From the beginning of Chinese medical practice, the use of herbs was messy - messy to find, prepare, consume, benefit by and survive. Unlike today, doctors took tremendous risks in administering herbal remedies.
The starting point, documented to be over 3,000 years ago, was primitive. Until around the 1st century BCE (Before the Common Era), herbal formulas were part medicine, part magic, as were the sources of disease. Archaeological digs unearthing Shang Dynasty (1,000 BCE) artifacts have revealed medical writings inscribed on divination bones. Early shamans, mostly women, used scapula bones for divination rites. These bones later became the writing tablets, or medical prescription pads and textbooks, for incantations and medical prescriptions.
For at least 1,000 years herbal formulas for exorcism were as important as those addressing fevers and snakebites. Illness was brought to people as revenge from ghosts, spirits and ancestors. Healing was caused when these entities were appeased. Life was hard. Healing was harder because of the real risks that it might kill you. If patients died as the result of treatment, it may have been due to ancestral displeasure, though it may also have been due to the shaman's error. But as the spiritual aspects of medicine faded into history, the results of treatment were attributed, in greater measure, to a physician's skill.
Most of us never consider the danger of trying new herbs because, for us, doing so has never been a life changing or life threatening issue. We walk on the paths cut into history by our professional ancestors. They cleared the way, knowingly threatening their lives, careers and families, by trying new herbs and herb combinations on themselves, patients and family members. Have you ever thought what it must have been like to risk all, over and over, in the name of progressing your medical expertise?
The composer, Wolfgang Mozart, was killed by mercury overdoses administered by his doctors. George Washington, the first United States president, was bled to death by his over zealous physicians who thought more was better. How many people, over thousands of years, were killed in the name of medical progress by poorly formulated, herbal medications created by ever hopeful, amazingly daring physicians who did their very best wrestling to gain knowledge over nature's costs and benefits?
The Wushi'er Bingfang, now called Recipes for 52 Ailments, is an ancient Chinese medical text that was discovered in 1973 in a tomb in Mawangdui. The tomb was sealed in 168 BCE during the Han Dynasty. The text was copied on sheets of silk around 215 BCE, during the Qin Dynasty, but might have dated from even earlier. I have seen suggestions that these writings are as old as 1100 BCE. The texts discuss diet, exercise, moxibustion, and herbal therapy.
Shennong (Shen-nung) whose name literally means "Divine Farmer" and who is also known as the Emperor of the Five Grains, or the Emperor of Agriculture, was a legendary hero and ruler of China. One of the Three Sovereigns who lived some 5,000 years ago. Shennong has been thought to have taught the ancient Chinese not only their practices of agriculture, but also the use of plants as medicine. He is among a group of heroic deities who have been given credit for innovations that transformed life for the better in ancient China. One of his claims to fame is that he ingested 100 herbs a day, determining which would make good medicine. He was poisoned many times during the process. It was understood that only a divine being could continue to sample plants for their medical value and survive the poisoning that would, inevitably, result.
The book that is attributed to him is known as the Classic of the Agriculture Emperor's Materia Medica. It was compiled in the 1st century CE and lists 365 medicines, made up of 252 plants, 67 animals, and 46 minerals. Tao Hong-Jing, the editor of the version of Shen Nong's Materia Medica in use today, divided the herbs into three classes. The upper-grade herbs are nontoxic tonics that strengthen the body, the middle-grade herbs are tonics with therapeutic qualities, and the lower grade consists of herbs that treat disease or possess toxicity. By the time this book was compiled, 2,000 years ago, there was a tremendous body of knowledge on lethal and beneficial dosages of toxic herbs as well as the disorders for which they were applicable. That knowledge could only have come from one place, the personal experience of bold physicians whose commitment to their medical practices meant that they might cause death. The courage required to practice medicine at that time must have been staggering.
For many years it was thought that the Yellow Emperor's Inner Canon, was written in the 3rd or 4th centuries CE. Since the discovery of Wushi'er Bingfang the believed date of publication has been moved back to the 1st century BCE. This book, which we have all read as a textbook, is a compilation of smaller treatises from many medical lineages. It is the first to present a comprehensive understanding of Yin/Yang and Five Phases and it clearly leaves out the idea of spiritual influence as a source or treatment of disease. By this time, most of the magical aspects of medicine had been left behind and the prevalent thought was that nature caused and cured disease. This tells us that doctors living during the first century BCE were fully immersed in the risks of finding and applying herbal medications within theoretical structures that defined both disease and treatment.
The Treatise on Cold Damage Disorders and Miscellaneous Illnesses, collated between 196 and 22 CE, the end of the Han Dynasty, by Zhang Zhongjing, focuses on drug prescriptions. It was the first medical work to combine Yin Yang and the Five Phases with herbal therapy. By the second century CE, physicians all over China were compiling writings of the latest discoveries in herbal medicine.
Why am I telling you about texts and dates? To give you an idea as to how long the deadly practice of herbal medicine remained dangerous and how vast the study of medicine must have been in such primitive settings.
But, tragedy did create progress in ancient China. One of the greats, Zhang Zhongjing, who wrote Treatise on Febrile and Miscellaneous Diseases, committed his life to medicine upon witnessing an epidemic that ravaged his city and killed most of his relatives. Certainly he was not alone in his inspiration. Pain and death were motivators to engage in medical practice.
The 7th century saw China's first formalized medical school. Prior to that it was all apprenticeship-based study in the context of small village and rural settings. One generation learned from the next and each tried to expand upon their teacher's knowledge. Every one in practice felt the dilemma within their mission to expand herbal medical care. Many paid the ultimate price.
Today we buy raw herbs, tinctures, salves and freeze dried herb tea in granular form from companies that grow the plants. We know their value and attributes and liberally dispense them to our patients, assured that their application will, possibly with slight variation, move our patients towards health.
As wonderful as modern technology is, and as easy as it has made herbal medication to acquire, prescribe and ingest, this is a rural, nature-based, system. Plants, animals and rocks are its foundation. Risk, death and survival are its history. Fortunately, we are no longer dying, nor are our patients, from engaging in these practices. But we owe a great deal to the people who sacrificed all for the ease with which we treat our patients today.
I wanted to use this piece to remind you of the sacrifices made for the development of this aspect of our medicine and to remind you of how easily and comfortably we prescribe with a modality that, for hundreds of generations, was a high-risk, even deadly venture into the unknown.
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