Chinese Medicine and Culture

: 2019  |  Volume : 2  |  Issue : 4  |  Page : 166--173

A historical overview on medical exchanges between China and Vietnam

Chenxue Jiang1, Boying Ma2,  
1 Chinese Medical Culture Research Center, Nanjing University of Chinese Medicine, Nanjing, China
2 Federation of Traditional Chinese Medicine Practitioners, London, England, UK

Correspondence Address:
Dr. Boying Ma
Federation of Traditional Chinese Medicine Practitioners, London, England


This article reviews the history of transmission and exchange of medicine between China and Vietnam. Systematic textual research found medical activities such as doctor visits, epidemics transmission, exchanges of therapies, import of local herbal, and drug specialties occurred in both countries. Vietnamese traditional medicine was once a truly large-scale system and one of the biggest branches of Chinese medicine abroad in history.

How to cite this article:
Jiang C, Ma B. A historical overview on medical exchanges between China and Vietnam.Chin Med Cult 2019;2:166-173

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Jiang C, Ma B. A historical overview on medical exchanges between China and Vietnam. Chin Med Cult [serial online] 2019 [cited 2020 May 30 ];2:166-173
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Medical exchange between China and Vietnam started early in ancient times. Doctors' visits, medical books spread and mutual supplement of herbs and drugs between the two countries developed during a long-drawn history. Although scattered literature could be collected, the present study is still going to examine the connections, exchanges, and linkages that occurred between the Vietnamese and Chinese medicines from the very early beginning to the present and to review what unifies or separates Chinese medicine from its overseas extensions.

 The Earliest Transmission of Chinese Medicine to Vietnam

The first medical messenger

The earliest mention of Chinese medicine brought to Vietnam can be found in Chen Cunren's[1] quotation that a doctor named Cui Wei (崔伟) recorded in Vietnamese historical text had written Gong Yu Ji Ji (《公余集记》 Collected Records of Gong Yu) and cured Yong Xuan (雍玄) and Ren Xiu (任休) of unspecific fatigue who both were high-level officials in Vietnam. That was in the year of 257 BC. Chen Cunren also noted that Chinese culture disseminated to Vietnam during the time of Emperor Wu of the Han Dynasty (汉武帝) of which medical technique was the best part. Medicine in Vietnam then developed into two divisions, namely “Vietnamese medicine” and “Chinese medicine,” which were also labeled “southern school” and “northern school,” respectively, by Fan Xingzhun.[2] However, the school divisions might be an inference from hearsay or rumors, because the medical situation in Vietnam in the Qin and Han dynasties (秦汉) barely supported such a development.

The Eastern Han saw Chinese doctors practicing medicine in Vietnam. Fan Xingzhun[3] once stated that “renowned Chinese doctor Dong Feng (董奉) cured the prefect of Rinan, Du Xie (杜燮), who was an overseas Chinese.” Although Fan Xingzhun did not mention his reference, probably, it was quoted from the chapter of Dong Feng in Shen Xian Zhuan (《神仙传》 The Immortals) by Ge Hong (葛洪): Du Xie, the feudal prefectural governor of Jiaozhou (交州) [Note 1], died of incurable disease 3 days before. Dong Feng was in the South at that time, and he then left for Jiaozhou. Dong Feng put three pills into the dead person's mouth, letting people around shake the head to assist the pills to go down. After a while, Du Xie opened his eyes and moved his hands and feet; his complexion returned to normal and he even sat up half a day later. He was brought back to life! After 4 days when he was able to speak, he recalled: “it was like a dream when I was dead. I dreamed dozens of people in black coming to catch me, taking me away in a cart without a curtain cover. We arrived at a red gate and walked straight to the prison where each person was kept in one cell. I was put into a cell which was then covered in earth. I could not see out. I was in a trance. Suddenly I heard that someone said: Taiyi (太乙 deity for saving the suffering) dispatched his envoy to call Du Xie, so I was soon dug out of the cell. It took a long time for me to walk out. The cart with red curtain cover was already waiting outside, in which three people were seated. I was asked to get on the cart, so I quickly trotted there. The minute I reached the gate, I felt the revival of myself.” Du Xie, therefore, held great banquets three times a day in appreciation of Dong Feng. However, Dong Feng only took the candied dried jujube sometimes with wine instead of the meal. Every time Dong Feng attended the banquet, he would fly from upstairs like a wild bird to fall on the seat. Nobody could perceive his arrival, and he went back upstairs in the same way. After a year, Dong Feng pleaded to leave, which upset Du Xie very much. He begged Dong Feng to stay in vain. He thus asked Dong Feng about the destination in order to prepare a big ship for him, while Dong Feng requested a coffin instead. Du Xie followed it. It was at high noon in the next day that Dong Feng died and was elaborately buried by Xie and his fellows afterward. Seven days later, someone from Rongchang (容昌) came to meet Dong Feng. He was grateful to Du Xie and asked him to look after himself. When Du Xie opened the coffin, he found merely a piece of silk drawn by a human body on one side and the emperor's letter on the other side. Dong Feng was said to have returned to Lu Mountain (庐山) where he settled. Accordingly, he must have been a citizen of Wu State of the Three Kingdoms Period (三国) around 2nd to 3rd centuries. There is another story about him, which is the original source of the allusion “Xinglin Chunnuan” (杏林春暖 spring in apricot forest) appreciating noble medical ethics. It is said that Dong Feng treated patients in Lu Mountain area without charge and suggested that each patient plant ten apricot trees. After several years, there was a forest of trees and the apricots were collected to exchange for cereal crop, which was then offered to the poor. Although the above are fairy tales, there must be fact-based evidence. As to commuting to Jiaozhou needs a big ship, there is no doubt that it is within the border of Vietnam. Dong Feng is regarded as one of the first medical messengers between China and Vietnam.

