Beauty is an eternal theme in human history. Cosmetology has developed along with human civilization as an aesthetic activity. As one of the world's four ancient civilizations,China has a long history of cosmetology.

TCM cosmetology and the pursuit of beauty are inseparable, and aesthetic sensibility as applied to the human body dates from ancient times. Among the artifacts found with the “Upper Cave Man” (Late Paleolithic) from 50 000 years ago at Zhoukoudian, Beijing,were many decorative objects, such as drilled stone beads, perforated animal teeth,and perforated sea shells. These decorative objects are quite elaborate. The holes in the objects have a red color, and it is estimated that their thread were dyed with hematite.In the Neolithic Period, adornment became more abundant in both materials and types.Examples of materials used are stone, shells, bone, tooth, and ceramic. Adornments were worn around the neck, on the head, in the hair, around the wrists, and so on. These adornments, sculpted elegantly and produced beautifully, were obviously produced by people with certain aesthetic abilities.

The earliest cosmetic behavior recorded in the Chinese language is washing the face. “ Mù”, inscribed on bones or tortoise shells, shows a person washing face with hair disheveled. The next common cosmetic behavior to appear in the language is powdering the face. Powder was first used in the Da Yu Age during the Xia Dynasty.Rice powder was used to whiten the face. This powder, dyed red, was also used to redden the cheeks. In the Shang Dynasty, lead powder was used for this purpose.According to historical records, in the Shang Dynasty, people already knew how to make rouge with Chinese medicinals such as hóng huā (Flos Carthami) juice. In the Spring and Autumn Period and the Warring States Period, there is also evidence of the use of face and lip rouge. Explanation of Terms, a book to explain the meaning of certain terms, written by Liu Xi at the end of the Han Dynasty, said “lip rouge is made red, like the red lips”. The eyebrows were also important facial features to the ancients. Since the Zhou Dynasty, people removed their eyebrows and then drew their favorite shape on with black stone.

During the Spring and Autumn Period and the Warring States Period, people also attached great importance to hair adornments. They painted on wax-like cosmetic products to make the hair shiny. This kind of cosmetic is called luster. Explanation of Terms said “luster is to moisten and add luster to the hair when it is always dry”.Hairstyles were given attention since the Zhou Dynasty, and wigs were popular during the Spring and Autumn Period.

In short, people have paid great attention to facial beauty since the Spring and Autumn Period. The pursuit of beautiful features practically became a ritual requirement in certain ages. Confucius said in Notes of Dài Dài's Ceremony - Encourage Learning,“The gentleman has to learn, and cannot be seen in public without adornment. If there is no adornment, one does not look good, and does not show respect to others, and is thus impolite. In the end, without politeness and respect, one cannot succeed”.

The following historical data illustrates TCM cosmetology in the pre-Qin to the Zhou period. According to records from the Ceremony in Zhou - Sky Officer - Tomb Chapter, in the Western Zhou Dynasty, beauty-impairing skin diseases were mainly treated internally,and skin diseases on the head and face were treated by specialized doctors. The Shan Han Classic, mainly including works from the Warring States Period, records 146 kinds of medicinals, many of which are used for beautifying, such as tiān yīng for acne, xún cǎo for looking good, yáo cǎo for charming, and so on.

Books on medicine and technology from the Warring States Period to the Qin Dynasty that were excavated from the Han Tomb in Mawangdui in Changsha, Hunan Province,discuss the etiology, diagnosis, treatment (including medicinals and acupuncture) of diseases such as facial black spots, white spots, acne, warts, contact dermatitis, keloids,and other diseases, and elaborate some theories and methods on how to maintain white and beautiful skin, black hair, and so on. As in Ten Questions, the Emperor asked Da Cheng (a legendary person): “What have the people lost that they look rough, black, and gray? What did they gain to look beautiful, delicate, soft, white, and shiny?” Da Cheng told the Emperor to “eat some fruits and drink animal's milk”.

