The transformations of diseases are endless, while my own formulas are limited. When attempting to use a limited number of formulas to penetrate endless transformation, it is rare for someone not to rely on conjecture and commit at least some errors. This is why we rely on differentiating patterns of manifestation by conduits and collaterals, and on methods for flexibly adding and subtracting medicinals from set formulas, praying for understanding and clarity from the people involved. Alas, when faced with illness, later generations can only hope to encounter someone like Bian Que or physicians like He and Huan once in a thousand years. Hence, when faced with situations where life and death hinge on the gap between inhalation and exhalation, such uncertainty cannot be avoided.
—Yang Tan 楊倓 (1120–1185)1
As for defining the dao of medicine, truly it lies in discernment. Indeed, in its marvellous capacity to bridge the gap between thought and action, discernment penetrates even the tiniest details. … A good physician pays close attention to voice and countenance. A divine craftsman delves deeply into a condition’s roots. Their mind/heart weighs every detail and does not rely on superficial evidence. Attuned to the trigger, they never let a moment of opportunity slip by. Who could achieve this without having penetrated the very essence of the cosmos?
—Sun Simiao 孙思邈 (581–682)2
Medicine occupied a central position in the intellectual landscapes of late imperial China. Across the entire period from the twelfth to the twentieth centuries, attempts to understand medicine as a dao 道 – a term used by medical writers in their efforts to define how virtuosity in medical practice should be cultivated, and which can be roughly translated as ‘way’, ‘path’ or ‘road’ – cannot be separated from the many other currents of thoughtful practice that explored dao as a way of life.3 These currents included but were not limited to various schools of classical scholarship, theories of rulership, Daoist life cultivation,4 Buddhism, poetry, calligraphy, painting and the military arts. Previous historical scholarship has taught us a great deal about how and what medicine borrowed from these currents. It has remained largely silent, however, on what medicine contributed in return.
In this book, I will patiently follow physicians and medical writers as they lay out four distinct dao, or pathways, for cultivating virtuosity in medical practice. This will unveil landscapes of thoughtful practice in which medicine and the body become fertile resources for all kinds of thinkers to ‘think with’, rather than merely subjects to ‘think about’. As boundaries between different social groups became ever more porous across the long period I will be discussing, classical scholars referred to their Buddhist teachers as ‘kings of medicine’ and perceived of officials as ‘doctors to society’. A seventeenth-century thinker widely celebrated for taking post-Song moral philosophy in a materialist direction claimed that ‘between Heaven and Earth, everything is a medicine’, inspired, perhaps, by the seventh-century physician Sun Simiao, quoted in one of the epigraphs to this chapter, who, in turn, may have drawn on ideas from India. A distinguished eighteenth-century physician told his even more distinguished poet friend that ‘my medicine is the same as your poetry’, both drawing on poetic thought and creativity that had deep roots in both Buddhism and Chinese medicine’s conception of the body. Even Matteo Ricci was introduced to a wider Chinese audience by an early acquaintance as offering ‘good medicine’.5
My point of departure for revealing this landscape of thoughtful practice is the emergence, between the eleventh and fourteenth centuries, of literati physician medicine. This was then a new medical tradition practised by members of the literati elite who came to be known as ‘scholar physicians’ (ruyi 儒醫).6 Over time, this development narrowed the social distance between physicians, who had previously belonged to a sub-elite stratum of society, and other members of the elite. It also elevated medicine from the status of a technique or craft (ji 技) to that of an art (yi 藝), placing it on a par with practices such as literature, calligraphy, music and archery, which had long been considered essential elements of literati culture and education (Fan Dawei 潘大為 2003).
Compared to classical scholarship – the ‘correct way’ (zhengdao 正道) of learning, which inquired into the principles on which the government of the state, the family and the self should be based – most gentlemen still considered medicine a ‘lesser art’ or ‘smaller way’ (xiao dao 小道). Besides medicine, the lesser arts included practices like divination and agriculture, considered essential to maintaining life but not worthy of a gentleman’s time and effort. Gradually, however, distinctions in scholarly discourse between these different fields began to erode (Liao Hsien-hui 2019, 2021). By the early fourteenth century, the popular Neo-Confucian thinker and teacher Wu Cheng 吳澄 (1249–1333) could claim that, despite their obvious differences, classical scholarship and medicine were expressions of the same dao.
Whether we call it the dao of scholarly learning or the dao of medicine, it is still the dao of the sages. Although there is a difference between [employing] an aspect [of a dao] and [embodying] the totality [of the dao], as far as enabling people to live their lives is concerned, there is no distinction. (2014: j.38: 773)
Freed from the constraints of the traditional Confucian system of knowledge classification, a path was thereby opened for reconfiguring existing intellectual landscapes. Medicine became part of an ensemble of thoughtful practices that communicated, interpenetrated and borrowed from each other in defining their respective dao. In addition to the ‘three teachings’ (sanjiao 三教) of Confucianism, Buddhism and Daoism, this ensemble also included poetry, literature and calligraphy, as well as the military, martial and mantic arts, and later fields such as agriculture and cooking.
The social and conceptual boundaries between medicine and literati culture were eroded even further during the sixteenth and seventeenth centuries under the influence of the teachings of the statesman, scholar and poet Wang Yangming 王陽明 (1472–1529) and his followers. Before this period, classical scholars had insisted on a clear distinction between themselves and others in terms of their different abilities to align their lives with the order, or dao, of the cosmos. Wang Yangming now claimed that everyone possessed this capacity. All one needed to do was allow an innate capacity for good knowing (liangzhi 良知) to organise the daily practice of one’s life.7
Historians have long noted similarities between Wang Yangming’s philosophical claims and Buddhist teachings, as well as Wang’s pivotal role in making the convergence of the three teachings an intellectual preoccupation for many literati.8 Far less attention has been paid to why and how Wang’s conception of good knowing became attractive to physicians and medical writers concerned with defining good medicine (liangyi 良醫).9 And even less to how Wang Yangming and his followers elaborated their teachings with the help of medically informed views of a somatically distributed mind, or to the broader importance of medicine in intellectual life at the time.10
In practical terms, the fact that physicians, classical scholars, poets, Buddhist monks and Daoist adepts were able to engage constructively with each other was made possible by their participation in a sophisticated culture of intertextuality that had developed organically over many centuries. This culture allowed different currents of thoughtful practice to borrow from one another, to reinterpret shared concepts in different ways, and to remain in conversation even across considerable differences in their ultimate goals. It also meant that historical actors could move between these currents with considerable ease.
The term dao 道 itself, employed by historical actors across all of the currents of thoughtful practice with which my study engages, clearly exemplifies this culture of intertextuality. Its literal sense of ‘way’ or ‘road’ leads to extended meanings like ‘method’ – a way of doing or teaching something – and ‘tradition’ – a way of transmitting something in both speech and writing. At the most general level, dao is cosmography: the ‘way of Heaven’ (tiandao 天道), nature or the cosmos.
