Historical accounts

The oldest extant biographies of Hua Tuo are found in the official Chinese histories for the Eastern Han dynasty (25-220) and Three Kingdoms period (220–280) of China. The third-century historical text Records of Three Kingdoms (Sanguozhi) and the fifth-century historical text Book of the Later Han (Houhanshu) record that Hua Tuo was from Qiao County (譙縣), Pei Commandery (沛郡) (in present-day Bozhou, Anhui) and that he studied Chinese classics throughout the Xu Province (covering parts of present-day Jiangsu and Shandong provinces). He refused employment offers from high-ranking officials, such as Chen Gui, and chose to practise medicine.

The dates of Hua Tuo's life are uncertain. Estimations range from 110 to 207 CE, and from 190 to 265 CE. conclude that the "best estimate" is circa 145–208. Hua Tuo was an older contemporary of the physician Zhang Zhongjing (150–219).

The name Hua Tuo combines the Chinese surname Hua (lang=zh華, literally "magnificent; China") with the uncommon Chinese given name Tuo (lang=zh佗 literally "hunchback" or lang=zh陀 literally "steep hill"). He was also known as Hua Fu (lang=zh尃; literally "apply [powder/ointment/etc.]"), and his courtesy name was Yuanhua (lang=zh元化; literally "primal transformation").

Medical techniques

Some scholars believe that he was responsible for the development of pressure points used in Chinese martial arts. Victor H. Mair describes him as "many hundreds of years ahead of his time in medical knowledge and practice".

Hua Tuo's biography in the Sanguozhi describes him as resembling a Daoist xian (仙; "immortal") and details his medical techniques.

Hua Tuo's biography in the Houhanshu explains this mafeisan "numbing boiling powder" decoction was dissolved in jiu (lang=zh酒; literally "alcoholic beverage; wine"). His prescription for the mafeisan anaesthetic liquor was lost or destroyed, along with all of his writings. The Book of Sui lists five medical books attributed to Hua Tuo and his disciples, but none are extant.

Chen Deng

The subsequent portion of Hua Tuo's biography in the Sanguozhi lists 16 medical cases: ten internal medicine, three surgical, two gynaecological, and one paediatric case. Hua Tuo's treatment of diseases was centred on internal medicine, but also included surgery, gynaecology and paediatrics. He removed parasites, performed abortions and treated ulcers, sores and analgesia. For example:

Cao Cao and execution

Cao Cao (155–220), a warlord who rose to power towards the end of the Han dynasty and laid the foundation for the Cao Wei state in the Three Kingdoms period, was probably Hua Tuo's best known patient. He suffered from chronic headaches, which were possibly caused by a brain tumour. Cao Cao's condition has also been translated as "migraine headaches accompanied by mental disturbance and dizziness" and the acupuncture point on the sole as identified as Yongquan (湧泉; "bubbling fountain").

Cao Cao ordered Hua Tuo to be his personal physician – a job Hua Tuo resented. In order to avoid treating Cao Cao, Hua Tuo repeatedly made excuses that his wife was ill, but Cao Cao discovered the deception and ordered Hua Tuo's execution. Xun Yu, one of Cao Cao's advisers, pleaded for mercy on behalf of the physician.

Hua Tuo wrote down his medical techniques while awaiting execution, but destroyed his Qing Nang Shu (青囊書; literally "green bag book", which became a Classical Chinese term for "medical practices text"). This loss to traditional Chinese medicine was irreplaceable. Ilza Veith notes that, "Unfortunately, Hua T'o's works were destroyed; his surgical practices fell into disuse, with the exception of his method of castration, which continued to be practised. Due to the religious stigma attached to the practice of surgery, the social position accorded to the surgeon became increasingly lower and thus made a revival of Chinese surgery impossible."

A Liezi legend claims that the renowned physician Bian Que ( 500 BCE) used anaesthesia to perform a double heart transplantation, but the fourth-century text was compiled after Hua Tuo used mafeisan.

Cao Cao later regretted executing Hua Tuo when his son Cao Chong (196–208), a child prodigy who may have independently discovered and used Archimedes' principle, died from illness. The Sanguozhi does not specify Hua Tuo's exact date of death, but since Cao Chong died in 208, Hua Tuo could not have lived past that year.

