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Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 148-157

Early interactions between the hellenistic and Greco-Roman World and the Chinese: The ancient afro-Eurasian routes in medicine and the transmission of disease

Foundation for PIHMA Research and Education, Phoenix 85012, Arizona, USA

Date of Submission15-Jul-2021
Date of Acceptance10-Aug-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Dr. Ioannis Solos
Foundation for PIHMA Research and Education, Phoenix 85012, Arizona
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CMAC.CMAC_32_21

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This paper discusses the historical exchanges, communications, and circumstances that initially enabled the opening of trade routes between China and the Hellenistic and Greco-Roman world. In addition, it explains how ancient Greeks first became aware of China, and the original premise of trading silk for horses. Historical Chinese texts are analyzed to identify references to the Hellenistic and Greco-Roman world in an attempt to elucidate the extent of official interactions between the two cultures. Historical and archaeological sources confirm that trade existed for millennia before Western Europeans traveled to China during the Age of Exploration. The thesis describes how silk and disease traveled from east to west and explains the historical conditions that allowed the exchange of ideas, practices, beliefs, and culture.

Keywords: Chinese medicine, Greco-Indian Kingdoms, Greek medicine, Serica, silk road

How to cite this article:
Solos I. Early interactions between the hellenistic and Greco-Roman World and the Chinese: The ancient afro-Eurasian routes in medicine and the transmission of disease. Chin Med Cult 2021;4:148-57

How to cite this URL:
Solos I. Early interactions between the hellenistic and Greco-Roman World and the Chinese: The ancient afro-Eurasian routes in medicine and the transmission of disease. Chin Med Cult [serial online] 2021 [cited 2021 Oct 26];4:148-57. Available from: https://www.cmaconweb.org/text.asp?2021/4/3/148/327159

  Why is the Presence of Greeks in Ancient China a Difficult Possibility to Accept Top

In 2013, a paper published in the Bulletin of the School of Oriental and African Studies[1] proposed that Greek artistic characteristics may have influenced the production of the terracotta army in China. This theory went largely unnoticed until 3 years later when several reports published by the Independent,[2] the BBC[3] and other online media quoted it as a possibility. The high-profile exposure of this idea caused an immediate backlash.[4] It was clear that in the era of political correctness some Western scholars felt it necessary to refute such a hypothesis[5],[6] because they felt that the mentioning of Greek influence could lead to viewing the achievements of other civilizations through the “Greek lens.”

After the renowned Chinese archeologist Li Xiuzhen (李秀珍) stated that “the terracotta warriors may be inspired by Western culture but were uniquely made by the Chinese,”[7] reflecting the official Chinese stance on the matter, the discussion largely died down.

Ideally, the achievements of every civilization should be viewed independently. However, at various stages in ancient times, the exchange of ideas, art, music, knowledge, and even technology occurred freely. This raises the question of whether a line can be drawn in cases where civilizations intimately interacted and mutually influenced one another.

Historically, several Greek states existed in central Asia for centuries. In these places, Greek and Asian culture and religion fused together to create an amalgam of syncretism and the blending of philosophies and cosmotheories.[8],[9] This facilitated communication between the East and West in ways that still impact on contemporary local populations. However, the presence of Greek populations in central Asia and South Asia should not be viewed through the lens of the horrors inflicted by Western Europeans during the Age of Exploration and European colonialism in their attempts to exploit China and the Far East, causing war and famine, and creating havoc.

I propose that Hellenistic and Greco-Roman communication with China represents a separate historical phenomenon based mainly on the trade and exchange of art, ideas, and knowledge.

  Etymology of Historical European Names for China and their Importance Top

To understand how the ancient Greeks viewed the Chinese, it is important to first explore the etymology of the various Greek names for China.

References to China first appeared in Greek literature around the 5th century BC, using the name Seres (Σῆρες) and Serica (Σηρική). Etymologically, Klaproth[10] traces the word Serica to the Chinese character 丝 (si) for silk. The difference between the pinyin pronunciation of 丝 and the Hellenized word σήρ (silk) was described by Yule[11] in 1866 as a variant which was possibly derived from other neighboring languages/dialects: “The Chinese See and Szu, Silk, is found in the Korean language or dialect in the form Sir, in Mongol Sirkek, in Manchu Sirghé. Klaproth supposes this word to have given rise to the, Greek σήρ, the silk-worm, and Σήρες, the people furnishing silk, and hence Sericum, silk.(Mem. rel. l'Asie, iii, 265.).”

Thus, China appears to have been known to the Greeks by its most famous product, silk, rather than the name of its people.

This situation radically changed around the 2nd century BC, when China became identified with the term Sinae (Σῖνα), or Thinae (Θῖνα).[12] Although the pronunciation differs from that in Chinese, etymologically it may indicate the unification of China under the Qin dynasty and the subsequent naming of China as the land of the Qin. The English geographic term “China” is considered to derive from the same root, but with an alternate spelling.

The Greco-Roman historian Theophylactus Simocatta (c.7th century AD)[13] uses the term Taugast (Ταυγάστ). This term, although not phonetically accurate, originates from the Chinese characters 拓跋 (tuo ba), pertaining to the Northern Wei dynasty (386 AD–535 AD) of the Three-Kingdom period. Theophylactus, who was perhaps the last great historian of late antiquity describes the Emperor of Taugast as being “The son of the God,” carrying the title “Ταισάν” – (taissan-perhaps 太上). Theophylactus writes: “The 'Taugastian' Emperor is never overthrown and his title is hereditary. Chinese society has its own religion, Gods, and statues. The laws are righteous, and the society lives harmoniously. The (Chinese) morals follow the letter of the law. The (Taugastian) men never wear gold in public, although gold and silver is plentiful due to trading.”[13] He also claims that Taugast is divided in two by a river, which is likely to refer to the Yellow River. In addition to describing the riches of the Taugastian, Theophylactus describes other important observations and historical anecdotes involving Alexander the Great and he briefly mentions silk and sericulture. However, the name Taugast soon became politically obsolete, and was not used in literature thereafter.

