The History of Traditional Chinese Medicine

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Traditional Chinese medicine has been practised continuously for over 2,500 years — the longest unbroken medical tradition in human history. From the oracle bones of the Shang Dynasty through the Han Dynasty classics, the Song–Jin–Yuan medical schools, Li Shizhen's Bencao Gangmu, the Warm Disease school of the Qing, the near-abolition and revival of the 20th century, and Tu Youyou's 2015 Nobel Prize, TCM has been refined, researched, regulated and exported worldwide.

On this page

1. Pre-classical origins (c. 2000–500 BCE)
2. Han Dynasty: the classical foundations (206 BCE–220 CE)
3. Tang Dynasty consolidation (618–907 CE)
4. The Song–Jin–Yuan medical schools (960–1368)
5. Ming Dynasty and Li Shizhen (1368–1644)
6. Qing Dynasty and the Warm Disease school (1644–1911)
7. The 20th century: near-extinction and revival
8. TCM in the modern world
9. Timeline of key events
10. References

1. Pre-classical origins (c. 2000–500 BCE)

The roots of Chinese medicine extend deep into pre-history. Archaeological evidence shows that sharpened stones called bian shi were being used for therapeutic puncture as early as the Neolithic period, and herbal knowledge was accumulating long before any of it was written down. Burial sites of the early Bronze Age contain pottery vessels with the residues of medicinal plants, and tomb texts of the Western Han Dynasty (such as the Mawangdui silk manuscripts unearthed in 1973) show that an extensive pre-classical body of medical writing existed before any of the canonical texts that survive today.

The earliest written references to medicine appear on oracle bones from the Shang Dynasty (1600–1046 BCE) — pieces of ox scapula and turtle shell used in royal divination. The inscriptions name specific diseases, identify body parts, record the role of the royal physician (shi) and describe rudimentary treatments. These oracle bone texts give us our first glimpse of an organised medical system in China.

The mythological figures of Fu Xi (said to have invented the eight trigrams and the principles of divination), Shen Nong (the “Divine Farmer”, said to have tasted hundreds of herbs to discover their properties — allegedly suffering 70 poisonings in a single day) and the Yellow Emperor (Huang Di) belong to this pre-classical tradition. While these figures are legendary rather than historical, they represent the long pre-literate accumulation of empirical knowledge that the later classical texts inherited and codified. By the late Warring States period (5th–3rd centuries BCE), the foundational concepts of yin and yang, the Five Phases, qi and the channels had developed into a coherent theoretical system — the system that would be set down in writing during the Han Dynasty that followed.

2. Han Dynasty: the classical foundations (206 BCE – 220 CE)

The Han Dynasty is the foundational period of Chinese medicine. During this single period, three of the four great classics of Chinese medicine were compiled, establishing the theoretical and practical framework that remains in use today.

The Huángdì Nèijīng (Yellow Emperor's Classic of Internal Medicine)

The Huángdì Nèijīng, compiled around 100 BCE from earlier materials, is the most important theoretical work in the history of Chinese medicine. Structured as a dialogue between the Yellow Emperor and his physician Qi Bo, its two parts — the Su Wen (Plain Questions) and the Ling Shu (Spiritual Pivot) — lay out the doctrines of yin and yang, the Five Elements, the meridian system, qi and blood, the six climatic factors that cause disease (Wind, Cold, Heat, Damp, Dryness, Fire), and the relationship between the human body and the natural world.

Every concept that still underpins TCM practice today — from pulse-taking to the channel system to the principles of disease causation to the seasonal and emotional bases of imbalance — is set out in the Nei Jing. It is to Chinese medicine what the Hippocratic Corpus is to Greek medicine, except that the Nei Jing has remained the working clinical reference of practitioners for over two millennia rather than a primarily historical document.

The Shénnóng Běncǎo Jīng (Shennong's Classic of Materia Medica)

The Shénnóng Běncǎo Jīng, compiled around the same period, was the first systematic Chinese herbal text. It catalogued 365 medicinal substances — one for each day of the year — divided into three classes:

• Superior (top class): 120 substances that nourish life and are safe for long-term use — including ginseng, astragalus, licorice, Goji and Reishi mushroom
• Middle class: 120 substances used to treat specific imbalances, requiring more care in dosing
• Lower (toxic) class: 125 strong-acting substances used briefly for specific severe conditions

Many of the herbs the Bencao describes remain among the most important in the modern Chinese pharmacopoeia, prescribed exactly as they were two thousand years ago.

Zhang Zhongjing and the Shāng Hán Lùn

Zhang Zhongjing (c. 150–219 CE), often called the “Hippocrates of China”, wrote the Shāng Hán Zá Bìng Lùn (Treatise on Cold Damage and Miscellaneous Diseases) after losing two-thirds of his own clan to a febrile epidemic. The work was later split into two texts: the Shāng Hán Lùn (Treatise on Cold Damage Disorders) and the Jin Gui Yao Lue (Essentials from the Golden Cabinet).

Together these introduced the system of pattern differentiation (biàn zhèng) — matching the patient's specific constellation of symptoms to a defined clinical pattern, and prescribing the appropriate formula for that pattern. This single innovation transformed medicine from symptom-by-symptom treatment into a sophisticated diagnostic framework that explains why two patients with identical symptoms may need different treatments, and why the same patient may need different treatments as their pattern evolves.

The 113 formulas Zhang catalogued in the Shang Han Lun — including Gui Zhi Tang, Xiao Chai Hu Tang, Da Cheng Qi Tang, Zhen Wu Tang and dozens more — are still prescribed today exactly as he described them 1,800 years ago, with substantial modern research now supporting their clinical effects.

3. Tang Dynasty consolidation (618–907 CE)

The Tang Dynasty was a period of cosmopolitan expansion in which Chinese medicine was consolidated, codified and disseminated across East Asia. Sun Si Miao (581–682 CE) — later known as the “King of Medicines” (Yao Wang) — was the period's defining physician.

Sun's two great works, the Qiān Jīn Yào Fāng (Essential Prescriptions Worth a Thousand Gold Pieces, c. 652 CE) and the Qiān Jīn Yì Fāng (Supplement to the Thousand-Gold Prescriptions, c. 682 CE), brought together over 5,000 formulas across the full range of medical specialties — gynaecology, paediatrics, dermatology, ophthalmology, orthopaedics and internal medicine. Sun is also remembered for his influential code of medical ethics, the “Great Physicians of Absolute Sincerity” essay — one of the earliest formal statements of medical professional ethics in any culture, predating the Western statements of Maimonides and others by several centuries.

His clinical recommendations remain in regular use today. It is Sun Si Miao who famously recommended moxibustion at BL 43 (Gao Huang Shu) for “all chronic and difficult diseases”, and many of his fertility and women's health protocols remain influential in modern TCM gynaecology.

During the Tang and the following Song Dynasty, the Imperial Medical Service (Tai Yi Shu) standardised medical education, examination and practice across the empire. Imperial commissions produced encyclopaedic compilations of the existing canon, ensuring its preservation. Chinese medicine spread to Japan, where it became the foundation of Kampo medicine, to Korea (where it evolved into traditional Korean medicine), and to Vietnam. Through Silk Road and maritime trade it was exchanged with the Islamic and Indian medical traditions, with Chinese pulse diagnosis influencing Arabic medicine and Chinese herbal knowledge incorporating Indian and Persian materia medica in return.

4. The Song–Jin–Yuan medical schools (960–1368)

The Song, Jin and Yuan dynasties produced some of the most intellectually vital periods in the history of Chinese medicine. Imperial publication of standardised editions of the classics — including the first proper printed editions of the Nei Jing and the Shang Han Lun — preserved the canon and made it widely available to physicians for the first time. The first formal acupuncture teaching model with marked points cast in bronze (the Tongren, or Bronze Man, of 1027 CE) was produced by Wang Weiyi as a standardised teaching aid; trainee physicians were tested by sealing the model with wax, filling it with water, and confirming they could needle the correct points to make the water emerge.

This period also saw the emergence of the four great medical schools of the Jin–Yuan, each associated with a master physician who reshaped theory and practice in a different direction:

• Liu Wansu (1110–1200) — the “Fire and Heat” school: emphasised the role of Heat in disease causation; advocated cooling herbs and methods. Wrote the Su Wen Xuan Ji Yuan Bing Shi.
• Zhang Congzheng (1156–1228) — the “Attack and Purge” school: advocated the vigorous expulsion of pathogenic factors through sweating, vomiting and purging. Wrote the Ru Men Shi Qin.
• Li Dongyuan (1180–1251) — the “Spleen and Stomach” school: emphasised that disease arises from injury to the Spleen and Stomach. Devised Bu Zhong Yi Qi Tang and Dang Gui Bu Xue Tang — both still among the most widely prescribed formulas today. Wrote the Pi Wei Lun.
• Zhu Danxi (1281–1358) — the “Nourish Yin” school: emphasised that Yang is often in excess and Yin in deficiency in chronic disease, devising many formulas to nourish Yin and clear deficiency Heat. Foundational for what we now call menopausal medicine and chronic Yin-depletion disorders.

The tensions between these schools forced ongoing clarification of the foundational theory and produced many of the formulas and clinical approaches that remain central to TCM today. The principle that emerged — that different patterns require fundamentally different therapeutic approaches — is the bedrock of modern pattern differentiation.

