Before the advent of modern medicine and pharmaceuticals, how did ancient societies manage healthcare? What options were available before the development of pills, capsules, tablets, or vaccines?
Infections caused by bacteria, parasites, viruses, and other microbes were the leading cause of death in the ancient world. Other significant causes included injuries, violence, and complications from childbirth, often due to infections.1 Physicians across different periods devised various ways to combat these myriad infections. In contrast, the current leading causes of death as per the CDC include heart disease, cancer, accidents, and chronic respiratory diseases.2
Contrary to common perception, ancient humans did not necessarily lead short and disease-ridden lives compared to modern populations. A study suggests that the median age at death before 100 BCE (Before Common Era—or approximately 2100 years ago) was 72 years, almost the same as between 1850 and 1949, which was 71 years.3 The current median lifespan in the US is 78.6 years, compared to 84.2 years in Japan, 82.0 years in Canada, and 81.1 years in Germany. While ancient societies had their own means of combating disease, it's crucial to remember that these methods varied in effectiveness.
So, how did they address infections? One major strategy was the use of plant-based medicines. Herbal medicine has been practiced by ancient civilizations like the Sumerians and Egyptians, as well as in Traditional Chinese Medicine (TCM), for thousands of years. Through a process of trial and error, they likely identified which plants and herbs were beneficial for different disorders and refined combinations of these natural medicines over centuries, determining the most effective mixtures for each condition.
The Underlying Philosophy of TCM
Like modern medicine, TCM and other traditional medical systems are underpinned by philosophies. The rich and complex theories and philosophies that form the foundation of TCM have evolved over centuries, with the earliest documentation dating back to the 15th century BCE, more than 3,500 years ago.4
Central to TCM is the concept of "qi" (pronounced "chee") or life energy. Ancient practitioners proposed that qi flowed throughout the body, and any disease was perceived as a blockage, stagnation, or deficiency of qi along the meridians, the routes of circulation. TCM also conceptualized qi as the balance or harmony between two types of energy—Yin and Yang.
Yin and Yang symbolize opposing forces including life/death; male/female; dark/light; hot/cold, and wet/dry. In a state of health, Yin and Yang are balanced, and energy or qi flows freely through the meridians. Disease arises when this free flow of energy becomes obstructed or diminished. All TCM methods, including herbal medicines, aim to restore balance to qi by eliminating or reducing any blockages in its flow. In terms of TCM, herbal medicines may work to reduce stagnation, decrease dampness, increase heat, or boost strength.
The Five Elements Theory
The philosophy of TCM also incorporates an understanding of the human body, albeit one that doesn't exactly align with Western medicine's anatomical concepts. In TCM, vital human organs are characterized as the Five Elements—fire, earth, metal, water, and wood.
Each element is associated with particular organ systems (not necessarily equivalent to the anatomical organs), emotions, senses, a direction, a color, and a temperature or weather condition. For instance, water is linked to the kidney and bladder, fear, cold, and the sense of hearing and balance. Wood is connected with the liver and gallbladder, anger, wind, and the ability to see.
TCM views the body holistically, assessing which elements are balanced or imbalanced, considering all aspects of an individual. Each modality in TCM employs its specific techniques to restore balance to the whole body, mind, and spirit.
TCM utilizes several modalities, including herbal medicine, acupuncture, cupping therapy, massage, qigong exercise, and dietary therapy, along with techniques like lymphatic brushing. While these modalities have shown promising results, please consult with a licensed professional before initiating any treatments.
In the realm of herbal medicine, multiple herbs are combined to achieve the desired effect—namely, to balance or harmonize the flow of qi. While traditional formulas often incorporate seven or fourteen herbs, there is no strict number, and many may include more or fewer. These herbs are known for their specific actions, many of which have been validated through Western scientific methodologies.5, 6, 7 Plants have evolved potent biochemical defenses against microbes, many of which can also benefit human health. Some plants also contain substances that help maintain water pressure in their vascular systems, which may similarly aid in maintaining healthy pressure in human vessels.
There are many studies evaluating TCM herbal preparations, with many indicating that these herbs are safe and effective when used appropriately. However, it is crucial to purchase herbs from reputable sources or practitioners. Cases of impurities in some herbal preparations have been reported, so it is essential to ensure the practitioner or company you purchase from has a solid reputation and proper licensing or training.