  Greek and the Greco-Roman Worlds Look Eastwards Top

In surviving early Greek literature, a number of Far East tribes were mentioned by Alcman.[14] (c.7th century BC) and Herodotus[15] (c.484 BC–c.425 BC). However, the Issedones (Ἰσσηδόνες) were a specific ethnic group that was historically discussed in relation to China. This discussion began relatively late in the historical record, after Ptolemy[16] (c. AD 100–c. 170) mentioned “Issedon Serica” (Ἰσσηδών Σηρική) and “Issedon Scythica” (Ἰσσηδών Σκυθική). According to Herodotus, the Issedones practiced customary cannibalism, eating the bodies of the dead.[15] However, because of a lack of sufficient evidence, it is historically challenging to draw reasonable conclusions regarding the association of the Issedones with China and Chinese culture. In 1955, Phillips[17] suggested that the river Isset, located over the Sverdlovsk Pass East of the Urals, is the region referred to as Issedon. In addition, according to the same author: “The ritual cannibalism of the Issedones, compared to similar customs in medieval Tibet, was also found anciently among the Massagetae and Scythians, and is known in modern times among people in northern Asia from the Samoyeds to the Ainu.”[17] This further suggested that China was heard of, but still not understood, during the time of Alcman.

China was first mentioned in western literature in the writings of Ctesias the Cnidian (5th century BC). Ctesias was a doctor, and according to Galen[18] he was a member of the family of the Asclepiads. Ctesias is known to have served as an imperial physician in the court of the Persian emperor Artaxerxes II Mnemon (435 BC or 445 BC–c. 358 BC). The extent to which Ctesias traveled around Asia is unclear, but he wrote extensively about Persia (Persica/Περσικά) and India (Indica/Ἰνδικά). Ctesias' books survived in a fragmentary form, mostly as descriptions of the topics he covered, and in ancient commentaries.

Ctesias was neither a historian nor a cartographer, and he was most likely to include (as Herodotus did) the “sensational” inaccuracies in his writings based on stories he heard during his time in the Persian court. Therefore, he was a controversial figure, both in ancient and modern times. Lucian[19] writes that Ctesias and Herodotus were both condemned to eternal punishment for their falsehoods. However, before Alexander the Great, it is possible that Ctesias' work was the only source of information about India that reached the civilized parts of ancient Europe.

Ctesias' Indica first contains the name “Σῆραι” (Seris), which is the earliest mention of China in Greek literature. However, because his original writings have been lost and only some of their fragments collected by Patriarch Photius have survived, the authenticity of any texts attributed to him may be disputable. Nevertheless, it is plausible that Ctesias did indeed obtain information about China during his time in Persia. Because the sphere of influence of the highly sophisticated Persian Empire extended far into central Asia, the complete absence of basic knowledge about neighboring countries seems unlikely.

The expedition of Alexander the Great (356 BC-323 BC) opened up central Asia to the Hellenistic world. Alexander built infrastructure and established important cities during his campaign, and maintained a strong Greek presence in Central Asia. This allowed communication between areas that are today located in modern Tajikistan, Afghanistan, and Chinese Xinjiang with the rest of the world, yielding accurate information about the East.

After the death of Alexander the Great in 323 BC, central Asia came under the Seleucid Empire, which lasted from 312 BC to 63 BC. The Seleucids strongly promoted the Hellenization of the urban centers across the empire, eventually leading to the fusion of civilizations with Greek characteristics. However, around 250 BC, Diodotus I (c. 285 BC–c. 239 BC) and his son Diodotus II (c. 252 BC–c. 223 BC), Satraps of the easternmost provinces, broke away and established what became known as the Greco-Bactrian Kingdom in the north. Demetrius I (reign c. 200 BC–c. 180 BC) established the Greco-Indian Kingdom in the south.

Even after the Greeks were no longer a political entity in those parts of the world, a large Greek population still thrived independently in the Far East for many centuries.

Strabo (c. 63 BC–c. 24 AD)[20] describes Bactria as follows:

“Some parts of Bactria lie along Aria to the north, but the greater part stretches beyond (Aria) to the east. It is an extensive country and produces everything except oil. The Greeks who occasioned its revolt became so powerful by means of the fertility and advantages of the country, that they became masters of Ariana and India, according to Apollodorus of Artamita. Their chiefs, particularly Menander, (if he really crossed the Hypanis to the east and reached Isamus,) conquered more nations than Alexander. These conquests were achieved partly by Menander, partly by Demetrius, son of Euthydemus, King of the Bactrians. They got possession not only of Pattalene, but of the kingdoms of Saraostus, and Sigerdis, which constitute the remainder of the coast. Apollodorus in short says that Bactriana is the ornament of all Ariana. They extended their empire even as far as the Seres (i.e., China) and Phryni.”

Thus, according to Strabo, the ancient Hellenistic world and the Greco-Bactrian Kingdom's influence and trade reached as far as ancient China.

The earliest attempts to develop a world map were made in the 3rd century BC, visually describing the geography of the various ancient realms.

The earliest extant world map was created by Eratosthenes of Cyrene (c. 276 BC–c. 195/194 BC). Eratosthenes accurately calculated the circumference of the earth and the tilt of its axis, and is regarded as the originator of geography and cartography. The world according to his “Geography” reaches as far as Bactria and the island of Taprobane (Ταπροβανῆ), which is the area of modern Sri Lanka in the Indian Ocean.

Several decades later, Posidonius of Rhodes (c. 135 BCE–c. 51 BCE) created a map (reconstructed by Petrus Bertius in 1630)[21] that included “Seres” (the land of silk) and “Sinae” (literally the country of the Qin) for the first time, signifying that the Greeks had known about and/or had contact with China.

