Hua Tuo (simplified: 华佗, traditional: 華佗, pinyin: Huà Tuó, courtesy name Yuanhua 元化, c. 140–208) was a physician of the late Eastern Han dynasty and one of the most celebrated figures in the history of Chinese medicine. He was from Qiao (譙, in modern Bozhou, Anhui), the same region as Cao Cao. His biography appears in both the Records of the Three Kingdoms (SGZ) by Chen Shou and the Book of Later Han (HHS) by Fan Ye, which is unusual for someone who was not a military or political figure. He is also a prominent character in the Romance of the Three Kingdoms (SGYY).
Medical achievements
Hua Tuo is credited with a number of pioneering medical innovations that were extraordinary for his time. His biography records treatments spanning internal medicine, surgery, acupuncture, moxibustion, and preventive health exercises.
Mafeisan (麻沸散) — Surgical Anaesthesia
The most famous of Hua Tuo’s contributions is the development of Mafeisan (麻沸散, “Bubble-Boiling Powder”), described as an oral anaesthetic used before surgery. According to his biography, he would have patients swallow a dose of the substance, after which they would lose consciousness “as though intoxicated” and feel no pain. He could then perform abdominal surgery — cutting open the abdomen, washing the intestines, removing diseased tissue, and suturing the wound. The patient would reportedly recover within a month.
If these accounts are accurate, Hua Tuo practised general anaesthesia for surgery roughly 1,600 years before its introduction in the West. However, the exact composition of Mafeisan is lost. Later scholars have speculated that it may have contained cannabis (麻), datura (洋金花), aconite (烏頭), or a combination of herbal anaesthetics. No recipe survives in the historical record.
The Five Animals Exercise (五禽之戲)
Hua Tuo developed a system of therapeutic exercises modelled on the movements of five animals: the tiger (虎), deer (鹿), bear (熊), monkey (猿), and bird/crane (鳥). He taught these to his disciples, including Wu Pu (吳普) and Fan A (樊阿), explaining that physical movement promotes the circulation of qi and blood, prevents stagnation, and prolongs life — just as a door hinge never rusts because it is constantly in motion.
Wu Pu reportedly practised the exercises into old age and remained vigorous; Fan A lived to the age of over a hundred. The Five Animals Exercise (五禽戲) remains a form of qigong practised in China today and is one of the earliest documented systems of therapeutic physical exercise.
Surgical and diagnostic skill
Hua Tuo’s biography records numerous successful treatments:
- He diagnosed internal parasites and prescribed a decoction that caused a patient to vomit a long parasitic worm.
- He treated a general whose arrow had pierced deep into bone; he cut open the arm, scraped the bone clean of poison, and sutured the wound.
- He treated a nobleman with chronic illness, prescribing treatment and warning that continued indulgence would be fatal; the patient ignored the advice and died.
- He correctly predicted the course of several illnesses, including identifying when a patient would recover and when death was inevitable.
Acupuncture and moxibustion
His biography also describes precision in acupuncture. When needling a patient, he would tell them exactly where to expect the sensation to travel, and the patient would confirm the accuracy. When moxibustion was required, he would place the moxa at precise points — no more than seven or eight treatments per condition — and cure would follow.
Relationship with Cao Cao
Hua Tuo’s most famous association is with Cao Cao, who suffered from debilitating headaches (often described in the sources as “head wind” 頭風). Cao Cao summoned Hua Tuo to his court, and the physician treated him with acupuncture, providing immediate relief.
However, Hua Tuo was reluctant to remain at court permanently. He requested leave to return home, claiming his wife was ill. Once home, he repeatedly sought extensions of leave, each time citing further illness. Cao Cao sent letters to check on him and even dispatched an official with orders to investigate. When it was discovered that Hua Tuo’s wife was not actually ill, Cao Cao was furious and had Hua Tuo arrested and imprisoned.
In prison, Hua Tuo was interrogated. He confessed that his wife was not ill but that he simply had no desire to serve as a court physician. Xun Yu, one of Cao Cao’s most trusted advisers, pleaded on Hua Tuo’s behalf, noting that Hua Tuo’s medical skill was extraordinary and that his life should be spared. Cao Cao refused, saying: “Do not worry. Could there not be other mice of this kind in the world?” (不憂，天下當無此鼠輩耶？)
Hua Tuo died in prison in 208. Before his death, he is said to have entrusted a medical text to a prison guard; the guard, fearful of the law, did not accept it. Hua Tuo then burned the manuscript himself. The loss of this text is considered one of the great tragedies in the history of Chinese medicine.
Cao Chong and Cao Cao’s regret
Cao Cao’s favourite son, Cao Chong, was a child prodigy who died in 208 — the same year as Hua Tuo’s death. After Cao Chong’s death, Cao Cao reportedly said in lament: “I regret having Hua Tuo killed, and now my son is dead.” (吾悔殺華佗，令此兒彊死也。) Whether Cao Cao directly blamed Hua Tuo’s death for his son’s is unclear, but the association between the two deaths entered the historical narrative and later fiction.
Medical writings
Hua Tuo is said to have written a medical treatise that was lost when he burned it in prison. Later texts attributed to Hua Tuo — including the Zhongzang Jing (中藏經, “Classic of the Viscera”) and works on veterinary medicine — are almost certainly later forgeries or compilations that drew on his reputation. No medical writing directly attributable to Hua Tuo survives.
In the Romance of the Three Kingdoms
In Luo Guanzhong’s Romance of the Three Kingdoms, Hua Tuo’s story is expanded and dramatised:
- He treats the general Guan Yu for an arrow wound to the arm. In the most famous scene, Hua Tuo proposes to cut open Guan Yu’s arm to scrape the bone; Guan Yu, rather than use anaesthetic, continues playing a game of Go (圍棋) while the surgery is performed, showing no sign of pain. This scene is one of the most iconic depictions of martial fortitude in Chinese literature.
- He proposes to open Cao Cao’s skull to remove the source of his headaches, which Cao Cao interprets as an assassination attempt and orders Hua Tuo’s execution.
- In prison, he entrusts his medical treatise (Qing Nang Shu 青囊書) to a jailer, who refuses it out of fear; Hua Tuo burns the book.
These dramatised episodes have no basis in the historical record but have shaped popular perception of Hua Tuo for centuries.
Legacy
Hua Tuo is regarded as one of the greatest physicians in Chinese history, often grouped with Zhang Zhongjing (張仲景, author of the Shanghan Lun) as one of the “Two Divine Doctors” of the Han period. Temples and shrines dedicated to him exist across China, and he is sometimes invoked as a deity of medicine.
His name has become synonymous with medical excellence in Chinese culture. The phrase “Hua Tuo reborn” (華佗再世) is a common compliment for skilled physicians. Many modern hospitals, clinics, and medical organisations in the Chinese-speaking world bear his name.