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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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arbitrary. The Treatise already possessed a clinical script in which yang-brightness disease heat caused delirious speech (zhanyu ) and Stomach-Regulating Order the Qi Decoction was used to treat it.393 As Fabien Simonis has shown, Liu Wansu had already drawn upon this and similar scripts in the Treatise to argue that heat was the major cause of madness, but Liu never used the Treatise’s formulae to treat madness.394 Zhang Congzheng, on the other hand, used precisely the formula the Treatise recommended. Likewise, the Treatise already recommended promoting urination in patients with unceasing diarrhea, and Poria-5 Powder was not only the premier urine-promoting formula of the Treatise, but was also explicitly recommended for patients suffering from sudden-turmoil disease (huoluanbing )—an illness characterized Rumen shiqin, juan 11, huoleimen, in ibid., 273; Simonis, “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” 87.

Rumen shiqin, juan 5, shuixie buzhi jiushisan, in Zhang Congzheng, Zihe yiji, 156.

Shanghan lun, juan 2, pian 5, p. 19b-20a, line 29, in Zhang Ji, Zhongjing quanshu, 366–367.

Simonis, “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” 82.

by incessant nausea and vomiting.395 Zhang merely took the recommendations of the Treatise on Cold Damage and applied them to similar patterns of illness that occurred in the course of miscellaneous diseases. Unlike Chen Yan, his use of the Treatise’s formulae remains clearly rooted in the Treatise itself; unlike Wang Shuo, his use of the Treatise’s formulae was not guided by symptomatology alone but was instead based on doctrines and principles he found in the Treatise. He read the Treatise not as a collection of clinical scripts for dealing with cold damage, but as a collection of clinical scripts that could be used with any illness. In so doing, he inaugurated a practice that became common during the Ming dynasty and has remained common up to today, but he never explicitly theorized his approach.

The Yishui Current Although Zhang Yuansu (styled Jiegu 潔古) is generally considered the founder of the Yishui current, it was his student Li Gao who became its central figure. Zhang, a native of Yi Prefecture in modern Hebei, passed the civil service exam as a young man, but lost his degree through violating the taboo on the use of characters in the personal names of deceased emperors.

He then devoted himself to medicine, becoming a famous physician. Li Gao, usually known by his literary name Dongyuan 東垣, was a native of Zhending, also in modern Hebei. Li came from a wealthy family and only took up the study of medicine after watching his mother die when the doctors summoned could reach no agreement about the nature of her illness. After searching for some time for a qualified teacher, he finally encountered Zhang Yuansu and went on to become Zhang’s most famous student.

Shanghan lun, juan 4, pian 7, p. 15a, line 159 and juan 7, pian 13, p. 2b, line 386, in Zhang Ji, Zhongjing quanshu, 412, 466.

The Yishui current’s ideas are often seen as something unrelated to, or even a reaction against, the Northern Song dominance of the Treatise on Cold Damage.396 A quote attributed to Zhang is often used in support of this argument: “Ancient formulae are not appropriate for modern illnesses; on the contrary they will harm people 古方今病,甚不相宜,反以害人.”397 This quote, however, is only found in a preface written after Zhang’s death. No similar statements are found in Zhang’s surviving works; on the contrary, they make extensive use of formulae from the Treatise to treat both cold damage and miscellaneous diseases. Moreover, Li

Gao quotes Zhang as saying:

Zhongjing’s medicinals are the method of the myriad generations. They are called the ancestors of all formulae. If later physicians take the methods of the Inner Classic as a model and study the intent of Zhongjing, then they can be taken as teachers.398 仲景藥為萬世法,號群方之租,治雜病若神,後之醫家,宗《內經》法,學仲景心,可以 為師矣。 The only relevant statement found in Zhang’s own writings also indicates his high regard for Zhang Ji’s texts. After discussing a subtle difference in two of the Treatise’s formulae, Zhang

notes:

One treats exterior vacuity and one treats interior vacuity. Thus for each I have stated its primary use. When later people use ancient formulae, if they extend [the same method] to each [formula], then they will know its root and not cause mistakes.399 一則治其表虛,一則治其裏虛,是各言其主用也。後人之用古方者,觸類而長之, 則知其本,而不致差誤矣。 From this quote, it would appear that Zhang’s objection to ancient formulae was not so much to the formulae themselves as to contemporary physicians’ poor understanding of how to use them.

E.g., Hanson, Speaking of Epidemics, 39.

