Birth, old age, illness and death are a description of the human life process. Naturally, there is a long history of using drugs to improve human health. Since the history of medicine and healthcare is vast and complex, it is not the purpose of this chapter to provide a comprehensive review, rather a very brief introduction. The main points here are: 1) In a certain historical period, drug research (and use) was based on (and limited by) the socioeconomic level and scientific & technological development at that time; 2) Innovative drug discovery and development (at scale) has a very short history.
The history of medicine and healthcare evolved through several distinct periods. Each era brought forward innovations and practices that significantly influenced the approach to health and medicine. Here's a brief overview, segmented into major historical periods of Europe (with a brief description of the healthcare practice in China around the same time):
Ancient Greek Medicine (c. 800 BC - 146 BC)
Foundations: Ancient Greek medicine is often considered the foundation of Western medical practice. It introduced the concepts of diagnosis, prognosis, and advanced ethical standards.
Hippocrates (c. 460 BC - c. 370 BC): Known as the "Father of Medicine," emphasized the importance of observing patients and proposed that diseases had natural, not supernatural, causes.
Humoral Theory: Health was believed to be a balance of four bodily fluids or "humors": blood, phlegm, black bile, and yellow bile. Treatment aimed to restore this balance.
In China, before Qin Dynasty (before 221 BC)
Shamanistic Origins: Early Chinese medicine had shamanistic roots, with disease believed to be caused by external supernatural forces. Healing practices included rituals, herbal medicine, and acupuncture.
Huangdi Neijing (The Yellow Emperor's Classic of Internal Medicine): This ancient text, written around the 1st century BC or earlier, is considered the fundamental doctrinal source for Traditional Chinese Medicine (TCM), introducing concepts like Qi (vital energy), Yin and Yang, and the Five Elements.
Roman Medicine (146 BC - 476 AD)
Expansion and Public Health: Romans adopted Greek medical practices and expanded them. They excelled in public health, building aqueducts and sewer systems to prevent disease.
Galen (AD 129 - c. 200/c. 216) further developed the humoral theory and performed extensive anatomical studies, which dominated medical understanding for centuries.
In China, Han, Wei, Jin, and Southern & Northern Dynasties (206 BC - 589 AD)
Systematization of TCM: The Han period saw the systematization of Chinese medicine. Theories of Yin-Yang and the Five Elements were applied to understand human anatomy and physiology.
Development of Acupuncture and Moxibustion: These practices were refined and became more widespread, with the compilation of texts detailing meridians and acupuncture points.
Medieval Medicine (476 AD - 1400 AD)
Monastic Medicine: With the fall of the Roman Empire, monasteries became the centers of medical knowledge, preserving Greek and Roman texts.
Arab Influence: The Islamic Golden Age (8th to 14th century) saw significant medical advancements in the Middle East. Scholars like Avicenna synthesized and expanded on Greek and Roman medical knowledge, which later influenced Europe through translations.
Universities and Hospitals: The establishment of universities in the 12th century revitalized medical study, and hospitals began to emerge as institutions for care.
In China, Tang Dynasty (618 - 907 AD) and Song Dynasty (960 - 1279 AD)
Imperial Medical Bureau: Established to organize medical practice and education, the bureau was a significant step in professionalizing healthcare.
Influence of Buddhism: The introduction of Buddhism influenced Chinese medicine, incorporating Indian herbal remedies and enhancing the humanitarian aspects of healthcare.
Public Healthcare: The government initiated public healthcare measures, establishing hospitals and providing medical services to the poor.
Renaissance Medicine (1400 AD - 1700 AD)
Human Anatomy: Advances in human anatomy, led by figures like Andreas Vesalius, challenged Galen’s anatomical theories.
Herbal Pharmacopeia: The use of herbs in medicine became more systematized, with extensive texts detailing their use for various ailments.
Ming Dynasty (1368 - 1644)
Pharmacology: The Ming dynasty is notable for significant advancements in pharmacology, including the publication of the Bencao Gangmu (Compendium of Materia Medica) by Li Shizhen in the 16th century, which remains a crucial reference for TCM herbal medicine.
Expansion of Medical Knowledge: These periods saw the expansion of medical texts and knowledge, with a focus on case studies and practical experience.
Modern Medicine I (1700 - 1900 AD)
18th and 19th Centuries: The Enlightenment and Industrial Revolution brought scientific approaches to medicine, with innovations like vaccination by Edward Jenner.
Germ Theory: In the late 19th century, Louis Pasteur and Robert Koch established that microorganisms cause diseases, revolutionizing healthcare practices.
In China, Qing Dynasties (1636 - 1912)
Continued Expansion of Medical Knowledge: These periods saw the expansion of medical texts and knowledge, with a focus on case studies and practical experience.
Missionary Medicine and Early Institutions (Late 19th Century): Western missionaries established the first modern hospitals and medical schools in China, introducing modern medical practices and education. Notable examples include the Boji Hospital in Guangzhou and the Peking Union Medical College in Beijing.
Modern Medicine II (1900 AD - Present)
20th Century: Rapid advancements included antibiotics, medical imaging, and vaccines, significantly increasing life expectancy.
In China, Republic of China and People Republic of China (1912 - Present)
TCM continued to develop, there was also resistance and challenge from within China, with debates on the efficacy and scientific basis of some practices.
Expansion of modern medicine supported by government and medical institutions: The establishment of the Republic of China marked a period of openness to Western ideas, including medicine. The Rockefeller Foundation established the China Medical Board, significantly investing in medical education and public health initiatives in China, including the expansion of Peking Union Medical College as a leading institution for modern medicine.
After the establishment of the People's Republic of China (1949), the new government embarked on a project to integrate Modern (Western) and Traditional Chinese Medicine (TCM) practices, promoting a unified healthcare system. Hospitals and clinics that practiced Western medicine were established across China. The government also initiated campaigns to eradicate infectious diseases, relying on both Western and Chinese medical practices.
Contemporary Medicine (Late 20th century - Present):
Today, medicine is characterized by cutting-edge technology, personalized medicine, and a focus on preventive care. The integration of digital technology into healthcare, known as digital health, is shaping the future of medicine with innovations like telemedicine, wearable devices, and AI-driven diagnostic tools.
Although the use of herbal medicines has a long history, it took thousands of years to systematize. In Europe, Herbal Pharmacopoeia emerged during the Renaissance. While in China, Bencao Gangmu was completed in 1578 and printed in 1596, which became a crucial reference for TCM herbal medicine since then. Before the industrial revolution, the development and use of drugs have relied on empirical knowledge in a very slow pace without institutional support.
In the 18th and 19th centuries, the Enlightenment and Industrial Revolution propelled the emergence of modern medicine. Rapid advancements included antibiotics, medical imaging, and vaccines, significantly increasing life expectancy in the 20th century globally (first in western countries followed by in developing countries in the second half of the century). Accumulation of wealth in industrialized societies and the parallel scientific & technology advancement made it possible for the medical institutions and scientific communities to play an active role in the development and use of drugs. In recent years, major investments in biomedical research and pharmaceutical industry further propelled drug discovery & development to an unprecedented pace.
