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Private authors were far less likely than the government to produce inclusive texts. No doubt the amount of time and effort required for such massive texts was more than most individuals were willing to undertake. Nonetheless, privately produced materia medica and comprehensive formularies—such as Liu Fang’s New Book on Children (Youyou xinshu 幼幼新書, 1150) which collected a vast number of formulae for treating children—were produced. Privately produced exclusive texts included two distinct genres. On the one hand, some of them, such as Luo Longyan’s (駱龍言, fl. late 13th c.) Formulary Supplementing Omissions in the Inner Classic (Neijing shiyi fanglun 內經拾遺方論, 1279) were commentaries or explanations of canonical texts, but others, such as Shi Song’s (史崧, fl. mid 12th c.) edition of the Numinous Pivot (Lingshu 靈樞, 1155)—part of the Inner Classic corpus—were canonical texts without commentary. Pragmatic publications were by far the most common privately produced medical text. The exceptionally numerous private formularies written during the Song are the key example.
Some privately produced texts enjoyed widespread popularity and authoritative status.
Zhu Gong’s Nanyang Book for Saving Lives (Nanyang huoren shu 南陽活人書, 1118) inspired three other works that supplemented it or simplified it for ease of memorization and was regularly cited in most Song books on cold damage.146 No privately produced work, however, This count is based on data in Wang Ruixiang and Wei Wang, Zhongguo guyiji shumu tiyao.
See Yiji Xulu Ji, 99–101.
enjoyed the universal appeal of the government publications, and detractors were generally both more numerous and harsher in their criticism.
The Consequences of Medical Publishing The increasing availability of medical books, both authoritative ancient texts and modern medical books of all sorts, had a number of important consequences for the study and practice of medicine during the Song. As noted in Chapter 1, the circulation of authoritative texts in standard editions meant that medical authors could debate the meaning of these texts with a precision not possible when variant editions made it unlikely that any two authors held exactly the same text. The ability to publish one’s ideas more readily also made intertextual dialogue simpler and more common. Another significant change brought about by the medical book trade was the ability of elite men and others to study medicine from books. The phenomenon of bookeducated physicians is first seen in the Song, and even those doctors who had studied with a teacher undoubtedly learned a great deal from reading as well. The availability of books fundamentally changed the process of learning medicine.147 Conclusion: The Song as a Watershed in Medical History Scholars have long appreciated that the Song laid the foundations for many of the developments in the late imperial period. By contrast, until the last fifteen years or so, most evaluations of medicine in the Song and the succeeding Jin and Yuan dynasties have presented it as an anomalous period distinct from the periods before and after it. This impression may be the result of carrying over traditional ideas about the history of Confucian thought—in which the Chen Yuanpeng, Liang Song de “shangyi shiren,” 56–62; Leung, “Medical Learning from the Song to the Ming,” 391–392.
Song came to be seen as an exceptional period—into histories of medical thought. Recent research, however, has suggested that the Song was profoundly influential on the development of Chinese medical thought and practice up to today. In this dissertation, I will argue that the Song represents a major point of rupture in Chinese medical history, shaping the broad outlines of much that followed, and that the changing status of the Treatise on Cold Damage was precisely due to its role in these momentous changes.
These five [difficulties in the practice of medicine] are [here] merely stated in outline.
Their subtlety reaches the point that speech cannot express it; their details reach to the point that writing cannot record them. How can vulgar people easily speak of medicine!
此五者，大概而已，其微至於言不能宣，其詳至於書不能載，豈庸庸之人而可以易言 醫哉！ —Shen Gua (沈括, 1031-1095), Excellent Formulas of Su and Shen (Su Shen liangfang 蘇沈良方, early 11th c.)148 As for where medicine comes from, it all has its source in the two books of the Divine Farmer and the Yellow Emperor. It is profound and subtle. There is nothing which does not tally with the principle of yin and yang, the five phases, dissolution and growth, nor fail to accord with the mutually complementary ways of ruler and minister. Therefore, it is not something into which the vulgar or common can delve.
