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[The copies of] the Divine Farmer’s Materia Medica, Numinous Pivot, Grand Fundamental, Systematic Classic [of Acumoxa], and Questions on the Fundamental, as well as the formularies Expansive Aid, [Formulae worth] a Thousand Gold, and Secret Essentials of the Outer Terrace …258 所有《神農本草》、《靈樞》、《太素》、《甲乙經》、《素問》之類，及《廣 濟》、《千金》、《外臺秘要》等方… Conspicuously absent from this list are the Treatise and the other two works attributed to Zhang Ji whose editing the Bureau undertook once it was dominated by Gao Ruona’s friends and relations. It has been suggested that Gao Baoheng, Sun Zhao, and Sun Ji obtained their positions in the Bureau through Gao Ruona’s influence. While this cannot be proven, it is clear that Gao’s protégés did effectively take over the Bureau and turned it to their own ends. The decision to edit and publish the Treatise and related texts came from the editors themselves, not from their superiors in the imperial government.
While acknowledging that their connection to Gao Ruona probably influenced the Bureau’s decision to publish the Treatise, Asaf Goldschmidt asserts that Gao’s interest in cold damage was unusual, since it was “almost an esoteric topic at that time.”259 He argues that the members of the Bureau were influenced by Gao, the rising frequency of epidemics in the 11th century, and the fact that they were officials and not physicians to make a choice—publishing the Treatise—that no physician would have made. I have already shown in Chapter 1 that Goldschmidt’s characterization of cold damage studies as an “esoteric topic” is inaccurate. Cold damage studies and the Treatise on Cold Damage were, on the contrary, well-known and highly It is worth noting that we do not know who requested this imperial mandate, raising the possibility that the Bureau was, in it is entirety, the creation of a this dissertationicular group of literati-officials.
Jiayou bencao, buzhu bencao zouchi, in Okanishi Tameto, Sō izen iseki kō, 1027.
Goldschmidt, Evolution, 94.
valued parts of the textual medical tradition of the time. Furthermore, as Goldschmidt’s own research shows, two of the six members of the Bureau—Sun Zhao and Sun Ji—are known to have been practicing physicians. They were also sons of the famous physician Sun Yonghe (孫 用和, fl. early 11th c.), and Sun Zhao composed two texts on cold damage—Cold Damage Formulae (Shanghan fang 傷寒方, date unknown) and Mnemonic Verses for Cold Damage Pulses (Shanghan maijue 傷寒脈訣, date unknown). While neither Lin Yi nor Gao Baoheng are known to have practiced medicine, it was not uncommon for elite men to have some medical knowledge and it seems highly unlikely they would be ignorant of a book written by their fatherin-law and father respectively. There was no lack of medical knowledge among the members of the Bureau. The decision to edit and publish the Treatise on Cold Damage was not only made by the editors, it was made on the basis of a sound knowledge of the learned medicine of the early Song.
Goldschmidt’s assertion that the Bureau’s publication of the Treatise was a result of their ignorance of medicine not only misconstrues the status of the Treatise at the time, it also creates the appearance that the medical changes of the Song were the inadvertent result of top-down imperial policies, when in fact they were the intentional result of actions undertaken by members of the literati elite. The Gao Ruona cluster in effect “hijacked” the Bureau for Editing Medical Texts and used it to accomplish their own purposes. Seen in this light, the subsequent centrality of the Treatise on Cold Damage is not, as Goldschmidt suggests, a capricious accident of history, but the result of intelligible, purposeful choices made by a group of individuals, and the important question, therefore, is what those purposes were.
Canonization and Lineage The publications of the Bureau for Editing Medical Texts had a tremendous impact, both during the Song and afterward. The rapidity with which the Bureau’s books dominated the medical world is attested by the fact that all later authors used the Bureau’s editions in creating their own books. No references to earlier editions of these texts are known after 1065. Even today, although earlier editions have been discovered by researchers—particularly in Japan—the Bureau’s texts are the standard editions of pre-Song texts used by clinicians of East Asian medicine. Moreover, while lists of essential medical texts before the Song differed widely one from another, from the Northern Song onward the essential pre-Song medical texts were precisely those texts published by the Bureau between 1065 and 1069. The Bureau’s publications became the canon of literati-physician medicine—and were intended to.
