«Stephen Boyanton Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and ...»
What the correct answer is depends on whether there are gravity waves hitting the Earth in detectable fluxes. To find this out we must build a good gravity detector and have a look. But we won’t know if we have built a good detector until we have tried it and obtained the correct outcome! But we don’t know what the correct outcome is until… and so on ad infinitum.240 The endless loop of the experimenter’s regress can only be broken by finding criteria outside of the experiment itself by which to decide which outcomes count as successful. In contemporary scientific practice, the regress is closed by a social process of consensus building in which a small group of interested parties, which Collins calls the “core group,” decides how the experimental results will be interpreted. These core groups are private, not because they exclude outsiders by rule, but because outsiders lack both the technical knowledge and the socialization necessary to participate in the discussions of the group. The closed nature of the core group makes resolution of the experimenter’s regress possible by limiting the size of the group which will negotiate to determine the meaning of experimental results and by obscuring the socially contingent process by which they did so.241 Song medical thinkers did not engage in experiments, but they did rely on experience as a guide to which approach to medicine was the most successful.
Ibid., 84, 142–145.
fickleness of climate could explain any given instance of a treatment’s failure. Like modern experimenters, Song medical thinkers found themselves in a position where the only way to evaluate the three approaches was to start from an assumption about which one was correct and evaluate therapeutic results accordingly. Unlike modern experimenters, Song medical thinkers did not have recourse to private core sets to resolve this dilemma. Medicine in the Song remained an open subject. Any educated individual could learn enough by self-study to enter the debate, and sick people and their families felt no compulsion to accept a doctor’s advice as better founded than their own. The nature of the conflict between the three approaches was such that it could not be resolved on formal or experiential grounds, and the social mechanisms for resolving it were lacking. Ultimately, therefore, it was not possible for Northern Song medical authors to resolve the crisis of trust in medicine, and the Northern Song bequeathed a fractured medical heritage to the periods that followed.
The resolution of this dilemma did not occur until the Yuan, when social and political changes led to large numbers of the literati taking up medicine as an occupation.242 For this reason, this dissertation takes the late Yuan and early Ming as its closure. In the ensuing roughly two-and-a-half centuries, all three approaches continued to have representatives, but the literatiphysician approach grew increasingly dominant, vastly out-producing the other two approaches in terms of medical texts and—of course—well-known physicians. More importantly, for the argument of this dissertation, it was literati physicians who made the Treatise on Cold Damage central to their medicine by using it as tool to fashion their identity, their medicine, and their arguments against their opponents. The remaining two chapters of this dissertation therefore Hymes, “Not Quite Gentlemen?,” 64–66.
examine the nature of and reasons for the Treatise’s appeal to literati physicians and the process by which it was enshrined at the heart of literati-physician medicine.
The modern secondary literature offers three explanations for the dramatic upswing in writing about the Treatise on Cold Damage. The first is primarily found in medical history texts written by Chinese physicians. The extremely influential work of Ren Yingqiu 任应秋 can serve to represent this point of view. Ren presents the development of a literature devoted to the Treatise as a natural and logical unfolding of the clinical principles and methods inherent in the text. For Ren the value of the Treatise is a given; therefore, no explanation of its attraction to Song medical authors is necessary. These authors simply correctly recognized the Treatise as a useful text and set about understanding and explaining it. The gap between the Discourse’s composition and the Song renaissance of writing on it is presented without explanation as a period of developing ideas.243 The second explanation is that of Paul Unschuld. He argues that the Treatise’s popularity derived from two developments. First, Song dynasty authors favored an approach that makes use of a “restricted etiology,” reducing the cause of all illnesses to one pathological factor—cold in the case of the Discourse. Second, Song authors saw the Treatise as the first medical text that combined the doctrines found in the Yellow Emperor’s Inner Classic with pharmaceutical therapy as opposed to acumoxa.244 The third and most recent explanation is that of Asaf Goldschmidt. He provides detailed evidence to show that the Song government published the Treatise to combat a rise in the frequency and severity of epidemics that occurred during the mid-eleventh century. Goldschmidt argues, as we saw in Chapter 1, that the Treatise and its ideas were not known among contemporary Song physicians. He concludes that the Ren Yingqiu, Qiu Peiran, and Ding Guangdi, Zhongyi gejia xueshuo (Shanghai: Shanghai Kexue Jishu Chubanshe, 1986), 8–9.
Unschuld, Medicine in China, 166–169.
decision to publish the Treatise was an idiosyncratic decision of the Bureau’s editors who were government officials and not physicians. Had they been physicians, they would have chosen some other book to publish. Following its publication, physicians felt a need to reconcile the conflicting theories of the Treatise with the medical practices then current, leading to the upsurge in writing on the Discourse.245 All three of these explanations are lacking in important ways. Ren Yingqiu’s discussion offers no real explanation and assumes both a socially unmediated value for the Discourse and a teleological line of development. The first part of Unschuld’s explanation simply does not accord with the evidence available to us. Unschuld’s concept of a “restricted etiology” clearly derives from the work of the “four great masters of the Jin-Yuan era (Jin-Yuan sidajia 金元四大家)”— four famous physicians whom later generations credited with founding currents246 of medical theory focused on particular etiologies. Recent research demonstrates the four great masters did not see their own work in this way, and there is good evidence that Song physicians did not favor such a practice. Consider, for example, the famous Song supporter of the Treatise, Zhu Gong, who explicitly criticizes physicians who do not distinguish between hot and cold illnesses, or his younger contemporary Xu Shuwei, who repeatedly emphasized that the essence of Zhang Ji’s medical ideas was to distinguish between, “exterior and interior, vacuity and repletion.”247 Unschuld’s second argument—that Song physicians saw the Treatise as the first text to integrate drug therapy with the theories of the Inner Classic—is not refuted by any known evidence, but Goldschmidt, Evolution, 69–72, 171–172.
