Hua Tuo
Encyclopedia
Hua Tuo was an ancient Chinese physician who lived during the late Han Dynasty
and Three Kingdoms
era of Chinese history
. The Records of Three Kingdoms
and Book of Later Han
record Hua as the first person in China to use anesthesia
during surgery. He used a general anesthetic combining wine with a herbal concoction called mafeisan (麻沸散 lit. "cannabis boil powder"). Besides being respected for expertise in surgery
and anesthesia
, Hua Tuo was famous for his abilities in acupuncture
, moxibustion
, herbal medicine, and medical Daoyin
exercises. He developed the Wuqinxi (五禽戲 "Exercise of the Five Animals") from studying movements of the tiger, deer, bear, monkey, and crane.
for the Eastern Han (25-220) and Three Kingdoms (189-280) eras. The 3rd-century Sanguozhi (三國志 "Records of Three Kingdoms
") and 5th-century Hou Hanshu (後漢書 "Book of the Later Han") record that Hua was from the district of Qiao
(譙) in the state of Pei (沛, i.e., modern Bozhou
district in Anhui
Province), and studied Chinese classics throughout the Xuzhou
region (modern Jiangsu
and Shandong
). Hua refused employment offers from high-ranking officials (e.g., Chen Gui
陳圭) and chose to practice medicine.
The dates of Hua's life are uncertain. Estimations range from 110-207 (Li 1974:296, Mair 1994:227) to 190-265 (Veith 1996:3); Lu and Needham (2002:117) conclude that the "best estimate" is circa 145-208. Hua Tuo was an older contemporary of the physician Zhang Zhongjing
(150-219).
The name Hua Tuo combines the Chinese surname
Hua (華, lit. "magnificent; China") with the uncommon Chinese given name
Tuo (佗 "hunchback", or 陀 "steep hill"). He was also known as Hua Fu (尃 "apply [powder/ointment/etc.]"), and his Chinese style name
was Yuan Hua (元化 "Primal Transformation").
Some scholars (e.g., Chen Yinke
1977:36-40, Chen Jinhua 2007:293) believe Hua Tuo's name was probably of Indian origin, and he learned Ayurveda
medical techniques from early Buddhist missionaries in China
. Victor H. Mair
(1994:227) describes him as "many hundreds of years ahead of his time in medical knowledge and practice", and suggests his name Hua Tuo, which was roughly pronounced *ghwa-thā in ancient Chinese, could derive from Sanskrit agada
"medicine; toxicology". Several stories in Hua's biography "have a suspiciously Ayurvedic character to them" (see Salguero 2009), and he was active "in the areas where the first Buddhist communities were established in China."
Hua Tuo's Sanguozhi biography describes him as resembling a Daoist xian
(仙 "immortal") and details his medical techniques.
Hua Tuo's corresponding Hou Hanshu biography explains this mafeisan "cannabis boiling powder" decoction
was dissolved in jiu (酒 "alcoholic beverage; wine"). Hua's prescription for mafeisan anesthetic liquor was lost or destroyed, along with all of his writings. The (c. 636) Book of Sui
lists five medical books attributed to Hua Tuo and his disciples, but none are extant (Fan 2004:316).
The subsequent portion of Hua Tuo’s biography in the Sanguozhi (Mair 1994:689-694) lists sixteen medical cases: ten internal medicine
, three surgical
, two gynecological, and one pediatric case. Thus, writes Fan (2004:314), "Hua Tuo’s treatment of diseases was centered on internal medicine, but also included surgery, gynecology and pediatrics. He removed parasites, performed abortions and treated ulcers, sores and analgesia." For example,
Cao Cao
(155-220), the tyrannical founder of the Cao Wei
kingdom, was Hua Tuo's best-known patient, and suffered from chronic headaches (possibly caused by a brain tumor).
Lu and Sir Joseph Needham
(2002:118) translate Cao's condition as "migraine headaches accompanied by mental disturbance and dizziness", and identify this acupuncture point on the sole as Yongquan (涌泉 "bubbling fountain").
Cao ordered Hua to work as his personal physician, which Hua resented.
In order to avoid treating Cao, Hua repeatedly made excuses that his wife was ill, but Cao discovered the deception and ordered Hua's execution. Xun Yu
, an advisor of Cao Cao petitioned on behalf of the physician.
Hua Tuo wrote down his medical techniques while awaiting execution, but destroyed his Qingnang shu (青囊書 lit. "green bag book", which became a Classical Chinese
term for "medical practices text").
This loss to traditional Chinese medicine was irreplaceable. Veith (1966:3) notes that, "Unfortunately, Hua T'o's works were destroyed; his surgical practices fell into disuse, with the exception of his method of castration, which continued to be practiced. Due to the religious stigma attached to the practice of surgery, the social position accorded to the surgeon became increasingly lower and thus made a revival of Chinese surgery impossible." A Liezi
legend (tr. Giles 1912:81-83) claims the renowned physician Bian Que (ca. 500 BCE) used anesthesia to perform a double heart transplantation
, but that (ca. 4th century CE) text was compiled after Hua Tuo used mafeisan.
Cao Cao later regretted executing Hua when his son Cao Chong
(196-208), a child prodigy who discovered Archimedes' principle
, died from illness.