It was natural for literati physicians to assume that medicine must have a canon. Literary learning had a well-defined, if open, canon, and Song thinkers regularly attributed the highest value to texts believed to date from the Han dynasty or earlier, particularly those associated with the legendary sages of high antiquity. The claim that medicine possessed a similar canon was both an assertion of medicine’s worthiness as a career for elite men and an attempt to improve the quality of medical care by reconnecting medical practice to its perceived roots in antiquity.
The assertion that the effective knowledge and practices of antiquity had been lost or neglected, but were now being restored, was common among Song writers, and the relatively poor quality and scanty circulation of medical texts before the Song supported such arguments about medical learning.
Given that they assumed medicine must have a canon rooted in antiquity, why did the members of the Bureau place such great emphasis on the Treatise on Cold Damage? It was not the oldest text they published, but it was clearly the text they were most anxious to canonize—as demonstrated by the fact that they published it in two separate and variant editions. What appeal did it have for them apart from a reputation for clinical efficacy?
The prefaces the Bureau wrote for the Treatise on Cold Damage and Questions on the Fundamental (Suwen 素問) may provide one answer. In these prefaces the editors trace the lineage of medicine from the earliest sage-emperors up to themselves. In both lineage lists, Zhang Ji occupies an important position. Their preface to the Treatise on Cold Damage most
clearly outlines his role in this lineage:
Thus, Zhongjing based his work on the method of Yiyin, and Yiyin based his work on the classic of the Divine Farmer. Can [the Treatise on Cold Damage] not be called the intent of the great sages?... From Zhongjing to now, for more than eight hundred years, only Wang Shuhe was able to study it. In the Kaibao reign period (968-976), the military commander Gao Jichong260 did select and edit [an edition of the Treatise] and presented it to the throne. Its wording and order contained errors … The state decreed that we scholar-officials should edit and correct medical books … Now we have first revised Zhang Zhongjing’s Treatise on Cold Damage …261 是仲景本伊尹之法，伊尹本神農之經，得不謂大聖人之意乎…自仲景於今，八百餘 年，惟王叔和能學之…開寶中，節度使高繼沖，曾編錄進上，其文理舛錯…國家詔儒 臣校正醫書… 今先校定張仲景《傷寒論》… To the editors of the Bureau, Zhang Ji (Zhongjing) was a crucial link in the transmission of the sages’ medical knowledge to later humans. Both the Divine Farmer and Yiyin were legendary figures of antiquity, but Zhang Ji was an ordinary, if highly skilled, human. The Treatise on Cold Damage was therefore an essential means of communicating the original and correct medical teachings of the sages. Equally important, by revitalizing the teachings of Zhang Ji, the Bureau also reestablished physicians’ connection to him and to the sages whose teachings he passed on.
Zhang Ji stood at the boundary between the legendary sages and later physicians. He was Gao was a military commander (jiedushi 節度使) under the later Zhou dynasty (951-960) which preceded the Song. The Song emperors permitted him to retain his title and rank but only in an honorary form.
Preface, Zhang Ji, Zhongjing quanshu, 5.
therefore a necessary link in the lineage of literati-physician medicine, establishing their connection with antiquity and the social and intellectual value that it possessed in their society.
Other figures, such as the Yellow Emperor and his interlocutors in the Yellow Emperor’s Inner Classic were too distant from ordinary humanity for contemporary physicians to claim any direct link with them. Zhang Ji was distant enough that he could be linked directly with the sages, but close enough that he could also be linked directly with physicians of their own time. In their preface to Essential Formulae worth a Thousand Gold, the Song editors explain why worthies (xian 賢)—exceptional, but otherwise ordinary humans such as Zhang Ji—are essential to the
unfolding of the sages benevolent intentions:
Long ago, the Divine Farmer tasted the hundred medicinals in order to differentiate the flavors of the five bitters and the six acrids. Only when [this knowledge] reached Yiyin were decoctions prepared. The Yellow Emperor wished to establish [the method of] the nine needles in order to treat the illnesses of the three yin and the three yang. Only upon obtaining [the aid of] Qibo was the method of stone needles and mugwort refined. Even the great sages, intent on saving the people from their ailments, must await [the appearance of] worthy and illumined officials of profound knowledge. Some appear sooner; some appear later. Afterwards, the actions of the sages are able to spread forever.262 昔神農嘗百藥，以辨五苦六辛之味，逮伊尹而湯液劑備。黃帝欲創九針，以治三陰 三陽之疾，得岐伯而砭艾之法精。雖大聲人有意於拯民之瘼，必待賢明博通之臣， 或為之先，或為之後，然後聖人之所為，得行於永久也。 Although the sages were the ultimate source of valid medical knowledge, the survival, development, and spread of that knowledge was dependent upon worthies who received and passed on the sages’ teachings. Zhang Ji—and through him the Bureau’s editors themselves— were thus part of the work of the sages.
