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As this example demonstrates, the imperial edition of the Treatise on Cold Damage served to establish both a common point of reference and a common set of problems among medical authors. Intertextual dialogue and debate were possible in part because everyone involved was looking at the same text. Han Zhihe (韓祇和, fl. late 11th c.) devoted a large section of his cold damage text to the treatment of yin jaundice (yinhuang 陰黃) because, although the Treatise mentions it, Zhang Ji “… did not further establish separate formulae [to treat it] 即不增 別立方藥.”106 Zhu Gong (朱肱, late 11th-early 12th c.) took up the same problem, but came to different conclusions about which formulae should be used.107 Likewise, discussions of how to treat warm disease —another illness which the Treatise names without providing a treatment— are found in the works of Zhu Gong, Pang Anshi, and Xu Shuwei among others.108 More broadly, the framework of the Treatise on Cold Damage—the diseases of the three yin and three yang— became the standard framework for discussions of cold damage, and the terminology of the Treatise—the names it uses for diseases, signs and symptoms, treatment methods, etc.—became the standard terminology of cold damage studies. In short, after 1065, cold damage studies became Treatise on Cold Damage studies.
Shanghan weizhi lun, juan xia, yinhuang zheng pian, in Zhu Pangxian and Wang Ruoshui, eds., Lidai zhongyi zhenben jicheng, vol. 3 (Shanghai: Shanghai Sanlian Shudian, 1990), 33.
Nanyang huoren shu, juan 6, question 47 and juan 11, question 89, in Zhu Gong and Pang Anshi, Zhu Gong, Pang Anshi yixue quanshu, 55, 74–75.
E.g., Zhu Gong, Nanyang huoren shu, juan 6, question 43, in ibid., 53; Pang Anshi, Shanghan zongbing lun, juan 5, tianxing wenbing lun, in ibid., 189; Xu Shuwei, Shanghan baizheng ge, juan 2, di’ershiqi zheng, in Xu Shuwei, Xu Shuwei yixue quanshu, 13–14.
Conclusion: A Narrowing of Vision, a Broadening of Discourse From its inception cold damage studies was a vital field within pre-Song text-based medicine. Its vitality never abated, and the interest in cold damage studies seen in the first century of the Northern Song was merely a continuation of preexisting trend possibly amplified by the rising number of epidemics during that period.109 Within this earlier tradition, the works of Zhang Ji, including the Treatise on Cold Damage in whatever forms it was circulating, were both well-known and highly valued. The Treatise may have been in limited circulation owing to the relatively immature state of a publishing industry, the habit of secrecy among physicians of the time, and a general disdain for medicine on the part of the elite, but the number of editions in which Treatise is known to have been transmitted and the number of references to it and its formulae make it clear that it was neither lost nor forgotten.
The sudden upsurge in writing on the Treatise that followed its imperial publication in 1065 cannot, therefore, be called a “renaissance” or even a “revival.” It was, in fact the narrowing of a once broad and vibrant tradition of cold damage studies to focus on a single edition of a single text. It is this narrowing of focus and its unexpected result—an explosion of discourse—which need to be examined and explained. Why was the Treatise on Cold Damage singled out from among other cold damage texts? Why did Song physicians focus on the Treatise to a greater degree than any other text—not merely in the cold damage tradition but in the entirety of the medical tradition? Why did the Treatise remain so salient for later physicians?
These are the questions that must be answered in order to understand the transformation of the Goldschmidt, “Epidemics and Medicine,” 56–78; A. Morabia, “Epidemic and Population Patterns in the Chinese Empire (243 BCE to 1911 CE): Quantitative Analysis of a Unique but Neglected Epidemic Catalogue,” Epidemiology and Infection 137, no. 10 (June 4, 2009): 1361–68.
status of the Treatise on Cold Damage during the Song and its relation to the broader transformations of medicine during that period.
As seen in Chapter 1, the Treatise on Cold Damage’s transformation into one of the most central texts of Chinese literate began in the Song Dynasty, and in this chapter I turn to the background of that change through an examination of the many important developments that occurred during that era. The Song dynasty has long been recognized as an era of profound change in Chinese society. Some scholars, looking forward from the Tang Dynasty have referred to these changes as the “Tang-Song transition;”110 others, looking back from the Ming, have incorporated them into the “Song-Yuan-Ming transition.”111 In either case, the Song is widely recognized as having laid the foundations for and set the basic patterns of the remainder of the imperial period.
