Hua Tuo - Ancestor of Surgery

Who is Hua Tuo 华 佗

Hua Tuo was born in Qiao County of the Pei State, near today’s Bozhou, Anhui, and Yongzheng, Henan. People are most familiar with Hua Tuo’s story that he scraped poison off the bone of Guan Yu. This story came from the “Romance of the Three Kingdoms” by Luo Guanzhong, the famous novelist of the early Ming dynasties of China. A poisoned arrow shot Guan Yu, a general of the Kingdom of Shu, from the army of Wei in the right arm in a clash, leading to a severe bruise in the arm, disabling it from any movement. To treat the wound caused by the poison in Guan Yu’s arm, he cut the skin open and cleared the poison on the bone with the scalpel. But Guan Yu managed to keep his composure and continued playing chess with his friend. This story not only extolled Guan Yu for his extraordinary bravery but also reflected Hua Tuo’s outstanding medical skill. However, the story everyone is familiar with was Luo Guanzhong’s fiction.

According to the record of historical books, the Records of the Three Kingdoms,” Hua Tuo passed away in the 13th year of the Jian’an Era. Meanwhile, the event of Guan Yu’s scraping the bone healing happened in the 24th year of the Jian’an Era. So, there were 11 years in between. The bone scraping poison treatment operation wasn’t carried out by Hua Tuo. But this story was probably a true story. Because in official historical recorded this story, probably some other doctor did this back then, but Hua Tuo was so famous that the “Romance of the Three Kingdoms” gave this credit to Hua Tuo.

Though the story about Hua Tuo scraping poison off Guan Yu’s bone was a fiction, Luo Guanzhong replaced the hero of the story with Hua Tuo because Hua Tuo was a very famous doctor of the late Eastern Han Dynasty, who was good at surgery. To make the story more dramatic, so people gave Hua Tuo the role that scraped the poison off Guan Yu’s bone.

Hua Tuo become the most famous doctor

Back in the Eastern Han Dynasty, it was unimaginable to cut open somebody’s skin for treatment. Ancient Chinese always believed, “Since your body is given by your parents, to be a good offspring, you won’t dare injure it.” Back in the Eastern Han Dynasty, doctors still used the Four Diagnostic Methods of TCM (Traditional Chinese Medicine), (inspection, listening and smelling, inquiry, and palpation) to find out the status of illness, and then made some medicinal soup to treat the patient. Meanwhile, Hua Tuo proposed the theory of surgery and even used it in practice. It was very audacious back at that time.

Because back in the era of the Three Kingdoms in the late Eastern Han Dynasty, there were frequent wars, people were in desperate need of field surgical techniques.

For example, for wounded soldiers, it would be more appropriate to treat their wounds with surgery. Under such a circumstance, because it was necessary in those times, and because the Chinese medicine was about giving the right treatment at the right time in the right place on the right person, the times called for it, and so Hua Tuo let the surgery come to its full play.

It is precise because Hua Tuo dared pioneer, having the audacity to try the surgery, which Luo Guanzhong gave the credit of scraping poison off the bone to him. In addition to this bold promotion on the surgery operation, Hua Tuo even got the idea of using anesthesia as operational support.

To alleviate patients from the pain, he dedicated himself to researching the anesthetic use of Chinese medicine in the hope to find out the agents that could anesthetize the patient. He studied ancient medicine records and discovered some materials showing a famous doctor, Bian Que of the Warring States period anesthetized a child with Datura flowers to treat his intestinal disorder pathogen, commonly known as dry cholera. Hua Tuo discovered that the Datura flower had an anesthetic effect, but it was also highly toxic. To extract the anesthetic substances from the Datura flower and curb its toxicity, he journeyed through Anhui, Shandong, Henan, Jiangsu, and many other places to combine it with other herbs and tested the combinations on himself. In the end, he developed the Chinese anesthetic drug, anesthesia. And then he was also inspired by the phenomena where people lost consciousness when they were drunk. Therefore, he told his patients to take the anesthesia with the wine before an operation to enhance the anesthetic effect.

Because Hua Tuo invented the surgical operation for the patient, he is seen by the posterity as the First Ancestor of Surgery. The fact that he used anesthesia on patients for the procedure affected the modern surgical anesthesiology. Then, as a fantastic doctor, Hua Tuo became increasingly popular.

Practicing his medicine skills

According to the record in the “Records of the Three Kingdoms: Biography of Cheng Deng,” one day, Prefectural Chief of Guangling Prefecture felt ill and got flushed cheeks, unable to eat. At that time, Hua Tuo happened to be nearby. So Chen Deng ordered to have him invited in for treatment. After a pulse-taking, Hua Tuo said with a serious look, “You have several liters of parasites in your stomach. I assume it happened because you always liked eating raw fish and meat.” 

Afterward, Hua Tuo made him 2 liters of herb medicine. With the medicine taken, after the time of an ordinary meal, he vomited about 3 liters of small parasites indeed, and he recovered from the illness. But Hua Tuo urged Chen Deng: “This kind of disease you’ve got will recur three years later. If you can find a good doctor by then, he may save you.” Just as expected, Chen Deng’s illness recurred three years later. He sent his people to find Hua Tuo, but unfortunately, Hua Tuo was harvesting medicine on a mountain and wasn’t back yet. With the unavailability of suitable doctors for this illness he got, he, unfortunately, passed away eventually.

This story also proves to us that Hua Tuo became unique when it came to medical techniques.