In the Spring and Autumn Period and the Warring States Period, China developed a feudal society. There was unprecedented economic prosperity during this period. Culture and education began to spread, with “thinkers rising in swarms, hundreds of schools contending”. Among these were Taoist and Confucian doctrines and other schools that developed the science of health preservation. Delaying aging and beautifying via qi gong became popular.

With the further development of adornment and cosmetic techniques in the Qin,Han, and Three Kingdoms Period, attention to facial beauty increased. Even the men in the palace powdered their faces. Starting in the Warring States Period, fragrant flowers and vanilla were used for their scent. They were worn or sometimes kept in the mouth to give the body a pleasant aroma, and were used commonly in the Qin, Han, and Three Kingdoms Period. In the Han Dynasty, officials in the palace even kept Chinese medicinals, such as jī shé xiāng (Caryophyllus) in the mouth when reporting to the emperor, to keep a pleasant odor, and women usually wore a perfume bag.

Medical classics from the Qin and Han dynasties, such as the monumental The Yellow Emperor's Inner Classic, touch on subjects involving cosmetology. Taken together,they contain the embryo of the concept of holism in TCM cosmetology. The Shen Nong's Classic Materia Medica is the first existing specialized book of materia medica,containing monographs of 365 kinds of herbs, in which more than 160 kinds have the care and treatment function of beauty. For example, bái jiāng cán (Bombyx Batryticatus) can “eliminate blackness on the face and make it good looking”. Bái zhĭ(Radix Angelicae Dahuricae), referred to in this book, can “make the skin moist, and be used as face rouge”.

At the end of the Eastern Han Dynasty, Zhang Zhong-jing (150-219 A.D.) wrote Treatise on Cold Damage and Miscellaneous Diseases, which set the principles of syndrome differentiation and treatment, and became an important component of the basic theory of TCM cosmetology. His explanation of the etiology and pathogenesis of certain diseases provided a guideline for treating beauty-impairing disease. For example, his treatise on the etiology and pathogenesis of so-called swarthy complexions outlined four aspects: kidney deficiency, spleen deficiency, damp-heat, and blood stasis obstructing the collaterals, embracing almost all current knowledge about the etiology and pathogenesis of soot black macules in TCM. Hua Tuo (145-208 A.D.), an outstanding doctor from the Eastern Han Dynasty, is the originator of Chinese surgery, and an expert in health preservation. He created an exercise for health preservation called “five animals exercise”. He practiced this daily and looked like a middle-aged man when he was one hundred years old. He was also an expert in preserving health through medicine. He imparted his formula for health preservation and longevity, which could benefit the five internal organs and prevent hair from turning white, to his disciples. After receiving the formula, his disciples lived to over a hundred years old ( Records of the Three Kingdoms-Records of Wei Kingdom - Biography of Hua Tuo).

In the Qin and Han dynasties and Three Kingdoms Period, the fashion for health preservation, longevity, and facial beauty was more prevalent than in the Spring and Autumn Period and the Warring States Period, and there were many effective examples.Besides Hua Tuo, Huang Fu-long, from the Three Kingdoms Period, who took medicinals and exercised to preserve health, “was not decrepit though over one hundred years old,could hear and see well and looked well” ( Important Formulas Worth a Thousand Gold Pieces for Emergencies- Volume 27). Ji Kang, a thinker and scholar, was also a wellknown expert in health preservation. By doing qi gong, he preserved his health and“heard and looked well, looked as noble as the dragon and phoenix, and as beautiful”, and displayed natural fitness and beauty of the body ( Books from the Jin Dynasty, abstracted from Readings by the Emperor During the Taiping Era, Volume 365).

TCM cosmetology developed during the height of power and splendor of the period,especially in the Tang Dynasty. People pursued beauty more intensively, as living standards improved due to economic prosperity. Attention to makeup, hairstyles, and fashion increased like never before. The quest for beauty led doctors to indulge in cosmetology. Representative doctors include Ge Hong (238-364 A.D.), Sun Si-miao (581-682 A.D.), Tao Hong-jing (456-536 A.D.), Chao Yuan-fang (605-616 A.D.), Wang Tao(670-755 A.D.), Meng Shen (621-713 A.D.) and others.