Disciples: Wu Pu and Fan A

Hua Tuo's biography ends with accounts of his disciples Wu Pu (吳普) and Fan A (樊阿). Fan A was skilled at acupuncture and inserted the needles to extraordinary depths. Victor H. Mair notes this unusual name may indicate Fan A was a foreigner, and this area was around present-day Tongshan County, Jiangsu, the "___location of the first known Buddhist community in China". These herbs are qiye (漆叶; Toxicodendron vernicifluum leaves) and qingdian (青黏; Sigesbeckia orientalis).

Legacy

The Song dynasty Confucianist scholar Ye Mengde (1077–1148) criticised the Sanguozhi and Houhanshu biographies of Hua Tuo as being mythological. His essay, "Physicians Cannot Raise the Dead", repeated the descriptions of Hua Tuo using anaesthesia to perform internal surgery, and reasoned,

In later times, a set of 34 paravertebral acupuncture points was named "Hua Tuo Jiaji" (華佗夹脊) in his honour. Hua Tuo is considered a shenyi (神醫, "divine physician") and is worshipped as a medicinal deity or immortal in some Chinese temples. "Hua Tuo zaishi" (華佗再世; "Hua Tuo reincarnated") is also an honourable term of respect that will be bestowed to a highly-skilled physician.

Fictional accounts

In the 14th-century historical novel Romance of the Three Kingdoms, Hua Tuo heals the general Guan Yu, who is hit by a poisoned arrow in the arm during the Battle of Fancheng in 219. Hua Tuo offers to anaesthetise Guan Yu, but he simply laughs and says that he is not afraid of pain. Hua Tuo uses a knife to cut the flesh from Guan Yu's arm and scrape the poison from the bone, and the sounds strike fear into all those who hear them. During this excruciating treatment, Guan Yu continues to play a game of weiqi with Ma Liang without flinching from pain. When Ma Liang asks him later, Guan Yu says that he feigned being unhurt to keep the morale of his troops high. After Hua Tuo's successful operation, Guan Yu allegedly rewards him with a sumptuous banquet, and offers him a gift of 100 ounces of gold, but Hua Tuo refuses, saying that a physician's duty is to heal patients and not to make profit. Although Hua Tuo historically died in 208, a decade before Guan Yu fought at the Battle of Fancheng, this story of him performing surgery on Guan Yu has become a popular artistic theme.

The historical document Sanguozhi recorded that there was actually a bone surgery performed on Guan Yu, and that Guan Yu, indeed, showed no pained expression. Sanguozhi gave neither the name of the surgeon nor the exact time of the operation.

Hua Tuo is later summoned by Cao Cao to cure a chronic excruciating pain in his head, which turns out to be due to a brain tumour. Hua Tuo tells Cao Cao that in order to remove the tumor, it would be necessary to open up the brain by cutting open the head, getting the tumor out, and sewing it back, with Cao Cao completely anesthesized in the process. However, Cao Cao suspects that Hua Tuo is planning to murder him, so he has Hua Tuo arrested and imprisoned. (Cao Cao's suspicions are in part due to a previous attempt by Ji Ping, an imperial physician, to force him to consume poisoned medicine.)

In Romance of the Three Kingdoms, Hua Tuo passes his Qing Nang Shu to a prison guard so that his medical legacy will live on. He dies in prison later. The prison guard's wife burns the book for fear of being implicated, but the guard manages to salvage some pages, which are about how to emasculate hen and ducks; the other pages are lost forever.

Mafeisan

Hua Tuo's innovative anaesthetic mafeisan (literally "cannabis boiling powder", considered to be the first anaesthetic in the world) and supposedly used on Hua Tuo's patients during surgery, is a long-standing mystery. The Records of the Three Kingdoms and the Book of the Later Han both credit him as having created this anaesthetic during the Eastern Han dynasty. However, no written record or ingredients of the original have been found, although estimations have been made by Chinese medical practitioners in later periods. There is controversy over the historical existence of mafeisan in Chinese literature.