Two centuries later, Ptolemy's Geographia[16] again placed China at the far east border of the world, naming the region “Serica” and “Sinae” [Figure 1]. According to Ptolemy, Serica was located beyond the island of Taprobane. His book and the various maps assembled from his writings confirm a continuous relationship between the Hellenistic and Chinese worlds. Ptolemy's writings and calculations remained authoritative until well into the 15th century.
Figure 1: A world map drawn by Nicolaus Germanus based on a late-13th century rediscovered Greek manuscript of Ptolemy's 2nd-century Geography

Click here to view

During the 1st century AD, a maritime route to China was drawn in the Hellenistic manuscript entitled the Periplus of the Erythraean Sea[12] (Περίπλους τς ρυθράς Θαλάσσης). This book was written by a Hellenistic Greek who had traveled across the east coast of Africa and India and described trade as far as China (Θῖναι). The Periplus was an influential book that allowed the Roman Empire to open sea trade routes and establish ports as far as Vietnam.

In the 6th century, Cosmas Indicopleustis (Κοσμᾶς Ἰνδικοπλεύστης), a Greek merchant from Alexandria (and later a monk), published a manuscript entitled Topographia Christiana (Χριστιανικὴ Τοπογραφία)[22] [Figure 2]. Although Cosmas only traveled as far as Sri Lanka (Taprobane), his book confirms that the maritime routes described in the Periplus of the Erythraean Sea had indeed been opened up and remained popular among traders. In Topographia Christiana, China is mentioned as Tzinitza (Τζινίτζα). Cosmas describes the location of China as follows: “The Indian philosophers, the Brahmans, claim that if you (imagine) a straight line commencing from China passing through to Persia and reaching the (Greco-) Roman empire (Ῥωμανία), it will cut through the middle of the (known) world. And they claim (the Brahmans) that this is true.”[22] He also mentions a network of trade routes and the products that China (by name) and other unnamed areas exported to the Greco-Roman (Byzantine) empire: “from the inner lands that include China and other trade routes, comes the silk, aloe, the buds of the clove tree, the cloves, sandalwood, and whatever each country produces.”[22]
Figure 2: World map created by Cosmas Indicopleustes. Vatican Library. The manuscript is likely to have come from the plunder of Constantinople

Click here to view

The “Periplus of the Erythraean Sea” and the works of Ptolemy allowed the newly-emerging Roman Empire to greatly expand its sphere of influence and knowledge to the Far East, through the land and maritime trade routes of the Hellenistic world. These routes were kept busy even after the move of the Roman capital from Old Rome to the New Rome (Constantinople) in 330 AD, and the eventual formation of the Greco-Roman Empire. Thus, it is evident that the trade of silk, fragrances, and medicine flourished for more than 1000 years.

After the plunder of Constantinople (1204 AD) by the Crusaders, many official maps and geography books were seized and taken to western Europe. People in the Latin West stored these books in libraries, being unable to read Greek or understand the contents. It took almost two centuries to construct accurate translations and realize the wealth of knowledge that they had looted from the people of the Greek-East. Marco Polo's travels also roused western interest for contacting China. While the Renaissance was finally stimulating western European scholarship, the Ottoman Empire was shutting down all of the ancient trading routes to China. The works of authors in the Greek-East and Ptolemy's Geography, however, continued to inspire new maritime explorations and ultimately spawned the Age of Exploration. As the gaps were filled, eventually the ancient maps and traveling manuals became obsolete. However, their historical and cultural significance is still apparent today.

Finally, of all the surviving documents pillaged from Constantinople (New Rome), the Peutinger Table (Tabula Peutingeriana) is perhaps the only official state chart that has remained from the ancient world. This document was based on the original depiction prepared during the reign of Roman Emperor Augustus (27 BC–14 AD). This map, which is now stored in the National Library of Austria,[23] shows China at the Far East, using the name “Sera Major” (Greater China).

  Historical Chinese Names for the Hellenistic and Greco-Roman World Top

Shi Ji (《史记》The Records of the Grand Historian),[24] and the Han Shu (《汉书》Book of Han)[25] mention the name Da Yuan (大宛) which in literal translation means “Great Ionians.” Yuan is a direct Chinese transliteration of the word Yona or “Ιων,” which was used to designate the Greeks throughout Asia. Thus, for the Chinese, Da Yuan was considered to be the descendants of the Greeks of Fergana. The Greco-Bactrian Kingdom was designated as the name Da Xia (大夏) in The Records of the Grand Historian.

In addition, the name Li Xuan (黎靬) was also found in the The Records of the Grand Historian. Although alternative explanations have been suggested, Li Xuan appears to be a Chinese transliteration of Alexandria. At the time when the The Records of the Grand Historian was compiled, Alexandria of Egypt was the center of the Hellenistic world, one of the largest trade ports on the planet and a global hub of science, philosophy and finance. If the Chinese had established trade with the Greeks of Bactria and Fergana, they would likely have heard about Alexandria, at least by reputation.

The names Da Qin (大秦), Li Jian (犁鞬) and Hai Xi Guo (海西国) appear together in the Hou Han Shu (《后汉书》Book of Later Han)[26] as an equivalent to Rome. Book of Later Han describes an embassy of Emperor Antoninus Pius (大秦王安敦), reaching China from the south, via the maritime route described in the “Periplus of the Erythraean Sea,” during the reign of the Emperor Huan of Han (汉桓帝 132 AD–168 AD). Rome at that time was described as Da Qin. It is unclear why the character Qin (秦) was used, except perhaps because it is suggestive of foreigners. In any case, although the Roman Emperor's name was recorded phonetically, the name of his Empire was not.

The name Da Qin (大秦), without any additional geographic locators, was also used in the text of the Nestorian Stele. However, in this case, it is highly unlikely that it indicated the Old Rome in Italy. At the time of Nestorius (Νεστόριος; c. 386–450), the capital of the Roman Empire had relocated to Constantinople (New Rome). Nestorius (who was born in Syria) held the title of Archbishop of Constantinople and New Rome, before his condemnation for heresy in 431 AD. Historically, even during Nestorius' lifetime, Old Rome (”Roma Aeterna”, The Eternal City) had been left in ruins, caused by the attacks of the Visigoths in 410 AD. This disaster pushed the Latin West into what became known as the Middle Ages.