The Sanguozhi does not specify Hua Tuo's exact date of death, but since Cao Chong died in 208, Hua Tuo could not have lived past that year.
Hua's biography ends with accounts of his disciples Wu Pu 吳普 and Fan A 樊阿.
Fan A was skilled at acupuncture and inserted the needles to extraordinary depths. Mair (1994:695) notes this unusual name may indicate Fan A was a foreigner, and this area was around modern Tongshan County, Jiangsu
, "location of the first known Buddhist community in China".
These herbs are qiye (漆叶 "Toxicodendron vernicifluum leaves") and qingdian (青黏 "Sigesbeckia
orientalis").
The Song Dynasty
Confucianist scholar Ye Mengde
(1077–1148) criticized the Sanguozhi and Hou Hanshu biographies of Hua Tuo as being mythological. Ye's "Physicians Cannot Raise the Dead" essay repeated the descriptions of Hua using anesthesia to perform internal surgery, and reasoned,
In later times, a set of 34 paravertebral acupuncture point
s was named the "Hua Tuo Jiaji" (華佗夹脊) in his honor. Hua is considered a shenyi (神醫 "divine doctor") and is worshiped as a medicinal god or immortal in Daoist temples. "Hua Tuo zaishi" (華佗再世 "Hua Tuo reincarnated") is a term of respect for a highly skilled doctor.
In the historical novel Romance of the Three Kingdoms
, Hua Tuo supposedly healed the Shu Han
general, Guan Yu
, who had been struck with a poisoned arrow during his Battle of Fancheng
. Hua Tuo offered to anesthetize Guan Yu, but he simply laughed that he was not afraid of pain. Hua Tuo used a knife to cut the flesh from Guan Yu's arm and scrape the poison from the bone, and the sounds chilled all those who heard them. During this excruciating treatment, Guan Yu continued to play the board game Weiqi with Ma Liang, without flinching from pain. When later asked by Ma Liang, Guan Yu said that he feigned being unhurt to keep the morale of the army high. After Hua Tuo's successful operation, Guan Yu allegedly rewarded him with a sumptuous banquet, and offered a present of 100 ounces of gold, but he refused, saying that a doctor's duty was curing patients, not making profits. Despite the historical fact that Hua Tuo died in 208, a decade before Guan Yu fought the 219 Battle of Fancheng, this storied operation is a popular artistic theme.
Hua Tuo was later called upon to cure a chronic excruciating pain in Cao Cao's head, which turned out to be a brain tumor. Hua Tuo told Cao Cao that in order to remove the tumor, it would be necessary to open up his skull. However, Cao Cao suspected the doctor intended murder, and ordered that Hua Tuo be jailed and executed. This was because Ji Ben, a former royal surgeon, had participated in Dong Cheng
's assassination plot on Cao Cao (this assassination attempt by Ji Ben however did historically happen).
The novel Romance of the Three Kingdoms has it that Hua Tuo gave his Qing Nang Shu, which recorded techniques for treating patients, to a prison official before his execution in order that his medical profession would survive. The wife of the official burned the book to avoid implication. Alarmed, the official immediately seized the burning papers from her, but the only parts he obtained were those dealing with how to emasculate hen and ducks and the other medical methods of Hua Tuo were lost forever.
The name mafeisan combines ma (麻 "cannabis; hemp; numbed"), fei (沸 "boiling; bubbling"), and san (散 "break up; scatter; medicine in powder form"). Ma can mean "cannabis; hemp" and "numbed; tingling" (e.g., mazui 麻醉 "anesthetic; narcotic"), which Li (1974:297) believes semantically "derived from the properties of the fruits and leaves, which were used as infusions for medicinal purposes".
Modern Standard Chinese mafei is reconstructed as Old Chinese
*mrâipəts, Late Han Chinese maipus (during Hua's life), and Middle Chinese
mapjwəi (Schuessler 2007:233, 373).
Many sinologists and scholars of Traditional Chinese Medicine
have guessed at the anesthetic components of mafei powder. Smith (1871:61) contends that Hua Tuo, "the Machaon of Chinese historical romance", used yabulu (押不蘆 "Mandragora officinarum
") rather than huoma (火麻 "Cannabis
") and mantoulo (曼佗羅 "Datura stramonium
", n.b., Hua's name Tuo) "infused in wine, and drunk as a stupefying medicine". Herbert Giles
(1897:323) translates mafeisan as "hashish
"; his son Lionel Giles
(1948:72) identifies "hemp-bubble-powder" as "something akin to hashish or bhang". Veith (1966:3) quotes the sinologist Erich Hauer's "opinion that ma-fei (麻沸) means opium." Victor H. Mair
(1994:689) notes that mafei "appears to be a transcription of some Indo-European word related to "morphine"." Although Friedrich Sertürner
first isolated morphine
from opium
in 1804, Mair suggests, "It is conceivable that some such name as morphine was already in use before as a designation for the anesthetic properties of this opium derivative or some other naturally occurring substance." Wang and Ping (1999:91) find consensus among "scientists of later generations" that mafei contained yangjinhua (洋金花 "Datura stramonium") and wutou (烏頭 "rhizome of Aconitum
, Chinese monkshood") or caowu (草烏 "Aconitum kusnezofflin; Kusnezoff monkshood").
