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Table of Contents
RESEARCH ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 210-215

The records of anatomy in ancient China


Department of Anatomy, College of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Submission15-May-2020
Date of Decision20-Jul-2020
Date of Acceptance15-Aug-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Prof. Lisheng Zhang
Department of Anatomy, College of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_18_20

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  Abstract 


Through long-term observations and repeated practices of human body structure, anatomical knowledge in ancient China has gradually developed from the sprouting period when ancient Chinese hunted animals for survival, to anatomical exploration, which breaks the shackles of fear and religious rites. For example, Hua Tuo (华佗), a famous doctor in the period of The Three Kingdoms, did exquisite abdominal surgery; Yan Luozi (烟萝子), a Taoist priest in the period of The Five Dynasties, drew a map of human anatomy; Wang Weiyi (王唯一), a medical official in Northern Song dynasty, was responsible for casting acupuncture bronze figures, an anatomical mold for practicing acupuncture; Song Ci (宋慈), a forensic expert in Southern Song Dynasty, wrote Xi Yuan Ji Lu (《洗冤集录》 Collected Cases of Injustice Rectified); Wang Qingren (王清任), a physician in Qing Dynasty wrote Yi Lin Gai Cuo (《医林改错》 Correction on Errors in Medical Works). Ancient Chinese anatomy is far ahead of Western anatomy in understanding and describing human body structures. It has made great contributions to the emergence of Huang Di Nei Jing (《黄帝内经》 Huangdi's Internal Classic) and laid a solid foundation for the establishment of visceral manifestation theory and meridian and collateral theory. Even now, it has served the basic theory of traditional Chinese medicine and clinical practices. Anatomical knowledges, such as relevant operation records, books, Atlas, models in ancient China, especially the names of Zang-organ and Fu-organ, bones and five sense organs, are still used in modern anatomy and modern medicine, making indelible contributions to the development of modern anatomy in China.

Keywords: Anatomy, Song Ci (宋慈), Xi Yuan Ji Lu (《洗冤集录》 Collected Cases of Injustice Rectified), traditional Chinese medicine, Yi Lin Gai Cuo (《医林改错》 Correction on Errors in Medical Works), Wang Qing Ren (王清任), Hua Tuo (华佗)


How to cite this article:
Shao S, Guo H, Mou F, Guo C, Zhang L. The records of anatomy in ancient China. Chin Med Cult 2020;3:210-5

How to cite this URL:
Shao S, Guo H, Mou F, Guo C, Zhang L. The records of anatomy in ancient China. Chin Med Cult [serial online] 2020 [cited 2021 Jan 25];3:210-5. Available from: https://www.cmaconweb.org/text.asp?2020/3/4/210/305173




  Introduction Top


Throughout the long history of China, we Chinese tried hard to search for the clues of anatomy and to summarize its formation and development as a discipline. The anatomy development has witnessed the anatomical germination in ancient times when people hunted animals, the exploration of human anatomy which needs to overcome fears and religious rites, and the medical anatomy for diagnosis and treatment. And this development has been closely linked to and mutually influenced by the living environment, politics, economy, social culture, and medical mainstream.


  From Ancient Times to the Western Zhou Dynasty Top


Anatomical origin of prehistoric culture

The prehistoric culture is archaeologically divided into the Paleolithic Age and the Neolithic age. In the former case, man's main social activity was hunting for food. Hunters rounded up animals and slaughtered them to cut out those parts which could be used for food and the other parts which could be used for sacrifice. Archeologists have found wild ox patterns on the murals in the primitive cave with an outstanding mark at its heart, which suggests that people at that time had already recognized the importance of this organ in hunting, and marked its anatomical location for practice and inheritance. Therefore, they could aim at the heart and kill the preys with one shot. In the Neolithic age, the body of animals was cut open by people with stone knives and axes in daily lives, or the broken limbs, belly sliced open and entrails removed after wars between tribes all helped people at that time to have a preliminary understanding of the internal structure of animals and human bodies. According to Li Ji “Ming Tang Wei” (《礼记・明堂位》 The Book of Rites “The Position of Ming Tang”), You Yu Shi (有虞氏a tribe in ancient China) takes the head as sacrifice; emperors in the Xia dynasty take the heart; those in the Shang dynasty take the liver and emperors in the Zhou dynasty take the lung. Li Ji “Ji Yi” (《礼记・祭义》 The Book of Rites “Significance of Sacrifice”) describes the process of killing cows for sacrificing. When the sacrificial ceremony was held, the monarch led a cow with his sons standing opposite to him to assist him and his subordinate officials following him. After entering into the temple, the monarch ties the cow to a stele in the court and one official exposes his left arm and kills the cow. Taking the hair from the ear, which is the best, the official cuts through the cow with Luan knife, takes the fat between blood and intestines out for the sacrifice and then leaves. Therefore, it can be inferred that the anatomy in China begins with the anatomy of animals in the ancient times.

