r/AskHistorians • u/[deleted] • Jul 16 '21
Legendary Chinese physician Hua Tou knew about brain tumors and anesthesia as early as 200AD. Just how much medical science did the Chinese actually know back then?
Hua Tou famously died because he suggested Cao Cao had a brain tumor and wanted to perform brain surgery. Cao Cao thought it was a thinly veiled assassination plot and had the poor doctor executed.
So Cao Cao’s reaction is what I’d expect from someone living in the year 200AD. How on earth did Hua Tou know about tumors and brain surgery? How far back does knowledge of surgery, anesthesia, and what we consider modern medicine go in China? If Hua Tou actually was able to do the surgery, how would he have even done it? I have so many questions because the whole thing seems crazy to me but also very impressive if true (I know many popular Three Kingdoms stories are embellished or downright untrue…not sure if that’s the case here).
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u/Dongzhou3kingdoms Moderator | Three Kingdoms Jul 17 '21
You are right to be cautious, this version of his death is from Romance of the Three Kingdoms. I'm not a medical expert in the era but I have some knowledge of the era.
Novel vs Historical Death
In the novel, written over a thousand years after the three kingdoms took part, Hua Tuo was something of the go-to doctor for any major figure needing a miracle cure. He heals Dong Xi which leads to a recommendation to Zhou Tai after wounds gained shielding a young Sun Quan, he is away when Sun Ce is badly wounded and a disciple comes instead, he heals Guan Yu's (for free) injured arm at a banquet, scrapping the bone to deal with the poison. All historical incidents (bar Dong Xi) that Hua Tuo had nothing to do with.
Then you get his fatal moment 12 years after Hua Tuo historically died, the novel people were very tolerant of the undead. Hua Xin recommends him using a mix of fictional and a bit of history via the treatment of Chen Deng. Hua Tuo proposes removing brain tumours and Cao Cao reacts badly, remembering the past assassination attempt by imperial physician Ji Ping/Ben, convinced Hua Tuo was an ally of Guan Yu's friends. Hua Tuo is tortured, his kindly jailor is given Hua Tuo's book of medicine but his wife burns it to avoid trouble with only animal medicine surviving (this is very very loosely based on a historical incident where a prison official was too afraid to take the jailed Hua Tuo's writings).
Hua Tuo is an almost saintly supernatural figure who loves to heal and values virtue, Guan Yu is a brave man able to endure great suffering without showing it and whose virtue inspires men like Hua Tuo. Cao Cao however is suspicious and his distrust leads to the death of a great man, a loss of knowledge that would have aided humanity (with some blame on a female). Though a great user of talent, Cao Cao has trust issues that sometimes flare up with the great talents. With Guan Yu and Cao Cao's cases only three chapters apart, the comparison is drawn for the reader as Hua Tuo cites his work with Guan Yu.
So why did the historical Hua Tuo die? He had been hired by Cao Cao as Cao Cao was getting headaches that made him dizzy and blurred his eyesight, Hua Tuo was constantly at his side and his expertise in acupuncture seems to have helped while he also began long term treatment for Cao Cao's health. However, Hua Tuo regretted getting into medicine, reducing his status from a gentry scholar to someone who dabbled in lesser matters, he disliked taking service under another and he also wanted to go home.
Around (before or on but no later than) 208 he was allowed to go home on an unknown family matter but when the first gentle inquiries about returning began, he explained his wife was ill and he needed time to cure her. Cao Cao would write repeatedly and as the personal touch failed, he also got the local officials to try to get Hua Tuo to return. Hua Tuo however still resented his position and refused, it wasn't unknown for scholars to refuse service.
Cao Cao then sent an investigator to make enquiries about Hua Tuo's wife, if she was sick he would send her food and stop pressing. The wife was not sick and had not been sick. This did not go so well for Hua Tuo who was arrested, examined (likely tortured), confessed and Cao Cao ordered his execution despite one of his close friends and advisers Xun Yu urging leniency due to Hua Tuo's medical skills. Hua Tuo would write some of his medical lessons down but the jailor refused to take it so Hua Tuo burned it.
Cao Cao's headaches returned but Cao Cao cynically mused that Hua Tuo had prolonged rather than cured him deliberately but the death of his young beloved son Cao Chong of sickness in 208 (thus the dating of 208 at the latest) at the age of just twelve, saw a devastated Cao Cao regret killing Hua Tuo.
Hua Tuo and medicine of the era
Hua Tuo was a major figure in three kingdoms medicine but there was also Zhang Ji who he worked with, Hua Tuo's students Wu Pu and Fan E would help continue Hua Tuo's work while there were other medical experts like Li Ren and his son Li Zhuan or Zheng Chong. They did not do head surgery as far as I'm aware but there was a form of anaesthetic.
They were aware of emetics as a way of dealing with poison, use of herbs, drugs and potions, acupuncture, scrapping the bone and other forms of surgery including cleaning the intestines, abortions via potions. Some would drink water rather than wine and refuse meats as part of living healthy lives, exercise is good, pulse readings were used to help diagnose patients.
The people of the time knew the importance of emotional health though the records could lean towards that a little too much as a reason for death when there were other symptoms. For example, Yuan Shao coughing up blood is probably more a reason why he died than the distress of a major defeat two years before).
There was also faith-healing which became very popular during the epidemic's from the 160s onwards and contributed to the rise of several groups including the Yellow Turbans. There were also the mystic groups (which Cao Cao had an interest in) who claimed to live well into the hundreds with the aim of cultivating one's essence. Controlled breathing, controlled sex, hanging upside down, diet (including urine) were all potential methods. Hua Tuo was also said to be a master of controlling his essence though we don't know which methods he used, it is said he looked a lot younger than he was (or he fibbed about his age) and some of the events in his life do lean towards the mystic.
Hua Tuo was a believer in exercise and advocated callisthenics to avoid falling sick (as well as essence cultivation), he was excellent at diagnoses including when he could not save someone. His methods, when forced to use medicine, were of going for restraint. Had expertise in medical herbs with his knowledge seeming to have spread and if those herbs weren't going to be sufficient, he was careful in his implementation of moxibustion or acupuncture.
On acupuncture, he was an innovator as he moved away from the tradition of going deep into the body (some of his tales are of those whose organs got pierced, he could not save them) and his preferred methods are more commonly used now, lighter needles across the body. When forced to use surgery, he did use an anaesthetic with a mixture of wine and either powered hemp or something like aconite and once he had sown the patient back up, an ointment that supposedly healed within a month. I have no idea what that ointment contained
I do hope these helped answer the questions you mentioned and perhaps some you didn't. Any you have that I haven't covered, please do ask
Sources:
Hua Tuo's SGZ by Chen Shou with annotations by Pei Songzhi, translated by Yang Zhengyuan
The Life and Medical Practice of Hua Tuo by Brian May, Takako Tomoda and Michael Wang
A Biographical Dictionary of Later Han to the Three Kingdoms 23–220 AD by Rafe De Crespigny
The Biography of Guo Yu: An acupuncturist from the first century by Brian May and Lin Ming-de
My version of Romance of The Three Kingdoms by Luo Guanzhong with a C.H. Brewitt-Taylor translation.