A chronological overview of common Chinese medicine treatment methods

Introduction

Across a 3,000-year span, the annals of Chinese Medicine (CM) unveil a narrative enriched by ancestral wisdom and evolving insights [1]. Rooted in the Shang dynasty, early records outline the unfolding of disease understanding [2]. The foundational concepts of yin and yang, interwoven with the five elements, took form during the Spring and Autumn Period [3]. Flourishing during the Qin and Han dynasties, seminal texts such as the Yellow Emperor’s Classic of Internal Medicine [4], Divine Husbandman’s Classic of the Materia Medica [5], and Treatise on Cold Pathogenic and Miscellaneous Diseases by Zhang Zhong Jing [6] contributed to different CM disciplines with advanced knowledge. Tao Hong Jing’s Collection of Commentaries on the Classic of the Materia Medica represented a groundbreaking innovation in the field through the introduction of a novel Chinese “materia medica” classification methodology, yielding far-reaching implications for future generations [7]. Wang Shu He’s Pulse Classic solidified pulse diagnostic methods, while confirming and hallowing acupuncture principles [8]. The Tang Dynasty formalized medical education, while Sun Si Miao’s contributions underscored life cultivation and herbal formulas [9]. The Song Dynasty celebrated medical progression, juxtaposed by the Jin and Yuan dynasties’ diversification of medical thought amidst challenges [10]. In the Ming Dynasty, a plethora of medical institutions emerged, culminating in Li Shi Zhen’s The Grand Compendium of Materia Medica. Here, the author illustrated different approaches for categorizing herbal constituents and remedies and managing various health conditions [11]. The Qing Dynasty marked the zenith of CM, as exemplified by masters such as Ye Tian Shi, an expert of the pathology and treatment of epidemic febrile diseases [12]. The 19th century’s infusion of Western insights catalyzed a synthesis of CM with contemporary knowledge, propelling the discipline towards innovative integration. Amid this continuum echoes the resonance of ancient wisdom, guiding the present and forging the future of medical inquiry.

The inclusion of the “T”, which stands for “traditional” (Chuan tong, 传统) in the abbreviation of CM, originates from the early years of the socialist government of the People’s Republic of China in the second half of the 20th century. This inclusion aims to translate the Chinese term “Zhong Yi” into English, indicating “Chinese Medicine” [13]. Interestingly, though, the prevailing practice in China involves predominantly using the term “Zhong Yi (中医)=Chinese Medicine” instead of “Chuan tong Zhong Yi (传统中医)=traditional Chinese medicine (TCM)” e.g., Chinese medicine hospital is translated into Zhong Yi Yi Yuan (中医医院); Zhong Yi Yi Sheng (中医医生) represents a Chinese medical doctor and Zhong Yi Ke (中医科) stands for “Chinese medicine department”.

Nowadays, TCM is recognized and practiced worldwide, gaining popularity in Switzerland, Germany, Austria, Canada, Australia, the UK, the USA, Russia, and many Asian countries. In the contemporary perspective and with a forward-looking prospect, TCM is deeply enmeshed in strategic alliances with academic and research organizations [14]. Moreover, TCM is actively propelling the convergence of information technology paradigms and concurrently promoting broader engagement in its evolutionary trajectory [14].

This overview aims to elucidate the historical evolution and contemporary relevance of TCM, showcasing its foundational principles, fundamental practices, and global integration. The following topics are discussed: Acupuncture, Auricular Acupuncture, Chinese Herbal Medicine, Cupping, and Tuina. This comprehensive perspective seeks to foster a deeper understanding of TCM’s heritage and demonstrate its ongoing relevance in contemporary healthcare.

