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This humble official has heard that those who thoroughly understand heaven, earth, and humanity are called scholars. Those who thoroughly understand heaven and earth, but not humanity, are called technicians. It is difficult to call this medicine of ours formulas and techniques. Is it not actually an undertaking for scholars? Ban Gu’s preface to the bibliographic treatise [of the History of the Han (Hanshu 漢書)] … also says that those who practice formulas techniques examine illnesses in order to involve themselves in the state and diagnose [illnesses] in order to understand government. How could one who cannot fathom the abstruseness of the three virtues involve himself in the governance of the state?223 臣聞通天地人曰儒，通天地不通人曰技，斯醫者難曰方技，其實儒者之事乎。班固序 《藝文誌》…又云方技者論病以及國，原珍以知政，非能通三才之奧，安能及國之政 哉。 Song editors preface to Huangfu Mi, Systematic Classic of Acupuncture (Zhenjiu jiayi jing 針灸甲乙經, 280 ), in Huangfu Mi, Zhenjiu jiayi jing jiaozhu, 2.
Medical learning, like other domains of literati learning, was fundamentally textual. Unlike supporters of proven formulae, for whom all texts were created equal, and proponents of authoritative sources, who might choose a single text as particularly reliable, advocates of literati-physician medicine formed a canon of medical classics parallel to the canon of classical learning (ruxue 儒學) and composed of surviving pre-Song medical works. They saw these texts as links between themselves and the origins of medicine in the writings of the sage-emperors of antiquity—particularly the Yellow Emperor (Huangdi 黃帝) and the Divine Farmer (Shennong 神農).224 Like Northern Song scholars of literary and Confucian texts, however, supporters of the literati-physician approach did not value the medical classics as mere cultural forms for imitation;
rather, they sought to use the concepts and principles contained in these texts to help them uncover the root (ben 本) or source (yuan 源) of an illness, knowledge of which made a successful treatment possible:225 Therefore, those who are good at practicing medicine must, once an illness has appeared, first investigate its source, determine how it was transmitted and contracted, scrutinize its generation and conquest [according the five phases],226 distinguish its coolness and heat, coldness and warmth, differentiate whether it is above or below, interior or exterior, whether the true [qi] or the evil [qi] predominates, whether it is vacuous or replete… Each of these has its standard and one cannot err in the slightest.227 故善為醫者，一病之生，必先考其根源，定其傳授，審其刑剋，分其冷熱寒溫，辨其上 下內外，有真有邪，有虛有實… 各有其常而不可差之分毫也。 Literati-physician texts are thus distinguished by a combination of reverence for the medical classics and an emphasis on doctrinal explanation for illnesses.
See, for example, Shanghan lun, Song editors’ preface, in Zhang Ji, Zhongjing quanshu, 303.
The formation of the literati-physician canon is described in chapter 4. Literati physicians’ understanding of how the texts were to be read and used is discussed in chapter 5.
All editions of this text read “punishment and conquest (xingke 刑剋),” a term which I have been unable to locate.
I have translated it here as “generation and conquest (shengke 生剋),” the closest term which would fit the context, though a scribal error of xing 刑 for sheng 生 seems unusual. For more on the five phases see note 54 above.
Shi Kan, Shi Zaizhi Fang, juan xia, “Weiyi zonglun,” in Qiu Peiran, Zhongguo yixue dacheng sanbian, 4:482.
In terms of genre and style, the literati-physician approach’s commitment to a textually and doctrinally rich form of medical learning led to far more variety than was characteristic of the other two approaches. In addition to formularies, the supporters of literati-physician medicine composed treatises on subtle points of doctrine,228 collections of questions and answers for pedagogical use,229 commentaries on the medical classics,230 mnemonic rhymes to help students memorize the essence of the classics,231 and even—for the first time in Chinese history— collections of case histories to illustrate the process of diagnosis and treatment.232 In their literary diversity and sophistication, as in other ways, literati-physician texts sought to meet the standards of elite learning and culture.