The name mafeisan combines ma (lang=zh麻; "cannabis; hemp; numbed"), fei (lang=zh沸; "boiling; bubbling") and san (lang=zh散; "break up; scatter; medicine in powder form"). Ma can mean "cannabis; hemp" and "numbed; tingling" (e.g. mazui 麻醉 "anesthetic; narcotic"), which is semantically "derived from the properties of the fruits and leaves, which were used as infusions for medicinal purposes".

Modern Standard Chinese mafei is reconstructed as Old Chinese *mrâipəts, Late Han Chinese maipus (during Hua Tuo's life), and Middle Chinese mapjwəi.

Many sinologists and scholars of traditional Chinese medicine have speculated about the anaesthetic components of mafei powder. Frederick P. Smith contends that Hua Tuo, "the Machaon of Chinese historical romance", used yabulu (押不蘆; "Mandragora officinarum") rather than huoma (火麻; "cannabis") and mantuolo (曼佗羅; "Datura stramonium", nota bene, Hua's given name "Tuo") "infused in wine, and drunk as a stupefying medicine".

Herbert Giles (1897:323) translates mafeisan as "hashish"; and his son Lionel Giles identifies "hemp-bubble-powder" as "something akin to hashish or bhang". Ilza Veith quotes the sinologist Erich Hauer's "opinion that ma-fei (麻沸) means opium". Victor H. Mair notes that mafei "appears to be a transcription of some Indo-European word related to "morphine"". Although Friedrich Sertürner first isolated morphine from opium in 1804, Mair suggests, "It is conceivable that some such name as morphine was already in use before as a designation for the anaesthetic properties of this opium derivative or some other naturally occurring substance." Wang Zhenguo and Chen Ping find consensus among "scientists of later generations" that mafei contained yangjinhua (洋金花; "Datura stramonium") and wutou (烏頭; "rhizome of Aconitum, Chinese monkshood") or caowu (草烏; "Aconitum kusnezofflin; Kusnezoff monkshood").

Lu Gwei-Djen and Joseph Needham suggest Hua Tuo may have discovered surgical analgesia by acupuncture, "quite apart from the stupefying potions for which he became so famous – if so he kept it to himself and his immediate disciples so that the secret did not survive".

生平

華佗早年遊學徐州，兼通數部經書。沛國相陳珪舉其為孝廉，太尉黃琬也徵辟他，他都不為所動。于鄉村行醫因醫術精湛名氣漸大因而求醫之人甚眾。

廣陵太守陳登因喜食魚膾（生魚片），胃中有大量寄生蟲而重病。雖經華佗醫治痊癒，但華佗提醒他此病三年後會復發，需要有良醫在場才能救治。三年後陳登的疾病果然復發，此時華佗不在，陳登於是病死。

《後漢書》及《三國志》二書都說華佗年近六十，但亦保持壯容，《後漢書》甚至說「時人以為仙」。

曹操頭風病嚴重，時常頭痛欲裂，聽聞華佗醫術了得，特地把他召來看病。華佗施針替曹操舒緩病情，但告訴曹操其疾病難以根治，曹操於是留下華佗為專門為自己看病。但華佗本為士人，為人性格孤傲又脾氣不好，因此把從醫為業視作恥辱並常感懊悔，加上離家太久思念親人，便向曹操推說得到家書，順道回家取回藥方。華佗回家後又託詞妻子患病，多次向曹操告假不返。曹操屢次發書信召華佗，又要求郡縣長官將之遣回，但華佗自恃才能，不肯回去事奉曹操。曹操大怒，派人查訪後發現華佗之妻詐病，便將華佗禁錮獄中。荀彧向曹操求情，曹操不許。華佗最終受嚴刑拷問而死。

