The History of the Chinese Pharmacist: From Ancient Origins to Modern Pharmacy in China

A Chinese pharmacist is a healthcare professional who prepares, dispenses, and advises on medicines within China's dual system of Traditional Chinese Medicine (TCM) and modern Western pharmacy. The role traces back more than three thousand years to the "tian-guan" court physicians of the 11th century B.C., yet today it spans hospital clinical pharmacy, community retail practice, drug-safety monitoring, and front-line response to public health emergencies such as COVID-19. This page traces that long arc — from Shennong and the first state pharmacies to the modern clinical pharmacist — and explains the education, responsibilities, and practice streams that define the profession in China.

History of Chinese Pharmacy and the Role of the Chinese Pharmacist

The history of Chinese pharmacy reflects the peculiarities of China's historical development and the distinctive nature of its pharmacology. The first pharmacies of Chinese medicine appeared in the same ancient era that produced the earliest mention of "tian-guan" — court doctors — dating to the 11th century B.C. (for more information: Medicine of ancient China). From these origins, two enduring streams of pharmaceutical practice developed in parallel: the herbal tradition of Traditional Chinese Medicine and, much later, modern Western pharmacy.

Pharmacy in China, in its broadest sense, covers the preparation, compounding, dispensing, and supply of both Chinese herbal medicine and modern medication. The term "pharmacist" describes the qualified professional responsible for these tasks — pronounced "FAR-muh-sist" in English and rendered in Chinese as 药剂师 (yàojìshī). Synonyms and related terms used across the field include druggist, chemist, dispenser, and apothecary, while specialised modern roles such as clinical pharmacist and hospital pharmacist describe practice in particular healthcare settings.

Ancient Origins: The First Pharmacies of Chinese Medicine

The earliest pharmacies of Chinese medicine grew directly out of the practice of the tian-guan, the court physicians who first appear in records of the 11th century B.C. Medicine and pharmacy were not yet separate professions: the same practitioners who diagnosed illness also gathered, prepared, and supplied the remedies. This integration of treatment and drug preparation shaped Chinese pharmaceutical practice for millennia.

Shennong and the Legendary Foundations of Chinese Pharmacology

Shennong, the legendary "Divine Farmer," stands at the mythological foundation of Chinese pharmacology and is traditionally credited with discovering the medicinal properties of hundreds of plants. Chinese tradition holds that Shennong personally tasted countless herbs to test their effects, founding the knowledge that would later be systematised in the materia medica. His name is attached to the Pen T-Sao — also known as The Divine Farmer's Herb-Root Classic — the earliest surviving Chinese pharmacopoeia, which catalogues hundreds of medicinal substances drawn from plants, minerals, and animals. One of the best-known entries is Ephedra (Ma Huang), the source of ephedrine and still used in respiratory remedies today.

The 'Tian-Guan' and Early Medical Practitioners

The tian-guan were among the first recognised medical practitioners in Chinese history, combining the duties of physician and pharmacist in a single office attached to the imperial court. Their appearance in records of the 11th century B.C. marks the earliest documented point at which the supply of medicines was organised as a formal responsibility rather than a purely folk activity. From these court doctors developed the later imperial medical organisations that institutionalised drug manufacture.

Chinese Folk Pharmacy

Alongside the official pharmacies, a vast folk pharmacy network operated throughout China, sustained by countless anonymous wandering physicians. These practitioners combined in one person the doctor of every specialty and the pharmacist, carrying their entire stock of remedies with them as they travelled from village to village. This grassroots network reached populations that official institutions never served.

Wandering Physicians as Doctors and Pharmacists

Wandering physicians were the backbone of folk pharmacy, serving simultaneously as doctor and pharmacist for the communities they passed through. Their indispensable attribute was a special bag or box holding up to 400 types of drugs — as many as were counted among the most commonly used in medical practice. The motto of these travelling healers might well have been: "I carry everything with me!"

Pocket Medicine Chests ('Yao Yihing Za')

Pocket medicine chests, known as "Yao yihing za," were widely used in China as a compact way to carry essential remedies. A typical chest consisted of six flat silver vials, each the size of a matchbox and closed with a screw cap. A miniature spoon was attached inside each cap, reaching to the bottom of the vial to scoop up the powdery substance, and the vials were cleverly hinged together so the whole set could be folded into a compact box.