Robert Hartwell’s work was among the first in English-language literature to draw attention to the transformations of the Song.112 Later work has revealed systemic changes in the composition and self-conception of the elite, family and lineage organization, elite survival strategies, commerce, governance, and intellectual discourse.113 More recently, research has Naitō Torajirō, “A Comprehensive Look at the T’ang-Sung Period,” trans. Joshua A. Fogel, Chinese Studies in History 17, no. 1 (October 1983): 88–99.
Paul Jakov Smith and Richard von Glahn, The Song-Yuan-Ming Transition in Chinese History (Cambridge:
Harvard University Asia Center, 2003).
E.g., Robert M. Hartwell, “Demographic, Political, and Social Transformations of China, 750-1550,” Harvard Journal of Asiatic Studies 42, no. 2 (December 1982): 365–442.
For a discussion of changes in the elite see Nicolas Olivier Tackett, “The Transformation of Medieval Chinese Elites (850--1000 C.E.)” (Ph.D., Columbia University, 2006); for changing family and lineage organization, Patricia Ebrey, “Conceptions of the Family in the Sung Dynasty,” Journal of Asian Studies 43, no. 2 (February 1984): 219– 45; and Patricia Ebrey, “The Early Stages of in the Development of Descent Group Organization,” in Kinship Organization in Late Imperial China, 1000-1940, ed. Patricia Ebrey and James L. Watson (Berkeley: University of California Press, 1986), 16–61; for changes in elite survival strategies, John W. Chaffee, The Thorny Gates of Learning in Sung China (New York: State University of New York Press, 1995); and John W. Chaffee, “Status, Family, and Locale: An Analysis of Examination Lists from Sung China,” in Liu Zijian Boshi Songshouji Songshi Yanjiu Lunji, ed. Kinugawa Tsuyoshi (Kyoto: Dohosha, n.d.), 341–56; for intellectual discourse, Peter Bol, “This Culture of Ours”: Intellectual Transitions in T’ang and Sung China (Stanford University Press, 1994); and Peter Bol, Neo-Confucianism in History (Cambridge: Harvard University Asia Center, 2008); for an overview of social argued that the Song dynasty also witnessed a major increase in Chinese society’s epidemiological burden.114 All of these changes were deeply interwoven with equally fundamental changes in medical learning, doctrine and practice.
This chapter contextualizes the rising importance of the Treatise on Cold Damage within the broader transformations occurring the Song dynasty. Part One begins by examining social changes, focusing on the transformation of Chinese social structure and the composition of the elite, literati social stratum. Part Two examines the evidence for a major epidemiological shift occurring during the Song, and Part Three surveys the changing medical landscape of the Song.
SECTION ONE: Social Change in the Song Dynasty The elite of the Northern Song were national in both their sphere of activity and their consciousness. They monopolized high office to the exclusion of other social groups, married among themselves even at great distances, and demonstrated little commitment to their natal places once they had achieved high office. By the Southern Song, this national elite had been absorbed into the far larger local elite and this amalgamated elite pursued predominantly, though not exclusively, localist strategies: they rarely obtained office but actively participated in the examinations, married primarily within the same county, maintained extensive social ties to their change in the Song genreally Robert Hymes, Statesmen and Gentlemen: The Elite of Fu-Chou Chiang-Hsi, in Northern and Southern Sung (New York: Cambridge University Press, 1987) and his forthcoming chapter in this dissertation 2 of the Song volume of the Cambridge History of China; for a summary of medical change during the Song, see Goldschmidt, Evolution; and Angela Ki-che Leung, “Medical Learning from the Song to the Ming,” in The Song-Yuan-Ming Transition in Chinese History (Cambridge: Harvard University Press, 2003), 374–98; for changes in elite attitudes to medicine, see Hymes, “Not Quite Gentlemen?”; and Chen Yuanpeng, Liang Song de “shangyi shiren.” Goldschmidt, “Epidemics and Medicine”; Alfredo Morabia, “Epidemic and Population Patterns in the Chinese Empire (243 BCE. to 1911 CE): Quantitative Analysis of a Unique but Neglected Epidemic Catalogue.,” Epidemiology and Infection 137, no. 10 (2009): 1361–68.