夫醫藥之來，皆源於農黃二書。其奧博微妙，莫不符契陰陽五行消長之理，脗合君臣 相與之道，則固非庸流俗輩所能鉤索之也。 —Meng Zhen (孟震, fl. late 11th c.), Essential Formulae for Travelers (Lüshe beiyao 旅舍備要方, 1093)149 The two authors quoted above are typical of Northern Song elite writing on medicine.
Central to elite thought on medicine at the time was anxiety regarding the extreme complexity of illness and healing and a conviction that the typical medical practitioner of their day was hopelessly inadequate to face that complexity. This anxiety and conviction were not new.
Northern Song writers on medicine could look back to a long tradition of similar complaints;
however, Northern Song medical anxiety differed from its predecessors both in the frequency with which it was voiced and in the sustained nature of the efforts made by both the imperial government and private individuals to remedy the situation.
The Northern Song elite were experiencing a crisis of trust in the learned medicine of Author’s preface, in Su Shi and Shen Gua, Su Shen neihan liangfang, 3. This preface comes from the no longer extant Excellent Formula Collected by Shen (Shen cunzhong liangfang 沈存中良方) which dates to ca. 1090. All translations and punctuation of Chinese texts my own unless otherwise specified.
Preface, in Siku Quanshu, 4.
their times, and their efforts to solve this crisis reshaped the medical landscape of their society in profound ways. The solutions developed by Northern Song medical authors envisioned radical and to varying degrees incompatible reworkings of medical thought and practice, which would continue to interact with one another until the Yuan dynasty.
This chapter falls into two parts. Part One begins by presenting the medical worries and complaints that troubled the Northern Song literati, and the figure around which their anxiety clustered: the common physician.150 I then examine the broad intellectual crisis of the Northern Song of which the medical crisis of trust was but one facet. Part Two opens with an analysis of the three methods proposed to solve the medical crisis of trust. I argue that these solutions offered radically different proposals for the reformation of medical learning and practice and the elite’s relation to both. While not wholly incompatible, the three proposals differed sufficiently to render any simple synthesis of them impossible. In the absence of any means of deciding between the solutions offered, the Northern Song bequeathed to succeeding eras three separate, though interacting, approaches to learned medicine The traditional translation of this term as “hereditary physician” is clearly incorrect. Many such physicians were not members of medical family lineages. Authors often urged their readers not to trust a physician whose family had been practicing medicine for less than three generations, attesting to the fact that many physicians did not have such pedigree. The translation “occupational physician” is also overly specific since some members of the Song elite took up medicine as an occupation, but were never called shiyi. I chose the translation “common physician” to avoid these errors and capture the conflation, common among the Song elite, between social status and medical skill. E.g., physicians like Qian Yi (錢乙, ca. 1035-1117) and Pang Anshi, whose families were shiyi, were no longer referred to as such once their status as learned doctors was accepted among the elite, and I have found no instance of a literatus who practiced medicine being referred to as a shiyi even in heated disputes.
SECTION ONE: The Northern Song Crisis of Trust in Medicine Northern Song Elite “Interest” in Medicine It has become something of a historical cliché that the Song elite were interested in medicine. Qing dynasty (1644-1911) observers were already aware of this anomaly in elite intellectual activity.151 More recently it has become the subject of an entire book, and a key issue in others.152 This interest has generally been read as a sign of the high or at least rising status of text-based medicine among the elite,153 but social historical research has tended to question such conclusions.154 An examination of the motives behind those statements and actions which are seen as reflecting a rise in the status of medicine reveals a more complicated picture: medicine, as a topic of curiosity or even of serious study, had become more interesting to Song intellectuals; physicians, on the other hand, were generally despised.
Some of the evidence for the high status of medicine in the Song results from misreading later stories backward into the Northern Song. One such story, which in fact dates from the Southern Song, purports to relate an incident from the childhood of the Northern Song prime minister, Fan Zhongyan (范仲淹, 989-1052). In this story, Fan is said to have asked an oracle whether he will be able to rise to the position of prime minister. On receiving a negative answer, he proceeded to ask if he would be able to become a good physician. On again receiving a Jiang Chaobo (蔣超伯, 1820-1875), Nanchun Kuyu 南漘楛語, juan 6, in Tao Yuefeng, ed., Biji zazhu yishi bielu (Beijing: Renmin Weisheng Chubanshe, 2006), 2.
