1 Medical history and Chinese society in the printed world
As Tobie Meyer-Fong pointed out in her 2007 article on publishing history, from the 1990s onward, an increasing number of social and cultural historians use Chinese books as a source and subject to develop a field to rethink intellectual, social, political, and cultural trends through the examination of the production, circulation, and consumption of books in historical contexts.1 In its formative stages, this field borrows associated terminology and methodology from its European counterpart, including the terms “book history,” “print culture,” “publishing history/publishing culture,” and the concept of “communication circuit.”1 Scholars then adapted these borrowed terms and methods to Chinese primary sources. Scholars have made great achievements through long-term studies of Chinese publishing history and micro studies. In her survey of publishing history in late Imperial China, Tobie Meyer-Fong mainly examined American and Japanese scholarship between 1990 and 2006 in terms of five themes: the periodization of Chinese publishing history, local publishing practices, the intended audience, gender and literati identities, and the relationship between political authority and print.
Chinese publishing history has always been faced with debates over methodology and risks about temporal and geographical imbalance. On the methodological level, scholars in the field of Chinese publishing culture, to a large extent, follow their European counterparts instead of promoting or challenging the Western-dominated methodology. The application of the concept of “communication circuit” encourages scholars to focus on commercial publishing and interactions among authors, editors, booksellers, and readers behind it. These topics were overlooked in the previously technology-dominated scholarship of Chinese publishing history and now become the center based on the popularity of Western methodology of publishing history. However, the focus on commercial publishing causes unevenness in the scholarship spatially and temporally. Scholars interested in commercial publishing focus on periods and places in which commerce thrived and political authority declined. The highlighted periods include the Southern Song dynasty, the late Ming dynasty and local or national commercial publishing centers such as Jianyang in Fujian province and the Jiangnan region along the lower reaches of the Yangzi River. By contrast, other periods such as the Qing dynasty and most northern and the far southern publishing and book markets were neglected. However, Cynthia Brokaw,2 Florence Bretelle-Establet,3,4 and other scholars have gradually filled the gap in recent years. This temporal and geographic imbalance not only impedes the creation of a balanced and comprehensive image of Chinese publishing history, but also limits the potential of comparative studies of Chinese and European publishing culture in the early modern period, especially the 18th and 19th centuries. In addition, Meyer-Fong states that overemphasizing commercial publishing might result in ignoring two important modes of publishing in China: official and house-hold production. This trend in the scholarship tends to neglect noncommercial transactions such as gift giving, and official and individual sponsors.1 This will result in the oversimplification of the complex interactions among politics, literati culture, and publishing. With regard to specific studies, she argues that scholars writing the history of Chinese books and printing make efforts to address a core question: “was the book an instrument through which historical change was realized or an indicator of how the times had changed?”1 This question is so complex that its answer seems inaccessible based on the limited primary sources and case studies. However, the examination of how the printed book “influenced conceptions of literati identity and gender roles,” and the exploration of the social status of the producers and consumers of books, more or less, reveal how printed books trigger the changes.1 Scholarship to date has considered works of fiction, encyclopedias, Confucian classics, and books related to civil examinations as sources and subjects for research. Most recently, scholars like Emily Mokros5 and Zhang Ting (张婷)6 have focused on the publication of court news and the realm of legal publishing. Their studies link publishing history to political and legal fields, and provide fresh sources and insights. Medical printing flourished in the early modern period, in spite of several notable exceptions. Medical publishing thus provides a fresh opportunity to explore the role of the printed book in Chinese history and thus stimulates questions drawn from the broader field of print history, such as: How were medical works produced through commercial, official, and private publishing? How did they circulate? Who were the intended readers? How did readers get books? How much could we know about their reading practices? To what extent did medical publications that were produced, circulated, and consumed affect the spread of medical knowledge in Chinese society and shape the pluralism of the medical market? Answers to these questions will help to add details and deeper understanding of the role played by published medical materials in the transmission of medical knowledge, and their impact on Chinese culture and society.