Jiaozhi(交趾) (Note 2)spread smallpox into China

Vietnam to the south border of China suffered many prevalent epidemics, of which smallpox was said to spread into China for the first time. Although medical history scholars like Fan Xingzhun disagreed with this argument, it deserves a discussion.

Zhou Hou Bei Ji Fang (《肘后备急方》 Handbook of Prescriptions for Emergencies) is the first book in China that records smallpox. Chapter Two of its current edition says the epidemics of last year caused sores on the face and overall on the body. The appearance was like heat sores with thick white liquid. The sores ulcerated and developed very fast. Once a sore stopped, another appeared. If not treated in time, the severely afflicted patients may all die. The scars left after recovery turned purplish-black, hardly disappeared even after several years. It was pestilent qi. This disease was said to be widespread from west to east in the 4th year of Yonghui reign, and almost destroyed the whole country. Kui Cai (葵菜 Malva verticillata) along with Suan Xie (蒜薤 Allium chinense G. Don) were said to treat it. It is better to eat them as soon as being infected. This disease was named Lu Chuang (sore from minority nationality), since it was brought from the area where minority nationalities lived after the war in Nanyang in the Jianwu reign. The following are effective formulas proven by doctors after careful treatment:

Apply honey of premium quality to the patient's body or decoct it with Sheng Ma (升麻 Rhizoma Cimicifugae) to take several times.

Another formula is described as follows: to decoct Sheng Ma with water into thick fluid, apply it with silk floss to wash the patient's body. Vinegar stain is quite effective except for bringing intense unbearable pain.

The present edition of Zhou Hou Bei Ji Fang also titled Zhou Hou Bai Yi Fang (《肘后百一方》 One in a Thousand Formulas for Emergencies) is revised and supplemented by Tao Hongjing (陶弘景). Therefore, it is impossible to distinguish the original text by Ge Hong (葛洪) from those supplemented by Tao Hongjing. However, textual research of Chapter Two of Wai Tai Mi Yao (《外台秘要》 Medical Secrets from the Royal Library) finds out different origins of the quotations.

Apparently, the paragraph above is the original text by Ge Hong, while the other is quoted from Tao Hongjing by Zhang Wenzhong: Doctor Tao Hongjing said malignant sore was widespread; the patient once infected found sores with white thick fluid all over the body within several days. It was pestilent qi. It was in the 4th year of the Yonghui reign that the epidemic sore was widespread from West to East. Decocted Kui Cai and Suan Xie cured it and so did fresh sheep blood. Immediate intake worked in the initial stage and they were still effective together with diet.

As these sentences were quoted separately from Tao Hongjing by Zhang Wenzhong, probably they were alternated in red or black, respectively, when Tao Hongjing was compiling Ge's Zhou Hou Bei Ji Fang as he did in his book Ben Cao Jing Ji Zhu (《本草经集注》 Collective Notes to Canon of Materia Medica). As a result, it is reasonable to sort out the text by Ge Hong and the text supplemented by Tao Hongjing later in the present edition of Zhou Hou Bei Ji Fang.

