The Evolution of Chinese Medicine

Song Dynasty, 960–1200

Asaf Goldschmidt

• Publisher: Routledge
• Year: 2008
• Print ISBN: 9780415426558
• eBook ISBN: 9781134091805
• Edition: 1
• Topic: History
• Subtopic: Chinese History
• Index: History

The history of Chinese medicine hinges on three major turning points: the formation of canonical theory in the Han dynasty; the transformation of medicine via the integration of earlier medical theories and practices in the Song dynasty; and the impact of Western medicine from the nineteenth century onwards. This book offers a comprehensive overview of the crucial second stage in the evolution of Chinese medicine by examining the changes in Chinese medicine during the pivotal era of the Song dynasty.

Scholars often characterize the Song era as a time of change in every aspect of political, social, intellectual or economic life. More specifically it focuses on three narratives of change:

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• the emperor's interest in medicine elevated the status of medicine in the eyes of the elite, leading to an increased involvement of intellectuals and the literary elite in medicine

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• government officials systematically revised, printed, and promulgated earlier heterogeneous medical manuscripts belonging to various traditions

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• the government established unique imperially sponsored medical institutions to handle public health and other aspects of medicine.

As the first book to study the transformation medicine underwent during the Song period this volume will appeal to Sinologists and scholars of the history of medicine alike.

Part I

1
Emperors and medicine

The revival of Classical Medicine

One of the most noticeable changes in medicine during the Northern Song dynasty was its rising prestige. For the first time in Chinese history, members of the imperial family and the scholar-official elite took personal interest in medicine, compiled medical treatises, and even took practice in treating patients. Prior to the Song dynasty, elite families did not consider medicine a desirable occupation for their sons.¹ The Tang dynasty (618–907 CE) serves as a good example for the lowly status of medicine. For example, when discussing possible career paths for the sons of the elite the famous Tang scholar, Han Yu

(768–824 CE) grouped together physicians, spirit-mediums, and musicians. He stresses that both the common people and the gentlemen despised these arts and regarded them as an unworthy.²

Han Yu was not alone in this perception. The official New History of the Tang dynasty grouped “astronomers, diviners, physiognomists, and physicians” together under one category, saying that these “were all artisans.” The authors continued by saying that the sages of the past did not take such crafts as their teachings.³ The fact that medicine during the Tang dynasty was a lowly art did not escape the eyes of Song scholar-officials. Gao Baoheng

(fl. 1050–1065), a Song scholar-official serving as an editor at the Bureau for Revising Medical Texts (Jiaozheng yishu ju

), commented in the preface he wrote to the Yellow Emperor’s Inner Canon saying, “It is a pity that the Tang-dynasty statutes classified medicine among crafts. As a result, men of the official class rarely spoke of it.”⁴ The best account on the status of medicine during the Tang comes from Sun Simiao

(581–682). Sun was probably the most famous and important physician of his era.⁵ In the preface to his book, Essential Prescriptions Worth a Thousand, for Urgent Need (Beiji qianjin yao fang

, in short: Essential Prescriptions), he scolds gentlemen who are unable to treat their relatives during their illnesses. In Sun’s mind this behavior does not conform to Confucian filial norms but rather follow the vulgar customs of the common people. He further expounds that due to the conventional elite’s emphasis on the moral (rather than the therapeutic) dimension of medicine and the incompetence of uneducated doctors,

Gentlemen in and out of office consider a reputation for medicine shameful. Many of them have their sons memorize little books and write little essays [to pass the civil service examinations] as a means to a livelihood. As for the curative arts, they ignore them. How aberrant! How sad it is that they violate the intentions of the sages and worthies!⁶

Setting the stage: change in perception of medicine

During the Northern Song dynasty perceptions about medicine changed. To disseminate medical knowledge, the Northern Song emperors commissioned the collection, revision, and printing of ancient medical canons as well as innovative medical manuals. With the help of the officials they also established a medical education and examination system. They further complemented these enterprises by establishing imperial institutions that aided the common people—or, in modern terms, they engaged in public health initiatives (see Chapter 2). During this period, we witness two interrelated phenomena. First, for the first time in Chinese history we see emperors and members of the literate scholar-official elite showing genuine interest in medicine as a worthy field of study. Second, and tightly linked to the former, we find government activism in medical theory, practice, and education. It should be noted that this government activism was not limited to medicine; it affected many other fields of knowledge.⁷

