Historical Development of Chinese Herbal Medicine

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Traditional Chinese Medicine (TCM) uses many therapeutic modalities, the major one being Chinese herbal medicine. Its development has been a historical process flowing and flowering with Chinese culture for more than four thousand years. Its practice follows theories of holistic and integrative principles. Therapy is based on understanding relations between part and whole, distinguishing symptom and appearance from true cause, and treating each individual case as unique.

The foundation for this medical practice is the Chinese materia medica. More than 6,000 substances have been used and their effects documented and researched in the past four millenia. Clinical practice and empirical results from millions of medical cases have created a data bank on individual substances as well as prescriptions of complex compounds. This literature is unparalleled and unsurpassed in the world's medical knowledge.

In fact, stories about the use of herbs to improve human health are older than TCM itself. Legends about herbal medicine start with Shen Nong (The Divine Farmer), who introduced agriculture and animal husbandry into China. According to the ancient book Master ofHuai Nan (Huai Nan Zi), by Liu An of the Han dynasty, Shen Nong Shi (3000 B.C.) "tasted a hundred herbs and came across seventy poisonous herbs each day."

The use of herbs is found in many historical texts. The five-taste concept of herbs is mentioned in the Spring and Summer Annals of Mr. Lu (Lu Shi Chun Qiu), a text of the Qin (221-206 B.C.) dynasty. Meanwhile, over 120 substances of plant, animal, and mineral origin were mentioned in the Classic of the Mountains and Seas (Shan Hai Jing), a text of the Warring States period (403—221 B.C.). The earliest known pharmacological work is the Prescriptions for Fifty-Two Ailments (Wu Shi Er Bing Fang), recovered from Ma Wang Dui Tomb Three in Hunan province in 1973. This work appears to have been composed before the end of the third century B.C. More than 250 medicinal substances were named and their prescriptions discussed. The medicinal substances in the book are comparable to those found in the later materia medica and prescription manuals, but the theoretical foundation of this book differs from that of contemporary traditional Chinese medicine. The theoretical foundation of what we now regard as Traditional Chinese Medicine is based mainly on the Classic of Internal Medicine, also called the Yellow Emperor's Inner Classic.

The Yellow Emperor's Inner Classic (Huang Di Nei Jing) was compiled in the Late Han dynasty (a.d. 25—220), but parts of it may come from the Warring States period (475—221 B.C.). Based on the theories of Yin-Yang and the Five-Phases (Wu Xing), it systematically interpreted the physiology and pathology of the internal organs and the meridian channels of the body. It set forth the origins of illness and defined principles for diagnosis and treatment. During the same period, a second major work appeared, summarizing the experience of Chinese practitioners in the prevention and treatment of disease. This was Zhang Zhong Jing's Discussion of Cold-Induced Diseases (Shang Han Lun). Building on the Inner Classic, this book provided guidelines for treatment and was considered a prescription manual. It listed 113 prescriptions and 397 therapies for infectious disease as well as 265 prescriptions for miscellaneous diseases.

The literary tradition of Chinese herbal knowledge also began in the Later Han dynasty with Shen Nong's Herbal(Shen Nong Ben Cao Jing), also known as the Classic of the Materia Medica. This was the first materia medica to appear in China. This text includes plant, animal, and mineral products, but plant products form the majority. Thus, Chinese pharmacological works are often termed Ben Cao, which literally means "of plant origin." The Classic of the Materia Medica is a summary of the clinical experience and the general knowledge of pharmacy prior to the Han dynasty. It contains 365 entries—252

botanical entries, 67 zoological entries, and 45 mineral entries—listing their properties and effects. Included among its prescriptions were Rhizoma Coptis (Huang Lian) for dysentery; Radix Dichroae (Qing Hao) for malaria; Herba Ephedrae (Ma Huang) for asthma; Sargassum (Kun Bu) for goiter; Radix et Rhizoma Rhei (Da Huang) for constipation; and mercury for scabies. All of these are still of clinical significance today. It also introduced the term "medicinal property" (Yao Xing) for the first time. This Classic of the Materia Medica was compiled in the Han Dynasty, for the original text of the book had been lost. The present text of the book is a reconstructed version by Han authors.

During the Liang dynasty (a.d. 456-536), Tao Hong-Jing summarized the new development of herbal medicine in his lifetime and compiled a new version of the classical text, called the Collection on Commentaries on the Shen Nong's Herbal (Shen Nong Ben Cao Jing Ji Zhu). This book expands the medical repertoire to 730 different herbs categorized to theories set forth in TCM according to their natural properties: upper, middle, and lower grade. The upper grade nourishes life, the middle grade nourishes constitutional types, and the lower grade expels disease. It also introduced the concept of taste (Wei) and temperature characteristics (Qi) to evaluate each herb. Toxicity was carefully recorded. Harvesting, selection, and processing of herbs were also discussed.

The first major materia medica after Tao Hong-Jing was the Newly Revised Materia Medica (Xin Xiu Ben Cao), edited by Su Jing et al., also known as the Tang Materia Medica (Tang Ben Cao), which was China's first illustrated materia medica. It had 844 entries and was published as the official pharmacopoeia of the Tang dynasty (a.d. 659). During the Tang dynasty, China's economy expanded and prospered. Cultural exchange with other countries increased dramatically. The number of herbs used in Chinese medicine reached one thousand. In a.d. 741, Chen Zang-Qi compiled another materia medica called the Supplement to the Materia Medica (Ben Cao Shi Yi), which included herbs not listed in Tao Hong-Jing's and Su Jing's texts. This book categorized herbs into ten groups according to their functions. It was the first clinical classification of herbs.