natal place even if they rose to high office, and focused to a greater degree on maintaining their status in the eyes of their local peers through local charity and local leadership.115 In addition to these changes in the nature of their own social group, the Song elite faced unprecedented challenges arising from the spread of printing and commerce in books. As printed books became more readily available and less prohibitively expensive, a wider social stratum than even the expanded literati was able to afford both literacy and books. This allowed for the proliferation of new social groups comprising individuals who were literate and made their living by means of their literacy but to varying degrees lacked the culture, learning, and social networks of the elite. Robert Hymes terms this group the “lumpenliterati” and includes in their number primarily religious specialists, litigation masters, and physicians. As a group, they aroused anxiety on the part of the literati, who saw them as destabilizing forces with the potential to encroach on literati privileges and powers.116 Along with changes in the composition of the literati stratum came changes in both the ideas the literati expressed and how they expressed those ideas. Peter Bol describes three fundamental changes that occurred in the eleventh century and heavily influenced the ideas and ideologies of Song thinkers. First, learning became politicized because of the increasing importance of the examinations in official careers. Political factions came to identify with particular styles of learning and attempted to enforce their style as the standard for the examinations and thereby for everyone who wished to participate in the examinations. Second, the previously accepted justifications for empire were gradually undermined as the conceptions of history, the cosmos, and humans’ place in both changed. The search for new formulations of a person’s place in the world and the proper role of empire inspired much of the intellectual fervor Robert Hymes, “Sung Society and Social Change,” in The Cambridge History of China, Vol. 5, Part 2: Sung China, 960-1279, ed. John Chaffee and Dennis Twitchett (New York: Cambridge University Press, 2015), 621–642.
Ibid., 557–562, 650–652.
of the Song. Third, just as learning became political, government became ideological. In addition to driving the extreme factionalism of the later Northern Song court, this climate of ideological government contributed to a level of government activism never seen in any Chinese dynasty before or since. 117 Significantly, Bol argues that the core of these intellectual changes were, “redefinitions of what it meant to be a good shih,”118 revealing one of the links between social and intellectual change in this period.
SECTION TWO: The Song Dynasty’s Epidemiological Frontiers For this dissertation, one of the most significant changes that occurred in the Song was the rise in the frequency and severity of epidemics. Such epidemics were more than a physical threat to the well-being of the state and its people. Epidemics were one of several natural phenomena that were traditionally held to indicate moral failings on the part of a ruling house, and the possibility that they had lost the “mandate of heaven,” which granted them the right to rule. Epidemics were therefore an existential threat to the state and its supporters.119 Historical epidemiology is always problematic. This is all the more true when studying a place like China, where radically different views of health, illness, and healing complicate the interpretation of the already limited number of surviving records. Nonetheless, recent research has provided persuasive evidence for an increase in the epidemiological burden of the Chinese populace during the Song. Asaf Goldschmidt, following the work of Miyashita Saburō, has shown that there was a decided increase in the number of epidemics recorded during the Northern Song and that the Song government was both aware of and concerned by this increase.
Goldschmidt argues persuasively that the fear of epidemics was part of the motivation behind the Bol, Neo-Confucianism, 43-44.
Bol, This Culture of Ours, 334.
Goldschmidt, “Epidemics and Medicine,” 76.
publishing of the Treatise on Cold Damage.120 Cold damage was the primary rubric under which epidemic febrile illnesses were understood in the Song, and the Treatise was the preeminent text on cold damage. The imperial publication of the Treatise further added to its luster, and its popularity is no doubt in part due to the perception that it was particularly useful in dealing with epidemic illness.
An important question is what led to these epidemics. The causes of any particular epidemic cannot be pinned down, but two factors have been highlighted as likely causes of the increased frequency of epidemics in general: the southward migration of the Chinese population and the absolute increase in population under the Song.