The Bureau’s formation of a medical canon thus simultaneously created a lineage linking contemporary physicians with the sage-emperors of antiquity. Together, the canon and lineage Xinjiao beiji qianjin yaofang xu, in Sun Simiao, Beiji qianjin yaofang jiaoshi, ed. Su Li et al. (Beijing: Renmin Weisheng Chubanshe, 1998), 9.
established grounds for valid medical knowledge and made a powerful argument that the study of medicine was parallel to the study of literature. Both disciplines were based upon textual study of classics and both traced their lineage back to the origins of Chinese civilization. For the members of the Bureau and the literati physicians who accepted their narrative, Zhang Ji played a role similar to the role Mencius had played in the thought of Han Yu (韓愈, 768-824) and would play in the teachings of Cheng Yi (程頤, 1033-1107).263 Zhang Ji was the last person to receive the sages’ knowledge. He passed it on, but it was lost until it was recovered by the efforts of the Bureau, who were now making it possible for all physicians to reconnect with the authentic and effective medicine of the sages.
The Second Generation (ca. 1080-1120): Popularization The second “generation” of Northern Song cold damage authors was animated by a desire to reform medical practice by popularizing the Treatise on Cold Damage. The texts produced by this cohort of medical writers are characterized by an attempt to present the contents of the Treatise in ways that would make them more easily understood and used by both common physicians and people who were not physicians. In this regard, they reveal the influence of the activist, reform-minded climate of the Northern Song.
I will discuss three members of this generation: Han Zhihe, Zhu Gong, and Pang Anshi.
Two of the three, Han Zhihe and Zhu Gong, passed the civil service exam and served as government officials. The third, Pang Anshi, came from a wealthy family of physicians.
Although later authors consistently refer to Pang as a member of the elite, references to him For a discussion of Han Yu and Cheng Yi’s presentiaton of the transmission fo the sages’ teachings, see Peter Bol, “This Culture of Ours”: Intellectual Transitions in T’ang and Sung China (Stanford University Press, 1994), 126–131, 302–306.
during and shortly after his life—including those by Su Shi and his circle—are far less clear. It seems likely that Pang’s family was at best part of the lower rungs of the literati-elite and may well have been a wealthy lumpenliterati physician family. Pang is a key example of how sufficiently wealthy and educated physicians could cultivate friendships with even the highest levels of the elite.
Han Zhihe Han Zhihe’s book on cold damage, the Profound Meaning of Cold Damage is the oldest surviving book devoted exclusively to cold damage. Little is known about its textual history.
References are found in works up to the early Ming,264 but the text was lost thereafter and reconstructed in the Qing based on quotes in the Yongle Encyclopedia (Yongle dadian 永樂大典).
Although Han’s preface has unfortunately been lost, the opening of the first section of the
text gives a clear idea of Han’s reasons for composing a text on cold damage:
As for cold damage illnesses, many physicians have not thoroughly investigated their origin. They merely say, “[The patient] is suffering an illness of cold damage …”265 夫傷寒之病，醫者多不審察其本源，但只云病傷寒… Like many Northern Song elites, he felt common physicians were ignorant, parroting words without understanding their meaning. His book presents the diagnosis and treatment of cold damage in a straightforward fashion so the elite would not be dependent on or fooled by common-physician quackery. After stating his plaint against contemporary physicians, he proceeded to explain the origins of cold damage, including diseases of warmth and heat that Wang Lü, Collection on Returning to the Classics (Yijing suhui ji 醫經溯洄集, late 14th c.), Zhang Zhongjing