Lu and Needham (2002:118) suggest Hua Tuo may have discovered surgical analgesia by acupuncture
, "quite apart from the stupefying potions for which he became so famous – if so he kept it to himself and his immediate disciples so that the secret did not survive".
Han Dynasty
The Han Dynasty was the second imperial dynasty of China, preceded by the Qin Dynasty and succeeded by the Three Kingdoms . It was founded by the rebel leader Liu Bang, known posthumously as Emperor Gaozu of Han. It was briefly interrupted by the Xin Dynasty of the former regent Wang Mang...
and Three Kingdoms
Three Kingdoms
The Three Kingdoms period was a period in Chinese history, part of an era of disunity called the "Six Dynasties" following immediately the loss of de facto power of the Han Dynasty rulers. In a strict academic sense it refers to the period between the foundation of the state of Wei in 220 and the...
era of Chinese history
History of China
Chinese civilization originated in various regional centers along both the Yellow River and the Yangtze River valleys in the Neolithic era, but the Yellow River is said to be the Cradle of Chinese Civilization. With thousands of years of continuous history, China is one of the world's oldest...
. The Records of Three Kingdoms
Records of Three Kingdoms
Records of Three Kingdoms , is regarded as the official and authoritative historical text on the Three Kingdoms period of Chinese history covering the years 184-280 CE. Written by Chen Shou in the 3rd century, the work combines the smaller histories of the rival states of Cao Wei , Shu Han and...
and Book of Later Han
Book of Later Han
The Book of the Later Han or the History of the Later Han is one of the official Chinese historical works which was compiled by Fan Ye in the 5th century, using a number of earlier histories and documents as sources...
record Hua as the first person in China to use anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
during surgery. He used a general anesthetic combining wine with a herbal concoction called mafeisan (麻沸散 lit. "cannabis boil powder"). Besides being respected for expertise in surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, Hua Tuo was famous for his abilities in acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
, moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...
, herbal medicine, and medical Daoyin
Tao Yin
Tao Yin is a series of breathing exercises practiced by Taoists to cultivate ch'i, the internal energy of the body according to Traditional Chinese Medicine....
exercises. He developed the Wuqinxi (五禽戲 "Exercise of the Five Animals") from studying movements of the tiger, deer, bear, monkey, and crane.
Historical accounts
The oldest extant biographies of Hua Tuo (tr. DeWoskin 1983:140-153 and Mair 1994:688-696) are found in the official Chinese historiesTwenty-Four Histories
The Twenty-Four Histories is a collection of Chinese historical books covering a period from 3000 BC to the Ming Dynasty in the 17th century. The whole set contains 3213 volumes and about 40 million words...
for the Eastern Han (25-220) and Three Kingdoms (189-280) eras. The 3rd-century Sanguozhi (三國志 "Records of Three Kingdoms
Records of Three Kingdoms
Records of Three Kingdoms , is regarded as the official and authoritative historical text on the Three Kingdoms period of Chinese history covering the years 184-280 CE. Written by Chen Shou in the 3rd century, the work combines the smaller histories of the rival states of Cao Wei , Shu Han and...
") and 5th-century Hou Hanshu (後漢書 "Book of the Later Han") record that Hua was from the district of Qiao
Qiao
Qiao was a small, but strategically brilliant city, originally Qiao belonging to Yuan Shu. However Cao Cao, Liu Bei, and Lu Bu defeated him in early AD 197...
(譙) in the state of Pei (沛, i.e., modern Bozhou
Bozhou
Bozhou is a prefecture-level city in northwestern Anhui province, People's Republic of China. It borders Huaibei to the northeast, Bengbu to the southeast, Huainan to the south, Fuyang to the southwest, and the province of Henan to the north.-Administration:...
district in Anhui
Anhui
Anhui is a province in the People's Republic of China. Located in eastern China across the basins of the Yangtze River and the Huai River, it borders Jiangsu to the east, Zhejiang to the southeast, Jiangxi to the south, Hubei to the southwest, Henan to the northwest, and Shandong for a tiny...
Province), and studied Chinese classics throughout the Xuzhou
Xuzhou
Xuzhou , otherwise known as Pengcheng in ancient times, is a major city in and the fourth largest prefecture-level city of Jiangsu province, People's Republic of China...
region (modern Jiangsu
Jiangsu
' is a province of the People's Republic of China, located along the east coast of the country. The name comes from jiang, short for the city of Jiangning , and su, for the city of Suzhou. The abbreviation for this province is "苏" , the second character of its name...
and Shandong
Shandong
' is a Province located on the eastern coast of the People's Republic of China. Shandong has played a major role in Chinese history from the beginning of Chinese civilization along the lower reaches of the Yellow River and served as a pivotal cultural and religious site for Taoism, Chinese...
). Hua refused employment offers from high-ranking officials (e.g., Chen Gui
Chen Gui
Chen Gui, style name Hanyu , was a minister serving under the warlord Lü Bu during the late Han Dynasty period of Chinese history. The loyalty of Chen Gui then caused him to plot with Cao Cao and betray Lü Bu. He and his son Chen Deng then manipulated Lü Bu, contributing to Liu Bei and Cao Cao's...
陳圭) and chose to practice medicine.
