The 4 Main Schools of Traditional Chinese Medicine and Their 12th Century Origins
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The four main schools of Chinese medicine — the Cooling School, the School of Excretion of Excesses, the School of Strengthening the Digestive Organs, and the Ying Support School — emerged during and after the Song Dynasty as physicians split over how diseases arise and how they should be treated. Each school was built around a leading scholar-physician and a distinct theory of the body, and together they marked a turn from passive inheritance of ancient texts toward critical, systematic medical reasoning.
By the Song Dynasty (960-1279), (read more: China in the 12th century), a vast body of medical knowledge had already accumulated in China. Physicians divided into competing schools according to their views on the origin, prevention, and treatment of disease.
What are the four main schools of Chinese medicine?
The four main schools of Chinese medicine were distinguished by their preferred methods of treating disease. Chinese physicians of the Song and post-Song period organised their practice and theory around these four traditions:
- Cooling School — led by Liu Wan-su, focused on lowering fever and dehydration.
- School of Excretion of Excesses — led by Zhang Tzu-he, focused on expelling harmful agents through purging.
- School of Strengthening the Digestive Organs — led by Li Dong-yuan, focused on the stomach and rational nutrition.
- Ying Support School — led by Zhu Dan-si, focused on the blood and moderation in living.
What did the Cooling School teach?
The Cooling School taught that high fever and dehydration determine how acutely a disease progresses, so treatment must focus on lowering the body's heat. It was headed by Liu Wan-su, a major scientist, physician, and philosopher born in Heichang County, Hebei Province, in 1120, who died in 1200. Liu is best known as the creator of a number of theories about diseases of the human body.
Central to Liu Wan-su's work was his theory of "fire and water," in which these two opposing causes govern the severity of a pathological process — fire standing for high temperature and the loss of water standing for dehydration of the organism.
To treat a disease marked by high fever, Liu Wan-su held that the physician must bring the temperature down, which he defined as the need to —
reduce the fire of the heart and increase the water of the kidneys,
— and to achieve this the patient should drink as much as possible. For this purpose Liu Wan-su created a whole series of antipyretics and diuretics. Throughout his works, preserved in ancient medical libraries to the present day, Liu repeatedly stressed the harmful influence of adverse natural factors on the body.
Liu Wan-su treated these external natural factors as the principal cause of disease, and this is the rational element of his teaching. In practice he applied his own theory consistently and with great success, and he was especially willing to treat the poorest of the population.
Liu Wan-su's popularity drew the attention of the imperial family. The emperor repeatedly summoned him and offered him the post of court physician, but Liu refused the honour each time, explaining that he wished to devote himself entirely to developing his theories while remaining "the doctor of the poor." His name is still sung in songs among the people, and monuments were raised to him.
What did the School of Excretion of Excesses believe?
The School of Excretion of Excesses believed that harmful agents collect in the body — chiefly the intestines — and must be driven out to preserve the body's own strength. Its members followed the famous 11th-century pharmacologist Zhai Zhong-zhen, who placed great importance on laxative and emetic remedies, which made up most of the school's drug arsenal. The school was headed by Zhang Tzu-he, born in 1156 and died in 1228.
Zhang Tzu-he developed the doctrine of "the expulsion of evil," also rendered as "removal of excesses," meaning that clearing the body of harmful agents itself sustains the body's strength. On this basis Zhang made wide use of laxatives, reasoning that the pathogens causing disease concentrate in the intestines and that systematically cleaning them — so that food never lingers long in the digestive tract — creates favourable conditions for health.
As one of Liu Wan-su's students, Zhang Tzu-he accepted his teacher's classification of diseases but rejected the "fire and water" theory. In treating any disease he considered three measures necessary — sweating, cleansing the intestinal tract, and vomiting — and he often applied all three at once, resorting most frequently to purification of the intestines.
Zhang Tzu-he gave close attention to rational nutrition in both his practice and his scholarship, and he opposed the rival school whose core principle was to strengthen the patient through intensified feeding. Among his writings are dedicated works on the dangers of irrational nutrition, and he attacked physicians who indiscriminately prescribed richer food as a cure-all.
Zhang Tzu-he recorded 200 case histories, each with a detailed analysis of the disease, identification of its causes, a description of its course, and the treatment given. These case histories were reprinted many times and long served as a training manual for physicians, their recurring theme being the harm of irrational nutrition. His successes and wide practice brought him great fame, and his memory survives to the present day.
How did the School of Strengthening the Digestive Organs treat illness?