Ge Hong, from the Western Jin Dynasty, provided an indelible contribution to the development of TCM cosmetology, both in ideas of aesthetics and in techniques. Bao Pu-zi and Emergency Formulas to Keep Up One's Sleeve were his representative books. Ge Hong's aesthetic thought is mainly embodied in the 50 volumes of Outer Chapters in Bao Pu-zi. He contributed new ideas to the profound discussion of beauty put forth in the pre-Qin period and the Han dynasties, which had a positive impact on the development of aesthetic theory after the Northern and Southern Dynasties and beyond. This aesthetic thought not only guided him in the application of medical cosmetology, but also influenced contemporary practitioners, which remains significant to TCM cosmetology to this day. In the 20 volumes of Inner Chapters, he advocated prolonging life through internal exercises like qi gong and nutrition, as well as alchemy, which he studied in his later years.

Besides some minerals used in alchemy, he specifically discussed medicinals that support longevity. Included were botanicals commonly used today, which enriched the subject of TCM cosmetology. The 56 ^th chapter of Emergency Formulas to Keep Up One's Sleeve includes “formulas to treat facial acne, dark speckles, alopecia,and body odor”. It has been discovered that this was the first article specializing in cosmetology, in which formulas and herbs for treating diseases such as acne,rosasea, soot black macules, and body odor were collected and cosmetic formulations recorded, such as the “formula to treat the face without smooth moist skin, with dark speckles and wrinkles, and to be used as facial rouge”, the “formula to treat dark skin,coarse complexion, and a turbid face with thick, ugly-looking skin”, the “formula to treat lusterless hair, so as to give the hair a luster like wax”, the “formula to make the body fragrant”, the “method to make hand rouge”, and others.

Tao Hong-jing was a well-known doctor and Taoist during the Northern and Southern Dynasties. He was proficient in medicine and exercise, and his book Collective Commentaries on the Classic of Materia Medica recorded 730 different medicinals.The amount of cosmetic medicinals exceeds the Shen Nong's Classic of the Materia Medica. For example, he added the function of “makes a person goodlooking if taken shé chuáng zĭ for a long time”, and added the function of “growing new skin, beautifying the complexion, used for washing, and as facial rouge”to găo bĕn. Another of his books, Records on Molding a Person's Temperament and Prolonging Life, was a discussion on health preservation through qi gong,which introduced many methods for facial beauty and longevity, such as “warm the hands by rubbing the hands together, and rub the face, from top to bottom, so as to dispel pathogenic qi and make the face lustrous”. He proposed that “ways of making people live long are not harmful”, and “the ways to mold a person's temperament is to not lie down after gorging oneself, and sitting all day may damage the body”.

Chao Yuan-fang (605-616 A.D.）was an imperial doctor during the Sui Dynasty. In his work Treatise on the Origins and Manifestations of Various Diseases, he systematically expounds the etiology and pathogenesis of diseases in different clinical departments, in which there were 85 mentions of beauty-impairing diseases, such as facial acne, facial dark speckles, rosasea, alopecia, white hair, and so on. This book used the Inner Classic as its basis, and further laid the foundation for studying the pathology of beauty-impairing diseases. It proposed the fundamentals of principle-method-recipe-medicinal for TCM cosmetology and allowed for its rapid development.

