Medical Practice in the Ming Dynasty -A Practitioner's View: Evidence from Wang Ji's Shishan Yi'an
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Chinese Science 15 (1998): 37-80 Medical Practice in the Ming Dynasty -A Practitioner's View: Evidence from Wang Ji's Shishan yi'an Joanna Grant [Joanna Grant completed her Ph.D. thesis on "Aspects of Gender and Culture in Ming Dynasty Medical Histories" at the School of Oriental and African Studies, University ofLondon, in March 1997.} AUTHOR'S NOTE: The research upon which this article is based was made possible by generous funding received from the Wei/come Trust. I would also like to thank my supervisor Dr. Christopher Cullen and the many reviewers, colleagues, and friends who have given me such invaluable assistance in the preparation ofthis article. * * * he Shishan yi'an £Ll.Jlf;t (Stone-mountain medical case histories) is Tperhaps the most famous work of the Ming physician Wang Ji d:t! (1463-1539), and constitutes a collection of over one hundred case histo ries taken from his clinical practice in Qimen, Anhui province, over a period of fifteen years. 1 The value of this text as source material lies in the potential of case histories to reveal aspects of clinical medical practice not accessible either through studies of its historical context or through examinations of theoretical texts. Much is now known about the general theoretical principles that underlie 1 Wang Ji's style name, zi '.cf'., was Shengzhi ~z. and his nickname, hao ~, was Shishan ELLI (Stone-mountain), which relates to the fact that Wang Ji's ancestors had come from Stone-mountain in Anhui. The words "Stone-mountain" in the title of this book Shishan yi 'an E Ll.Jfi~ (Stone-mountain medical case histories) therefore denote Wang Ji. All references to the Shishan yi'an in this article, unless otherwise stated, are taken from the following edition: Siku quanshu [9)]1[i::j: (photographic reprint, 1987), vol. 765, pp. 325-409. 37 Downloaded from Brill.com10/08/2021 01:39:02AM via free access 38 Chinese Science I 5 (1998) both traditional Chinese medicine and its contemporary counterparts, and also, to a lesser extent, their temporal, regional, and spatial variations.2 However, whereas anthropologists of contemporary Chinese cultures have been able to observe and document the various dimensions of traditional Chinese medicine as it is currently practised, including the interrelationship between theory and practice, the patient/physician encounter, and interactions with other sectors of the contemporary health system,3 historians have had little opportunity to ex plore the world of clinical medical practice in a historical context.4 As a result, while much has been written about continuity and change from a theoretical perspective, medical practice remains a little-known area. In this article I draw on the information given in the Shishan yi 'an in order to build up a picture of various aspects of Wang Ji's medical practice. I begin by examining the nature of the text itself, in terms of its author, its historical ante cedents, its purpose, and its reliability as a source material. This is followed by a description of the structure of text, both overall and in relation to the individual cases. I then focus on the data contained within the case histories to reconstruct certain features of Wang Ji's medical practice, including his theoretical beliefs and their implementation in clinical practice, his interaction with other medical healers, and the dynamics of the patient/physician relationship. The Nature of the Shishan yi'an The Author of the Text Wang Ji lived and worked in Qimen, in the Huizhou prefecture of southern An hui, during the late fifteenth and early sixteenth century. He was an important part ofXin'an medical culture during perhaps its most influential and productive period.5 Powerful social and economic changes affected the entire region at this time, and their impact was noticeable on many aspects of medical culture. The social mobility characteristic of the period meant that physicians came from a variety of backgrounds and often had differing reasons for deciding to pursue a career in medicine. However, despite their diversity of background, physicians appeared as more of a cohesive group than they had previously. The increasing 2 See, for example, Needham et al. 1954-; Sivin 1987; Porkert 1974; Unschuld 1985. 3 Influential anthropological studies include Kleinman 1980; and Farquhar 1994. 4 There is, however, some research emphasizing practice as opposed to theory. See, for example, Cullen 1993, which describes the social dimensions of healing to be found in a Ming dynasty novel; and Furth n.d., which analyses gender differences in over 400 case histories from the Qing dynasty. 