In Chinese, nouns do not change form depending on whether they are singular or plural. Instead, this is marked by the words around them. Dao can thus be used in both the singular and the plural. It can refer to the way one lives one’s life, to a particular tradition of social or cultural practice, to the way one enacts or instantiates that tradition, and to the way that a traditional practice performed in the present can enact a more enduring conception of a given tradition. Thus, one can talk about the dao of poetry and the dao of warfare, and the dao of medicine or the various martial arts in both the singular and the plural. In as much as dao can also refer to the nature or being of the universe itself, the term lends itself to situations in which one is thinking about how an individual life or a particular current of thoughtful practice mirrors the (cosmic) dao; or to thinking about how a tradition or a practice connects what is personal, local and specific to what is shared, cultural and transcendent of the here-and-now.
Thinking about such problems was a persistent concern for physicians and medical writers in late imperial China. As Neo-Confucianism, known in Chinese as daoxue 道學 or ‘the Learning of the Way’, rose to intellectual pre-eminence among the literati elite from the twelfth century onward, physicians increasingly referred to what they did as a dao rather than an art. This is why I have called this book, which examines debates about how virtuosity in the art of medicine might best be cultivated, Searching for the Dao of Medicine.
To get a sense of the conceptual, practical and moral issues at stake in these debates, it will be helpful to reflect briefly on the connection between medicine as a dao and medicine as an art. Miranda Brown (2015) traces this conjunction back to a group of archivists and historians in early medieval China who transformed a diverse array of previously separate techniques into a ‘unified art’. They designated this art ‘the way of medicine’ (yidao 醫道).
Both Western and Chinese traditions of thought recognise an inherent tension in artistic creativity between craft, technique and mimesis, on the one hand, and spontaneity, inventiveness and transcendence on the other. They have long been aware, too, of a similar tension in the domain of medicine, such as between medicine as a science that claims universal validity and the practice-oriented nature of all medicine in clinical practice.11
While artistic excellence relies on craft, technique and skill, it invariably involves an aspiration to transcend them in the creation of singular works of art. Based on this observation, the literary theorist Zhiyi Yang argues that artistic spontaneity, as ‘a dialectical concept that embraces the mediacy of materiality, craft, learning, rule, ritual and tradition’, even as it also seeks to leave them behind, is the force that holds these poles together in the act of artistic creation (2015: 3).
As the epigraphs to this chapter demonstrate, practitioners of the medical arts in China were aware of a similar tension in their own domain of practice. This tension arose from the demand that master physicians should be able to respond to the unique exigencies of each case, which could demand transcending the learned skills, set formulas and classical texts that defined the tradition in which they worked. The twelfth-century polymath Shen Gua (also known as Shen Kuo) 沈括 (1131–1195) lamented the fact that most physicians were unable to live up to this demand, thereby establishing the ideal more firmly in the minds of his readers:
These days, when they provide treatment, doctors select a couple of medicines, write down a regimen for taking them, hand it over to their patient, and that’s that. Before the ancients treated patients, they became familiar with the cycles of yin and yang and of time, and with the exhalations of qi from the mountains, forests, rivers, and marshes. They discerned the patient’s age, weight, social status, style of life, disposition, likes, sentiments, and degree of vigour. Selecting from what was appropriate to these characteristics and avoiding what was not, they chose among drugs, moxa, acupuncture, lancing with the stone needle, decoctions, and extracts. They straightened out old habits and manipulated the patient’s emotional patterns. Feeling their way, missing no opportunity, and constantly adapting, there was not a hair-breadth’s gap in their reasoning. They went on to regulate the patient’s dress, rationalise his diet, change his living habits, and follow the transformations of his emotions, treating him sometimes according to environmental factors, sometimes according to individual factors.12
‘Medicine is indeed an art’, Shen Gua went on to say, ‘and formulas can be truly effective provided its application is to the point’ (Yan Shiyun 1990: 2193–94). Put in contemporary terms, the difficulties described by Shen Gua have their roots in the fact that all healing arts are located at the interface of biology and culture, the irreducible difference between disease and illness, and the limitations of the human mind to contain the dynamic complexity of life in limited and bounded conceptual schemes. In the Chinese medical literature, this tension is sometimes likened to a gap (xi 隙), or rather a series of gaps, that medical practice must bridge in order to be effective.13
Yang Tan, the author of the first epigraph in this chapter, was a high-ranking official at the court of Song Dynasty Emperor Xiaozong (r. 1162–1189).14 After retiring from his official posts, Yang decided to edit and publish his father’s collection of medical formulas. In his Foreword to this collection, he defines the core problem of the art of medicine as the gap between the protean character of illness and the limitations of the human mind in capturing such complexity through fixed disease categories, patterns of illness and treatment methods.15
Another important theme in the medical literature is the gap between thought and action, between knowing and doing, and between the grounding of medicine in the words of the ancient sages and the importance of implicit knowledge to success in clinical practice. This is highlighted by the famous seventh-century physician Sun Simiao 孙思邈 in the second epigraph to this chapter.16 But there were further gaps. The gap between the past and the present, for instance, had both practical and ethical implications. Physicians were expected to demonstrate filiality to a tradition that was believed to embody the wisdom of the ancient sages. Yet, they could not fail to realise that this wisdom did not always deliver the hoped-for results in one’s day-to-day clinical practice. Similar questions arose from the use of formulas composed in northern China – where ancient Chinese medicine originated – in treating southern bodies and diseases once the state expanded to include those areas. The applicability of treatments formulated for patients with robust constitutions to populations perceived as feeble and weak was another such issue.17
Sun Simiao, Yang Tan and Shen Gua all agree that clinical virtuosity (my term) is the solution to resolving these tensions. They differ in their estimation of the likelihood that doctors might become virtuoso physicians, and their opinions diverge as to how such mastery might be cultivated. Sun Simiao’s famous essay ‘Preparing for the Vocation of Great Physician’ (Lun dayi xiye 論大醫習業) advocated an ecumenical education rooted equally in Confucian, Daoist and Buddhist traditions (2009c: 17).18 This education included training in prognostication, spells and incantations that later authors would seek to remove from the domain of scholarly medicine. Yet his grounding of the medical arts in the study of texts constituted an important change from earlier definitions that emphasised technical skills and the transmission of family traditions.19
Writing several centuries later, Yang Tan was more pessimistic. This reflects a shift in cultural mood, in which members of the literati elite had lost trust in the skills and ethics of the literate but sub-elite ‘common physicians’ (shiyi 世醫), on whom they had previously relied for their healthcare needs. Publishing collections of medical formulas was a common response to this dilemma.20 The aim was to provide a resource that reduced the elite’s dependency on these common physicians. As for genuine clinical virtuosi, according to Yang Tan, these were few and far between.
The variations of illness are endless, while the formulas in my possession are limited. Being able to use a limited number of formulas to master endless variation without strained interpretations and unwarranted conjecture is rare. (Tameto Okanishi 1958: 883)
Yang Tan’s negative (but probably realistic) assessment demonstrates a sharpened awareness of the existential gap at the heart of the medical arts. By the end of the Song dynasty (960–1279), it was becoming clear to the new class of scholar physicians that none of the available means of training – the transmission of family knowledge, the study of classical texts in master-disciple relationships, or the possession of medical formulas – were sufficient for reliably bridging this gap.21 In their search for a solution, literati physicians thus increasingly turned to the cultivation of clinical virtuosity. Sun Simiao had already called this solution ‘the dao of medicine’, and defined it by attributes like the capacity for discernment (yi 意) and awareness of the triggers (ji 機) of disease, terms we will encounter frequently throughout this study.