Sun Si-miao was an outstanding doctor from the Tang Dynasty who made great contributions to the development of TCM cosmetology. Before him, most cosmetic methods were secret. He pointed out that “facial rouge, hand cream, clothing perfume,and bath soap are necessities for everyone, while doctors today keep the prescriptions secret and don’t permit apprentices to give them away. Even a father is not allowed to tell his son. Sages prescribed in order to make each family or individual known. If people didn’t know the prescriptions and they couldn’t be handed down because they were kept secret”. To meet the needs of people, he wrote two articles on “facial medicinals”and “facial medicinals for women” in Important Formulas Worth a Thousand Gold Pieces for Emergencies and Supplement to “ Important Formulas Worth a Thousand Gold Pieces”, and published 130 cosmetic secrets, extensively collected by him. In other chapters there are over 200 formulas to be taken orally or applied externally,such as Rùn Pí Gāo (Spleen-Moistening Paste) for “withered and dry lips”, “bath soap formula for washing hands and face” for “dirty face”, “formula of facial cream” for “making the face smooth and fair, and reducing wrinkles”, “formula of fairness and luster” for “making the face white and clear”, formulas for “treating coarse and rough facial skin”, “treating chapped hands due to dryness and lack of moistening”, “treating mouth and body odor by making them fragrant”, and others.All cosmetic prescriptions had abundant contents, and were mostly used to beautify the face, skin, and hair, and to treat facial diseases. Sun Si-miao also introduced acupuncture cosmetology, diet cosmetology, qi gong cosmetology, health-preservation cosmetology, and other cosmetic methods, such as freezing, jade grinding, and so on.He advocated health preservation and longevity, and because of his practices, he died at the age of ripe old age of 101. Sun Si-miao published cosmetic secrets to make them known to the world, covering medicinals, prescription, diet, qigong and health preservation, and so on. He earnestly practiced what he advocated and became a true example of longevity by health preservation. He is a giant among great masters in the history of TCM cosmetology.

The Arcane Essentials from the Imperial Library, written by Wang Tao in the Tang Dynasty, also contained special articles on cosmetology. There were 221 formulas in the 32 ^nd volume, which covered “facial rouge and drugs, hair cream, sideburns, clothing perfume, and bath soap”. There was even a series of recipes for purple, flesh-colored, and vermilion lip rouge (lipstick). The components of the lip rouge: wax, suet, perfume, and pigments, were almost the same as contemporary lipstick. Perfume and pigments were made with extra care from natural Chinese medicinals. As we can see, the production of cosmetics in the Tang Dynasty was already at quite a high level.

Meng Shen, a disciple of Sun Si-miao, wrote a book called Materia Medica for Dietary Therapy, in which there were many cosmetic therapies and advice on health foods. For example, “persimmon, cold in nature, ...when there are dark spots on the face,is best to eat long term”, “litchi, mild and warm in nature...will improve the qi and color”,“carrot, cool in nature, ...will give people white and fine skin after eating”, and so on.This book has undoubtedly enriched the contents of Chinese dietary cosmetology.

The first book specializing in cosmetic formulas, Makeup Formulas, was written during the Sui Dynasty. Unfortunately, that book has been lost. In the Northern and Southern Dynasties to the Sui and Tang Dynasties, cosmetic surgery also advanced to certain level. For example, in the Jin Dynasty, harelip repair was practiced. Wei Yong,the prime minister during the Jin Dynasty, was born with a harelip, and could not win a promotion without an operation. In the Tang Dynasty, artificial eyes made of wood and resembling real ones were used to replace damaged eyes. In the Tang Dynasty,dental cosmetics also appeared and there are records of filling teeth in Newly Revised Materia Medica from the Tang Dynasty.

To sum up, we can see from the Northern and Southern Dynasties to the Sui and Tang Dynasties, TCM cosmetology developed enormously. Some of the most influential and important medical works in the history of TCM had specialized chapters on cosmetology.Health cultivation and cosmetics became an important part of TCM cosmetology,including such means as medicinals, diet, acupuncture, tui na, qi gong, and health cultivation. This period marked the establishment of TCM cosmetology.

The Confucianists of the Song Dynasty were opposed to women's gorgeous clothing and adornment. The philosophy that “nature and humans are one” was brought forward and widely discussed, and ideas of natural beauty such as “combined with nature” and “in nature without adorning” in the field of aesthetics were widely popular. From the Song Dynasty to the Ming Dynasty, the luxuriant costumes seen in the Tang Dynasty were rare.Women, whether the wives of a prince or civilian women, pursued light and elegant facial make-up, showing their pursuit of natural beauty. The use of light makeup lasted until the Qing Dynasty.