A few book historians have taken medical publications as a source and subject for their studies, although the medical aspect in these studies is usually a secondary concern. In her noted 1986 article “The Huanduzhai of Hangzhou and Suzhou: A study in seventeenth-century publishing,” Ellen Widmer paid attention to medical publishing practices from two publishers Wang Qi (汪淇) and Wang Ang (汪昂) who successively operated a family printing house called Huanduzhai (还读斋) first in Hangzhou and then in Suzhou in the 17th century.7 According to Widmer, both Wang Qi and Wang Ang were interested in medicine and published a number of medical books through their Huanduzhai publishing business. However, Wang Qi published different kinds of books primarily for money, including literary books, travel guides, and medical works, while Wang Ang concentrated on medical publishing for charity. Through the analysis of prefaces, title pages, layouts of medical works published by them, Widmer illustrates the differences between Wang Qi and Wang Ang in terms of publishing aim, strategy, and choice. She further examines the changes of print culture from the more open late Ming dynasty to the more restrictive early Qing dynasty behind their publishing practices. This mainly involves transforming from the flamboyant commercial culture of the late Ming dynasty focusing on “salability, sociability, and celebrity” to the culture of the early Qing dynasty having a strong interest in utility and being apolitical. In summary, Widmer’s study of Huanduzhai during the Ming-Qing transition is a great case study revealing changes of print culture during this period through analysis of different publishing practices (some of which were related to medicine) over time in a publishing house. Unfortunately, while she uses medical publications as primary sources, at least to some extent, Widmer provides a few details of the contents of the printed medical books she focuses on, and she does not attempt to situate her analysis of the two Wangs’ medical publishing practices within the broader context of medical practice or medical knowledge during this period. The questions she tries to solve and the method she uses in this article are typical in the field of Chinese publishing history. What she is interested in is the changing publishing strategies of a publishing house in relation to changes of political regime. Therefore, this is an exemplary study of book history in China rather than an exploration of an integration of publishing and medicine.
Similarly, both Lucille Chia and Cynthia J. Brokaw noted the presence of medical publications in the Fujian book trade from the Song dynasty to the Qing dynasty and Republican periods. In Printing for Profit: The Commercial Publishers of Jianyang, Fujian (11th-17th Centuries), Chia outlines the continuities and changes of medical publications in Jianyang from the Song dynasty to the Ming dynasty on the level of scale, content, and characteristic. Commercial publishers in Jianyang in the Song and Yuan dynasties mainly published “collections of prescriptions, pharmaceutical works, and discussions on cold damage disorders.” The Ming dynasty, especially the late Ming, witnessed an increased diversity of medical works, both scholarly and popular, from “critiques and revisions by medical scholars of earlier works”8 to publications with different trends in medical ideas and practice, from medical classics to medical treatments such as surgery and acupuncture, from gynecology, obstetrics to pediatrics and smallpox treatment. Furthermore, Chia emphasizes that commercial publishers who published medical works in Jianyang were not physicians, although they had interest in medicine. Their taste in medicine, to some extent, shaped textual forms of medical publications, and decided what kind of medical resources could be more accessible to readers.8
In Chapter 11 “Guides to Good Manners, Good Health, and Good Fortune” of her masterwork, Commerce in Culture: The Sibao Book Trade in the Qing and Republican Periods, Brokaw examines the medical publishing output of publishing houses in Sibao, including “medical compendia, materia medica, prescription collections, specialized texts for women, children, and specific types of diseases, and medical casebooks.”2 Through textual and material analyses of the extant medical texts published in Sibao, Brokaw argues that most medical publications in Sibao were well-known works providing practical medical knowledge and effective remedies for a range of diseases, being directed to medical beginners, partially trained country doctors, folk practitioners, and households, instead of highly trained and knowledgeable physicians. In contrast to Widmer’s study of Huanduzhai in the 17th century, Brokaw situates her exploration of Sibao’s medical texts in the broader context of medical practice during the Qing dynasty and Republican Period, which bridges publishing and medical practice. Her work corresponds well with Angela Leung’s study of medical learning and popularization of medical knowledge in the Ming and Qing dynasties. I will discuss this in the next section.
Recently, in the field of Chinese book history, a new trend focusing on studies of readers and their reading practices has promoted an integration of publishing history and medical history from an innovative perspective. In the article “Science for the Chinese common reader? Myriad treasures and new knowledge at the turn of the twentieth century,”9 Joan Judge analyzes how common readers in the late Qing dynasty (1890–1911) and early Republic of China (1912–1930) had exposure to knowledge and information on health through reading relatively cheap, “traditional,” and daily-use published books such as Wan Bao Quan Shu (《万宝全书》 Comprehensive Compendia of Myriad Treasures) instead of consuming new-style textbooks, newspapers, periodicals, and other forms of new media that attempted to disseminate scientific knowledge from the West. Based on the existing scholarship on encyclopedia, Judge illustrates characteristics of Wan Bao Quan Shu as a genre in publishing history of late Imperial China, explores its changes in printing technology, edition and content in the late Qing dynasty and early Republic of China, and draws a picture of consumers of this kind of encyclopedia. Such comprehensive examination of production, publication, circulation, and consumption of Wan Bao Quan Shu helps to bring medical information in the book into social and cultural context. In this way, Judge creates a more detailed and compelling image of the production, dissemination, and acceptance of practical medical knowledge.
2 Role of printing in the medical world
Like the previously mentioned scholars writing Chinese publishing history, a number of medical historians also pay attention to the role of printing in the history of Chinese medicine.
