Traditional Chinese Medicine spans thousands of years and, distinctly, a parallel tradition in Japan known as Kampo. What follows is the history behind both.
The origin of Chinese acupuncture appears in the New Stone Age, approximately 8000 to 3000 BC, and it is considered older in its origins than herbal therapies. Initially, in those times, stone needles were used and specimens have been discovered in caves in Mongolia and Hunan provenance in China. The degree of sharpness was the determining factor for treatment: sharp for situations like skin infections, dull for scraping the skin. Later in the era, needles changed from stone to bone and bamboo.
The Bronze Age (2205-1122 BC) ended with the fall of the Shang dynasty. There was fragmentation of society, encouraging the development of feudal estates until the beginning of the Eastern Zhou dynasty. Bronze needles were produced that allowed for more precision and durability.
The Eastern Zhou Dynasty (770-256 BC) was a time of advancing intellectual concepts and philosophy which established the early foundations of Chinese medicine. Needles started being made from metal, steel, around 500 BC, an impressive feat at that time.
The Warring States period (475-206 BC) into the early Han Dynasty (206-220) was a time in Chinese history characterized by warfare and military campaigns due to political struggles between different state factions. It was also a time of great economic and cultural advancement, and of the growth of acupuncture theories and their philosophies of treatment. Several philosophical schools developed during this time, all devoted to understanding how people could remain in balance with their environment. The major philosophies included Daoism, Confucianism (a way of life focused on virtue, ethics, and social harmony), and Mohism (ethics, logic, and concern for others). The medicine of the time drew on all of these to form its principles of care.
The Prominent Schools of Chinese Medicine
The Naturalist School, founded by Zou Yan, was a prominent influence in medical theory, showing the interconnection of Yin and Yang, opposite but complementary forces in nature, interconnected with the Five Elements: water, earth, wood, fire, and metal. Nature and people were believed to follow similar processes, so rather than asking what disease was present, the question became what pattern of imbalance was occurring in a person’s relationship to nature. Yang represented action, warmth, day, and outward transformation; Yin represented inward nourishment, coolness, and night. This period refined diagnostic skills such as the pulse and Zang/Fu organ pathology, supported by increasingly codified herbal therapies with consistent formulas, indications, and dosages.
The Five Phases School embraced wood, fire, earth, metal, and water to explain the natural phenomena related to seasons, climate, emotions, organs, tastes, and development, and their relationship to health. Earth, for instance, corresponds to the digestive system, the Spleen and Stomach, characterized by transforming, distributing, nourishing, and centeredness; its season is late summer, its flavor sweet, its emotion worry. Imbalance reflected disturbances in these characteristics and allowed a holistic approach to restoring patient balance.
Daoism, represented by the spiritual master Laozi, holds that the Dao is the Way in which nature operates, and in medicine this operates via the Qi, or vital energy, flowing through the body and sustaining health. This philosophy asked what was blocking that natural process and how to remove it and return to balance, a framing still central to Traditional Chinese Medicine today. It influenced TCM through acupuncture points that regulate Qi, herbs that restore balance, dietary guidelines, and Qigong for movement and meditation.
The founding texts
As these philosophies took hold, they were recorded in the Huangdi Neijing, the Yellow Emperor’s Inner Canon, which described the body’s systems as a collaborative interaction of yin (structure) and yang (function), manifesting in the vital substances Qi, Blood, Essence, Fluids, and the Shen (mind and spirit). Conversations in the text between the Yellow Emperor and his physicians defined yin and yang, excess and deficient dispositions, organ functions, and treatments; its Ling Shu section explained the use of the acupuncture meridian system for therapy.
The Neijing also treated infection as an attack by an external evil posing a significant threat, and listed recommendations for prevention alongside the fundamentals of maintaining health: a harmonious relationship between one’s outer and inner environment, physical, emotional, and spiritual. This was to be achieved through a moderate lifestyle, a diet balanced to the seasons, regular activity and sleep, and avoiding stressors that negatively affected organ health.