I propose that Da Qin at that time may have been a general term denoting the Greco-Roman (Byzantine) world, not referring specifically to Old Rome or another city on the Italian peninsula.

The word Fu Lin (拂菻) as an alternative to Da Qin appears in the Jiu Tang Shu (《旧唐书》Old Book of Tang).[27] The word Fu Lin may be a near transliteration of the word Polis (Πόλις), the short name for Constantinople (Κωνσταντινούπολις), the capital of the Greco-Roman (Byzantine) Empire. However, like Da Qin, this name may have been used to describe the entire Greco-Roman (Byzantine) Empire.

According to the Xin Tang Shu (《新唐书》New Book of Tang),[28] Fu Lin is the same as Da Qin, possibly indicating that it generally referred to the Roman Empire.

Ming Shu (《明书》Book of Ming)[29] also provided a summary of the name changes and official communications between the Greco-Roman world in different periods.

Many names of non-Chinese cities are also found in the Chinese historical records, but their accurate identification has largely been a matter of inconclusive and speculative debate. In the current study, the focus is mainly the major cities of the Greco-Roman empire that initiated ancient trade routes. Other important Kushan, Parthian/Persian, or Syrian cities, although significant in terms of the politics, conflicts, and history of the region, are outside the focus of this thesis.

  China Looks Westwards to Greece and Rome Top

For cultural and/or geopolitical reasons, the Chinese were less eager to initiate westward explorations. Therefore, their expeditions began much later in history, and were related to the trade of military horses. According to Liu,[30] once the various nomadic tribes living in Central Asia learned to ride horses and fight on horseback, they began plundering rural areas of China. To counteract these attacks, the Chinese needed horses to maintain the balance of peace. After the 3rd century BC, the Yuezhi (月支) established themselves as a powerful confederacy on the steppes of Central Asia. During this time, the Chinese formed a symbiotic and harmonious relationship with the nomadic tribes, supplying each other with the materials they needed, including jade, warhorses, and silk. The Xiongnu (匈奴) lived to the East of the Yuezhi territory and were not on peaceful terms with either the Yuezhi or the Chinese. Eventually, they defeated the Yuezhi and pushed them towards Bactria, creating difficulties for the Chinese. During the Qin dynasty, China maintained peace through the efforts of General Meng Tian (蒙恬 c. 210 BC), who expanded the Great Wall to defend against the Xiongnu. However, the Xiongnu soon formed a confederation and became a threat to the Han dynasty, the dynasty that succeeded Qin dynasty. After the Han Emperor Gaozu (汉高祖 256/247 BC-195 BC) narrowly escaped capture in battle, a marriage treaty was signed to maintain peace. The Chinese kept supplying the Xiongnu with silk and other commodities, and the Xiongnu allowed the intermarriage of their chiefs with Chinese princesses and women of the Imperial Court. This treaty, however, was not considered to be a dignified way to keep the peace, and did not stop the Xiongnu from periodically pillaging Chinese settlements. According to The Records of the Grand Historian,[24] during the reign of Emperor Wu of the Han dynasty (汉武帝 141 BC-87 BC), the Chinese emperor decided to send ambassador Zhang Qian (张骞 d. 113 BC) to the Yuezhi to negotiate an alliance against the Xiongnu. This trip failed in its primary purpose, but was successful for a different reason: Zhang Qian became the first Chinese official to make the first contact with other countries, obtained accurate information about the world immediately outside the Great Wall, and directly contributed to the opening of the ancient Afro-Eurasian trade routes, which later became known as the Silk Roads.

  Chinese Silk Top

The terms “Seres” and “Serica” indicate that China was well known throughout the Greek world for their production of silk centuries before the opening of the trade routes.

In late antiquity, when historical circumstances allowed the establishment of an extensive network of land and maritime Afro-Eurasian trade routes between China and Rome (before 330 AD), and later Constantinople (New Rome) (330 AD–1453 AD), Antioch and Alexandria, the rich and powerful could easily, though not cheaply, obtain this important material.

I propose that evidence appears to suggest a correlation between the Greek letter “π,” which, in contrast to the Erasmian pronunciation, is traditionally pronounced as “pee,” and the Chinese character 匹 (pi), which is a near homophone. In addition to the similar pronunciation, there is a close resemblance in shape between the letter “π” and the character 匹. This similarity is related to the basic agreement that opened the silk roads: The letter “π” represents the word πῆχυς (cubit) as a unit of length, while the character 匹 is still used in the Chinese language as a “measure word” for horses. Thus, it can be theorized that the silk trade was originally established between the Greek States in Central Asia and the Chinese on the premise of exchanging lengths (cubits) of silk cloth for Ferghana horses (大宛马/宛马 da yuan ma), otherwise known as “blood sweating horses” (汗血马 han xue ma) [Figure 3].
Figure 3: Comparison between the letter “π” and the character 匹

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Because of its political and social importance as well as high market value, silk remained a crucial commodity for China, and was heavily guarded as a state and trade secret for many centuries. Nevertheless, the new overland and the maritime routes allowed communication, influence, and the exchange of ideas between the East and the West for the first time.

  Ancient Overland and Maritime Afro-Eurasian trade Routes Top

As the above description demonstrates, both “overland” and “maritime” routes were established between China and Europe. From the perspective of Chinese traders, the overland routes were largely concerned with the trade of horses for silk. Where the silk would end up and whether it was transported to Europe or elsewhere was not their concern. The various intricacies of the horse trade are recorded in Yuan Zhen's (元稹 779–831) “Yinshan Dao” (阴山道 Yin Mountain Route), a Tang dynasty poem which describes the worries of China about the production of silk, the horse exchange and the various stresses related to this trade.[31]

Territorially, these paths were controlled by various ancient ethnic groups, including the Kushans (Yuezhi), Turkic tribes, Russian tribes, Mongols, and the Parthians/Persians among various other cultures and civilizations. This made traveling to and from Europe a lengthy and perilous journey. Despite the dangers, this is the road that Marco Polo[32] and early Catholics and Franciscans[33] attempted to use for traveling to China.