History of acupuncture

Based on historical records and archaeological findings, acupuncture is believed to have originated during the Neolithic Age, dating back approximately 5,000 years. In its early forms, acupuncture possibly involved the employment of sharpened stones, bones, or bamboo slivers as instruments [15]. In the Yellow Emperor’s Classic of Internal Medicine (Ling Shu, 475-200 BC), the core knowledge of acupuncture is systematically presented for the first time. Alongside pathology, diagnosis, and therapeutic methods, this guide provided detailed descriptions of nine types of acupuncture needles, including their shapes, sizes, and applications (Figure 1) [16]. Each variation of the instrument was designed to treat distinct medical conditions. While the Yellow Emperor’s Classic of Internal Medicine provides comprehensive recorded knowledge on the nine needles, the earliest visual representation of these tools was found in The AB Cannon of Acupuncture and Moxibustion (266-420 AD) written by Huangfu Mai [17]. The publication also consists of a thorough exploration of Zang-Fu organs and meridians, alongside the documentation of 349 acupoints used for common ailments. Subsequently, the Great Compendium of Acupuncture and Moxibustion and the Golden Mirror of Medicine also documented several illustrations of the aforementioned nine needles [16]. During the Song Dynasty (960–1279 AD), physician Wang Wei Yi edited the three-volume Illustrated Manual of Acupuncture Points on a Bronze Figure, documenting a total of 354 acupoints [18]. Famous physician Jizhou Yang (1522–1620 AD) meticulously reported a complete set of 365 acupoints in The Great Compendium of Acupuncture and Moxibustion, which serves as the foundation of modern acupuncture. His work investigated the inception of acupuncture and ancient works concerning the topic. It also provided a comprehensive overview of the insights of past Chinese practitioners, revealing the applications of primary and supplementary acupuncture points. Today, the manual demonstrates a profound knowledge of human anatomy and inner organs, as well as the integrative approach of acupuncture to the management of maladies alongside various medicinal herbs. In the 6th century AD, acupuncture was initially introduced in Japan and Korea and consequently gained recognition in these countries [19]. The earliest records of acupuncture in the West can be traced back to 1680, thanks to European physician Willem Ten Rhijne. Subsequently, in the early 1800s, a notable upsurge of curiosity in both America and Britain resulted in a plethora of works on the subject published in scientific literature [20]. James Reston, an American journalist, played a significant role in presenting acupuncture to the Western world when he published an article in The New York Times entitled “Now, About My Operation in Peking.” Reston’s article marked the first notable American account of undergoing acupuncture in China, gaining attention as it appeared in mainstream Western media [21]. In 2012, Klein et al. reported that acupuncture and other TCM therapies were among the most popular Complementary Medicine methods embraced by the adult population in Switzerland [22]. The demand for acupuncture has been steadily growing in the past years.

Figure 1:

Nine various types of needles. Source adapted from Hyo Jin Kim et al. [16]. a. Spade needle, b. Round-pointed needle, c. Pressure needle, d. Sharp-edged needle, e. Sword-shaped needle, f. Round-sharp needle, g. Fine needle, h. Long needle, i. Large needle [16].

The existing body of literature comprises a substantial number of randomized controlled trials (RCT) and systematic reviews examining the application of acupuncture as a therapeutic modality for numerous medical conditions. For the management and prevention of tension-type headaches, migraine, episodic migraine [23], [24], [25], [26], [27], and various types of pain [28], the evidence for acupuncture is meanwhile substantial.

History of auricular acupuncture

The history of Chinese Auricular Acupuncture (AA) dates back more than 2,000 years, when Chinese ancestors noticed a correlation between certain ailments and the ear. The classical textbook Yellow Emperor’s Classic of Internal Medicine described the correlation between the auricle and meridians in detail, recognizing diseases by observing the ear [29]. Sun Si Miao, a renowned Chinese physician of the Tang Dynasty (618-907 AD), composed two medical books – Important Formulas Worth a Thousand Gold Pieces and A Supplement to Recipes Worth a Thousand Gold Pieces – in which, across 30 volumes, he documented the positions and characteristics of auricular points, as well as the Yangwei Vessels behind the ears. Additionally, he detailed the use of auricular points for treating jaundice [30]. During the Ming Dynasty, Ji Zhou Yang’s Compendium of Acupuncture and Moxibustion underlined the importance of the peak of the ear and provided a theoretical basis with instructions. Yu Fan Zhou’s Massage Technique for Children includes a theory in which each of the five Zang organs (Heart, Liver, Spleen, Lung, and Kidney) corresponds to a section in the back of the ear. Towards the end of the Qing Dynasty, Zhen Jun Zhang created the first auricular map in Essential Techniques for Massage, which derived from Zhou’s concept [30].

