Professional Documents
Culture Documents
History of Orthopaedics
a r t i c l e i n f o a b s t r a c t
Article history: Chinese history annals recorded cultural interchange between China and the Roman Empire during the
Received 7 February 2014 Han dynasty. The first medical missionaries were Nestorian Christians from the Middle East who arrived
Accepted 8 February 2014 in China in AD 635. They introduced Western medical practice into China. This paper compares the first
comprehensive Chinese treatise on bone and joint injuries by a hermit monk named Lin and the Hip-
Keywords: pocratic Corpus. Based on external knowledge from the author's background as well as textural com-
bone setting parison the text of Hippocrates, a remarkable similarity is noted. Although these similarities could have
Chinese medicine
arisen by chance, it is reasonable to hypothesize that traditional bone setting in China originated from
Hippocratic Corpus
history of medicine
the Hippocratic tradition and was later integrated with indigenous herbal medicine.
中 文 摘 要
中國歷史史冊有證據顯示中國和羅馬帝國之間的文化交流在漢代已經出現。第一羣醫療傳教士來到中國始於
公元635年,他們是來自中東的景教基督徒,把西方的醫術引進中國。於是就有了第一個對中西醫學經典的
全面性比較之研究,它以一個自稱藺道人之隱士所著作的【中國骨傷手册】和西方的希波克拉底醫學文獻庫
作對比,在作者的背景和希氏的文獻內容分析,有着明顯的相似性。雖然可能是偶然發生的,然而照合理的
推論使然,中國的固有跌打術可能源於希氏的醫學傳統,後與土產草藥醫療融合起來。
註: 中國的首本骨科著作I仙授理傷續斷秘方J————自漢代末,古羅馬帝國巳與中國交往。西方醫學源自
希臘醫學之父希波克拉底;當中不少學說亦隨啇人傳教士東來,最早到者乃基督教之景教派。唐朝會昌年間
有一自稱藺道人之隱士著有【骨傷手册】,流傳至今,其中不乏與西方希氏之治療方法有異曲同工之處。更
有學者推斷藺氏乃西方東來之景教徒,因受迫害而隱居山中。然而中西方之骨關節創傷學也可以是各自發展
形成,相同之虎亦可能純屬巧合而矣!
Introduction: Eastewest cultural interchanges “[In AD 667] an envoy from Fu-lin [Syrian province of the Roman
Empire] offered ti-ya-cha [theriac, antidote against all poisons]”
Since the days of the Roman Empire, there has been commu-
nication between China and the West through the silk route, as
And in the New History of the T0ang Dynasty2,4:
documented in the standard histories of China, such as the History
of the Later Han Dynasty1,2: “There are clever physicians in Ta-ch’in who open the brain to
extract worms and cure blindness.”
“The nation of Ta-ch’in [Eastern part of Roman Empire] is to the
west of the great sea. [In AD 166] an envoy from King An-tun
[Emperor Marcus Aurelius Antoninus, AD 121e180] came to
China, bearing gifts of ivory, rhinoceros horns, and tortoise shells.” Entry of Western medicine into China
Later, in the Old History of the T’ang Dynasty2,3: After the banishment of the Patriarch of Constantinople Nes-
torius in AD 431, his teachings spread throughout the Eastern
E-mail: louisfu@kinetics.hk. churches.5 There was a strong missionary spirit among them during
http://dx.doi.org/10.1016/j.jotr.2014.09.001
2210-4917/Copyright © 2014, The Hong Kong Orthopaedic Association and Hong Kong College of Orthopaedic Surgeons. Published by Elsevier (Singapore) Pte Ltd. All rights reserved.