Imperial Medical Organizations for Manufacturing Medicines

Imperial courts maintained entire medical organisations devoted to the manufacture of medicines, according to historiographical records from somewhat later than the tian-guan era. These organisations included both physicians and medics whose duties extended beyond treating patients to producing the drugs the court required, marking an early institutional separation of pharmaceutical work.

The Faculty of Pharmacy at 'Tai and Shu'

A dedicated faculty of pharmacy is mentioned in the 7th century A.D. among the faculties of "Tai and Shu," the prototype of a medical institute. This faculty not only manufactured medicines for the court but also trained the cadres of so-called medicinal gardeners, making it one of the earliest documented pharmacy education institutions in the world.

Training Medicinal Gardeners and Pharmacy Cadres

The faculty of pharmacy at Tai and Shu maintained its own nursery, which served both as a place of practice and as a source of supply for the special management of plant medicines. The nursery was tended by students, and of the 337 trained at Tai and Shu, 52 went on to practice pharmacy — an early record of formal pharmaceutical qualification and specialisation in China.

Publicizing the Most Important Prescriptions

The Tang dynasty (618–907) promoted medical knowledge by publicly promulgating the most important prescriptions with brief explanations of when to use them (for more information: Books of Chinese medicine). This was an early form of public health education, making proven remedies accessible far beyond the literate elite.

The prescriptions were written on large boards or even carved on stone slabs and displayed in prominent places in major cities. At first 101 prescriptions were publicized; by 796, the number had grown to 586 prescriptions, demonstrating a steadily expanding effort to disseminate verified treatments.

The First State Pharmacies of Chinese Medicine

The first state pharmacies of Chinese medicine emerged during the Song dynasty (960–1279), when strengthened foreign trade relations led to a lively exchange of medicines, especially with Arab countries. This trade proved so profitable that the sale of medicines became a state monopoly, an arrangement that gave rise to a popular saying about the value of medicine.

The Song Dynasty State Monopoly on Medicines

The Song dynasty monopoly on medicines arose because the medicine trade was extraordinarily lucrative, particularly the exchange with Arab merchants along expanding trade routes. The profitability of this commerce is captured in the saying that grew out of the period:

The price of gold has a limit, but the price of medicine is limitless.

Despite its commercial motives, the state monopoly had a positive side, bringing standardisation and oversight to the production and supply of ready-made medicines.

The First State Pharmacy in Kaifeng (1076)

The first state pharmacy of ready-made medicinal forms was established in 1076 in Kaifeng, then the capital of China. It was soon followed by similar pharmacies in other large cities. In these state pharmacies, medicines were dispensed both to physicians and directly to patients on their prescriptions — an early model of organised, regulated medication dispensing.

Chinese Herbal Medicine Dispensing and Preparation

Chinese herbal medicine dispensing and preparation remains a defining feature of pharmacy in China, sitting alongside modern medication supply as one of the two main streams of practice. A TCM pharmacy department handles the storage, weighing, combining, and dispensing of herbal materia medica according to a physician's prescription, a process that demands detailed knowledge of hundreds of individual substances and their interactions.

Pharmacies of Chinese medicine differ sharply in appearance from modern retail outlets, resembling large artisanal workshops for processing medicinal raw materials and making galenic preparations. The medicine shelving in a traditional TCM pharmacy holds rows of labelled drawers and jars for raw herbs, while staff manage inventory, prepare patent medicine formulations, and serve customers across the counter — for example, a female customer collecting a prescribed herbal remedy.

Traditional Methods of Preparing Herbal Remedies

Traditional methods of preparing herbal remedies in Chinese pharmacy include decoction, where herbs are boiled into a concentrated liquid; pill and powder formulation; and the compounding of standardised patent medicines. Each preparation follows established processing techniques — drying, roasting, steaming, or stir-frying with honey or wine — chosen to modify the properties of the raw materia medica. These techniques, refined over centuries, are now also reproduced industrially to ensure consistent dosing and quality.