Ancient Egyptian women who desired to cease childbearing were known to prick their external ear with a needle or use heat to cauterize it. Mediterranean sailors were said to wear golden earrings not only as decorative pieces, but also to enhance their eyesight [31]. Hippocrates (460 BC-370 BC) proposed a procedure that involved performing small cuts behind the ear to enhance ejaculatory capacity and resolve erectile dysfunction issues [32]. In the 2nd century, Greek physician Galen brought Hippocratic medicine to the Roman Empire and highlighted the therapeutic effects of scratching the outer ear [33]. The decline of the Roman Empire led to Middle Eastern Islamic cultures safeguarding the medical accounts from Egypt, Greece, and Rome, one of which was the cauterization of the external ear to treat sciatica troubles [34]. In 1637, a Portuguese physician by the name of Zacatus Lusitanus became the first person in Europe to document the therapeutic use of ear cauterization to reduce sciatic pain resistant to bloodletting. Subsequently, anatomist and surgeon Antonio Maria Valsalva published the Aura Humanus Tractatus in 1717, which provided instructions for scarifying the antitragus to treat dental pain. Ignazio Colla from Parma, Italy, disclosed in 1810 that a person stung by a bee in the antihelix had experienced relief from leg pain [32].

In modern times, traditional AA methods are being further enhanced. In 1957, P. Nogier from France developed European auricular somatotopy, a detailed illustration of the entire human shape in the form of a homunculus or reversed fetus, mapped onto the ear (Figure 2) [35].

Figure 2:

First ear cartography publication by P. Nogier 1957. A detailed illustration of the entire human shape in the form of a homunculus or reversed foetus, mapped onto the ear by P. Nogier [34]. © R. Nogier; with the permission of Raphaël Nogier.

In 1974, P. Nogier and colleagues F. Bahr and R. J. Bourdiol released the Loci Auriculomedicinae to further develop this concept [30]. Since P. Nogier introduced the inverted fetus map to Western Medicine (WM) in 1957, AA has been systematically and comprehensively added to the treatment modules of various chronic pain diseases [35], [36], [37]. In 1988, the Chinese Association of Acupuncture and Moxibustion released an article named “The Project of the Standardization of Auricular Acupuncture Points.”, which proposed a standardization of both sides of the auricle. This map is still known as the Nanjing Map and is a benchmark for Chinese standardization [38]. The manuscript presented a novel way of locating AA points, dividing the auricula into sub-zones and implementing a point-based technique for their identification. Additionally, the front side of the ear lobe is essentially covered [39]. The Chinese auricular map shares some features with the French version, though they are not identical. Basically, AA can be partitioned into the Chinese and Western auricular systems, whereas Western AA evolved towards auriculomedicine and auriculotherapy.

Systematic reviews, meta-analyses and RCTs have shown the effectiveness of AA in immediate pain relief [40], cancer pain [41], chronic back pain [42], cancer patients with chronic musculoskeletal pain [43], migraine treatment [44], [45] as well as improvement and maintenance of positive outcomes in substance abuse and addiction [46], 47].

History of Chinese herbal medicine

Chinese Herbal Medicine (CHM) has been exploited for the healing of illnesses in China for millennia, tracing back to the ancient era of Chinese history when the Chinese people resided in primitive surroundings. The application of natural herbs for medicinal purposes sprang from the indispensable need for survival in such settings, as the Chinese people, while inhabiting rudimentary habitats, had to contend with various life-challenging ailments. As time passed, victorious endeavors were etched into consciousness, while ineffective herbs faded into oblivion. The triumphant encounters that endured the test of time were transcribed into written records, thus giving birth to the captivating history of CHM. Plentiful historical texts from abundant influential TCM physicians contain a wealth of information on volumes of herbal formulas and their applications. The most ancient herbal knowledge can be found in the texts of the Classic of Changes and Classic of Poetry [48]. In these classics, various herbs were referenced in diverse contexts, referring to treatment and nutrition. As time went by, CM evolved into a distinct field as the accumulated knowledge found its way into medical literature. The most renowned classics include:

1. The Yellow Emperor’s Classic of Internal Medicine (475-200 BC) is an ancient and highly esteemed traditional Chinese medical book, influenced by Taoist philosophy. This guide contains queries from the emperor and replies from his minister Qi-Bo. The original author is uncertain, but it is assumed that several authors contributed to its creation over the course of different decades. The textbook is divided into Su Wen (Plain Questions) and Ling Shu (Spiritual Pivot) and consists of nine volumes and 81 chapters. The essence of the publication lies in its discussions on Yin and Yang, the five elements, life cultivation, anatomy, physiology, pathology, and therapeutic procedures. Given that CHM involves botanical compounds with nourishing, healing, or preventative characteristics, it is considered an integral component of nutrition. The Yellow Emperor’s Classic of Internal Medicine contains valuable insights into the application of Chinese herbs (CH) as food items in regular diets. It explores their diverse effects, ranging from hot/warm characteristics (e.g., Zingiberis Rhizoma, Cortex Cinnamomi) to cool/cold qualities (e.g., Mentha × Piperita, Coriandrum Sativum), along with neutral attributes (e.g., Radix glycyrrhizae, Rhizoma Dioscoreae) and strengthening abilities (e.g., Radix Ginseng, Fructus Jujubae). Additionally, the text elaborates on the yin and yang aspects of these dietary items, along with their impacts on the Zang-fu organs. It also mentions discussions on decoctions and wines [49], 50].

2. Divine Husbandman’s Classic of the Materia Medica (25-200 AD) precisely documents 365 CH, encapsulating centuries of medicinal wisdom from the Han Dynasty and beyond. These herbs are categorized into three distinguished tiers: the superior-grade (120 CH), intermediate-grade (120 CH), and inferior-grade (120 CH), with their classification guided by therapeutic efficacy and potential toxicity [51]. For each herbal essence, the narrative divulges crucial details, incorporating its specific name, inherent qualities, administration methods, compatible combinations, and the diverse array of therapeutic applications it offers. The superior-grade herbs promote the sustenance of vitality and can be safely consumed regularly and for extended periods, posing no harm to individuals. In contrast, intermediate-grade herbs serve to enhance physical well-being and exhibit varying degrees of toxicity. As for the inferior-grade herbs, these are intended for treating diseases, although many of them are toxic and unsuitable for extended usage, thus requiring caution in their application [52]. The book also mentions that CH in a formula is categorized as the “sovereign,” “minister,” “assistant,” and “envoy.” A balanced combination typically combines one “sovereign,” two “ministers,” and five “assistants” to achieve harmonious effects. However, it is also feasible to apply one “sovereign,” three “ministers,” and nine “assistants” and “envoys”, accordingly adjusting the proportions of the ingredients in the prescription [52].

3. Treatise on Cold Pathogenic and Miscellaneous Diseases (150-219 AD), authored by esteemed physician Zhang Zhong Jing and often referred to as the “Medical Sage,” stands as a highly influential medical work in TCM. This profound book is divided into Treatise of Cold Damage Disorder and Synopsis of Prescription of the Golden Chamber. While the former serves as a comprehensive exploration of epidemic/pandemic exogenous infectious diseases, enveloping their diagnostic methods and treatment strategies [6], the latter scrutinizes the treatment of internal ailments. The Treatise on Cold Pathogenic and Miscellaneous Diseases features an extensive compilation of 269 formulas, presented in more than 10 diverse forms of administration. This remarkable compilation surpasses the achievements of any preceding medical literature, earning the opus a distinguished status as a pioneer of formulas.

4. Collection of Commentaries on the Classic of the Materia Medica (420–589 AD) was compiled by Tao Hong Jing, a medical practitioner of the Liang Dynasty. He accomplished this by modifying the Divine Husbandman’s Classic of Materia Medica and incorporating an additional 365 CH, thereby augmenting the total count to 730. In order to differentiate between the primary content sourced from the Divine Husbandman’s Classic of Materia Medica and his personal notes, Tao Hong Jing employed contrasting red and black ink, with red ink indicating the content from the Divine Husbandman’s Classic of Materia Medica. Each entry in the compilation includes comprehensive details, incorporating, among others, the precise nomenclature of the medicinal substance, its diverse flavors, intrinsic characteristics, toxicity (or lack thereof), medicinal applications, alternative designations, production region, harvest time, and interactions with other medicinal substances [53]. Furthermore, the remedies are thoroughly sorted into seven different classes based on their inherent qualities: gemstones, botanicals, arboreal specimens, creatures and insects, fruits and vegetables, crops, and herbs with designated names but without actual utilization [54].