E.g., Chen Yuanpeng, Liang Song de “shangyi shiren”; Goldschmidt, Evolution.
Joseph Needham and Lu Gwei-Djen, “Medicine and Chinese Culture,” in Clerks and Craftsmen in China and the West (Cambridge: Cambridge U.P., 1970), 265; Joseph Needham and Lu Gwei-Djen, “China and the Origins of Qualifying Examinations in Medicine,” in Clerks and Craftsmen in China and the West Ȃ: Lectures and Addresses on the History of Science and Technology (Cambridge: Cambridge U.P., 1970), 391–395; Goldschmidt, Evolution, 19.
Hymes, “Not Quite Gentlemen?” negative answer he became despondent about his future. When questioned by his relatives as to why he wished to become a physician, he responded, The ancients had a saying, “[The Sage is] always good at rescuing people, and therefore no one is forsaken; always good at rescuing the world, and therefore nothing will be cast aside.”155… As to being able to reach the great and the small among the people, admittedly, only a prime minister can do so, but that was already unattainable. So, for being able to realize the intention of rescuing people and benefiting the world, none compare with a good physician.156 古人有云：“常善救人，故無棄人，常善救物，故無棄物。”… 能及小大生民者，固惟相 為然，既不能得矣。夫能行救人利物之心者，莫如良醫。 Later authors would summarize the moral of this story with the phrase “If you cannot be a good minister, then be a good physician (不為良相，則為良醫, or variations to that effect).”157 This phrase has since been attributed to Fan by several modern scholars.158 It does not, however, appear in his collected works.
The more substantive argument for a rising status of medicine during the Song is based largely on the actions of the imperial government and some of its chief representatives. The early emperors of the Song dynasty were said to possess not only interest in medicine but also competence in its practice. They sponsored the composition of several medical texts, on some of which they bestowed imperial prefaces.159 As discussed in chapter 2, later Northern Song emperors sponsored the editing and publication of famous medical texts, the composition of a This is a quote from the Daode jing, chapter 27. A more literal translation would read, “[The Sage is] always good at saving people, and therefore no one is rejected; always good at saving things, and therefore nothing is rejected,” e.g. Laozi, The Way of Lao Tzu (Tao-Tê Ching), trans. Wing-tsit Chan (Indianapolis: Bobbs-Merrill, 1963), 146. Other Song authors, however, use the phrase “jiushi 救事” to indicate ensuring that situations turn out as positively as possible, e.g. “Since I already made rescuing the world my intention… (予既以救物為心…),” Puji benshifang, author’s preface, in Xu Shuwei, Xu Shuwei yixue quanshu, 83).
Wu Zeng 吳曾, Neng gaizhai manlu 能改齋漫錄, juan 13, in Yufeng Tao, ed., Biji zazhu yishi bielu (Beijing Shi:
Renmin Weisheng Chubanshe, 2006), 738.
E.g., Wu Weiye 吳偉業, 1609-1671, Meicun jiacang gao 梅村家藏稿, 44.2a, in Sibu Congkan, Electronic ed.
(Beijing: Beijing Shutongwen Shuzihua Jishu Youxian Gongsi, 2010).
E.g., Charlotte Furth, A Flourishing Yin Gender in China’s Medical History, 960-1665 (Berkeley: University of California Press, 1999), 63; Goldschmidt, Evolution, 44.
Goldschmidt, Evolution, 22–26.
number of innovative medical texts, and the establishment official medical schools, an imperial pharmacy, a medical examination system, and a hierarchy of imperial medical officials designed to parallel the prestigious civil bureaucracy with its schools and examination system.160 These developments clearly reveal that medicine was an important preoccupation of the Song imperial government, but they do not of themselves demonstrate that the status of medicine was high. On the contrary, had the status of medicine already been elevated, there would have been no need for government intervention. The Northern Song government’s161 persistent concern with medicine indicates, rather, a desire to raise the status of medical practice and therefore suggests that medicine remained a low-status occupation in the eyes of the elite.