From the Xia Dynasty to the Spring and Autumn Period （21 ^st century-476 B.C.） our ancestors deepened their understanding of disease, and gradually freed themselves from the unenlightened state in which the healing arts and witchcraft were inextricably linked.

The earliest records of the knowledge of disease, healing arts and health care practices can be seen in the oracle-bone inscriptions. Researches may only offer us a glimpse of the morbid conditions in the Shang Dynasty （16 ^th century-11 ^th century B.C.）and we should bear in mind that they may not give us a complete picture of the state of medical knowledge in those times.

The oracle-bone inscriptions unearthed from the Yin-Shang Dynasty ruins provide us with valuable insight into how the causes of disease were perceived in those times. Disease was atributed to the wrath or interference of deities, haunting by dead family members, or the curses of other malevolent entities. This type of magical or religious thinking was common to all ancient civilizations.

One of the most striking examples of early Shang medical thinking is the description of “蛊, gŭ” and “龋, qŭ ”. The former means abdominal parasite and the later refers to a decayed tooth. These two concepts represent a signifcant milestone in world medical history.

In the extant literature of the Western Zhou, including the Rites of Zhou （ Zhōu Lĭ,周礼）, The Book of Songs （ Shī Jīng, 诗经）, The Classic of Mountains and Seas （ Shān Hăi Jīng,山海经）, and The Commentary of Zuo （ Zuŏ Zhuàn, 左传）, we find many references to diseases and medical treatment. In the Rites of Zhou, chapter “Physician”, in particular, we fnd disease names such as swollen sores, ulcers, bone fractures, incised wounds, malaria, scabies and carbuncles. The Book of Songs lists more than 40 diseases and symptoms, remarkably including some psychosomatic disorders like depression and exhaustion.

Parasitic and infectious diseases are also mentioned in the above two books. The Classic of Mountains and Seas lists 38 diseases and symptom terms, and out of these, 23 disease names are consistent throughout the text, indicating the development of medical knowledge. Upper arm fracture is also mentioned in The Commentary ofZuo.

But what is recorded in this period is mostly about disorders of a certain part of the body and its related symptoms, indicating that observation of the body and its environment was of great importance. This became a significant and enduring feature of Chinese medicine in later centuries.

The Rites of Zhou states that internal disorders are obviously related to seasonal changes. “Head disorders usually occur in spring, itching and scabies in summer, malaria and chills in autumn, and coughing in winter.”

“Six climatic factors causing diseases”, a chapter in The Commentary of Zuo is considered to be an important early source for development of the theory of disease causation.

It should be noted that during that era the concept of disease causation was based on notions related to climatic changes in the four seasons and the six evils or climatic factors. The belief that diseases are caused by supernatural beings had already diminished by that time. This was an important beginning for the development of etiology.

The Book of Rites （ Lĭ Jì, 礼记） states, “if, in the frst month of spring there is autumnlike weather, epidemic diseases will prevail, and if there is summer-like weather in the last month of spring, diarrhea may prevail. If there is autumn-like weather in midsummer, people may die from epidemic diseases.” ^[6] From these passages we can see that people at that time realized the fact that abnormal changes in the weather may cause diseases.

References to the relationship between the occurrence of disease and the environment can be seen in literary and historical works of the pre-Qin period.

The Commentary of Zuo records “some diseases may occur when people live in bad environments and have poor sources of water.” ^[7] In the Zhou Dynasty （11 ^th century-221 B.C.） an imperial court official was appointed to manage the imperial family’s daily life, including diet, environmental hygiene and sanitation, and especially food safety. Local officials were appointed to manage and control infectious diseases with medicinal herbs and to oversee road cleaning.

People gradually realized the importance of diet in keeping well and treating diseases. They had accumulated experience using diet to treat and prevent diseases. In the Zhou Dynasty, （11 ^th century B.C.） an official system was set up to help the imperial family to manage its diet. When someone fell ill, they used nutritional therapy first, only taking medicinal substances when absolutely necessary.