Acupuncture and Massage Therapies in Pharmacy Practice

Acupuncture and massage (tuina) therapies frequently accompany herbal dispensing within the broader practice of Traditional Chinese Medicine. While these treatments are delivered by practitioners rather than pharmacists, the TCM pharmacy supports them by supplying the herbal formulas prescribed alongside such therapies for internal diseases. The integrated approach treats conditions ranging from digestive complaints to chronic pain using herbs, acupuncture, and manual therapy in combination.

The Pharmaceutical Industry in China

The pharmaceutical industry in the modern sense appeared in China only at the end of the nineteenth century, and its early development was very slow. This was largely a result of the policy pursued by imperialist invaders, who bought the best raw materials at extremely low prices and re-imported finished products, reaping huge profits from the medicine trade.

Early Industrial Development and Foreign Influence

Early pharmaceutical industrial development in China was held back by foreign domination of the medicine trade. In old China it even came to importing ampoules from abroad, although the country was perfectly capable of producing its own glass. After the change in government, the central authorities pursued a policy of consolidating small factories into large public and public–private enterprises, which raised both output and the capacity to manufacture complex new medicines using modern equipment and technology.

On the basis of several small enterprises, the largest North-Eastern chemical-pharmaceutical plant was built, producing glucose, chloromycetin, DDT and other products. Shanghai became the main centre of the pharmaceutical industry: in 1954 the city produced sixteen times more sulfathiazole than in 1952, and nationally the output of the most important medicines rose almost nineteenfold in just five years. Drugs such as penicillin (more information: Ozokerite and women's health), streptomycin, and aureomycin were produced in 1957 at 900 times the 1952 level.

The Chinese pharmaceutical industry never produced only modern medicines, however. Industrial methods are also used to manufacture large quantities of traditional medicine based on the therapeutic value of plants, minerals, and extracts of animal origin. The first factory of this kind started up in 1954, and workshops for traditional medicines exist in many state-owned enterprises, alongside countless cooperative and private TCM pharmacies in towns and villages.

According to the Chinese Ministry of Commerce, in 1952 across twelve major cities new types of medicines accounted for 42.6% of sales and Chinese folk medicines for 57.4%, meaning traditional remedies served more than half the urban population — and in rural areas the great majority. These vigorous measures to develop the industry and expand the pharmacy network disproved the ancient saying about the inaccessibility of medicines in the new China.

Modern Pharmaceutical Manufacturing in China

Modern pharmaceutical manufacturing in China today ranks among the largest in the world, spanning generic drug production, traditional Chinese materia medica modernisation, and new drug development. Contemporary manufacturers operate under the oversight of the National Health Commission of the People's Republic of China and support an extensive ecosystem of clinical trials registered through the China Clinical Trials Registry. The sector increasingly applies pharmacogenomics and intelligent, AI-assisted production methods, while also standardising classic herbal formulas so that traditional medicine meets the same quality and safety expectations as Western medication.

The Modern Chinese Pharmacist: Roles and Responsibilities

The modern Chinese pharmacist is responsible for dispensing medication, advising patients, monitoring drug safety, and increasingly contributing to direct clinical care. Since China's economic reform, the pharmacist's role has evolved from a primarily product-focused dispenser toward a patient-centred clinical professional, paralleling the gradual move to separate prescribing from dispensing as distinct professional functions. Pharmacists practise in hospital pharmacies, community and retail pharmacies, manufacturing, and research.

Core responsibilities of the contemporary pharmacist in China include:

• Dispensing prescribed medication and counselling patients on correct use;
• Managing pharmaceutical inventory, equipment, and the display and shelving of products in retail settings;
• Providing customer service and pharmacist–customer interaction at the counter;
• Reviewing prescriptions for appropriateness, interactions, and dosing;
• Supporting prescribing decisions as part of multidisciplinary clinical teams;
• Monitoring adverse drug reactions and contributing to pharmacovigilance.

Clinical Pharmacy Development and Education

Clinical pharmacy in China developed substantially after economic reform, shifting hospital pharmacists from behind-the-counter dispensing toward direct involvement in patient therapy. The National Educational Committee and leading universities such as Zhejiang University and Central South University established clinical pharmacy curricula and graduate education to train pharmacists for these expanded roles. Clinical pharmacists now participate in ward rounds, optimise drug regimens, conduct pharmacoeconomic analysis, and inform healthcare policy, with hospital pharmacy quality assessment and research becoming established academic activities.