The dates of Hua's life are uncertain. Estimations range from 110-207 (Li 1974:296, Mair 1994:227) to 190-265 (Veith 1996:3); Lu and Needham (2002:117) conclude that the "best estimate" is circa 145-208. Hua Tuo was an older contemporary of the physician Zhang Zhongjing
Zhang Zhongjing
Zhang Zhongjing , formal name Zhang Ji, was a Han Dynasty physician and one of the most eminent Chinese physicians during the later years of the Han Dynasty...
(150-219).
The name Hua Tuo combines the Chinese surname
Chinese surname
Chinese family names have been historically used by Han Chinese and Sinicized Chinese ethnic groups in mainland China, Taiwan, Hong Kong, and among overseas Chinese communities. In ancient times two types of surnames, family names and clan names , existed.The colloquial expressions laobaixing...
Hua (華, lit. "magnificent; China") with the uncommon Chinese given name
Chinese given name
Chinese given names are generally made up of one or two characters, and are written after the family name, therefore "John-Paul Smith" as a Chinese name would be read "Smith John-Paul". Chinese names can consist of any character and contain almost any meaning...
Tuo (佗 "hunchback", or 陀 "steep hill"). He was also known as Hua Fu (尃 "apply [powder/ointment/etc.]"), and his Chinese style name
Chinese style name
A Chinese style name, sometimes also known as a courtesy name , is a given name to be used later in life. After 20 years of age, the zì is assigned in place of one's given name as a symbol of adulthood and respect...
was Yuan Hua (元化 "Primal Transformation").
Some scholars (e.g., Chen Yinke
Chen Yinke
Chen Yinke was a sinologist and a fellow of Academia Sinica. His representative works are The Origins of Sui and Tang Institutions: A Brief Account 《隋唐制度淵源略論稿》, On the Political History of the Tang Dynasty 《唐代政治史述論稿》, and An Alternative Biography of Liu Rushi 《》.-Early life:Chen Yinke was born in...
1977:36-40, Chen Jinhua 2007:293) believe Hua Tuo's name was probably of Indian origin, and he learned Ayurveda
Ayurveda
Ayurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,...
medical techniques from early Buddhist missionaries in China
Buddhism in China
Chinese Buddhism refers collectively to the various schools of Buddhism that have flourished in China since ancient times. Buddhism has played an enormous role in shaping the mindset of the Chinese people, affecting their aesthetics, politics, literature, philosophy and medicine.At the peak of the...
. Victor H. Mair
Victor H. Mair
Victor Henry Mair is a Philologist specializing in Sinitic and Indo-European languages, and holds the position of Professor of Chinese Language and Literature in the Department of East Asian Languages and Civilizations at the University of Pennsylvania, Philadelphia, United States...
(1994:227) describes him as "many hundreds of years ahead of his time in medical knowledge and practice", and suggests his name Hua Tuo, which was roughly pronounced *ghwa-thā in ancient Chinese, could derive from Sanskrit agada
Agada
Agada is one of the eight branches into which ayurveda medicine is traditionally divided. Literally, gada means a disease and agada means any agent which makes the body free from disease; however the term agada is used specifically for the branch dealing with toxicology, the description of the...
"medicine; toxicology". Several stories in Hua's biography "have a suspiciously Ayurvedic character to them" (see Salguero 2009), and he was active "in the areas where the first Buddhist communities were established in China."
Hua Tuo's Sanguozhi biography describes him as resembling a Daoist xian
Xian (Taoism)
Xian is a Chinese word for an enlightened person, translatable in English as:*"spiritually immortal; transcendent; super-human; celestial being"...
(仙 "immortal") and details his medical techniques.
Hua-t'o had mastered the technique for nourishing one's nature. Although his contemporaries thought that he must have been a hundred years old, he still looked hale and hardy. Hua-t'o was also highly skilled in prescribing medicines. In curing illnesses, the decoctions that he prepared required only a few ingredients. His mind was so adept at dividing up and compounding according to the right proportions that he did not have to weigh the different components of his medicines with a balance. Once the decoction was boiled thoroughly it could be drunk. Hua-t'o would tell the patient how to take the medicine and then would go away, after which the patient's condition would promptly improve.
If Hua-t'o employed moxibustion, he would only burn punk in one or two places and in each place he only made seven or eight separate cauterizations, to which the disease would rapidly respond during the course of its elimination. If he employed acupuncture, it was also only in one or two places. As he instated the needle, he would instruct the patient, "I am going to guide the point to such-and-such a spot. When you feel it reach there, tell me." As soon as the patient told him that the point had already reached the designated spot, he would withdraw the needle and the sickness would likewise be virtually alleviated.
If a sickness were concentrated internally where the effect of acupuncture needles and medicines could not reach it, Hua-t'o would recognize that it was necessary to operate. In such cases, he would have his patients drink a solution of morphean powder whereupon they would immediately become intoxicated as though dead and completely insensate. Then he could make an incision and remove the diseased tissues. If the disease were in the intestines, he would sever them and wash them out, after which he would stitch the abdomen together and rub on an ointment. After a period of about four or five days, there would be no more pain. The patient would gradually regain full consciousness and within a month he would return to normal. (tr. Mair 1994:688-689)
Hua Tuo's corresponding Hou Hanshu biography explains this mafeisan "cannabis boiling powder" decoction
Decoction
Decoction is a method of extraction, by boiling, of dissolved chemicals, or herbal or plant material, which may include stems, roots, bark and rhizomes. Decoction involves first mashing, and then boiling in water to extract oils, volatile organic compounds, and other chemical substances...
was dissolved in jiu (酒 "alcoholic beverage; wine"). Hua's prescription for mafeisan anesthetic liquor was lost or destroyed, along with all of his writings. The (c. 636) Book of Sui
Book of Sui
The Book of Sui was the official history of the Chinese dynasty Sui Dynasty, and it ranks among the official Twenty-Four Histories of imperial China. It was compiled by a team of historians led by the Tang Dynasty official Wei Zheng and was completed in 636.-External links:* of the Book of Sui,...
lists five medical books attributed to Hua Tuo and his disciples, but none are extant (Fan 2004:316).
