Tongues on Fire: On the Origins and Transmission of a System of Tongue Diagnosis Nancy Holroyde-Downing University College London A Dissertation Submitted to the Faculty of University College London In Partial Fulflment of the Requirements for the Degree of Doctor of Philosophy in History in the Department of History 2017 I, Nancy Holroyde-Downing, confrm that the work presented in this thesis is my own. Where information has been derived from other sources, I confrm that this has been indicated in the thesis. Abstract Tongues on Fire: Te Origins and Development of a System of Tongue Diagnosis Tis dissertation explores the origins and development of a Chinese diagnostic system based on the inspection of the tongue, and the transmission of this practice to Europe in the late 17th century. Drawing on the rich textual history of China, I will show that the tongue is cited as an indicator of illness or a portent of death in the classic texts of the Han dynasty, but these references do not amount to a system of diagnosis. I will argue that the privileging of the tongue as a diagnostic tool is a relatively recent occurrence in the history of Chinese medicine. Paying particular attention to case records kept by physicians from the Han dynasty (206 bce–220 ce) to the Qing dynasty (1644–1911), I will show that an increasing interest in the appearance of the tongue was specifcally due to its ability to refect the presence and intensity of heat in the body. Tongue inspection’s growing pervasiveness coincided with an emerging discourse among Chinese physicians concerning the relative usefulness of shang- han 傷寒 (Cold Damage) or wenbing 溫病 (Warm Disease) theories of disease progression. With the establishment of global trade routes in the 16th and 17th centuries the trans- mission of knowledge, objects and practices from China to Europe was facilitated. I will argue that among the various medical practices of China that fascinated European audi- ences, tongue diagnosis, unlike pulse diagnosis, was able to stand outside the constraints of Chinese medical theory in its transmission to Europe. 2 Contents Abstract ..........................................................................................................2 Acknowledgements ........................................................................................7 1 Introduction ....................................................................................9 Te Physician in China ................................................................................ 12 Chinese Medicine through Western Eyes ................................................. 17 Te Search for the Development of Tongue Diagnosis ..............................22 Te Tongue Images Appear ........................................................................24 A Brief Textual History ...............................................................................24 Epidemics and the Search for Efective Treatment .....................................27 Tongue Inspection Emerges as an Illustrated Aspect of Diagnosis ..........28 Te Tongue’s Rise to Prominence ................................................................31 Tongue Texts Become Part of Medical Compilations ................................ 37 Proliferation of Tongue Texts During the Qing Dynasty .......................... 38 Tongue Diagnosis Becomes More Comprehensive .................................... 38 Observation, Illustration, and Chinese Tongues in Europe ......................40 Chapter Outline ..........................................................................................42 2 Textual Evidence of Tongue Inspection in Early Writings ........ 45 Han Texts ..................................................................................................... 45 Attributed Writing ........................................................................................53 A Brief Overview of Early Recorded Cases ................................................. 57 Beyond the Han to the Song ....................................................................... 58 Te Jin-Yuan Period and Innovation ........................................................... 61 Brief Descriptions of the Four Currents of the Jin-Yuan Masters .............62 Te Ming 明 Dynasty (1368–1644) ..............................................................64 Who Were the Ming Physicians? .................................................................67 Te Adaptations of Medical Texts ...............................................................69 Te Development of Wenbing 溫病 (Warmth Factor Disease) ..................70 New Diagnostic Tinking about Febrile Illness .........................................72 Roots and Branches .................................................................................... 73 3 3 What Does the Aoshi shanghan jinjing lu 敖氏傷寒金鏡錄 Tell Us? ......................................................................................... 75 SECTION 1: TRANSLATION OF THE YUAN AOSHI SHANGHAN JINJING LU 元敖氏傷寒 金鏡錄 (THE YUAN SCHOLAR AO’S GOLDEN MIRROR OF COLD DAMAGE) ........ 75 SECTION II: DISCUSSION OF THE JINJING LU ......................................................87 Description of the Jinjing Lu .......................................................................87 Questions about Images, and Answers they Provide ..................................90 A Question of Colour ................................................................................... 93 Nuances and Defnitives ............................................................................ 102 Beyond the Shanghan lun: Innovation ..................................................... 104 Shanghan Recipes and Beyond .................................................................. 106 4 Case Record Beginnings ............................................................. 109 Introduction ............................................................................................... 109 Section 1 .....................................................................................................110 Han Dynasty Medical Record Keeping and the Beginnings of Case Records .......................................................................110 Case Records and Clinical Norms ..............................................................112 Te Early Recording of Medical Cases ...................................................... 113 Te First Case Record Collection ...............................................................114 Chunyu Yi’s Case Number Four .................................................................118 Section II ..................................................................................................... 122 Record Keeping Post-Han to Tang ............................................................ 122 Record Keeping in the Song (960–1278) ....................................................123 Xu Shuwei and Shanghan Cases ................................................................ 124 Textual Debut of the Discrimination of Tongue Coatings ...................... 126 5 Te Case Records and the Physicians ......................................... 131 Introduction ................................................................................................ 131 Section I: Physicians and Early Ming Case Records .................................. 133 Hierarchies in Medicine .............................................................................136 Variations and Constancies in Recording Cases .......................................137 Te Tongue Images Reappear ...................................................................138 Xue Ji and his Publication of the Jinjing lu ..............................................139 Wang Kentang and a Further Publication of the Jinjing lu ..................... 142 Case Record Examples of Two Ming Physicians .......................................143 4 Section II: Encyclopaedic Collections of Case Records ............................150 Introduction ................................................................................................150 Case Records to Encyclopaedias ................................................................ 151 Te Mingyi lei’an ....................................................................................... 151 Section III: It’s All About Heat ................................................................... 162 From Shared Beginnings to Separate Categories ..................................... 164 Ye Tianshi 葉天士 (1666–1745) .................................................................. 166 Tongue Inspection in Ye Tianshi’s Case Records ..................................... 168 Tongue Occurrences and Distribution in Ye Tianshi’s Lizheng zhinan yi’an ..................................................................................175 Wu Jutong 吳鞠通 (1758–1836) .................................................................. 177 6 Transmission of Chinese Medicine to Europe ...........................183 Te VOC, Jesuit Scholars, and the Transmission of Texts ...................... 186 Te Jesuits, the Physicians, and the Publications .................................... 189 Beyond the Specimen ..................................................................................191 European Medical Practice and Chinese Diagnostic Techniques .......... 192 European Diagnostics in the 17th and 18th Centuries ............................ 192 Out