Probably the best representative of the changing perceptions of medicine was Emperor Huizong (r. 1100–1126), who wrote a preface to the most comprehensive medical formulary to that date—Medical Encyclopedia: A Sagely Benefaction of the Zhenghe Reign Period (Zhenghe sheng ji zong lu

, in short: Medical Encyclopedia).⁸ There, Huizong stresses the importance of medicine as well as his personal interest in this field:

When Zhang Zhongjing of the Han dynasty wrote the Treatise on Cold Damage Disorders, he interpolated formulas. When Sun Simiao of the Tang dynasty compiled the Essential Prescriptions, he followed it with a supplement [i.e., the Qianjin yifang

]. One might say that otherwise [i.e., without the formulas included in these books] their successors would have been unable to make use of their skill and knowledge. While these two scholars explored the art of prescription, they also had exceptional insights outside this art. But only when they looked down at the followers of Qi Bo and debated them can we speak of their knowing the Dao [of medicine].⁹

I have written the General Register to meet an urgent need of this world and to be used in curing the people’s diseases.¹⁰ But it is no more than a “fish trap and rabbit snare” designed to catch the Way of medicine.¹¹ Let future generations throughout the realm focus on forgetting the trap and the snare and obtaining [mastery of medicine] themselves. As quickly and easily as nodding the head or changing the expression on one’s face, let them master the constant [relations] of the Five Phases and manipulate the changes of the Six Climatic Configurations of Qi

.¹² Thus they can physiognomize heaven and earth and nourish the myriad things. And if they can succeed to the extent of returning souls and reviving all those who should live, surely that is no small matter. In the future it will come!¹³

Huizong chose to put himself at level with two of the most famous doctors in Chinese history, Zhang Zhongjing

of the late Han dynasty (206 BCE—220 CE) and Sun Simiao

of the Tang (618–906 CE). Like them, he wrote a book of medicinal formulas that was intended to serve as the basis for treating disorders in clinical practice or, in Huizong’s words, as the means for attaining the “Dao or Way of medicine.” The comparison Huizong makes between his work and that of the two ancient famous physicians is odd; even more puzzling is the fact that Emperor Huizong himself raises this comparison. It seems that he did it to stress the importance of medicine and to entice the scholar-official gentlemen to become involved with medicine and medical practice.

To Huizong, as to many of the Northern Song elite, the art of medicine went beyond prescribing drugs. According to him, in order to attain the Dao of medicine or the right way of medical practice, physicians have to understand the doctrines of the Inner Canon (Huangdi neijing

). That is, physicians must assimilate both cosmological and medical doctrines and incorporate them with clinical drug therapy till they become second nature.

Huizong, in his preface to the Medical Encyclopedia, touches upon many of the themes running through the transformation in medicine during the Song dynasty. First, he presents medicinal formulas as a prominent therapeutic choice, but one that is worthless without the classical doctrinal foundation of the qi and the Five Phases. He advocates for the integration of the doctrines of Classical Medicine into prescription therapy, a process that began during and following his reign. Second, Huizong claims that in order to be able to practice medicine one has first to understand the interaction between cosmological changes, changes in the natural world, and the human body; only then apply them in medical therapy. This emphasis of cosmological doctrines found its way back into medicine during the second half of the Northern Song dynasty. Lastly, Huizong’s example of how the two doctors debated with the followers of Qi Bo may allude to the need, increasingly felt during the Song dynasty, to critically evaluate ancient knowledge handed down through the ages.

In this chapter I concentrate on how emperors’ interest in medicine facilitated the revival of Classical Medicine during the Northern Song dynasty. The Song government’s involvement with medicine had three evident facets. First, it collected books, then sponsored collating, revising, editing, printing, and disseminating them, thus filling gaps in knowledge. The need to treat epidemics motivated the state to establish a new bureau to expand this project. Second, it established medical schools and enforced an examination system, both on the pattern used to prepare and select conventional officials. Third, it promoted the classical canons, which were all but out of use. The most important were the Inner Canon, the Canon of Problems, and the Treatise on Cold Damage Disorders. As part of this effort, the government promoted the use of acu-moxa therapy.

The Song emperors’ personal interest in medicine

Convictions about medicine began to change with the ascent to the throne of the founding emperor of the Song dynasty, Zhao Kuangyin

(r. 960–976), better known by his posthumous title, Taizu

.¹⁴ Taizu was fond of medicine. It is unclear whether he received train...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of tables and figures
• Acknowledgements
• Introduction
• PART I
• PART II Introduction: Creating a comprehensive systematic medicine
• Epilogue
• Notes
• Bibliography