華佗在臨死前把一卷醫書贈給獄卒。可是獄卒因懼怕獲罪而不敢接受，華佗也不強求，取得火種將它燒毀。在他死後不久，曹操因兒子曹沖病重身故，後悔當初不應該殺害華佗。

華佗有弟子吳普與樊阿頗得真傳；樊阿更善於針灸以華佗所教的「漆葉青黏散」保身年亦高達百多歲而頭髮不白，但已失傳。

《隋書·經籍志》中記載有《華佗方》十卷、《華佗內事》五卷、《華佗觀形察色並三部脈經》一卷、《華佗枕中炙刺經》一卷。

醫術

華佗一生行醫濟世，精通內科、外科、婦科、兒科、針灸等。特點是用藥少，只用幾味藥而已；執藥隨手抓出，不用稱量。針灸也只是針一兩處。下針前對病人說：「當引某許，若至，語人」（針感會到某個部位，若你感覺到了就告訴我），病人說：「已到」，便拔針，不久病便會好。

如針藥都不能醫治，就給病人用酒服麻沸散，飲後有如麻醉，然後施手術，再縫合傷口，擦下藥膏，四、五日後創愈，一月就已平復。但麻沸散與外科手法已經失傳。華佗是醫史上公認第一位使用麻醉藥來麻醉病人，然後進行外科手術的醫師，同時也是中國第一位將手術刀組在使用之前用火來殺菌消毒，平時不用時浸泡在酒水裡的醫生。

吳普一直學習，活到九十多歲，耳目仍然聰敏，牙齒完整。

病例

《三國志》原文中有十六則病例（包括《後漢書》中所載七則），裴註另外引述《佗別傳》所載五則，連同其他文獻中的五則，共二十六則病例。

華佗的行醫事蹟中，以關羽「刮骨療毒」最為膾炙人口，但事實上是源於《三國演義》的虛構故事。《三國志》中確有關羽手臂中箭，刮骨療毒的記載，但在史實中，當時華佗早已為曹操所殺，執刀刮骨者並非華佗。

評價

《三國志》評曰：「華佗之醫診，杜夔之聲樂，朱建平之相術，周宣之相夢，管輅之術筮，誠皆玄妙之殊巧，非常之絕技矣。昔史遷著扁鵲、倉公、日者之傳，所以廣異聞而表奇事也。故存錄雲爾。」

《後漢書》記載荀彧曾說：「佗方術實工，人命所懸，宜加全宥。」

近代人們多用神醫華佗稱呼他，又以「華佗再世」、「元化重生」稱譽有傑出醫術的醫師。

質疑

陳寅恪認為，華佗本身就是個神話故事，華佗二字的上古音與印度藥神「阿伽陀」音近。故「當時民間比附印度神話故事，因稱為華佗，實以藥神目之。」而且他的病例原型來自於印度佛教傳說，「其有神話色彩，似無可疑。」認為這個故事與「曹沖稱象」一樣，都是印度的舶來品。華佗這個人可能真有其人，但他的醫學傳奇是虛構的。

于賡哲認為華佗動手術確有其事，因為：一，華佗之前已有原始手術；二，對華佗手術的描寫比原始手術精細，且和現代外科術有相對應處，對于不懂手術的後人來說很難偽造。在華佗健在時很可能就已屬醫家另類，因此失傳也是意料之中。

後世紀念

典故

• 「華佗再世」：華佗以醫術高超聞名，後世讚他醫術高明，有如華佗再度來到人世。也作「華佗再生」、「元化重生」。

• 「華佗再世也醫不好」：這則代表某人已病入膏肓，再醫術高明的醫生都會無能為力。

安奉

• 墓塜

世傳華佗墓於安徽亳州、江蘇徐州和河南許昌各有一座，其中有衣冠塜者。亳州為華佗故鄉；徐州為華佗本籍（原彭城）及遊學、行醫之地；許昌為華佗喪生之地，許昌之墓於1993年經許昌市人民政府列為市級文物保護單位。

• 廟祠

徐州華佗墓曾於明永樂年間重修，同時於墓北建造「華佗庵」供奉華佗神像。信徒建有華佗廟，或配祀華佗像，道教尊為「青囊濟世華真人」、「神功妙手華真人」，信眾尊稱華佗仙師、華佗仙翁、「華佗神醫」等。臺灣有許多廟宇奉祀華佗，如台北市艋舺龍山寺、高雄市新莊仔天公廟等。