L. Fu / Journal of Orthopaedics, Trauma and Rehabilitation 18 (2014) 128e135 129
the 7th and 8th centuries.6e8 Nestorian Christians were famous in The Hippocratic Corpus
western Asia for their medical skills.9 They translated many Greek
medical works into Arabic.2 It is reasonable to conclude that they “Theory is the flower, not the root of experience”
also introduced Western medical practices into China.10,11
Alternating between periods of xenophobia and receptiveness
in Chinese history, the T0ang dynasty (AD 618e906) opened its doors Hippocrates of Cos
to foreigners of every order. Missionaries were welcomed, bringing
fresh streams of foreign thoughts. Interaction with India, central Orthopaedics in the West began in Greece as a branch of surgery
Asia, and the Near East was carried out via trade routes.6 Chris- that concerned itself with correction or realigning body deformities
tianity following trade routes had been strongest in commercial subsequent to injuries. It was closely associated with the tech-
centres. The capital Hsi-an-fu (modern Hsi-an in Shen-shi Province niques of treating athletics injuries in the gymnasium.16 Its foun-
in northwestern China) was a cosmopolitan meeting place where dation is the Hippocratic Corpus. This collection in its extant form
Arabs, Persians, and Syrians met with Koreans, Japanese, and Ti- contains 60 or so treatises from 460 BC to 350 BC, corresponding to
betans to discuss literature and religion with Chinese scholars.12 A the active lifetime of Hippocrates (the Second or the Great) of Cos
monument erected in 781 commemorating the “diffusion of the (from about 460 BC to 375 BC).17 It is believed that Hippocrates wrote
brilliant doctrine of Ta-ch’in through the Middle Kingdom” was at least part of the collection to preserve the oral tradition of his
unearthed in 1625 at Hsi-an-fu.6,7 It documented the arrival of a family of Asclepiads. The two treatises e On Fractures and On Joints
missionary A-lo-pen (Olupun, or Ruben, an apostle) from the em- e written by the same author, are remarkable for the competence
pire of Ta-ch’in in AD 635. On the monument is the following of the technical analysis and the quality of writing.18 Exuding the
inscription indicative of the medical mission of this religious sect: strong personality of the author throughout, these are worthy of
admiration among the surgical writings of the Hippocratic school.19
“The hungry came and were fed, the naked came and were
Rational and accurate, they reflect a profound practical knowledge
clothed, the sick were attended to and restored, the dead were
and wide experience in the management of these conditions, the
buried in repose.”13,14
results of a long and profound experience. Traditionally attributed
to the school of Cos, many believe that these were indeed written
by Hippocrates himself.20,21
The first Chinese treatise on bone and joint injuries After the disintegration of the Roman Empire, knowledge of
Hippocratic works continued down to the 7th century in the Middle
A manual dedicated to bone and joint injuries surfaced around East. From the 8th century on, preservation and inquiry depended
AD 846, attributed to a hermit named Lin Tao-jen (literally Lin, a man on the Arabic translation of Hippocrates. It was through Latin
of the Way, c. AD 790e850): the Secret prescriptions from immortals translations of Arabic authors and then of the Greek works that
for the treatment of injuries and bone setting.15 It commences with Greek medicine was revived in the West.22 These were transmitted
practical instructions on management of fractures and dislocations, to the Western world via Greek manuscripts compiled by Appol-
followed by formularies of 44 decoctions and drugs for external and lonius of Kitium between 85 BC and AD 51, and by Soranus of Ephesus
internal applications. in the 2nd century AD.23 They represented the genuine Hippocratic
An anonymous author writes in the preface: tradition as transmitted through Greek channels to Byzantium. A
10th century Greek manuscript of the surgical treatises, made by a
“This work is by a hermit-monk during the T0ang dynasty [Em-
Byzantine physician was brought from the East and came into the
peror Wei Chang's reign AD 841e846] … He supported himself by
possession of the bibliophile Cardinal Ridolfi.24 After the fall of
cultivating maize. A villager named Pang visited him often and
Constantinople the transcripts fell into Turkish hands, brought to
helped in farming. One day Pang's son fell to the ground from a
Crete in 1495 and eventually ended in Florence. At the suggestion of
tree while logging and broke his neck. He was in great pain, Pang
Ridolfi, Guido Guidi (aka Vidus Vidius, 1508e1569) undertook the
consulted the hermit, who examined the young man, prepared
translation.23 The illustrations of the book are copies or in-
medicine and administered them personally. Pain was immediate
terpretations of the original Greek drawings.24 The book, published
relieved, after a few days he recovered. Since then many people
in Latin, is entitled Surgery translated into Latin from the Greek by
came from far and near to seek treatment … He said that he was
Vidus Vidius of Florence together with some commentaries by the
Lin Tao-jen from the capital … He drank wine and frequently got
same Vidius, Paris 1544.23,25
drunk, sang incomprehensible songs … Later the circuit officers of
the province arrived and when they visited the hermit, he was
gone, leaving behind his manual on treating injuries.”15 On fractures
Figure 1. Hippocratic methods for reduction of shoulder dislocation, employing suspension from ladder and cross beam, in addition to manual technique. From a facsimile print of
Guidi's Chirurgia of 1544 in the author's collection.
