun Szu-mo of the 7th century taught that the mouth should be cleansed with water several times after each meal so as to preserve the teeth.

Sir James Cantlie, teacher of Dr. Sun Yat-sen, once speaking before a medical congress in England said that the Chinese knew a great deal of fundamental hygiene. As illustrations, he mentioned the light, loose and comfortable Chinese dress, and the habit of drinking tea. This general adoption of tea as a beverage is a distinct step of progress. It saves people from many intestinal diseases caused by contaminated water such as typhoid, dysentery, cholera and diarrhoea, etc. The present day habit of taking cold drinks and ice creams is a common source of infection for these diseases. It seems that the ancients were wiser, in this respect, than we moderns. Now, a few words about Chinese medical education and administration in the early days.

State medical examinations may be said to date from as early as the 10th century B.C. The Chou Rituals state that at the end of the year the work of the doctors was examined and the salary of each fixed according to the results shown. If the statistics showed that out of ten patients treated, all got well, the results may be regarded as very satisfactory. If, however, one out of ten died, the results may be regarded as good; if two out of ten died, only fair; if three out of ten died, poor; and if four out of ten died, bad.

Regular medical schools were organized in the Sung dynasty, about the 10th century, first in the capital and later in other parts of the country. In 1076 A.D. an Imperial Medical College was founded. At first it was put under the Tai Shang Szu (Imperial Court of Sacrifical Worship) but later transferred to the Kuo Tzu Chien (Directorate of Education). Three hundred students were enrolled, with a staff of medical officers to teach them the three branches of medicine; namely, medicine, surgery and acupuncture. After examination, the candidates were classified into grades. The best ones were given official appointments or ordered to compile and write medical books, or engaged as teachers. The second grade ones were given a licence to practise. Those who were not satisfactory were required to study again; while those who failed were ordered to change their profession.

Officers and other medical staff were appointed to the prefectures and districts, the number depending on the size and importance of the places. These positions were often filled by men selected by competitive examinations. Thus, it appears that the medical services CHINESE MEDICINE of this period were quite well organized. The Tai I Yuan had special charge of medical education, the Han Lin I Kuan Yuan of general administration and the Yu Yao Yuan of tne medical needs of the Imperial Household.