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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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Finally, the fragments of the Han dynasty Canonical Methods of Decoctions contained in the Helpful Instructions on Methods for Using Medicinals According to the Viscera and Bowels are worthy of separate consideration. Canonical Methods of Decoctions is first mentioned in the bibliographic section of the Book of the Han (Hanshu 漢書, 92 CE), in a section labeled “canonical formulae (jingfang 經方)” and is said to have contained thirty-two fascicles. The fragments of the Canonical Methods found in the Helpful Instructions—itself a previously unknown text found at Dunhuang—are its only extant portions. Although Zhang Ji makes no mention of the Canonical Methods in his preface, where he lists the sources he used for compiling his text,44 both Huangfu Mi (皇甫謐, 215-282) in the preface to his Systematic Classic of Acumoxa (Zhenjiu jiayi jing 針灸甲乙經) and the Helpful Instructions assert that Zhang Ji Moreover, this section of the preface is widely suspected to be a later addition, a suspicion supported by its presentation as commentary in the Kōhei edition.

adapted the formulae of the Canonical Methods in producing his text. This is confirmed by the fragments of the Canonical Methods included in the Helpful Instructions, the formulae of which show clear kinship to many of Zhang Ji’s formulae in their names, ingredients, preparation, and use.45 Interestingly, the fragments of the Canonical Methods with the greatest similarity to the Treatise on Cold Damage refer to neither cold damage nor the theory that cold damage in winter can produce warm or hot illnesses later in the year. Instead, they mention only heavenlymovement illness (tianxing bing 天行病), and the names given the formulae—many of which are taken from the cosmic animals associated with the four directions—show a concern for yin and yang as conceived through the four directions, a framework entirely absent in the Treatise.46 This seems to suggest that Zhang Ji adopted the formulae of the Canonical Methods but fit them into a doctrinal framework derived from the Inner Classic corpus; but too little of the Canonical Methods has survived to permit more than conjecture.

The diversity of pre-Song cold damage studies traditions as revealed here further supports the argument that cold damage studies was an active and thriving part of medical thought and practice before the Song. It was certainly not, “A unique approach… that had been virtually lost for eight centuries.”47 Not only was the Treatise on Cold Damage far from being the sole representative of cold damage studies in this period, it existed in a milieu replete with contending voices and differing points of view.

Huangfu Mi, Zhenjiu jiayi jing, author’s preface, in Huangfu Mi, Zhenjiu jiayi jing jiaozhu, 17; Tao Hongjing, Fuxingjue zangfu yongyao fayao, in Ma Jixing, ed., Dunhuang Yiyao Wenxian Jijiao (Yangzhou: Jiangsu guji chubanshe, 1998), 187–193.

E.g., minor white tiger decoction (xiao baihu tang 小白虎湯) and minor green dragon decoction (xiao qinglong tang 小青龍湯), which correspond to white tiger decoction (baihu tang 白虎湯) and ephedra decoction (mahuang tang 麻黃湯) in the Treatise.

Goldschmidt, Evolution, 141.

The Structure of Pre-Song Cold Damage Studies Texts The doctrinal diversity of pre-Song cold damage studies contrasts with a striking lack of diversity of genre. As we have seen, compilations and compendia dominate the surviving medical writing from this period, and no author wrote a text devoted exclusively to cold damage.

Although the Treatise on Cold Damage itself may have been separated from the remainder of the Treatise on Cold Damage and Miscellaneous Illnesses at an early date, it was not originally composed as a text specializing in cold damage. Furthermore, with the exception of the Treatise (in its various editions), the Inner Classic corpus, the Classic of Difficulties, and the Treatise on the Origins and Signs of Diseases, all of the texts are structured as formularies (fangshu 方書), i.e., listings of formulae followed by the signs and symptoms they treat.

It is this common structure that Goldschmidt cites in support of his argument that before the Song diagnosis proceeded solely by symptom-matching.48 The very size of these texts, however, reveals the implausibility of such a method. Formulae Worth a Thousand Gold contains more than six thousand formulae, and Further Formulae Worth a Thousand Gold and Secret Essentials of the Outer Terrace, each contain similar numbers. No individual could possibly memorize all the formulae and symptoms in even one of these texts. Large compendia such as Formulae Worth a Thousand Gold and Essentials of the Outer Terrace were intended as E.g., Goldschmidt, “The Song Discontinuity: Rapid Innovation in Northern Song Dynasty Medicine,” 83, in which Goldschmidt refers to this style of organization in Formulae of Sagely Beneficence (Shenghui fang 聖惠方, 992); in, Goldschmidt, Evolution, 143, Goldschmidt cites two case histories of the Song physician and literatus, Xu Shuwei (許叔微, 1080-1154), to argue that Xu also practiced symptom-matching, but this is also a stylistic issue.

The cited passages are this dissertation of the case narrative which is followed by doctrinal discussions not included in the narrative itself. The first case Goldschmidt cites is followed by a discussion of the meaning of a term found in the Treatise on Cold Damage; the second case is followed by a discussion which analyzes two quotes from Zhang Ji and the physiology of the eyes to diagnose the patient’s ailment as a form of untreatable fatal expiry (sijue 死絕) of the viscera; see, Xu Shuwei, Shanghan jiushi lun, cases 20 and 26, in Xu Shuwei, Xu Shuwei yixue quanshu, ed. Li Jushuang and Liu jingchao (Beijing: Zhongguo Zhongyiyao Chubanshe, 2006), 62–63.

references and are not representative of the way practicing physicians learned medicine or selected formulae.

Moreover, these compendia were written primarily as references for laypeople not trained in medicine. In his Short Treatise on Classical Formulae, Chen Yanzhi clearly states that even

his far shorter text is not intended for medical specialists:

Now, if you wish to take the art of formulae as your study, you ought to thoroughly read the great, fundamental treatises on canonical methods… If you do not wish to take the art of formulae as your study, but merely [wish] to prepare yourself against emergencies, you should take oral instructions on formulae and reading this one book, a Short Treatise on Classical Formulae, as essential.49 今若欲以方為學者,當精看大品根本經法… 若不欲以方術為學,但以備身昉急者, 當以方訣,看此《經方小品》一部為要也。 In origin, these published formularies are larger and more sophisticated versions of household formularies compiled by elite families, which consisted of formulae which members of the family had used or otherwise encountered and considered valuable enough to merit recording.

The existence of household formularies is well attested in the Song dynasty by mention of such compilations in prefaces,50 references in published formularies,51 and the lengthy list of such formularies in Liu Fang’s (劉昉, ca. 1080-1150) New Book on Children (Youyou xinshu 幼幼新 書).52 Their existence among the pre-Song elite is attested by Chen Yanzhi in his discussion of

extant medical texts:

All of the aristocratic families each compose themselves a compilation of medicinal formulae that they have taken. Ultimately, these large collections are what the court and scholars supplement and amend. It is not possible to record them all.53 一切諸貴家皆各自撰集服藥方,終歸是大集中事及術士所增損耳,不可悉錄也。 Juan 1, shu kan fangjue, in Yan Shiyun and Li Qizhong, Sanguo liang Jin Nanbeichao yixue zongji, 785.

E.g., Wang Gun (王袞, fl. 1047-1082) Bojifang (博済方, 1047), author’s preface, in Siku Quanshu, Wenyuange, Dianziban, digital ed. (Taibei: Zhongwen Daxue Chubanshe, n.d.), 6–7.

E.g., Su Shi (蘇軾, 1037-1101), Su Shen Liang Fang (蘇沈良方, 1075), juan 2, lun fengbing, in Su Shi and Shen Gua, Su Shen neihan liangfang, ed. Song Zhenmin and Li Enjun (Beijing: Zhongyi Guji Chubanshe, 2009), 66.

Juan 40, pian 15, in Qian Yi and Liu Fang, Qian Yi, Liu Fang yixue quanshu, ed. Li Zhiyong (Beijing: Zhongguo Zhongyiyao Chubanshe, 2005), 975.

Juan 1, shu kan fangjue, in Yan Shiyun and Li Qizhong, Sanguo liang Jin Nanbeichao yixue zongji, 785.

The existence and use of these family formularies prior to the Song can also be seen in Formulae

to Keep Close at Hand’s reference to “households prepared for emergencies (beiji jia 備急家)”:

If heat illness is not treated promptly or is treated but [the patient] does not recover after more than ten days, all of these are aggravated illnesses. You should only take greater or lesser turtle shell (biejia tang 鱉甲湯) decoction. The measures [of the ingredients in] these formulas are small and the medicinals many. It is not something which households prepared for emergencies make; therefore, I have not recorded it.54 若熱病失治及治不差十日以上,皆各壞病,唯應服大、小鱉甲湯,此方藥分兩乃少 而種數多,非備急家所辦,古不載。 Family formularies were a reference for the members of the family to use when someone fell ill.