Anatomical terms found in oracle bone inscriptions

During the period of the Shang dynasty, hunting, sacrifice and war were common. Slaughtering animals laid a foundation for ancient Chinese to understand the structure of human body, while the anatomy of slaves and prisoners of war deepened that understanding and people began to describe the shape and the structure of human body in words. This is the time when human perception of anatomy deepened.

Oracle bone inscriptions, the earliest Chinese characters, recorded[1] a series of human anatomical results like head, face, nose, ears, mouth, tongue, teeth, neck, abdomen, breasts, shoulder, arm, elbow, hand, fingers, hip, knee, leg, toes, foot, etc., as well as external tissues like beard, mustache, sideburns, hair, etc., and the internal structures like heart, bones, blood, spine. These bone inscriptions also pictured the physiological functions of eyes, ears, mouth, nose, tongue, hand, and foot. These anatomical terms indicate that anatomical knowledge was available in primitive China. In addition, early anatomy was closely related to medicine. Among all oracle bone inscriptions found in the Yin ruins, 323 pieces of bones have recorded 34 diseases pertaining to such body organs as the head, the eyes, the ears, the nose, the teeth, the abdomen, and the heart.

The ancestor of anatomy----Yu Fu

Yu Fu (俞跗), a physician in ancient times, is said to excel in surgeries. Sima Qian (司马迁) pointed out in his book Shi Ji “Bian Que Cang Gong Lie Zhuan” (《史记·扁鹊仓公列传》Historical Records “Biography of Bian Que and Chunyu Yi”) that there was once a physician named Yu Fu who could treat diseases without using decoction, herbal wine, acupuncture, stone needle, Dao Yin (导引), massage or hot medicinal compress. He knew where the disease was after undressing the patient's clothes and observing the naked body. To treat the patient, he cut through the skin and then the muscles at the Shu-points. After dredging meridians, ligating tendons and massaging brain marrows, relieving Gao Huang (a part between heart and diaphragm), washing intestines, stomach, and five zang-organs, the essence and qi was restored, and the patient began to feel much better immediately. The process is basically in line with the procedure of modern abdominal surgery, suggesting that anatomy before the Han dynasty had developed into a sophisticated level.

Seven orifices found in heart

Zhou (纣), the last sovereign of the Shang dynasty, was notorious for his extreme debauchery and cruelty. His uncle Bi Gan (比干), master of the prince, was loyal and righteous. Bi Gan dissuaded Zhou repeatedly, until eventually Zhou killed Bi Gan and removed his heart to confirm whether Bi Gan had a heart with seven orifices like other sages. The story was recorded in Shi Ji “Yin Ben Ji Di San” (《史记・殷本纪第三》 Historical Records “The History of the Shang Dynasty”).


  From the Spring and Autumn Period and Warring States Period to Qin and Han Dynasties Top


Huang Di Nei Jing (《黄帝内经》 Huangdi's Internal Classic)---the pioneer of anatomy in Traditional Chinese Medicine

Huang Di Nei Jing (《黄帝内经》 Huangdi's Internal Classic) is the first classic on the theory of Traditional Chinese Medicine (TCM) as what it exists today. As a cornerstone of TCM anatomy, it describes surface anatomy, osteology, bone-length measurement, splanchnology, otorhinolaryngology, meridian and collateral theory in detailed length, weight, volume and capacity. The terms in the book like viscera, bone, five sense organs, are still used in modern anatomy and medicine. Even the term of Jie Pou (解剖 anatomy) is first recorded in this book. It says that there are two ways to study the human body structure and its parts. Externally, we can measure it; internally, we can observe it after we dissect it.

Anatomy in Nan Jing (《难经》 Classic of Difficult Issues)

In terms of anatomy, Nan Jing (《难经》 Classic of Difficult Issues) is complementary to Huang Di Nei Jing, as it has a more comprehensive understanding of the shape, size and weight of five zang-organs. For example, Nan Jing “Si Shi Er Nan” (《难经·四十二难》 Classic of Difficult Issues “the Forty-second Issue”) recorded that heart weighs twelve liang (a unit of weight) with seven orifices and three mao (毛) and can contain three he (a unit of capacity) of essential liquid. Seven orifices include four chambers of the heart, aortic orifice, pulmonary orifice, superior and inferior vana cava. Three mao indicate papillary muscle and chordae tendinae between valves. Three he of essential liquid refers to the blood capacity of four chambers. Nan Jing “San Shi San Nan” (《难经·三十三难》 Classic of Difficult Issues “the Thirty-third Issue”) also said that lungs can float on water, which is derived from anatomical observation on the weight of lungs. Classic of Difficult “the Forty-second Issue” also recorded that there are two kidneys and each weighs one jin (a unit of weight) and one liang, suggesting that kidneys are paired organs and its weight is recorded.

