Ming Dynasty 1368 - 1644 AD

About the Ming
Map of Ming Dynasty

Emperor Hongwu

The founder of the Ming dynasty was Zhu Yuanzhang, better known as Hongwu. Hongwu was a Han Chinese peasant and former Buddhist monk turned rebel army leader. He led the defeat of the Mongols in 1368 AD Extensive political and agricultural reforms were undertaken by the early Ming resulting in a period that was both rich and fruitful in terms of economy, art and culture. This was especially so under the reign of the second Emperor Yongle, 1403-24.

Under Emperor Yongle's leadership China flourished. This was a period of many firsts. The Forbidden City was constructed, dictionaries such as the Yongle Dadian (Great Dictionary of the Yongle Reign) were written and explorers such as Zheng He traveled the world for new ideas. Famous literary works such as the Xiyouji (Journey to the West) and Jin Ping Mei (The Golden Lotus) were written during this time.

Despite such progress, the dynasty became increasingly dictatorial and the Ming reign was to be short-lived. In the 1440s, the Mongols once again became a threat and Japanese pirates, known as wokou, became an increasing menace. In the seventeenth century, the Manchus began to gather power over an already weakened country, and would eventually form the Qing Dynasty. During the later period of the Ming, Western culture flooded into China. A number of Jesuits arrived bringing with them their religion, philosophies and knowledge. Matteo Ricci , the famous Italian Jesuit missionary scholar, was to develop a close relationship with Chinese scholars.

Different Schools of Medicine

The work of many eminent physicians and the publication of numerous treatises testify to the blossoming of medical theories and practices during the Ming period. Despite this, Chinese medicine continued to rely mostly on the medical classics and many Ming handbooks drew on these. Following the Jin and Yuan dynasties, there were great debates among physicians from the different schools advocating different philosophies of Chinese medicine. The three major schools in this period were the school of nourishing the yin, the school of warming and invigoration, and the school of epidemic disease.

School of Nourishing the Yin
The founder of this school was Zhu Zhenheng, whose theory was aimed at nourishing the yin and quenching the minister fire. Two famous doctors, Wang Lu and Dai Sigong , became disciples of this school and continued to advocate, as a Ming therapeutic approach, Zhu Zhenheng's theory in their practice.

The School of Warming and Invigoration
Although the schools of medical thought founded by Zhu Zhenheng had their followers during the Ming dynasty, many physicians supported the ideas of the "school of warming and invigoration" (wenbu) founded by Li Gao. They believed that tonifying the spleen and stomach preserved the vital energy (qi) and kept away illness. The foremost physicians in this area of thought were Xue Ji, Zhao Xianke and Zhang Jiebin.

Xue Ji (c. 1488-1558), whose father had been a member of the official Academy of Medicine, was a specialist in internal medicine, surgery, gynecology, pediatrics and otorhinolaryngology. He published a wide variety of medical classics, including Neike Zhaiyao (A Summary of Internal Medicine), Waike Shuyao (Essentials of External Medicine), Waike Fahui (The Development of External Medicine), Nuke Cuoyao (A Resume of Gynecology), Zhengti Leiyao (A Repertory of Traumatology), and Kouchi Leiyao (A Repertory of Stomatology), providing ample testimony to his medical interests. He also recommended decoctions to treat poor appetite and fatigue which were described as being able to "regulate or invigorate the middle burner and increase energy," in the book of Piweilun (Treatise on the Spleen and Stomach) by Li Gao and commonly made use of atractylodes rhizome, ginseng, liquorice and milkvetch root.

Zhao Xianke developed the teachings of Xue Ji to formulate the theory of the "gate of vitality" (mingmen). According to Zhao, it was this "gate of vitality," located between the kidneys, rather than the heart that governed the body. The amount of "fire" generated by this gate determined the degree of available energy. Zhao believed in a relationship between fire (yang) and water (yin). Nourishment of one or the other was the basis for his treatment and to achieve this he gave his patients one of two pills: "the pill of eight ingredients" to reinvigorate fire (yang), and "the pill of six ingredients" to reinvigorate water(yin)." The prescriptions for these were taken from the text written by Zhang Zhongjing in the second century AD, Jingkui Yaolue (Summary from the Golden Chest).

Another notable medical commentator of the time was Zhang Jiebin (1563-1640), also known as Zhang Jingyue. He disagreed with Zhu Zhengheng that yang was generally excessive whilst yin was insufficient, believing instead that yang was the source of life and the root of our physical existence. He wrote many works aimed at explaining and simplifying the ancient classic Huangdi Nei Jing (The Yellow Emperor's Classic of Internal Medicine).

The School of Epidemic Disease (wenbing)
Prior to the Ming dynasty, febrile illness (wenbing) or cold-induced illness (shanghan) were the general names for acute feverish disease caused by exogenous pathogens. The terms covered both infectious and non-infectious diseases. It was only at the beginning of the Ming dynasty that the precise features and a definition of wenbing were formulated. Wang Lu was the first physician to clearly define different approaches to the treatment of shanghan and wenbing. Wenbing became the name for cases of infectious disease only.

Wu Youxing ( 1580-1660)

Plague was a major problem during the Ming period and was spoken of as wenyi (pestilence), that is any kind of fatal epidemic disease. An outbreak in 1641 wiped out a large portion of the population in China. The physician Wu Youxing (c. 1580-1660) made an important breakthrough on wenbing. After extensive research into epidemic disease, he published a book Wenyilun (On Pestilence) in 1642. In this, he described the specific symptoms of different kinds of epidemic disease and proposed the theory of liqi (excessive influences).