During the 15th centuries that the overland caravan paths were kept open, a perceived westward movement of populations (i.e., the migration of the Yuezhi, the Xiongnu, and the Turkic tribes) allowed substantial exchange among various civilizations in terms of art, religion, and culture, something that is best documented in the archaeological findings in the Tarim Basin and the Takla Makan desert.

The maritime routes to China were substantially faster and they adhered to the text of the Periplus of the Erythraean Sea described earlier. This is the same route used by the ancient Greeks, Romans, and later Persians to sail to Taprobane (Sri Lanka), and Vietnam, and by the Song dynasty to sail to Canton. When Michal Boym traveled to China from Rome, he took the same route because it was faster than Vasco da Gama's much longer trip. Although canals linking the Mediterranean with the Red Sea existed even during ancient times, the opening of the Suez Canal ensured that the same route would keep flourishing indefinitely as one of the most influential maritime routes in history.

The trade routes to China allowed various religions to reach China through the Greco-Bactrian and the Yuezhi Kingdoms, e.g., Manichaeism (明教) from Persia, Nestorian Christianity (景教) from Byzantium and Syria, Zoroastrianism (祆教) from Persia, and Buddhism (佛教) from India. The presence of so many ancient religions, as well as the fusion of cultures and foreign trade, indicates a much more cosmopolitan ancient China than is typically perceived today. Various accounts in the Old Book of Tang, and the New Book of Tang suggested that various foreign physicians with different religious backgrounds practiced what appears to be Greek medicine in China.

  Nestorians and the Nestorian Stele Top

As mentioned above, the opening of trade routes permitted several western religions and their divisions to enter China. One such example, Nestorianism (景教), was vital to the work of Michal Boym. Nestorius (c. 386–450) was a Patriarch of Constantinople and New Rome and was considered a heretic. After his condemnation, his followers broke away from the Church and formed the “Church of the East,” eventually re-establishing itself in Persia.[34] From Persia, they expanded through missionary work to areas as far as India, China, and the Arabian Peninsula. In China, the Nestorians developed a large following group, and archeological findings have revealed churches and Nestorian worship as far as Beijing, Guangdong, and the North.

The Nestorian stele in Xi'an of Northwest China is considered to be the most important surviving relic from this time [Figure 4]. This relic was discovered in 1625 during construction close to Xi'an Fu, and a Christian Mandarin named Leo[35] understood the text and informed Rome of the discovery. The stele was copied and moved to a nearby Taoist temple.
Figure 4: Nestorian stele in Xi'an (photograph from 1907)

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However, because it defied their preconceptions, many Western European scholars initially believed the stele to be a Jesuit forgery. The various intricacies of the stele were explored in depth by Salisbury,[36] including Abel Remusat's commentary on why the stele was impossible to forge in imperial China.

Boym conducted a transliteration and a rudimentary translation of this stele, and this collection of characters formed the first Sino-Latin (French) Dictionary. Boym's work on the stele was first published in Kircher's China Illustrata. The full text was translated several times, but the translations by Holm[36] and Legge[37] are the most notable.

Boym also transliterated the pronunciation of the Chinese characters of the Xi'an Fu into the Cantonese dialect. Unable to make this connection even today, many Western scholars have developed theories about Boym's pronunciation method. I plan to explore this topic in more detail in a future thesis.

The persecution of the three foreign religions (三夷教) occurred during the Tang dynasty, and a massacre in Guangzhou in 878–879[38] almost completely eradicated foreign religions from China,[39],[40] except for Buddhism and Islam. Although the Nestorians had largely recovered by the time of the Yuan dynasty, there is no historical evidence that any Christians persisted in China by the time the Jesuits arrived during the Ming dynasty.

When comparing the maritime and overland routes to China, it is obvious that the land routes were slow, and although Chinese goods were transported along them, they were not necessarily opened for the sole purpose of exporting/transporting silk to Europe. The quantity of European (Roman and Greco-Roman) coins[41] were found in south India, Vietnam, and Sri Lanka and this suggested that the maritime route was substantially more successful and popular than the overland routes. Using this route, silk, ivory, exotic animals, medicine, and fragrances were transported more quickly and safely to Constantinople and the rest of Europe via Alexandria and Antioch, as attested in the Topographia Christiana.

  Greek Medicine in China Top

Research on Greek medicine in China is currently at an embryonic stage and is overshadowed by substantial research attention focused on the impact of Persian medicine and Arabic medicine, both of which arrived in the region many centuries later.

The current thesis focuses on three main topics in the hope that it will spark further discussion and research: cupping, the trade of bezoar in China, and possible theoretical exchanges between Greek and Chinese texts, as evident in early sources.

In recent years, particularly during Olympic sporting events, many athletes from various countries have appeared with cupping marks on their backs. This endorsement of the ancient Chinese medical technique has become a selling point for the efficacy of Chinese medicine abroad. However, few Chinese practitioners understand that cupping entered China from the West, along with the establishment of the Afro-Eurasian land and maritime trading routes.

Historically, the earliest complete mention of cupping can be found in the writings of Hippocrates, and detailed illustrations of cupping vessels first appeared on the Greek coins of Astakos, Akarnania around 360 BC-330 BC[42],[43] [Figure 5]. It can be hypothesized that cupping had become a popular Greek medical technique for centuries before it appeared on coins.
Figure 5: Astakos, Acarnania. 400-344 BC. The flip side depicts a cupping vessel and tongs

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Several previous papers mention Papyrus Ebers[44],[45] as evidence that the cupping treatment originated from Egypt. However, close examination of the translated text[46] reveals no strong indications supporting this notion. To the best of my knowledge, archaeological findings in Egypt to date have also failed to produce any cupping apparatus of that era to support such a hypothesis. Hopefully, future excavations might yield evidence for this theory, but it cannot currently be validated.

In China, cupping was first documented as a popular medical procedure in Ge Hong (葛洪)'s Zhou Hou Bei Ji Fang (《肘后备急方》Handbook of Prescriptions for Emergencies) Ge Hong (283 AD–343 AD) died in Luo Fu Shan, in Guangdong, a potential destination of the maritime trade routes described by Arrian. The many Greek glass objects[47] excavated across China, particularly in the Xinjiang, Guangdong and Guangxi provinces of China, potentially supported the hypothesis that cupping arrived together with glass objects, probably during the Han dynasty (202 BC–220 AD).

An influential article by Hong,[48] describes how bezoar, an object first described in Greek medicine, was ultimately traded in China by the Persians. Historically, after Alexander's campaign, ancient Persia became a Hellenistic Kingdom under the Seleucids (312 BC–63 BC) and the Greek influence continued even during the Parthian Empire (247 BC–224 AD). Therefore, Greco-Persians and Persians were well versed in Greek medicine, and traded medical knowledge and goods with China even centuries after the Greek influence waned in that part of the world.

Certain passages from the Huang Di Nei Jing (《黄帝内经》Huangdi's Internal Classic), a traditional Chinese medicine literature, appear to resemble the known Greek medical texts, and the most striking of these is given in the example below. However, more research is needed to compare ancient Greek and Chinese medical texts in detail, to extend current understandings of the direction of the exchanges and the impact of each system on each other in the late antiquity and medieval periods. The text in the example shown was written by Solon (630 BC-560 BC), and is entitled The Ten Ages of Man[49] [Figure 6]. The text survives in a fragmentary form. However, even in this state, it is strikingly similar to the text found in the chapter Discourse on the True Qi Endowed by Heaven in High Antiquity of the Huangdi's Internal Classic. Further research may yield interesting conclusions regarding early interactions between Greek and Chinese people at the beginning of the establishment of the ancient Silk Roads.
Figure 6: The Ten Ages of Man by Solon (630 BC-560 BC)

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  Transmission of Disease Across the Silk Roads Top

In addition to the perceived positive effects of the Silk Roads, which included cross-cultural exchange, trade, exploration and knowledge, severe negative impacts also occurred. Of these negative effects, the most damaging was the transmission of disease and plague.

The first pandemic (541–542), named the “Justinian plague” (from the name of the Byzantine Emperor Justinian), ravaged the southern provinces of the Byzantine Empire, including Egypt, Syria, Palestine and Anatolia, bringing an end to late antiquity and facilitating the rise of Islam. Modern research confirms that the Justinian plague was caused by Yersinia pestis and it was originated from China.[50],[51],[52],[53] Although it is not possible to construct a fully accurate map of the transmission route, the fact that it first arrived in Alexandria without leaving an obvious overland disease trail behind suggested the transmission was spread via the maritime trade route. The Justinian plague wiped out populations of the areas occupying the southern provinces of the Greco-Roman (Byzantine) Empire (Egypt and Syria), reaching Constantinople in 542 and North Africa, Italy, Spain, and the French-German border by winter of 543.[54] In the aftermath, large areas of the Greco-Roman (Byzantine) Empire were left unpopulated, enabling the Arabs to move into previously Christian areas, affecting the terrain in a way that is still reflected in world history and continues to create military, political and cultural friction, even fifteen centuries later. Importantly, the Arabs inherited the infrastructure of these key maritime trade routes, which were then renamed the “Spice Route.”

The second pandemic is better known as the “black death” (1343–1353). Modern genetic research has confirmed earlier speculation that the black death originated from China.[55] The black death first arrived in Europe through Crimea, leaving an obvious overland trail of death recorded across the Silk Roads.

The death toll of the second pandemic was extremely heavy in both Europe[56],[57] and China.[58] The second pandemic heavily influenced art, culture, music, literature, medicine, and religious practices, occurring towards the end of the Dark Ages. The Europe that came out in the aftermath was ready to move towards rebirth. This rebirth occurred almost a century later with the Renaissance and the Age of Exploration. Although these developments helped rebuild Europe, they also led to the worst kinds of imperialism, colonialism, and modern slavery practices.

  Conclusions Top

The formation of the ancient Silk Roads led the “known world” to the earliest experiences of globalization. The available evidence suggests that people in the East and the West were aware of each other at least since the 6th century BC. Over the course of several centuries, these cultures were progressively brought together by mutual trade interests. The Chinese sought horses, while western populations developed a demand for silk, exotic animals, fragrances, medicine, and ivory. These trade routes facilitated all kinds of exchange, including cultural, medical, and religious communication between China and the western world.

The first pandemics broke out as a result of these interactions, and diseases were transmitted across the world much more quickly than would have been possible in the past.



Ethical approval

The author has no ethical conflicts to disclose.

Conflicts of interest

Ioannis Solos is an editorial board member of Chinese Medicine and Culture. The article was subject to the journal's standard procedures, with peer review handled independently of this editorial board member and his research groups.

  References Top

Nickel L. The first emperor and sculpture in China. Bull Sch Orient Afr Stud 2013;76:413-47.  Back to cited text no. 1
Johnston I. Ancient Greeks may have Built China's Famous Terracotta Army – 1,500 Years before Marco Polo. Independent; 2016. Available from: https://www.independent.co.uk/news/science/china-terracotta-army-ancient-greek-sculptors-alexander-the-great-marco-polo-a7357606.html. [Last accessed on 2021 Jul 13].  Back to cited text no. 2
BBC Editorial. Western Contact with China Began Long Before Marco Polo, Experts Say. BBC; 2016. Available form: https://www.bbc.com/news/world-asia-china-37624943. [Last accessed on 2021 Jul 13].  Back to cited text no. 3
Hanink J, Silva FR. Why There's So Much Backlash to the Theory that Greek art Inspired China's Terracotta Army. The Conversation; 2016. Available form: https://theconversation.com/why-theres-so-much-backlash-to-the-theory-that-greek-art-inspired-chinas-terracotta-army-67488. [Last accessed on 2021 Jul 13].  Back to cited text no. 4
Hanink, J. Stop Crediting the West for “Inspiring” Classical Chinese Art. Quartz; 2016. Available form: https://qz.com/842102/stop-crediting-the-west-for-inspiring-classical-chinese-art/. [Last accessed on 2021 Aug 08].  Back to cited text no. 5
AFP. Greek Influence? 'Foreign Forces Spar Over China's Terracotta Warriors. Hindustan Times; 2016. Available from: https://www.hindustantimes.com/world-news/greek-influence-foreign-forces-spar-over-china-s-terracotta-warriors/story-Ca5KuYSoZS4EdAvycJc2AM.html. [Last accessed on 2021 Aug 08].  Back to cited text no. 6
Xinhua. Chinese Archaeologist Refutes BBC Report on Terracotta Warriors. China Daily. Available from: https://www.chinadaily.com.cn/china/2016-10/18/content_27097821.htm. [Last accessed on 2021 Jul 13].  Back to cited text no. 7
Stoneman R. The Greek Experience of India: From Alexander to the Indo-Greeks. New Jersey: Princeton University Press; 2019.  Back to cited text no. 8
Beckwith CI. Greek Buddha: Pyrrho's Encounter with Early Buddhism in Central Asia. New Jersey: Princeton University Press; 2015.  Back to cited text no. 9
Klaproth J. Memoires Relatifs a l'Asie, Contenant Des Recherches Historiques, Géographique Et Philologiques Sur Les Peuples De L'orient. Vol. 3. Paris: Libraire Orientale de Dondey-Dupré Père Et Fils; 1828. p. 264-5.  Back to cited text no. 10
Yule H. Cathay and the Way Thither; A Collection of Medieval Notices of China. Vol. 1. London: Haklyut Society; 1866. p.265.  Back to cited text no. 11
Fabricius B. Arriani Alexandrini Periplus Maris Erythraei. Dresdae: Gottschalck HM; 1849. p. 30.  Back to cited text no. 12
Simocatta T, Bekker I. Corpus Scriptorum Historiae Byzantinae. Bonnae: Impensis ed Weberi; 1834. p. 286-8.  Back to cited text no. 13
Byzantius S. Cum Guilielmi Dindorfii Praefatione, Cui Insunt Lectiones Libri Vratislav. Vol. 1. Lipsiae: Kuehn; 1825. p. 225.  Back to cited text no. 14
Horton TE, Grover J, Dunmore IJ, Chiswel R, Tooke B, Sawbridge T, et al. Herodoti Halicarnassei Historiarum Libri 9., 9. Musarum Nominibus Inscripti. Londini: Typis E. Horton & J. Grover, Impensis Johannis Dunmore, Richardi Chiswel, Benjamin Tooke, & Thomae Sawbridge; 1679. p. 229-30.  Back to cited text no. 15
Ptolemaeus C. Claudii Ptolemaei Geographia Edidit Carolus Fridericus Augustus Nobbe. Vol. 2. Lipsiae: Sumptibus et typis Caroli Tauchniti; 1845. p. 127-30.  Back to cited text no. 16
Phillips ED. The legend of Aristeas: Fact and fancy in early Greek notions of East Russia, Siberia, and Inner Asia. Artibus Asiae 1955;18:161-77.  Back to cited text no. 17
Butyras SI, Karydis G. Lexikon Historias Kai Geogrphias Bialambanon Perilēpsin Tēs Historias, Physikēn Kai Politikēn Chōrographian, Tous Bious Tōn Meglaōn Andrōn, Tous Mythous Kai Tas Paradoseis Pantōn Tōn Ethnōn Apo Tōn Archaiotatōn Chronòn Mechri Tou Nyn. Vol. 3. Constantinople: Butyras Print; 1881. p. 842-3.  Back to cited text no. 18
Smith W. Dictionary of Greek and Roman Biography and Mythology. Vol. 2. London: Taylor and Walton; 1846. p. 816.  Back to cited text no. 19
Hamilton HC, Falconer W. The Geography of Strabo. Vol. 2. London: Bohn HG; 1856. p. 252-3.  Back to cited text no. 20
Dilke OA. Greek and Roman Maps. Baltimore: The Johns Hopkins University Press; 1998. p. 37-8, 61-2.  Back to cited text no. 21
Cosmas Indicopleustis. Christiana Topographia (MPG 088 0051 0476) [0500-0600]. Available from: https://www.documentacatholicaomnia.eu/04z/z_0500-0600__Cosmas_Indicopleustis__Christiana_Topographia_(MPG_088_0051_0476)__GM.pdf.html. [Last accessed on 2021 Jul 14].  Back to cited text no. 22
Nussli C. The Complete Tabula Peutingeriana. Euratlas. Available from: http://www.euratlas.net/cartogra/peutinger/index.html. [Last accessed on 2021 Jul 13].  Back to cited text no. 23
Sima Q. Treatise on the Dayuan. The Twenty-Five Official Dynastic Histories (Volume 1). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 344-5. Chinese.  Back to cited text no. 24
Ban G. Biography of the Western Regions. The Twenty-Five Official Dynastic Histories (Volume 1). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 723-5. Chinese.  Back to cited text no. 25
Fan Y. The Biography of Zhang, Wang, Zhong. The Twenty-Five Official Dynastic Histories (Volume 2). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 962-3. Chinese.  Back to cited text no. 26
