12 a Brief Introduction to Illustration in the Literature of Surgery And
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12 ABriefIntroductiontoIllustrationintheLiteratureofSurgeryand TraumatologyinChineseMedicine Hu Xiaofeng 胡曉峰 As we have seen throughout this volume, visual images 要訣 (Golden Mirror of Medicine: Knowledge and Skills have been a major vector for the transmission of Chinese of External Medicine in Verse).1 medical culture. They figure largely in Chinese medical Images enhanced, and sometimes replaced, textual texts from medieval times onwards, and there are numer- instructions, but they also had other functions. Thus for ous examples in post-Song printed books. This chapter will example, diagrams of body parts served to identify affected argue that words and graphics are closely integrated, and areas and therapeutic locations; illustrations of therapeutic most effective, in conveying practical knowledge in the techniques served as an aid to acquiring and carrying out literature of manual therapies such as skin-deep surgery these techniques; and illustrations of medical instruments and orthopaedics of various styles; the visual medium were important to both the manufacturer and the user. In therefore assumes a particular importance for Chinese such cases, illustration played a vital role that words alone surgical and manual therapies associated with waike 外科, could not fulf il. The importance of manual skills and their literally ‘external medicine’, and specifically for shangke illustration in the history of medicine in China is often 傷科, the treatment of injury and trauma to the body. The overlooked, particularly as they arose in military medicine, very nature of these subjects demands the communication the martial arts, and bone-setting. Historians generally of certain kinds of dexterity and spatial awareness that favour researching scholarly medical works, and this bias may be obscured by the textual medium. distorts the record and our appreciation of the range and There has been a specialised medical literature in China plurality of medicine in the past in China (for examples devoted to the science of treating wounds, sores and ab- from veterinary surgery, see Buell et al., Chapter 22 in scesses, and using mercury to treat skin diseases, with heat this volume). This chapter therefore offers an overview of sterilisation of surgical instruments, since Liu Juanzi guiwei illustration in the literature of surgery and traumatology fang 劉涓子鬼遺方 (Liu Juanzi’s Remedies Bequeathed in China by way of preliminary redress. by Ghosts), which dates from the Jin period (265–420 ce). The first edition of the National Union Catalogue of Early treatises on external medicine and traumatology of Traditional Chinese Medicine Books (Quanguo zhongyi this kind were not illustrated, and relied solely on textual tushu lianhe mulu 全國中醫圖書聯合目録) lists 12,124 description. But as the sum of medical knowledge and the works on medicine published before 1949. They include fund of clinical experience grew, this format posed increas- 448 texts listed as external medicine and 181 listed in the ing challenges for the student, and so illustrations were category of traumatology (shangke) – 629 in all, making introduced as an adjunct to the written text. The earliest up a significant 5% of the total. Weiji baoshu, introduced surviving illustrated book on surgery and traumatology in above, provides a good introduction to the range of interest China is Weiji baoshu 衛濟寶書 (Wei Ji’s Precious Book), in and expertise in surgery and trauma study. It discusses the two juan (fascicles), compiled by the hermit Dong Xuan 東 causation and pathogenesis of sores and abscesses, the five 軒 in the Song period (960–1279). The images illustrate skin good practices (wu shan 五善) and seven evil karmas (qi diseases as well as therapeutic locations, and demonstrate e 七惡) of Buddhist philosophy, and symptoms of illness. the kinds of pathologies associated with waike. The Buddhist terms wu shan and qi e refer respectively These earliest illustrations had an indicative value only, to five or seven prohibitions: no killing, no stealing, no being intended as aids to understanding and mastering adultery, no lying, and no alcohol; and no killing, stealing, difficult points in the text. Later, visual images became adultery, lying, speaking senselessly, harsh words, and an integral part of many medical works, regardless of the slander. Chinese physicians then brought these Buddhist degree of difficulty of the text. Lavish productions became concepts of morality to bear in describing the state of, for ever more numerous and sophisticated. The prime example example, the five organs. with the greatest number of surgical illustrations, 260 in all, is the Qing-dynasty book Waike xinfa yaojue 外科心 法要訣 1 This is a separate edition of the sections on external medicine (Knowledge and Skills of External Medicine in Yizong jinjian 醫宗金鑒 醫宗金鑒外科 of (The Golden Mirror of Medicine), a Verse), also known as Yizong jinjian waike large-scale medical work published under the aegis of the Qing (External Medicine from the Golden Mirror of Medicine) government in 1742 (7th year of the Qianlong reign period of the and Yizong jinjian: waike xinfa yaojue 醫宗金鑒外科心法 Qing dynasty). 