Almost at the same time that Widmer’s article “The Huanduzhai of Hangzhou and Suzhou: A study in seventeenth-century publishing” appeared in the Harvard Journal of Asiatic Studies, Marta Hanson published her book chapter “Merchants of medicine: Huizhou mercantile consciousness, morality, and medical patronage in seventeenth-century China.”10 In this article, Hanson examines different motivations behind five medical texts published by Huizhou book merchants (three texts relating to Wu Mianxue [吴勉学], two of which were published by Huan Du Zhai) to show the social context of a new genre of medical literature in the mid-16th and 17th centuries, namely, self-sufficient handbooks and comprehensive textbooks. Specifically, Wu Mianxue’s career of publishing medical texts reveals that medical publishing was considered as a way of respecting orthodoxy and accumulating spiritual merit for literati and scholars.10 Hanson further argues that although the medical publishing projects of Wang Qi and Wang Ang were based on different motivations that resulted in different contents and intended readers, these medical publishing projects reveal that medical publishing provided social, economic, and moral opportunities for merchant families who failed to achieve political power and social prestige through the Imperial examination system. Both Widmer and Hanson focus on medical texts including Ji Yin Gang Mu (《济阴纲目》 A Compendium of Female Disorders) and Ben Cao Bei Yao (《本草备要》 Essentials of Materia Medica) published by Wang Qi and Wang Ang, respectively. However, Widmer uses them to illuminate the changing choices of one publishing house during a dramatic political transformation, whereas Hanson considers the medical publications as part of the changing medical culture of the period and relates them to the social aspirations of educated men without examination degrees.
Following Hanson’s study of commercial printed medical handbooks and textbooks in 17th-century Huizhou, Angela Ki-che Leung (梁其姿) chose to focus on medical primers of the Ming and Qing dynasties. In her 2011 article “Medical instruction and popularization in Ming-Qing China,” Leung examines a number of Ming-Qing medical primers to show the development of medicine from the Ming dynasty to the Qing dynasty.11 She pays attention to the flourishing of easy verses and rhymes of medical publications including individual texts and introductory medical textbooks and popular family encyclopedias or almanacs. The verses and rhymes were used to describe the nature and use of drugs, recipes, channels and pulse, and common illnesses, for the purpose of instructing beginners, self-taught readers, and those who had different interests in medicine. In this way, Leung illustrates the new characteristics of Ming-Qing medical publications, namely, further simplification on the level of language style and content, and a more pragmatic and clinical trend.11 These changes further reveal the transformation of the medical market from honoring ideal and moralistic “Confucian doctors” during the Song and Yuan dynasties to pursuing a more pragmatic and realistic career as “professional” medical practitioners of the late Imperial period.11 In general, Leung’s argument about changes of medical publications in late Imperial China, which include a more pragmatic and clinical trend, and an increasing number of printed medical texts in the market, corresponds to and supplements studies on publishing history during the same period. In addition, there are two main innovations of Leung’s research. First, her analysis is based in an innovative perspective on medical texts. Leung analyzes the language style of the popular medical publications, especially verses and rhymes, to examine their intended readers and the effects of reading. Another innovation is that Leung develops her understanding of Ming-Qing medical publications to think comparatively about Chinese and European medicine in practice. This comparison reveals the key role of medical publications in the shaping of the medical market. It also inspires scholars to do research on comparison between Chinese and European medical publishing in the future.
