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the prodigious, innovative, and contentious output of Song statesmen and social thinkers was in large part driven by these questions, and that the ultimate success of the Learning of the Way movement (Daoxe 道學) was primarily due to its ability to provide satisfactory answers.179 Furthermore, the limits of acceptable elite activities were in flux to such an extent that even those in the highest echelons of the elite had difficulty knowing where the boundaries might lie. If Ouyang Xiu’s (歐陽修, 1007-1072) experiments in novel forms of elite involvement in the arts and literature were largely successful,180 his experiments, with Fan Zhongyan, in justifying novel forms of political organization among officials collided disastrously with boundaries which proved far more solid than he anticipated.181 Even the question of elite membership itself was more problematic than before.
Bol, This Culture of Ours, 1994, 334.
Ronald C. Egan, The Problem of Beauty: Aesthetic Thought and Pursuits in Northern Song Dynasty China (Harvard University Asia Center, 2006), 7–59, 109–161.
Levine, Divided by a Common Language, 10, 47–56.
Chaffee, Thorny Gates, 161–162; Hugh R. Clark, “Reinventing the Genealogy: Innovation in Kinship Practice in the Tenth to Eleventh Centuries,” in The New and the Multiple: Sung Senses of the Past, ed. Thomas H. C. Lee (Hong Kong: Chinese University Press, 2004), 237–86; Robert Hymes, “Marriage, Descent Groups, and the Localist Strategy in Sung and Yuan Fu-Chou,” in Kinship Organization in Late Imperial China, 1000-1940, ed. Patricia Buckley Ebrey and James L. Watson (Berkeley: University of California Press, 1986).
Hymes, “Sung Society and Social Change,” 643–645.
Solutions, however, were more easily conceived than agreed upon. Peter Bol describes what he terms a “crisis of culture” beginning in the late 8th century. At the core of this crisis lay a separation between cultural forms (wen 文) and the Way (Dao 道) or moral values. A series of failures on the part of the Tang government, most notably the disastrous An Lushan rebellion and the government’s inability to reestablish effective central rule thereafter, convinced many scholars that imitating ancient and revered cultural forms did not necessarily bring the desired results. The scholars who sought to remedy this situation turned to a personal understanding of the Way as the missing component in restoring the efficacy of cultural forms—in particular, of writing (wenzhang 文章)—in transforming the individual and society. In emphasizing the importance of personal understanding, however, these thinkers undermined the possibility of the shared values necessary to their goal of restoring a normative social order.184 The ramifications of this collapse of shared norms reverberated throughout the Northern Song, with each social thinker or statesman identifying a different source for shared values. As Conrad Schirokauer and Robert Hymes have noted, a common feature of Song social thought was a concern for the “nature and locus of authority.”185 More specifically, this issue resolved into two related questions: what were the sources or grounds of authority and in what type of individual or group could this authority be vested.186 The crisis that Bol describes, however, was not limited to revered cultural forms, debates held at court, or the highest echelons of society. The quotes from elite medical texts cited above display anxiety over the grounds of medical authority and the qualities of the proper doctor.
Likewise, the arguments over who was and was not a member of the elite reveal similar concerns Bol, This Culture of Ours, 1994, 109.
Hymes and Schirokauer, “Introduction,” 36.
about the grounds of elite identity and the characteristics which should distinguish the elite from others. Moreover, worries about the grounds of trust and the identification of trustworthy individuals even reached into mundane aspects of life. In an analysis of material found in the jottings of Hong Mai (洪邁, 1123-1202), Robert Hymes finds such worries in discussions of religion, marriage, business transactions, and many other areas. The frequency of these anxieties led him to argue for a “pervasive concern with truth, falsity, fakery, and pretense in Song elite and commoner culture.”187 My own study of the medical jottings literature supports this suggestion: the most common medical jottings from the Song are complaints about betrayals by doctors and pretense on the part of the new medical officials.188 The crisis of culture that Bol discusses was a pervasive feature of Song intellectual life at least among the literati elite, and perhaps reaching into the lower social strata as well. Why were the issues of trust, doubt, and the need for authoritative knowledge so prevalent in Song writing?
The importance of trust in social order has been remarked upon since antiquity.189 Discussions of the role of trust in the production of knowledge, though far more recent, are by no means new. Writing in the 19th century, Georg Simmel observed, … existence rests on a thousand premises which the single individual cannot trace and verify to their roots at all, but must take on faith. Our modern life is based to a much larger extent than is usually realized upon the faith in the honesty of the other. Examples are our economy, which becomes more and more a credit economy, or our science, in which most scholars must use innumerable results of other scientists which they cannot examine.190 Robert Hymes, “Truth, Falsity, and Pretense in Song China: An Approach through the Anecdotes of Hong Mai,” in Zhongguo Shixue Di 15 Juan, 2005, 23.
E.g., Shen Gua, Mengxi biji, juan 1, in Tao, Biji zazhu yishi bielu, 1; Hong Mai, Yijian zhi 夷堅志, ding zhi, “Wu zhi sha ren,” in ibid., 739–740; Yijian zhi, geng zhi, “Yongyi sha ren,” in ibid., 740–741.
Steven Shapin, A Social History of Truth: Civility and Science in Seventeenth-Century England (Chicago: The University of Chicago Press, 1995), 8–15.
Georg Simmel, The Sociology of Georg Simmel (New York: Free Press, 1964), 313.
