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specialty: “formulae and pulses (fangmai 方脈),” “acupuncture (zhen 鍼),” or “medicine for sores (yangke 瘍科).” In addition to actively training more physicians, the Song government also expanded the number of medical posts, providing career opportunities for its graduates and incentive for elite men to study medicine. The hierarchy of physician-officials was likewise refashioned to resemble that of other government officials. More than any dynasty before or after, the Song made a concerted effort to make medicine an appealing career for elite men.136 The Imperial Pharmacies Before the Song, the distribution of medicines to the populace had occurred on an ad hoc basis during epidemics and was often limited to the capital. The imperial offices that existed for the purchase and processing of medicinals were intended to supply the needs of the imperial family and did not serve the broader community even within the capital. Even in the early years of the dynasty, the Song government took steps to strengthen the provision of medicines to the people. The second emperor, Taizong (r. 976-997) included funds for the purchase of medicines for distribution within the state budget. He also assigned ten doctors to tend to the people of the capital. While these measures were no doubt helpful, they were only enacted during epidemics and they remained limited to the capital. In 1076, as part of the New Policies, these measures were expanded dramatically.
Barnes (Cambridge: Harvard University Press, 2013), 100–101; Goldschmidt, Evolution, 44–57.
was ultimately expanded to include offices in many prefectures. Although we have no way of verifying how thoroughly this imperial order was carried out, the fact that it was necessary to cut back the program during the war with the Jurchen armies and that the prefectural pharmacies were reestablished early in the Southern Song suggests that a significant number of offices must have been in operation.
The offices of the Pharmacy Service fulfilled two related functions. The first was economic. The Song witnessed a dramatic rise in the cost of raw medicinals. The imperial pharmacy sold both its stock of raw herbs and its prepared medications at below market prices in an effort to stabilize them. The second was medical. The Pharmacy Service produced medicines that were distributed free during epidemics but were available for purchase at other times. Unlike other pharmacies, which largely compounded medicines to order on the basis of a doctor’s prescription, the imperial pharmacy sold specific, prepared medicines, usually in the form of powders or pills. This made it possible for a doctor to send a patient to the imperial pharmacy office to purchase a cheap, ready-made remedy and also allowed individuals to purchase medicinals for themselves without consulting a doctor. To facilitate this process, from 1078 to 1107 to the Pharmacy Service produced a series of books listing its formulae. Called Formulae of the Imperial Pharmacy Service for the Benefit of the People in the Era of Great Peace (Taiping huimin heji jufang 太平惠民和劑局方, final edit ca. 1241, hereafter Formulae of the Imperial Pharmacy). 137 These books listed each formula with a brief indication of the signs and symptoms of the illness it treated. The final edition also included a short introduction to medical practice. References to this book as late as the Yuan Dynasty indicate that it remained popular and widely consulted even after the demise of the Pharmacy Service at the end of the Song.
Miyashita Saburō, “Sō Gen no iryō,” 139–141; Goldschmidt, Evolution, 123–128; Hinrichs, “The Song and Jin Periods,” 100–102.
Transforming Southern Customs As it engaged more actively in epidemic relief—by training doctors, distributing medicines, and publishing medical books (see below)—the Song government claimed a stake in the medical marketplace and put the weight of its prestige behind China’s literate tradition of medicine. In so doing it came into conflict with health-related beliefs and practices in the increasingly populous and important regions of southern China, in particular with the southern ritual healers government officials referred to as “spirit mediums (wu 巫).”138 Southern popular customs were generally looked down upon by the predominantly northern-oriented officials of the Northern Song. North China was seen as the ancestral source of Chinese culture and the seat of its ancient capitals. By contrast, the customs of southern Chinese were viewed as backward or even barbaric. Good magistrates, it was believed, should guide their southern charges away from these uncivilized customs and toward the correct and upright customs of North China. The consultation of spirit mediums during illness was one of the customs singled out for eradication. According to officials’ reports—the only source that survives—spirit mediums encouraged a number of behaviors that were repugnant to the government’s representatives. One of these was the avoidance of the medicines that the government was working so hard to promote. Spirit mediums advised patients to depend entirely on ritual and religious cures. The custom that elicited the greatest opprobrium, however, was the isolation or abandonment of the sick. Spirit mediums were said to encourage healthy family T.J. Hinrichs translates wu as “shaman,” as do many other scholars, though acknowledging the problems with that term, see Hinrichs, “The Medical Transforming of Governance and Southern Customs in Song Dynasty China (960--1279 C.E.),” 11; I have chosen to avoid using the term, “shaman,” not out of deference to Mircea Eliade’s distinction between shamans and spirit mediums, but rather because I consider the word hopelessly problematic. For a diiscussion of these problems see Alice Beck Kehoe, Shamans and Religion: An Anthropological Exploration in Critical Thinking (Prospect Heights: Waveland Press, 2000).
members to stay distant from sick ones, to burn their clothes and blankets, and generally to keep them isolated. This practice was justified in terms of demonic theories of illness in which contagion played a large role. Abandoning one’s relatives when they were suffering was seen as a gross violation of Confucian norms, and although the custom actually had a long history even in North China, southern spirit mediums were blamed for encouraging it.139 It was not the concept of contagion itself that officials—with a few exceptions—opposed.