In Western languages, virtuosity, indicating skilled performance, shares the same root as ‘virtue’. It is an apt term for capturing a master physician’s ability to align local singularities with cosmic process, ‘leaving not a hair-breadth’s gap’ between them. However, like artistic spontaneity, clinical virtuosity is difficult to define positively. It is grounded in explicit knowledge and in technical skills honed through years of dedicated practice, yet it must often transcend the limits of spoken words and routine performance. Hence, as Eric Karchmer notes in his ethnography of Chinese medicine in contemporary China, ‘for most practitioners, virtuosity is elusive, hard to obtain, and beyond understanding. It is thought to be ineffable, and its results are imagined to be magical’ (2022: 216).
Karchmer’s ethnography demonstrates that, despite its elusive nature, doctors of Chinese medicine consistently manifest virtuosity in their clinical practice. When it comes to defining virtuosity, however, Karchmer does not look to Chinese sources but instead turns to Bruno Latour’s writings. Most other discussions of clinical virtuosity in the Western medical tradition invoke Aristotle and his philosophical heirs.22 I argue that such detours through Western philosophy are unnecessary and only obscure a historically informed account of why and how doctors working within the tradition of literati physician medicine made the pursuit of virtuosity the central concern of medicine imagined as dao.23
In the broader context of the daoxue movement, referring to medicine as a dao represented a breakthrough in physicians’ attempts to resolve the conundrum of clinical virtuosity. It implied that such virtuosity was not mystical, or magical, or gifted only to certain exceptional individuals.24 Conceptualised as a dao, medicine located clinical virtuosity in a physician’s ability to align their actions with the rhythms and patterns of life in the cosmos and thereby close the gaps that clinical virtuosity had to bridge. Theoretically, this was achievable by anyone of a certain level of intelligence who was willing to devote sufficient time and effort to the task. Practically, this meant developing concrete cultivation strategies to transform aspiring physicians into virtuoso practitioners. During the period spanning the eleventh to the twentieth century, physicians and medical writers outlined four such strategies. I call these pathways of cultivation the syncretic, devotional, poetic and evidential dao of medicine (see Table 0.1).
This shift from medicine as an art, where the sources of clinical virtuosity are ineffable, to medicine as a dao, implying that such virtuosity can be cultivated by following distinctive pathways, was clearly influenced by similar shifts in the domain of classical learning. As Peter Bol has shown, Neo-Confucian daoxue teachings appealed to increasing numbers of southern gentry because they provided them with a clear sense of identity and purpose.25 Literati physicians were similarly inspired by these teachings and incorporated them into their own formulation of medicine as dao. Yet, this was not a process of simple adaptation, or, as it has sometimes been called, of a ‘Neo-Confucianisation’ of medicine and the body (Leung 2013: 130–31). Rather, physicians selectively borrowed elements from a variety of daoxue teachings as part of a broader effort to define clinical virtuosity and medicine as dao. This effort also drew on cultivation strategies from other domains of thoughtful practice, such as Buddhism, poetry, the cultivation of life, and the military and magical arts – as mentioned previously – while also tracing its roots to earlier efforts to define clinical virtuosity in the medical literature.26
Comparing the cultivation of clinical virtuosity in medicine with the pursuit of artistic spontaneity in the fine arts helps us clarify why medicine is indeed an art, yet not in the same way that poetry or calligraphy are arts. The veneration of artistic spontaneity celebrates transcendence as an expression of individual genius. Most medical writers in late imperial China, however, and even more so their literati audiences, were highly sceptical regarding the value of individuality in medical practice. It was seen as necessary to a certain extent, but it was also dangerous. Medicine was charged with preserving human life. This made it a powerful expression of the virtues that elites valued, such as benevolence and filial piety. Stepping beyond the boundaries of what had proven to be effective in the past was risky and, therefore, perhaps best avoided. Any public display of clinical virtuosity thus required physicians to demonstrate that they remained within the bounds of tradition, even where they were obviously transcending those bounds.27
In their search for the dao of medicine, physicians and medical writers disagreed on numerous matters. But they held two things in common. They believed that virtuoso practice could bridge the many gaps that both defined and troubled the medical arts. And they all, without exception, agreed that the formulas contained in the writings of the Han dynasty author Zhang Zhongjing 張仲景 (ca. 150–219), especially his Treatise on Cold Damage (Shanghan lun 傷寒論), provided essential models for clinical practice in the present.28
As in all living traditions, the answers given to the problem of how clinical virtuosity might be cultivated with the help of the Treatise were mostly taken for granted and did not need to be repeatedly explicated. However, at certain moments some of those answers no longer worked, and questions that seemed to have been settled demanded attention once more. The period between the eleventh and the fourteenth centuries, during which literati physician medicine first emerged as a distinctive tradition, was one such moment. The period spanning the late Ming (1368–1644) and early Qing (1644–1911) dynasties (roughly from the 1570s to the 1730s), which I will refer to as China’s long seventeenth century, was another.29
Both periods were characterised by multiplications at either side of the gap that literati physician medicine attempted to bridge through virtuoso practice. On one side, this refers first and foremost to the emergence of new diseases and conditions that consistently failed to respond to known treatments. Notable examples we will encounter throughout this study include the epidemics of the Song and the late Ming periods; the rise in psychoemotional disorders linked to the cult of emotions in the sixteenth and seventeenth centuries; and childhood convulsions, a persistent issue in paediatric practice that played a crucial role in the emergence of the devotional dao of medicine that I discuss in Part Two. Physicians listed many other mismatches between textual resources and clinical practice, and they blamed these mismatches on differences between the past and the present relating to bodily constitutions, environmental conditions, habits and lifestyles (Hanson 1998, 2011).
On the other side of the gap, the invention of block printing during the Song dynasty and increasing access to medical primers, case histories by famous physicians and other medical literature associated with the rise of commercial publishing during the Ming multiplied the resources that physicians could draw on in their efforts to write effective prescriptions. Broader social and cultural changes magnified the effect of these multiplications. The steady rise in the number of gentry who turned to medicine as an occupation made medical practice increasingly competitive. Combined with the state’s withdrawal from the domain of medicine, this created conditions in which physicians felt compelled to seek ways to distinguish their art from others’.30 This was further complicated by an increasing porosity of the boundaries between different groups of social actors, associated with the popularity of Wang Yangming’s teachings and those of his students in the sixteenth and seventeenth centuries. Attempts to synthesise the three teachings of Confucianism, Buddhism and Daoism in this period also filtered into the domain of medicine. Conversely, medicine and the body became essential resources for classical scholars in their contemplations of a wide range of non-medical issues. As a result, physicians could draw on an ever-broader array of resources in constellating their medical art in practice and in reflecting on the very nature of this art.31
This book focuses on controversies regarding how clinical virtuosity should be cultivated and enacted. For this reason, I devote only passing attention to the content of medical doctrines and the material and sociocultural contexts of medical practice. This approach is innovative because it draws our attention to debates that have largely gone unnoticed in previous historical scholarship, while simultaneously presenting us with a clearer view of the landscapes of thoughtful practice in which these debates took place. My approach is methodologically informed by the broader field of controversy studies, but I have endeavoured to avoid uncritically importing some of that field’s modernist biases into a study of late imperial China.
