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«Stephen Boyanton Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and ...»

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Ian Hacking, “Making up People,” in Historical Ontology (Cambridge: Harvard University Press, 2004), 107.

The ties holding the literati-physician community together, however, were not merely those of shared identity. The community of literati physicians is most clearly revealed in the intertextual dialogues they engaged in through their books. As we saw in the Song physician Xu Shuwei’s response to the Jin doctor Cheng Wuji’s commentary on the Treatise,251 even the division of China into two hostile empires did not split the community of literati physicians or dull their interest in one another’s writings. Historiographically less durable interactions, in the form of conversations and connections through networks of teachers and students, are also documented in scattered references. The literati physician community functioned as a thought collective, defined by Ludwik Fleck as “a group of persons mutually exchanging ideas or maintaining intellectual interaction” which is the “ ‘carrier’ for the historical development of any field of thought, as well as for the given stock of knowledge” and the “thought style” of that field.

A thought style is the distinctive approach to perceiving, understanding, and acting of a given field. Fleck notes, “It is characterized by common features in the problems of interest to a thought collective, by the judgment which the thought collective considers evident, and by the methods which it applies as a means of cognition.”252 In the following two chapters, I bring these two perspectives—literati-physician medicine as cultural tradition and as thought collective—together to shed light on why literati physicians placed such great emphasis on the Treatise on Cold Damage. Chapter 4 focuses on the Treatise’s usefulness in producing, promoting, and defending the community of literati-physicians, and Chapter 5 is devoted to understanding the Treatise’s role in forming the distinctive thought style of literati-physician medicine.

See Chapter 1 for the full quote.

Ludwik Fleck, Genesis and Development of a Scientific Fact (Chicago: University of Chicago Press, 1981), 39, 99.

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The proponents of literati-physician medicine saw neither their medicine nor the social role of literati physician as a novelty. From their point of view, theirs was a return to the authentic and correct in medicine. They were reestablishing a connection with the medicine of the ancient sages, and as such their medicine was simply “medicine (yi 醫)” as it should be learned and practiced. Likewise, the literati physician was simply a “physician (yi 醫)” who learned and practiced medicine correctly. Although literati physicians at times distinguished themselves from others by using terms such as “excellent physicians (liangyi 良醫)” and, from the late Northern Song onward, “scholar-physicians (ruyi 儒醫),” these terms were used for emphasis and contrast, not as names for the role of literati physician, whose novelty was recognized only in contrast to the common physicians against whom they were arguing. In their conception of themselves as champions of the virtues of antiquity against degraded modern customs, literati physicians shared much in common with literary and political thinkers of their time, who also saw themselves as restoring the purity of ancient teachings and practices.

Similarly, literati physicians in the Song, Jin, and Yuan saw the structure of their community in terms familiar to them from their other social relations. They saw the literati physician community as composed of teachers, students, friends, and family members and managed their relationships accordingly. Later authors, however, would discern a new social structure among the physicians of this period: the current (pai 派). The term pai 派 is more commonly translated as school or group, but recent scholarship has shown that these translations imply a degree of fixity that contrasts with the actual flexibility of the social structures called pai.

I follow Volker Scheid both in translating this term as “current” and in using it to denote a “group of practitioners whose members are related to each other by personal association, actual or fictive kinship ties, retrospective histories, or affiliation on the basis of having read or adopted the texts or case records of a deceased physician, and who share ideas, techniques, geographical proximity, stylistic similarities, aesthetic preferences or any combination of these.”253 Several points in this definition should be clarified. First, currents are self-conscious groups, not retrospective impositions by modern historians. While the currents sometimes defined themselves by appropriating past physicians as lineage heads, there was, at the time the current formed, an actual group of physicians who constituted the current. The notion of currents has been attacked as anachronistic, perhaps because the book which popularized the concept— Ren Yingqiu’s influential Doctrines of the Various Schools of Chinese Medicine—took an unabashedly modern perspective in defining them.254 However, as I will show in this chapter, such groups of physicians did exist and were actively recognized by their contemporaries, even if they were never referred to as “currents.” Second, the boundaries of currents were always fuzzy.

Membership in a current frequently meant no more than having read the central texts of that current and adopted their methods. There were no barriers (save occasional intergroup ill-will) preventing membership in multiple currents. Third, most currents took the form of fictive lineages. The head of the lineage was the founder of the current, though not necessarily its most important figure.

As defined above, a current has both diachronic and synchronic realizations, but in my study I have found similar groups of physicians that lacked diachronic extension. Their members were all contemporaries who knew and interacted with one another in close personal Scheid, Currents of Tradition, 13.

Ren Yingqiu, Qiu Peiran, and Ding Guangdi, Zhongyi gejia xueshuo.

relationships. I refer to such groups as “clusters.” Some clusters became the putative source of currents—most notably the Yishui current (Yishui pai 易水派), but others—such as the Gao Ruona 高若納 cluster—did not. Like the boundaries of currents, the line dividing currents from clusters is fuzzy. The Yongjia 永嘉 cluster continued to be influential for at least 150 years, but there is no evidence that physicians using its methods saw themselves as belonging to an identifiable group.

This chapter breaks into three sections. The first examines the changing ways in which three “generations” of Northern Song physicians promoted both the themselves and the Treatise on Cold Damage. The second looks at the usefulness of the Treatise in literati physicians’ social arguments—whether arguing for their status as members of the elite or attempting to persuade patients and their families to accept the authority of a literati physician and not his competitors.

The final section examines how the Treatise remained socially useful for literati physicians even as the social context of their medical practice changed during the Southern Song, Jin, and Yuan.

