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shanghan lifa kao, in Wang Lü, Yijing suhui ji, ed. Zhang Shengmao, Zhongyi guji zhengli congshu (Beijing:
Renmin Weisheng Chubanshe, 1993), 21.
Juan shang, shanghan yuan pian, in Siku Quanshu.
manifest in the spring and summer respectively.266 He then discussed his understanding of pulse diagnosis in cold damage. Like many Northern Song authors, Han felt that the system of pulsetaking presented in the Treatise on Cold Damage differed from the system used in other illnesses, and he explained his understanding of this system in detail. The remainder of the first fascicle of the text discusses basic medical theory, the modification of formulae to match a patient’s illness, errors in using medicinals, and the types of cold damage for which sweating or purging was appropriate. Taken as a whole, his first fascicle of his text presents the basic knowledge a layperson would need to understand, diagnose, and treat simple cold damage illnesses.
The second fascicle describes more complex patterns. It begins by discussing the treatment methods of sweating and purging in more detail, such as the need to distinguish between patients requiring stronger or milder treatments. This is followed by examinations of several more severe developments of cold damage illnesses—cold in the interior of the body, problems with urination and bowel movements, blood accumulation (xuxue 蓄血), and yin jaundice—before finally addressing recovery and relapse. The second fascicle thus builds on the first, providing information necessary for treating more complicated cold damage illnesses.
Throughout his text, Han Zhihe showed a concern for supplementing lacunae in the Treatise on Cold Damage. His discussions of blood accumulation and yin jaundice flesh out concepts the Treatise mentioned but did not develop. Furthermore, in his section on illnesses for which sweating is appropriate, he presented a different formula for each of the seasons, providing clinical applications for the Treatise’s doctrine that cold damage manifests differently in different seasons.
See the discussion of this issue in Chapter 1.
Overall, Han’s work leaves the impression of a well-crafted, not-too-lengthy summary of the diagnosis and treatment of cold damage. Although he addressed a small number of doctrinal issues, he did so only to clarify diagnosis and treatment. He discussed ideas and methods from the Treatise on Cold Damage but did not engage the text of the Treatise as a text. His work was neither commentary nor even explanation but merely presentation of the Treatise’s useful content in a more accessible form.
Pang Anshi The arrangement of Pang Anshi’s text, the Treatise on All Types of Cold Damage (Shanghan zongbing lun 傷寒總病論, 1100), is similar to Han Zhihe’s. It opens and closes with some doctrinal discussion, but the bulk of the text is organized by disease name. Each disease is described briefly and one or several formulae presented for treating it. Unlike Profound Meaning of Cold Damage, Pang’s text lacks an obvious didactic progression of material from simple to complex. In this regard it resembles the medical compendia of the Tang and earlier, but it differs from them in its explicit and exclusive focus on cold damage as described in the Treatise. It also retains a didactic element in the form of Pang’s comments. These are interspersed among paraphrases form the Treatise, but rather than explaining the previous line—as would a
commentary—they provide additional clinical information:
In greater yang disease, if there is headache, fever, body aches, aching joints and bones, aversion to wind, aversion to cold, and panting, Ephedra Decoction governs it.267 … Pang says: … The person will only fear cold, the tips of the hands and feet will definitely have a slight reversal [cold], [but] after some time will again be warm. The center of the palms will not have reversal [cold]. This is a pattern of cold damage without sweating in which you should use Ephedra Decoction.268 This is a paraphrase of line 35 of the Treatise, juan 3, pian 6, in Zhang Ji, Zhongjing quanshu, 376–377.
Shanghan zongbing lun, juan 2, ke fahan zheng, in Pang Anshi, Shanghan Zongbing Lun, ed. Zou Dechen and Liu Huasheng, Zhongyi Guji Zhengli Congshu (Beijing: Renmin Weisheng Chubanshe, 1989), 30–31.