As a method for exploring how scientific knowledge and practice are socially and historically constituted, the study of controversies has long been central to disciplines such as science and technology studies (STS), epistemic historiography, and the histories of science and medicine. This broader field has informed and facilitated my study in several important ways.32
First, it has helped me to conceptualise the various dao of medicine as creating different possibilities for cultivating and enacting clinical virtuosity. Second, it suggested a case study approach that examines the lives and writings of a select group of key historical figures who imagined, embodied and disseminated distinctive visions of the dao of medicine. Third, it allowed me to see how controversies in the domain of medicine both informed and were informed by similar controversies in other domains of thoughtful practice within a contiguous landscape of such practices. Fourth, it alerted me to the importance of several key terms, shared yet contested, that were consistently employed in definitions of how medicine should be cultivated as a dao.
Like the concept of dao itself, these terms – yi 意, zhijue 知覺, quan 權, huofa 活法, tong 通, ji 幾/機, xin 心, and even qi 氣 – have long and complex histories of use across time and across different domains of thoughtful practice. As a result, it is extremely difficult to translate any one into a single English term. Nonetheless, it is precisely this polysemy that facilitated their shared use across so many different contexts.
In his history of sexuality in Europe, Donald Davidson argues that lexical continuities frequently obscure radical epistemological breaks. In Augustinian theology, for instance, ‘perversion’ means a deficiency of the will, while in nineteenth-century psychiatric discourse it is a disease of the sexual instinct. Because the two uses of this term occur in profoundly different conceptual spaces, the meaning in each instance is shaped by what Davidson calls a different ‘style of reasoning’ (2001: 139–40). That terms like those given above were used by the authors of different visions of the dao of medicine suggests that in China, too, lexical continuity may conceal the presence of fundamentally different styles of medical reasoning or practice. Throughout the period I examine, medical writers did indeed endeavour to define various key terms and determine their significance through their own specific lenses of inquiry. However, they rarely ceased engaging either with each other or with thinkers in other domains of thoughtful practice, meaning that their definitions were never rendered entirely opaque to other users of these terms.
I therefore argue that while the four dao of medicine I have identified present very different conceptions of clinical virtuosity and its cultivation, they were never separated by the kinds of breaks conventionally taken to differentiate styles of reasoning, epistemes or paradigms in the field of controversy studies. As Reinhart Koselleck has demonstrated, demands for a difference to exist between past and future, for the flow of time to be interrupted by a series of crises that demand a critical response, for ‘history’ to emerge as a discipline, and for us to know the world as history – all of these demands stem from a specific Enlightenment ethos that appeared in Europe in the eighteenth century and that continues to shape our thinking today (1977, 1988).33
Koselleck thus raises important questions about how we, as modern historians, might approach a tradition like literati physician medicine, which is constituted by very different ideas about time and history. I will return to these questions in the Conclusion, by which point we will be in a better position to answer them in light of the evidence I present throughout my study. For now, it may suffice to note that the concept of dao itself provides some of the answers.
While capable of reaching the heights of philosophy and metaphysics, dao is also a highly practical concept. In its meaning of ‘way’, it refers quite literally to the path that physicians must traverse in every clinical encounter as they endeavour to bridge the gap between the inexhaustible singularity of concrete illnesses and the textual and practical resources of their tradition, between the (presumed) stability and universality of cosmic processes and the challenge to this very notion of stability presented by the existence of disease. At a very fundamental level, then, all four dao of medicine I describe below can be viewed as descriptions of the path one should follow to navigate this gap consistently and reliably. At a certain level, every person follows a singular path. This is one reason why my study is based on individual life histories, which I have intentionally framed as quests or journeys of development. However, just as common paths invariably form over time as people traverse a given territory, shared dao of medicine become evident as one follows these individual life histories.
The analogy of a territory traversed by different paths allows us to imagine the historical coexistence of different dao. It helps us to account for their entanglement with a multitude of other paths followed by other types of social actors, or the same kinds of actors on different individual journeys. All these paths emerge within specific historical contexts. Over time, they adapt to changes in the terrain they cross, even as they contribute to transforming it. For all that, though, they endure and remain recognisable as distinct paths.
Analytically, dao thus constitutes the problem of tradition and history in a manner very different from the conceptualisation of epistemes, paradigms or styles of practice that replace one another over time. Dao transcends problematic distinctions between ‘real’ and ‘invented’ traditions, which are likewise marked off by temporal breaks and thereby resolves the apparent opposition between continuity and change that has long troubled the analysis of tradition (Beckstein 2017), and the field of Chinese medicine (Scheid 2006). Instead of looking for essential differences, I interpret the four dao as possibilities for enacting clinical virtuosity differently, and in doing so, as limning the horizon of possibility for literati physician medicine to exist as a distinctive medical tradition.
A similar caveat applies to a second fundamental assumption in controversy studies: that epistemes, styles of reasoning and practice, or modes of being on either side of a historical break are socially embodied in distinct research traditions, thought collectives or cultural formations. The landscape revealed in this book was traversed, instead, by actors who were extremely comfortable moving between different traditions of thoughtful practice. They were gentlemen of broad learning, polymaths and masterless physicians who studied with many teachers to fashion uniquely personal ways of being. Their quest for dao required them, intellectually and physically, to crisscross varied and often challenging terrain. Attempts to force such complex personalities and fertile thinkers into bounded schools, traditions, currents or disciplines, therefore, invariably fail. This is also one of the reasons that historians have largely overlooked the role of medicine in the lives of their literati subjects, and why the place of medicine in the landscapes of thoughtful practice of late imperial China has remained veiled for so long.34
My ability to lift this veil stems from an anthropologist’s focus on actors’ perspectives and a commitment to understanding different ways of living and thinking from the ground up. By approaching my sources this way, I observed that the issues troubling physicians in late imperial China also concerned many others interested in dao in its sense of ‘ways of life’. Poets, calligraphers, generals, classical scholars and Buddhist teachers all needed to make ancient texts and cherished models from the past relevant to contemporary lives. On a more philosophical level, physicians, like classical scholars or Buddhist teachers, had to bridge the epistemic gap between a world of direct sensory experience and a deeper order not immediately accessible to human perception, believed to have been captured in the writings of ancient sages. Everyone committed to the project of self-cultivation had to develop strategies to overcome personal biases and limitations that prevented acting in accordance with dao in all its aspects.
As I became aware of the numerous underexplored interfaces between medicine and other currents of thoughtful practice in late imperial China, I had to cultivate a sensibility to the multiple, constantly evolving repertoires and resources shared by actors connected across a broad range of intersecting currents that facilitated the exchange of ideas and the translation of concepts and practices in multiple directions. These are sensibilities that we, as historians of medicine, can learn from other disciplines that explore life and thought in late imperial China, which are already more attuned to their existence.35
Throughout this book, I therefore emphasise the significance of Neo-Confucianism and Buddhism in shaping a medical tradition that was as inherently religious as it was cosmological, empirical and pragmatic.36 While I devote less attention to the various ways in which Daoism, in its many forms, contributed to medicine in late imperial China, this is because that impact has already been extensively documented.37 This does not apply to Buddhism, and even less so to medicine’s own contributions to Neo-Confucian thought.38 Nevertheless, Daoist influences will be evident throughout my narrative. Daoist practices of life cultivation and internal alchemy connect to the imagination of qi transformation that underpins all the dao of medicine I describe, as well as the literati worlds with which they communicated.39 They show in seventeenth-century scholars’ increased interest in the Daoist classics (Struve 2019). They become evident at an institutional level through the close interaction between the cult of the aforementioned Zhang Zhongjing, regarded as a medical sage who embodied Neo-Confucian ideals of sagehood, and the Daoist monks who assumed responsibility for the shrine built at his presumed birthplace (Liu Xun 劉迅 2014).