Contributions made by medical books unearthed at Mawangdui on anatomy

Medical books unearthed at Mawangdui Tomb of Han Dynasty also mentioned the names of viscera.[2] For example, in Wu Shi Er Bing Fang (《五十二病方》 Prescriptions for Fifty-two Diseases), the character of heart appears in the 47th and 48th clauses, while the character of kidneys (actually refers to scrotum and testis) present in the 140th, 143rd and 164th clauses. The character of liver appears in the 34th clause of Yang Sheng Fang (《养生方》 Prescriptions for Life Cultivation) and the 8th clause of Za Liao Fang (《杂疗方》 Prescriptions of Miscellaneous Treatments). Medical books with the richest anatomical records are Zu Bi Shi Yi Mai Jiu Jing (《足臂十一脉灸经》 Moxibustion Classic on Eleven Meridians along Arms and Legs) and Yin Yang Shi Yi Mai Jiu Jing (《阴阳十一脉灸经》 Moxibustion Classic on Eleven Meridians of Yin and Yang). Both books contain numerous anatomical terms and many parts on the body surface are named to demonstrate the course of meridians.


  From Wei and Jin Dynasties to Sui Tang and the Five Dynasties Top


Hua Tuo (华佗), a famous doctor with a good command of anatomy

San Guo Zhi (《三国志》 The History of the Three Kingdoms) by Chen Shou (陈寿) depicts that if the internal disease cannot be treated by acupuncture or herbal medicine, the part which is sick needs to be removed. At this time, Hua Tuo often prescribes Ma Fei San (麻沸散 Anesthetic Powder) for the patient. After the patient loses the awareness and sensation, the cutting and removing of the sick parts can be performed. If intestines are diseased, remove the sick part and cleanse the rest. After stitching the abdomen, the doctor needs to apply some cream and massage the wound. 4 or 5 days later, the patient will recover. And a month later, the wound will heal. The book describes the superb abdominal surgical skills of Hua Tuo, indicating that there is no way by Hua Tuo to remove intestines without a good command of anatomical knowledge on human abdomens.

Zhang Xiugu (张秀姑), a civilian anatomy performer

Nan Shi “Gu Ji Zhi Zhuan” (《南史·顾觊之传》 History of the Southern Dynasties “ Biography of Gu Ji”) recorded that Tang Ci (唐赐), a man living in Xiang county, Pei prefecture, went to Peng's residence which was next to his village to have dinner. However, Tang got sick and vomited dozens of worms after he returned home. He asked his wife Zhang Xiugu to dissect him to find the cause when he was dying. After he passed away, his wife followed his last words. She cut open his abdomen and dissected all his viscera. However, the local official considered Zhang immoral and a criminal as she dissected her husband and his son Tang Fu (唐副) unfilial as he didn't stop his mother. According to the law at that time, a wife injuring her husband would be sentenced to 5-year imprisonment and an unfilial son could be sentenced to death. However, the case wasn't in full accordance with the law. This is the first record of autopsy in China and it takes the lead in human pathoanatomy. It was not until 800 years later in 1302 that Bartolomeo da Varignana, the famous anatomist in Europe did the first autopsy on a man who was poisoned to death in Bologna.