太陽病，頭痛發熱，身疼痛，骨節疼煩，惡風，惡寒而喘者，麻黃湯主之 … 龐 曰：… 其人但憎寒，手足指末必微厥，久而復溫，掌心不厥，此傷寒無汗用麻黃 證。 Like larger medical compendia, Pang’s work was intended as a reference and was organized with that aim in mind. However, its focus on the Treatise and its inclusion of clinical minutiae rarely seen in compendia mark it as generically distinct from them. It is not a small compendium;
it is a text devoted to promoting the Treatise on Cold Damage by making that text more accessible to non-specialists.
Zhu Gong In the preface of his Nanyang Book for Saving Lives, Zhu explains his purpose in
composing a text on the Treatise:
It is difficult for ordinary people to understand the use of Yiyin’s decoctions and Zhongjing’s channels and network vessels. The literati, moreover, take it as an accomplishment of skill [as opposed to learning] and lay it aside, disdaining to read it.
Frequently, at the time of an emergency, their hands are tied, and they must simply die and return their allotment [of life]. Commoners who know [they should] read this book are also rare. Even if they wish to read it, they do not understand its meaning.269 持以伊尹湯液，仲景經絡，常人難曉，士大夫又以藝成而下，耻而不讀，往往倉卒 之際，束手待盡，卒歸之於命而已。世人知讀此書亦鮮。縱欲讀之，又不曉其義。 Zhu finishes his preface by stating that the members of the literati elite will find his book “easy to understand and enjoyable to read 易曉而喜讀,”270 thus preventing unnecessary suffering and death. Zhu’s concern was that the difficulty of reading the Treatise, combined with the elite’s disdain for medicine, would leave the Treatise a dead text whose potential for benefiting people was never realized. He hoped that by presenting the information in the Treatise in a more easily understandable form, he could convince the elite of the importance of this medical work.
Nanyang huoren shu, author’s preface, in Zhu Gong, Huoren shu, 19.
To accomplish his purpose Zhu Gong adopted an innovative format. The Nanyang Book for Saving Lives is structured as one hundred questions and answers about cold damage. The questions range from lists of signs and symptoms for diagnosis, to issues relating to pulse diagnosis, to general inquires about the various types of cold damage. The answers vary from quite short to quite lengthy, and frequently include specific medicinal formulae to treat the condition being discussed. The formulae themselves are all listed in detail in the second half of the text.
Zhu also adapted elements of the Treatise to accord with contemporary standards. For example, throughout the Treatise on Cold Damage, “headache” is written “toutong 頭痛” but Zhu consistently uses the synonymous “touteng 頭疼”—which was more commonly used in the Song—even when paraphrasing the Treatise. The decision to “translate” the text of the Treatise in this way—for which Zhu was criticized by later authors—is highly significant.271 Choosing to value ease of comprehension and familiarity over faithfulness to the original text demonstrates both that Zhu’s primary concern was to make the Treatise more accessible to a wider audience and that he believed his audience might have difficulty with the more archaic aspects of the Treatise. This choice is all the more striking because the term “toutong 頭痛” was by no means an abstruse term. It seems likely that Zhu’s audience would have understood it with little to no difficulty, but Zhu still chose to use the more commonplace term throughout his book. Later authors would make very different decisions.272 For an example of Zhu Gong’s use of touteng and a later commentator’s criticism of it, see Huoren shu, juan 1, question 1, in ibid., 12.
My point here is very similar to Pierce Salguero’s recent arguments about the importance of analyzing the choice of terminology used by Buddhist translators even when they were not technically translating but were composing a
text entirely in Chinese; see, C. Pierce Salguero, Translating Buddhist Medicine in Medieval China (Philadelphia:
University of Pennsylvania Press, 2014), 4–11, 96–97.
Likewise, he altered the method of administration of the Treatise’s formulae. The majority of the Treatise’s formulae were designed to be prepared as decoctions made from whole or coarsely ground medicinals. By Zhu’s time, however, most formulae were prepared in the form known as a “boiled powder (zhusan 煮散).” In this preparation, the medicinals are finely ground and boiled briefly before the decoction and the powdered medicinals are drunk together.
Boiled powders required a far smaller quantity of medicinals than a straightforward decoction, and they may have become widespread in the Song as a result of a sharp increase in medicinals’ prices. Zhu altered the dosages and preparation instructions of the Treatise’s formulae to make them boiled powders, bringing their preparation and administration more into line with contemporary expectations.
