Hua Tuo

Hua Tuo was a Chinese physician of the late Eastern Han Dynasty. His courtesy name was Yuanhua. As per the historical texts Records of the Three Kingdoms and Book of the Later Han record, Hua Tuo became the first Chinese who used anaesthesia during surgery. This physician used a general anaesthetic that mixes wine, and a herbal concoction called mafeisan (literally "cannabis boil powder"). While he was popular for Hua Tuo acupuncture abilities, he was also an expert in surgery and anaesthesia. Besides, he was popular in acupuncture, moxibustion, herbal medicine, and medical Daoyin exercises. This famous physician developed the Wuqinxi after analyzing the movements of tiger, deer, bear, ape & crane. 

 Hua Tuo

Hua Tuo is especially famous for surgical operations and mafeisan uses. In this regard, you should know that mafesian is an herbal anesthetic formulation created from hemp.

Previously, Chinese doctors thought that surgery was the last task. They gave little time and didn't give much importance to describing surgical techniques. A low classed medical worker carried out the surgery. But around the beginning of the 3rd century, it was changed as Hua Tuo was there to change the surgery field in China. When he was young, he traveled and read widely. He was the first Chinese who take an interest in medicine. Besides, he tried to assist many soldiers who had been wounded in multiple wars at that time. 

 Hua Tuo Life History:

This young surgeon was very simple. He used some prescriptions only and some points for acupuncture. He prepared hemp and wine so that patients didn't need to feel the pain. It is believed that Hua Tuo is the discoverer of anesthetics. However, there is a possibility that Chinese physician Bian Qiao of the 5th century BCE might have used these.

You should know that Hua Tuo, the honored physician is involved in many surgical methods—

• laparotomy (incision into the abdominal cavity), 
• removal of diseased tissues, and 
• a partial splenectomy (removal of the spleen).

He resected the viscera and washed the inside to treat gastrointestinal diseases. Besides, he performed end-to-end anastomosis (connections) of the intestines, but we still don't know which material he used for the sutures.

There is a story of Hua Tuo. In this story, we learn that Guan Di called Kuan Ti was once a General and one of the great military heroes during that period. Kuan Ti later became the god of war also. However, he came to Hua Tuo as one of his hands was wounded by an arrow. As a result, it had infected his hand badly. Then Hua Tuo made a normal anaesthetic drink to offer his patient. When General Guandi saw this, he laughed and called for a board & stones to play a game.

Once the surgeon scraped the flesh and bone free of infection to repair the wound, Guandi and his teammates stopped laughing and continued playing the game. Surgery was one of his pursuits despite being his main interest. He was an expert in hydrotherapy. That's why he did some great unique work in physiotherapy. He invented a series of exercises called the frolics of the five animals where the patient copied the movements of the tiger, deer, bear, ape, and bird. This series was very popular and widely adopted.

Historical accounts:

His biographies are officially found in Chinese history during the Eastern Han dynasty (25-220) and Three Kingdoms (220-280). The text records of the Three Kingdoms (Sanguozhi) and the fifth-century historical text Book of the Later Han (Houhanshu) said that this surgeon was from Qiao County, Pei Commandery. It is currently in Bozhou, Anhui. This famous surgeon got employment offers from high-ranking officials like Chen Gui but refused them and wanted to practise medicine. You should know that there is no certainty regarding the dates of his life. However, as per the estimations from 110 to 207 and from 190 to 265, we can say that the most appropriate time is 145-208. He was an older contemporary of the physician Zhang Zhongjing (150-219).

While Hua means "magnificent, China," whereas Tuo indicates "hunchback" or 陀, literally "steep hill ."People also called him Hua Fu, meaning "apply [powder/ointment/etc." Yuanhua was his courtesy name that indicates "primal transformation". According to a few scholars, he learned the medical techniques of Ayurveda from early Buddhist missionaries in China. Victor H. Mair said that he was several years ahead of his time in medical knowledge and practice. His name was also pronounced ghwa-thā in Old Chinese. It came from the term agada, "medicine; toxicology". Hence, the Sanskrit word agada is the source of it. As per the stories related to his biography, he was active mainly where the first Buddhist communities were set up.

According to the biography in the Sanguozhi, he resembled a Daoist xian (仙; "immortal"). We have got the details of his medical techniques from the biography. This famous surgeon was a master in nourishing one's nature. While his contemporaries thought he might be a hundred years old, he still looked hale and hardy. His great skills are illustrated through the medicines he prescribed. Besides, to cure the illnesses of patients, he prepared decoctions which needed only some ingredients.

He was excellent in different fields, such as he could easily divide up and compound based on the right proportions. This famous surgeon did not even need to weigh the different components of his medicines. After boiling the decoction, one can drink it. Hence, he used to tell patients how they should take medicine and then would go away. After taking the medicines, the condition of the patient would improve promptly.

Suppose Hua Tuo employed moxibustion, he need ro burn punk in one or two places. In every place, he used to make seven or eight separate cauterisations. Due to which the disease used to respond quickly during the elimination time. Suppose Hua Tui employed acupuncture. Hence, it will be in one or two places only. He gave instructions to the patients when using the needle and said that he would guide the point to a location. Once it reaches the spot, the patient feels that they need to tell him. Once the patient told him that the point had reached the designated spot, he started to remove the needle, and as a result, the sickness would be alleviated virtually.