The subsequent portion of Hua Tuo’s biography in the Sanguozhi (Mair 1994:689-694) lists sixteen medical cases: ten internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, three surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, two gynecological, and one pediatric case. Thus, writes Fan (2004:314), "Hua Tuo’s treatment of diseases was centered on internal medicine, but also included surgery, gynecology and pediatrics. He removed parasites, performed abortions and treated ulcers, sores and analgesia." For example,
The governor of Kuang-ling, Li Teng, had an illness which caused him to be distressed by a feeling of stuffiness in his chest. He also had a red face and no desire for food. Hua-t'o took his pulse and said, "Your honor, there are several pints of parasitic bugs in your stomach and you are on the verge of developing an ulcer. This was caused by eating raw fish." Whereupon he prepared two pints of a decoction for the governor, Hua-t'o had him drink one pint first and then after a little while had him finish the remainder. In the space of time that it takes to eat a meal, the governor vomited up three pints or so of parasites. They had red heads and were all wriggling; half of their bodies looked like sashimi. The discomfort that he had experienced was immediately relieved. "This sickness will erupt after three years. If you are attended by a good doctor, he will be able to save you." The sickness did indeed erupt after the specified period. At the time, Hua-t'o was not in the area and the governor died as Hua-t'o had said he would if he did not have a good doctor. (tr. Mair 1994:692-693)
Cao Cao
Cao Cao
Cao Cao was a warlord and the penultimate chancellor of the Eastern Han Dynasty who rose to great power during the dynasty's final years. As one of the central figures of the Three Kingdoms period, he laid the foundations for what was to become the state of Cao Wei and was posthumously titled...
(155-220), the tyrannical founder of the Cao Wei
Cao Wei
Cao Wei was one of the states that competed for control of China during the Three Kingdoms period. With the capital at Luoyang, the state was established by Cao Pi in 220, based upon the foundations that his father Cao Cao laid...
kingdom, was Hua Tuo's best-known patient, and suffered from chronic headaches (possibly caused by a brain tumor).
Ts'ao Ts'ao heard about Hua-t'o and summoned him to court where he henceforth was often in attendance. Ts'ao Ts'ao suffered from blustery headaches. Whenever an attack came on, he would become dizzy and confused. Hua-t'o would employ acupuncture treatment at the diaphragmatic transport insertion point and the condition would be alleviated as soon as the procedure was carried out. (tr. Mair 1994:693)
Lu and Sir Joseph Needham
Joseph Needham
Noel Joseph Terence Montgomery Needham, CH, FRS, FBA , also known as Li Yuese , was a British scientist, historian and sinologist known for his scientific research and writing on the history of Chinese science. He was elected a fellow of the Royal Society in 1941, and as a fellow of the British...
(2002:118) translate Cao's condition as "migraine headaches accompanied by mental disturbance and dizziness", and identify this acupuncture point on the sole as Yongquan (涌泉 "bubbling fountain").
Cao ordered Hua to work as his personal physician, which Hua resented.
Examples of Hua-t'o's superlative skills are in general of this sort. However, since he was originally a scholar, he often regretted that he was looked upon as a physician by profession. Later, when Ta'ao Ta'ao took personal control of the affairs of state, his sickness intensified and he had Hua-t'o attend him exclusively. "It will be difficult to heal you in the near term but if we maintain a program of treatment over a longer period, it will be possible to extend your life-span." (tr. Mair 1994:694)
In order to avoid treating Cao, Hua repeatedly made excuses that his wife was ill, but Cao discovered the deception and ordered Hua's execution. Xun Yu
Xun Yu
Xun Yu was a strategist and statesman who served as an advisor to the warlord Cao Cao during the late Han Dynasty period of Chinese history.-Early life:...
, an advisor of Cao Cao petitioned on behalf of the physician.
Hua-t'o had been far away from home for a long time and wished to return, so he said, "I just received a letter from home and would like to go back temporarily." After he reached home, excusing himself on the grounds of his wife's illness, he requested several extension of his leave and did not come back. Ts'ao Ts'ao repeatedly wrote letters to Hua-t'o calling him back, and he issued imperial orders to the commandery and district authorities to send Hua-t'o back. Proud of his ability and finding it distasteful to wait upon others for a living, Hua-t'o continued to procrastinate in setting off on the journey. Ts'ao Ts'ao became very angry and dispatched men to go and investigate. If Hua-t'o's wife were really sick, Ts'ao Ts'ao would present him with forth bushels of lentils and be lenient in setting a date when his leave would expire. But if Hua-t'o were prevaricating, then he would be apprehended and escorted back. Consequently, Hua-t'o was handed over to the prison at Hsü where after interrogation, he confessed his guilt. Interceding on behalf of Hua-t'o, Hsün Yü said, "Hua-t'o's techniques are truly effective and people's lives are dependent upon them. It is fitting that you be clement toward him." "Don’t worry," said Ts'ao Ts'ao. "Do you think there aren't any other rats like him under heaven?" (tr. Mair 1994:694)
Hua Tuo wrote down his medical techniques while awaiting execution, but destroyed his Qingnang shu (青囊書 lit. "green bag book", which became a Classical Chinese
Classical Chinese
Classical Chinese or Literary Chinese is a traditional style of written Chinese based on the grammar and vocabulary of ancient Chinese, making it different from any modern spoken form of Chinese...
term for "medical practices text").