Acupuncture involves the insertion of very fine needles to theoretically open the meridians and allow the free flow of qi. While the exact mechanisms of how acupuncture works remain elusive, there is ample evidence of its effectiveness in treating a range of health issues including muscle pain, nausea, migraines, anxiety, depression, and infertility, among others.8 It has also been shown to alleviate menstrual cramps, asthma, arthritis, and has been used to treat addiction.9
Cupping therapy creates suction on points of the body, often over a meridian, to relieve swelling, remove toxic wastes, and help clear meridians for the free-circulation of qi. It is used to treat various conditions including muscle pain, arthritis, skin diseases, high blood pressure, and to stimulate the immune system. While the evidence supporting the benefits of cupping is less comprehensive than that for TCM herbal medicines and acupuncture, there is some supporting its use for pain, skin infections, and when combined with other techniques.10 11
Qigong is an exercise form that promotes holistic health through "integrating posture, movement, breathing technique, self-massage, sound, and focused intent."12 While there are numerous forms and styles of Qigong, broadly, they have been shown to benefit overall health and have specific benefits for cardiovascular health, cancer treatment, arthritis, fall reduction in older adults, and mood disorders.13
Effectiveness of TCM
TCM's effectiveness is widely recognized, as it has been honed and developed over thousands of years. The longevity of TCM suggests a degree of effectiveness that has been appreciated by generations of people worldwide.
Conventional Western medicine has also provided evidence supporting the effectiveness of TCM practices, such as for pain management and various health conditions, as well as in preventive medicine and overall health maintenance.14, 15 The World Health Organization (WHO) has acknowledged TCM as a significant contributor to global health care.16
Despite its unique philosophy and methodologies, which sometimes pose challenges for translation into Western context and languages, various aspects of TCM, including herbal medicines, acupuncture, and Qigong, have been scientifically validated. Much work remains in fully understanding and integrating TCM with Western medical practices, but as the famous ancient philosopher Lao Tzu once said, "A journey of a thousand miles begins with a single step". The scientific validation of TCM continues to progress, each new piece of research contributing another step towards the journey of better understanding this ancient practice. However, it is important to remember that individual results may vary, and the best approach to health care is always one that is individualized and supervised by a health care professional.
- Montagu JD., Length of Live in the Ancient WorldL A Controlled Study, J Roayl Soc Med, 87, January 1994, 25-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294277/pdf/jrsocmed00089-0029.pdf
- Lao L, Xu L, Xu S. Traditional chinese medicine. InIntegrative pediatric oncology 2012 (pp. 125-135). Springer, Berlin, Heidelberg. https://link.springer.com/chapter/10.1007/978-3-642-04201-0_9
- Chen RQ, Wong CM, Cao KJ, Lam TH. An evidence-based validation of traditional Chinese medicine syndromes. Complementary Therapies in Medicine. 2010 Oct 1;18(5):199-205. https://www.sciencedirect.com/science/article/pii/S0965229910000737
- Liu Z, Zhao J, Li W, Shen L, Huang S, Tang J, Duan J, Fang F, Huang Y, Chang H, Chen Z. Computational screen and experimental validation of anti-influenza effects of quercetin and chlorogenic acid from traditional Chinese medicine. Scientific reports. 2016 Jan 12;6:19095. https://www.nature.com/articles/srep19095/
- Chassagne F, Huang X, Lyles JT, Quave CL. Validation of a 16th century traditional chinese medicine use of Ginkgo biloba as a topical antimicrobial. Frontiers in microbiology. 2019 Apr 16;10:775. https://www.frontiersin.org/articles/10.3389/fmicb.2019.00775/full
- Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, Xu S, Liu J. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC complementary and alternative medicine. 2010 Dec;10(1):1-0. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/1472-6882-10-70
- AlBedah A, Khalil M, Elolemy A, Elsubai I, Khalil A. Hijama (cupping): a review of the evidence. Focus on Alternative and Complementary Therapies. 2011 Mar;16(1):12-6. https://www.academia.edu/download/53950911/j.2042-7166.2010.01060.x20170723-2777-1j85stx.pdf
- Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. American Journal of Health Promotion. 2010 Jul;24(6):e1-25. https://journals.sagepub.com/doi/pdf/10.4278/ajhp.081013-LIT-248
- Eng YS, Lee CH, Lee WC, Huang CC, Chang JS. Unraveling the molecular mechanism of traditional chinese medicine: formulas against acute airway viral infections as examples. Molecules. 2019 Jan;24(19):3505. https://www.mdpi.com/1420-3049/24/19/3505/pdf
- Chao J, Dai Y, Verpoorte R, Lam W, Cheng YC, Pao LH, Zhang W, Chen S. Major achievements of evidence-based traditional Chinese medicine in treating major diseases. Biochemical pharmacology. 2017 Sep 1;139:94-104. https://www.sciencedirect.com/science/article/pii/S0006295217304471