Food should be in harmony with seasonal changes. Rites of Zhou states: “it was believed that sour, bitter, pungent and salty flavors prevailed in spring, summer, autumn and winter respectively. Sweet foods may be used to harmonize the negative effects of other foods.” ^[8]

In oracle-bone inscriptions, we find references to medicinal liquors, massage, moxibustion, dietary regimens, herbal medicine and Bian stone acupuncture, being used to treat pain and other ailments.

According to The Record of the Court Historian, Bian Que, a famous physician in ancient China, was able to use many therapies in addition to herbal decoctions, including Bian stone acupuncture, tui na, “ironing” with hot medicinal compresses and surgery. From the Bian stones unearthed in many places across China, we can surmise that Bian stone acupuncture was widely used at that time.

The Yellow Emperor’s Inner Classic recounts the invention of the “nine kinds of needles”, indicating that acupuncture originally entailed using a variety of needles and selecting them according to the patient’s condition.

The following descriptions are also found in the Rites of Zhou. It says, “in the treatment of ulcers, we use mineral or herbal substances. Their sour properties effects bones, pungent properties work on vessels, sweet properties on muscles, and lubricating properties on sense organs.” Is this really a quote? In the treatment of trauma, it emphasizes external application of toxic, corrosive substances as well as oral administration of medicinal substances based on their five properties. The integration of internal and external therapies indicates the advances in the treatment of trauma.

Archeological evidence suggests that in the middle Neolitiic Age or the Yanshao Culture Period people began to make alcoholic beverages. Ceramic liquor jars were unearthed from the late Neolitic Age or the Longshan Culture Remains, as well as the Xia Dynasty Cultural Remains, Henan Province.

In the Shang Dynasty, （16 ^th century-11 ^th century B.C.） agriculture developed quickly. The oracle-bone inscriptions record a wide variety of crops, such as millet, sorghum, wheat and rice. Liquor-making developed in this period partially due to the abundance of cereals.

There are records describing rituals honoring the Yin imperial ancestors with liquor. Ruins of liquor workshops in the Shang Dynasty have been found in Henan and Hebei provinces, and even an entire workshop was unearthed in Taixicun. At the latter site, a large number of earthen wares, including earthen jars, crocks, urn-shaped containers and kettles were found.

Among the cultural relics of the Shang Dynasty （16 ^th century-11 ^th century B.C.）there were many varieties of bronze goblets, evidence that drinking liquor was common amongst the nobility of that time.

In ancient times, in the process of moving away from shamanistic healing towards systematic medical healing, liquor, as a medium to be mixed with medicinal substances in the treatment of illnesses, became an important bridge.

In the Zhou Dynasty （11 ^th century B.C.） the term “doctor for illnesses” appeared. According to the Rites of Zhou: “A doctor takes care of all the people’s health, and he has the ability to evaluate patients’ conditions by observing their body odor, speaking manner, voice, appearance, expression, and complexion. He repeatedly examines the condition of the nine orifices together with zang-fu organs.” ^[9]

The ancient Chinese had to adapt themselves to nature because they had an agrarian economy. They advocated the concept of harmony and correspondence between humans and the universe. They believed that the five phases—wood, fire, earth, metal and water were the constituents of the Heaven and Earth. The conception of the five phases permeated the process of diagnosis and treatment. The five flavors, five cereals, five kinds of medicinals, five qi, five sounds and five colors were all extrapolated from the theory of the five phases.

In this period, the traditional Chinese medicine culture had many distinguished features. First, living in harmony with nature; second, emphasis on practical value; third, attaching importance to the interrelation between external, observable phenomena and internal disorders. From those times up to the present, these features define the traditional Chinese medical system.

In The Commentary of Zuo there is an allusion to “illnesses that enter the ’ gāohuāng’ and are beyond recovery”. ^[10] It was believed that if it would not respond to moxibustion, acupuncture or herbal medicine it was therefore incurable. This passage also shows us that needles, moxa and herbs were considered the main categories of medical treatment at that time.