Around the same time, the Shang Han Lun (the Treatise on Cold Damage Disorders) and the Jin Gui Yao Lue were written by the medical sage Zhang Zhong-jing. Dated to 220 AD, this foundational herbal text was a manual on diagnosing and treating externally contracted, infectious disease, characterizing how pathogens invade the body through phases from superficial to very deep. The model held that these patterns did not travel in a strictly linear fashion; a healthy person with a strong constitution could mount a robust response from their superficial protective Wei Qi to drive an evil out before it lodged deeper, while someone already depleted, or wrongly diagnosed or treated, might see the illness settle in at a deeper level from the start. The Shennong Bencao Jing, also published during the Han dynasty, organized medicinal substances according to their therapeutic properties.
The Golden Age through the Qing Dynasty
The Song and Tang Dynasties are considered a Golden Age of Chinese Medicine, marked by state-sponsored medical education and the organization of the field’s accumulated knowledge. During the Tang Dynasty (618-906 CE), the first recorded pharmacopeia was published, Chinese medical knowledge extended to Korea and from there to Japan, and illustrated acupuncture manuals were printed. The physician Sun Simiao wrote The Thousand Golden Prescriptions and also brought early attention to physician ethics and medical mortality. The Song Dynasty (960-1279) advanced ideas about normal physiology and disease pathology, and saw the first forensic medicine practice, developed by Song Ci.
The Jin-Yuan period saw individual schools form around specific theoretical approaches to disease: Heat and Fire (Liu Wansu), pathogenic factors damaging the body (Zhang Congzhong), and Spleen-Stomach Deficiency (Li Dongyuan). The Ming Dynasty (1368-1644) expanded treatments for gynecology and pediatric disease, herbal texts, and acupuncture theory. The Qing Dynasty (1644-1912) saw significant growth, with medical colleges founded under strong Imperial backing and state examinations established to regulate practice. Texts on Wenbing, warm and febrile disease theory, incorporated updated concepts of infectious disease, tracking its progression from the outer Wei level through the Qi and Ying levels to the deepest Blood level, along with the herbal formulas suited to each. Around the same time, Western medical influence began to surface as missionaries entered the country in the early nineteenth century.
Modern China
During the Republic of China (1912-1949), tension grew between Western and Chinese medicine, as physicians trained in the Western model wanted proof of meridian channels, the pharmacology behind herbs, and explanations for why a single Western diagnosis might correspond to several distinct Chinese ones. Western medicine became the preferred approach, and Chinese medicine began to be marginalized by leaders.
Mao personally experienced acupuncture and believed in its value for the Chinese people, even as many experienced practitioners of the old schools had been purged or left the country. Since knowledge had traditionally passed down within families, it was decided that education needed standardizing, and the clinical system now called Traditional Chinese Medicine, distinct from earlier dynastic practice, was developed. In 1968, TCM was officially integrated into China’s healthcare system on Mao’s decision, giving rise to the barefoot doctors who brought care to rural areas where Western physicians were unavailable.
Beginning in the 1970s, researchers sought scientific evaluation of Chinese medicine against Western frameworks, documenting acupuncture’s physiological effects on pain control via the endogenous opioid system, the autonomic nervous system, neuroendocrine regulation, and immune modulation. Today, Chinese medicine continues to emphasize its traditional concepts, Yin/Yang, Qi/Blood, Zang/Fu organs, the channels, while deeper investigation continues into their effects on immune signaling, the microbiome, the HPA axis, metabolism, cytokines, and neural regulation. Pharmaceutical companies are also isolating specific molecules from individual herbal plants for new drug development.
