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later physicians, the most significant of these omissions concerned warm disease, which Zhang Ji mentioned twice in the Treatise, but for which he gave no treatment.361 Since warm diseases were seen as a major cause of epidemics, particularly in the southern parts of the empire, physicians were particularly interested in finding effective treatments, and efforts to supplement this gap in the Treatise accounts for a significant portion of the writings on cold damage in this period.362 The second area was doctrinal rationale. While a great deal of medical doctrine is implicit in the clinical advice of the Treatise on Cold Damage, there is very little explicit discussion of doctrine or explanation for the treatments recommended. It was in this regard that the Inner The original meaning of zhi is unclear, but it was understood by Song and later interpreters of the Treatise as “tetany (jing ),” a reading supported by the use of jing in place of zhi in the Classic of the Golden Coffer and Jade Case (Jingui yuhan jing ).
Juan 6, question 50, in Zhu Gong, Huoren shu, 82.
See, Shanghan lun, juan 2, pian 4, p. 9a, in Zhang Ji, Zhongjing quanshu, 356.
Shanghan lun, juan 2, pian 3, pp. 2a-b and juan 3, pian 5, p. 13a, line 6, in ibid., 349, 360.
E.g., juan 4-5, in Pang Anshi, Shanghan Zongbing Lun, 101–143; and juan 6, in Zhu Gong, Huoren shu, 69–83.
Classic became relevant to cold damage. Han Zhihe, for example, used it to explain the
mechanism by which the invasion of external cold could lead to a febrile illness:
The use of the Inner Classic to explain the Treatise reached its height in the work of Cheng Wuji, who composed the first complete commentary on the Treatise, the Annotated Treatise on Cold Damage, drawing primarily on the Inner Classic for his explanations.366 Observing these developments in Song dynasty medicine, Asaf Goldschmidt has argued that the upsurge in writing on the Treatise on Cold Damage was a result of the desire of medical authors to “integrate” cold damage doctrine into the “pragmatic, symptom-centered practice” that previously dominated medicine and the “classical medicine” of the Inner Classic after the “reintroduction” Treatise by its imperial publication.367 I demonstrated in chapter 1 that the narrative of a “reintroduction” of cold damage doctrine and the concept of “pragmatic, symptomcentered” medicine are both historically untenable. We can, therefore, neither speak of the integration of cold damage doctrine with current practices within which it had no place nor appeal to intellectual dissonance between the old and the new as a motivation for writing on the Suwen 31, the title could also be translated “Treatise on Heat,” since the character re 熱 has both meanings. I have translated it as “fever” because the text of this chapter of the Suwen is devoted to febrile illnesses caused by cold damage not heat.
This is the commentary by Wang Bing (fl. 8th c.), as included in the Song imperial edition of the Suwen.
Shanghan weizhi lun, juan shang, Shanghanyuan pian, pp. 1b-2a, in Siku Quanshu.
Cheng Wuji, Zhujie Shanghan lun.
Goldschmidt, Evolution, 141–172.
Treatise.368 In chapter 4, I argued that the use of the term “classical medicine” in the Northern Song is highly problematic, but if we read “classical medicine” as the doctrines of the Inner Classic corpus, there is an important way in which we can speak of their integration with the methods of the Treatise on Cold Damage.
Song medical authors did not perceive a gap between the Treatise and the Inner Classic.
They assumed the Treatise on Cold Damage drew upon the Inner Classic and therefore they drew upon the Inner Classic in attempting to explain and interpret the Treatise. They had good reasons for making this assumption. The preface of the Treatise explicitly names the Questions
Inner Classic corpus) as sources that Zhang Ji drew upon in composing the Treatise.369 Furthermore, while no explicit references to the Inner Classic are found in the body of the Treatise, there are a number of similar passages and many more passages that can easily be read as drawing on its doctrines. At no point did any Northern Song medical author feel the need to argue that the Inner Classic’s ideas were applicable to the Treatise; they drew upon it unselfconsciously in explaining the Treatise’s methods. They did not see themselves as integrating, they were explicating.
