Why Did Ancient China Never Develop a Rabies Vaccine?

In this world there have always been only two kinds of people: people like me, and people not like me.

Compared with speech, thought is far broader and fuller.

— The writer Wang Xiaobo

Rabies is a disease with an extremely high fatality rate; once it breaks out, the mortality is 100%. Today, when people are bitten or scratched by a cat or dog that may carry the rabies virus, their first action is to go to the hospital for rabies vaccination. After vaccination, rabies is essentially impossible to develop.

So who first developed the rabies vaccine? It was the French microbiologist Louis Pasteur—honored as the founder of modern microbiology; the pasteurization method used for the milk we drink was his invention.

How did Pasteur develop humanity's first rabies vaccine? He first tried using attenuated live virus from a dried suspension of rabbit spinal cord infected with rabies to prevent the disease. He gave a child bitten by a rabid dog 13 consecutive injections of the vaccine prepared this way, and it succeeded. Later, scientists kept improving on this basis, eventually producing the rabies vaccine widely used today.

In hindsight, the principle of Pasteur's rabies vaccine is not complicated; a junior medical student who has taken medical immunology can work it out. The rabies virus chiefly invades the nervous system of animals. Extracting attenuated live virus from the spinal cord (the central nervous system includes the brain and spinal cord) of an animal infected with rabies, and injecting a low dose into the human body so it produces corresponding antibodies, prevents rabies. This is a process by which our immune system generates adaptive immunity.

Was Louis Pasteur the first to discover this principle? No—it was Ge Hong, a physician of the Eastern Jin dynasty. In his Zhouhou Beiji Fang (also called Zhouhou Jietu Fang), Ge Hong recorded a method to prevent rabies: "Kill the dog that bit the person, take its brain and apply it to the wound; afterward it will not recur." Ge Hong's method follows the same principle as Pasteur's: both extract attenuated live virus from the nervous system of a rabies-infected animal and let it stimulate the body's own antibodies to prevent rabies. Moreover, Ge Hong clearly stated this was prevention ("afterward it will not recur"), not treatment after onset; he had already grasped the principle.

Of course, Ge Hong's anti-rabies method was probably not his own invention but folk experience he collected. Ge Hong wrote the Ge Hong Yuhan Fang, a huge work of 100 volumes. Later he himself felt embarrassed: such a massive book was too cumbersome for people to use. So he condensed it into a small booklet—the Zhouhou Jietu Fang, later renamed Zhouhou Beiji Fang and abbreviated as Zhouhou Fang.

This book has great documentary value. Professor Tu Youyou was inspired by it when researching artemisinin. Zhouhou Beiji Fang records the treatment of malaria in extremely terse language: "A handful of Artemisia annua, soaked in two sheng of water, wring out the juice, and take it all." In this one short sentence there is no yin-yang or five-phases doctrine; it uses plain language everyone can understand to record the disease-treatment experience people had worked out in practice.

Ge Hong's writings, in modern terms, are packed with solid content. Zhouhou Beiji Fang not only contains the above but also records mouth-to-mouth artificial respiration, cauterization to stop bleeding, abdominal paracentesis, catheterization, enema, wound cleaning, drainage, external fixation of fractures, reduction of joint dislocations, and mercury ointment for pinworms. His book was written over 1,700 years ago, but for a long time afterward China made very slow scientific progress. So although some of the experiences he recorded are very valuable, they failed to receive attention in ancient times.

The rabies vaccine has saved countless lives, and artemisinin has saved countless lives; both can be traced to Ge Hong's writings. This shows that some ancient Chinese physicians had real insight and innovative spirit. In another article I wrote the day before yesterday, "The Long Struggle of Humanity Against the Smallpox Virus," I recounted how ancient Chinese people developed the smallpox vaccine; from that history too we see the insight and innovation of ancient Chinese physicians.

This insight and innovation are the most important forces driving medical progress. Regrettably, for a long time such positive factors that could advance medical technology were not valued but instead constantly suppressed.

Ge Hong himself was a Daoist alchemist; another very famous ancient Chinese physician, Tao Hongjing, was also a Daoist figure. They were in fact the earliest chemists. Ancient China called such people "itinerant sorcerers," a term loaded with contempt.

Ge Hong must have felt this discrimination in his lifetime. The preface to Zhouhou Beiji Fang says: "The age suffers from valuing the distant and devaluing the near, praising the past and disparaging the present; I fear that, seeing these formulas, without the discernment of Huangdi, Cang Gong, Bian Que, or Yu Fu, people cannot adopt them. How can this be forced?"

This passage vividly describes the Chinese tendency to believe blindly in authority. Even today, many people still have this tendency. On TCM, they cannot help but praise the past and disparage the present, citing the Huangdi Neijing, classical formulas, and Han-Tang medicine, dismissing everything after the Han and Tang as worthless—contempt for progress taken to a pitiful extreme, yet with countless believers. This shows how difficult medical innovation has always been on our soil.

If our nation had always valued innovation, the father of microbiology and the father of immunology might both have been Chinese, and our medicine would be far more advanced than it is today.