In the same year, Leung also published an article on the role of printing in medical learning in the Song, Yuan, and Ming dynasties. In her chapter “Medical learning from the Song to the Ming” published in the volume The Song-Yuan-Ming Transition in Chinese History (2003), Angela Ki-che Leung considers “the popularization of printing” as one of the three new elements during the Song dynasty that resulted in the transformation of the scholarly and the popular medical traditions during the long Song-Yuan-Ming transition, and in the final split between the two medical traditions.12 Specifically, the increasingly flourishing medical publication business promoted by both official printing projects and by private printing houses broke the monopoly of medical teaching formerly held by masters or lineages and increased the number of self-taught doctors. At the same time, printing also helped to set new trends in medical thought and practice, constructed medical communities, and created medical stars. However, compared with her examination of Ming-Qing popular medical publications through analysis of verses and rhymes, Leung’s arguments about the role of medical publications during the Song-Yuan-Ming transition largely depend on Zhong Guo Yi Ji Kao (《中国医籍考》 Studies of China’s Medical Books), reprint of an original edition compiled by Tamba no Mototane in 1831. This book collects information about Chinese medical books in different times, including title, author, editor, preface, and edition. However, a lack of details about the printed medical books including the number of copies, the format, the intended readership and the strategy of medical publication makes Leung’s more nuanced examination of the role of the printed book in the history of the transmission of medical knowledge in this crucial period limited.12
In 2020, Hanson published her research article “From under the elbow to pointing to the palm: Chinese metaphors for learning medicine by the book (4th - 14th centuries).”13 This article, to some extent, fills a gap in the analysis of medical texts before the late Ming dynasty. Through the examination of a range of genre distinctions, descriptors, and more importantly, metaphors in the titles of Chinese medical manuscripts and printed texts from antiquity through the late medieval period, Hanson shows how editors organized medical knowledge and presented it to potential readers. Hanson, in this article, analyzes a large number of title metaphors mainly from the fourth century to the fourteenth century, referring to “summarizing the essentials (yao 要), mirroring reality (jing jian 镜鉴), versifying prose (jue 诀, fu 赋, ge 歌) and bodily metaphors, such as behind the elbows (zhou hou 肘后), handheld mirrors (shou jian 手鉴, shou jing 手镜), the heart-mind (xin 心), pointing south (zhi nan 指南) and pointing to the palm (zhi zhang 指掌).”13 Among, “pointing south” (zhi nan) and “pointing to the palm” (zhi zhang) as new bodily metaphors appeared in the medical publishing realm since the 13th century guided readers through a specific medical subject and potential mastery of medical knowledge. The expanding application of “pointing south” and “pointing to the palm” in the Ming and Qing dynasties in titles of medical publications, as Hanson observes, further reveals the transformation of medical learning during this period. The increasingly complex medical knowledge was formulated, managed, and popularized through medical publications with new genres and innovative titles. On the other hand, such phrases utilized in titles showed the intellectual context of fingers and palms for medical learning through correlating fingers and palms with Heaven and Earth and further considering hands as a microcosm of the world that should and could be learned, and memorizing medical knowledge through hands. In fact, as early as 2008, Hanson started to explore the ways in which hand metaphors reshaped medical knowledge through medical learning and publications since the Song Dynasty.14 In this way, Hanson correlates the survey of bodily metaphors in the titles of medical publications with medical learning through the book, thereby supplementing and broadening Leung’s studies of medical learning from the Song, Yuan, and Ming dynasties and popular medical publications in the Ming and Qing dynasties. Similar to Leung’s article “Medical instruction and popularization in Ming-Qing China,” Hanson’s study is exemplary in comparative reach. In this article, Hanson compares the use of metaphors in titles in Chinese and European publishing. Hand metaphors in the history of European publishing referred to three main textual genre terms: “enchiridion, handbook and manual,” conveying accessibility and portability of texts.13 In comparison, Chinese counterparts utilized hand metaphors to signify the mastery of knowledge instead of designating any separate genre comparable to enchiridion, handbooks, or manuals in Europe. This comparative perspective helps Hanson to bring title metaphors, especially bodily metaphors, into studies of Chinese publications, increasing a new viewpoint of text analysis, and compensating for the relative lack of publishing details for medical texts from the medieval period.
In addition to the studies of commercial medical publishing from the Song dynasty forward, some medical historians also pay attention to the role of official publishing in the history of Chinese medicine. In her 2011 article “Governance through medical texts and the role of print,” TJ Hinrichs focuses on the key but limited role of printing in the developments of medicine in the Song dynasty.15 She considers official publishing as “a critical component in the expanding medical repertoire of Northern Song statecraft,” but she locates the origins of this dramatic shift with the use and dissemination of medical texts as a tool of governance instead of the technology of print. Hinrichs emphasizes that medical texts engraved on stone or on wooden blocks and posted in public places rather than printed medical publications played a key role in the local spread of official medical knowledge and in the transformation of “noxious” southern customs. Hinrichs further reveals the tension between printing technology and authority. On the one hand, medical publications sponsored by the central government and emperors were issued to local governments, which promoted the Song government’s involvement with producing and disseminating official medical knowledge and further contributed to a unified and uniform empire from a medical standpoint. In this way, printing technology expanded political authority. On the other hand, both emperors’ and scholar-officials’ interests in medicine and their ambitions of creating a standard medical knowledge system were limited within the print culture of the Song dynasty. Both on the local and central levels, based on emphasis on correcting errors and pursuit of a purified edition, an excess of editions of official medical books were produced through printing, although these books had similar contents. This led to the destabilization of textual authority, and accordingly contributed to a decentralized medical culture.