The act of explicating the Treatise in terms of the Inner Classic did, however, forge links between specific methods of the former and specific doctrines of the latter. Potential new scripts were formed which not only explained the Treatise’s methods, but also provided concrete treatments for the Inner Classic’s doctrines. Since most of these doctrines were not specific to Even if intellectual dissonance were present, it is never an adequate explanation of historical actors’ activities.
Humans live surrounded by intellectual dissonance, but we are seldom aware of it and even less frequently do we take action to remedy it. Some other factor must make its resolution important in a given situation.
Shanghan cubing lun xu, in Zhang Ji, Zhongjing quanshu, 305. Most modern scholars believe this section of the preface is a later addition, but Song authors accepted it as authentic.
cold damage, this created the possibility of eliding the division between cold damage and miscellaneous diseases. While Northern Song physicians did not choose to do so, later physicians would do with increasing frequency.
SECTION TWO: The Treatise in the Southern Song, Jin, and Yuan The separation of miscellaneous diseases and cold damage was maintained throughout the Northern Song and the first several decades of the Southern Song and Jin, but beginning in the last half of the 12th century the barrier began to erode, as literati physicians applied the formulae and ultimately the doctrines of the Treatise on Cold Damage to the treatment of miscellaneous diseases.
At the same time, medical thinkers began to focus on a problem that they felt the Treatise did not adequately address: the pathology of fire. All of the most influential physicians of the Southern Song, Jin, and Yuan were concerned with fire in one form or another. If the key distinction in Northern Song literati-physician medicine was miscellaneous diseases versus cold damage, the key distinction in this period was illness due to cold versus illness due to fire or heat—whether contracted from the external environment or generated internally.
The medicine of the Jin and Yuan dynasties has traditionally been seen as a reaction against the medicine of the Northern Song. While this is largely true, the degree to which the medicine of this period was based upon Northern Song medicine has not been adequately appreciated. In particular, previous studies have underestimated the role of the Treatise in the formation of a number of doctrines that have traditionally been seen as standing in opposition to it. The clinical utility of the Treatise and the high status accorded to it in the medical canon made it an appealing model for new medical developments—even those developments which sought to modify, supplement, or set limits on the Treatise itself.
In this part of the chapter, I examine how influential physicians made use of the Treatise to go beyond its traditional limits, both by expanding the discussion of heat and fire and by applying the methods of the Treatise to miscellaneous diseases. I have organized this section according to the clusters or currents that dominated medicine at this time. While the boundaries of these currents were never fixed or firm, they are useful in following the development of medical doctrine and practice in this period.
The Yongjia Cluster As mentioned in Chapter 4, there is no evidence for the existence of self-conscious currents of medical learning in the Southern Song; nevertheless, the ideas and methods of particular physicians and particular medical texts enjoyed widespread popularity and influence.
Like currents, appeal to these popular physicians and texts could strengthen the social position of physicians vis-à-vis their competitors, but, unlike currents, there was no self-conscious sense of commitment to a particular set of ideas and practices derived from a particular set of physicians who were perceived as constituting a medical lineage.
Apart from the government-published formulary Formulae of the Imperial Pharmacy which is known to have remained popular throughout the Southern Song and into the Yuan, data exist for only two examples of such popularity in the Southern Song: the physician Chen Yan and the short text Easy and Simple Formulae (Yijian fang, ca. 1196). Because Formulae of the Imperial Pharmacy did not deviate from the Northern Song pattern in its use of the Treatise on Cold Damage, I will focus on the latter two examples. These two are in fact related.
Defu ), was a part of the circle of friends with whom Chen Yan frequently discussed medicine in Wen Prefecture, frequently called by its old name Yongjia. The Yongjia cluster was a group of elite men with medical interests all connected—at a minimum—by their relationship to Chen Yan.370 It was Wang Shuo’s text, Easy and Simple Formulae, however, which became the focus of the cluster.