• 紀念館

安徽亳州永安街中段路北建有華祖庵，1962年增設「華佗紀念館」，由郭沫若題寫館名。1980年經維修，次年（1981）正式列為省級重點文物保護單位。該紀念館介紹華佗一生事跡，並特別展示了華佗施行外科手術之工具及過程資料。

形象

File:HuaTuo.jpg|清代《三國演義》繡像中的華佗

File:Chinese woodcut, Famous medical figures; Portrait of Hua Tuo Wellcome L0039320.jpg|萬曆刻本《本草蒙筌》卷首載「歷代名醫圖」中的華佗像，轉繪自《醫學源流》

File:Hua Tuo Hefei.jpg|位于安徽合肥的安徽中醫大學的華佗塑像

File:A man playing go (a board game) Wellcome L0033024.jpg|歌川國芳浮世繪「刮骨療毒」，左側為華佗

File:Hua Tuo figurine.JPG|華佗塑像(香港藝術館展品)

File:Huatuo-longshansi.jpg|艋舺龍山寺華佗廳

藝術形象

藝文作品

《三國演義》的描述

《三國演義》共有三處描述華佗的事蹟：

• 第十五回中描述華佗醫治周泰戰傷的過程：周泰守宣城時被山賊半夜來襲，為保護年幼的孫權逃走，身中十二槍，金瘡發脹，命在旦夕。郡吏虞翻向孫策推薦華佗救治周泰，當中描述華佗「童顏鶴髮，飄然有出世之姿」。周泰經華佗用藥，一個月後痊癒。孫策以厚禮答謝華佗。

• 第七十五回中描述華佗為關羽治療箭毒的過程：關羽在樊城之戰中被曹仁軍士以毒箭射中右臂，箭毒入骨，不能活動。華佗「方巾闊服，臂挽青囊」前往關羽營中，為關羽刮骨療毒。關公痊癒後設席款待華佗。華佗堅拒關羽所贈的黃金百兩，留下外用藥物一帖後離去。

• 第七十八回中描述華佗為曹操診治頭痛病，被曹操下獄而死的過程：關羽死後，曹操因為砍伐梨樹興建新宮，被樹神在夢中驚嚇，醒後頭痛難忍，經華歆推薦召來華佗診治。華佗看後建議用利斧砍開腦袋，取出腦中「風涎」根治疾病。曹操疑心華佗欲藉此殺死自己為關羽報仇，不聽賈詡勸諫，把華佗下獄拷問。華佗死前向獄卒「吳押獄」贈送《青囊書》，結果醫書被吳押獄妻子燒毀。吳押獄僅搶回一兩頁，當中記有閹割雞和豬等小手術。

歷史上周泰於宣城作戰受傷之事見於《三國志》，但僅記載他「身被十二創，良久乃蘇」，也沒有提及被華佗所救治；為關羽刮骨療毒亦非華佗所為（當時華佗已去世）；為曹操診治頭痛之事則被《演義》推遲時間並作改編。後世作品對華佗事蹟的描繪，多受到《三國演義》影響。

其他作品

• 1983年電影《華佗與曹操》：鄭乾龍飾演華佗

• 1994年電視劇《三國演義》：王忠信飾演華佗

• 1996年電視劇《關公》：歐陽龍飾演華佗

• 2000年電視劇《醫神華佗》：林文龍飾演華佗

• 2004年電視劇《神醫華佗》：庹宗華飾演華佗

• 2009年電視劇《終極三國》: 曾子余飾演華佗

• 2010年電視劇《三國》：蔡軍飾演華佗

• 2012年電視劇《回到三國》：蔡康年

• 2015年電視劇《半為蒼生半美人》：何晟銘飾演華佗

• 2017年電視劇《軍師聯盟》：許還山飾演華佗

• 2017年網路劇《終極三國2017》: 夏志遠飾演華佗

動漫遊戲

• 三國志系列（電玩）

• 少年華佗（動畫）

• 《火鳳燎原》 (陳某): 於長安風雲篇登場，醫術承於「南華八怪」之于吉，曾為郭嘉、曹操、呂布、小孟(貂蟬)和陳登等診治

• 《真·三國無雙 起源》：有位名為「元化」（華佗的字）的角色，但是外貌設定上過於年輕不合史實。

延伸閱讀