5 Xin'an ffi';i_', in reference to the Xin'an mountain in Qimen, was the term used by many sixteenth-century scholars to refer to the Huizhou area. Downloaded from Brill.com10/08/2021 01:39:02AM via free access Joanna Grant: Medical Practice in the Ming Dynasty 39 contact between physicians, both in tenns of direct contact resulting from im proved transport networks and greater mobility and in tenns of indirect contact resulting from the boom in publishing and increased access to books, created an environment in which the physicians were highly aware of each other. In addi tion, one effect of the general prosperity and merchant patronage also charac teristic of the period was to increase the variety and quantity of medical books being produced, and many new genres, such as general readers and medical case histories, emerged to satisfy the needs of a new and diverse readership. According to Wang Ji's biography, in his youth he had studied the classics and made repeated attempts at the civil service examinations, but after repeated failures he decided to become a physician like his father before him.6 His repu tation is said to have spread far and wide, with people coming from all around to receive treatment. Contemporary evidence also substantiates the assertion that Wang Ji was well known and respected in his own lifetime. Not only did he produce at least eleven medical texts on a variety of subjects, but versions of his biography appear in the Qimen xian zhi ffi~r~!M:;t (Qimen gazetteer) dating from the Wanli period (1573-1620), and also in the comprehensive medical text Gujin yitong daquan ~~&ME::k~ (Complete synthesis of medical knowledge past and present) compiled by Xu Chunfu ~ff.ML another Xin'an physician and contemporary of Wang Ji. Wang Ji also had more case histories included in the Mingyi lei'an :ggm~ (Cases of famous physicians arranged by category), a sixteenth-century case history compilation, than almost any other physician. Despite the increasing transmission of medical knowledge through the medium of published works, the master/disciple relation was still an important mecha nism for transmitting and disseminating knowledge, and Wang Ji's disciples, of whom at least seven can be positively identified, played a key role in ensuring the spread of his medical theories throughout the region. Wang Ji was also greatly influenced by a number of other contemporary physicians. In particular the writings of Xue Ji ffa (1486--1558) and Wang Lun .:E~ (1453-1510) from Zhejiang, Han Mao~~ (fl. 1522) from Sichuan, and Wei Guiyan ftti!s (fl. 1525) were very influential on Wang Ji's own writings and theories. No doubt the presence of Huizhou merchants throughout China at this time accounts for the texts of these physicians reaching Wang Ji so soon after publication. Travelling merchants also enabled Wang Ji to obtain infonnation on the acupuncture and moxibustion skills of Ling Hanzhang ~¥1~ and Li Qianhu c$:f-p from neighbouring provinces. Such transporta tion networks played an important role in the distribution of medical texts and stimulation of intellectual debate during this period, and enabled Wang Ji to keep track of contemporary developments in the field of medicine on a national, as well as regional, basis. 6 Shishanyi'an fulu [appendix]: 21--47. Downloaded from Brill.com10/08/2021 01:39:02AM via free access 40 Chinese Science I 5 (I 998) In Wang Ji we see reflected many of the main characteristics of Xin'an medical culture in the early sixteenth century. His reasons for becoming a doc tor-repeated failure in the civil service examinations coupled with a desire to realise the Confucian virtues of benevolence and filial piety-could not be more typical. The three most common modes of transmission of medical knowledge, that is hereditary transmission, the master/disciple relationship, and transmission through published materials, are all represented during his working life: he learnt from his father, he passed his skills onto his disciples, and he both ac quired knowledge from books and wrote books for others to read. His medical writing, in terms of both the types of books he wrote ( case histories, annotated classics, revised editions, and general readers), and his motivations for doing so (Confucian benevolence, correcting errors, and increasing the accessibility of medical texts to the public), are also very characteristic of the period. Finally, the extent of his influence and his ability to keep track of recent medical devel opments are a reflection of the increased level of contact between physicians which was a distinctive feature of Xin' an medical culture at that time. The Case History Genre Physicians' case histories (yi'an 9~) are records written by physicians (or their disciples) of their medical practice, which describe individual cases treated by the physician, and in doing so often reveal details of the many dimensions of healing, from diagnosis and treatment to social relations and contemporary per ceptions. The writing of case histories by physicians has been traced back through Chinese medical history primarily to those of Chunyu Yi iJ f g re corded in chapter 105 of the Shiji 51:~c (Records of the historian) by Sima Qian l'i],~~- Prior to this there are also certain examples of encounters between phy sicians and patients to be found in the Zhouli ffllm (Rites of Zhou), the Zuo zhuan ti:f$ (Zuo commentary of the Spring and autumn annals), and the Liishi chunqiu §Ei:.lfct)c (Spring and autumn annals of Mr.