In her recent monograph Know Your Remedies: Pharmacy and Culture in Early Modern China,16 Bian He (边和) outlines correlations between the official and the commercial, the central and the local, Confucian scholars and professional physicians in publishing ben cao monographs from the 7th century to the 19th century, and the political, cultural, and intellectual transformations behind the medical publishing history. Specifically, Bian describes the discontinuity of state-centered tradition of ben cao from the 16th century forward and the demise of a unified pharmaceutical objecthood, which was caused by the separation between Confucian natural history and pharmacy in the 18th century.16 Unlike most medical historians focusing on the textual analysis of classic and ben cao pharmacopeias, Bian keeps a perfect balance between classics and popular ben cao publications, the textual analysis and the examination of the production, circulation, and consumption of ben cao publications. In this way, Bian’s study of ben cao publications produces a new understanding of science, knowledge, and culture in premodern and early modern China from the perspective of medical history. The success of Know Your Remedies is based on the author’s successful combination of publishing and medical history.
Florence Bretelle-Establet provides another model of the integration of publishing and medical history. In her two articles “Is the lower Yangzi River region the only seat of medical knowledge in late Imperial China? A glance at the Far South region and at its medical documents”3 and “Human mobility and books: modes of circulation of medical ideas and doctrines in the Far South of China, 18th and 19th centuries,”4 she pays attention to the Far South of China, which has been neglected by both book and medical historians, including Yunnan, Guangxi, and Guangdong provinces.
In the first article, Bretelle-Establet analyzes how the medical culture of the Lower Yangzi (Jiangnan) region has played a dominant role in shaping the historiography of medicine since the late 1970s in Western academic field. Specifically, the viewpoint that academics of Chinese medical history centered on Jiangnan was formed because of the following reason. Scholars paid attention to the late Imperial period, and they emphasized the complexity and diversity of Chinese medicine, which made Jiangnan region important in the study of Chinese social and cultural history in the late Imperial period. Furthermore, the greatest number of surviving medical books were published in the Jiangnan area or by doctors who lived in this area. However, Bretelle-Establet reminds readers of caring about the limitations of the Jiangnan priority and confirms the value of outside Jiangnan area in creating a more comprehensive and balanced image of Chinese medicine. In her second article “Human mobility and books,” she further shows the potential to use methodologies of book history to study medical culture in the Far South. After pointing out the inadequacy of biographies and extant medical writings in Guangdong and Guangxi, Bretelle-Establet tries to sketch medical culture in the two provinces through the investigation of quotations and citations in the surviving published medical texts written by four medical experts who practiced medicine in the Far South in 18th and 19th centuries. She reveals that these medical experts in the Far South could access medical resources including ancient and classical medical texts, medical writings by more recent authors and their contemporaries from provinces of Guangdong and Guangxi, and from outside the two provinces in the Jiangnan area. Bretelle-Establet further examines the ways in which the medical resources were disseminated and were available to He Mengyao (何梦瑶) and the other medical experts in the Far South. In her analysis of the two modes of dissemination of medical knowledge, she focuses on the interaction between books and people. Mobility of books depended on the local book market while human mobility between peripheral areas (Guangdong and Guangxi) and cultural centers (Jiangnan and the capital) promoted the long-distance circulation of books. Bretelle-Establet first traces which kind of medical resources were available to medical experts in the Far South by using the methodology of reading history. This means investigating reading practices of authors of medical writings in the Far South. In the process, citations and quotations He Mengyao and his contemporaries mentioned in their medical publications played the key role. Bretelle-Establet further examines the ways in which these medical experts in the Far South could access these medical resources from the perspective of book history through the analysis of local book markets and the long-distance circulation of books depending on human mobility to illustrate the dissemination of medical ideas and doctrines. Therefore, Bretelle-Establet uses methodologies of book history to delve into the medical culture in peripheral areas where few book historians and medical historians have paid attention, and extant biographies and medical writings are insufficient to support comprehensive and deep studies.
Scholarship on medical history from the perspective of medical publications has achieved great contributions. In terms of content, relevant studies refer to commercial and official medical publishing, medical culture in both central and peripheral areas, and medical learning through the printed book. In terms of methodology, scholars mainly apply close reading of texts and paratexts through analysis of prefaces, body content, verse and rhyme, metaphor of title, citations and quotations. Comparative methods to interpret medical texts were also used, revealing a complex and diverse medical world of China. Furthermore, Bian He’s study of pharmacy and culture, and Florence Bretelle-Establet’s exploration of medical culture in the Far South of China reveal the great potential of the combination of publishing and medical history. In addition, as Hanson’s article “From under the elbow to pointing to the palm” shows, a few scholars gradually have begun to examine medical genres and have produced good academic work. In the next section, there are several representative studies that discuss the existing scholarship on genres in Chinese medical history, mainly focusing on medical case histories.