I am indebted to Volker Scheid for this translation of the Chinese term pai 派, see Volker Scheid, Currents of Tradition in Chinese Medicine 1626-2006, 1st ed. (Eastland Press, 2007), 11–13.
E.g., Book on Saving Lives (Huoren shu 活人書, 1118), authors preface, in Zhu Gong, Huoren shu, ed. Wan Yousheng, Zhongyi guji zhengli congshu (Beijing: Renmin Weisheng Chubanshe, 1993), 19; and Songs on One Hundred Patterns of Cold Damage (Shanghan baizheng ge 傷寒百證歌, mid 12th c.), diliu zheng biaoli xushi ge, in
Xu Shuwei, Xu Shuwei Shanghan Lun Zhu Sanzhong, ed. Chen Zhiheng, Zhongyi Guji Zhengli Congshu (Beijing:
Renmin Weisheng Chubanshe, 1993), 217.
not supported by any known evidence either. Song authors assume the Inner Classic and the Treatise are in harmony, but never cite this as a reason for promoting it.
Goldschmidt’s explanations for the government’s publication of the Treatise are compelling, but his explanation for the flood of private authors writing on the Treatise is less so.
First, his proposal that intellectual dissonance alone was adequate to motivate a large number of people—some of whom were not even practicing physicians—to write at length on the Treatise seems highly unlikely in the absence of a broader and more immediate motivation. Dissonance between doctrines has been quite common in the history of medicine in China, and no other case of dissonance has produced a response like that seen in the Song. Second, we have seen that his assumption that Song dynasty medicine prior to the publication of the Treatise was radically different from the medicine contained in the Treatise is unsupported. We have no texts that indicate the existence of such a diverging medical tradition, and the evidence presented in Chapter 1 indicates that the Treatise was well-known, highly valued, and circulating in multiple editions among physicians prior to its imperial publication.
In contrast to these three explanations, I argue that the increased centrality of the Treatise on Cold Damage in textually based medicine from the Song onward is due to the formation of literati medicine at this time. In particular, it was the usefulness of the Treatise to literatiphysician medicine, and the ultimate dominance of that form of literati medicine, which secured the Treatise’s position.
As we saw in Chapter 3, literati-physician medicine differed in important ways from both the proven-formulae and authoritative-source approaches to resolving the Northern Song crisis of trust in medicine. Only literati-physician medicine was primarily supported by members of the literati-elite who were practicing physicians and sought to form a medical canon modeled on the literary canon studied in preparing for the civil service exams. The Treatise on Cold Damage was a preeminent part of that emerging medical cannon, and it is the ultimate success of literati physicians in dominating Chinese text-based medicine which secured the Treatise’s centrality to later Chinese medical thought and practice. The following two chapters explore the reasons for literati physicians’ fondness for the Treatise. Writing about the Treatise on Cold Damage was neither a natural response to its inherent excellence nor an attempt to resolve intellectual discomfort caused by its supposed divergence from current standards. Rather, it was a conscious argument for a particular kind of medicine, and it was the usefulness of the Treatise in making that argument that led Song authors to write about it in such numbers. Chapter 4 examines why the Treatise was useful in the formation of the literati physician community and in its interaction with society at large. Chapter five investigates how the Treatise was helpful in dealing with the variability and complexity of illness—the central concern of elite medical authors. Before doing so, however, it is necessary to discuss in more detail what literati-physician medicine was and how medical books were used.
Literati-Physician Medicine as a Cultural Tradition and Thought Collective In his study of European Renaissance natural history, Brian Ogilvie adapted Marshall Hodgson’s concept of a cultural tradition to describe European natural history as a phenomenon with continuity over a considerable length of time. He defines a cultural tradition as a “continuity within a group that shares a common commitment to … an evolving problematic and method.”248 This definition includes three parts: a community, a problematic, and a method. The provenformulae and authoritative-source approaches possessed a problematic and a method, but neither Brian W. Ogilvie, The Science of Describing: Natural History in Renaissance Europe (Chicago: University of Chicago Press, 2006), 10.
of them attempted to create a new community. Their sense of community was extended to the entirety of the elite stratum of society. Only literati-physician medicine envisioned a new medical community—the group of literati physicians—unified by its commitment to addressing a particular problematic—the complexity of illness—with a shared method—individualizing treatment in accord with the theories found in the newly formed medical canon.
The literati physician as the ideal medical practitioner was central to the coherence of the literati physician community. The ideal medical practitioner for the proven-formulae or authoritative-source approaches was simply an elite man. They expanded a preexisting social role in the repertoire of elite men—who had always been expected to be informed consumers in the healthcare marketplace—but they did not create anything new. The literati physician, on the other hand, was a new social being that had never existed previously. This is not to say that elite men before the Song never studied or practiced medicine. Some of them certainly studied medicine, and it is likely that a few of them even practiced medicine as an occupation. Such individuals were literati and physicians (though perhaps not both in the same moment), but they were not “literati physicians” because no such role existed. In describing the coming into being of “possible ways of being a person,”249 Ian Hacking argues that in the case of humans, new ways of being a person are more than merely new names for old behaviors. Unlike objects, humans make choices about how to behave. Social roles not only define existing behaviors, but also generate new ones: “The category and the people in it emerged hand in hand.”250 The role of literati physician came into being with the first literati physicians, and in doing so opened up new ways of being a physician, a literatus, and a person. The community of literati physicians was, at its most basic level, founded on this new, shared identity.
Ian Hacking, “Historical Ontology,” in Historical Ontology (Cambridge: Harvard University Press, 2004), 2.