Nei Jing Tu (《内境图》 Illustrations of Inner Body), the first human anatomy map

Six human anatomical maps drawn by Yan Luozi (烟萝子) were collected in the 18th volume of Xiu Zhen Shi Shu “Za Zhu Jie Jing” (《修真十书・杂著捷径》Ten Chapters of Taoist Internal Alchemy “Za Zhu Jie Jing”). Among the six maps, Yan Luo Zi Shou Bu Tu (烟萝子首部图 The Anatomical Drawings of Head by Yan Luozi) and Yan Luo Zi Chao Zhen Tu (烟萝子朝真图 The Map of Meditation by Yan Luozi) illustrated nine palaces in head and the spirit in brain, suggesting that brain plays an essential role in Taoist life cultivation. The drawings in the left and right side view showed that there were 24 vertebrae, and the tube along the inner side of the spinal cord was the spinal canal. The dark crescent in the center was diaphragm, and the liver and gallbladder were located above the diaphragm. The drawings in the front and back view [Figure 1] and [Figure 2] were anatomical illustrations. On the one in the front view, there were two holes in the throat. One was the esophagus and the other one was trachea. There were four lobes of lungs that were located above the heart, and the stomach was below the heart and located centrally below the lungs. The stomach was located below the heart with its cardia on the left and pylorus on the lower left. The liver was on the upper left with gallbladder on its lower side, while spleen was on the upper right. In the abdomen, there were small intestines, large intestines, bladder, and other organs. The drawing in the back view accurately illustrated that kidneys were on the left side and Ming Men (命门) were on the right side.[3] Compared with modern anatomy, the biggest error in the book was that the liver was located on the left side, spleen on the right side, and liver and gallbladder above the diaphragm. Even so, Illustrations of Inner Body is still the earliest anatomical drawing in China and even so in the whole world. It is the first attempt to draw anatomical drawing and the end of the anatomical era of “talking without drawings” five generations before it.
Figure 1: Front view of inner body

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Figure 2: Back view of inner body

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  From Song, Liao, Jin and Yuan Dynasties to Ming and Qing Dynasties Top


Ou Xi Fan Wu Zang Tu (《欧希范五脏图》 Ou Xifan's Anatomical Illustrations), the first human anatomical atlas

In Northern Song dynasty, Ou Xifan (欧希范) and his 55 subordinates revolted in Yi Zhou, Guang Xi. Being deceived by Du Qi (杜杞), they were executed immediately after surrender. Wu Jian (吴简), the official in Yi Zhou, ordered a doctor to dissect the corpses of 56 surrenderors and remove their kidneys and intestines. Meanwhile, he recorded the body structure and asked a painter to illustrate them according to the dissection.[4] The illustration was named Ou Xifan's Anatomical Illustrations [Figure 3]. According to the records, Wu Jian described the location of viscera and the relation between each other accurately. For example, he noticed that the right kidney was slightly inferior to the left one, which is a remarkable finding. He also confirmed that spleen is located under the left side of the heart, which corrects the error of the liver in the left and spleen in the right as was recorded in Huangdi's Internal Classic. In addition, he noticed some pathological signs. For example, a man who coughs a lot gets dark lungs and gallbladder; a man who has eye diseases in his younger days gets white spots on the liver. This is a massive anatomical activity in history, and the book is the first human anatomy illustration.
Figure 3: Ou Xifan's Anatomical Illustrations

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Zhen Jiu Tong Ren (《针灸铜人》 Acupuncture Bronze Figure), the first human anatomical mould for practicing acupuncture

Wang Weiyi (王唯一), a medical official in the Northern Song dynasty, was ordered to revise acupuncture books and to design and cast two human-sized bronze figures for teaching acupuncture. Wang Weiyi wrote a new book named Tong Ren Shu Xue Zhen Jiu Tu Jing (《铜人腧穴针灸图经》 Illustrated Manual of Acupuncture Points of the Bronze Figure). The bronze figure is an imitation of the real human body of a young male, who is naked and upright. The limbs and internal viscera are detachable. On the body surface, 354 points are inscribed with their names written beside in golden. All these points are sealed with wax and the figure is filled with water. If a point is selected correctly, water will flow out after insertion. If not, a needle cannot be inserted. According to Emperor Renzong's order, one figure is placed in the imperial palace for appreciation; the other is sent to Imperial Medical College as a teaching and examining aid. The design and cast of the bronze figure is a major creation in medical history. As the earliest human anatomy mold and a teaching aid for acupuncture, two bronze figures are of great significance in history.

Cun Zhen Tu (《存真图》 Anatomical Atlas of Truth) by Yang Jie (杨介)

Yang Jie (杨介), a doctor in the Northern Song dynasty, drew Anatomical Atlas of Truth according to the autopsy of prisoners who were executed in Si Zhou. The illustration is extremely exquisite and in great detail. It includes drawings of thoracoabdominal anatomy in the front, the back and the lateral view [Figure 4], [Figure 5], [Figure 6]. Besides, there are detailed drawings of each part and each system.[5] The location and shape of internal organs drawn by Yang are basically consistent with the real conditions. In addition, blood vessels, digestive, urinary, and reproductive systems are also drawn into pictures. All illustrations have explanatory notes attached to them. Therefore, Atlas is of great value in history. Human anatomy is rare in Europe before the 16th century. Ou Xi Fan Wu Zang Tu and Cun Zhen Tu marked the advanced anatomical level of China, which was ahead of the other civilizations in the world before the 11th century.
Figure 4: Front view of viscera