The invention of the five-animal exercise

In addition to treating disease, Hua Tuo also achieved something in terms of preservation with Chinese medicine. He invented a sort of Qigong movement pattern, the five-animal exercise.

One day, Hua Tuo saw a kid having fun swinging by grabbing a latch, which inspired him the theory that the door hinge that kept spinning was not prone to wormholes. Hua Tuo came up with the idea that Qi-blood inhibition and stasis caused most diseases. So, like the latch, if a body kept moving so that the Qi-blood kept flowing smoothly, health would be nurtured, and infections would not occur quickly. 

So, Hua Tuo only spent his free time studying the best way to exercise. According to the movements of all sorts of animals, he created a set of movement pattern that mimics the tiger, deer, ape, bear, and bird’s movements. This movement pattern simulates the tiger’s attack, deer are running, ape’s jumping, bear’s walking, bird’s wing spreading, and many other kinds of movements. By practicing this series of moves, one can clear the mind and the eyes, boost the cardiopulmonary functions, strengthen the waist and kidneys, and smoothen the joints. It is easy to learn and practice. Whether men or women, no matter how old you are, there is always a suitable setting for you. 

Hua Tuo and Cao Cao

For decades in his medical career, Hua Tuo was always accurate, and so he was seen as a great doctor. Meanwhile, his superb medical skill also caught the attention of the ruler of State of Wei, Cao Cao, which then brought a fatal disaster to himself.

People have all sorts of opinions about Hua Tuo’s death. Then, what indeed happened in history? The most popular belief about Hua Tuo’s death is like the one Luo Guanzhong wrote in his novel “Romance of the Three Kingdoms.” Cao Cao developed a persistent headache. He tried all excellent doctors, but none of them was effective. So he had Hua Tuo invited. Hua Tuo told Cao Cao: “The stroke caused your headache, the root of which is in the center of your head. No herbal medicine can cure it. You need surgery to remove the root of the illness.” Always skeptical, Cao Cao thought Hua Tuo wanted to take this advantage to kill him to avenge Guan Yu. Thus, Cao Cao arrested Hua Tao, in the end, Hua Tao died in prison out of frustration.

In fact, this is also a fiction Luo Guanzhong imagine. Then, how did the great doctor Hua Tuo of his time die in the end? The historical record of the Chinese Western Jin Dynasty, “Records of the Three Kingdoms: Biography of Hua Tuo,“Taizu learned about Tuo and summoned him, and Tuo stayed by his side.” Because of Hua Tuo’s outstanding medical skills, Cao Cao summoned him to cure his disease. 

Cao Cao developed some “headwind” disease, on every episode of which, he could not think and get into dizziness and an unendurable headache. No matter how hard they tried, many doctors couldn’t achieve a significant effect. After his visit, Hua Tuo inserted an acupuncture needle in Cao Cao’s thoracic vertebra at the Geyu acupoint. Soon, Cao Cao’s mind and eyes were as bright as new. Therefore, every time Cao Cao had a headache, he would invite Hua Tuo for treatment. However, later, Cao Cao’s headache grew more severe progressively. So, Cao Cao wanted Hua Tuo to treat only him alone. Nevertheless, Hua Tuo didn’t want to.

Hua Tuo was a folk doctor, and his ambition was to relieve everyone from the pain. Because Cao Cao was also a patient, he would treat Cao Cao as well. But, it isn’t what he wanted to be a personal doctor exclusively for Cao Cao.

One day, Hua Tuo told Cao Cao he was away from home for too long, and he wanted to go home and take a look. Cao Cao accepted his request and let him go back. When he arrived home, Hua Tuo claimed that his wife was sick and requested for more days off. Cao Cao wrote to Hua Tuo repeatedly to tell him to come back and even had the local magistrate of Hua Tuo’s place urges him, but Hua Tuo just wouldn’t go back. Cao Cao was furious, so he decided to send some officials to check what was going on. He told those officials he sent he would grant Hua Tuo more days if his wife were sick, but if she was not, they should take him back by force.

It was apparent to them during the investigation that Hua Tuo’s wife was not stuck at all. So, Cao Cao burst into fury and ordered to have Hua Tuo incarcerated. Hua Tuo delivered the medical work, “Green Bag Book,” he wrote to prison guards. Nevertheless, the warden was afraid that he would get involved so that he would not accept this. Hua Tuo had no choice but to swallow his pain and burn the book. Though the “Green Bag Book” was saved from the fire by the prison guards, in the end, it had already been burned to be incomplete.

Epilogue

The fantastic doctor of his time, Hua Tuo, died in prison. In addition, the anesthesia he invented failed to be handed down as a result. This is a significant loss for Chinese medicine. However, Hua Tuo’s medical ideology hasn’t died out. Notably, his disciples have passed down his research achievements for Chinese medicine. Additionally, the preservation movement pattern he invented, the five-animal exercise, has also been passed down and treated as the precious medical fortune.

key persons in the history of traditional Chinese medicine

Bian Que                 BC 407 - 310      Ancestor of traditional Chinese medicine

Hua Tuo                  AD 145 - 208      Ancestor of Surgery

Zhang Zhongjing   AD 150 - 215      Sage of traditional Chinese medicine

Ge Hong                 AD 284 - 364      Ancestor of first-aid

Sun Simiao             AD 541 - 682       King of the traditional Chinese medicine

Li Shizhen               AD 1518 - 1593   Sage of Medicine and Herbal