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Hua Tuo and the Origins of Surgery in Ancient China


When we look at the history of medicine and surgery, several figures stand out as exemplary. For much of recorded history, works from the ancient Greeks led the medical establishment. The teachings of Galen and Hippocrates would prevail for centuries until the age of the Renaissance, where physicians began making strides in our understanding of the human body. However, what discoveries were being made in the East?


Interactions between India and China during the transmission of Buddhism in the first century of the Christian era may have led to the proliferation of physician stories. Much of what we understand of Chinese medicine, particularly surgery, originates from one central figure, a man named Hua Tuo (華佗). Believed to have been born around 108 AD, his theories evolved independently of his Western contemporaries at the time. Records indicate Hua Tuo lived during the Eastern Han Dynasty, in what is now modern-day Haoxian, Anhui province. He became passionate about the art of medicine from the early age of seven following his father’s death. Studying under a physician named Cai, he would go on to revolutionize our understanding of the human body. While poorly documented, his work defied the beliefs of traditional Chinese medicine. These traditional teachings revolved around energy within the human body, diagnosing problems in the body as imbalances. By combining these traditional beliefs with his own experience as a physician, Hua Tuo was able to make extraordinary diagnoses. Sensationalized stories hail him as supernatural, curing a wide variety of ailments such as brain cancer, poisoning, inflammation, infection, and battle wounds.


Hua Tua’s notable advancements developed anesthetics, suturing, antiseptics, anti-inflammatory remedies, and anthelmintics, many of which incorporated herbal remedies which will be discussed later. Much of Hua Tuo’s records come in the form of stories, which emphasized his craft and understanding of the human body centuries before they were recorded again. These accounts can be found in novels such as Romance of the Three Kingdoms (三國演義) by Luo Guanzhong and Taiping’s Comprehensive Anthology of Stories, a collection from the Taiping Zingguo (太平興國) reign period (976-984).


In one famous tale, the general Guan Yu (關羽) was wounded by a poisonous arrow in battle. To fix this, Hua Tuo proceeded to clean the wound using his antiseptic technique. As dramatized in Romance of the Three Kingdoms, Hua Tuo states, “This is what I shall do. In a private room, I shall erect a post with a ring attached. I shall ask you, Sir, to insert your arm through the ring, and I shall bind it firmly to the post. Then I shall cover your head with a quilt so you cannot see, and with a scalpel, I shall open up the flesh right down to the bone. Then I shall scrape away the poison. This done, I shall dress the wound with a certain preparation, sew it up with a thread, and there will be no further trouble.” The general proceeded to play a game of Wei-chi (Chinese chess) while Hua Tuo operated.


Hua Tuo’s death would come around 207 AD at the hands of one of his patients. According to Fenghen Yanyi (Investiture of the Gods 封神演義), Hua Tuo treated the Prince of Wei, CaoCao (曹操) for a brain tumor. The prince perceived Hua Tuo’s surgical procedure as an assassination attempt and condemned him to execution. Before his death, the physician gifted CaoCao the Book of the Black Bag, which was a culmination of all his medical work. CaoCao burned the book, and with Hua Tuo’s death came a stagnation to the art of medicine in China for centuries.


One of Hua Tuo’s biggest discoveries was the use of herbal treatments for anesthesia and antiseptics. As one of the first physicians to practice surgeries such as splenectomy and colostomy, he utilized mafeisan (麻沸散) to anesthetize his patients. Mafeisan was an herbal concoction, described as a comatose drunk without any feeling. Several theories have posited the components of mafeisan, pointing to historical Chinese and Japanese texts. The Shennong Bencaojing (神農本草經) details the use of herbs such as Cannabis sativa, Aconitum, Anisodus tanguticus, Datura stramonium, and Lingusticum chuanxiong as commonplace in early Chinese medicine. The mixture was boiled in wine and consumed before surgery. After a period of four to five days, surgical site pain subsided, and the patient regained consciousness. Although mafeisan’s original prescription was lost, a mixture of these herbs would provide the effects described in historical records. In addition, accounts from physicians such as Bian Que (秦緩)

reference a similar mixture called Shui-Sheng-san which was used similarly to mafeisan.


Several scholars debate the existence of Hua Tuo altogether, stating his stories were a fairy tale. The theory believes he was created by ordinary people to give respect to the physician’s occupation in society. Socially, surgeons were regarded as a separate social class lower than physicians, occupying a similar space to that of artisans and craftsmen. Others describe Hua Tuo’s procedures as impossible – stating bowel resection requires modern medical knowledge and technology. However, Hua is still a common family name in China, and scholars have confirmed he was not from Persia or India, which is another common theory (Zhang, 2017).


The phrase “A second Hua Tuo” is considered an honor to outstanding physicians and surgeons. Ahead of his time, Hua Tuo pioneered techniques in surgery, gynecology, pediatrics, and acupuncture. The “Hua Tuo Jiaji” (華佗夹脊), a set of 34 spinal nerve points, is named in his honor, and he created a fitness regimen that spearheaded Tai Ji Chuan (tai chi). Concerned with patient safety, he sought to minimize harm with his early anesthesia, which predated western means by over 1600 years. Referred to as the god of surgery, Hua Tuo set an early precedent for quality patient care. As quoted in Romance of the Three Kingdoms:


“Here as surgeons, there are physicians, leeches boast their skill; Bitter few are those that cure one when one’s really ill. As for superhuman valour rivals Kuan had none, So for holy touch in healing Hua T’o stood alone.”


References


Dorr, S. D. / C. (n.d.). References. Hua Tuo. Retrieved January 2, 2022, from http://www.itmonline.org/arts/huatuo.htm


Fu, L. (2009). Surgical history of ancient China: Part 1. ANZ Journal of Surgery, 79(12), 879–885. https://doi.org/10.1111/j.1445-2197.2009.05138.x


Sherer A, Epstein F, Constantini S. Hua Tuo, patron of surgeons, or how the surgeon lost his head! Surg Neurol. 2004 May;61(5):497-8. doi: 10.1016/j.surneu.2003.11.037. PMID: 15120241.


Tubbs RS, Riech S, Verma K, Chern J, Mortazavi M, Cohen-Gadol AA. China's first surgeon: Hua Tuo (c. 108-208 AD). Childs Nerv Syst. 2011 Sep;27(9):1357-60. doi: 10.1007/s00381-011-1423-z. PMID: 21452005.


Zhang, L. S. (2018). Hua-Tuo is a true Chinese! – not a Persian and not imaginative. Journal of Anesthesia History, 4(1), 62. https://doi.org/10.1016/j.janh.2017.11.046


Zhao P, Yu X, Kagemoto Y. Was Mafeisan an Anesthetic in Ancient China? J Anesth Hist. 2018 Jul;4(3):177-181. doi: 10.1016/j.janh.2018.01.009. Epub 2018 Feb 2. PMID: 30217390.


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