5. The Grand Compendium of Materia Medica (1578), compiled and authored by Li Shi-Zhen, stands as the most complete and thorough medical compendium ever created in the annals of TCM. After devoting 27 years of effort to the endeavor, the author finally achieved its publication. The opus includes 1,892 medicinal entries, with 374 being newly introduced. It also incorporates over 1,000 illustrations and an extensive collection of 11,096 formulas. The book documents CHM products, providing their names, origins, types, forms, preparations, inherent traits, flavors, effects, and applications [55]. Li Shi Zhen systematically categorized these CHM into 16 groups entrenched on intrinsic qualities such as aqueous elements, fiery attributes, terrestrial components, metallic substances, plant life, cereals, plant-derived edibles, fruits, timber, arthropods, scale, crustacean exoskeletons, avian creatures, living organisms, and humankind. Each category covers a range of items, spanning from non-living matter to living organisms and from rudimentary to complex forms [55]. Therefore, this compendium is a pioneering accomplishment in the realm of herbalism, establishing an advanced and comprehensive categorization structure.

The application of CHM for treating female infertility, as revealed in a meta-analysis, yielded promising outcomes by doubling pregnancy rates within a 3–6 month period, in comparison to fertility drug therapy in WM [56]. Another study indicated that, compared to conventional WM, the use of classical CHM in the treatment of COVID-19 showed improvements in various clinical parameters, including clinical cure rates, duration of hospitalization, symptom scores, and inflammatory biomarkers. No severe adverse effects were observed with CHM [57]. In the context of weight management, CHM demonstrates promising adjunct effects on both body weight and Body-Mass-Index at the conclusion of the treatment period when compared to the control group. Furthermore, CHM has also demonstrated potential benefits in headache treatment [58], [59], [60], [61].

History of cupping

Cupping stands as one of the earliest known medical therapies in Ancient Egypt. Originating in Ancient Egypt around 1550 BC, Papyrus Ebers represents one of the earliest medical documents referencing the practice of cupping therapy (CT) [62]. Another famous document is Recipes for Fifty-Two Ailments (Wu Shi Er Bing Fang), an ancient silk manuscript discovered in a Han Dynasty tomb (202 BC–220 AD) in 1973, which holds the earliest recorded accounts of cupping in China [63].

Around 400 BC Herodotus, a Greek historian and geographer, meticulously documented the practice of employing both wet and dry cupping as therapeutic interventions for a wide array of conditions. These ranged from headaches to fainting, abscess evacuation, and other afflictions [64]. During the first century AD, Aulus Cornelius Celsus recommended the application of CT to draw out venom from bites and treat abscesses [64]. Moving into the 2nd century AD, Greek physician Aretaeus of Cappadocia expanded the application of wet cupping to address ailments such as uterine prolapse, cholera, epilepsy, and ileus [64]. Greek physician Galen showed enthusiastic support for CT, providing detailed insights into a variety of cup materials, including horns, glass, and brass [64]. Hippocrates delineated two distinct cup types: one featuring a slender aperture and elongated handle and the other boasting a broader opening. The former was utilized to target profound fluid retention, while the latter was harnessed to mitigate the dispersal of pain. He applied CT in the treatment of conditions such as musculoskeletal afflictions of the spine and limbs, gynecological concerns, throat inflammation, ear disorders, and lung ailments [65].

CT enjoyed notable acclaim in Arabic and Islamic regions. Eminent healers from these cultures, such as Abu Bakr Al-Razi (854-925 AD), Al-Zahrawi (936-1036 AD), and Ibn Sina (980-1037AD), endorsed and advocated for its practice [62]. Al-Zahrawi delineated cupping locations and provided visual representations of cupping instruments through illustrations [66]. The implementation of CT expanded to Italy and gradually extended throughout Europe from the 14th to the 17th century, during the Renaissance. Notably, cupping gained widespread recognition for its efficacy in managing conditions like gout and arthritis during this epoch in Italy [67]. Chinese physician Zhao Xuemin (1753–1803) completed Supplements to the Compendium of Materia Medica (Ben Cao Gang Mu Shi Yi), providing a comprehensive account of the historical context and origins of various cupping techniques and shapes. Furthermore, the book delves into the multifaceted functions and wide-ranging applications of CT [68]. During the 1950s, the medical effectiveness of CT gained validation through collaborative research involving Chinese scholars and acupuncturists from the former Soviet Union. This joint endeavor led to the official endorsement of CT as an established remedial method, subsequently integrating it into medical institutions across China [69].