Literati Dilettantes or Literati Physicians: The Ideal Medical Knower Throughout the Northern Song, the three approaches to resolving the medical crisis of trust coexisted in harmony. Their supporters did not attack one another; instead, they all participated in the joint attack on common physicians. Moreover, as noted above, there was a large degree of interpenetration among the three. Shen Gua authored what might be considered the paradigmatic collection of proven formulae but cited some of the same texts literati-physician advocates included in their canon. Xu Shuwei was a fervid supporter of the literati-physician approach but cited case records in support of his arguments in all but one of his four extant texts.
The overlap of the three approaches was made possible by a set of assumptions they shared: (1) medicine is both important and abstruse, (2) common physicians are unreliable, and E.g. Cheng Wuji 成無己, Shanghan mingli lun 傷寒明理論, in Cheng Wuji, Cheng Wuji yixue quanshu, 151– 192.
E.g., Zhu Gong, Nanyang huoren shu, in Zhu Gong and Pang Anshi, Zhu Gong, Pang Anshi yixue quanshu, 1– 139.
E.g., Cheng Wuji, Zhujie shanghan lun, in Cheng Wuji, Cheng Wuji yixue quanshu, 1–150.
E.g., Xu Shuwei, Shanghan baizheng ge 傷寒百證歌, in Xu Shuwei, Xu Shuwei yixue quanshu, 1–36.
E.g. Xu Shuwei, Shanghan jiushi lun, in Ibid., 51–80.
(3) some new foundation of authority must be sought to validate medical knowledge and practice.
The third assumption was the point on which the three approaches differed one from another, each relying on a different source of authority to resolve the medical crisis of trust. The proven formulae approach insisted that experience alone should arbitrate the value of therapeutic technique. The authoritative source approach, more modestly, looked to various widely valued authorities—famous texts, family lineages, or the imperial government—as arbiter. The literatiphysician approach chose to rely on a set of texts, the medical canon they were in the process of forming. As shown by the examples of Shen Gua and Xu Shuwei, however, even on this point it remained possible to harmonize the three approaches. Experience could be shown to validate the formulae in the revered texts of the literati-physician canon, which, owing to their long-standing fame and more recent imperial publication, could easily claim to be authoritative sources of medical knowledge.
If a community of trust in medicine was to be formed, however, in addition to agreeing upon an authoritative foundation for medical knowledge, it was also necessary to agree upon what type of person could be trusted to produce medical knowledge on that basis. Who was an ideal medical knower? On this point, the proven formulae and authoritative sources approaches differed irreconcilably with the literati-medicine approach.
Supporters of the first two approaches assumed that common physicians would remain the primary occupational practitioners of textually based medicine, though they were far from the ideal medical knower. The formularies produced within these two approaches were intended as guides for home use, to avoid as much as possible the risks of consulting common physicians.
Like the pre-Song medical compendia discussed in chapter 1, the formularies produced by advocates of these two approaches were often lengthy and made no effort to facilitate retention of the contents by a student. Instead, these texts were usually organized topically—grouping formulae by the illness they treated—to facilitate searching for a remedy when it was needed, and they emphasized simple, easily prepared remedies. For the authors of these texts, the ideal medical knower was a literatus with enough knowledge of medicine to make use of formularies to treat his family and friends but who did not practice medicine as an occupation, in short, a medical-dilettante literatus. Medicine might be a dignified and even laudable interest for a literatus to cultivate, but the practice of medicine as an occupation was still beneath the dignity of the elite.