Yet, even as I emphasise the scholarly and religious dimensions of elite medicine, I consistently highlight other influences that consistently oriented the various dao of medicine. All educated people in late imperial China read poetry, and many tried their hand at writing it. Poetry, therefore, had a significant impact on medical practice, both directly and indirectly. Poetic practice, for instance, challenged representational modes of knowing. It also offered the possibility of conceptualising tradition as simultaneously rooted in shared models and constantly self-renewing and progressive. Meanwhile, medical views of the body infused poetic thought and creativity.40
I was also compelled to pay close attention to military strategy and the art of warfare. While the influence of these kinds of thinking is evident in the earliest medical classics, they gained new centrality during the Ming dynasty. From its inception, the Ming state valorised military strength. Action novels like Water Margin (Shuihu chuan 水滸傳) and Romance of the Three Kingdoms (Sanguo yanyi 三國演義), with their ethos of knightly chivalry, were perennially popular among young scholars. The military crises of the sixteenth and seventeenth centuries prompted them to train in the martial arts and study military strategy. Even a dandy like Fang Yizhi 方以智 (1611–1671), the central figure of Chapter 8, and his poet and artist friends – renowned for having spent their early adult lives in the courtesan quarter of Nanjing – were adept at wielding a sword and in combat techniques, and knew how to don armour, ride a horse and shoot arrows. Such interests were not confined to elite families. Theatre, storytelling, religious ceremonies and a multitude of popular legends prominently featured martial exploits and themes. Many commoners possessed military training or martial skills that they utilised to earn a living, whether legally or otherwise. According to David Robinson, a military historian of the period, by the middle of the Ming dynasty, an economy of violence ‘linked military personnel, bandit chiefs, county magistrates, and local elites into a constantly shifting set of tension-filled relations’ (2001: 172).
In this environment, it is unsurprising that physicians, who shared the same cultural and social backgrounds as their scholarly peers and may even have served in the military, increasingly used military analogies when contemplating medical issues. They employed military language to delineate clinical strategies and arranged their formulas in battle formations. Over time, as we will see, this led physicians to reimagine the body in territorial terms and to see themselves as men of action – generals on the battlefield as much as scholars striving to become sages. This redirected their focus from cosmology to the use of herbs as soldiers. It also re-emphasised the craft aspects of medical practice, such as preparing individual herbs to modify their clinical action. Such military thinking resonated with Wang Yangming’s concept of the unity of knowing and action (zhi xing heyi 知行合一), but also with the poetic search for vital methods (huofa 活法), Buddhist notions of expedient means (fangbian 方便), and the Daoist appreciation of effortless action (wuwei 無為).
If I remain largely silent about the numerous interactions between elite and non-elite domains of medicine and healing during the period I cover, it is because my sources pay little attention to non-elite practices, thereby setting natural limits to my study. Moreover, as in the case of Daoism, other scholars have already written extensively about the various types of healing available during this period, allowing me to focus on my narrower concerns.41
I do, however, take seriously the realities of qi transformation expressed in my sources and enacted by physicians in the company of their patients. The fact that I have practised Chinese medicine for over four decades greatly facilitated this effort, as did my intimate familiarity with medical formulas and prescribing practices (Scheid et al. 2009). This experience allowed me to read a physician’s prescription as one would read a poem or a piece of literature, appreciating its composition, intertextual references to famous formulas in the history of Chinese medicine, and the way it expresses clinical virtuosity. The anthropologist Judith Farquhar noted some time ago that even in contemporary China,
[Medical formulas] are not only a particular expression of one doctor’s brilliance and habits of thought; they are not only a sign of strong medicine acting directly; they are also deeply felt reflections or representations of the power, beneficence, and esoteric insight of medicine in general. (2020: 89)42
Formulas and prescribing practices are thus a recurring topic in the narrative arc of my study. As embodiments of medical virtuosity, the composition of formulas was not simply informed by devotion to past models and a profound understanding of the qi processes that network the body and the cosmos. It was also shaped by combinations of poetic sensibilities, ideas about military strategies and tactics, Buddhist conceptions of expedient means, Daoist internal alchemy and Confucian ethics. In that sense, formulas are the material manifestations not only of the various dao of medicine, but also sediments of the landscapes of thoughtful practice in which they were composed.
The effects of formulas in daily clinical practice showed to physicians, patients and readers of medical literature that, ultimately, it was possible to bridge the gaps mentioned earlier. However, because formulas did not always work as expected, they also became sites of contestation. The resulting controversies were central in the search for the dao of medicine in late imperial China and offer us a way to understand literati physician medicine as a living tradition.43
Moreover, ideas, concepts and techniques of the self were not only carried into the domain of medicine by actors moving between different currents of thoughtful practice. They also moved in the opposite direction, and more specifically from medicine into the domain of classical scholarship. A physician’s ability to bridge the gap between the past and the present, and between the particular and the universal, had visible and often dramatic consequences. By caring for their patients, physicians became models of the Confucian virtues of filiality and benevolence (Fan Dawei 潘大為 2003). This lent their voices authority, even as it could make them look fallible, immoral or ridiculous if they failed to live up to these ideals (Berg 2000, 2001; Schonebaum 2016).
The medical classics, meanwhile, offered critical insights into the bodily foundations of cognition, perception and other functions of the human mind/heart that classical scholars regarded as crucial to their quest of aligning human agency with the dao of the cosmos. Physicians also practically engaged with the question of the nature of qi. All thinkers in late imperial China were interested in understanding how the ‘ten thousand things’ (wanwu 萬物), a term referring to all phenomena – material things as well as events – that in their entirety constitute a self-generating cosmos of qi processes. In seeking to describe and map these processes, physicians drew on the same sources as classical scholars, particularly the Book of Changes (Yijing 易經). They were inspired by scholars’ analyses of these qi process and borrowed their vocabulary. In turn, they demonstrated to classical scholars how one might translate abstract ideas into concrete action.
Over time, therefore, medical knowledge and remedies became potentially valuable conceptual resources for anyone pondering life, the cosmos and dao. This is why, even as my study focuses on debates about cultivating virtuosity in medical practice, it also reveals exciting new vistas on the broader intellectual landscapes of that period.
To assist readers in navigating the landscapes explored in this book, Table 0.1 presents the four dao of medicine at its core, situating them materially and conceptually in time and space. As previously noted, I classify these four dao as syncretic, devotional, poetic and evidential. The four main sections of the book examine the historical emergence of each dao, with particular focus on two periods: the rise of literati physician medicine as a distinct medical tradition between the eleventh and fourteenth centuries, culminating in the formation of the syncretic dao of medicine; and the challenge to this syncretic dao by three alternative visions proposed during China’s long seventeenth century.
Table 0.1. The four dao of medicine
SYNCRETIC DAO
Zhu Danxi 朱丹溪, Wang Lun 王綸, Zhang Jiebin 張介濱
Cultivating discernment through reading and apprenticeships.