His theory of liqi stated that pestilence was not caused by exogenous pathogens (such as wind, cold, summer-heat and wet), but was the result of infection by excessive influences. Liqi had the following characteristics:

* It could be cured by herbs.
* Penetration of the body took place through the mouth and nose.
* Occurrence of disease depended on the quantity and virulence of the excessive influence, and body resistance.
* Each pestilence was associated with its own particular liqi.

Wu Youxing also claimed that the liqi affecting humans was different from that occurring in animals. He suggested that liqi was the cause of smallpox and other inflammatory skin diseases.

Smallpox was a great scourge of the country during the Ming dynasty and there is documented use of anti-smallpox vaccination dating from the years 1567-72.

Advancement in Surgery

Various other new medical ideas arose during the Ming. The concept that internal and external treatment should be combined to tackle illness was shared by several physicians and surgeons. The theory was extended to the treatment of cancer by a number of practitioners who recognized contributory causative factors, such as depression and the eating of fried, spicy or charred food. The development during the Ming of methods for achieving analgesia (pain relief), asepsis (absence of illness causing organisms) and hemostasis (the arrest of bleeding) contributed to an improvement in surgical technique.

Waike Zhengzong
(The Genuine Surgery)

Chen Shigong (1555-1636) was one of the outstanding surgical figures of this time. He dedicated himself to external medicine for over 40 years. His Waike Zhengzong (The Genuine Surgery), first published in 1617, covered a series of surgically treatable diseases and many effective prescriptions. The book outlined the surgical procedure for the repair of a slashed throat, the use of copper wire to excise nasal polyps under local anesthesia, and described in detail cancer of the lip and breast. These were the earliest surgical records in TCM history.

Ravages of Venereal Disease

The cleanliness of the sexual habits observed by the Chinese was thwarted during the sixteenth and seventeenth centuries by outbreaks of syphilis that ravaged the country. The disease appears to have spread from the southern coastal region of Canton. Physicians of the period devoted much effort to combating syphilis and two notables were Wang Ji and Chen Sicheng.

Wang Ji (1463-1539) held the view that a combination of internal and external therapy was needed to deal with venereal disease and prescribed a "decoction of the four rulers" (ginseng, large head atractylodes root, Indian bread and liquorice root) to sustain vital energy (qi), while applying an ointment containing honeysuckle to the lesions. At times he cauterized the ulcers using garlic. To complete recovery, he gave a further decoction, which in addition to the ingredients used in the "four rulers" contained rehmannia root, peony root, chinese angelica and szechwan lovage rhizome. This remedy is still in use in Chinese medicine as a tonic for qi and blood.

Chen Sicheng, who lived about 100 years after Wang Ji, devoted an entire work to the treatment of syphilis. His Meichuang Milu (Secret Writings on Putrid Ulcers) published in 1632 was the first of its kind in China. The book suggested prescribing arsenic and mercury to cure syphilis. This preceded their use in Western medicine by about three hundred years.

Promotion of Acupuncture

Acupuncture and moxabustion continued to be widely used and studied under the Ming. In 1443, the Ming government ordered the casting of a bronze statue marked with the acupuncture points after the one produced in the Song dynasty. Yang Jizhou (1522-1620) published the most significant text of the period on acupuncture, Zhengjiu Dacheng (The Great Success of Acupuncture and Moxabustion). The book gathered important information from previous texts and enjoyed much popularity within the medical community. It was regularly reprinted in subsequent centuries.

Pharmacopoeias and Prescription Books

The Bencao Gangmu (Compendium of Materia Medica)
One of the most prolific writers and innovative medical practitioners of the Ming period was Li Shizhen (1518-93). A native of Qizhou, he was born into a family of physicians, the vocation often passing down in families for generations.

The Bencao Gangmu (Compendium of Materia Medica) - was translated into different languages

Of the seventeen works that Li published, the Bencao Gangmu (Compendium of Materia Medica) is perhaps the most well known and regarded. Li Shizhen used Tang Shenwei's work Zhenglei Bencao (Classified Materia Medica) as a reference. He revised the classification of drugs, expanded the list of known drugs, corrected previous errors, and created guidelines for the collection, preparation and use of drugs. Li unveiled 374 new drugs in his text in a list of 1,892 and included over 1,000 illustrations. The book summarized most of drug information available in the sixteenth entury.

Illustrations form the Bencao Gangmu (Compendium of Materia Medica)

Classification in the Bencao Gangmu (Compendium of Materia Medica) differed from previous materia medica by listing drugs under 16 headings:

1. Water 9. Fruit
2. Fire 10. Tree
3. Earth 11. Products derived from 'garments and tools'
4. Metal 12. Insect creatures with scales (reptiles, fish)
5. Stone 13. Creatures with shells
6. Plant 14. Bird
7. Cereal 15. Quadruped
8. Vegetable 16. Products of human origin

These headings were further subdivided. Plants were organized under their habitat or special character and to some extent Li anticipated the concept of a "plant family." Previous materia medica had been organized by toxicity or by the somewhat arbitrary origins of substances.

Li was also a well-respected physician and maintained a critical approach in his work. He believed that the mind had an important influence on the body. He was the first in China to identify gallstones, he used ice to reduce fever and developed techniques of disinfection. He attached greater attention in his work to the prevention of illness rather than to its cure. By the end of his career, he had a reputation as a herbalist, pharmacologist and physician, and also as a botanist, zoologist and mineralogist. He was a great humanitarian, promoting the Confucian principle that care should be extended to everyone.

Prescription Monographs
Standards for the combination, pharmacology, efficacy and administration of herbal prescription were improved during the time of the Ming. Many texts were published, including in 1406 the largest ancient Chinese prescription book, the Puji Fang (Prescriptions for Saving the Public). Zhu Su and Teng Shuo edited this book, listing 61,739 prescriptions with 239 illustrations. They gathered a wide variety of prescriptions and folk remedies, preserving most of the previous records of herbal use for future generations.