This ancient treatment method has been exploited to address a wide spectrum of health conditions over the course of history, involving the utilization of diverse cup materials such as bamboo, glass, plastic, ceramic, silicon, and animal horn (Figure 3), placed on specific sites on the skin to create a vacuum through suction using either flames or manual techniques.

Figure 3:

Several cuppings sets applied in cupping therapy.

The cups remain on the body for 5 to 10 minutes and are then removed. Two distinct cupping techniques exist: dry and wet cupping. Dry cupping takes a noninvasive approach, sidestepping the practice of bloodletting. In contrast, wet cupping is an invasive procedure, entailing the deliberate release of blood. Wet cupping is further divided into traditional wet cupping and Al-hijamah, with “Al-hijamah” originating from the Arabic word “hajm” and meaning suction, expansion, and blood extraction [70]. Al-hijamah gained greater traction across the expanse of the Middle East and North Africa [71].

Cupping operates on multiple fronts: it boosts the flow of the blood, triggers the activation of the immune response, provokes the stimulation of mechanosensitive fibers, promotes the repair of capillary endothelial cells, accelerates the granulation process, and triggers angiogenesis in adjacent tissues [64]. The culmination of these effects is a noticeable alleviation of pain. Encouragingly, emerging scientific data substantiates the efficacy of dry cupping in mitigating musculoskeletal discomfort [72]. A growing body of evidence suggests that cupping can foster systemic comfort and relaxation. This, in turn, prompts an elevation in the brain’s natural opioid production, thereby enhancing pain management [73]. CT has demonstrated its efficacy in addressing an array of conditions, including lower back pain [74], chronic neck pain [75], tension-type headache and migraine [76], knee osteoarthritis [77], facial paralysis [78], diabetes mellitus [79], rheumatoid arthritis [80] and bronchial asthma [81].

History of Tuina/An-Mo

“Tui” denotes the action of applying pressure through thrusting, while “Na” indicates the technique of holding. These synergize into a sophisticated system that integrates massage, manual acupuncture point stimulation, and manipulation. The utilization of Tuina traces its roots back to ancient China, with historical documentation in the Yellow Emperor’s Classic of Internal Medicine attesting to its early efficacy [82]. Tuina emerges as a subtly nuanced and tender intervention. Functioning as a complementary therapeutic approach, it adeptly orchestrates the harmonization of physiological and pathological dynamics within the body. Its overarching objective revolves around the cultivation of physiotherapeutic benefits, embodying the essence of balance and well-being. Tuina is underpinned by a multifaceted array of potential mechanisms. These consist in active inhibition of peripheral inflammatory processes, modulation of ion channels pivotal in nociceptive transmission, attenuation of activation in spinal glial cells implicated in pain sensitization, and intricate modulation of neural activity within the brain’s pain-processing centers [83].