Contextual bricolage of elements of tradition.
EVIDENTIAL DAO
Ke Qin 柯琴, Yoshimasu Tō dō 吉益東洞, Lu Yuanlei 陆渊雷
Critical textual hermeneutics coupled to empirical validation.
Matching formula patterns with empirically validated formulas.
POETIC DAO
Fang Yizhi/Monk Yaodi 方以智, Yu Chang (later life) 喻昌,
Xue Shengbai 雪生白, Ye Tianshi 葉天士
Cultivating discernment through full immersion in tradition.
Warranted transcendence of tradition.
DEVOTIONAL DAO
Fang Youzhi 方有執,
Yu Chang (early life) 喻昌, Chen Xiuyuan 陳修園
Devotional hermeneutics coupled to empirical investigation.
Penetrating Zhang Zhongjing’s discernment.
To chart these processes, I have employed a case history approach. I focus on the lives and works of historical actors who either developed a clear vision of a specific dao or were fundamental to shaping the intellectual contexts in which these visions could be developed. My choice of actors is not arbitrary. In their writings and clinical practices, these actors directly contested each other’s ideas or took them in new directions, and they all had a demonstrable influence on the development of Chinese medicine. Most of them lived and worked in China’s prosperous Yangzi Delta region. Known in Chinese as Jiangnan 江南 (‘south of the river’), this macroregion was the economic and cultural heartland of the Chinese empire at the time. It was also the pre-eminent centre of medical learning. As a result, my actors were connected through loosely intersecting networks that drew together Confucian scholars, Buddhist monks, military figures, physicians, poets, martial arts experts and aficionados of the game Go. For this reason, my subjects are not limited to practising physicians. Four chapters are devoted to historical figures who are not usually associated with medicine. Their thinking, however, was profoundly influenced by medicine (commonly overlooked by their biographers), thereby exemplifying my argument that ‘thinking with’ medicine was a distinctive aspect of the intellectual landscapes of late imperial China.
Table 0.1 lists the actors I associate most closely with the emergence of the four dao of medicine. It also provides a summary of the strategy each dao proposes for cultivating clinical virtuosity and an equally brief synopsis of how this strategy is manifested in concrete clinical practice. I have arranged the table into a grid to emphasise that the four dao are not ‘paradigms’ that replaced each other over time. Instead, as previously explained, they limn the horizon of possibilities for enacting literati physician medicine.44
Each of this book’s four sections is centred on one of the four dao of medicine. Part One consists of four chapters. Chapter 2 analyses the syncretic dao of medicine itself, while the three other chapters chart the changing relationship between medicine and classical learning within the broader landscapes of thoughtful practice in the Song and Ming dynasties. Chapter 1 introduces medicine in Song dynasty China as a field defined by a set of interlinked problems that each of the four dao of medicine would later seek to overcome in their different ways. To this end, I explore the different ways in which the Northern Song polymath Su Shi 蘇軾 (1037–1101) discussed medicine. Su lived in a period when medicine was an ‘art’ that classical scholars began to engage with more widely, but before literati physician medicine had developed into a recognisable tradition. His writings do not present a coherent account of the nature of medical practice, but examine it from different angles, foreshadowing the different dao of medicine. Su developed these different perspectives not simply because he engaged with medicine as a practice, but also because he used medicine as a tool for thinking about other issues he was interested in. This enables me to state the book’s second key argument: that for intellectuals in late imperial China, medicine was both explanans and explanandum, a topic to ‘think about’ but also a tool for ‘thinking with’. This made medicine a central element of a broader intellectual landscape. I conclude Chapter 1 with a brief review of the emergence of Neo-Confucianism to facilitate readers’ understanding of why physicians in late imperial China framed their pursuit of clinical virtuosity as a search for the dao of medicine.
Chapters 2 to 4 review the period between the fourteenth and the sixteenth centuries. I focus on the two figures who clearly dominated the fields of medicine and scholarly learning at the time: the physician Zhu Danxi 朱丹溪 (1282–1358) and the statesman and philosopher Wang Yangming. Danxi – the main subject of Chapter 2 – is mostly remembered today for successfully aligning medicine with the Neo-Confucian teachings of Zhu Xi 朱熹 (1130–1200), but I am interested in him as the author of the concrete pathway for cultivating clinical virtuosity that I call the syncretic dao of medicine. I argue that rather than assimilating medicine to Neo-Confucianism, Danxi’s syncretic dao created an autonomous space for medicine within a society intellectually dominated by Zhu Xi’s daoxue. To support this argument, I highlight other influences that shaped Danxi’s conception of clinical virtuosity, specifically ideas about poetic creativity and the art of adapting one’s actions to local exigencies.
In the case of Wang Yangming, who stands at the centre of Chapter 3, I show that medicine was an important resource in the development of his thought. Wang saw himself as a kind of ‘physician to society’ and his teachings as medicine. Moreover, key concepts in his philosophy were rooted in medical understandings of the body. Paying attention to the medical roots of Wang Yangming’s conception of the relationship between the heart and the mind deepens our understanding of his disagreements with Zhu Xi. Conversely, Wang’s theory of the unity of knowing and acting, along with his conception of good knowing as intrinsic to human nature and rooted in discernment, would profoundly influence medical practice in the late Ming.
In Chapter 4, we turn our attention to the increasing porosity of the boundaries between various domains of thoughtful practice in seventeenth-century China. In conjunction with other factors, such as the attention seventeenth-century literati devoted to Buddhism and Daoist life cultivation, Wang Yangming’s prominence in intellectual life ensured that medicine and the body became ever more important tools for scholars to think with. This facilitated an increasingly intense exchange between scholarly, religious and medical worlds, which, in turn, raised physicians’ self-confidence to the point where they would insist on the centrality of their art in the landscapes of thoughtful practice of the time. These transformations generated the conditions in which physicians began to question the validity of Danxi’s dao of medicine, and three different conceptions of clinical virtuosity emerged from the ensuing debates.
Part Two is organised around the late sixteenth-century scholar physician Fang Youzhi’s 方有執 (b. 1522) quest to reconstitute a dao of medicine that he believed had been lost. This was a very personal quest on which he embarked after the death of two wives and five children from acute fevers. Its outcome, however, had profound consequences for literati physician medicine. Fang found the lost dao he was searching for in the pages of the Treatise on Cold Damage referenced above, which, in Fang’s eyes, had been misread for centuries. Modelling literati physician medicine on the branch of Neo-Confucianism known as the ‘Learning of Principle’ (lixue 理學), also called the Cheng-Zhu school, Fang reorganised the Treatise’s text and outlined distinctive hermeneutic strategies for accessing what he identified as its original meaning. These strategies assumed that Zhang Zhongjing, the Treatise’s author, had been an authentic medical sage. Like Confucius, Zhongjing had therefore been in a unique position to facilitate access to this dao for others.
Following Zhongjing on this path necessitated a personal and devotional approach to medical learning, centred on the study of the Treatise. Intensive engagement with this single text would, over time, grant students access to Zhongjing’s intentions, thereby transforming them into medical sages or clinical virtuosi. Such a virtuoso physician was, at once, filled with love for the world around him and, simultaneously, a general on the battlefield of disease. Fang thus developed new strategies for reading the Treatise and outlined a new ‘territorial’ body on which to wage war against disease. In doing so, he laid the foundations for a new vision of literati physician medicine, centred on Zhongjing as a medical sage distinct from all other historical physicians. If Danxi’s dao was designed to enable local practice by way of intellectual bricolage, Fang Youzhi’s dao presented itself as orthodox – the only authentic (and permissible) way of learning and practising medicine.