The magnum opuses on cosmetology in the Song Dynasty were Formulas from Benevolent Sages Compiled During the Taiping Era and Comprehensive Recording of Divine Assistance. In Formulas from Benevolent Sages Compiled During the Taiping Era there were many cosmetic formulas. In the 40 ^th volume, they were mainly for facial issues, such as “formulas for sores on the face”, “formulas for acne”, “formulas for black nevus”, “formulas for facial rouge”, and so on. The 41 ^st volume contained specialized formulas for the beard and hair, such as “formulas to give luster to hair”, “formulas to treat thinning beard and hair”, “formulas to grow eyebrows”, and so on.

In Comprehensive Recording of Divine Assistance, there were also many cosmetic formulas, as well as meticulous and thorough discussions about the etiology and pathogenesis of some beauty-impairing diseases. The importance of preserving health and treating disease internally was discussed. Taking the example of facial beauty, it was said that one must tonify and replenish qi and blood by taking medicinals orally, instead of just powdering with rouge and dyeing the beard. It indicated that using medicinals frequently for tonifying and replenishing qi and blood would harmonize the qi and blood so the hair and beard would naturally be lustrous and bright, and much better than the effect of hair dyeing, reflecting the concept of holism of TCM cosmetology.

In the Song Dynasty, other classics appeared, such as Beneficial Formulas from the Taiping Imperial Pharmacy, Materia Medica of the Kaibao Era, Fine Formulas of Su and Shen, Hong's Collections of Proven Formulas, Formulas Faithfully Handed Down For Expedient Use, Formulas to Aid the Living, Experiential Formulas for Universal Relief, Formulas for Universal Relief, Selected Formulas from the Praiseworthy Studio, Secret Formulas of the Wei Family, and Treatise on Medicine, which all had records of cosmetic formulas.

Formulas Used in the Royal Pharmacy from the Yuan Dynasty collected more than a thousand royal secret formulas of the Song, Jin, and Yuan dynasties, in which more than 180 formulas were used for cosmetic and health care, such as “face-washing herbs before meeting with the emperor”, “face-washing herbs used by the queen”, “hair-blackening cream”, “face-beautifying cream”, and so on. One formula prescribed the application of three different herbs on the face in succession. Firstly one washes the face, then massages,and then applies facial cream. This is remarkably similar to three-consecutive methods used in facial procedures in modern cosmetic care. There was a high level of facial care in the Yuan Dynasty. Another book from the Yuan Dynasty was Principles of Correct Diet,the first nutritional book in China. This book included many dietary recipes from the palace during the Yuan Dynasty, most of them for longevity.

The Grand Compendium of Materia Medica, written by Li Shi-zhen (1518-1593)during the Ming Dynasty, contains many cosmetic formulas and introduces hundreds of cosmetic herbs. In Formulas for Universal Relief, there were more than 60 000 formulas.Under articles entitled “Figure”, in the 44 ^th to 86 ^th volumes, there were many formulas for cosmetic treatment and care. In the Ming Dynasty, changes in surgical methods books were developing from abscesses, carbuncles, sores, and ulcers to dermatology.The representative medical book was Orthodox Lineage of External Medicine, which contained many methods for diagnosing and treating beauty-impairing skin diseases,such as soot black macules, acne, rosacea, freckles, glossy scalp, wind, goose-foot wind,black dots, armpit odor, dry and cracked lips, and others. For each disease, there was an outline of pathology, symptoms, and treatment, including pharmaceutical composition and preparations. This book made a great contribution to the development of cosmetic dermatology in TCM cosmetology.

The Great Compendium of Acupuncture and Moxibustion outlined selected points for several beauty-impairing diseases or physical defects, and discussed methods of deferring aging by use of moxibustion on the navel. The book was very important as a reference. The Collection of Books on Longevity and Health Preservation contained a volume called Dressing with Trousseaux ( Xiāng Lián Rùn Sè), including instructions for women on make-up and adornment, in which many cosmetic formulas were compiled on hairdressing, whitening the face, beautifying and maintaining the features, whitening the teeth, moistening the lips, caring the hands and perfuming the body. Cosmetic surgery was also practiced in the Ming Dynasty, as evidenced in the book Standards for the Diagnosis and Treatment - Sores. This book recorded surgical methods such as the correction of congenital lip and ear deformities.