Preface, Awakening to the Origin of Medicine (Yixue qiyuan 醫學啟原, date unclear, in Zhang Yuansu, Yixue qiyuan, 1.

Elminating Doubts Regarding Internal and External Damage (Neiwaishang bianhuo lun 內外傷辨惑論, 1247),

juan xia, linzheng zhifang, in Li Gao, Dongyuan yiji, ed. Ding Guangdi, Zhongyi guji zhengli congshu (Beijing:





Renmin Weisheng Chubanshe, 1993), 44.

Yixue qiyuan, juan xia, 12, yongyao beizhi, 6, yongyao yongfang bian, in Zhang Yuansu, Yixue qiyuan, 162.

In his own lifetime Li Gao himself was known as an expert on cold damage,400 and composed a text on cold damage that is no longer extant. Wang Haogu, who studied medicine under both men, saw their knowledge of Zhang Ji’s writings as the foundation of their medical skill: “… the venerable Jiegu, Zhang Yuansu … and the gentleman Dongyuan, Li Gao [who was styled] Mingzhi all revered Changsha Zhang Zhongjing’s formulae … 潔古老人張元素 … 東垣先生李 杲明之,皆祖長沙張仲景湯液.” The Yishui current was best known for Li Gao’s concept of internal damage (neishang 內 傷). The term “internal damage” was not novel. It is found as early as the Inner Classic, but in Zhang and Li’s hands it became far more important in textually based medicine than it had ever been before. In the Inner Classic, internal damage was not a technical term, but simply a literal phrase referring to any form of harm suffered by the interior of the body. This included damage due to incorrect acupuncture technique,401 emotional excess,402 incorrect use of medicinals,403 damage to the bones caused by deep-rooted ulcers,404 and any damage to the viscera generally.405 Zhang Yuansu’s views on internal damage are difficult to reconstruct. The majority of the texts he authored appear to have been lost during the Mongol conquest of the Jin, and none of his surviving texts discuss internal damage.406 The only surviving evidence of Zhang’s views are quotes attributed to him in the works of Wang Haogu. According to Wang, Zhang associated internal damage specifically with the three-yin diseases (sanyin bing 三陰病) seen in the Yuan History (Yuanshi 元史, 1370), fangji, Li Gao liezhuan, in He Shixi, Zhongguo lidai yijia zhuanlu, 1:301;

Wang Haogu, These Things are Difficult to Know (Cishi nanzhi 此事難知, 1264), preface, in Wang Haogu, Wang Haogu yixue quanshu, 115.

Suwen, juan14, pian 50, p. 1a, in Chen Yongguo, Chongguang Buzhu Huangdi Neijing Suwen, 100.

Lingshu, juan 19, pian 66, p. 6a, in Lingshu (zuishanben) [Xinkan Huangdi neijing Lingshu], 83.

Suwen, juan 11, pian 40, p. 7a, in Chen Yongguo, Chongguang Buzhu Huangdi Neijing Suwen, 83.

Lingshu, juan 21, pian 75, p. 10a, in Lingshu (zuishanben) [Xinkan Huangdi neijing Lingshu], 93.

Lingshu, juan 4, pian 4, p. 4b, in ibid., 20.

The preface, written at the request of Li Gao, to Yixue qiyuan states that the majority of Zhang’s works were lost in 1232, when Li Gao suffered through the Mongol siege of Kaifeng, see Zhang Yuansu, Yixue qiyuan, 1.

Treatise on Cold Damage. Wang titles his discussion of Zhang’s ideas, “The Venerable Jiegu’s Precedent on Internal Damage to the Three Yin 潔古老人內傷三陰例.” The primary argument of this section is drawn from several passages in the Inner Classic, one of which discusses how to diagnose damage to the three yin.407 Although there is nothing in the quote from Zhang Yuansu indicating that the three yin referred to are identical with the three yin of the Treatise, three of the seven formulae recommended are taken from the Treatise, and Wang himself, in a

comment, opines explicitly that the three yin mentioned are in fact the three yin of the Treatise:

When they have not seen Zhongjing’s medicines, people do not speak of the three yin.

Once they have seen that Zhongjing’s medicinals [for yin patterns] are divided into three, everyone comes to know that there are three yin.408 未見仲景藥時,人皆不言三陰,既舉仲景藥分而三之,人皆得知有三陰。 Once again we see that far from disparaging the Treatise, Zhang Yuansu was actively broadening the scope of its application.