Likewise, the pragmatist philosopher, William James, noted that, “Truth lives, in fact, for the most part on a credit system.”191 More recently, the trust-dependent nature of knowledge has become an important issue in science studies. Speaking form a philosophical point of view, John Hardwig argues that, since it is impossible for any individual to verify all of the data upon which any but the simplest conclusions rest, “The trustworthiness of members of epistemic communities is the ultimate foundation of much of our knowledge,” and therefore, “In order to qualify as knowledge (or even as rational belief), many epistemic claims must meet ethical standards. If they cannot pass the ethical muster, they fail epistemologically.”192 In the words of Steven Shapin, speaking from the point of view of social history, knowledge depends on a “moral economy” of trust, and such a moral economy can only be created and maintained by a community.193 Communities, however, are dependent for their existence upon social order, and social order, in its turn, is dependent upon trust. Trust is thus constitutive of and produced by the community, and any serious disruption to social order threatens production of knowledge by disrupting the moral economy of trust.194 Solutions to such crises of trust must address both social order and the validity of knowledge. A new moral economy of trust must be formed by creating a community which shares a consensus about what sources of knowledge are reliable and which individuals or groups are trustworthy wielders of those sources; hence, as Shapin and William James, Pragmatism and The Meaning of Truth (Cambridge: Harvard University Press, 1978), 100.
John Hardwig, “The Role of Trust in Knowledge,” The Journal of Philosophy 88, no. 12 (December 1991): 694, 708.
Shapin, A Social History of Truth, 22–27, 34–36.
Steven Shapin and Simon Schaffer, Leviathan and the Air-Pump: Hobbes, Boyle, and the Experimental Life, Reprint (Princeton: Princeton University Press, 2011), 283–298; see also Diego Gambetta, “Mafia: The Price of Distrust,” in Trust: Making and Breaking Cooperative Relations, ed. Diego Gambetta (New York, NY, USA: B.
Blackwell, 1988), 158–75, which discusses the consequences of a breakdown in trust, but focuses on issues other than knowledge-production.
Simon Schafer observe, “Solutions to the problem of knowledge are solutions to the problem of social order.”195 The momentous changes occurring in all areas of life from the late Tang through the Song—particularly the radical changes in the composition, status, and justification of the elite social stratum— disrupted the economy of trust within Chinese elite society. The resulting crisis was felt in many different sectors of society, and the attempts to remedy this crisis created a period of intellectual and social foment. In view of breadth of this crisis, I follow Shapin and term it a crisis of trust, rather than a crisis of culture.
In the sphere of medicine, the crisis of trust among the elite was as severe as it was in spheres of literary learning and statecraft. Northern Song medicine witnessed a period of intense competition as differing approaches were put forward by elite authors to resolve the crisis of trust. The solutions offered differed in fundamental ways, but they were in agreement on one point: the condemnation of common physicians.
The Problems with Common Physicians and their Medicine In the case of medicine, the Song elite’s anxiety was no doubt heightened by the increasing numbers of epidemics with which they were threatened, as discussed in chapter 2. The perceived inability of common physicians to deal with the new illnesses may have increased the opprobrium with which they were viewed by the Song literati, but while elite authors were aware of certain aspects of their new epidemiological situation, they placed responsibility for the failure of medical treatment squarely at the feet of common physicians.
Shapin and Schaffer, Leviathan and the Air-Pump, 332.
Lumpenliterati physicians might look (to an outsider) quite similar to members of the literati. They were literate, and their medical practice was based on the study of texts, but their literacy, their relationship with texts, and their ethical standards all differed from those of the literati as they were coming to define themselves. It was on precisely these points that Song elite medical authors criticized them. Not only were their medical practices and understanding impugned, but their methods of learning, business practices, and personal character were also maligned.
Unfortunately, while traces of what appear to be common physician practices and formulae are found in Northern Song elite medical texts, they are never explicitly identified as such.196 Furthermore, physicians like Qian Yi (錢乙, 1035-1117) and Pang Anshi, who may have come from a lumpenliterati background, only wrote books after they had been accepted in elite society. Both what they chose to write and how it was received were therefore altered. The only surviving evidence of Northern Song common physicians’ ideas and practices, therefore, are the criticisms elite medical authors leveled against them. While such sources must be used with caution, there are reasons to believe that what they report is basically accurate. First, many of their criticisms are not found in elite criticisms of physicians before the Song; second, the criticisms are consistent without repeating one another; third, they are consistent with what little we do know of the practices of physicians prior to the Song; and fourth, they are consistent with some of the idiosyncrasies found in medical texts from the first century of the Song (before the Bureau for editing medical texts began its publications) and texts by figures like Qian Yi and Pang Anshi. Finally, even if these criticisms are not accurate portrayals of how common In the Southern Song (1127-1279), some texts explicitly claimed common physician provenance, such as Effective Formulae from Common Physicians (Shiyi dexiaofang 世醫得效方), but their contents were at the very least framed by the doctrines of the new medical canon, discussed below. It is doubtful that they are truly reflective of common physician practice, though they may have been important avenues by which certain formulae or other practices of common physicians gained entry into the new elite medicine.
physicians practiced in the Song, they are accurate depictions of how the elite viewed the practice of common physicians. Since the actors responsible for the medical changes I am examining were all members of the elite, it is the viewpoints of the elite which are important for this argument.
The most frequent accusation made by elite medical authors was that common physicians’ approach to medicine was too facile. As suggested by the quotes which opened this chapter, the elite were deeply impressed by the overwhelming complexity of illness and healing.
Illnesses came in myriad forms, diagnosis required tremendous skill and experience, knowing which medicinal to use required long study, and variations in the environment due to location, the seasons, and the particular climate of a given year further muddied the picture. According to elite authors, common physicians’ approach to medicine was too simple to take account of this mass of complexity.
In treating cold damage illnesses, for example, common physicians often made use of only two treatment methods, sweating and purging, and determined which was to be used
according to how many days had passed since the illness commenced: