Hua Tuo is a famous physician of the Han Dynasty who is so widely respected that his name and image adorn numerous products (e.g., as a brand name for acupuncture needles and for medicated plasters) and a set of frequently used acupuncture points (called Hua Tuo Jiaji, see Appendix). He is known for the early qi gong exercise set known as the frolics of the five animals, in which one imitates the actions of tigers, deer, bears, apes, and birds; these practices were later incorporated into various health promoting martial arts practices, such as taijiquan. His name is always mentioned in relation to surgery, as he was considered the first surgeon of China, and one of the last famous surgeons of ancient China. He has been compared, in this regard, to Jivaka of India, who lived at the time of Buddha (about 500 B.C.) and was renowned for surgery, but had no significant successors until the modern era when surgery was reintroduced by Western doctors (4).
Legends of Hua Tuo's work are mentioned in historical novels, such as Romance of the Three Kingdoms and Taiping's Comprehensive Anthology of Stories. It was a tradition in the past that when a patient had recovered due to the efforts of a competent physician, the family would present a congratulatory board to the doctor inscribed with the words: A Second Hua Tuo.
Hua Tuo was born around 110 A.D., in Qiao of Peiguo (today called Haoxian or Bo) county, in what is now Anhui Province, one of the four major herb distribution centers of modern China. He lived for about 100 years, having died around 207 A.D. He was an older contemporary of China's famous herbalist Zhang Zhongjing, who died around 220 A.D. In the Chronicles of the Later Han Dynasty, it is said that: "Knowing well the way to keep one in good health, Hua Tuo still appeared in the prime of his life when he was almost 100, and so was regarded as immortal." It is said that Cao Cao, ruler of the state of Wei, had Hua Tuo put to death for reasons that are unclear. Cao Cao summoned him to serve as his personal physician, and either became enraged with Hua Tuo's hesitancy to return again later to provide more treatments or suspected an assassination attempt when Hua Tuo suggested brain surgery as a treatment for his severe headaches. According to the Records of the Wei Dynasty (Wei Zhi), Cao Cao had Hua Tuo killed in 207 A.D. at age 97. Cao Cao's second son, Cao Pi (187-226 A.D.), became Emperor of the Wei Dynasty, taking over China upon the forced abdication of Emperor Xian; China then collapsed into chaos, and Cao Pi was left only a few years rule of Wei, the northern kingdom of the "three kingdoms" that resulted from the breakdown.
According to the limited existing reports of his life, it is said that Hua Tuo studied and mastered various classics, especially those related to medical and health measures, but also astronomy, geography, literature, history, and agriculture, when he was young. He was stimulated to pursue a career in medicine after seeing so many people die of epidemics, famines, and injuries from wars (Zhang Zhongjing also mentioned the epidemics as leading him to undertake medicine as a career). His father had died when Hua Tuo was seven. His family lived in poverty and his mother wanted him to pursue a career. So, he walked hundreds of kilometers to Xuzhou to access all the medical classics retained there and learned from a famous physician named Cai. He studied tirelessly while practicing medicine, and became expert in several fields, including acupuncture, gynecology, pediatrics, and surgery. For the latter, he invented various herbal anesthetics. One, known as numbing powder (Mafai San), was taken with alcohol before surgery. His ancient prescriptions are lost, but the ingredients are thought to include cannabis and datura, which had been recorded later, during the Song Dynasty, as an anesthetic.
Two specific cases of abdominal operations were relayed in Hua Tuo's official biography:
A patient who went to Hua Tuo was told: 'Your disease has been chronic, and you should receive an abdominal operation, but even that could lengthen your life by not more than ten years.' The patient, being in great pain, consented to the surgery and was cured immediately, but he died exactly ten years later.
A patient who suffered from abdominal pain for more than 10 days and had depilation of his beard and eyebrows asked Hua Tuo for treatment. The doctor diagnosed him as having a deterioration in the abdomen, asked him to drink the anesthesia, then explored his abdomen and removed the deteriorated part, sutured and plastered the abdomen, and administered some herbs. The patient recovered after 100 days.
The latter story is believed to be a treatment of acute appendicitis. In the Wei Zhi (5), it was reported that for intestinal diseases Hua Tuo "would cut them out, wash them, sew up the abdomen, and rub on an ointment; the illness would remit if four to five days." There is also the story of general Guan Yu, whose arm was pierced by a poisoned arrow during a battle; General Guan calmly sat playing a board game as he allowed Hua Tuo to clean his flesh down to the bone to remove necrosis, with no anesthetic. This event is a popular historical subject in Chinese art.
Hua Tuo has been called the "miracle working doctor" (also translated as divine physician; shenyi) because of his emphasis on using a small number of acupuncture points or small number of herbs in a prescription to attain good results. Some sayings have been attributed to him; for example, in advocating that people exercise to stay healthy, he said: "The body needs exercise, but it should not be excessive. Motion consumes energy produced by food and promotes blood circulation so that the body will be free of diseases just as a door hinge is never worm eaten." Being an accomplished Taoist (Anhui was the birthplace also of the legendary Taoist founders Laozi and Zhuangzi) and following its principles, he did not seek fame or fortune, though much praise was heaped upon him. He served as a physician in what are now Jiangsu and Shandong Provinces adjacent to his home Province of Anhui, and turned down offers for government service.
It is said that Hua Tuo wrote several books, but none of them has been handed down, so his teachings remain largely unknown. One story is that while in prison awaiting his death, Hua Tuo handed over his works, collectively referred to as the Book of the Black Bag, to the prison ward and asked him to help save people's lives with his medical books, but the warden dared not accept it, and Hua Tuo burned it. Another story is that the warden took the volume home, but that his wife, afraid of the trouble it might bring them, burned it. Either way, the lasting story is that his written teachings went up in smoke. It is thought that some of Hua Tuo's teachings have been preserved within other books that came out in subsequent centuries, such as the Pulse Classic, Prescriptions Worth a Thousand Gold, and Medical Secrets of an Official. An existent book was ascribed to him, but it has been determined to be from a much later writer; it was translated to English under the title Master Hua's Classic of the Central Viscera (Zhong Zang Jing), with the unsubstantiated claim that only one of Hua's scrolls was burned and this came through unscathed (6). Similarly, a book called Prescriptions of Surgery was attributed to Hua Tuo, but is believed to have been compiled at least a century or two after his death (7).
Despite Hua Tuo's reputation in the field, the loss of his works resulted in the first monographs on surgery being erroneously attributed to others. There were many short documents produced during the time from the end of the Han Dynasty through the 5th century, of which one survives, called Liu Junzi's Mysterious Remedies. Like the other documents of this time, it mainly focused on lancing of carbuncles and cleaning out deep ulcers, as well as some other superficial surgeries, not the abdominal surgery that Hua Tuo is said to have done.
Hua Tuo had several disciples, including Wu Pu, Fan E, and Li Dangzhi, all of whom were excellent physicians. They also practiced qi gong, acupuncture, herbal medicine, and other things learned from Hua Tuo. It is said that Wu Pu wrote an herb guide and that Fan lived to be over 100, thanks to the exercises he practiced regularly.