5. Ming Dynasty and Li Shizhen (1368–1644)

The Ming Dynasty saw the production of the most comprehensive single work in the history of Chinese medicine: the Běncǎo Gāngmù (Compendium of Materia Medica) by Li Shizhen (1518–1593).

Over 27 years of meticulous work, Li examined 1,892 medicinal substances — herbs, minerals, animal products and foods — correcting errors that had accumulated in earlier texts, integrating clinical observation with botanical accuracy, and providing detailed entries on preparation, dosage, indications and contraindications. He travelled widely to collect specimens, consulted physicians, farmers and hunters, and re-examined every herb he could obtain. He documented over 11,000 prescriptions. The Bencao Gangmu ran to 52 volumes and contained over 1.9 million Chinese characters.

It remains a primary reference for Chinese pharmacognosy and was the principal source consulted by 19th-century European botanists and pharmacologists when investigating Chinese materia medica. Charles Darwin cited Li's work in The Origin of Species, drawing on Li's observations of artificial selection in domestic animals. Joseph Needham, the great historian of Chinese science, called the Bencao Gangmu “the greatest scientific achievement of the Ming”.

The Ming also saw the codification of acupuncture in works such as Yang Jizhou's Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion, 1601), which standardised point locations, indications and clinical application for centuries to follow. This is the text that most modern acupuncture point teachings ultimately derive from.

6. Qing Dynasty and the Warm Disease school (1644–1911)

The Qing Dynasty witnessed a major theoretical development in response to the recurring epidemics of febrile disease that swept China during the period. The Warm Disease school (Wēn Bìng Xué Pài), led by physicians including Ye Tianshi (1667–1746) and Wu Jutong (1758–1836), developed a sophisticated framework for understanding and treating epidemic infectious disease.

Where Zhang Zhongjing's Shang Han Lun had described disease in terms of penetration through six channels in cold-pathogen patterns, the Warm Disease school described it as progression through four levels — wei (defensive), qi (vital energy), ying (nutritive) and xue (blood) — for heat-pathogen patterns. Each level corresponds to a different depth of pathogenic penetration, with different clinical signs and different therapeutic approaches. The framework was developed empirically through detailed observation of large numbers of fever patients during multiple epidemics, and remains a primary clinical tool for treating viral and febrile illness in modern Chinese medicine; it was used extensively in the management of SARS and COVID-19 in China.

The Qing also produced Wang Qing Ren (1768–1831), who in his Yī Lín Gǎi Cuò (Corrections of Errors in the Forest of Medicine) made original observations on blood stasis as a cause of disease that had been underweighted in the earlier tradition. Wang's work gave us Bu Yang Huan Wu Tang (still the principal post-stroke formula), Xue Fu Zhu Yu Tang and the rest of his still-essential Blood-moving formulas. His emphasis on Blood stasis as a clinical pattern has been substantially validated by modern research into cardiovascular disease, stroke recovery and chronic pain.

7. The 20th century: near-extinction and revival

The early 20th century was the most precarious period in the history of Chinese medicine. The fall of the Qing Dynasty in 1911 and the subsequent Republican period saw modernising reformers, inspired by Western science, seek to abolish Chinese medicine as “feudal” and “unscientific”. In 1929, the Nationalist Ministry of Health passed a resolution to outlaw Chinese medicine entirely. The resolution was reversed only after massive public protests by physicians, students and patients across the country — one of the largest popular medical demonstrations in history.

Even so, the period 1911–1949 saw the closure of many traditional schools, the suppression of TCM publications, and the marginalisation of practitioners. Many physicians moved to Hong Kong, Taiwan or Southeast Asia to continue practice. The tradition's survival was not assured.

The decisive intervention came after the founding of the People's Republic in 1949. Mao Zedong declared that “Chinese medicine is a great treasure house, and we must work hard to discover its contents and raise it to a higher level”. State policy from 1954 onwards mandated the preservation of Chinese medicine, its integration with Western medicine, and the establishment of academic TCM colleges. The first state TCM colleges opened in Beijing, Shanghai, Chengdu and Guangzhou in 1956, offering five-year degree programmes equivalent to Western medical training.

This effort produced the modern, standardised version of TCM that is now taught worldwide. The curriculum was rationalised, the diagnostic framework systematised, terminology standardised, and pattern differentiation codified into a teachable, examinable form. Hospitals were established offering integrated TCM and Western medicine, with TCM physicians qualified to the same legal standard as biomedical physicians.