During the Song dynasty, further progress of herbal medicine was achieved in determining standards for herb processing and differentiation. Several new pharmacological books appeared. The first book was the Materia Medica from the Kai Bao Era (Kai Bao Ben Cao, a.d. 973-974), edited by Liu Gan, et al. Another one was the Illustrated Classic of Materia Medica (Ben Cao Tu Jing, a.d. 1058 —1061), edited by Su Song et al. Unfortunately, all of these books were lost. The only major materia medica to survive this period is Tang Shen-Wei's Materia Medica Arranged According to Pattern (Zheng Lei Ben Cao, a.d. 1082). After several revisions, in a.d. 1108 it was republished as the official pharmacopoeia of the Song dynasty. This 30-volume book has 1558 entries and more than 3000 formulae plus figures and processing methods. The concept of herbs entering specific meridian channels was introduced. This book became the major textbook for Chinese medical practice for 500 years.

The development of herbal theory expanded in the Song dynasty. One major difference between Shen Nong's Herbal and later materia medica is that the theoretical links between tastes and characteristics of herbs and their detailed therapeutic effects are absent in the earlier work. While the Yellow Emperor's Inner Classic provided a major theory for Traditional Chinese Medicine, its coverage of herbal characteristics was not extensive. It was not until the Late Sui (a.d. 581 -618) and Early Tang (a.d. 618-907) dynasties that there appeared a book entitled Materia Medica of Medicinal Properties (Yao Xing Lun), which had comprehensive discussions of herbal combinations, reaction, taste, temperature, toxicity, function, primary clinical application, processing, and preparation. The attempt to link the knowledge of herbs and classical theories of medicine started in earnest in the Song dynasty (a.d. 960—1279) and developed fully in the Jin (a.d. 1195—1233) dynasty. One of the major works in the Song dynasty is the well-known Professional and Popular Prescriptions from the Taiping Era (Tai Ping Hui Min He Ji Ju Fang), in which the techniques for combining herbs were summarized and the incompatibility of herbs was introduced.

In the Jin and Yuan dynasty, practitioners paid special attention to the functions of herbs. Explicit discussion about the linkage between particular herbs and particular organ imbalances and pathology began in the twelfth century with Zhang Yuan-Su in his two books, Origins of Medicine (Yi Xue Qi Yuan) and Pouch of Pearls (Zhen Zhu Nang). He wrote that Rhizoma Coptidis (Huang Lian) drains Heart Fire, Radix Scutellariae Baicalensis (Huang Qin) drains Lung Fire, and Radix Anemarrhenae Asphodeloidis (Zhi Mu) drains Kidney Fire. Based on the theory of the Five-Phases (Wu Xing), the particular effect of an herb upon a particular organ depends on the relationship of the taste of the herb and the phase of the organ. This theory has since become a foundation for understanding the functions of herbs. In addition, Zhang Yuan-Su illustrated in detail the concept of herbs entering specific channels. This has been introduced by Tao Hong-Jing in his materia medica. In Zhang Yuan-Su's book, an herb was, for the first time, said to have a certain function because of the meridian channel it enters.

Many other herbal theories were established during the Jin and Yuan period. Liu Wan-Su proposed that certain herbs are related to particular pathogenic factors, for example, Radix Duhuo (Du Huo) treats Wind. He made connections between the herbs and the Five-Phases. For example, beans belong to the water phase and therefore can be used for water-related diseases. Another elaborate synthesis of this period was that of Li Dong-Yuan, in his book Discussion of the Spleen and Stomach (Pi Wei Lun, a.d. 1249). He proposed that each medicinal substance has a tendency to rise, fall, float, or sink within the body, and that this tendency is an indication of the types of clinical situations in which the substance can be effectively used. Substances that rise and float basically move upward and outward, promoting sweating, dispersing Cold, expelling Wind, and raising the Yang. Substances that fall and sink move primarily downward and inward, redirecting rebellious Qi, pacifying wheezing, preventing abnormal loss of fluids, and restraining arrogant ascendant Yang.

During the Ming dynasty (a.d. 1368-1644), Li Shi-Zhen compiled his famous Compendium of Materia Medica (Ben Cao Gang Mu), also called Grand Materia Medica. This is one of the major pharmacological works in Chinese history. As a physician and pharmacologist, Li systematized the folk experience of the previous generations by conducting his own investigation of medicinal substances. This 52-volume book recorded 1892 medicinal substances, including 1173 from plants, 444 from animals, and 275 from minerals. It included more than 10,000 prescriptions as well as more than 1000 illustrations of medicinal substances. Soon after its publication this book was translated into numerous languages and gradually distributed around the world. Over the years, the Compendium has achieved worldwide recognition as a major contribution to the development of medicinal herbs and systematic botany. Later in the Qing dynasty, Zhao Xue-Ming carefully examined the entries in the Compendium, then collected medicinal substances that were not included in the book, and published the Supplement to the Compendium of Materia Medica (a.d. 1765). In this herbal book, he listed 921 substances, of which 716 were not included in the earlier Compendium, and gave additional notes to 161 entries already contained in the Compendium.

Since 1949, the Chinese government has encouraged the use of traditional herbs as a cost-effective alternative to Western drugs. In the past decades, more and more folk herbs from various parts of China have been integrated into the national materia medica. In 1977, Jiangsu College of New Medicine published the monumental materia medica entitled, Encyclopedia of Traditional Chinese Medicinal Substances (Zhong Yao Da Ci Dian). It contains 5767 entries and is China's current materia medica. Meanwhile, studies on the integration of traditional herbal medicine with Western medicine have been encouraged in China. More and more new drugs of botanical origin have been discovered and traditional herbal medical formulae have been reevaluated using Western medical standards. These processes will certainly accelerate the development of Chinese herbal medicine in the future.

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