Contagion had long been recognized in China, and even Zhu Xi—whose interpretation of Learning of the Way (Daoxue 道學) Confucianism ultimately became state orthodoxy— cautioned that attempting to deny something that so clearly existed would only make the people doubt you. The problem was that by refusing medicines the government promoted and abandoning relatives in contradiction to the moral principles the government supported, southern Chinese were in effect defying government authority.140 If the imperial bureaucracy was going to engage in medical governance, it had to insist on recognition of its authority in this sphere just as it did in others. Spirit mediums and their practices were widely accepted in southern society and represented a form of religion deemed undesirable by the Song state. They were singled out as the principal targets in government campaigns to reform southern customs.
The efforts of Song officials were by no means uniform. Some officials took no action whatsoever against spirit mediums. Others took a moderate approach, publishing and distributing medical texts in an attempt to reduce people’s dependence on spirit mediums. Yet others took harsher measures, destroying spirit mediums’ shrines and ordering them to stop their practices or Hinrichs, “The Medical Transforming of Governance and Southern Customs in Song Dynasty China (960--1279 C.E.),” 20–60, 76–100.
even publicly flogging them as a demonstration of the magistrate’s superior power and authority.141 The most intense period of confrontation between spirit mediums and officials was the Northern Song. In the Southern Song, as the government backed away from the activist reform efforts of the late 11th and early 12th centuries, magistrates intervened in these matters with much less frequency. This pattern is also seen in other aspects of medical governance. Neither the Southern Song nor later dynasties attempted to restore the Northern Song’s full array of tools for transforming the populace through medicine. Nevertheless, the impact of these efforts extended far beyond the period of time in which they were active. While the Song elite largely continued to see occupational medical practice as something of low status, the seed of the idea that elite men could also be doctors had been planted, and would eventually bear fruit. The Song government’s medical publications, discussed below, contributed greatly to the medical transformations witnessed from the Song through the Yuan dynasties.
Medical Publishing Arguably the most significant change in the medical landscape of the Song Dynasty was the vast increase in the trade in medical books. The growth of the book trade resulted in a vast increase in the number of books that were written, the number in circulation, and the number that survived to modern times. The number of books published on medicine increased along with those on other topics. These books had a profound impact on the learning and practice of medicine from the Song onward.
The two main sphere’s of medical book production in the Song were government publications and publications by private individuals—whether an individual without government Ibid., 21–26, 76–80, 218, 227–231.
position or an official writing in a private capacity. These two spheres differed in the types of books they produced and in the way those books were received.
Song Government Publishing Before the Song, it was rare for the court to commission the creation of medical texts. A total of five medical books that we know of were produced for the court in all of the pre-Song dynasties. From its inception the Song broke with this precedent, and the state continued to commission and distribute medical books throughout the Northern Song. T.J. Hinrichs has identified three approaches found in different government medical publications: inclusive, exclusive, and pragmatic. Inclusive texts attempted to gather all the knowledge on a given topic within a single book. Key examples of these projects were the various materia medica texts that strove to include all known medicinals throughout the empire. Likewise, early government formularies like Formulae of Sagely Beneficence for the Era of Great Peace were massive attempts at describing all of medical therapeutics in a single book. By contrast, exclusive texts reflected a focus on orthodox knowledge. These texts were usually much shorter than the inclusive projects and for the first time in Chinese medical history distinguished between medical forms of healing and ritual or other non-medical forms of healing. The Treatise on Cold Damage itself was the most significant exclusive text produced by the government but other examples included the texts from the Inner Classic corpus. Pragmatic texts were of a more miscellaneous character. These were generally formularies designed to simplify medical knowledge in a way that made it easier to apply.142 The height of Song government medical publishing occurred between 1057 and 1069, when Emperor Renzong established the Bureau for Editing Medical Texts. The Bureau was Hinrichs, “The Song and Jin Periods,” 102–108.
founded in yet another effort to benefit the people by improving the quality of medical practice.
It was the first—and almost the only—time a Chinese court used medical publication expressly for this purpose. The court was concerned that most important medical texts were in limited circulation in numerous, often erroneous, editions. The Bureau was to correct this problem by producing and distributing accurate editions of these books. Over the course of twelve years, the Bureau produced fourteen books, all of which rapidly became among the most widely cited medical texts in Chinese history.143 Medical texts produced by the government carried a type of authority that other medical texts lacked. They were more widely cited than other texts and seem to have received a more ready reception. It is difficult to discern whether this authority derived from the reflected authority of the government itself or from the fact that the government saw to it that its texts were widely distributed—and private reprinting of government texts no doubt spread them even further. It is also possible that their use in the curriculum of the medical schools may have been a factor in their popularity. Whatever its source, their authority and popularity did not completely prevent medical authors from critiquing them. During the Song, however, such critiques were relatively mild and limited in scope. It was only after the Song that any government medical text was condemned in its entirety.144 Private Medical Publishing It is difficult to gauge how much private medical publishing took place during the Song.
Undoubtedly there were many texts of which no trace now survives. Nonetheless, the fact that Miyashita Saburō, “Sō Gen no iryō,” 135–138; Goldschmidt, Evolution, 87–93.
For an example see the discussion of Zhu Zhenheng’s (朱震亨, 1281-1358) attack on the Taiping huimin heji ju fang in Chapter 5.
some 257 privately produced medical texts are known from the Song indicates that the market for private medical publishing must have been quite large.145 Private individuals during the Song authored all three of the types of texts described by Hinrichs for government publications, but the nature and emphasis of their writing differed.