3 Scholarship on epistemic medical genres in Chinese medical history
As for the history of genres in Chinese medicine, as Hanson mentions in her article “From under the elbow to pointing to the palm,” the excavated texts and bibliographic references in late antiquity (3rd century BCE–3rd century CE) reveal that there were eight genre terms used to describe medical texts. These include fang (方 formulary), shu (书 writing), lun (论 discourse/treatise), zhen ji (诊籍 consultation record), fa (法 method), jin (禁 interdiction), dao (道 way/teaching), and jing (经 canon). Ancient and later medical authors continued and developed the application of these eight genre terms. For example, as a recognized medical genre, fang existed in Chinese medical traditions from antiquity to the modern period.17 By contrast, case narrative, as one of the oldest surviving medical records in China, had many different terms used to differentiate it from other narrative forms but was not considered as a full-fledged medical genre until the 16th century.18
Scholarship on medical case histories showed the potential to consider the medical genre as a research object. Christopher Cullen’s chapter “Yi’an (case statements): the Origins of a Genre of Chinese Medical Literature” in the 2001 book Innovation in Chinese Medicine edited by Elizabeth Hsu, could be considered the most comprehensive study of medical case history as a genre in China.18 In this chapter, Cullen illustrates the evolution of medical case narratives from antiquity to the Ming and Qing dynasties, and clarifies that yi an (医案 medical case statements) came into being as “a special printed genre” in the 16th century in the specific social and intellectual context of the late Ming dynasty. This includes the increasingly expanding commercial publishing market, the model of legal case statements, the bureaucratic tradition of Chinese culture, and both physicians’ and patients’ increasing demand for medical publications. Another chapter in the same volume, “From Case Records to Case Histories: the Modernisation of a Chinese Medical Genre, 1912-49” by Bridie Andrews expands the survey of case histories in Chinese medicine from the 16th century to the first half of the 20th century.19 By comparing the two case reports from a single case by Ding Ganren (丁甘仁) and He Lianchen (何廉臣), Andrews examines the process through which medical case histories adopted and adapted “the rubrics of western case histories.”19 While the “modernization” of this Chinese medical genre prompted the creation of standardized prescriptions, it also provided a path for Chinese medicine to survive into the “modern” world through defining Chinese medicine within the theoretical framework of Western medicine. Both Cullen and Andrews contextualize the history of Chinese medical cases in specific social and cultural conditions and trace the evolution of medical texts from an emic perspective. Cullen’s article seems to have historicized the genre yi an by demonstrating how it fit into the context of the late Ming dynasty, while Andrews emphasizes internal motives rather than external causes for the restructuring of medical case records in the Republican period. Andrews’ description of the transformation of Chinese medicine during this period is vivid and complicated, but she follows the dichotomy of tradition and modernity, which weakens the historicization of the medical genre.
In 2007, Charlotte Furth, Judith T. Zeitlin, and Ping-chen Hsiung co-edited and published Thinking with Cases: Specialist Knowledge in Chinese Cultural History, including eight case studies of knowledge production in Chinese law, medicine, religion, and philosophy. The collection includes three chapters dealing with the Chinese medical case histories by Furth, Hsiung, and Zeitlin, respectively.20–22 Based on Cullen’s and Andrews’ research on medical case histories in late Imperial China and early modern China, this book expands the examination of medical case histories into the subfield of pediatrics. In terms of methodology, both Furth and Zeitlin focus on the rhetorical styles of specific medical case collections, which is a deep and close reading of terminology and texts like Hanson’s study, and explore the interactions among publications of medicine, law, classics, and literature. Thinking with Cases is the first attempt to systematically think about the role of the case as a mechanism in the knowledge production and organization in Imperial Chinese culture. It was inspired by the “case thinking” model of science historian John Forrest, a specific method of producing valid knowledge “style of reasoning.”20–22 Furthermore, Thinking with Cases has provided more space to reconsider the relation between medicine and publishing in late Imperial China. Specifically, the Song dynasty witnessed the maturity of the legal case, the medical case matured in the Ming dynasty, and the learned case was a product of the late Ming dynasty. The late Ming dynasty witnessed the combination of all major types of case collections and the flourishing of publishing. A printed world where knowledge and practices of law, medicine, philosophy, religion and literature interacted with each other was further created for both authors and readers during this period. Therefore, there is potential for scholars to examine Chinese medicine through a case study of a specific genre beyond the medical field. Recently, Andrew Schonebaum, in his monograph, explores how the literary genres intersected with medical knowledge in early modern China. Through the analysis of fictional and “vernacular” medical texts (the former includes novels, oral tales, biographies, performance literature; the latter includes published medical case collections, collections of medical recipes, and pharmacopeia), he examines how “fictional texts were used or imagined as medical texts, but medical texts increasingly looked like fiction and drama.”23 This correlation between literature and medicine in early modern period dominated the production and transmission of vernacular knowledge of medicine and the body, and shaped how people understand diseases, the body, medicine, and even popular culture.23 In this way, Chinese medical history goes beyond a subfield of cultural and social history and gradually develops as a perspective and methodology to understand Chinese culture and society.