Fan Xingzhun made a mistake in his inference that the reign title “Yonghui” should be Yuanhui, and it was the 4th year of Yuanhui (476) when smallpox was spread to China from the West, because he omitted the notes “quoted from Tao Hongjing by Zhang Zhongwen” when he made reference to Wai Tai Mi Yao. The Nanyang battle against the minority group was of little account to any other military action except the Xiangyang battle. Fan Xingzhun mixed two issues that smallpox spread by those captured in the Nanyang battle and that smallpox spread from the West in the same breath, thus committing an error.

As he was not explicit, Ge Hong was thus excluded from the list of the first recorders of smallpox, which delayed the Chinese recording of smallpox for 200 years when Tao Hongjing recorded smallpox in the book.

This conclusion evidently runs contrary to the historical recordings. As for the reign title “Yonghui,” it is indeed an error. Some historians suggest it should be “Yongjia” rather than “Yuanhui”.[4] Actually, there are obvious language mistakes in spite of the recordings of the same origins. For example, “from West to East,” “from the west area to the east” and “so did sheep blood.” It can be seen that the spreading texts contained anomalies long ago.

The above all forcefully prove the statement that this disease was named Lu Chuang since it was brought from the area where minority nationalities lived after the war in Nanyang in the time of Ge Hong. Therefore, Jianwu must be the reign title before 318 AD when Ge Hong wrote Zhou Hou Bei Ji Fang. It was probably between 25 and 56 BC of the Jianwu reign when Ma Yuan (马援) [Figure 1] commanded Jiaozhi.{Figure 1}

Dou Zhen Shi Yi Xin Fa (《痘疹世医心法》 Teachings on the Treatment of Pox from a Family Lineage of Doctors) [Figure 2] written by Wan Quan (万全) of the Ming dynasty recorded that the battle against minority nationalities in the Jianwu reign saw the spread of smallpox all over China, so it was named Lu Chuang …… It was a hot summer when Ma Yuan commanded Wuling in the 25th year of the Jianwu reign of the Han Dynasty. Accordingly, Wan Quan should be the first one to clarify the time of Jianwu as being in Ma Yuan's time. However, Wuling which Ma Fubo conquered in the 25th year of the Jianwu reign was in fact around Xiangxi area today rather than a foreign country. Wan Quan is suspected of misjudging it.{Figure 2}

Generally speaking, Lu Chuang discussed by Ge Hong in the punitive expedition to minority nationalities was introduced from foreign countries, so Ma Yuan probably brought back smallpox as he fought against Jiaozhi. India and the islands in the southeast were just the original epidemic focus of smallpox. In addition, Dashan, the eminent Qing monk in Guangdong who applied to work in Vietnam arrived in Hue in 13th July, saying “I followed the army to stay in the Amitabha Temple to find everyone who got fever with sores.” This was very likely the start of widespread smallpox (see Volume Four of A Chronicle of Foreign Countries《海外纪事》).

Ma Yuan spent as much as 5 years from the 16th to the 20th year of the Jianwu reign (40–44 AD) commanding Jiaozhi. Hou Han Shu Ma Yuan Zhuan (《后汉书·马援传》 Post Han Book of Ma Yuan Records) recorded that the troops returned to the capital in the 20th year, when four to five of tenths of the soldiers were dead of epidemic diseases among which smallpox was at least included. It must have been brought into China then. Hou Han Shu did not mention any place named Nanyang during Ma Yuan's commanding, so Nanyang might be a mishearing of Anyang which Ma Yuan once reached and where he erected a bronze column. Anyang was mentioned in the chapter of Jiaozhou Region in Shui Jing Zhu (《水经注》 Commentrory on Waterways Classic).

According to the analysis above, the viewpoint that smallpox was brought into China across Vietnam in time of 44 AD when Ma Yuan was commanding that area comes up. Smallpox has been a significant influence on China's society, the progress of infectious disease study, and made a significant impression on Chinese medical culture in particular.

