The Tang “Imperial Medical Office” (Taiyi Shu) — The World’s Earliest Medical School

In the 20th year of the Yuanjia reign of the Liu Song dynasty (443 CE), Qin Chengzu, the Imperial Physician Director (tai yi ling), memorialized the throne and obtained approval to establish a medical education institution for teaching students. At the same time, official posts such as Imperial Physician Erudite (tai yi bo shi) and Assistant Instructor (tai yi zhu jiao) were established. By the Sui dynasty in the 6th century, an institution called the “Imperial Medical Office” (tai yi shu) was founded. It was mainly a place where imperial physicians worked together, equivalent to today’s administrative institution of medical education. The Sui Imperial Medical Office was directly under the leadership of the Court of Imperial Sacrifices (tai chang si), which was in charge of rites, music, suburban and ancestral temple ceremonies, and state altars. The Sui Imperial Medical Office had 2 chief pharmacists (zhu yao), 200 physicians (yi shi), 2 herbal garden masters (yao yuan shi), 2 medical erudites (yi bo shi), 2 assistant instructors (zhu jiao), 2 massage erudites (an mo bo shi), and 2 incantation and prohibition erudites (zhou jin bo shi). However, the Sui Imperial Medical Office was small in scale and incomplete in structure, so it can only be regarded as a preliminary stage of a medical school, not a formal medical school.

The first formal medical specialty school established by the state in China was the Tang “Imperial Medical Office” founded in Chang’an in the 7th year of the Wude reign of Emperor Gaozu of the Tang dynasty (624 CE). The Tang Imperial Medical Office consisted of four parts: administration, teaching, medical treatment, and pharmaceutical work, similar to the administrative structure of a modern medical college.

The Tang Imperial Medical Office was directly under the imperial household. It had 2 Imperial Physician Directors (tai yi ling), the highest administrative officials, equivalent to the president of a modern medical college. It also had 2 Imperial Physician Assistants (tai yi cheng), who assisted the directors. Under the assistants were 4 medical supervisors (yi jian) and 8 medical rectifiers (yi zheng). The above 18 persons were the administrative officials of the Imperial Medical Office.

The Imperial Medical Office was divided into a medical department and a pharmaceutical department, similar to the division of medicine and pharmacy in modern medical colleges. Medicine was further divided into four major specialties: medicine, acupuncture, massage (including traumatology), and incantation and prohibition. Among the four specialties, medicine was the largest, with a total of 164 personnel.

These included 20 physicians (yi shi), 100 medical artisans (yi gong), 40 medical students (yi sheng), 2 pharmacy managers (dian yao), 1 medical erudite (yi bo shi), and 1 assistant instructor (yi zhu jiao). After entering the school, students first had to study basic courses such as Su Wen (Plain Questions), Shen Nong Ben Cao Jing (Divine Husbandman’s Classic of Materia Medica), Mai Jing (Pulse Classic), and Jia Yi Jing (AB Canon), and then proceed to specialized study. Students were taught by the erudites and assistant instructors of the Imperial Medical Office. The specialized studies were: “first, physical therapy (ti liao); second, sores and swellings (chuang zhong); third, pediatrics (shao xiao); fourth, eyes, ears, mouth and teeth (er mu kou chi); fifth, horn therapy (jiao fa).” Of every twenty students, “eleven studied physical therapy, three studied sores and swellings, three studied pediatrics, two studied eyes, ears, mouth and teeth, and one studied horn therapy.” The required length of study was also stipulated: “those studying physical therapy completed in seven years; pediatrics and sores and swellings in five years; diseases of the eyes, ears, mouth and teeth and horn therapy in two years.” In practice, physical therapy corresponded to internal medicine, pediatrics to the specialty of children’s diseases, sores and swellings to surgery, eyes, ears, mouth and teeth to the specialty of the five sensory organs, and horn therapy was an external treatment method.

Among the other three specialties, the acupuncture specialty had a total of 52 faculty, staff and students, including 1 erudite, 1 assistant instructor, 10 acupuncturists (zhen shi), 30 acupuncture artisans (zhen gong), and 20 students. Acupuncture students first studied basic medical theory, and then focused on acupuncture and moxibustion. The massage specialty had a total of 36 faculty, staff and students, including 1 erudite, 4 massage practitioners (an mo shi), 16 massage artisans (an mo gong), and 15 students, focusing mainly on massage techniques. The incantation and prohibition specialty had a total of 21 faculty, staff and students, including 1 erudite, 2 incantation practitioners (zhou jin shi), 8 incantation artisans (zhou jin gong), and 10 students, mainly studying Daoist prohibitions and the five Buddhist prohibitions. This specialty had the smallest number of personnel and the least influence.

The Imperial Medical Office stipulated that in addition to entrance examinations, students were examined monthly, quarterly, and annually. Students who still failed after nine years of study were expelled. Those with excellent results were rewarded. Such an examination system ensured the quality of students and allowed early identification of talent. The Imperial Medical Office not only required periodic assessment of students but also stipulated that “all physicians, medical rectifiers, and medical artisans who treat diseases shall have their number of cures recorded as a basis for performance evaluation.” The assessment system for teachers and teaching assistants guaranteed the quality of the teaching staff, which in turn ensured the educational quality of the entire medical school.

Although the pharmaceutical department was not as large as the medical department, it still had a certain scale. The pharmaceutical department included “2 storehouse keepers (fu), 4 clerks (shi), 8 chief pharmacists (zhu yao), 24 pharmacy apprentices (yao tong), 2 herbal garden masters (yao yuan shi), and 8 herbal garden students (yao yuan sheng).” The pharmaceutical department also had a herbal garden, so at that time pharmaceutical specialists were trained not only through theory but also through practice. Because the Tang Dynasty placed considerable importance on pharmacy, preparations were made for the publication of China’s first pharmacopoeia, Xin Xiu Ben Cao (Newly Revised Materia Medica).

China’s first medical school — the Tang Imperial Medical Office — trained many medical talents for the Tang Dynasty, and later dynasties established medical schools similar to the Tang Imperial Medical Office. In 1102, during the Song Dynasty, the medical school was placed under the administration of the Directorate of Education (Guo Zi Jian), the senior institution in charge of education at that time. The scale of the Song Dynasty medical school was also expanded. The medical schools of the Yuan, Ming, and Qing dynasties were all similar to the Tang Imperial Medical Office, with little change. Many famous physicians of successive dynasties came from medical schools, such as Zhu Gong and Chen Ziming of the Song Dynasty, Wei Yilin and Qi Dezhi of the Yuan Dynasty, and Xu Chunfu and Xue Ji of the Ming Dynasty.

Many countries around the world learned from the form of China’s Tang Imperial Medical Office and established similar medical education institutions. For example, Korea later established erudite positions modeled on the Tang Imperial Medical Office, using Chinese medical books such as Su Wen, Nan Jing, Jia Yi Jing, and Ben Cao Jing to teach medical students. In 701, Japan enacted the Taihō Ritsuryō (大宝律令; the Chinese text writes “大室律令,” likely a typographical error for “大宝律令”), establishing a medical education system similar to the Tang Imperial Medical Office, and stipulated that students must use Chinese medical books such as Su Wen and Xin Xiu Ben Cao as textbooks. However, the scale, scope, and form of these medical schools could not yet formally qualify as medical schools. The so-called earliest medical school in the world was the Salerno Medical School, established in the 11th century. Not only was this medical school more than 500 years later than the Tang Imperial Medical Office, but its organization and scale were also far inferior.