Despite the enormous political turbulence of the Cultural Revolution (1966–1976), TCM survived this period of disruption and emerged at the end of the 20th century as a fully institutionalised medical system at university and hospital level — with research programmes, clinical trials, pharmaceutical-grade manufacturing of herbal products, and an established place in the country's public health system.

8. TCM in the modern world

Since the 1970s, traditional Chinese medicine has spread rapidly across the world. Acupuncture was introduced to the United States after President Nixon's 1972 visit to China, when New York Times reporter James Reston wrote a famous front-page report on the effective use of acupuncture in managing his post-operative pain after appendectomy in Beijing. American physicians and journalists travelled to China to observe acupuncture surgical anaesthesia, and the resulting publicity opened Western interest in Chinese medicine.

From the 1980s onwards the World Health Organisation published standardised acupuncture point nomenclature, established research programmes and published lists of conditions for which acupuncture is supported by clinical evidence. In 2019, the WHO formally included TCM in the 11th revision of the International Classification of Diseases (ICD-11) — the first time any traditional medical system has been formally incorporated into the global health classification used by health systems worldwide.

The Nobel Prize: Tu Youyou and artemisinin

The most significant modern scientific recognition of TCM came in 2015, when Tu Youyou was awarded the Nobel Prize in Physiology or Medicine for her discovery of artemisinin — an anti-malarial drug derived from Artemisia annua (Qing Hao), a herb used in Chinese medicine for over 1,600 years.

In the 1960s, malaria was killing hundreds of thousands annually in Southeast Asia, and existing treatments were losing effectiveness as resistance spread. Mao Zedong launched a secret research programme (Project 523) to find a new antimalarial. Tu Youyou's team screened thousands of herbs from the classical pharmacopoeia. Initial extractions of Qing Hao gave inconsistent results until Tu re-read Ge Hong's 4th-century classical text Zhǒu Hòu Bèi Jí Fāng (Handbook of Prescriptions for Emergencies), which described preparing Qing Hao by cold-water steeping rather than boiling. This detail preserved the heat-sensitive artemisinin and enabled Tu's team to isolate the active compound.

Artemisinin combination therapy (ACT) is now the global first-line treatment for falciparum malaria. The drug has saved millions of lives, particularly in sub-Saharan Africa, and is recognised as one of the most important medical advances of the late 20th century. Tu's Nobel Lecture, delivered in Stockholm in December 2015, made the case forcefully: traditional Chinese medicine, properly investigated with modern scientific methods, remains a source of major therapeutic innovation for the world.

TCM in the UK and the West today

In the UK, TCM is now widely available. Acupuncture is recommended by the National Institute for Health and Care Excellence (NICE) for chronic primary pain, used routinely in NHS hospitals, GP surgeries and pain clinics, and supported by a growing evidence base across many conditions. The British Acupuncture Council provides voluntary professional regulation for acupuncturists, with members trained to a minimum of 3,000 hours.

Chinese herbal medicine is regulated through professional bodies including the Register of Chinese Herbal Medicine (RCHM). Herbal products are subject to MHRA quality control, with major manufacturers like Sun Ten in Taiwan producing pharmaceutical-grade granules tested to international quality standards.

Over 2,500 years after its first written records, the system remains very much alive — refined, researched, regulated, and continuing to evolve. I trained in the standardised five-year university curriculum that emerged from the 20th-century revival, with clinical placements at Whittington Hospital in London and Zhong Ri Hospital and Xi Yuan Hospital in Beijing — and like every contemporary TCM practitioner, I remain a small part of this long tradition.

9. Timeline of key events

10. References

• Unschuld, P. U. (1985). Medicine in China: A History of Ideas. Berkeley: University of California Press.
• Unschuld, P. U. (2003). Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. Berkeley: University of California Press.
• Needham, J. (1954–present). Science and Civilisation in China. Cambridge: Cambridge University Press — particularly Volume VI: Biology and Biological Technology, Part 6: Medicine.
• Hsu, E. (Ed.) (2001). Innovation in Chinese Medicine. Cambridge: Cambridge University Press.
• Scheid, V. (2002). Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham: Duke University Press.
• Tu, Y. (2015). Artemisinin — a gift from traditional Chinese medicine to the world. Nobel Lecture, 7 December 2015. Stockholm: Nobel Foundation. Available at: https://www.nobelprize.org/prizes/medicine/2015/tu/lecture/
• World Health Organization. (2019). WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization.
• World Health Organization. (2019). ICD-11 for Mortality and Morbidity Statistics — Chapter 26: Supplementary Chapter Traditional Medicine Conditions. Available at: https://icd.who.int/
• NICE. (2021). Chronic pain (primary and secondary) in over 16s. NICE guideline [NG193]. Available at: https://www.nice.org.uk/guidance/ng193

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