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Figure 5: Back view of viscera

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Figure 6: Right side view of viscera

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Xi Yuan Ji Lu (《洗冤集录》 Collected Cases of Injustice Rectified), the first forensic monograph

Song Ci (宋慈), a forensic scientist in the southern song dynasty, was honored as the founder of forensic medicine and compiled Collected Cases of Injustice Rectified.[6] This book is a summary of the long-accumulated knowledge of pathology, anatomy, and pharmacology in ancient times, as well as a collection of forensic knowledge and experience by the feudal government before the Song dynasty. Therefore, hailed as the world's first systematic treatise on forensic medicine, the book was widespread and was translated into Japanese, Korean, English, German, French, Dutch, and other languages. It covers almost all branches of modern forensic medicine, such as internal medicine, surgery, gynecology, pediatrics, orthopedics, anatomy, pathology, first aid, etc. Therefore, this book is of great value. What it mainly contributes to in anatomy are anatomical terms and maps of the human body and osteological knowledge applied in the bone examination.

Yi Lin Gai Cuo (《医林改错》 Correction of Errors in Medical Classics), the first anatomy monograph

When it comes to the great figures in China's anatomy history, Wang Qingren (王清任), a physician in Qing dynasty, mustn't be missed. He is believed to be an innovative anatomist in the history of Chinese anatomy. In 1797, an epidemic broke out in what is now Hebei Province. He studied and observed dozens of child corpses at the risk of being contaminated. With the field anatomy, he gained a lot in human body structure. In 1830, Wang Qingren drew a map of Zang-Fu organs and corrected the mistakes made by his predecessors. Combined with his clinical experience, he wrote Correction of Errors in Medical Classics.

The book[7] recorded many vital organs that have never been mentioned in previous medical books, such as the aorta (referred to as wei zong guan by Wang 卫总管), the superior and inferior vena cava (rong zong guan 荣总管), common carotid artery (the left and the right qi guan 气管), ureter (long guan 珑管), great omentum (qi fu 气府), pyloric sphincter (zhe shi 遮食), common hepatic duct, common bile duct (jin guan 津管); pancreas (zong ti 总提), etc. In addition, the difference between arteries and veins is clarified in the theory of combining qi and blood. These descriptions are of little difference from those the modern anatomy.

The book also pointed out that thinking and memory depend on brain. Besides, it showed the relationship between the spinal cord, cranial nerve and the brain in anatomy and functions, especially that between the brain and organs of special senses, cranial nerve I, II and VIII. Wang also divides brain diseases into functional disorders and organic lesions. Due to the limitations of historical conditions, there are inevitably some mistakes in the book, but the splendor still outweighs the flaws.

Through anatomical records in ancient China, we can see that its understanding and description of human body structure is far ahead of the Western anatomy. Anatomical knowledges, such as relevant operation records, books, Atlas, models in ancient China, especially the names of Zang-organ and Fu-organ, bones and five sense organs, are still used in modern anatomy and modern medicine, making indelible contributions to the development of modern anatomy in China. In the long feudal era, Confucianism, feudal ethics, and the feudal system have seriously hindered the development of anatomy. Another reason for its slow development is related to the methodology of a simple system followed by TCM theory. The methodology, discovered by ancient physicians in their long exploration, is another way conducive to developing TCM. Such methodologies are namely taking analogies and knowing the inside by appearances, which are first elaborated in Huang Di Nei Jing. The concept of holism, the theory of Yin and Yang, and the five elements theory greatly enriched and developed the basic theory of TCM, which greatly reduced the dependence of TCM on anatomy. It has to be admitted that ancient physicians are stubbornly conservative and they pursue the concept of analyzing but not doing. Most of their anatomical activities were to verify the theory of predecessors, and the study was terminated as soon as they reached the goal. In addition, ancient Chinese intellectuals attached more importance to dao (道 metaphysics) than qi (器 physics), so they considered technical activities as the work of ordinary craftsmen, and in doing so they often ignored or even despised practical operations, which made ancient physicians shy away from anatomy. In addition, sectarian bias, complacency, and conservative thoughts among different medical schools also impede the development of anatomy.[8] As time went on, people began to acquire a thorougher and deeper understanding of anatomy, which makes people's understanding on the law of human life activities clearer and more scientific and the TCM theory has thus become more perfect. It is believed that with the further study of anatomy in TCM, we Chinese people will make greater contribution to human health.

Translator: Lei Lan (兰蕾)

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Conflicts of interest

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  References Top

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Song C. Collected Cases of Injustice Rectified. Shanghai: The Commercial Press; 1937.  Back to cited text no. 6
    
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