SECTION ONE: The Treatise and Three “Generations” of Northern Song Physicians The change in the status of the Treatise on Cold Damage was accomplished during the Northern Song. By the middle of the 12th century, when the last men who were educated and lived most of their lives under the Northern Song passed away, the Treatise’s position within literati-physician medicine was already secure.

In this section I outline the process by which this occurred. I divide it into three periods that I term “generations.” They are not, strictly speaking, generations. They cover too large a span of time, and I examine only a few physicians and authors from each period. Nevertheless, the authors I discuss in each period were contemporaries and were aware of one another. Judging from their references to each other and mention of them in the Song bibliographic literature, they were seen, both during their lives and immediately afterward, as among the most important medical writers of their time, and their activities regarding the Treatise on Cold Damage were animated by common concerns. I have identified three distinct goals pursued by the members of the three generations respectively: canonization, popularization, and explication.

Although I have framed this discussion in dynastic terms, the dynastic periods do not perfectly match the changes occurring in medicine. Medical tendencies in the first century of the Northern Song closely resemble those of the periods preceding it. Although the imperial government and private gentlemen were already involving themselves in medicine to a greater degree than before the Song, the medical texts published in this period follow the pattern of the Tang dynasty. In particular, the Formulae of Sagely Beneficence for the Era of Great Peace— which included the Gao Jichong edition of the Treatise255—was a medical compendium like those of Sun Simiao though on a grander scale than ever before attempted. The distinctive pattern of government and private medical publishing we now associate with the Northern Song began only in the middle of the 11th century, and I therefore take it as the starting point for this discussion. The end of the Northern Song, with the loss of North China to the Jin, likewise did not cause an immediate change in medical writings. The two members of the third generation published—and probably wrote—all of their books under the Southern Song or Jin, but they were both educated during the Northern Song and lived most of their lives under its rule. Though published under different regimes, their medical writings share both Northern Song optimism about the possibility of activist social reform and a common orientation to the Treatise on Cold Damage. They were Northern Song men even though they wrote after its demise. I have

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therefore grouped them with the Northern Song authors who were their primary points of reference and interlocutors.

The First Generation (ca. 1040-1070): Canonization The first generation of Northern Song cold damage authors were all members of a single cluster—the Bureau for Editing Medical Texts. Although posterity has not remembered them as great physicians, they were respected in their time and are arguably among the most influential people in all of Chinese medical history. It is therefore worthwhile to examine who they were as well as the texts they produced.

The Bureau’s Editors and Publications As discussed in Chapter 2, the Bureau was formed by imperial command in 1057. We do not know how the members were selected, but a substantial change in membership occurred following the Bureau’s first two publications. The Bureau’s first publication, in 1062, was the Jiayou Materia Medica (Jiayou bencao 嘉祐本草), a large treatise on medicinal substances following in the tradition of comprehensive materia medica prior to the Song. All eight known members of the Bureau at the time participated in this project. A second, more innovative, materia medica text, the Illustrated Classic of Materia Medica, published in the following year, was, for reasons not recoverable today, the work of only one Bureau member. Two years later, in 1065, when the Bureau published the imperial edition of the Treatise on Cold Damage, the staff of the Bureau had changed dramatically. With the exceptions of Gao Baoheng (高保衡, fl. midth c.) and Lin Yi (林億, fl. mid-11th c.), all of the editors for this project were new members.

This new group of six editors would remain relatively constant for the remaining eight books produced by the Bureau over the following four years (see Table 4-1).

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We do not know the reason for the changes in the Bureau’s editors, but it is striking that all but two of them had close personal connections to Gao Ruona (高若訥, 997-1055), the father of the editor Gao Baoheng. The chief editor, Lin Yi was Gao Ruona’s son-in-law. Sun Zhao (孫 兆, fl. 11th c.), a respected physician, studied medicine with him, and Sun Ji (孫奇, fl. 11th c.), also a physician, was Sun Zhao’s brother. The remaining two members, Qian Xiangxian (錢象先, fl. 11th c.) and Fan Zhen (范鎮, fl. 11th c.) had no reconstructable personal connections to Gao Ruona, but participated in only two of the reformed Bureau’s eight publishing projects.256 Given their close ties to one another and their shared interest in the Treatise on Cold Damage, I refer to those editors with connections to Gao Ruona as the Gao Ruona cluster.

Gao Ruona himself passed the civil service examination in 1024, finishing third in his cohort. He held several high positions in the Song government, but also nourished an interest in medicine and is known to have written a text on the Treatise entitled Categorized Essentials of Cold Damage (Shanghan leiyao, 傷寒類要, date unclear). The majority of the Bureau’s editors were therefore familiar with the Treatise, and it is likely that Sun Zhao and Sun Ji came to the Bureau sharing Gao Ruona’s high opinion of it. It is surely significant that the change in the personnel of the Bureau also coincided with a dramatic shift in the focus of their publishing efforts. The year following the 1065 publication of the Treatise on Cold Damage, the Bureau’s new editors published both the Classic of the Golden Coffer and Jade Case—a variant edition of the Treatise—and Essentials of the Golden Coffer—the Treatise’s sister text devoted to miscellaneous diseases.

The original imperial mandate that created the Bureau appears to have included a list of texts to be edited and published. The editors’ memorial on submitting the Jiayou Materia Medica Goldschmidt, “Epidemics and Medicine,” 79–83.

to the throne states that Yuxi (禹錫, fl. 11th c.), Lin Yi, Zhang Dong (張洞, fl. 11th c.), and Su

Song (蘇頌, 1020-1101) were entrusted257 with editing:

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