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Zhu’s approach to using the formulae from the Treatise on Cold Damage demonstrates that the trend I have been tracing—of greater use of the Treatise’s ideas and formulae in treating miscellaneous diseases—was neither ubiquitous nor linear in its progress. In spite of the fact that he had studied Wang Haogu’s works,425 he never recommends the use of a formula from the Treatise for a miscellaneous disease. He did not, however, ignore the Treatise. Like Li Gao before, him, Zhu composed a text, now lost, discussing the Treatise. In his lambasting of the Song dynasty Formulae of the Pharmacy Bureau, Exposition on the Bureau’s Formulary (Jufang fahui 局方發揮, date unclear), Zhu substantiated his criticisms by copious citations from both the Treatise on Cold Damage and its sister-text Essentials of the Golden Coffer. These quotations and paraphrases are so frequent that they constitute the bulk of the text. In spite of the obvious esteem in which he held the Treatise and the authoritative way in which he quoted from it, Zhu held that the Treatise’s formulae were for treating cold damage and not miscellaneous diseases. Near the beginning of the Exposition, he divides the totality of illness between Zhang Ji and Li Gao: “Treating external contraction by effusing and scattering is Zhongjing’s method;
treating internal damage by supplementing and nurturing is Dongyuan’s method. Who can alter Insightful Views Produced by Investigation of Things (Gezhi yulun 格致餘論, 1347), author’s preface, in Zhu Zhenheng, Zhu Danxi yixue quanshu, ed. Tian Sisheng (Beijing: Zhongguo Zhongyiyao Chubanshe, 2006), 3.
them? 治外感以發散，仲景法也，治內傷以補養，東垣法也，誰能易之?”426 Zhu thus retained the Song distinction between cold damage and miscellaneous diseases, and none of the many case histories attributed to him by his students show him treating miscellaneous disease— the latter reconceived as forms of internal damage—with formulae from the Treatise. His student, Wang Lü, however, would break with Zhu’s precedent on this point.
Wang Lü Wang Lü (styled Andao 安道) was born in Kunshan in modern-day Jiangsu. He was a student of Zhu Zhenheng, but his views on the Treatise’s range of application—as seen in his quote which opened this chapter, were quite different. For Wang, Zhang Ji’s methods were so profound that if properly understood, “later people can neither add to it nor go beyond it 後人莫 能加莫能外矣.”427 Like Wang Haogu, Wang Lü addressed the division of cold damage and
miscellaneous diseases directly:
Zhongjing’s established methods are the standard for later generations under heaven;
therefore, you can borrow them to use for other illness … In treating miscellaneous diseases, there is not one [disease for which] you cannot borrow them.428 夫仲景之立法，天下後世之權衡也，故可借焉以為他病用 … 凡雜病之治，莫不可 借也。 For Wang Lü, as for Wang Haogu, the Treatise on Cold Damage transcended the division between cold damage and miscellaneous diseases.
Wang did not, however, conclude that there was no need for further development in medicine. The section of Collection on Returning to the Medical Classics (Yijing suhui ji 醫經溯 洄集, late 14th c.) from which this passage is taken is devoted to arguing against the use of the Jufang fahui, in ibid., 34.
Yijing suhui ji, Zhang Zhongjing shanghan lifa kao, in Wang Lü, Yijing suhui ji, 20.
Yijing suhui ji, Zhang Zhongjing shanghan lifa kao, in ibid., 20–21.
Treatise’s formulae in cases of warmth and summerheat illnesses (wenshubing 溫暑病). For Wang, the real goal was to understand Zhang Ji’s “intention (yi 意)” in establishing a particular method. If you understood his intention, you would use his methods and formulas correctly. If you failed to understand his intention, you would turn the Treatise on Cold Damage into a “calamity for later generations 貽禍後人.”429 In the case of warm disease and summerheat, Wang argued that one had to understand that Zhang Ji’s intention in writing the Treatise had been to treat illnesses in which external cold immediately produced an illness (jibing shanghan 即病傷寒). Such illnesses were cold in nature and demanded the use of the warm medicinals seen in Zhang Ji’s signature formulae. On the other hand, warmth and summerheat illnesses were examples of illnesses in which external cold hid within the body and only manifested as an illness in the spring or summer. Such illnesses were hot in nature, and warm medicinals were contraindicated. Wang attributed this gap in the Treatise to the ravages of time. The parts of the Treatise describing such treatments had been lost, but by understanding Zhang Ji’s intentions, one could know that different methods and formulae were necessary for treating warm and
If Zhongjing had established formulae for warmth and summerheat, it would certainly not be like this. There would have to be separate methods. I merely regret that his legacy was lost and not transmitted.430 若仲景為溫暑立方，必不如此，必別有法，但惜其遺佚不傳。 The incompleteness of the Treatise was thus not an indictment of its value any more than its universal applicability was an end to all medical learning. The importance of the Treatise lay in the intentions of which it was an outer manifestation. By understanding these intentions, a doctor could learn to respond to the variability of illness with an equally variable repertoire of Yijing suhui ji, Zhang Zhongjing shanghan lifa kao, in ibid., 19.
Yijing suhui ji, Zhang Zhongjing shanghan lifa kao, in ibid., 25.
treatments. The Treatise on Cold Damage was the solution to the problem of the mutability of illness, but only if it was read as a living document.
CONCLUSION: The Dioscorides of Chinese Medicine In his study of Renaissance natural history, Brian Ogilvie describes the formation of the
discipline of natural history:
… natural history was invented in the sixteenth century, but Renaissance naturalists drew upon ancient and medieval predecessors in the study of nature. Steeped in medical humanism, the first generation of naturalists turned naturally to the Roman and especially Greek classics to delineate their subject and defend their methods. Subsequent generations pursued lines of inquiry set by the ancient and medieval authors even as those authors works received less and less attention.431 In particular, Dioscorides’ work on medicinal substances, De materia medica, drew the admiration of early Renaissance naturalists. In their eyes, Dioscorides was the “model of the careful naturalist” and his work “served as a pattern for descriptive natural history.”432 Renaissance natural historians learned how to “do” natural history by studying Dioscorides.
Ogilvie enumerates several reasons why Dioscorides was chosen as a model instead of Aristotle, Theophrastus, or Pliny—all of whose texts on natural objects were available to Renaissance naturalists. Dioscorides’ text had a reputation for reliability, it was medical (most early naturalists were also physicians), and it focused on description of medicinal substances—their appearance, where they were found, how they were used—and largely ignored philosophical questions, a trait that appealed to the dominant humanist point of view.433 In short, Dioscorides was useful to Renaissance naturalists. De materia medica combined the pedigree of antiquity and Ogilvie, The Science of Describing, 87.
a reputation for accuracy with an approach to the study of nature that was in harmony with the prejudices and preferences, goals and desires of Renaissance naturalists.
In its initial stages, then, natural history consisted of a combination of philological work and an effort to match Dioscorides’ descriptions to plants familiar to Renaissance naturalists, but—especially for naturalists living in Northern Europe—there were difficulties. Dioscorides’ descriptions were far from perfect, and as naturalists honed their own descriptive skills and explored territory Dioscorides had never known, they came to see their own work as superior to his. Respect for Dioscorides became merely respect for one’s forbears: he was no longer pragmatically useful.
The parallel with the history of Treatise on Cold Damage is instructive. Like their Renaissance counterparts, Song intellectuals placed a high value on Antiquity. The Song witnessed a resurgence of interest in the practical application of ancient ideas and methods to contemporary problems. The Treatise was both an ancient text and had a well-established reputation for efficacy in medical circles. Moreover, Zhang Ji’s emphasis on the variability and of illness—and the need to adapt treatments in accord with that diversity—matched the Song elite’s concerns over the diversity of illness. The Treatise on Cold Damage was useful because it could be read as an answer to this central problematic of Song elite medical thought.