Ma Yuan did not know smallpox when he commanded Jiaozhi, as he named the epidemic diseases “miasma” in general. However, the prevalence of miasma and its fatality contributed to the import of Yi Ren (薏仁 Semen Coicis) to China. Ma Yuan Zhuan (《马援传》 Biography of Ma Yuan) said when he was in Jiaozhi, he often ate Yi Ren which could reduce body weight, get rid of worldly desires (省欲), and prevent miasma. Since the fruit of Yi Ren in the south was bigger, Ma Yuan brought many back. When the troops returned, he filled one carriage with Yi Ren. It was regarded as rare a valuable and the influential people all looked forward to it. No one dared to mention that Ma Yuan brought back a carriage of treasure from the southern area, since Ma Yuan was high in the emperor's favor. However, he was accused of transporting pearl and veined rhinoceros horns after he passed away. The emperor was infuriated. His wife was too terrified and wanted to bury him in the ancestral tomb, so she bought several mu (1 mu = 0.0667 hectare) of land to bury him hastily. It was really a tragedy that Ma Yuan was falsely accused of Yi Ren being pearls, but this is undoubtedly the first recording of Vietnamese medicine introduced to China. Chapter Yi Ren of Da Guan Ben Cao (《大观本草》 Grand View of Materia Medica) quoted from Ming Yi Bie Lu (《名医别录》 Miscellaneous Records of Famous Physicians) by Tao Hongjing says: Yi Ren produced in Vietnam is of the biggest size. It sounds like Ganzhu in Vietnamese language. Once brought into China by Ma Yuan, people even considered it as pearl. Indeed, the heavy ones are of great quality and its flesh is the part of efficacy. Nowadays, the root of Yi Ren is is decocted to gruel to treat worms in children, usually achieving excellent results. There is Yi Ren in the native land of China as well, but worse in quality than that growing in Vietnam. Furthermore, Chinese Yi Ren seems not to be used for preventing epidemic disease. However, what we are certain is that Yi Ren has been used as medical herb since Ma Yuan introduced it to China, which made him deserve the title of the envoy of medical culture exchange.

 Medical Activity of Vietnamese Doctors After Tang and Song Dynasties

Nasal sucking therapy

Quoting from Yu Tang Xian Hua (《玉堂闲话》 Small Talk in Yutang), Tai Ping Guang Ji (《太平广记》 Anthology of Tales from Records of the Taiping Era) records a story about Shen Guangxun (申光逊) treating a Vietnamese man. Shen Guangxun, an assistant to the chief local official in Caozhou, came from Guilin. Sun Zhong'ao (孙仲敖) was an official, living in Guilin (桂林). One day Shen paid a visit to him and was led to his bedroom. After paying a courtesy call, Shen said: “you are not too lazy to wash your hands and face; you have a headache.” He then ordered several liters of alcohol and spicy food soaked with crumbs of pepper and ginger to mix with the warmed alcohol. Afterward, he took a black-colored tube-like Sheng (a reed pipe wind instrument), put it in Sun's nose to let him suck. Taking all the mixture through the nose, Sun lay down and then recovered once he began sweating. This is nasal sucking therapy among minority nationalities in Southwest of China, and also a common treatment method applied by Vietnamese people. It looks like nasal feeding but in fact it is nasal sucking.

Not surprisingly, many books have recorded that people in Vietnam and Champa Kingdom drank through bamboo tube by nasal sucking. Ling Biao Lu Yi (《岭表录异》 Anecdotes and Rare Talents in Lingnan Area) [Figure 3] by Liu Xun (刘恂) in the Tang Dynasty described it as follows: Vietnamese people like Bunai gruel which is made of lamb, venison, chicken, pork and pig bones, extremely greasy and thick. All the meat is removed to gruel, which is then added with onion, ginger and other flavors. The gruel is stored in a basin and poured into a dish to drink. A silver spoon of 1 Sheng (approximately 594.4ml) capacity is prepared along with the gruel. Bowing with hands clasped to give precedence to others, usually the host has a full spoon in the beginning, pours it into the nose, raises his head to let the gruel slowly flow down, and then, the spoon would be passed to the guests one after another to suck the soap, just like the round of drink. By finishing the gruel, they would have many other dishes and drinks. This kind of banquet is Bunai, which is often held for business exchange and official communication. All are likely to attend Bunai banquet. Lu Xun (鲁迅) has checked against the authoritative text and annotates to confirm that heart-penetrating, head-flying black magic, nasal sucking pictured in An Nan Lu Yi (《安南录异》 Annan Anecdotes and Rare Talents) were local customs. How fantastic it is that the official Sun Zhong'ao even carried nasal sucking tools from Vietnam and Shen Guangxun, who must have been well versed in local customs, used the tool as a treatment method!{Figure 3}

Medical service for Vietnamese imperial family

According to Da Yue Shi Ji Quan Shu (《大越史记全书》 The Historical Records of Vietnam), senior monk Mingkong (明空) who was resident of Chang'an in China once cured the difficult and complicated disease of Emperor Shenzong (李神宗) in the 4th year of the Tianzhang Baosi reign (1136, the 6th year of Shaoxing reign of Song dynasty). The emperor was absent-minded, crying out in distress day and night. All the doctors were found at a loss at what to do with him. However, Mingkong cured him and was honored as a national master. In the 1st year of Shaofeng reign of Emperor Yu of the Chen dynasty (1341, the 1st year of Yuanzhi reign), the Chinese doctor Zou Geng (邹庚) was appointed as court doctor, because he had saved the drowning young Emperor Yu (裕宗) by using acupuncture and offered many superior therapies. Zou Geng was also exempt from a death sentence for he saved Emperor Yu's son with acupuncture and cured his hemiplegia later. He was also rewarded with a large number of treasures as he cured Emperor Yu's impotence to have two children afterward.