Whereupon the investigation against Hua-t'o was concluded with the announcement of the death penalty. When Hua-t'o was about to be executed he brought out a scroll with writing on it and handed it over to the jailer, saying, "This can preserve people's lives." Fearful of the law, the prison subaltern would not accept it, nor did Hua-t'o force it upon him. Instead, he asked for a fire in which he burned the scroll. (tr. Mair 1994:694)
This loss to traditional Chinese medicine was irreplaceable. Veith (1966:3) notes that, "Unfortunately, Hua T'o's works were destroyed; his surgical practices fell into disuse, with the exception of his method of castration, which continued to be practiced. Due to the religious stigma attached to the practice of surgery, the social position accorded to the surgeon became increasingly lower and thus made a revival of Chinese surgery impossible." A Liezi
Liezi
The Liezi is a Daoist text attributed to Lie Yukou, a circa 5th century BCE Hundred Schools of Thought philosopher, but Chinese and Western scholars believe it was compiled around the 4th century CE.-Textual history:...
legend (tr. Giles 1912:81-83) claims the renowned physician Bian Que (ca. 500 BCE) used anesthesia to perform a double heart transplantation
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...
, but that (ca. 4th century CE) text was compiled after Hua Tuo used mafeisan.
Cao Cao later regretted executing Hua when his son Cao Chong
Cao Chong
Cao Chong was a son of the late Han Dynasty warlord Cao Cao. He was renowned as a child prodigy, having the intelligence of an adult at the age of five. He is best known for his ingenious method of weighing an elephant using the law of buoyancy...
(196-208), a child prodigy who discovered Archimedes' principle
Archimedes' principle
Archimedes' principle relates buoyancy to displacement. It is named after its discoverer, Archimedes of Syracuse.-Principle:Archimedes' treatise On floating bodies, proposition 5, states that...
, died from illness.
After Hua-t'o's death, Ts'ao Ts'ao's blustery headaches did not go away. "Hua-t'o could have cured me," said Ts'ao Ts'ao, "but the scoundrel prolonged my illness, wishing thereby to enhance his own position. Thus, even if I hadn't put the knave to death, he never would have eradicated the source of my sickness." Later on, when his beloved son Ts'ang-shu was critically ill, Ts'ao Ts'ao said with a sigh, "I regret having put Hua-t'o to death and causing my son to die in vain." (tr. Mair 1994:695)
The Sanguozhi does not specify Hua Tuo's exact date of death, but since Cao Chong died in 208, Hua Tuo could not have lived past that year.
Hua's biography ends with accounts of his disciples Wu Pu 吳普 and Fan A 樊阿.
Wu P'u of Kuang-ling and Fan Ah of P'eng-ch'eng both studied with Hua-t'o. Using Hua-t'o's methods of treatment, many people were completely cured by Wu P'u. "The human body needs exertion." Hua-t'o told Wu P'u, "but it shouldn't be pushed to the limit. Movement of the limbs facilitates the absorption of nutrients in food and enable the blood in the arteries to flow freely, preventing sickness from occurring. It's like a door-pivot that never decays from bugs or worms because of the constant opening and closing. That's why, when the ancient transcendent practiced duction, they strode like a bear and turned their head backward like an owl. They elongated their waist and limbs and moved all of their joints, seeking to stave off old age. I have a technique called 'the exercise of the five animals'. The first is the tiger, the second is the deer, the third is the bear, the fourth is the ape, the fifth is the bird. They may also be used to get rid of illness and are beneficial for the legs and feet because they are a type of duction. If there is discomfort somewhere in your body, get up and do one of my animal exercises until you're soaking with sweat, then sprinkle powder on yourself. Your body will feel relaxed and you'll have a good appetite." (tr. Mair 695-696)
Fan A was skilled at acupuncture and inserted the needles to extraordinary depths. Mair (1994:695) notes this unusual name may indicate Fan A was a foreigner, and this area was around modern Tongshan County, Jiangsu
Tongshan County, Jiangsu
Tongshan District , formerly Tongshan County is a district of the city of Xuzhou, Jiangsu province, People's Republic of China, bordering Anhui and Shandong provinces. The area derives its name from the copper-filled mountains to the north and east, and until September 2010 was a county. The...
, "location of the first known Buddhist community in China".