184 hu xiaofeng 胡曉峰 Weiji baoshu contains illustrations of five categories of conditions that do not have a specific location. Juan 15 skin disease: ai 癌 (cancers), biao 瘭 (whitlows), ju 疽 (car- deals with miscellaneous disorders, and juan 16 is devot- buncles, abscesses, phlegma), gu 痼 (chronic, intractable ed to paediatrics. The entire text is a reworking of Waike conditions), and yong 癰 (abscesses). Apart from fulf illing dacheng 外科大成 (The Great Compendium of External the pleasures of professional connoisseurship, differen- Medicine), 1665. The entry for each disorder begins with a tiating skin diseases presumably served the function of summary of symptoms and remedies in heptasyllabic verse, matching symptom with therapeutic procedure. There for ease of memorisation. This is followed by more detailed are also illustrations of instruments and techniques that explanations. A highly influential text, it was studied and have obvious practical value: an injection method, the recited from memory by generations of medical students. application of poultices to the back, and the moxibustion The 629 pre-1949 texts on external medicine and technique called ‘Riding the Bamboo Horse’, of which we traumatology cited above contain a higher-than-average will see more of in a moment. proportion of illustrations. Nonetheless it should be not- The second volume of Weiji baoshu contains 50 pre- ed that only eight of them actually have the word tu 圖 scriptions for external application, and discusses in detail (illustration, visual representation) in their title, and all medications for breast abscesses and soft boils. In addition, of those were published in the Qing period (1644–1911) or the book contains two further diagrams. One of these later. This is suggestive of an increasing modern attention shows a method for establishing the location on the spine to establishing this genre of illustrated texts. for applying poultices. The other shows six moxibustion Waike and shangke illustrations can be divided into the points for treating abscesses and ulcers, labelled quchi 曲 following 18 categories according to their subject matter. 池, shou qili 手七里, jianfeng 肩峰, zu sanli 足三里, fengshi 風市, and tui fenggu zhong 腿縫骨中. 1. Affected Parts The 260 illustrations of surgical conditions in Waike Images showing diseased or injured body parts. This is the xinfa are divided into 16 juan (volumes or fascicles). Juan largest group of illustrations. They convey information 1 and 2 form a general introduction. Juan 3–11 deal with at a glance, in the most readily comprehensible manner. external conditions with a specific location, proceeding The Ming (1368–1644) work Waike qixuan 外科啓玄 by from the head to the feet. Juan 12–14 deal with external Shen Gongchen 申拱宸 (1607), contains more than 150 illustrations of this kind. Primarily intended to indicate the location of the disease or injury, they rarely show any BookTitlesIncludingtheCharacterTu圖(pre-1949) Title Translation Date Author Zhengcang waike tu Surgical Images to be Kept under the Pillow c. 1767 Anon. 枕藏外科圖 Waike tuxing maizheng Pulses, Signs and Symptoms of External Medicine 1795 Zheng Yutan 外科圖形脉證 in Pictures 鄭玉壇 Waike tushuo 外科圖說 Pictorial Guide to External Medicine 1834 Gao Wenjin 高文晉 Waike dazheng xingtu Major External Disorders in Pictures 1852 Wang Jinfu 外科大症形圖 王晉夫 74 zhong dingchuang tushuo Pictorial Guide to 74 Types of Boils and Sores 1889 Mr Ye 葉氏 七十四种疔瘡圖說 Ciding tu 刺疔圖 Illustrations of Lancing Boils Qing Anon (1644–1911) Quanshen gutu kaozheng A Study of Illustrations of the Skeleton c. 1854 Xu Lian 許槤 全身骨圖考正 Zhongguo jiegu tushuo Pictorial Guide to Chinese Bone-Setting 1807 Ninomiya Hika 中國接骨圖說 二宮彥可 illustration in the literature of surgery and traumatology in chinese medicine 185 details of the condition itself, which is generally signalled by a dot or circle. 2. Therapeutic Locations These images show the location where treatment is to take place, which does not necessarily coincide with the affect- ed area. As this information could be difficult to convey in words, illustrations were an essential visual aid. The illustration of the moxibustion technique called ‘Riding the Bamboo Horse’ (Qi zhuma jiutu 騎竹馬灸圖) in Chen Ziming’s 陳自明 Song-dynasty work Waike jingyao 外科 精要 (Essentials of External Medicine), 1263, is a case in Figure 12.1 Riding the Bamboo Horse (moxibustion technique). Chen point (Fig. 1). This is essentially a moxibustion technique, Ziming 陳自明 1263, Waike jingyao 外科精要 (Essentials but it demonstrates the manual skill needed to find the of External Medicine). © Library of China Academy of locations, and the complexities of collaboration with the Chinese Medical Sciences patient and the physician’s assistants incurred in the treatment of sores and abscesses. As the accompanying text explains, this is a technique The accompanying text reads: used to treat an injury approximating to the modern slipped This is used to treat all kinds of sores and abscesses; it is disk, with stiffness and pain in the lumbar region.