However, there are very few recordings as such about the spread of Chinese medicine to Vietnam. Ming Shi (《明史》 The Historical Records of Ming Dynasty) states that the emperor issued an imperial edict to call for the hermits, learned scholars, and doctors in Annan (the northern and middle part of Vietnam) in the 5th year of the Yongle reign of Emperor Cheng (1407) and promised them a courteous reception and high position. However, the details are unable to be found. It also records “Annan once traded local products for books and medicinal materials in the 1st year of Jingtai reign (1450)” also without specific facts.

 Flow Of Special Local Herbs Between China And Vietnam

Spread of Vietnamese spices to China

There is no doubt that many herbs used in Chinese medicine were introduced from Vietnam, even though they are rarely mentioned in historical records. Tang Hui Yao (《唐会要》 Book of Economic and Political Institutions and Regulations of Tang Dynasty) says “in the middle of Kaiyuan reign, Vietnamese emperor Vikrantavarman II presented the tame elephants, Chen Xiang (沉香 Lignum Aquilariae Resinatum), Hu Po (琥珀 Succinum), etc.;” “In the 8th year of Tianbao reign, Emperor Rudravarman II presented hundreds of pearls. Chenxiang …… in the 9th year of Zhenyuan reign, Indravarman dispatched envoys to present Xijiao, then the envoys were asked to pay a courtesy call in the Imperial Ancestral Temple. Tang Liu Dian (《唐六典》 Code of Tang Dynasty) says that Vietnam presented turtle shell, betel nut, skin of shark, and gallbladder of anaconda snake. Moreover, Bai Hua Teng (白花藤 Caulis Trachelospermi), Ding Xiang (丁香 Flos Caryophylli), Phyllanthus emblica, Terminalia bellirica, Zhan Tang Xiang (詹糖香 Lindera erythrocarpa Makin), Ke Li Le (诃黎勒 Terminalia chebula), Su Fang Mu (苏方木 Caesalpinia sappan L.) recorded in The Xin Xiu Ben Cao (《新修本草》 Newly Revised Materia Medica) and Supplement to “Ben Cao Shi Yi (《本草拾遗》 The Grand Compendium of Materia Medica)” were produced in Vietnam as well. There is a story about the collection of herbs in Vietnam recorded in Da Tang Xi Yu Qiu Fa Gao Seng Zhuan (《大唐西域求法高僧传》 Senior Monks of Tang Dynasy Going West to Acquire Buddhist Scriptures) by Yijing (义净): Samghavarman, who was a settler of Kang, left for Liusha at an early age, strolling along the capital …… he followed the imperial decree to accompany envoys to present to west in Xianqing reign …… on returning to Tang, he was dispatched to Vietnam to collect herbs. At that time, people in Vietnam were starving, he thus provided the poor with food and relief every day. Being greatly distressed, he could not help weeping and was called crying Buddha thereafter. Yijing soon died of an ailment aged over 60. Kang was Samarkand in the Soviet Union. Although he was not praised by the imperial government for this collection of herbs, it still disclosed some traces for medical exchange.

The presented drugs recorded in the historical books of the Song Dynasty were mainly Xi Jiao (犀角 Cornu Rhinocerotis), Long Nao (龙脑 Borneolum), Ru Xiang (乳香 Olibanum), Chen Xiang (沉香 Lignum Aquilariae Resinatum), Tan Xiang (檀香 Lignum Santali Albi), Ding Xiang (白花藤 Flos Caryophylli), Hui Xiang (茴香 Fructus Anisi Stellati), Dai Mao (玳瑁 Carapax Eretmochelydis), Dou Kou (豆蔻 Fructus Amomi Rotundus), Bi Cheng Qie (毕澄茄 Fructus Litseae), and Bing Lang (槟榔 Semen Arecae). It was said that formulas for dysentery were introduced to China as well.