Fan Ah requested from Hua-t'o the recipe for an orally ingested medicine that would be beneficial to one's health, and Hua-t'o instructed him how to make a powder of varish tree leaves and herbe de flacq. The proportions are fourteen ounces of shredded herbe de flacq for each pint of shredded varnish tree leaves. Hua-t'o said that if one takes a long course of this medicine, it will get rid of the three worms [types of parasites], benefit the five viscera, make the body feel nimble, and prevent you hair from turning white. (tr. Mair 1994:696)
These herbs are qiye (漆叶 "Toxicodendron vernicifluum leaves") and qingdian (青黏 "Sigesbeckia
Sigesbeckia
Sigesbeckia is a genus of annual plants in the aster family.-Origin:Sigesbeckia is named for a a botanist Johann Sigesebeck, who was a strong critic of Carl Linnaeus's botanic classification system...
orientalis").
The Song Dynasty
Song Dynasty
The Song Dynasty was a ruling dynasty in China between 960 and 1279; it succeeded the Five Dynasties and Ten Kingdoms Period, and was followed by the Yuan Dynasty. It was the first government in world history to issue banknotes or paper money, and the first Chinese government to establish a...
Confucianist scholar Ye Mengde
Ye Mengde
Ye Mengde was a Chinese scholar who lived from 1077 to 1148....
(1077–1148) criticized the Sanguozhi and Hou Hanshu biographies of Hua Tuo as being mythological. Ye's "Physicians Cannot Raise the Dead" essay repeated the descriptions of Hua using anesthesia to perform internal surgery, and reasoned,
There is absolutely no principle whereby to account for this. That which makes a human being a human being is his physical form, and that which enlivens the physical form is the vital breath. I have no way of knowing whether Hua-t'o's medicine could make a person intoxicated to the point of unconsciousness so that he could endure being cut open and could fully recuperate, causing the damaged portions to grow back together again. However, once the abdomen, back, intestines, or stomach have been cut open and dissected, how can they again be infused with vital breath? Being in such a condition, how could they be brought back to life again? If Hua-t'o could do this, then whoever was subjected to the punishment of dismemberment could be brought back to life again and there would no longer be any reason for carrying out royal punishments [involving physical mutilation]. (tr. Mair 1994:697)
In later times, a set of 34 paravertebral acupuncture point
Acupuncture point
Acupuncture points are locations on the body that are the focus of acupuncture, acupressure, sonopuncture and laser acupuncture treatment. Several hundred acupuncture points are considered to be located along meridians...
s was named the "Hua Tuo Jiaji" (華佗夹脊) in his honor. Hua is considered a shenyi (神醫 "divine doctor") and is worshiped as a medicinal god or immortal in Daoist temples. "Hua Tuo zaishi" (華佗再世 "Hua Tuo reincarnated") is a term of respect for a highly skilled doctor.
Fictional accounts
Romance of the Three Kingdoms
Romance of the Three Kingdoms, written by Luo Guanzhong in the 14th century, is a Chinese historical novel based on the events in the turbulent years near the end of the Han Dynasty and the Three Kingdoms era of Chinese history, starting in 169 and ending with the reunification of the land in...
, Hua Tuo supposedly healed the Shu Han
Shu Han
Shu Han was one of the three states competing for control of China during the Three Kingdoms period, after the fall of the Han Dynasty. The state was based on areas around Sichuan, which was then known as Shu...
general, Guan Yu
Guan Yu
Guan Yu was a general serving under the warlord Liu Bei during the late Eastern Han Dynasty of China. He played a significant role in the civil war that led to the collapse of the Han Dynasty and the establishment of the state of Shu Han during the Three Kingdoms period, of which Liu Bei was the...
, who had been struck with a poisoned arrow during his Battle of Fancheng
Battle of Fancheng
The Battle of Fancheng was fought between the forces of warlords Liu Bei and Cao Cao in 219 during the prelude to the Three Kingdoms period of Chinese history...
. Hua Tuo offered to anesthetize Guan Yu, but he simply laughed that he was not afraid of pain. Hua Tuo used a knife to cut the flesh from Guan Yu's arm and scrape the poison from the bone, and the sounds chilled all those who heard them. During this excruciating treatment, Guan Yu continued to play the board game Weiqi with Ma Liang, without flinching from pain. When later asked by Ma Liang, Guan Yu said that he feigned being unhurt to keep the morale of the army high. After Hua Tuo's successful operation, Guan Yu allegedly rewarded him with a sumptuous banquet, and offered a present of 100 ounces of gold, but he refused, saying that a doctor's duty was curing patients, not making profits. Despite the historical fact that Hua Tuo died in 208, a decade before Guan Yu fought the 219 Battle of Fancheng, this storied operation is a popular artistic theme.
Hua Tuo was later called upon to cure a chronic excruciating pain in Cao Cao's head, which turned out to be a brain tumor. Hua Tuo told Cao Cao that in order to remove the tumor, it would be necessary to open up his skull. However, Cao Cao suspected the doctor intended murder, and ordered that Hua Tuo be jailed and executed. This was because Ji Ben, a former royal surgeon, had participated in Dong Cheng
Dong Cheng
Dong Cheng was originally a subordinate general of Niu Fu during the late Han Dynasty, and later joined forces with the White Wave Bandits to protect the emperor from the hands of Li Jue and Guo Si. He was also Emperor Xian's father-in-law...
's assassination plot on Cao Cao (this assassination attempt by Ji Ben however did historically happen).