Chen Yan achieved fame as a physician during his own lifetime. Lu Shanzu (盧檀祖, fl.
late 12th-early 13th c.), one of the members of the cluster, reported that “There were more than seventy youths of the neighborhood who followed the gentleman [Chen Yan] in his travels … 鄉 之從先生游者七十餘子 …”371 Chen’s magnum opus, Treatise on the Essentials of Using the Three Causes to Evaluate the Origin of an Illness (Sanyin ji yibingyuan luncui 三因極一病源論 粹, 1174), often abbreviated as the Formulae for the Three Causes (Sanyin fang 三因方),372 used the three causes of illness—internal (neiyin 內因), external (waiyin 外因), and neither external nor internal (buneibuwaiyin 不內不外因)—as rubrics to organize all types of illness. The three causes are originally mentioned in the Treatise on Cold Damage’s sister text, Essentials of the Golden Coffer, but Chen substantially modified their definitions. In particular, he moved many The existence of the Yongjia cluster and most of its texts was forgotten from the early Ming through the late 19th c. when a Wen Prefecture native, Sun Yiyan 孫衣言 and his son Sun Zhirang 孫治讓 rediscovered it. The contemporary scholar Liu Shijue 劉時覺 named it the Yongjia medical current (Yongjia yipai 永嘉醫派) in parallel to the Yongjia scholarly current (Yongjia xuepai 永嘉學派) which flourished at roughly the same time. I have termed it a cluster and not a current in accord with my distinction between the two as discussed in the introduction to This dissertation 2 of this dissertation; see Liu Shijue, Yongjia Yipai Yanjiu, 1–5.
Correcting Errors in Easty and Simple Formulae (Yijian fang jiumiu, 1241), juan 1, Yangwei tang, in ibid., 242.
Most of the Yongjia cluster texts have only been recently reconstructed. Sanyin ji yibing fang, Yijian fang, Xu yijian fanglun are the exceptions. Sanyin ji yibing fang has remained extant since its composition. The remaining three texts were rediscovered in Japan during the 20th century after having been lost since the early Ming.
This is the title given by Chen Yan in his preface. The book is better known by the title Formulae Using the Three Cuases to Evalute a Pattern of Illness (Sanyin ji yibingzheng fanglun 三因極一病證方論); see author’s preface, in Chen Yan and Wang Shuo, Chen Wuze yixue quanshu, ed. Wang Xiangli (Beijing: Zhongguo Zhongyiyao Chubanshe, 2005), 3.
of the causes which Zhang Ji classified as internal into the neither internal nor external category, leaving only the emotional excesses of the seven affects (qiqing 七情)—which Chen stressed as etiologies—as internal causes.373 Chen Yan’s combination of the doctrines and methods of the Inner Classic and Treatise was idiosyncratic. On the one hand, he often gave Inner Classic doctrines precedence even when discussing cold damage. He used the associations of the six qi, for example, to argue that while Han dynasty (206 BCE-220 CE) authors (including Zhang Ji) thought all evils which invaded the exterior were located in the foot greater yang channel (zu taiyangjing 足太陽經), the actual reason cold damage began in the foot greater yang channel was the affinity of greater yang with cold qi. On the other hand, he expanded the application of the Treatise’s doctrines and formulae in significant ways. He frequently used the Treatise’s formulae to treat illnesses that were not caused by cold damage, and, even more strikingly, he applied the three-yin-three-yang system of the Treatise to the diagnosis of foot qi (jiaoqi 腳氣), a miscellaneous disease characterized by weakness and withering of the legs and progressive deterioration. In so doing, Chen broke with the Northern Song rule that the Treatise’s doctrines and methods could only be used in treating cold damage, but he did so unsystematically. Among all the miscellaneous diseases which he described, he applied the three-yin-three-yang system to foot qi alone. Likewise, although he usually used the Treatise’s formulae to treat miscellaneous diseases similar to the cold damage illnesses for which the Treatise used them, at times he used them in ways that have no connection to their use in the Treatise.374 Moreover, at no point did he cite the Treatise to justify his use of such formulae.
Sanyin jibingzheng fanglun, juan 2, sanyin lun, in ibid., 36.