Spices seemed to be the staple herbs presented to China then. Xian Bin Lu (《咸宾录》) by Luo Yue (《咸宾录》) of the Ming Dynasty recorded that Annan was abound with Suheyou (Styrax oil), Ji She Xiang (鸡舌香 Eugenia caryophllata Thunb.), etc.; Champa Kingdom presented Xi Jiao (犀角 Cornu Rhinocerotis), Long Nao Xiang (龙脑香 Dipterocarpaceae), Chen Xiang (沉香 Lignum Aquilariae Resinatum), Tan Xiang (沉香 Lignum Santali Albi) etc., Xi Yang Chao Gong Dian Lu (檀香Records of West Paying Tribute) written by Huang Xingzeng (《西洋朝贡典录》) of the Ming Dynasty also mentioned that the Champa Kingdom had Jialanxiang (迦阑香), a. k. a Qi'nan (奇南). It is a dark red, local specialty particularly guarded against illegal collection and traded with silver.” These spices were occasionally employed in medical formulas in a small amount but much more used during worship in the temple.

A puzzling respect in the study of medical exchange between Vietnam and China is the term Lingnan (South of the Five Ridges in China) used in ancient literature. It in general referred to Vietnam, especially its northern area. Due to geographic and historical reasons, Jiaozhi was often mixed with the name of Lingnan. Both Li's Hai Yao Ben Cao (《海药本草》 Materia Medica from the Southern Seaboard Area in China) [Figure 4]and Lingnan Formulas for Health (《岭南卫生方》) edited by Li and Zhang Zhiyuan in the Song Dynasty, revised by Shi Jihong in the Yuan Dynasty recorded many drugs from Lingnan, Nanhai (South China Sea), and even countries in the East sea. In fact, these drugs were produced in Vietnam, or Guangdong and Guangxi of China, countries in the Southeast of Asia, India, and Persia.{Figure 4}

Vietnamese specialties

Textual research into other ancient books found that drugs, particularly in Vietnam or their Vietnamese varieties were of high quality. For example, Doukou produced in Jiaozhi had the root-like Yi Zhi (益智 Fructus Alpiniae Oxyphyllae) and the seed-like pomegranate with a tiny thick shell. It smelled fragrant and shaped in the form of a tree. Similar to but smaller than Wan Lan (芄兰 Metaplexis japonica), its leaves were usually collected in March and then finely broken and dried in the shade. It tasted bitter and a little sweet. The above were recordings of Materia Medica from the Southern Seaboard Area in China (《海药本草》). Doukou were not only produced in Jiaozhi, but also in China and so was Binglang. However, in all their Vietnamese varieties, they were more honored. According to Guangzhi (《广志》), Binglang was produced in the East sea. Tao Hongjing said it treated Bentunqi (disease of qi running up to the chest), Wugeqi (disease caused by sorrow, qi, diet, coldness, or fluid), Fenglengqi, and indigestion. Qinyi (Bianque) said: we need two Binglang nuts, one is raw, another prepared. Pound them into powder and decoct with wine for drinking. It can cure Pangguangqi (disturbance of bladder qi transformation). Ling Biao Lu Yi《岭表录异》Anecdotes and Rare Talents in Lingnan Area交广tells that Binglang produced in Jiaoguang (交广) was actually Da Fu Zi (大腹子– Areca catechu), though it was called Binglang (betel nut) there. The rich in Jiaozhi all planted it at home …… they said it was hard to prevent communicable subtropical diseases without Binglang since the Jiaozhi area was so hot. People in Guangzhou also liked chewing Binglang, while not as many as those in Annan. Lingnan Formulas for Health (《岭南卫生 方》) also recorded that it was a traditional custom to eat Betel nuts in Lingnan area, and some people even had more than ten pieces a day. Communicable subtropical diseases belonging to qi fullness and phlegm stasis syndrome were mainly caused by over-eating it. Betel nut was good at promoting digestion and removing phlegm. Li Xiangen (李仙根) in Wanjin Reign (from Opium War to the establishment of New China) reported in his An Nan Za Ji (《安南杂记》 Annan Random Notes) “that Vietnamese people never stop eating Betel nuts except when sleeping. Their teeth turned black once in contact with the medicine. They even laughed at those with white teeth.” That was what he saw when he visited Vietnam in the Qing dynasty when eating Betel nuts had become a custom. But Betel nuts was also believed to promote fluid production to quench thirst, for Vietnam did not produce tea. People in some areas of south China ate Betel nuts as well, and they were often criticized by people in the north in the Qing dynasty. In the 7th chapter of Leng Lu Za Shi (《冷庐杂识》 Lenglu Knowledge Notes), Lu Yi wrote Binglang was recorded to treat miasma in medical literature(s), and people in Sichuan and Guangdong all liked it, and even people in their neighboring provinces imitated them. They did not know that the nature of Betel nuts was descending to break and purge the original qi, while prolonged consumption of qi is hard to be supplemented. People were not aware of this problem and not warned to stop eating it. I once discussed this issue with a doctor, he said Betel nuts not only descended qi but also consumed qi. The lung above the diaphragm is governing qi and regarded as the canopy to cover the turbid in the abdomen. It withers after long-term consumption of Betel nuts; therefore, turbid qi rises and smells around mandible and cheek. Although Betel nuts is always thought to descend qi, it actually fails to treat miasma. This view hits the mark, that is, it is better not to take Betel nuts in the area without communicable subtropical diseases, and people who are addicted to Betel nuts should learn the lesson from it. As the matter of fact, Betel nuts is used in the prescription of Chinese medicine to treat Cunbaichong (tapeworm) with great efficacy.