By contrast, the proponents of the literati-medicine approach were vociferous promoters of the high status of medicine as an occupation. They argued that medical practice was not only an acceptable occupation for members of the elite but also a noble choice which provided a means of benefiting the people. The story of Fang Zhongyan’s youthful desire to become a doctor, recounted above, aptly expresses the convictions of literati-physician medicine’s supporters. Xu Shuwei, characteristically, surpassed even that story in his praise of the virtues of
The Way of medicine is great. With it, one can nourish life, complete the body, fulfill [one’s allotted] years, and benefit all under heaven and generations to come…233 醫之道大矣。可以養生，可以全身，可以盡年，可以利天下與來世… The generic breadth and innovative features of literati-physician texts reflect their authors’ commitment to medicine as an occupation. They are often explicitly pedagogical elucidating fine points of theory or providing easily memorized summaries of the medical classics. The proponents of literati-physician medicine envisioned a new kind of physician, a literatus who brought the education, textual practices, and ethical commitments of the elite to the study and Puji benshifang, author's preface, in Ibid., 83.
practice of medicine. I call such doctors literati physicians. They simply called themselves physicians (yi 醫 or yizhe 醫者),234 for they saw themselves the only practitioners of the authentic medicine passed down from antiquity. Those who did not meet their standards they denigrated as vulgar doctors (yongyi 庸醫), common physicians, or medical workers (yigong 醫工). Medicine was a literati occupation, and anyone who did not at least conform to the norms of elite learning and behavior was unqualified as a physician.
At the same time, literati-physician medicine’s emphasis on textual learning also produced a radical change in the way physicians learned medicine. If medical learning, like the more well-established field of literary learning, was rooted in texts, it became possible to study medicine by oneself.235 Even if one studied with a teacher, the relationship between the teacher and the students was no longer that of master and disciple, but rather that of a classical teacher and his students. The teacher helped to explain and supplement the texts, but the primary act of learning occurred between the students and the texts themselves. It was therefore possible to study with multiple teachers simultaneously, and no bonds of secrecy were laid on the material learned.236 By altering the nature of medical learning, the supporters of the literati-physician approach made the practice of medicine more palatable to the elite, for whom textual learning was the norm.
The sharpness of the distinction between the three approaches on this point is made clear by a comparison of the authors of extant Northern Song formularies (see table 3-1).237 Not one In the late Northern Song, a new term ruyi 儒醫 would be developed. It may be translated as “literati physician” and was used to indicate a physician with the literary learning expected of a literatus, but the term was not widely used at this time, Goldschmidt, Evolution, 56–57.
Chen Yuanpeng, Liang Song de “shangyi shiren,” 116–127.
Leung, “Medical Learning from the Song to the Ming,” 387; Yiyi Wu, “A Medical Line of Many Masters: A Prosopographical Study of Liu Wansu and His Disciples from the Jin to the Early Ming,” Chinese Science, no. 11 (1994): 44–45.
I have limited the comparison to formularies since proven formulae authors did not work in other genres.
author of a proven formulae or authoritative source text was a practicing physician, while all but one of the authors of literati-physician texts are known to have been practicing physicians as well as literati. The exceptional literati-physician author, Shi Kan (史堪, late 11th-early 12th c.), was almost certainly a physician, judging by the section in his text titled, “General Treatise on Practicing Medicine (Weiyi zonglun 為醫總論),” but biographical data on him is lacking. The division into three approaches on the basis of the authority chosen as the foundation for medical knowledge thus conceals a more basic partition into two approaches characterized by the choice of ideal medical knower. If the three approaches were reconcilable in terms of their preferred source of medical knowledge, they were absolutely irreconcilable on this issue.
CONCLUSION: The Unresolvable Dilemma of Song Medicine Harry Collins has observed that in modern scientific discourse, experiment can only serve as a test to decide between propositions when it is already known what the outcome of the experiment ought to be. Otherwise, there is no way of being certain that the experiment was not invalidated by some error in its performance. If we do not know what a successful outcome to the experiment would look like—as we typically do when we wish to use an experiment to For further discussion of the problems surrounding these texts see Su Shi and Shen Gua, Su Shen neihan liangfang, 263–264; and Ma Jixing, Zhongyi wenxianxue (Shanghai: Shanghai Kexue Jishu Chubanshe, 1990), 180.
answer a question—a potentially infinite regress is produced which he terms “the experimenter’s regress.”239 As he explains using the example of modern experiments designed to detect gravity