Note. This illustration is a reproduction of original works published prior to 1923 that are in the public domain in the United States of America, and some other countries. No entity
(individual or corporate) has a copyright on the body of the work.
The authorship of the Chinese manual activities inevitably lingered despite their subsequent banish-
ment. From the description of Lin in the preface to his manual, his
After the introduction of GrecoeRomaneArabic medicine into name, appearance, his diet of maize, his wine consumption, and
China by Nestorian missionaries, remnants of their medical his incomprehensible songs all suggest that he could be of foreign
132 L. Fu / Journal of Orthopaedics, Trauma and Rehabilitation 18 (2014) 128e135
Figure 2. Chinese methods for reduction of shoulder dislocation. Note the resemblance of the suspension technique over the shoulder, and pushing with the foot, to those in
Figure 1. From a facsimile print of a Chinese manual of 1817 in the author's collection.
Note. This illustration is a reproduction of original works published prior to 1923 that are in the public domain in the United States of America, and some other countries. No entity
(individual or corporate) has a copyright on the body of the work.
origin. His hermitic existence and his abhorrence of authority Christian in hiding after banishment of that sect by imperial
indicate that he could be a refugee consequent to religious decree.35
persecution by the State. From the above evidence, it has been Such assertions and conclusion on the identity of Lin are caused
hypothesized that Lin was a foreigner, possibly a Nestorian by misinterpretation of the descriptions of him. The title of Tao-jen
L. Fu / Journal of Orthopaedics, Trauma and Rehabilitation 18 (2014) 128e135 133
Figure 3. Hippocratic “succussion” for hip and spine injuries. From a facsimile print of Guidi's Chirurgia of 1544 in the author's collection.
Note. This illustration is a reproduction of original works published prior to 1923 that are in the public domain in the United States of America, and some other countries. No entity
(individual or corporate) has a copyright on the body of the work.
could be equally applied to Taoist disciples and Buddhist monks. indigenous religion of China, had for its purpose the drawing away
During the T0ang dynasty, due to influx of foreigners, coconut of worldly cares to Nature worship. It taught religious, alchemical,
container and wine drinking were not unusual even among strict and health methods to attain longevity. It flourished during this
indigenous religious persons. It was more likely that Lin was a period and had many followers among the literary and elite. It has
Chinese Taoist priest. Taoism (signifying a “way of life”), the been closely associated with traditional medical practice.36 Lin's
134 L. Fu / Journal of Orthopaedics, Trauma and Rehabilitation 18 (2014) 128e135
Figure 4. Chinese methods for reduction of hip dislocation. Note the resemblance of the suspension method to that of Hippocratic succussion in Figure 3. From a facsimile print of a
Chinese manual of 1817 in the author's collection.
Note. This illustration is a reproduction of original works published prior to 1923 that are in the public domain in the United States of America, and some other countries. No entity
(individual or corporate) has a copyright on the body of the work.
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Osleriana: a catalogue of books illustrating the history of medicine and science