Ming Yi Bie Lu (《名医别录》 Miscellaneous Records of Famous Physicians) has written that Betel nuts kills Sanchong (pinworm) and Cunbai (tapeworm); Shenggong Powder (圣功散 recorded in Zheng Zhi Zhun Sheng (《证治准绳》Standards for Diagnosis and Treatment), particularly combines Betel nuts and Mu Xiang (木香Radix Aucklandiae) to kill tapeworms; according to Yi Fang Kao (《医方考》Investigations of Medical Formulas), it accompanies the root skin of the pomegranate to enhance the efficacy. They all develop from the methods of killing tapeworms invented by Sun Simiao. Chapter 18 of Qian Jin Yao Fang (《医方考》Important Formulas Worth a Thousand Gold Pieces) is titled “Formulas for Killing Tapeworms,” introducing a formula: 14 Betel nuts are dried, crushed and sifted to get fine pieces; the shells are decocted with 2.5 Sheng (approximately 1486 ml) water. 1.5 Sheng (approximately 891.6 ml) of the decoction is sifted to remove lees and foam. The patient is asked to take the decoction frequently and lie down with a warm quilt. Usually, the tapeworms can be expelled, but if not, drink more and stop taking meals one night. Sun Simiao also mentions that Betel nuts is is from the South sea. The cultural difference in the application of Betel nuts in different areas is easily noticed.

A zoological drug Xijiao is the local specialty of Vietnam as well. Ling Biao Lu Yi (《医方考》Anecdotes and Rare Talents in Lingnan Area) says rhinoceros in Lingnan is in the shape of cow, its head looks like pig and its feet are like elephant with three nails on each hoof and two horns on the forehead and the nose respectively…… Xijiao has been applied in medicine since the time of Ben Jing (《本经》Classic of Materia Medica), and most of them were brought from the south sea.

Ge Jie (蛤蚧 Gecko) now is mainly produced in Guangxi, while Jiaozhi finds it too. Ling Nan Lu Yi records “Liers (the ancient ethnic minority in the west of Guangdou, South and East of Guangxi and north of Vietnam) brought medicine for lung disease to our market. Doctors said the efficacy of the drug was in the tail part, so those without tails were not effective at all.” This book also records Hong Fei Shu (红飞鼠) and Pang Jiang (庞降) which are produced in the Lingnan area and used as an aphrodisiac. However, they are not included in the formula books.

Anti-gu herbs

Chai Zi Gu (钗子股 literarily hairpin-like herb) is just like what is recorded in Ling Biao Lu Yi (《岭表录异》 Anecdotes and Rare Talents in Lingnan Area): gu (legendary venomous worm) was popular in the villages and prefectures of Guangdong area but hardly tested then. 70%–80% patients were cured when treated with herbs like a golden hairpin, such as Shi Hu (石斛 Caulis Dendrobii), Gu Lou Zhi (古漏之), and Gan Teng (肝藤). Here, the villages and prefectures of Guangdong area included Jiaozhi. The main body of Ling Biao Lu Yi (《岭表录异》 Anecdotes and Rare Talents in Lingnan Area) says mountains and rivers in Lingbiao area twist to stagnate, difficult to get free flow of qi; therefore, there are so many miasma obstacles that humans are diseased. Their abdomens are distended because of the legendary venomous worms, which mainly inhabit in the humid and hot area. People in Lingbiao who get this disease are usually living a miserable life. In fact, this condition is hepatosplenomegaly or ascites caused by hepatitis, schistosomiasis, or dysentery. However, people at that time never knew it so they were often taken advantage of by witchcraft and believed it was gu. Even today, the so-called gu resealed by witchcraft is still a common practice in some distant area such as Yunnan and Guizhou, though doctors have begun to treat it with medicine since the ancient times. Chaizigu is one of the examples. Ling Biao Lu Yi (《岭表录异》 Anecdotes and Rare Talents in Lingnan Area) says, Bai Yao Zi (白药子), owned only by the Chens in Wuzhou, was good at treating gu. It was well known since it had saved a lot of peoples' lives. Patients used to ask for it once they got gu …… all the other drugs of detoxification were not as good as Baiyaozi which was probably introduced to Vietnam, too.