In forming his internal damage doctrine, Li Gao relied upon the Treatise even more heavily than Zhang had, but he also took the concept of internal damage in a new direction. As seen in Wang Haogu’s excerpts of his texts, Zhang Yuansu spoke of internal damage to any of the three yin, which correspond to the spleen, kidneys, and liver. Li, however, emphasized internal damage to the qi of the spleen and stomach, the organs of digestion, which he held were the root of vitality in the body.409 Moreover, for Zhang internal damage illnesses were always cold in nature, but Li argued that in their early stages, internal damage illnesses could present with fever and other signs of heat, making it difficult to distinguish them from cold damage Brief Precedents Reagarding Yin Patterns (Yinzheng lueli 陰證略例, 1243), Jiegu laoren neishang sanyin li, in Wang Haogu, Wang Haogu yixue quanshu, 77–78; The relevant Inner Classic passage is found in Suwen, juan 3, pian 9, p. 9a, in Chen Yongguo, Chongguang Buzhu Huangdi Neijing Suwen, 28.

Yinzheng lueli, Jiegu laoren neishang sanyin li, in Wang Haogu, Wang Haogu yixue quanshu, 77.

Piwei lun, juan shang, piwei xushi chuanbian lun in Li Gao, Dongyuan yiji, 57–59.

illnesses.410 The inspiration for this idea was the epidemic that ravaged northern China in the wake of the Mongol conquest. Li was present at Kaifeng during and after the Mongol siege, and

recorded his observations of the epidemic which followed the fall of the city:

… After the siege was lifted, the people of the capital who did not become sick numbered one or two in ten thousand. The sick and dead followed one upon another without end.

The capital has twelve gates. Each day [the dead] sent out through each gate numbered two thousand if there were many and no less than one thousand if there were few. It was like this for two to three months. How can it be that all of these one million people contracted wind-cold external damage? It need not be said that by and large people during the siege were damaged by irregular eating and drinking and excessive toil. Owing to two or three months of being hungry in the morning and full at night, rising and sleeping irregularly, and suffering from cold and heat due to being homeless, their stomach qi had been exhausted for a long time. If one day they were damaged by eating excessively, and, furthermore, the treatment [of their illness] was inappropriate, then there is no doubt they would die. It was not only Daliang that was this way. Far away in Zhenyou and Xingding, in places like Dongping, Taiyuan, and Fengxiang, after the siege was lifted, there were no cities which did not suffer illness and death in the same way. In Daliang, I personally witnessed that there were some [physicians] who effused [patients’] exterior. Some used croton fruit to eliminate [the evil qi]. Some used Order the Qi Decoction to purge [the patients]. Suddenly the illness would become chest-bind and jaundice, and [the physician] would then use Sunken into the Chest Decoction or Pill taken with Virgate Wormwood Decoction. There were none that did not die. It must be that [the illness] was not cold damage to begin with. Because the treatment was mistaken, it changed and appeared similar to the pattern of true cold damage. It is all the fault of the medicine.411 … 解圍之後,都人之不受病者,萬無一二,既病而死者,繼踵而不絕。都門十有 二所,每日各門所送,多者二千,少者不下一千,似此者幾三月。此百萬人豈俱感 風寒外傷者耶。大抵人在圍城中,飲食不節及勞役所傷,不待言而知。自其朝飢暮 飽,起居不時,寒溫失所,動經三兩月,胃氣虧乏久矣。一旦飽食大過感而傷人, 而又調治失宜,其死也無疑矣。非惟大梁為然,遠在貞祐、興定間,如東平,如太 原,如鳳翔,解圍之後,病傷而死,無不然者。余在大梁,凡所親見,有表發者, 有以巴豆推之者,有以承氣湯下之者,俄而變結胸、發黃,又以陷胸湯、丸及茵陳 湯下之,無不死者。蓋初非傷寒,以調治差誤,變而似眞傷寒之證,皆藥之罪也。 According to Li, internal damage due to irregular diet and fatigue could produce what we would now call a febrile epidemic. The cold, generally chronic illness seen in Zhang Yuansu’s version of internal damage is here transformed into a hot, potentially acute, febrile illness.

Neiwaishang bianhuo lun, juan shang, bian laoyi shoubing biaoxu buzuo biaoshi zhizhi in ibid., 16.

Neiwaishang bianhuo lun, bian yinzeng yangzheng, in ibid., 8–9.



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