The novel Romance of the Three Kingdoms has it that Hua Tuo gave his Qing Nang Shu, which recorded techniques for treating patients, to a prison official before his execution in order that his medical profession would survive. The wife of the official burned the book to avoid implication. Alarmed, the official immediately seized the burning papers from her, but the only parts he obtained were those dealing with how to emasculate hen and ducks and the other medical methods of Hua Tuo were lost forever.
Mafeisan
Hua Tuo's innovative anesthetic mafeisan "cannabis boiling powder" is a long-standing mystery.The name mafeisan combines ma (麻 "cannabis; hemp; numbed"), fei (沸 "boiling; bubbling"), and san (散 "break up; scatter; medicine in powder form"). Ma can mean "cannabis; hemp" and "numbed; tingling" (e.g., mazui 麻醉 "anesthetic; narcotic"), which Li (1974:297) believes semantically "derived from the properties of the fruits and leaves, which were used as infusions for medicinal purposes".
Modern Standard Chinese mafei is reconstructed as Old Chinese
Old Chinese
The earliest known written records of the Chinese language were found at a site near modern Anyang identified as Yin, the last capital of the Shang dynasty, and date from about 1200 BC....
*mrâipəts, Late Han Chinese maipus (during Hua's life), and Middle Chinese
Middle Chinese
Middle Chinese , also called Ancient Chinese by the linguist Bernhard Karlgren, refers to the Chinese language spoken during Southern and Northern Dynasties and the Sui, Tang, and Song dynasties...
mapjwəi (Schuessler 2007:233, 373).
Many sinologists and scholars of Traditional Chinese Medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
have guessed at the anesthetic components of mafei powder. Smith (1871:61) contends that Hua Tuo, "the Machaon of Chinese historical romance", used yabulu (押不蘆 "Mandragora officinarum
Mandragora officinarum
Mandragora officinarum is a species of the plant genus mandrake. It has a variety of medicinal uses, especially anodyne and soporific, though in the past much of the use was due to superstition.-Physical characteristics:...
") rather than huoma (火麻 "Cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
") and mantoulo (曼佗羅 "Datura stramonium
Datura stramonium
Datura stramonium, known by the common names Jimson weed, devil's trumpet, devil's weed, thorn apple, tolguacha, Jamestown weed, stinkweed, locoweed, datura, pricklyburr, devil's cucumber, Hell's Bells, moonflower and, in South Africa, malpitte and mad seeds, is a common weed in the...
", n.b., Hua's name Tuo) "infused in wine, and drunk as a stupefying medicine". Herbert Giles
Herbert Giles
Herbert Allen Giles was a British diplomat and sinologist, educated at Charterhouse. He modified a Mandarin Chinese Romanization system earlier established by Thomas Wade, resulting in the widely known Wade-Giles Chinese transliteration system...
(1897:323) translates mafeisan as "hashish
Hashish
Hashish is a cannabis preparation composed of compressed stalked resin glands, called trichomes, collected from the unfertilized buds of the cannabis plant. It contains the same active ingredients but in higher concentrations than unsifted buds or leaves...
"; his son Lionel Giles
Lionel Giles
Lionel Giles was a Victorian scholar, translator and the son of British diplomat and sinologist, Herbert Giles. Lionel Giles served as assistant curator at the British Museum and Keeper of the Department of Oriental Manuscripts and Printed Books...
(1948:72) identifies "hemp-bubble-powder" as "something akin to hashish or bhang". Veith (1966:3) quotes the sinologist Erich Hauer's "opinion that ma-fei (麻沸) means opium." Victor H. Mair
Victor H. Mair
Victor Henry Mair is a Philologist specializing in Sinitic and Indo-European languages, and holds the position of Professor of Chinese Language and Literature in the Department of East Asian Languages and Civilizations at the University of Pennsylvania, Philadelphia, United States...
(1994:689) notes that mafei "appears to be a transcription of some Indo-European word related to "morphine"." Although Friedrich Sertürner
Friedrich Sertürner
Friedrich Wilhelm Adam Sertürner was a German pharmacist, who discovered morphine in 1804.-Biography:He was born on 19 June 1783 in Neuhaus ....
first isolated morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
from opium
Opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...
in 1804, Mair suggests, "It is conceivable that some such name as morphine was already in use before as a designation for the anesthetic properties of this opium derivative or some other naturally occurring substance." Wang and Ping (1999:91) find consensus among "scientists of later generations" that mafei contained yangjinhua (洋金花 "Datura stramonium") and wutou (烏頭 "rhizome of Aconitum
Aconitum
Aconitum , known as aconite, monkshood, wolfsbane, leopard's bane, women's bane, Devil's helmet or blue rocket, is a genus of over 250 species of flowering plants belonging to the buttercup family .-Overview:These herbaceous perennial plants are chiefly natives of the mountainous parts of the...
, Chinese monkshood") or caowu (草烏 "Aconitum kusnezofflin; Kusnezoff monkshood").
Lu and Needham (2002:118) suggest Hua Tuo may have discovered surgical analgesia by acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
, "quite apart from the stupefying potions for which he became so famous – if so he kept it to himself and his immediate disciples so that the secret did not survive".
External links
- Hua Tuo, Subhuti Dharmananda
- Hua Tuo: A miraculous healer in ancient China, Association for Asian Research
- A Brief Biography of Hua Tuo, John Chen