Clinical Drug Efficacy and Safety Studies

Clinical drug efficacy and safety studies form a major part of modern hospital pharmacy practice and pharmaceutical management research in China. Pharmacists contribute to clinical trial evaluation and support, applying evidence-based medicine and systematic reviews to assess whether treatments work and remain safe in real-world use. Institutions such as Xiangya Hospital and the First Affiliated Hospital of Chongqing Medical University host pharmacist-led research that feeds into national drug policy and treatment protocols, much of it indexed in the Chinese National Knowledge Infrastructure.

Adverse Drug Reaction Monitoring and Pharmacovigilance

Adverse drug reaction monitoring and pharmacovigilance are central duties of the Chinese pharmacist, ensuring that medication safety is tracked across the healthcare system. Pharmacists identify, document, and report adverse reactions, feeding data into national surveillance systems coordinated by the China National Health Commission. This work underpins drug-safety concerns that become especially acute during public health emergencies, when new or off-label treatments enter use rapidly.

Chinese Pharmacists in Public Health Emergencies

Chinese pharmacists play a critical role in public health emergencies, providing pharmaceutical care, building drug formularies, and supporting frontline clinical teams. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, demonstrated this responsibility on a national scale, with hospital pharmacists across Hubei Province and beyond integrated into emergency response teams. Their involvement spanned medication supply, treatment protocol design, patient counselling, and public education.

Clinical Pharmacist Roles During the COVID-19 Pandemic

During the COVID-19 pandemic, clinical pharmacists joined multidisciplinary teams to manage the pharmaceutical care of patients with a novel disease and no established treatment. Pharmacists at institutions such as the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU) helped develop hospital treatment protocols, advised on the antiviral and supportive drugs in use, and provided remote and internet-based clinical pharmacy services, including consultations delivered through WeChat. They also delivered public health education on COVID-19 and managed therapy for special patient populations such as pregnant women, children, and patients with comorbidities.

COVID-19 Drug Formulary Development

COVID-19 drug formulary development required pharmacists to assemble and continually revise lists of medicines used against a disease that lacked a proven cure. Formularies during the pandemic included antivirals such as lopinavir/ritonavir, ribavirin, and interferon; immunomodulators including glucocorticoids and tocilizumab; and a range of Traditional Chinese Medicine preparations recommended in national treatment guidance. Pharmacists evaluated the evidence for each agent, flagged off-label drug use, and monitored drug-safety concerns as protocols shifted from week to week.

Barriers to Clinical Pharmacy Services in Emergencies

Several barriers limited clinical pharmacy services during the COVID-19 emergency, even as demand for them rose sharply. Reported obstacles included restricted physical access to isolation wards, limited patient record access requirements being met remotely, shortages of trained clinical pharmacists, the rapid pace of changing protocols, and the challenge of evaluating treatments before robust evidence existed. These constraints highlighted the need for better integration of pharmacists into emergency planning and for stronger remote-service infrastructure.

Pharmacist Education, Qualifications, and Credentials in China

Becoming a pharmacist in China requires formal university education followed by national licensing, with credentials that vary by practice stream and setting. Undergraduate pharmacy degrees, offered at pharmacy colleges and university schools of medicine, cover both modern pharmaceutical science and Traditional Chinese Medicine, after which graduates may pursue specialisation or graduate education in clinical pharmacy, pharmaceutical management, or pharmacology.

Key elements of pharmacist qualification and credentialing in China include:

• An accredited undergraduate degree in pharmacy or Chinese materia medica;
• National licensing examinations regulating entry to the profession;
• Departmental credentialing of hospital pharmacy staff according to role and specialty;
• Optional graduate study and clinical residencies for hospital and clinical pharmacists;
• Continuing professional development to maintain registration.

Pharmacy curricula increasingly offer specialisation options reflecting the two streams of Chinese practice — modern pharmacy and TCM pharmacy — as well as emerging fields such as pharmacogenomics and intelligent pharmacy. This dual training equips the Chinese pharmacist to operate across the full breadth of healthcare service delivery, from compounding herbal remedies to managing the medication needs of patients in advanced hospital settings such as Chongqing University Cancer Hospital, where pharmacists support cancer and malignant tumour management alongside oncology teams.