In her 2014 article “The medical case narrative: Distant reading of an epistemic genre,” Gianna Pomata further defines medical case histories by using the term “epistemic genre.” The term refers to the “specific kind of genre whose function is fundamentally cognitive,” and in this way Pomata differentiates epistemic genre from literary genre, namely, the kind of genre whose primary goal is “aesthetic or expressive.”24 Even though studies on the history of such genres as medical case history, materia medica, and recipe already exist, this is the first time a standard name is given to indicate genres that are “deliberately cognitive in purpose.” Furthermore, Pomata’s examination of the medical case as an epistemic genre relying on the strategy “distant reading”24 instead of close reading provides an innovative perspective of understanding the production and transmission of medical knowledge in different cultures. She also published a comparative study of medical case narratives in premodern Europe and China.17 In this study, Pomata examines both similarities and differences of premodern European and Chinese medical case narratives, and discusses the possible exchange of cases between East and West in late Imperial China. If Thinking with Cases emphasizes that China created and followed a different scientific tradition from Europe through the exploration of history of the case in Chinese medicine, law, religion, and philosophy, Pomata’s chapter focuses on more similarities than differences. This includes the similar overall pattern, format, origins, genre awareness, epistemic goals, and the context of individualized medicine. Furthermore, Pomata argues that the case has a twofold epistemic function. Cases can lead to generalizations while “the cognitive arrow of the case” points toward “particularization and individualization,” that have received much less attention. She further defines the case as “a tool for the cognitive purpose of individualization” that is different from that of Forrester.17
Pomata’s concept of “epistemic genre,” to some extent, enlightens Liu Yan (刘焱)’s reexamination of Sun Simiao (孙思邈)’s medical works from the perspective of medical genres. Through the analysis of Bei Ji Qian Jin Yao Fang (《备急千金药方》 Important Formulas Worth a Thousand Gold Pieces for Emergency) written by Sun Simiao in the 7th century, Liu argues that Sun’s Bei Ji Qian Jin Yao Fang could be considered as the first formula book in Chinese history with medical cases, which, to some extent, combined two medical genres: fang shu (formula books) and yi an (medical cases). Borrowing from Pomata’s definition of cases as an “epistemic genre,” Liu distinguishes medical texts from formula books, valuing Sun’s priority on medical practices and therapeutic effects. In this way, Liu demonstrates that Sun initiates “a new mode of knowledge production that is rooted in personal experience.”25 In general, Pomata’s concept of “epistemic genre” could be considered as a powerful analytical tool to examine individual medical works and specific medical genres.
In addition, Pomata and Hanson collaborated on a research article “Medicinal formulas and experiential knowledge in the 17th-century epistemic exchange between China and Europe” in 2017.26 This article focuses on the role of the medical recipe in the cross-cultural transmission of medical knowledge. After a brief introduction of the general history of two recipe forms in China and Europe from antiquity to the 16th century, they examine the process of how Chinese pharmacological knowledge spread to Europe with the aid of the translation of Chinese recipes into Latin and the commercial publication of the translated texts. Unlike Pomata’s study of medical case histories in both cultures from a comparative perspective, this article uses a cross-cultural method of analysis. Pomata and Hanson explore the procedures and mechanism of translating recipes from Chinese into Latin which is a combination of translation and transcription, and the application of “typographical devices” including “a vertical structure and an italic font.”26 This process and the modular character of both Chinese and European formulas accordingly reveal how the recipe could become a bridge across cultures. Pomata and Hanson continue to examine the transmission of Chinese pulse texts through translation. In this study, they change from the synchronic method that focuses on the transmission of Chinese recipes into Europe in the 17th century, to a diachronic method that examines different translation choices of Chinese pulse texts from early 14th century to early 18th century related to these distinctions: primary text/commentary, verse/pose and original illustration/newly created image.27
Hanson, in her recent article “Epistemic genres as a conceptual tool in the history of Chinese medicine,”28 also confirms the value of epistemic medical genres in studies of Chinese medical history, through the analysis of Pomata’s research and her collaboration with Pomata on research about medical exchanges between China and Europe. Using the medical case as an epistemic genre is a powerful means to re-periodize the long history of medical cases both in China and Europe. It is also useful for scholars to explore transformations of medical doctrines and tension among different genres behind the periodization. Epistemic genre as an analytical tool further provides an innovative perspective to think about cross-cultural medical history just as Pomata’s and Hanson’s analysis of different translation choices related to distinct textual forms.