Sometimes, illnesses were concentrated internally where medicines and needles couldn't play any role. Hence, he realized that it was essential to operate. Then, he asked his patients to drink a solution of morphean powder. As soon as they drink this, they would be intoxicated as though dead and completely insensate.

After making an incision, he removed the diseased tissues. Sometimes the diseases can be in the intestines. He was capable of serving them & washing them out. Then, he stitched the abdomen together and rubbed on an ointment. Once the period of 4-5 days is passed, patients will no longer face pain. They would become conscious and normal within a month.

According to the explanation of his biography in the Houhanshu, the mafeisan decoction was dissolved in jiu. In this case, you should know that mafeisan is a numbing boiling powder. However, there is no more prescription for mafeisan anaesthetic liquor and his writings because all were destroyed or lost. We can find the mention of five medical books attributed to him & his disciples in the Book of Sui.

Fictional accounts:

He heals general Guan Yu, as per the 14th-century historical novel Romance of the Three Kingdoms. A poisonous arrow hit the General's arm during the Battle of Fancheng in 219. When he gave anaesthetis to Guan Yu, this General said that he didn't feel afraid of pain. The surgeon cut the affected flesh using a knife to scrape the poison from the bone. While Tup continued the treatment, Guan Yu continued playing a game of weiqi with Ma Liang, even though he didn't flinch from pain.

Later when Ma Liang asked him about the incident, Guan Yu says that he feigned being unhurt to keep the morale of his troops high. Once the surgeon completed the operation successfully, he gave a sumptuous banquet as a reward and a gift of 100 ounces of gold. But the surgeon refused to take the reward and told him that his responsibility is to heal patients and not to make a profit. Although the famous surgeon died in 208, his surgery story became famous a decade before Guan Yu fought at the Battle of Fancheng.

According to the historical document Sanguozhi, bone surgery was performed on Guan Yu, who showed no painful expression. Sanguozhi didn't tell the surgeon's name and the operation name. Cao Cao summons the surgeon later to treat chronic excruciating pain in his head, which was actually a brain tumour. As per the statement of

Cao Cao, Hua Tuo told him that it is essential to open up the brain cut the open head to remove the tumour. Then, it would be possible to get the tumour out and sew it back. In this procedure, Cao Cao will be anesthesized. But there happened a misconfusion. He thought that Hua Tuo planned to murder him. That is why he was arrested and imprisoned later. But there is a strong reason behind this. Previously, Ji Ping, an imperial physician, tried to attack him & forced him to consume poisoned medicine.

Hua Tuo gave his Qing Nang Shu to one prison guard to keep his medical legacy alive in the Romance of the Three Kingdoms. Later, he died in prison. Although the guard's wife burnt the book as she was afraid of being implicated. But somehow, the guard somehow managed to save a few pages but, the other pages were lost forever.

Mafeisan:

The use of innovative anaesthetic mafeisan on Hua Tuo's patients during surgery is still a long-standing mystery. He got credit from Records of the Three Kingdoms and the Book of the Later Han because he made this anesthetic during the Eastern Han Dynasty. Although there was no written record or finding of real ingredients, Chinese medical practitioners made estimations in later periods. You can find a controversy over the presence of mafeisan historically in Chinese literature.

Ma means "cannabis; hemp; numbed," whereas fei indicates "boiling; bubbling," and San refers to "break up; scatter; medicine in powder form." The combination of these terms indicates mafeisan. You should know that ma can indicate "numbed; tingling" (e.g., mazui "anesthetic; narcotic"). It came from the properties of the fruits and leaves used for medicinal purposes.

After the reconstruction of Modern Standard Chinese mafei, it is called Old Chinese *mrâipəts, Late Han Chinese maipus (during Hua Tuo's life), and Middle Chinese mapjwəi.

Several sinologists and scholars of traditional Chinese medicine have different assumptions at mafei powder's anaesthetic components. As per the assumptions of Frederick P. Smith, the great surgeon Hua Tuo, "the Machaon of Chinese historical romance", have used yabulu ("Mandragora officinarum") Instead of huoma ("cannabis") and mantuolo ("Datura stramonium," nota bene, which was given the name "Tuo" By Hua) mixed in wine, and after that could be drunk like a stupefying medicine.

Mafeisan was translated by Herbert Giles (1897:323) as "hashish." After that, Lionel Giles, son of Herbert Giles, recognizes "hemp-bubble-powder" as "something akin to hashish or bhang". It was noted by Victor H. Mair that mafei becomes a transcription of a few Indo-European words related to "morphine."

Morphine was first isolated in 1804 from opium by Friedrich Sertürner. Mair suggests that it is conceivable that any name like morphin was in use before as a designation for the anaesthetic properties.