The nomenclature “Tuina” remained absent from Chinese literature until the Ming dynasty (1368–1644). In previous eras, the dominant terminology utilized to describe therapeutic massage was “An-Mo,” a phrase that directly conveys the actions of “pressing” and “grasping” [63]. Archaeological exploration of inscriptions etched onto bones and tortoise shells, integral to ancient divination practices, has unveiled captivating insights. These inscriptions show allusions to the utilization of massage as a remedial procedure aimed at alleviating illnesses. Encoded within Oracle-Bone Scripture (Jia Gu Wen), the earliest form of script in China, these references harken back to the Shang Dynasty (16th–11th centuries BC), shedding light on an enduring history of massage [84]. Through the meticulous excavation of the Ma Wang Dui tomb (202 BC–220 AD) located in Hunan Province, an invaluable repository of medical knowledge was disclosed. Among the notable discoveries were medical manuscripts transcribed onto both silk scrolls and bamboo strips. Of particular significance is a specific document entitled Recipes for Fifty-Two Ailments, which offers illuminating insights into the domain of An-Mo [85]. Within the context of the Recipes for Fifty-Two Ailments, precise references elucidate an array of An-Mo techniques, containing distinct actions such as “pressing” (An), “grasping” (Mo), “scratching” (Sao), “scraping” (Gua), “rubbing” (Fu), and “striking” (Ji). Zhang Zhong Jing (150–219 AD), author of the Treatise on Cold Pathogenic and Miscellaneous Diseases, includes Tuina in his array of therapies, particularly in his work Synopsis of Prescriptions of the Golden Chamber. He advocates for Tuina to prevent the blockage of the nine orifices when sensing extremity heaviness [84]. Hua Tuo (140–208 AD), a famous Chinese physician and the first person in China to apply anesthesia during surgery, promoted the application of An-Mo for postoperative recuperation and childhood anorexia [86]. Sun Si Miao (581–682 AD), also known as the “King of Medicine,” thrived during the dynamic eras of the Sui and Tang dynasties. He accomplished the creation of two extensive 30-volume compendia on medical practice, firmly solidifying his position as a pivotal figure in the field of CHM. Within his renowned work Prescriptions for Emergencies Worth a Thousand Gold, he outlined a sequence of 18 exercises, attributing them to ‘the An-Mo technique from India method.’ Additionally, he expounded on a comprehensive compilation of 49 exercises, characterizing them as ‘the An-Mo method of Laozi’ [87]. Sun Si Miao also described massaging cranial soft spots, hands, and the undersides of the feet in young children, acting preventively against pediatric flu. The establishment of the Imperial Medical Office, the topmost legislative jurisdiction of medicine, supported by the Tang Government (618–907 AD), marked a significant milestone, encapsulating areas including four medical departments [2]. Massage therapy was a distinctive component within one of the four departments of the Imperial Medical Office. In the Song dynasty (960–1279 AD) and the following Yuan dynasty (1280–1368 AD), an extensive exploration of Chinese massage practices unfolded, resulting in their following enhancement. These advancements led to the predominant utilization of massage within the departments specializing in orthopedics and pediatrics at the Imperial Medical School. This epoch was characterized by a pronounced emphasis on the systematic examination and refinement of massage techniques [88]. During the Ming Dynasty (1368–1644 AD), the practice of pediatric massage, formally named “Tuina” for the first time, underwent notable advancements, resulting in the establishment of a rigorously structured and scientifically substantiated treatment modality [89]. Within the Qing Dynasty (1644–1911 AD), the “Rolling Method School” emerged as an entity in the field of massage methodologies. This school’s methodology is based on different variations of a single technique known as “Yi Zhi Chan,” characterized by its use of oscillating compression, with the thumb as the primary tool for therapeutic adjustment [90]. In 1956, a milestone was reached with the establishment of the inaugural official training course for Tuina therapy in Shanghai [91]. This development catalyzed a widespread adoption of Tuina within the healthcare infrastructure, as numerous hospitals across China subsequently instituted their own Tuina departments. By 1974, Tuina departments had become ubiquitous throughout China’s medical facilities, solidifying their integral role in the healthcare sector [91], 92].

More recent studies have shown the potential of Tuina in various conditions: it seems favorable for the treatment of allergic rhinitis in children [93], it can improve the clinical efficacy and sleep quality in primary insomnia [94], it has an effect in treating tension-type headache and chronic nonspecific low back pain [95], 96] and patients with temporomandibular disorder treated with Tuina showed functional improvement, pain reduction and improvement in quality of life, with fewer adverse events in one systematic review [96].

Conclusions

Traditional Chinese Medicine encompasses a variety of therapeutic techniques. While acupuncture is probably the most popular and widely recognized, other therapeutic approaches such as CHM, cupping, and Tuina also constitute a fundamental part of TCM. These disciplines have developed over time, often intertwining with Western concepts and influencing modern medical practices. The development of TCM spreads over centuries, mostly thriving under certain dynasties but never ceasing to prosper. This historical overview offers a chronological timeline (Figure 4) of TCM, facilitating a deeper comprehension of its present-day popularity and relevance in modern healthcare.

Figure 4:

Chronological timeline of TCM.