The School of Strengthening the Digestive Organs treated illness by reinforcing the stomach and the digestive system, which it regarded as the foundation of health. Its representative, the physician Li Dong-yuan (1180-1251), was a longtime student of the then-famous physician Zhang Yuan-su, a proponent of small drug doses.
Coming from a wealthy feudal family, Li Dong-yuan did not need to earn a living through practice and so devoted himself heavily to theory. He refused outright to use the older recipes created before him, judging them too complicated and therefore irrational, and instead composed a number of his own medicinal combinations.
Li Dong-yuan objected to the overuse of antipyretics and laxatives recommended first by Liu Wan-su and later by Zhang Tzu-he. He held that, beyond the climatic factor, fatigue was among the most important causes of disease.
As a follower of the doctrine of "chi" — the external and internal agents acting on the body — Li Dong-yuan treated it as a broad philosophical category, the whole sum of factors affecting the body. He argued that different organs are affected by different agents even when these produce the same diseases. In 1249 Li wrote a book on the gastrointestinal tract, which he divided into five departments.
For his time, Li Dong-yuan gave a remarkably accurate description of the stomach and its functions, as well as of the large and small intestines.
The book on the gastrointestinal tract, written by Li Dong-yuan in 1249.
Li Dong-yuan believed the stomach played the leading role in digestion, writing:
On the basis of weak stomach function, all diseases arise. When the stomach is weak, then the viscera, vessels and various other organs cannot receive the corresponding healthy "chi" of the stomach, as a result of which diseases arise.
Li Dong-yuan did not reject laxatives and emetics outright, but he held that none of them should be used once the stomach itself was sick. On this point he stood directly opposed to the teaching of the Zhang Tzu-he school. Li attached the greatest importance to an intensified and rational diet, calling it the most powerful weapon against disease.
For Li Dong-yuan, rational nutrition supported the normal function of the stomach and the production of healthy gastric "chi," which in turn conditioned the other four parts of the gastrointestinal tract. In proper nutrition, he held that taste sensations and the temperature of food were extremely important.
In many diseases, Li Dong-yuan wrote, sweet dishes were the only curative means of increasing the production of gastric "chi." The tradition he led became known as the school of "strengthening the functions of digestion and combating its disorders," and folk physicians widely adopted his methods for many generations. Li's theory and philosophical teaching were a great contribution to Chinese medicine.
What was the Ying Support School?
The Ying Support School held that the blood is central to health and that most disease arises from disturbances in it, so the patient needs maximum rest to keep the blood in a normal state. Its proponents — the name "yin support" referring chiefly to the blood — taught that tranquillity preserves the blood's proper condition.
The ideologist of the Ying Support School was Zhu Dan-si (1281-1358), better known as a practising physician under the name Zhen Heng. According to his biographers, Zhu Dan-si studied under the leading philosophers of his time until the age of thirty; only his mother's illness drew his attention to medicine, to which he then, as a mature and educated man, devoted himself entirely.
Zhu Dan-si held that the main causes of disease were excesses — not only in food but in virtually everything else. This view reflected his early grounding, before he turned to medicine, in the philosophical system of the Chinese scholar-philosopher Zhu Xi, who preached temperance and a sense of proportion in all things.
Zhu Xi's teaching shaped Zhu Dan-si's medical theory, whose motto was
to live without excess.
In building his theories of disease, Zhu Dan-si gave great weight to the role of the blood and to its quantitative and qualitative composition.
If a person satisfies all his desires - he allows excesses, and these excesses spoil the blood ...
— wrote Zhu Dan-si. The second principle of his teaching was:
If a person does not allow excesses, the blood in the body acquires better qualities and is in the right quantity.
Unlike most physicians of his time, Zhu Dan-si tried to use as few drugs as possible, especially complex prescriptions, and he opposed the heavy use of the then-popular preparations of silver, mercury, sulphur, and gold. In treating nervous and mental diseases he turned to irritant remedies, though even within his own school he found no supporters for this practice.
The doctrine Zhu Dan-si created and his principal works had a great influence on the development of Chinese medicine:
- "Bian que yan and bui" ("Addition to the most necessary in 'Bian Que'"),
- "Ge zhi yu lun" ("Discourse on Difficult Medical Subjects"),
- "Fing Mu Wen Da" ("Questions and Answers on Liver Diseases").
Taken together, the schools of Chinese medicine represent more than a quantitative accumulation of knowledge — they show a clearly expressed critical attitude toward the heritage of the past and toward many traditional ideas, methods, and remedies, which is what makes the Song-era schools a turning point in the history of Chinese medical thought.