Finally, like Han Zhihe and Pang Anshi before him, Zhu showed an interest in supplementing gaps he perceived in the formulae found in the Treatise on Cold Damage. He provided descriptions of and formulae for a variety of warm diseases and other illnesses whose treatment is not described in the Treatise.
Popularizing the Treatise The second generation of Northern Song cold damage authors strove to make the Treatise on Cold Damage more widely known and accepted. As Zhu Gong noted, the Treatise was difficult to read, so the members of this generation produced texts that presented the information in the Treatise in a simpler form. They structured their texts for easy reference, included greater clinical detail than normally seen in medical handbooks, used contemporary language to explain the Treatise, adapted its formulae to meet Song expectations, and supplemented material on forms of cold damage like warm disease and seasonal qi, which were pressing current concerns of the Northern Song elite.
The effort to popularize the Treatise and the form that effort took were driven by the concerns and needs of elite non-physicians, and not by any perceived gap between the ideas of the Treatise and contemporary medicine. We have no way of knowing the reception of these texts among common physicians, but the prefaces of the texts discussed above make it clear that the literati-elite was their intended audience. The structure and contents of these texts further indicate that their authors expected that most of their readership were not practicing physicians.
The Treatise on Cold Damage was published and canonized by literati men wielding the machinery of the Song government, and it was popularized by another group of literati men writing as private individuals. From its inception, the ascendency of the Treatise was caused by and served the purposes of members of the elite social stratum.
The Third Generation (ca. 1120-1150): Explication The third generation of Northern Song cold damage authors continued the didactic approach of the second generation but wrote for a different audience. The texts produced by the third generation do not attempt to simplify the presentation of the Treatise’s ideas and formulae, nor are they structured as medical reference works. Rather than popularization and simplification, this generation of authors focused on explication of the Treatise on Cold Damage in all its complexity. Their intended audience was not lay-people looking for handy medical advice, but rather people who were actively practicing medicine—whether as an occupation or a benevolent avocation. They assumed a great deal of medical knowledge on the part of their readers and designed their texts to provide guidance on how to apply the ideas of the Treatise in clinical practice. The third generation of Northern Song cold damage authors were physicians writing for physicians.
I have identified only two authors in this generation: Xu Shuwei and Cheng Wuji. As I have mentioned, their books were published, and most likely written, in the early Southern Song and Jin, but they were born, educated, and lived most of their lives under the Northern Song. Xu was indisputably a member of the elite, though his parents both died while he was young and he is said to have been poor. He ultimately earned fifth place in the civil service exam in 1132 at the age of 52—a feat that earned him the moniker “Literati Learning Xu (Xu Xueshi 許學士)” and a post in the imperial Hanlin academy. Cheng’s background is far less clear. His family is known to have practiced medicine as an occupation, but it is striking that all discussions of his background say specifically that he came from a family of “scholar-physicians (ruyi 儒醫),” employing the new term for learned physicians that had come into use several decades earlier.273 The fact that his biographers felt obliged to note that his family were scholar-physicians—no authors refer to Xu Shuwei by this term—suggests that Cheng Wuji’s family were not in fact members of the literati-elite. This inference is supported by the fact that there is no evidence of Cheng sitting for the imperial exams. It is possible that Cheng, like the Sun brothers in the Bureau for Editing Medical Texts, was a member of a physician family that had successfully moved into the lower ranks of the elite, but it is also possible that Cheng Wuji himself was the first of his family to gain acceptance among the literati elite. The ambiguity of his status motivated his biographers to praise him as a scholar-physician, while Xu Shuwei, whose literati status was beyond question, needed no such defense. Regardless, Cheng’s writing reveals a wellThe earliest description of Cheng’s family as scholar-physicians is found in Yan Qizhi’s (嚴器之, fl. mid 12th c.) 1142 preface to Cheng’s Illuminating the Principles of Cold Damage (Shanghan mingli lun 傷寒明理論, 1142), see Cheng Wuji, Shanghan mingli lun, ed. Qian Chaochen and Huang Zuozhen (Beijing: Xueyuan Chubanshe, 2009), 5.