Wang Zhenguo and Chen Ping noticed similarities among "scientists of later generations," in which mafei contained yangjinhua, wutou, or caowu. The first one means "Datura stramonium," whereas the second one indicates "rhizome of Aconitum, Chinese monkshood," and the last term caowu means "Aconitum kusnezofflin; Kusnezoff monkshood."

According to the suggestions from Lu Gwei-Djen and Joseph Needham, this famous surgeon from China might have found surgical analgesia through acupuncture.

Wang Shuhe and the pulse: In Chinese history, medicine got more importance than surgery. That's why the diagnosis was of considerable significance. The early Chinese physician tested patients' skin color at different sections and noted several other external signs. But he started the pulse diagnosis. Studying pulse was a major occupation of the physician who heard countless sounds and rhythms of different kinds. Maijing was a classic work written by Wang Shuhe. Wang wrote a crucial commentary on Huangdi neijing also. But remember that his labors over the pulse made him the best Chinese physician. The assertion "Nothing surpasses the examination of the pulse" can be discovered in the Huangdi neijing.

The physician had three areas on every wrist where it was necessary to ascertain the quality and quantity of the pulse. Cun ("inch") is the nearest area to the hand, whereas guan ("bar") is the middle position. The chi ("cubit") was the farthest from the hand. Remember that yang represents left, whereas Yin represents right. The right pulse of a woman meant disorder, whereas her left pulse order. For men, it is vice versa.

While the physician reads three different pulses on every wrist, he reads every pulse at two levels. For instance, if the inch was lightly pressed on your left wrist, the pulse meant the state of the small intestines. When the inch was heavily pressed, it indicated the heart. When the bar is pressed lightly, it means the state of the gallbladder. It indicated the liver state when pressed heavily. If the cubit was lightly pressed, it meant the state of the urinary bladder. On the other hand, it meant the state of the kidneys when pressed heavily. The right wrist came with specific connections to the body organs.

The pulses were categorized into 7 biao ("superficial") and 8 li ("sunken") pulses. But do you know what these refer to? For instance, the seven pulses on inch position might mean, among other things:

• pains and heat in the middle region of the body and the head; 
• accumulation of blood in the chest; 
• belching and vomiting; 
• insufferable heat within the thorax; 
• severe thoracic pains; 
• headaches; and 
• heat in the chest.

These relationships seem complex to western minds. However, this Chinese physician achieved some remarkable diagnoses in pulse lore.

Final period:

There were significant contributions of several people behind the fame of Chinese medicine, like three emperors, physicians including Bian Qiao, Zhang Zhongjing, Hua Tuo, & Wang Shuhe, and others who contributed individually. We got a clear and elaborated description of smallpox from Ge Hong (3rd century CE). Ge Hong achieved his achievement about 600 years before al-Rāzī (Rhazes), a physician of Persia. He got credit because he first described the deadly disease.

Approximately 700 years after Ge Hong, the inoculation practice against smallpox started debuting. A spiritual old woman or a physician brought inoculation. They used to live on a mountain and started this practice using scrabs. Hence, scabs must be dried, ground into powder, and inserted into the nostrils.

From the 3rd century to the middle of the 16th century CE, was the time of Wang Shuhe. During this time, Chinese medical men started investing more effort in the compilation of encyclopaedias and the commentaries writing on the classical works. Official rites to worship old Physicians were set up in 1644 at the Qing Hui Palace near the College of Imperial Physicians in Peking (Beijing). In spring, the rites were celebrated.

Medical communication started between East & West in the sixteenth century when Portuguese Bishop Belchior Carneiro set up Saint Raphael's Hospital near Guangzhou (Canton). As soon as some western medicine cured several diseases, a few Chinese people started believing that everything is good and scientific in Western medicine, even better than traditional medicine. The belief and trust of western medicine started growing more despite the appearance of the country's ruler, Sun Yat-sen. Although, it was the early 20th century when the TCM interest renewed. Whereas during the end of 20th century and the starting of 21st century, TCM practices started all over the world.

The End Life:

The end life of this famous Chinese surgeon is hidden in a mist of conflicting and doubtful stories. As per a few stories, he was the court physician of Cao Cao who was the king of Wei. Hua Tuo relieved the ruler temporarily through acupuncture. Once the ruler told Hua Tuo to remove the annoyance permanently, he said that cutting into the royal skull was necessary. Although the wife of Cao Cao supported surgery, the king suspected Hua Tuo as one of his enemies or someone whom his enemies had sent to kill. Then, the ruler decided to throw the surgeon into jail. The Book of the Blue Bag, named Qingnang shu, one of the major books of Hua Tuo, was burnt for removing all traces of his work. In the history of China, he earned the place of the greatest surgeon.

Frequently Asked Questions:

• Q. When was Hua Tuo born?

He was born in 145 AD.

• Q. Which person is a famous doctor in the field of traditional Chinese medicine?

HUANG Yu-jie is Taiwan's most renowned traditional Chinese medical physician during the late Qing dynasty and early republican period of China.

• Q. How did Hua Tuo die?

Hua Tuo wanted to avoid treating Cao Cao. So, he repeatedly made excuses by telling him that his wife is sick. However, after discovering the deception, Cao Cao ordered the execution of Hua Tuo.