Classics from the Ming Dynasty included Complete Works of [Zhang] Jing-yue, Prolonging Life and Preserving the Origin, Restoration of Health from the Myriad Diseases, Safeguarded Formulas from the Lu, Essential Formulas For Prolonging Life,Elaboration on External Medicine, Precious Book on Brightening the Eyes, Essentials of Materia Medica Distinctions, Notices for Diet, A Collection of Gems in Acupuncture and Moxibustion, Precious Mirror of Oriental Medicine, and others, all of which enriched and developed TCM cosmetology both in theory and practice.

In the 61 ^st to 76 ^th volumes of Essential Teachings on External Medicine in Golden Mirror of the Medical Tradition from the Qing Dynasty, many beauty-impairing diseases,such as soot black macules, freckles, nevus pigmentosus, wandering wind of the face,glossy scalp wind, acne vulgaris, rosacea, hordeolum, lip wind goose-foot wind, and others were recorded. The diagnosis, etiology and pathogenesis, and treatment using herbs and formulas were discussed for these diseases. Examples of formulas include Yù Róng Săn, Shuǐ Jīng Gāo, Diān Dǎo Săn, Pí Pa Qīng Fèi Yĭn, which are still adopted these days with effective clinical function. Surgery in the Qing Dynasty also had some degree of success. The influential surgical texts at that time included The Great Compendium of External Medicine, Profound Implication in Facinating Place, Life-Saving Manual of Diagnosis and Treatment of External Diseases , The Complete Compendium of Sores,and others, which all referred to many beauty-impairing diseases. An immense number of books about TCM came out of this period, most of which involved some discussion of cosmetic problems. In the Qing Dynasty, cosmetology in the palace reached a very high level. Many cases from empress Ci Xi, and emperor Guang Xu regarding health preservation and beauty were recorded in the medical cases of the court in the Qing Dynasty.

In summary, during the Song, Yuan, Ming, and Qing Dynasties, TCM cosmetology entered an in-depth discussion of theory, giving prominence to the concept of holism,and syndrome differentiation and treatment. Cosmetic formulas were more abundant and cosmetic techniques more comprehensive.

In 1911, the Qing Dynasty was overthrown. During the subsequent Northern Government and the Kuomintang periods, TCM was excluded. Consequently, TCM cosmetology made no progress during this period. After the founding of the P. R. C in 1949, TCM gained considerable ground, but for various reasons, cosmetic treatment in TCM cosmetology were covered by surgery, dermatology, and other subjects, and cosmetic care was rarely attended to. In 1980s, with the rapid development of medical cosmetology in China, TCM cosmetology also began to grow again. Various works about Chinese medicine aesthetics and cosmetic Chinese medicine have been published,and papers relating to TCM cosmetology and published in various magazines have been increasing. In 2002, the Ministry of Health of PRC issued the Medical Cosmetic Service Management Approach, which clearly states: “medical cosmetology is an A clinic subject, and cosmetic surgery, cosmetic dentistry, cosmetic dermatology and cosmetic Chinese medicine are B clinic subjects”. This established the academic status of TCM cosmetology. Secondary and higher education in TCM cosmetology have also increased during the last decade. Many secondary and higher medical institutions have offered study in medical cosmetology, and TCM cosmetology is one of the key subjects in both TCM and Western medical colleges.

Chinese medical cosmetology has a long history and profuse contents. It has made unprecedented progress in the last three decades, but there is always more to do in its inheritance and development. Today and in the future, humanity and nature remain intertwined. TCM cosmetology holds great promise for the pursuit of natural beauty, both spiritually and formally.

Please describe the concept of TCM cosmetology briefly.

Which two components are included in the basic theory of TCM cosmetology?

What are the characteristics of TCM cosmetology?

What are the similarities and differences between TCM cosmetology and nonmedical cosmetology?

The development of TCM cosmetology contains which five stages? What are the representative works and physicians in each stage?