The above-mentioned studies of medical case histories and recipes have contributed to the emergence of a new subfield focusing on medical genres in the study of Chinese history. Scholars moreover have identified some genres as possessing an epistemic function that differentiates them from literary genres. As Pomata argues, epistemic medical genres are the vehicles of a cognitive project and also shaped by the cognitive project. Therefore, studies of epistemic medical genres respond to a central question in the history of medicine, namely, how do people create and validate medical knowledge through texts in specific genres? Because epistemic medical genres from the Song dynasty on circulated at least partly in printed form, scholars of the later imperial period further asked how people created and validated medical knowledge through medical publications. They consider a central question for the history of medicine in China, and also address a general question of scholarship on the history of Chinese books and printing from the perspective of medicine, mainly answering the question of “was the book an instrument through which historical change was realized?”1 In other words, studies of epistemic medical genres in the printed world help to clarify the role of printed texts in the production and validation of medical knowledge, while research on medical publishing will also provide answers to the role of medical publications in the spread and understanding of medical knowledge in Chinese society. This indicates the feasibility and desirability of the integration of publishing and medicine in scholarship on Chinese history. In addition, Pomata’s and Hanson’s studies of medical case histories and recipes provide in-depth analysis of medical genres from China and Europe. They reveal the potential of studies of book history in a global context. Research on medical publishing will also contribute to the participation of Chinese book history in broader and transnational studies of the history of book publishing, and in the study of the transmission of medical knowledge within and outside specific languages and regions.
Both Chinese publishing history and medical history have emerged as important fields within the broader study of China’s social and cultural history. Book historians and medical historians consider medical publications as sources and subjects for research, although their studies differ in goals, questions, and methodologies. However, recent scholarship from both book historians and medical historians shows a new trend of the integration of Chinese publishing history and medical history. Joan Judge’s study of Wan Bao Quan Shu demonstrates the value of methodology of publishing history (and reading history) in analysis of the production, dissemination, and acceptance of practical medical knowledge. Both Florence Bretelle-Establet and Bian He as representative medical historians provide excellent models for research projects that combine the history of publishing and of medicine. Bretelle-Establet innovatively uses citations and quotations to trace circulation of medical publications in the Far South and shows the ways in which accessible medical resources shaped local medical culture. Bian combines text and genre analysis of classic and popular publications of ben cao, and the examination of the production, circulation, and consumption of this kind of medical publications to produce a new understanding of science, knowledge, and culture in early modern China. Gianna Pomata and Marta Hanson apply epistemic genres as a conceptual tool to examine medical exchanges between China and Europe and rethink the periodization of distinct medical genres and what their changes reveal about broader historical transformation. All of them show the potential for this newly developing integrated field.
Both book historians and medical historians will discover new questions and directions of research in this integrated field in the future. One of the possible directions is to broaden and deepen studies of medical genres and medical information collected in different kinds of publications. The existing scholarship on genres in Chinese medical history is largely concentrated on cases, recipe and formulary and ben cao. It would be helpful to explore other medical genres such as canon, discourse, treatise, method, and teaching to not only create a more comprehensive image of the plural medical world, but also to develop new insights into transformations in publishing history and the history of knowledge in China more broadly. Some scholars have focused on medical knowledge and ideas in novels, textbooks, and encyclopedias, and have achieved great contributions to interactions between physicians and patients, and image construction of scholars and common readers. At the same time, systematic studies of other kinds of popular publications such as gazetteer and poem which also include valuable medical information, promise great potential for exploration. In addition, it would be fruitful to explore the fluidity, acceptance, and reconstruction of medical knowledge among different genres, such as Joan Judge’s examination of the prescription of He Shutian (何书田) and Lin Zexu (林则徐) about a cure for opium addiction, which was mentioned and rewritten in various literature including Lin’s memorial, Wan Bao Quan Shu, articles, fictions and advertisements by commercial periodical press, and in quasi-official journals.
This integrated publishing-medical field will provide a comprehensive image of the production, circulation, consumption, and understanding of medical knowledge in Chinese society through the text-based and epistemic genre analysis of medical texts and the examination of cultural history of medical publishing. This field will also help integrate studies of medical publishing of China into a broader comparative and transnational conversation about the exchange of knowledge in global history. Progress in this unified project in the future is worthy of further exploration.
Note 1: This literature review only refers to a selection of the existing researches on medical history and publishing history in Imperial China. Although the author tries to select representative works as much as possible, omissions are inevitable. The author will be responsible for any error and omission.
Note 2: In this article, I use both “late Imperial China” and “early modern China.” I acknowledge that they are not self-explanatory terms but bear very different implications concerning the periodization of China in the Ming and Qing dynasties. I usually decide which term to use based on scholars’ own priorities.
I want to thank Marta Hanson, Tobie Meyer-Fong, William T. Rowe, and two anonymous reviewers who gave me their valuable suggestions about this article.
This study does not contain any studies with human or animal subjects performed by the author.
MANG Fan wrote and revised this article.
Conflicts of interest
The author declares no financial or other conflicts of interest.