No direct evidence links Fang Youzhi’s quest for the dao of medicine with the contemporaneous ‘return to the ancients’ (fugu 復古) movement in poetry, but they shared the belief that seeking to embody ancient models of practice was the only way to achieve mastery of one’s metier. In poetry, such attempts were criticised by seventeenth-century literary theorists who argued that poetry should be an expression of the individual self in the present moment. These critics were influenced by Wang Yangming’s teachings about good knowing and the unity of thought and action, but they also drew on Chan Buddhist notions of vital methods (huofa 活法). Part Three of this book explores the lives and works of four classical scholars, physicians and healers who were also poets or who practised medicine in poetic ways.
All four scholars and physicians were ‘masterless’, which means that they did not see themselves as belonging to any single current of learning or school of thought. Instead, they drew on a broad range of resources to constellate what I call a poetic dao of medicine: a way of learning and practice that demanded the deepest possible immersion into the medical tradition, yet aimed, if necessary, to transcend it. This conception of clinical virtuosity is close to the idea of artistic spontaneity, which is why I refer to it as the poetic dao.
Yu Chang 喻昌 (1585–1664), Xue Shengbai 雪生白 (1681–1770) and Ye Tianshi 葉天士 (1665–1746), the actors at the centre of Chapters 9, 10 and 11, were among the most influential physicians of the seventeenth and eighteenth centuries. Chapter 8 is devoted to the polymath Fang Yizhi 方以智 (1611–1671), widely portrayed today as a key figure in China’s move into early modernity. Fang was a complex figure, and his late writings are challenging to understand. A celebrated classical scholar who, in his forties, became a Buddhist monk under the name Yaodi 藥地 (translatable as ‘Healer of this World’), Fang maintained a lifelong interest in medicine. More than any other seventeenth-century scholar, he utilised medicine as a tool for contemplating life and living, and he eventually came to view himself as a healer who worked with words as remedies. In addition to documenting the intersections of medicine, religion, healing and scholarly learning that defined the seventeenth century, Fang Yizhi is also a case study in the systematic neglect of medicine as a central element of the broader landscapes of thoughtful practice in that period.
In reacting against the subjectivist tendencies inherent in poetic conceptions of clinical virtuosity, but also in developing Fang Youzhi’s earlier effort to centre medical practice on Zhongjing, some scholar physicians in seventeenth-century China began to create an evidential dao of medicine. These efforts found their most radical expression, however, in eighteenth-century Japan, substantially stimulated by Chinese texts, from where the evidential dao moved back to China in the early twentieth century. These historical processes are the subject of Part Four. They resonated with broader transformations in intellectual orientations in both China and Japan, and they have consequently been analysed in relation to modernisation processes in both countries. However, my analysis reveals that even as these processes set the stage for the emergence of the evidential dao, it was very much a response to problems and tensions that had accumulated within the domain of medicine ever since Danxi’s formulation of his syncretic dao.
Chapter 12 is centred on the seventeenth-century exegete and physician Ke Qin 柯琴 (b. 1619?) Ke sketched out an evidential dao before evidential research (kaozheng 考證) became a dominant force among Chinese intellectuals in the Qing dynasty. This evidential dao attempts to resolve the problem of clinical virtuosity by separating the roles of knowledge producers and knowledge users. Knowledge producers – like Ke Qin himself – possessed specialised hermeneutical skills that enabled them to extract unambiguous relationships between clinical presentations and effective medical formulas from classical texts such as the Treatise. Physicians – being the users of such knowledge – then merely needed to apply this knowledge in clinical practice.
In the eighteenth century, the territory on which the search for the dao of medicine was conducted expanded from Jiangnan China to Japan. This is reflected in the main character discussed in Chapter 13, Yoshimasu Tōdō 吉益東洞 (1702–1773), representative of the ancient formula current (J. kohōha, C. gufangpai 古方派) in Edo period (1603–1868) Japan, who developed Ke Qin’s ideas to their logical endpoint. Tō dō attempted to eliminate all speculative theory from the domain of clinical practice, discarding most classical texts and concepts in the process. As far as he was concerned, it was the formulas contained in the Treatise, not Zhongjing as medical sage, that embodied the dao of medicine.
The two chapters of Part Four help us understand why, even today, it is so difficult to find clear boundaries between the traditional and the modern in Chinese medicine. The apparently modern-looking critical scholarship and empirical orientation of medical writers in China and Japan during the first half of the twentieth century remained fundamentally invested in conceptualising dao to bridge the perennial gap between the protean character of illness and the limited tools provided by tradition by cultivating new forms of clinical virtuosity.
The Conclusion to this book draws the two key themes of my study together once more with the help of the well-known twentieth-century philosopher, politician and writer Liang Shuming 梁漱溟 (1893–1988). Seeking to find value in Chinese ways of thinking at a historical moment in which they were being called into question by Western rationality and science, Liang emphasised the value of Chinese medicine as an art that validated the practical effectiveness of a distinctly Chinese way of life. He thereby highlights the enduring place of medicine in the landscapes of thoughtful practice in late imperial and even post-imperial China. From Su Shi in the eleventh century to Liang Shuming in the twentieth, China’s intellectuals turned to medicine and the body not merely as a source of handy but ultimately inessential metaphors. They relied on medicine to help them conceptualise the place of an embodied self within a cosmos animated by processes of qi transformation.
Throughout this period, physicians and medical writers were aware of the broader powers of their art. But they were also listeners and learners who understood that poets, Buddhist monks, Daoist adepts, classical scholars and military generals had a great deal to teach them about dao. My study only provides an initial survey of this landscape, but in doing so opens avenues for deeper explorations of the many interfaces between these different currents of thoughtful practice. It also enables a reflection on the craft of doing history. By way of comparison with Lorraine Daston and Peter L. Galison’s (2007) well-known concept of ‘epistemic virtues’, I connect my study back to the field of controversy studies. The various dao of medicine, like Daston and Galison’s epistemic virtues, conjoin virtue and virtuosity, the search for enduring knowledge and distinctive practices of self-transformation. Unlike epistemic virtues, however, the different dao – as intersecting paths through fertile landscapes – are not exclusive of each other. They do not define epochs that succeed each other over time but describe possibilities for enacting a tradition against a forever receding horizon.
Living a productive life in such a landscape requires ways of being that differ from those historians of Chinese medicine and practitioners of controversy studies have taken to be universal. Being able to see the four dao of medicine for what they are requires accepting that a ‘geological’ conception of history as a succession of epochs, paradigms or epistemic virtues separated by breaks and revolutions is only one way of configuring space in historical terms. Landscapes of thoughtful practice configure this same space as one to be explored along different but sometimes intersecting paths. Such exploration demands distinctive ways of being, or, in Foucauldian terms, technologies of the self. I close the book by reflecting on these ways of being, relating them to the concept of nomadic subjectivity developed by the contemporary European philosopher Rosi Braidotti.