Suhexiang pill

Ling Nan Wei Sheng Fang (《岭南卫生方》 Lingnan Formulas for Health) records Suhexiang Pill (苏合香丸). Since most of the herbs used in this formula are produced in Vietnam, it seems to be made up of local resources by doctors practicing medicine there to treat Qizhong (similar to stroke), sudden syncope, heart pain, and diseases caused by turbid qi or miasmic qi around mountains. Nowadays, Suhexiang pill is more often used for angina pectoris.

There are many such cases that deserve further exploration. Drugs such as Teng Huang (藤黄 Garcinia cambogia), Pang Da Hai (胖大海 Semen Sterculiae Lychnophorae), and Sha Ren (砂仁 Fructus Amomi) are mostly imported from Vietnam now. Very little historical recordings about them can be found. As for Dan Sha (丹砂 Cinnabaris), however, Ge Hong had requested to be the magistrate of Goulou County since he once heard that Jiaozhi had this drug. Unfortunately, the emperor refused him due to his older age. But Ge Hong said: “I did not seek for personal glory, but for Danshan.” The emperor then agreed as was recorded in Jin Shu · Ge Hong Zhuan (《晋书·葛洪传》 The Book of the Jin Dynasty-The Biography of Ge Hong). Unfortunately, he did not arrive in Vietnam at last (alst) but was held up in Guangzhou. However, it can be inferred that there must have been alchemists who made Dan in Vietnam; otherwise, Ge Hong would not have heard of Dansha produced there.


Vietnamese traditional medicine was once truly a large-scale system and one of the biggest branches of Chinese medicine abroad, following Kampo medicine and Korean medicine. Vietnam was occupied by France in 1886 and then reduced to a colony. But in the first 30 years of French colonization, Western medicine was not popular. Herbs and acupuncture were always primarily used to treat the locals until the French ruler forbade it. Even though west medicine was advocated afterwards, Chinese medicine did not lie low. In 1935, the Western doctor Huang Boliang (黄博良) even studied acupuncture and published a paper in the Indochina Medial Newspaper; in 1936, a renowned Vietnamese doctor Deng Xun (邓逊) applied to the local authority for the establishment of a Vietnamese Medicine Association. In 1950, both the Vietnamese Medicine Association and Trade Association of Chinese Residing Doctors were set up, who then issued the Journal of Vietnamese Medicine, established the Vietnamese Medical Collage and participated in the International Acupuncture Association. It can be seen that Chinese and Vietnamese medicines have come down in one continuous line. Vietnam declared independence in 1954, then local medicine was further advocated and its development has escalated.


Note 1. Jiaozhou was an imperial Chinese province under the Han and Jin dynasties. Under the Han, the area included Liangguang and northern Vietnam but Guangdong was later separated to form the province of GuangzhouNote 2. Jiaozhi (交趾), also known as Jiaozhou (交州).

Financial support and sponsorship

This work is supported by the Project of Chinese Medical Culture Research Center of NJUCM (NO. ZYWH2017-25) and The Ministry of Education of Humanities and Social Science Project (NO.17YJCZH073) and Key Programme of National Social Science Fund (NO.18ZDA322).

Conflicts of interest

There are no conflicts of interest.


1Chen CR. Transmission History of Chinese Medicine to Vietnam and Vietnamese Medical Books. Medical History and Preserving Health 1957;1:19.
2Fan XZ. Brief History of Chinese Medicine. Beijing: Ancient Chinese Medical Book Publishing House; 1986.
3Fan XZ. History of China's Preventive Medicine Thought. Beijing: People's Medicine Publishing House; 1954.
4Kong JM. A Historical Compendium of Chinese Medicine. Beijing: People's Medicine Publishing House; 1996.