Liu X. Biography of Xirong. The Twenty-Five Official Dynastic Histories (Volume 5). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 4112-5. Chinese.  Back to cited text no. 27
Song Q. Treatise on the Western Regions. The Twenty-Five Official Dynastic Histories (Volume 6). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 4799-801. Chinese.  Back to cited text no. 28
Zhang TY. The History of Foreign Countries VII. The Twenty-Five Official Dynastic Histories (Volume 10). Shanghai: Shanghai Chinese Classics Publishing House, Shanghai Bookstore; 1986. p. 8701-3. Chinese.  Back to cited text no. 29
Liu XR. The Silk Road in World History. Oxford: Oxford University Press; 2010. p. 3. Chinese.  Back to cited text no. 30
Ah TM. Exonerating the horse trade for the shortage of Silk: Yuan Zhen's “Yin Mountain Route”. J Chin Stud 2013;57:50-95.  Back to cited text no. 31
Yule H. The Book of Ser Marco Polo, The Venetian: Concerning the Kingdoms and Marvels of the East. Vol. 1. London: John Murray; 1875.  Back to cited text no. 32
Dean W. The China Mission: Embracing a History of the Various Missions of all Denominations among the Chinese. New York: Sheldon; 1859. p. 72-5.  Back to cited text no. 33
Yohannan A. The Death of a Nation, or, the Ever Persecuted Nestorians or Assyrian Christians. New York: G. P. Putnam's Sons; 1916.  Back to cited text no. 34
Salisbury EE. On the genuineness of the so-called Nestorian monument of Singan-Fu. J Am Orient Soc 1853;3:399-419.  Back to cited text no. 35
Holm F. The Nestorian Monument: An Ancient Record of Christianity in China, with Special Reference to the Expedition of Frits V. Holm. Chicago: Open Court Publishing Company; 1909.  Back to cited text no. 36
Legge J. The Nestorian Monument of Hsî-an Fû in Shen-Hsî, China: Relating to the Diffusion of Christianity in China in the Seventh and Eighth Centuries. London: Trübner & Company; 1888.  Back to cited text no. 37
Pearson M. Trade, Circulation, and Flow in the Indian Ocean World. London: Springer; 2016.  Back to cited text no. 38
Shapiro S, editor. Jews in old China: Studies by Chinese Scholars. New York: Hippocrene Books; 2001. p. 60.  Back to cited text no. 39
Huang R. China: A Macro History. 2nd ed. London and New York: Routledge; 1997. p. 117.  Back to cited text no. 40
Bondada G. The role of monetary networks in the trade between India and the Roman Empire. Südasien Chronik South Asia Chronicle 2015;5:399-426.  Back to cited text no. 41
Ashton R, Nocivin I, Ashton RH, Levell N. Cupping on ancient Greek coins: A numismatic case series and its relationship to dermatology. Clin Dermatol 2021;39:344-7.  Back to cited text no. 42
Georgiou E. Acarnanian Astacus: New numismatic evidence. In: Alfaro Asins C, Marcos C, Olero P, editors. XIII Congreso Internacional de Numismática Madrid 2003. Actas-Proceedings-Actes; 2005. p. 253-8.  Back to cited text no. 43
Furhad S, Bokhari AA. Cupping therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.  Back to cited text no. 44
Aboushanab TS, AlSanad S. Cupping therapy: An overview from a modern medicine perspective. J Acupunct Meridian Stud 2018;11:83-7.  Back to cited text no. 45
Bryan CP. The Papyrus Ebers: Translated from the German version. London: Geofrey Bles; 1930.  Back to cited text no. 46
Henderson J, An J, Ma H. The archaeometry and archaeology of ancient Chinese glass: A review. Archaeometry 2018;60:88-104.  Back to cited text no. 47
Hong M. Investigation on “posuoshi” (Bezoar Stone) in Tang and Song dynasties. Zhong Guo Ke Ji Shu Yu 2010;12(03):51-5. Chinese.  Back to cited text no. 48
Solon. The Ten Ages of Man. Available from: http://homepages.gac.edu/~panciera/solonsources.pdf. [Last accessed on 2021 Jul 14].  Back to cited text no. 49
Harbeck M, Seifert L, Hänsch S, Wagner DM, Birdsell D, Parise KL, et al. Yersinia pestis DNA from skeletal remains from the 6th Century AD reveals insights into Justinianic Plague. PLoS Pathog 2013;9 :e1003349.  Back to cited text no. 50
Morelli G, Song Y, Mazzoni CJ, Eppinger M, Roumagnac P, Wagner DM, et al. Yersinia pestis genome sequencing identifies patterns of global phylogenetic diversity. Nat Genet 2010;42:1140-3.  Back to cited text no. 51
Cui Y, Yu C, Yan Y, Li D, Li Y, Jombart T, et al. Historical variations in mutation rate in an epidemic pathogen, Yersinia pestis. Proc Natl Acad Sci USA 2013;110:577-82.  Back to cited text no. 52
Wagner DM, Klunk J, Harbeck M, Devault A, Waglechner N, Sahl JW, et al. Yersinia pestis and the plague of Justinian 541-543 AD: A genomic analysis. Lancet Infect Dis 2014;14:319-26.  Back to cited text no. 53
Little LK. Plague and the End of Antiquity, the Pandemic of 541–750. Cambridge: Cambridge University Press; 2007. p. 144.  Back to cited text no. 54
Bos KI, Schuenemann VJ, Golding GB, Burbano HA, Waglechner N, Coombes BK, et al. A draft genome of Yersinia pestis from victims of the Black Death. Nature 2011;478:506-10.  Back to cited text no. 55
Crawford D. Deadly Companions. How Microbes Shaped Our History. Oxford: Oxford University Press; 2007. p. 119.  Back to cited text no. 56
Austin S. A Pest in the Land: New World Epidemics in a Global Perspective. Albuquerque: University of New Mexico Press; 2003. p. 21.  Back to cited text no. 57
Spengler J. Review (Studies on the population of China, 1368–1953 by Ping-Ti Ho). Comp Stud Soc Hist 1962;5:112-4.  Back to cited text no. 58


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