While this is clearly a specialist text, I have aimed to make this book accessible to readers who are not already familiar with the history of medicine and thought in late imperial China. Besides practitioners of Chinese and other East Asian medical traditions, this may include scholars working in science and technology studies and other non-European medical traditions. This has not been an easy task.
I am aware, for instance, that Chinese names can be difficult for non-Chinese speakers to pronounce and are often hard to distinguish from one another. For this reason, I follow the usage in many Chinese texts of referring to some of the actors discussed by their courtesy names (zi 字). This was a name given to a Chinese man around age twenty, used by peers and in formal situations, because the use of a person’s formal name was considered disrespectful among adults. For example, using ‘Mizhi’ instead of ‘Fang Yizhi’ will make it easier for readers to distinguish Fang Yizhi from Fang Youzhi. Using ‘Danxi’ instead of ‘Zhu Zhengheng’, or even the more common Zhu Danxi, makes it easier to distinguish him from Zhu Xi, especially as their respective ways of thinking are closely intertwined in my narrative.
The longue durée approach required to capture the emergence of the four dao of medicine, as well as some back-and-forth movement in my narrative, will place further demands on readers not intimately familiar with late imperial China and its history. To mitigate this, the frontmatter includes a timeline that lists all main actors I discuss in my narrative in chronological order and a map of China that will help readers to locate these actors in space. Appendix 1 provides a comprehensive list of all historical actors, including their real, courtesy and hao names, and their dates.
I largely try to steer clear of sinological debates regarding the translation of technical terms. As I argue throughout this study, most of the key terms employed in the debates over the dao of medicine constitute semantic fields rather than ‘words’ that bear a specific meaning on which all discussants agreed. In general, no single English term can capture all the possible meanings of such a semantic field. At the same time, the same English term can (and must) sometimes be used to translate different Chinese words. Most of my translation choices are discussed in the text as they occur. However, introducing some key terms at this point will facilitate access to my argument.
I agree with Stephen Boyanton (2015) when he argues that what we call ‘Chinese medicine’ (zhongyi 中醫) today is, to all intents and purposes, a continuation of the tradition of ‘literati physician medicine’ that developed as an identifiable tradition between the eleventh and the fourteenth centuries. Even though some of my central characters were adamant that they were not ‘scholar physicians’ (also ruyi 儒醫), depending on the context, I use either of these two terms (literati physician medicine and Chinese medicine) to designate the medical tradition whose history I explore.
I generally translate li 理 as ‘pattern’, but sometimes ‘principle’ is more appropriate (lixue 理學, for example, is most often translated as ‘the Learning of Principle’). I translate wu 物 as ‘things’ in contexts where ease of reading trumped conceptual issues, and as ‘thing-event’ when I want to emphasise the ontological status of things as qi processes. I have translated liangzhi 良知 as ‘good knowing’ to avoid having to choose between the numerous non-literal translations that have been suggested by other scholars.
The only terms I have left untranslated throughout are qi 氣 and dao 道. Today, qi is part of the English language. Having discussed the various meanings of dao earlier in this Introduction, I believe it can be left untranslated from this point forward. When I am not specifically referring to the writings of historical figures, however, I do play with its meaning by using English terms like ‘way’, ‘path’ and ‘pathway’ in my own argument.
Yi 意 is one of the most critical terms in my narrative, so I felt that I needed to translate it, but no single translation can capture all its uses. For reasons explained in Chapter 2, I translate yi 意 as ‘discernment’ wherever possible, but sometimes other translations are more appropriate. There are many other Chinese terms pronounced yi, and many of my sources actively play with such homophony. This means I frequently need to add the pinyin and the character (‘yi 意’) to the translation that seems most appropriate in a given context. This is probably unsatisfactory from the point of view of aesthetics and readability, but it cannot be helped.
The only other term I do not always translate is zhijue 知覺. In many of the contexts in which it is used in the following chapters, it can also be translated as ‘discernment’. In fact, the similarities and differences between discernment as yi and discernment as zhijue are a crucial aspect of some of the debates I discuss. To avoid confusion with yi 意, then, I subsequently use zhijue in its pinyin transliteration. This does not work for yi 意 because of the many other words pronounced yi that my actors use in their writings.
The term xin 心 carries three interrelated meanings. It can refer to the physical organ in our chests. It can also denote what in English is referred to as ‘mind’. And it can also designate a conjunction, the ‘mind/heart’, in which the physical heart and the faculties of the mind are not clearly separated from each other. Therefore, I translate xin according to context using one of these three terms. (I return to this problem in more detail in Chapter 3.)
In many English-language texts on Chinese medicine, it has become conventional to distinguish the organs of Chinese medicine from those of Western biomedicine by capitalising the former. So ‘Kidneys’ translates shen 腎, while ‘kidneys’ denotes the biomedical organ. I have deliberately abstained from following this convention to minimise any a priori judgements about how the ten thousand things are rendered into language. Or, to put it differently, in my eyes the biomedical notion of ‘kidneys’ does not enjoy a superior ontological status to that of shen 腎.
As for translation in a broader sense, I have explicitly not sought to translate either Chinese medicine or my actors’ search for the dao of medicine into terms that will sit easily within our own conceptual worlds. This would simply be replacing one veil with another. Rather, I wish to encourage productive conversations across all kinds of currents of thoughtful practice.
34. Lisa Raphals’ contribution to The Stanford Encyclopedia of Philosophy, entitled ‘Chinese Philosophy and Chinese Medicine’, is exemplary of this veiling effect. Raphals documents the influence of philosophy on medicine but does not even hint at any influence in the other direction. Some historians are quite aware of the influence of medicine on other currents of thoughtful practice, as Handlin’s (1983) and Kun’s (2024) studies of the official Lü Kun 呂坤 (1536–1618) and Birdwhistell’s (1995) reflections on the writings of the philosopher Li Yong 李顒 (1627–1705) demonstrate. However, neither Handlin, Kun nor Birdwhistell link their subjects’ ‘thinking with’ medicine to the broader engagement with medicine among seventeenth-century literati that I document in this study. Handlin gives several other examples but reads these as indicative of a broader turn towards a fact-centred mode of thinking among late Ming intellectuals. In doing so, Handlin (1983: 209) turns someone like Zhou Rudeng 周汝登 (1547–1629), who clearly ‘thought with’ medicine, but who as a third-generation follower of Wang Yangming was interested in the hidden benefits of illness as a means of self-cultivation, into someone who appears to be concerned with empiricist observation. Chen Mengjun 陳孟君 (2015) includes a comprehensive overview of the use of medical metaphors in the history of Chinese thought, and especially during the seventeenth century. However, Chen largely limits himself to the use of a single metaphor: that of using medicine according to the disease. Bian (2020) is clearly aware of a more widespread concern for medicine among seventeenth-century literati. However, she limits this to an interest in medicinals, which she connects to a broader turn among classical scholars towards ‘things’.
Readers will find references to other scholarly works documenting the interest of literati in late imperial China in medicine throughout my study. However, such interest is either treated as anecdotal – limited to literati ‘knowledge of’ medicine rather than exploring their ‘thinking with’ medicine – or it remains limited to a matter of an individual’s biography and thinking. Chen Hsiu-fen’s 陳秀芬 (2006) study of life cultivation in Ming China comes closest to my own exploration of landscapes of thoughtful practice by widening the lens of why and how literati came to be interested in such cultivation beyond a narrow focus on Daoism.