Like Renaissance natural history, Northern Song cold damage studies were focused to a large extent on solving the philological problems the Treatise on Cold Damage presented (as discussed in chapter 4). In the Southern Song and Jin dynasties, however, writing about the Treatise took on new dimensions. Liu Wansu combined the Treatise’s ideas with the Inner Classic’s doctrine of the five movements and six qi, arguing for a view of cold damage as an illness dominated by heat qi. Zhang Zihe adapted the Treatise’s three “attacking methods” to form a new therapeutic approach that emphasized expelling evil qi from the body, and Li Gao used the Treatise as a basis to refashion internal damage as the complement of cold damage, arguing against Zhang Zihe and emphasizing the necessity of warming and supplementing medicinals.
In spite of this near abandonment of philological enquires into the Treatise on Cold Damage, the Treatise itself—unlike Dioscorides’ De materia medica—did not become obsolete.
It remained an essential support for any medical argument and its medical purview expanded in a slow and uneven but relentless progress to include all of cold damage and miscellaneous diseases—the entirety of medicine at the time. Arguments about the need for contemporary formulae to treat contemporary illnesses served to emphasize the need to individualize prescriptions—a technique learned from the Treatise itself—and make room for new ideas and practices—whose validity was always defended, at least in part, by reference to the Treatise.
Why did the Treatise on Cold Damage remain pertinent to medical discourse in the Southern Song, Jin, and Yuan dynasties while Dioscorides gradually became irrelevant? The wider cultural contexts of Renaissance Europe and middle-period China no doubt offer many explanations, but such broad arguments run the risk of falling into generalization and stereotypes.
I will therefore limit myself to discussing a few specific points. First, Renaissance naturalists were primarily concerned with identifying and distinguishing various plants and animals. If Dioscorides misidentified a plant or described it incorrectly or incompletely, not only was he incorrect, but his description would also be superseded by any more accurate or complete account.434 Human illnesses and healing, the Treatise’s topic, were less susceptible to clear refutation. It was always possible to explain any given failure of treatment in terms that did not It is worth noting that a similar process occurred in the Chinese materia medica tradition. New materia medica both built on and superseded previous ones. As a result, our knowledge of older materia medica texts is the result of arduous reconstructions by Qing and modern scholars.
impugn the Treatise. Second, for Renaissance naturalists, commentary on Dioscorides and other early sources was limited to correcting their errors and giving modern identifications for the plants and animals described. Chinese medical authors used commentary for far more diverse purposes. Commentary could justify treatment choices and doctrinal innovations, it could tie together historically unrelated texts, it could argue against other author’s ideas, and it could establish the commentator’s erudition. The flexibility of commentary among Chinese physicians allowed the Treatise to remain pertinent to a large range of issues and useful in many endeavors.
Finally, while De materia medica offered a model of detailed natural description, it did not—and given the two constrains mentioned above, could not—offer a true solution to the central problematic of Renaissance natural history: how to meaningfully describe and catalog the diversity of living things. By contrast, the Treatise on Cold Damage not only offered a model for the treatment of illnesses, it also offered both the conceptual solution to the problem of the variability of illness—the individualization of treatment—and a set of practical tools—in the form of diagnostic methods, treatment principles, and medicinal formulae—which could serve as the basis for realizing this conceptual solution—for treating actual illnesses.
For all of these reasons, the Treatise on Cold Damage remained actively useful to Chinese physicians even after the initial phases of popularization and explication were over. The Treatise was useful in arguing with other physicians, in convincing patients to follow your advice, and in the learning and practice of medicine. Literati physicians first learned to deal with the complexity of illness by studying the Treatise, and their successors continued to learn this skill by studying it. So long as it continued to play these important roles, the Treatise on Cold Damage would continue to occupy a place in the heart of literati-physician medicine.
The medical crisis of trust that began in the Northern Song came to an end in the Yuan.
As discussed in Chapter 3, there is no purely intellectual or analytical means of closing such crises. They can only be resolved through social action. In this case, the “solution” was the inadvertent result of social and political changes unrelated to medicine.