Japan: acupuncture and Kampo
Japan’s acupuncture and herbal medicine practice, called Kampo, arrived through Korea in the 5th to 8th centuries but was reinterpreted in a distinctly Japanese way. During the Asuka and Nara periods, Japan integrated features of the Chinese model, including Yin/Yang, pulse diagnosis, herbal medicine, Zang/Fu organ functions, moxibustion, and Five Phase Theory. The Ishimpo, compiled by Tamba no Yasuyori, translated and interpreted Chinese medical concepts, and, since it was customary for a new dynasty to destroy the artifacts of the one before it, this text ended up preserving Chinese medical materials that survive today only in Japan.
During the Heian period (794-1185), Chinese medicine remained deeply influential, but physicians began adapting their approaches, particularly herbal treatment, to Japan’s own geography, climate, and disease patterns. In the Muromachi period (1336-1573), momentum shifted from copying existing Chinese practice toward studying the classical texts directly, producing the Koho-ha, or ancient formula schools, which revived the Shang Han Lun and Jin Gui Yao Lue.
It was during the Edo period (1603-1868), a time of national isolation under the Tokugawa shogunate, that Japan’s distinctive Kampo approach fully took form. Practitioners had studied the Shang Han Lun and Jin Gui Yao Lue, and Japanese cultural belief held a strong association between the vitality of a person’s Hara, or abdomen, and the strength of their physical and spiritual energy. On this basis, Dr. Toto Yoshimatsu developed the abdominal exam known as Fukushin, mapping areas of muscle tension to individual organ systems, since he believed indirect information like the pulse required too much speculation. Combined with a patient’s symptoms, this exam identified a pattern called the Shoh, which then directed the precise herbal formula for treatment, on the principle that diagnosis determines treatment and treatment confirms diagnosis. In contemporary Kampo practice, this approach avoids labeling a patient with a fixed disease entity that can flatten the severity and individuality of what they’re actually experiencing. The Fukushin and the Shoh are designed to address the primary imbalance in the moment, with the expectation that the pattern will shift over time as rebalancing the Hara leads toward recovery. The abdominal exam is not part of practice in China, and Japan has since successfully integrated Kampo into its Western-style medical care. Also during the Edo period, Dutch physicians introduced Japan to Western anatomy, physiology, surgery, and pharmacology, creating three distinct, sometimes competing currents: classical Chinese medicine, Japanese empirical practice, and Western medicine.
The Meiji Restoration (1868-1912) shifted national policy firmly toward Western medicine: an 1874 law adopted Western medical care as the basis of the national health system and a requirement for physician training, and acupuncture and moxibustion, while not forbidden, declined substantially. Kampo education was discontinued and survived mainly through individual practitioners and family tradition. Through the twentieth century, Japanese acupuncture continued to diverge from Chinese practice, developing a style built on thorough palpation of the body and meridians, closer attention to the Hara alongside the pulse, and a focus on re-establishing overall equilibrium rather than treating symptoms alone. Japanese practitioners also came to favor very thin needles inserted shallowly with gentle stimulation, in contrast to the deeper needling and stronger stimulation typical in China.
After the Second World War, figures such as Dr. Yasuo Manaka, through his Topological Society, pursued original research to expand diagnostic and therapeutic methods, refining abdominal diagnosis, exploring electrical stimulation in acupuncture, and developing clinical applications for the Eight Extraordinary Vessels and Channel Divergents described in ancient texts but not used clinically in China. Around the same time, as Japan’s aging population began experiencing the complex chronic diseases of an industrial society, and Western medicine recognized its own limits in treating them, Kampo saw a revival. With the help of physicians such as Otsuka, Yumoto, and Yakuza, Kampo modernized into a therapeutic approach physicians could use empirically, matching a symptom or abdominal pattern to the correct formula. It became successful enough to be reintegrated into the modern medical model, with Kampo training incorporated into Western medical school curriculums. In 1967, the Japanese government expanded national insurance coverage to include Kampo herbal formulas. Today, roughly 170 Kampo herbal formulations are available, a significant share of Japanese physicians use Kampo in daily and hospital practice, and over two-thirds of gynecologists use it as a regular therapeutic approach.