Keeping such a formulary, and—judging from Ge Hong’s comments—some of the medicinals used in common formulae, prepared a household against medical emergencies. The full title of Formulae to Keep Close at Hand is Formulae to Keep Close at Hand in Preparation for Emergencies (Zhouhou beiji fang 肘后備急方), and that of Formulae Worth a Thousand Gold is Formulae Worth a Thousand Gold in Preparation for Emergencies (Beiji qianjin yaofang 備急 千金要方). These texts were never intended to be tracts on medical doctrine or even textbooks of medicinal formulae. Even the Treatise on Cold Damage, which is not structured as a formulary, was intended primarily for non-physicians, as indicated by Zhang Ji’s lamentation that the literati trusted their lives to ordinary physicians (fanyi 凡醫).55 While we know that many of these texts came to be used by practicing physicians as well as laypeople, the surviving pre-Song medical works were overwhelmingly aimed at literate, elite, non-physicians. They were meant as references, massive compilations which could be consulted at need. Their emphasis on symptomology followed from their assumption that most of their readers were at best medical amateurs.

Juan 2, pian 13, in Ge Hong, Tao Hongjing, and Yang Yongdao, Buji Zhouhou fang, 56.

Shanghan lun, author’s preface, in Zhang Ji, Zhongjing quanshu, 305.

Zhang Ji’s Place in Pre-Song Cold Damage Studies Having examined the content and structure of the pre-Song cold damage studies tradition, we are now in a position to explore the place of Zhang Ji and his works in that tradition. In addition to arguing that cold damage studies was a neglected branch of medicine prior to the Song, both Unschuld and Goldschmidt have argued that the Treatise on Cold Damage was largely unknown and unimportant during the period from its composition to its publication by the Song government. Unschuld asserts that the Treatise “exerted marginal influence on medical thought and literature between the Han and Sung dynasties.”56 Goldschmidt, rather more specifically, argues that, “It seems that most physicians during the centuries following the third century CE until the eleventh century were not familiar with the Treatise,” and, “there is only one source that refers to texts that can be associated with the Treatise prior to the seventh century.”57 Once again, however, Unschuld and Goldschmidt fail to consider a number of important compendia which cite the Treatise and neglect the possibility that the Treatise may not have been separated from its mother text at this time. When seen through the lens of the preSong cold damage studies tradition described in this chapter, the position of the Treatise looks very different.

References to the Treatise on Cold Damage in Texts Prior to the 7th Century As Goldschmidt notes, references to Zhang Ji and the full text of the Treatise on Cold Damage and Miscellaneous Diseases, of which the Treatise on Cold Damage is but one part, are easily found in the third century. The earliest surviving citations from the Treatise are found in Unschuld, Medicine in China, 168.

Goldschmidt, Evolution, 97.

Wang Shuhe’s Classic of the Pulse which paraphrases large sections of the Treatise. While the extensive editing of Wang’s work by Song editors makes it unreliable as a source for the early textual history of the Treatise on Cold Damage, its extensive citations of Zhang Ji’s work attest to Wang’s admiration. The next reference to the writings of Zhang Ji is found in Huangfu Mi’s preface to his Systematic Classic of Acumoxa, in which Zhang is included in a list of famous physicians (mingyi 名醫) alongside such venerated figures as Hua Tuo and Bian Que (扁鵲, fl.

5th c. BCE).58 Clearly, third century medical authors both knew of and respected Zhang Ji and his works.

Medical authors of the following centuries continued to draw on Zhang Ji extensively, though not always by name. Ge Hong, writing in the early 4th century, does not mention either Zhang Ji or the Treatise on Cold Damage, but he does record several of the formulae found in the Treatise and includes two of them—Major and Minor Bupleurum Decoctions (da/xiao chaihu tang 大/小柴胡湯)—in a list of the four most essential formulae for treating cold damage and seasonal qi illnesses.59 The surviving fragments of Fan Wang’s formulary, also dating to the fourth century, likewise include the Treatise’s formulae without mentioning its name.60 Chen Yanzhi, writing around the early 5th century, explicitly records a Zhang Zhongjing’s Differentiation of Cold Damage with Formulae (Zhang Zhongjing bian shanghan bing fang 張仲景辨傷寒並方) as well a Zhang Zhongjing’s Miscellaneous Formulae (Zhang Zhongjing zafang 張仲景雜方) in a list of the “great works (dapin 大品)” which a serious student of formulae should study, and quotations from “Zhongjing’s Treatise on Cold Damage author’s preface, in Huangfu Mi, Zhenjiu jiayi jing jiaozhu, 16–17.

Juan 2, pian 2, in Ge Hong, Tao Hongjing, and Yang Yongdao, Buji Zhouhou fang, 55–56.

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